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Data are available online at https://err.ersjournals.com/content/32/168/220243.figures-only . Supplementary material is available online at https://err.ersjournals.com/content/errev/32/168/220243/DC1/embed/inline-supplementary-material-1.pdf?download=true . The effect of meditative movement, which includes yoga, tai chi and qi gong, on breathlessness in advanced disease is unknown. This systematic review aims to comprehensively assess the evidence on the effect of meditative movement on breathlessness (primary outcome), health-related quality of life, exercise capacity, functional performance and psychological symptoms (secondary outcomes) in advanced disease. 11 English and Chinese language databases were searched for relevant trials. Risk of bias was assessed using the Cochrane tool. Standardised mean differences (SMDs) with 95% confidence intervals were computed. 17 trials with 1125 participants (n=815 COPD, n=310 cancer), all with unclear or high risk of bias, were included. Pooled estimates (14 studies, n=671) showed no statistically significant difference in breathlessness between meditative movement and control interventions (SMD (95% CI) 0.10 (−0.15–0.34); Chi2=30.11; I2=57%; p=0.45), irrespective of comparator, intervention or disease category. Similar results were observed for health-related quality of life and exercise capacity. It was not possible to perform a meta-analysis for functional performance and psychological symptoms. In conclusion, in people with advanced COPD or cancer, meditative movement does not improve breathlessness, health-related quality of life or exercise capacity. Methodological limitations lead to low levels of certainty in the results. L.J. Brighton is funded by an Economic and Social Research Council Post-Doctoral Fellowship (ES/X005259/1). Y. Mo is funded by King’s-China Scholarship Council (K-CSC 202106370016). I.J. Higginson, M. Maddocks, J. Bayly and L.J. Brighton are supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. M. Maddocks is supported by a National Institute for Health and Care Research (NIHR) Career Development Fellowship (CDF-2017–10–009) and the NIHR Applied Research Collaboration South London.

RATIONALE: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from pulmonary rehabilitation but face challenges completing programmes. However, research to understand ways to optimise participation in this group is lacking. OBJECTIVE: To explore the experiences, needs and preferences of people with COPD and frailty referred for out-patient pulmonary rehabilitation. METHODS: Semi-structured interviews with people with COPD and physical frailty, purposively sampled by age, living status, level of frailty, and completion of pulmonary rehabilitation. Thematic analysis with a critical realist perspective was used, involving relevant stakeholders with clinical, academic and lived experience for interpretive rigour. RESULTS: 19 people with COPD and frailty were interviewed, with a median age of 78 years (range 58-88). Nine did not complete their pulmonary rehabilitation programme. Four themes were identified: striving to adapt to multidimensional loss, tensions of balancing support with independence, pulmonary rehabilitation as a challenge worth facing, and overcoming unpredictable disruptions to participation. Participants described constantly adapting to their changing health and resulting multidimensional losses (e.g. functional abilities, relationships, confidence). This involved traversing between independence and seeking support, set against a mismatch between their needs and what support is available. People with COPD and frailty can be highly motivated to participate in pulmonary rehabilitation, despite the physical and mental demands it entails, and report a range of benefits. Yet in the context of changeable health, they must often overcome multiple unpredictable disruptions to completing rehabilitation programmes. Participant determination and flexibility of services can facilitate ongoing attendance, but for some, these unpredictable disruptions erode their motivation to attend. CONCLUSIONS: People with COPD and frailty experience accumulating, multi-dimensional loss. This group are motivated to complete pulmonary rehabilitation but often require additional support and flexibility due to fluctuating and unpredictable health. Person-centred approaches should be considered to minimise disruptive health events and support pulmonary rehabilitation participation and completion. Service adaptations could allow more flexibility to meet the changing needs of this group and enable communication around how pulmonary rehabilitation might align with their priorities.

Despite consensus on the diagnosis and staging of cancer anorexia/cachexia syndrome, there is currently no accepted standard of care, and affected patients remain widely undertreated. There is general agreement that, because of the complex pathophysiology involved, management should be multimodal and offered earlier in the course of anticancer treatment.[1] However, clarification is needed regarding how to deliver the appropriate anticachexia and antianorexia therapies. In this issue of ONCOLOGY, Dev et al provide an important step forward, offering a model for the multimodal management of cachexia that includes core treatments, as well as evidence-based and investigational approaches, and that details how these target different aspects of the syndrome.[2] Acknowledging the limited data available on some of the treatments discussed, the authors also provide valuable clinical practice points to guide the delivery of cancer care. We wish to draw further attention to the role of physical activity and exercise, which they propose as core treatments.

The Archaeological Journal, 38, 201-206

The Archaeological Journal, 36, 70-77