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Amy A Kirkham,1 Sean A Virani,2 Kristin L Campbell1,31Rehabilitation Sciences, 2Department of Medicine, 3Department of Physical Therapy, University of British Columbia, Vancouver, BC, CanadaBackground: Heart function tests performed with myocardial stress, or “cardiac stress tests”, may be beneficial for detection of cardiovascular disease. Women who have been diagnosed with breast cancer are more likely to develop cardiovascular diseases than the general population, in part due to the direct toxic effects of cancer treatment on the cardiovascular system. The aim of this review was to determine the utility of cardiac stress tests for the detection of cardiovascular disease after cardiotoxic breast cancer treatment.Design: Systematic review.Methods: Medline and Embase were searched for studies utilizing heart function tests in breast cancer survivors. Studies utilizing a cardiac stress test and a heart function test performed at rest were included to determine whether stress provided added benefit to identifying cardiac abnormalities that were undetected at rest within each study.Results: Fourteen studies were identified. Overall, there was a benefit to utilizing stress tests over tests at rest in identifying evidence of cardiovascular disease in five studies, a possible benefit in five studies, and no benefit in four studies. The most common type of stress test was myocardial perfusion imaging, where reversible perfusion defects were detected under stress in individuals who had no defects at rest, in five of seven studies of long-term follow-up. Two studies demonstrated the benefit of stress echocardiography over resting echocardiography for detecting left ventricular dysfunction in anthracycline-treated breast cancer survivors. There was no benefit of stress cardiac magnetic resonance imaging in one study. Two studies showed a potential benefit of stress electrocardiography, whereas three others did not.Conclusion: The use of cardiac stress with myocardial perfusion imaging and echocardiography may provide added benefit to tests performed at rest for detection of cardiovascular disease in breast cancer survivors, and merits further research.Keywords: heart diseases, heart function tests, exercise test, breast neoplasms, review

OBJECTIVES: Research supports the use of exercise to improve quality of life and reduce the side effects of breast cancer treatment, such as fatigue and decreased aerobic capacity. Previously published reviews have focused on reporting the outcomes of exercise interventions, but have not critically examined the exercise prescriptions. The purpose of this review is to evaluate the application of the principles of exercise training in the exercise prescriptions reported in intervention studies for breast cancer survivors. METHODS: Databases were searched for randomised controlled trials of exercise in women diagnosed with breast cancer. Data were extracted to evaluate the application of the principles of exercise training, the reporting of the components of the exercise prescription and the reporting of adherence to the exercise prescription. RESULTS: Of the 29 papers included, none applied all principles of exercise training. Specificity was applied by 64%, progression by 41%, overload by 31%, initial values by 62% and diminishing returns and reversibility by 7% of trials. No study reported all components of the exercise prescription. CONCLUSION: The application of the principles of exercise training varied greatly, and reporting of the exercise prescribed and completed was incomplete. When principles of exercise training are applied to the development of exercise protocols, there is greater confidence that non-significant findings reflect lack of efficacy of exercise rather than deficiencies in the prescription. Incomplete reporting of the exercise prescription and adherence to the prescription limits the reproducibility of the intervention, and the ability to determine the dose of exercise received by participants. [ABSTRACT FROM AUTHOR]

BACKGROUND: Progressive loss of kidney function results in an increased risk of malnutrition. Despite this, there is little evidence informing the impact of nutrition intervention on predialysis patients with chronic kidney disease (CKD; stages 4 and 5). STUDY DESIGN: Randomized controlled trial. SETTING & PARTICIPANTS: 56 outpatients (men, 62%; mean age, 70.7 +/- 14.0 [SD] years) with CKD were randomly allocated to intervention (n = 29) or control (n = 27) by using a concealed computer-generated sequence. INTERVENTION: The intervention group, provided with individualized dietary counseling with regular follow-up aimed at achieving an intake of 0.8 to 1.0 g/kg of protein and greater than 125 kJ/kg of energy, or control, receiving written material only. OUTCOMES & MEASURES: Change in body composition (body cell mass, measured by means of total-body potassium, in 40 of 56 participants), nutritional status (Subjective Global Assessment), and energy and protein intake (3-day food record). RESULTS: During the 12 weeks, the intervention group had 3.5% (95% confidence interval, -2.1 to 9.1) less decrease in body cell mass, 17.7-kJ/kg/d (95% confidence interval, 8.2 to 27.2) greater increase in energy intake, greater improvement in Subjective Global Assessment (P < 0.01), and no significant difference in protein intake compared with the control group (-0.04 g/kg/d; 95% confidence interval, -0.73 to 0.16). The intervention was associated with greater increases in energy and protein intake in women than men (interaction P < 0.001 for both). LIMITATIONS: Power to detect change in body cell mass, potential bias in ascertainment of Subjective Global Assessment. CONCLUSIONS: In predialysis patients with CKD, structured nutrition intervention had a greater effect on energy and protein intake in women than men. Additional investigations are warranted to determine the impact on body composition. Copyright © 2008 National Kidney Foundation, Inc. [ABSTRACT FROM AUTHOR]

Chronic physical activity may alter estrogen metabolism, a proposed biomarker of breast cancer risk, by causing a shift toward higher 2-OHE1 and lower 16alpha-OHE1 levels. PURPOSE: To investigate the association between an objective indicator of chronic exercise, aerobic fitness, and 2-OHE1 and 16alpha-OHE1 in premenopausal women. METHODS: Women with high aerobic fitness (N=17; VO2max>or=48 mL.kg.min-1) were compared with women with average aerobic fitness (N=13; VO2max

Introduction: Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions., Methods: Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish., Results: The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators., Conclusion: Remote exercise interventions using technology appear to be feasible and acceptable in OACA., Implications for Cancer Survivors: Some remote exercise interventions may be a viable way to increase PA for OACA., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Relationships are the core of Indigenous Peoples' spiritual and cultural identities, and therapeutic relationships are an integral part of the physical rehabilitation process, directly influencing health outcomes. However, participating in therapeutic relationships can be difficult for First Nations Peoples, particularly in the virtual landscape. There is limited understanding of First Nations Peoples' perspectives on this issue, and this understanding is crucial to developing culturally safe and effective telehealth physiotherapy programs. Therefore, the purpose of this study is to explore the perspectives of First Nations Peoples from British Columbia, Canada, on telehealth physiotherapy, with an emphasis on the virtual therapeutic relationship., Methods: A narrative qualitative study that utilized one-on-one, semistructured interviews was conducted with 19 First Nations adults from remote and rural First Nations communities in north-central British Columbia, Canada. Interviews were recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis., Results: Three themes emerged from data analysis. 'Therapist's attitude and rapport' captures participants' perceptions of what matters the most in how physiotherapists relate to First Nations Peoples and carry out their work. 'Remote nature of virtual care' encompasses the main challenges of virtual care visits, particularly how these were perceived to impact establishing and maintaining solid therapeutic relationships. 'Fostering culturally appropriate and safe telehealth physiotherapy' focuses on what is needed to advance telehealth physiotherapy in a manner that respects and reflects First Nations cultures, equipping all involved parties to provide comprehensive and sensitive services. Our findings advocate a hybrid model that combines in-person and telehealth visits to address communication barriers and the absence of physical interaction. Bridging the digital health literacy gap through training and collaboration with local support staff is crucial (as it is to bridge the possible cultural literary gap of therapists), and the incorporation of cultural elements holds promise for enhancing the engagement and effectiveness of telehealth services in these communities., Conclusion: The pursuit of equitable health care for First Nations communities demands not only increased access but also a thoughtful, culturally safe, trauma-informed, and holistic approach. This approach must be tailored to the unique needs of First Nations Peoples, emphasizing the integration of cultural elements and community support. A hybrid model combining in-person and telehealth visits is recommended to address logistical challenges and enhance the therapeutic relationship, ensuring that care is both effective and respectful of cultural values and practices.

Shared cognitive processes underlie our ability to remember the past (i.e., episodic memory) and imagine the future (i.e., episodic simulation) and age-related declines in episodic memory are also noted when simulating future scenarios. Given older adults' reduced cognitive control and protracted memory retrieval time, we examined whether imposing time limits on episodic simulation of future helping scenarios affects younger and older adults' willingness to help, phenomenological experience, and the type of details produced. Relative to a control task, episodic simulation increased younger and older participants' willingness to help, scene vividness, and perspective-taking regardless of the time spent imagining future helping scenarios. Notably, time spent imagining influenced the number, but not proportion of internal details produced, suggesting that participants' use of episodic-like information remained consistent regardless of the time they spent imagining. The present findings highlight the importance of collecting phenomenological experience when assessing episodic simulation abilities across the lifespan.

While previous work has shown a positive relationship between cognitive performance and lifestyle factors in younger adults, evidence for this relationship among middle-aged and older adults has been mixed. The current study aimed to further test the relationship among physical activity, sleep quality, and memory performance in middle-aged and older adults, and to test whether this relationship holds up during the COVID-19 pandemic. Our results showed that physical activity was associated with better sleep quality and better working memory performance, and better sleep quality was associated with better working memory and self-perceptions of everyday memory abilities. Additionally, we found that the effects of physical activity on working memory were partially mediated by sleep quality. While these effects were small and only correlational in nature, they lend further support to the notion that sleep quality and physical activity are beneficial to memory later in life, even during a global pandemic.

Visual working memory is thought to have a fixed capacity limit. However, recent evidence suggests that a greater number of real-world objects than simple features (i.e., colors) can be maintained, an effect termed the object benefit. Here, we examined whether this object benefit in visual working memory is due to qualitatively different memory processes employed for meaningful stimuli compared to simple features. In online samples of young adults, real-world objects were better remembered than colors, had higher measures of recollection, and showed a greater proportion of high-confidence responses (Exp. 1). Objects were also remembered better than their scrambled counterparts (Exp. 2), suggesting that this benefit is related to semantic information, rather than visual complexity. Critically, the specific objects that were likely to be remembered with high confidence were highly correlated across experiments, consistent with the idea that some objects are more memorable than others. Visual working memory performance for the least-memorable objects was worse than that of colors and scrambled objects. These findings suggest that real-world objects give rise to recollective, or at least high-confidence, responses at retrieval that may depend on activation of semantic features, but that this effect is limited to certain objects., (© 2024. The Psychonomic Society, Inc.)

Background: There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness., Aim: This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions., Design: Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability., Setting: In-person and remotely delivered rehabilitation interventions., Population: Adult cancer survivors., Methods: Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT)., Results: Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios., Conclusions: While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness., Clinical Rehabilitation Impact: Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.

Background: As the prevalence of chemotherapy-related cognitive impairment rises, investigation into treatment options is critical. The objectives of this study were to test the effects of an aerobic exercise intervention initiated during chemotherapy compared to usual care (wait list control condition) on (1) objectively measured cognitive function and self-reported cognitive function, as well as on (2) the impact of cognitive impairment on quality of life (QOL) postintervention (commensurate with chemotherapy completion)., Methods: The Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE) trial was a two-arm, two-center randomized controlled trial conducted in Ottawa and Vancouver (Canada). Fifty-seven women (M age , 48.8 ± 10 years) diagnosed with stage I-III breast cancer and awaiting chemotherapy were randomized to aerobic exercise initiated with chemotherapy (n EX  = 28) or usual care during chemotherapy with aerobic exercise after chemotherapy completion (n UC  = 29). The intervention lasted 12-24 weeks and consisted of supervised aerobic training and at-home exercise. The primary outcome was objective cognitive function measured via 13 neuropsychological tests (standardized to M ± SD, 0 ± 1); secondary outcomes of self-reported cognitive function and its impact on QOL were assessed via questionnaires. Data collected pre- and postintervention (the primary end point) were analyzed., Results: Although no significant differences between groups were found for objective cognitive function outcomes postintervention after accounting for multiple testing, four of six self-reported cognitive function outcomes showed significant differences favoring the aerobic exercise group., Conclusions: Among women initiating chemotherapy for breast cancer, aerobic exercise did not result in significant differences in objective cognitive function postintervention after chemotherapy completion; however, the results do support the use of this intervention for improving self-reported cognitive function and its impact on QOL., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Associative memory declines with age, and this decline is thought to stem from a decreased ability to form new associations or bind information together. However, a growing body of work suggests that (a) the binding process itself remains relatively intact with age when tested implicitly and (b) older adults form excessive associations (or "hyper-bind") because of a decreased ability to control attention. In this article, we review evidence for the hyper-binding hypothesis. This work shows that older adults form more nontarget associations than younger adults, which leads to increased interference at retrieval and forgetting, an effect that may extend to others with poor attentional control, such as children and people with attention-deficit disorder. We discuss why hyper-binding is apparent only under implicit test conditions and how it affects memory for everyday events. Although hyper-binding likely contributes to forgetting, it may also confer certain advantages when seemingly irrelevant associations later become relevant., Competing Interests: The author(s) declared that there were no conflicts of interest with respect to the authorship or the publication of this article., (© The Author(s) 2024.)

Background: Electronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers., Methods: Implementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy's feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review., Results: Of the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups., Conclusion: We present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway., (© 2024. The Author(s).)