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Background: Determine whether true exercise-associated interindividual response differences (IIRD) occur in cardiorespiratory fitness as a result of exercise-based cardiac rehabilitation in heart transplant patients. Methods: Using data from a recent (2023) meta-analysis of 9 randomized controlled trials representing 296 patients (163 exercise, 133 control), an aggregate data meta-analysis of treatment effects (change outcome differences between exercise and control groups) was conducted as well as an IIRD meta-analysis using the inverse variance heterogeneity model. The primary outcome was cardiorespiratory fitness (VO2max) in ml/kg/min. Results: Statistically significant and clinically important increases equivalent to 14.5% were observed for VO2max in ml/kg/min (X̅, 3.0, 95% confidence interval (CI), 2.4-3.7 ml/kg/min, p

Background: When it comes to chemotherapy, maintaining the dose and schedule of treatment are of vital importance, as clinical evidence suggests that dose intensity is associated with optimal treatment outcomes for various tumors. Yet, reduced dose intensity is a common method of mitigating the chemotherapy-induced side effects. Exercise has been shown to attenuate chemotherapy-related symptoms that frequently cluster together. Understanding this, we conducted a retrospective analysis in patients with advanced disease treated with adjuvant or neoadjuvant chemotherapy regimens and who completed exercise training during treatment. Methods: Data were collected retrospectively in a chart review of 184 patients, aged 18 years or older and treated for Stage IIIA-IV cancer. Data collection included baseline patient demographics and clinical characteristics, including age at diagnosis, cancer stage at initial diagnosis, chemotherapy regimen, and planned dose and schedule. Cancer types included brain (6.5%), breast (35.9%), colorectal (8.7%), non-Hodgkin’s lymphoma (7.6%), Hodgkin’s lymphoma (11.4%), non-small cell lung (16.8%), ovarian (10.9%), and pancreatic (2.2%). All patients completed at least 12 weeks of prescribed, individualized exercise. Each program included cardiovascular, resistance training, and flexibility components, under the supervision of a certified exercise oncology trainer once a week. Results: RDI was measured for each myelosuppressive agent in a regimen over the entire chemotherapy course and then averaged across the myelosuppressive agents in a regimen. An RDI of less than 85% was designated as the clinically meaningful threshold for reduction in RDI based on previously published studies. Conclusions: A considerable proportion of patients across regimens had dose delays (18.3%-74.3%) and dose reductions (18.1%-84.6%). Between 12% and 83.9% of patients missed at least 1 dose of a myelosuppressive agent that was part of their standard regimen. Overall, 50.8% of patients received less than 85% of the RDI. In short, patients with advanced cancer and an exercise adherence above 84.3% saw fewer chemotherapy dose delays and dose reductions. These delays and reductions occurred significantly less frequently compared to the published norms in the sedentary population ( P

Nova Scotia's Supportive Care Program (SCP) is an individualized funding program that provides funds for people living with dementia (PLWD) or acquired brain injuries to purchase basic home care services such as personal care, respite, cleaning and cooking. The SCP has the potential to address the Quintuple Aim of enhancing care experience, improving population health, reducing costs, improving provider experience and improving health equity, yet qualitative evidence is lacking. The aim of this study is to use participatory program evaluation methods to evaluate the SCP and consider how effective it is in addressing the Quintuple Aim. The study objectives and corresponding methods are to (1) Co-develop a SCP logic model to guide the evaluation through consultations with a diverse group of stakeholders including PLWD, caregivers, care providers, researchers, government representatives, and nongovernment organizations, with attention to gender; (2) Evaluate the SCP based on the outcomes and outputs identified in the logic model using focus groups with PLWD, caregivers and home care providers, and interviews with PLWD and their caregivers; and (3) Mobilize knowledge about the ways the SCP addresses the Quintuple Aim through integrated knowledge translation activities with public, policy and research audiences. By focusing on clinically and socially vulnerable populations of PLWD and caregivers, the proposed evaluation of the SCP offers a valuable case in assessing the effectiveness of individually-funded home care in addressing the Quintuple Aim including health equity within the context of dementia care.

Background and Hypothesis: There is increasing concern about the role sport specialization might play in the increasing injury rates observed among youth baseball pitchers. However, existing research on specialization in baseball has focused on high school and professional baseball populations. We hypothesized that pitchers who were highly specialized, reported pitching more than eight months in the past year, received private coaching, or pitched with pain or fatigue in the previous year would report worse throwing-arm health. Methods: One-hundred eighty-four Little League pitchers (boys N = 181, age 9.8 ± 1.6 years old) between 7 and 12 years of age completed an anonymous, online questionnaire with their parents’ assistance. The questionnaire consisted of participant demographics, sport specialization status, months of pitching per year, whether they traveled regularly to participate in showcases, if they received private coaching, whether they pitched with elbow or shoulder pain, whether they pitched with fatigue, and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. The associations between variables of interest and YTS were examined using multivariable linear regression, adjusting for covariates. Results: Sport specialization, pitching year-round, and receiving private coaching were not associated with the YTS (P > .05). Pitching with pain in the previous year was associated with a worse YTS score than pitching without pain (least square mean [standard error]: 49.6 [1.8] vs. 57.8 [1.1], P < .001). Similarly, pitching with fatigue in the previous year was associated with worse YTS scores (least square mean [standard error]: 52.1 [1.4] vs. 55.3 [1.3], P = .01). Pitchers who reported traveling regularly for showcases scored worse on the YTS compared with those who did not travel regularly for showcase events (least square mean [standard error]: 51.0 [2.0] vs. 56.4 [0.9], P = .01). Conclusions: Pitching with pain or fatigue was associated with worse throwing-arm health in Little League baseball pitchers. While traveling at least once a month to participate in showcases was also associated with worse throwing-arm health, specialization and private coaching were not related to worse throwing health. Clinicians working with pediatric patient populations should be aware that while the factors examined in this article were reported relatively infrequently, screening for Little League pitchers who participate in showcases or pitch with pain or fatigue may be an effective strategy for identifying these individuals who are at higher risk of injury.

Lay health workers (LHWs) have been effective in delivering health promotion to underserved, vulnerable populations. Hair stylists are well positioned to serve as LHWs in addressing health disparities among Black women in the U.S. The purpose of this qualitative study was to explore the extent to which hair stylists influence their Black female clients and clients’ preferences for their stylist’s role in salon-based health promotion programming. Eight virtual platform focus groups were conducted with Black women (n = 39) who receive hair care services from a licensed hair stylist across the U.S. Most participants had a college degree (89.8%), health insurance (92.3%), a primary care provider (89.7%), and the majority had at least one chronic disease (56.4%). Participants reported higher potential for influence related to level of trust in the stylists and for stylists they find relatable and credible. Trust, relatability, and credibility were further determined by racial and gender congruence. Client interviewees felt stylists should model healthy behaviors and reported they may not be receptive to stylist-delivered health promotion out of the context of a hair-health connection. In this sample of well-educated clients, there was an expressed preference for stylists to provide referral to healthcare professionals or solicit experts for health topics out of the scope of haircare rather than guide the health promotion efforts themselves. Findings from this study can inform future development of acceptable salon-based, stylist-led health promotion programs that partner stylists with health experts to deliver health promotion.

Background: This video presents assessment and management of hallux limitus using intrinsic foot strengthening and joint mobilization techniques with combination of extracorporeal shockwave therapy (ESWT). Indications: Clinical history includes pain with walking, running, jumping, or loaded plantarflexion localized to the first metatarsophalangeal (MTP) joint. Indications for our treatment approach of hallux limitus include pain localized to the first MTP joint, corresponding lack of active range of motion/passive range of motion, and reduced foot/ankle strength often with joint space narrowing on imaging. Technique Description: Our program uses the principle of foot core exercises that enhance intrinsic muscles of the foot to assist in medial longitudinal arch stabilization and hallux strengthening. Progression of these exercises can be done in weight-bearing and impact activities specific to patient goals. In addition to these foot intrinsic exercises, calf raises should be incorporated to strengthen the gastroc-soleus complex to both improve plantar foot strength and facilitate extension of the first MTP joint. Manual therapy techniques reduce the rigidity of the first MTP joint and restore appropriate medial-lateral and plantar-dorsal balance. With severe limitations in mobility or pain limitations, ESWT can be incorporated to treat the joint and surrounding soft tissue restrictions. Results: Increased first MTP extension is observed. Reduced symptoms of first MTP joint pain with activity allow patients to return to walking and other physical activities with improved comfort. Complications are rare. Pain over the first MTP joint is expected during ESWT. Rarely, irritation of the plantar components of the first MTP joint, including the tibial and fibular sesamoid bones, may occur. Discussion/Conclusion: Non-surgical management of hallux limitus may improve using the described technique of intrinsic foot strengthening with focus on stabilization of the medial longitudinal arch and strategies of improved mobility of the first MTP joint. Adding ESWT may address joint limitations and facilitate gains in exercise and mobility.