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Background Adjuvant endocrine therapy (ET) in patients with breast cancer (BC) increases the risk of becoming less physically active. Physical inactivity is associated with a higher risk of treatment-related side effects and mortality. This study investigated whether supervised exercise increased the proportion of patients adhering to the national physical activity (PA) guideline during adjuvant ET in overweight or obese BC patients. Methods This multicentre single-arm clinical trial included patients with BC participating in a 12-week supervised exercise intervention. An accelerometer measured moderate to vigorous PA (MVPA) at baseline (T0), after 12 (T1) and 26 weeks (T2). The primary endpoint was change in the proportion of patients with weekly ≥150 min of MVPA at T1 compared to T0. Secondary endpoints were adherence to PA guideline at T2, metabolic syndrome (MetS), body composition, health-related quality of life (HRQoL) and BC-specific functioning and symptoms, self-reported PA, self-efficacy, exercise motivation and satisfaction with life. Results 141 patients with a median age of 61 years and a mean BMI of 31.3 participated. Adherence to the PA guideline increased from 38.3% at T0, to 40.4% at T1 (p = .112) and 44.7% at T2 (p = .003). MetS, body composition, HRQoL, BC-specific functioning and symptoms (i.e. fatigue, dyspnoea), self-reported PA, self-efficacy, exercise motivation and satisfaction with life improved significantly over time. Conclusions Supervised exercise increased the proportion of BC patients adhering to the PA guideline over time. Furthermore, MetS, body composition, HRQoL and symptoms improved. Our findings highlight the clinical relevance of supervised exercise during ET in overweight BC patients. Clinical trial information (NCT02424292)., Highlights • Overweight breast cancer patients on endocrine therapy can be motivated for supervised exercise. • Supervised exercise increases adherence to the physical activity guideline. • Metabolic syndrome and quality of life improved due to our intervention. • Participation in supervised exercise induces persistent clinical improvements.

STUDY DESIGN: Retrospective cohort study.BACKGROUND: Persons with a lower limb amputation can regain mobility using a prosthetic device. For fast and adequate prescription of prosthetic components, it is necessary to predict the mobility outcome early in rehabilitation. Currently, prosthetic prescription is primarily based on empirical knowledge of rehabilitation professionals.OBJECTIVE: In this study, we explored motor ability tests, to be completed without a prosthetic device, which have predictive value for mobility outcome at the end of rehabilitation.METHODS: For this study, data of 82 patients with a lower limb amputation were included. The Single-limb standing balance test (Balance test), the Lower-Extremity Motor Coordination Test and the Amputee Mobility Predictor Assessment Tool (AMPnoPRO) were used as measures for motor ability. Mobility outcome was measured using the Timed Up and Go Test, the Two-Minute Walking Test and K levels were used.RESULTS: The explained variance of the Balance test, the Lower-Extremity Motor Coordination Test and the AMPnoPRO was, respectively, 0.603, 0.534 and 0.649 on the Two-Minute Walking Test (linear regression); 0.597, 0.431 and 0.624 on the Timed Up and Go Test (linear regression); and 0.432, 0.420 and 0.526 on the K levels (logistic regression).CONCLUSION: The AMPnoPRO predicted mobility outcome statistically (largest amount of explained variance).CLINICAL RELEVANCE: This study explored the possibility of statistically predicting mobility outcome in lower limb amputees at the end of rehabilitation, using motor ability tests conducted in early rehabilitation. This study suggests the use of the AMPnoPRO to predict mobility outcome in lower limb amputees.

Increasing numbers of long-term cancer survivors face important treatment related adverse effects. Cancer treatment induced metabolic syndrome (CTIMetS) is an especially prevalent and harmful condition. The aetiology of CTIMetS likely differs from metabolic syndrome in the general population, but effective treatment and prevention methods are probably similar. In this review, we summarize the potential mechanisms leading to the development of CTIMetS after various types of cancer treatment. Furthermore, we propose a safe and accessible method to treat or prevent CTIMetS through lifestyle change. In particular, we suggest that a lifestyle intervention and optimization of energy balance can prevent or mitigate the development of CTIMetS, which may contribute to optimal survivorship care. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

12018 Background: Cancer treatment outcome may be impaired due to treatment-related adverse effects like decreased cardiorespiratory fitness. Evidence on exercise during or after chemotherapy shows positive effects on cardiorespiratory fitness, fatigue and quality of life (QoL) in cancer patients. However, optimal timing of starting exercise is unknown. This study aimed to investigate if an exercise intervention that starts during chemotherapy (early group) is superior to a program starting after completion of chemotherapy (late group) to reduce cardiovascular morbidity. Methods: In this multicenter randomized controlled trial, 266 patients (testicular-, (n = 95), breast-, (n = 139), and colon cancer (n = 30) or non-Hodgkin lymphoma (NHL) (n = 2)), treated with curative chemotherapy were randomized to a 24 week aerobic and resistance exercise intervention starting either early, i.e. during chemotherapy (n = 131) or late, i.e. at completion of chemotherapy (n = 135) (NCT01642680). Effect on VO2 peak was evaluated with intention-to-treat linear mixed-effect models, adjusted for baseline values (T0) and diagnosis at post-chemotherapy (T1), post-exercise intervention (T2) and 1-year post-exercise intervention (T3, i.e., primary endpoint). Here we report T0, T1 and T2 data. Secondary endpoints were QoL (EORTC-QLQ-C30) and fatigue (MFI-20), with higher scores indicating more fatigue. Results: Median age was 33 yrs for testicular-, 52 yrs for breast- and 64 yrs for colon cancer and NHL patients. Patients in the early group declined significantly less in VO2 peak and QoL at T1 compared to the late group (adjusted between-group differences were 3.2 ml/min/kg (95% confidence interval CI 2.3 to 4.1, P < 0.0001) and 5.8 (95% CI 0.6 to 10.9, P = 0.028). Patients in the early group experienced reduced general and physical fatigue at T1 (adjusted between-group differences were -2.0 (95% CI -3.3 to -0.8, P = 0.002) and -2.9 (95% CI -4.3 to -1.5, P < 0.0001). At T2, VO2 peak, QoL, general and physical fatigue were comparable and regained baseline levels (adjusted between-group differences - 0.08 ml/min/kg (P = 0.9), -1.4 (P = 0.7), 0.7 (P = 0.3) and 0.2 (P = 0.7), respectively. Conclusions: A supervised exercise program for patients with testicular-, breast- and colon cancer that is initiated at start of curative chemotherapy effectively reduces a decline in VO2 peak and QoL and reduces fatigue. After completion of the exercise intervention, initiated both during and after chemotherapy, patients regained their baseline VO2 peak, levels of fatigue and QoL. Clinical trial information: NCT01642680 .

In this study, the occurrences of stabilizing and destabilizing external moments of force on a prosthetic knee during stance, in the first steps after gait initiation, in inexperienced users were investigated. Primary aim was to identify the differences in the external moments during gait initiation with the sound leg leading and the prosthetic leg leading. A prosthetic leg simulator device, with a flexible knee, was used to test able-bodied subject, with no walking aid experience. Inverse dynamics calculations were preformed to calculate the external moments. The subjects learned to control the prosthetic leg within 100 steps, without walking aids, evoking similar patterns of external moments of force during the steps after the gait initiation, either with their sound leg loading or prosthetic leg leading. Critical phases in which a sudden flexion of the knee can occur were found just after heelstrike and just before toe off, in which the external moment of force was close to the internal moment produced by a knee extension aiding spring in the opposite direction. (C) 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

Objective: To study balance control on a moving platform in lower limb amputees.Design: Observational cohort study.Participants: Unilateral transfemoral and transtibial amputees and able-bodied control subjects.Interventions: Balance control on a platform that moved in the anteroposterior direction was tested with eyes open, blindfolded and while performing a dual task.Main outcome measures: Weight bearing symmetry, anteroposterior ground reaction force and centre of pressure shift.Results: Compared to able-bodied subjects, in amputees the anteroposterior ground reaction force was larger in the prosthetic and non-affected limb, and the centre of pressure displacement was increased in the non-affected limb and decreased in the prosthetic limb. In amputees body weight was loaded more on the non-affected limb. Blindfolding or adding a dual task did not influence the outcome measures importantly.Conclusion: The results of this study indicate that experienced unilateral amputees with a high activity level compensate for the loss of ankle strategy by increasing movements and loading in the non-affected limb. The ability to cope with balance perturbations is limited in the prosthetic limb. To enable amputees to manage all possible balance disturbances in real life in a safe manner, we recommend to improve muscle strength and control in the non-affected limb and to train complex balance tasks in challenging environments during rehabilitation. (c) 2007 Elsevier B.V. All rights reserved.

Objective: To study adjustment strategies in unilateral amputees in uphill and downhill walking.Design: observational cohort study.Subjects: Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects.Methods: In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured.Results: In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee Groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body.Conclusion: Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability. (c) 2007 Elsevier B.V. All fights reserved.

Objective: To study limitations in function and adjustment strategies in lower limb amputees during obstacle crossing. Design: Observational cohort study.Subjects: Transfemoral and transtibial amputees and able-bodied control subjects. Methods: In a motion analysis laboratory unimpeded and obstacle crossing runs were performed. The subjects stepped over an obstacle of 0.1 m height and thickness and 1 m width. Outcome measures were gait velocity, hip, knee and anklejoint angles and leading limb preference.Results: Whereas able-bodied and transtibial subjects demonstrated an increase in knee flexion during obstacle crossing compared to unimpeded walking, in transfemoral amputees the opposite was seen, namely a decrease in knee flexion. The lack of knee strategy in transfemoral amputees was compensated by circumduction at the hip on the prosthetic side and plantar flexion of the non-affected ankle. Transtibial amputees preferred to cross the obstacle with the prosthetic limb first, while transfemoral amputees preferred the non-affected limb.Conclusion: The different leading limb strategy in transfemoral and transtibial amputees could be explained by the restricted flexion and propulsion properties of the prosthetic knee. Training of obstacle crossing tasks during rehabilitation and improvement of prosthetic design may contribute to safe obstacle crossing. (c) 2007 Elsevier B.V. All rights reserved.

In this study we investigated how leading limb angles combined with active ankle moments of a sound ankle or passive stiffness of a prosthetic ankle, influence the center of mass (CoM) velocity during the single limb support phase in gait termination. Also, we studied how the trailing limb velocity influences the CoM velocity during this phase. We analyzed force plate data from a group of experienced transfermoral (TF) amputee subjects using a prosthetic limb, and the outcome from a two-dimensional mathematical forward dynamics model. We found that when leading with the sound limb, the subjects came almost to a full stop in the single limb support phase, without the use of the prosthetic limb. When leading with the prosthetic limb, the CoM deceleration was less in a relatively short single limb support phase, with a fast forward swing of the trailing sound limb. Slowing down the heavier trailing sound limb, compared to the prosthetic limb, results in a relatively larger braking force at the end of the swing phase. The simulations showed that only narrow ranges of leading limb angle and ankle moments could be used to achieve the same CoM velocities with the mathematical model as the average start and end velocities of the prosthetic limb user. We conclude that users of prosthetic limbs have a narrow range of options for the dynamics variables to achieve a target CoM velocity. The lack of active control in the passive prosthetic ankle prevents the TF amputee subjects from producing sufficient braking force when terminating gait with the prosthetic limb leading, forcing the subjects to use both limbs as a functional unit, in which the sound limb is mostly responsible for the gait termination. (C) 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

Objective: To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process.Design: Prospective and descriptive study.Subjects: Fourteen subjects with a recent transfemoral, knee disarticulation or transtibial amputation.Methods: Subjects stepped over an obstacle and initiated and terminated gait at four different times during the rehabilitation process.Outcome measures: Success rate, gait velocity and lower limb joint angles in obstacle crossing, centre of pressure shift and peak anteroposterior ground reaction force in gait initiation and termination.Results: In obstacle crossing amputees increased success rate, gait velocity and swing knee flexion of the prosthetic limb. Knee flexion in transfemoral and knee disarticulation amputees was not sufficient for safe obstacle crossing, which resulted in a circumduction strategy. In gait initiation and termination amputees increased the anteroposterior ground reaction force and the centre of pressure shift in the mediolateral direction in both tasks. Throughout the rehabilitation process the centre of pressure was shifted anteriorly before single-limb stance on the trailing prosthetic limb in gait initiation, whereas in gait termination the centre of pressure in single-limb stance remained posterior when leading with the prosthetic limb.Conclusion: Subjects with a recent amputation develop adjustment strategies to improve obstacle crossing, gait initiation and gait termination. Innovations in prosthetic design or training methods may ease the learning process of these tasks.

Objective: To study limitations in function and adjustment strategies in lower limb amputees during gait initiation.Design: Observational cohort study.Setting: University Medical Center.Participants: Amputees with a unilateral transfemoral or transtibial amputation, and able-bodied subjects.Main outcome measures: Leading limb preference, temporal variables, ground reaction forces, and centre of pressure shift.Results: Amputees demonstrated a decrease in peak anterior ground reaction force, a smaller or absent posterior centre of pressure shift, and a lower gait initiation velocity. The main adjustments strategies in amputees were more limb-loading on the non-affected limb, prolonging the period of propulsive force production in the non-affected limb and initiating gait preferably with the prosthetic limb.Conclusion: Since an intact ankle joint and musculature is of major importance in gait initiation, functional limitations and adjustment strategies in transfemoral and transtibial amputees were similar. Improving prosthetic ankle properties and initiating gait with the prosthetic limb may facilitate the gait initiation process in amputees. (C) 2007 Elsevier B.V. All rights reserved.

During prosthetic gait initiation, transfemoral (TF) amputees control the spatial and temporal parameters that modulate the propulsive forces, the positions of the center of pressure (CoP), and the center of mass (CoM). Whether their sound leg or the prosthetic leg is leading, the TF amputees reach the same end velocity. We wondered how the CoM velocity build up is influenced by the differences in propulsive components in the legs and how the trajectory of the CoP differs from the CoP trajectory in able bodied (AB) subjects. Seven TF subjects and eight AB subjects were tested on a force plate and on an 8m long walkway. On the force plate, they initiated gait two times with their sound leg and two times with their prosthetic leg. Force measurement data were used to calculate the CoM velocity curves in horizontal and vertical directions. Gait initiated on the walkway was used to determine the leg preference. We hypothesized that because of the differences in propulsive components, the motions of the CoP and the CoM have to be different, as ankle muscles are used to help generate horizontal ground reaction force components. Also, due to the absence of an active ankle function in the prosthetic leg, the vertical CoM velocity during gait initiation may be different when leading with the prosthetic leg compared to when leading with the sound leg. The data showed that whether the TF subjects initiated a gait with their prosthetic leg or with their sound leg, their horizontal end velocity was equal. The subjects compensated the loss of propulsive force under the prosthesis with the sound leg, both when the prosthetic leg was leading and when the sound leg was leading. In the vertical CoM velocity, a tendency for differences between the two conditions was found. When initiating gait with the sound leg, the downward vertical CoM velocity at the end of the gait initiation was higher compared to when leading with the prosthetic leg. Our subjects used a gait initiation strategy that depended mainly on the active ankle function of the sound leg; therefore, they changed the relative durations of the gait initiation anticipatory postural adjustment phase and the step execution phase. Both legs were controlled in one single system of gait propulsion. The shape of the CoP trajectories, the applied forces, and the CoM velocity curves are described in this paper.

Objective: To study the limitations in function and adjustment strategies of lower limb amputees in gait termination.Design: Observational cohort study.Setting: University Medical Centre.Participants: Unilateral transfemoral and transtibial amputees, and able-bodied control subjects.Main outcome measures: Leading limb preference, temporal variables, lower limb joint angles, ground reaction forces, and centre of pressure shift.Results: Compared to able-bodied subjects, amputees showed a decreased peak braking ground reaction force in the prosthetic limb, no anterior centre of pressure shift during leading with the prosthetic limb and an increased mediolateral centre of pressure shift. Amputees used several adjustment strategies to compensate for the limitations in function; leading limb preference for the non-affected limb, longer production of braking force in the non-affected limb, decreased gait termination velocity and more weight-bearing on the non-affected limb.Conclusion: Limitations in function and adjustment strategies were mainly similar in transfemoral and transtibial amputees. Due to the lack of active ankle function, amputees were not able to increase the braking force and to shift the centre of pressure anteriorly. Leading with the non-affected limb is favourable for adequate deceleration and balance control, but in daily life not always applicable. It is important that amputees are trained in gait termination during rehabilitation and prosthetic design should focus on a more active role of the prosthetic foot and knee. (c) 2007 Elsevier B.V. All rights reserved.