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This study investigated differences in standard measurements used to determine bra size, underbust chest circumference (UBCC) and over-bust chest circumference (OBCC), measured from a three-dimensional scan (hand-held scanner) compared to the direct measurement in 111 women (age 21–56 years; right breast volume 57–1672 mL; bra size 10A–18G). Bland–Altman plots of UBCC measurements showed a large positive bias and wide limits of agreement (12 cm; −4.6 to 28 cm), which increased as band size increased but decreased when the breasts were digitally removed from the scan prior to the UBCC measurement. The difference in UBCC measurements determined from scans compared to direct measurement had a strong positive correlation with breast volume and breast ptotis. The OBCC measurements showed a small positive bias (2.4 cm; −3.4 to 8.4), consistent across the range of bra sizes. Bra band size measurements determined from three-dimensional scans can be inaccurate in women with large, ptotic breasts.

Background: Although the most supportive sports bras can control breast motion and associated breast pain, they are frequently deemed uncomfortable to wear and, as a result, many women report exercise bra discomfort. Given that exercise bra discomfort is associated with decreased levels of physical activity, there is a pertinent need to develop innovative solutions to address this problem. Objectives: This research aimed to evaluate the use of electromaterial sensors and artificial muscle technology to create a bra that was capable of detecting increases in breast motion and then responding with increased breast support to enhance active living. Methods: The research involved two phases: (i) evaluating sensors suitable for monitoring and providing feedback on changes in the amplitude and frequency of breast motion, and (ii) evaluating an actuator capable of changing breast support provided by a bra during activity. Results: When assessed in isolation, the developed technologies were capable of sensing breast motion and actuating to provide some additional breast support. Conclusions: The challenge now lies in integrating both technologies into a functional sports bra prototype, and assessing this prototype in a controlled biomechanical analysis to provide a breast support solution that will enable women to enjoy active living in comfort.

This study investigated the effect of sports bra type (encapsulation versus compression) and gait speed on perceptions of breast discomfort, bra discomfort and breast movement reported by Chinese women. Visual analogue scales were used to evaluate breast discomfort, bra component discomfort and perceived breast movement of 21 Chinese participants when they wore an encapsulation or a compression sports bra, while static and while exercising at three different gait speeds. Participants perceived less breast discomfort and breast movement when wearing a compression bra compared to an encapsulation bra at a high gait speed, suggesting that compression bras are likely to provide the most effective support for Chinese women. However, significantly higher bra discomfort was perceived in the compression bra compared to the encapsulation bra when static and at the lower gait speed, implying that ways to modify the design of sports bras, particularly the straps, should be investigated to provide adequate and comfortable breast support.

Background Tibial head depression fractures demand a high level of fracture stabilization to prevent a secondary loss of reduction after surgery. Elderly individuals are at an increased risk of developing these fractures, and biomechanical investigations of the fractures are rare. Therefore, the aim of this study was to systematically analyze different types of osteosyntheses in combination with two commonly used bone substitutes. Methods Lateral tibial head depression fractures were created in synthetic bones. After reduction, the fractures were stabilized with eight different treatment options of osteosynthesis alone or in combination with a bone substitute. Two screws, 4 screws and a lateral buttress plate were investigated. As a bone substitute, two common clinically used calcium phosphate cements, Norian® Drillable and ChronOS™ Inject, were applied. Displacement of the articular fracture fragment (mm) during cyclic loading, stiffness (N/mm) and maximum load (N) in Load-to-Failure tests were measured. Results The three different osteosyntheses (Group 1: 2 screws, group 2: 4 screws, group 3: plate) alone revealed a significantly higher displacement compared to the control group (Group 7: ChronOS™ Inject only) (Group 1, 7 [p < 0.01]; group 2, 7 [p = 0.04]; group 3, 7 [p < 0.01]). However, the osteosyntheses in combination with bone substitute exhibited no differences in displacement compared to the control group. The buttress plate demonstrated a higher normalized maximum load than the 2 and 4 screw osteosynthesis. Comparing the two different bone substitutes to each other, ChronOS™ inject had a significantly higher stiffness and lower displacement than Norian® Drillable. Conclusions The highest biomechanical stability under maximal loading was provided by a buttress plate osteosynthesis. A bone substitute, such as the biomechanically favorable ChronOS™ Inject, is essential to reduce the displacement under lower loading.

Participating in exercise is beneficial for women who have been treated for breast cancer. However, not being able to find a comfortable exercise bra can be a barrier to exercise participation. This study aimed to systematically investigate what breast support women treated for breast cancer want when they exercise in order to provide evidence-based recommendations to improve exercise bra designs for these women. Based on 432 responses from a national online survey, frequency and relationship data were analysed (binary logistic regression) to understand exercise bra issues pertinent to this population. These issues included being able to control for asymmetrical cup sizes, managing heightened skin sensitivity, managing fluid (size) fluctuations, managing a prosthesis and restoring body image by restoring shape. This study provides evidence-based recommendations to inform an exercise bra design that will meet the unique needs of women treated for breast cancer. Rigorous, evidence-based evaluations of exercise bras for women treated for breast cancer may contribute to their well-being and quality of life through enhanced designs. Practitioner Summary: Exercise bras worn by women treated for breast cancer were investigated with the aim of improving exercise bra designs, which may ultimately contribute to the well-being and quality of life of these women. Evidence-based recommendations to inform an exercise bra design for women treated for breast cancer are provided.

Background: Regular exercise is highly beneficial for women who have been treated for breast cancer. Bra discomfort has been cited as a potential barrier to exercise for these women, due to the unique physical side-effects of breast cancer treatment. These women have specific needs in an exercise bra that must be met in order to enable them to participate in exercise with minimal bra discomfort. Research Question: The overall aim of this thesis was to evaluate cause of, and extent to which, bra discomfort is a barrier to exercise; to systematically investigate what women treated for breast cancer required in an exercise bra; and to build a better exercise bra for these women based on this information. Methods: To fulfil these aims, a series of studies were conducted, which are presented in three parts. In the first part of the thesis, a national online survey was conducted to understand the influence of exercise on treatment side effects, the benefits and barriers of exercise for women treated for breast cancer, and the impact bra discomfort had on the exercise levels of these women (Chapters 2-4). The second part of this thesis identified specific exercise bra design requirements for women treated for breast cancer, and designed an experimental bra solution (Chapters 5-6). In the final part of the thesis, a laboratory-based biomechanical study (Chapter 7) evaluated an experimental exercise bra design, which was based on the information concluded from the first two parts of the thesis. Major Conclusions: Breast cancer treatment has lasting side-effects, which can be positively influenced by participating in regular exercise. However, exercise bra discomfort is a key barrier to exercise, such that reporting exercise bra discomfort is significantly linked to low levels of exercise among women treated for breast cancer. It is apparent that several unique issues surrounding breast cancer treatment side-effects exacerbate the bra discomfort experienced by these women, an

Objectives This study aimed to determine the effect of perceived exercise benefits and barriers on exercise levels among women who have been treated for breast cancer, and who were not part of formal exercise interventions. Design Anonymous, national online cross-sectional survey. Methods 432 women treated for breast cancer completed an online survey covering their treatment and demographic background, current exercise levels, and perceived exercise benefits and barriers. Each perceived benefit and barrier was considered in a binary logistic regression against reported exercise levels to ascertain significant relationships (p < 0.05) and associative values (odds ratio). Results Agreement with sixteen out of 19 exercise barriers, were significantly related to being more likely to report insufficient exercise levels, whereas agreement with 6 out of 15 exercise benefits were significantly related to being less likely to report insufficient levels of exercise. Feeling too weak, lacking self-discipline and not being a priority were the barriers with the largest association to insufficient exercise levels (OR (95% CI) = 10.97 (3.90-30.86); 8.12 (4.73-13.93); and 7.43 (3.72-14.83), respectively). Conversely, exercise enjoyment, improved feelings of well-being, and decreased feelings of stress and tension were the top three benefits associated with being less likely to have insufficient exercise levels (OR (95% CI) = (0.21 0.11-0.39), 0.21 (0.07-0.63), and 0.31 (0.15-0.63), respectively). Limitations Self-reported data measures were used to collect exercise data. Conclusions Targeting exercise barriers specific to women treated for breast cancer may improve exercise participation levels in this cohort. Awareness of the impact of exercise barriers identified in the present study will enable physical therapists to better plan exercise interventions that support all women treated for breast cancer.

Purpose Although participating in exercise is beneficial for breast cancer survivors, not being able to find a comfortable exercise bra can be a barrier to exercise. It is likely that side effects specific to breast cancer treatment exacerbate exercise bra discomfort. This study aimed to determine the relationship between patient characteristics, physical side effects, exercise bra discomfort and exercise behaviours. Methods Four hundred thirty-two breast cancer survivors completed an online survey related to their treatment and demographic background, current exercise levels, reported exercise bra discomfort and breast cancer treatment side effects. Patient characteristics and exercise levels were considered in a binary logistic regression against reporting bra discomfort to ascertain significant relationships (p < 0.05) and predictive value (odds ratio). Pearson's chi-square statistics was used to determine significant relationships between reporting a side effect and exercise bra discomfort. Results Eight out of nine physical side effects were significantly related to reporting exercise bra discomfort. Reporting exercise bra discomfort was significantly related to not achieving a minimal recommended level of exercise. Conclusions This is the first study in the scientific literature that systematically links the reporting of exercise bra discomfort to not achieving recommended levels of exercise. This effect of bra discomfort on exercise was found after controlling for age, surgery type and current treatment among a large cohort of women treated for breast cancer. Furthermore, results from this study suggest that physical side effects, as a result of surgery and treatment associated with breast cancer, are linked to experiencing bra discomfort during exercise.

Purpose Side effects as a result of breast cancer treatment may have a lasting detrimental impact on quality of life. Exercise has been shown to be an effective intervention in post-treatment care. This study aimed to gain a better understanding of breast cancer treatment-related side effects through identifying potential patient characteristic associations, including current levels of exercise. Methods Four hundred and thirty-two breast cancer patients completed an online survey covering their treatment and demographic background, current exercise levels, and self-reported treatment side effects. Side effects were considered in a binary logistic regression against age, surgery, currently undergoing treatment, and exercise levels to ascertain significant relationships (p < 0.05) and associative values (Odds Ratio). Results Lumpectomy patients were less likely to report aching muscles (OR 0.61, 95 % CI 0.39-0.96), hot flushes (OR 0.60, 95 % CI 0.38-0.96), and weight gain (OR 0.59, 95 % CI 0.38-0.92) than mastectomy patients. Women currently undergoing treatment were more likely to report hot flushes (OR 3.77, 95 % CI 2.34-6.08), aching muscles (OR 1.62, 95 % CI 1.02-2.57), and weight gain (OR 1.89, 95 % CI 1.19-2.99) than women finished treatment. Sedentary women were more likely to experience shoulder limitations (OR 1.77, 95 % CI 1.14-2.77), muscular chest wall pain (OR 1.69, 95 % CI 1.07-2.65), weight gain (OR 2.29, 95 % CI 1.44-3.64), lymphedema (OR 1.68, 95 % CI 1.04-2.71), and breathlessness (OR 2.30 95 % CI 1.35-3.92) than their physically active counterparts. Conclusions Patient characteristics may inform interventions to improve care post-breast cancer treatment. Sufficient levels of exercise were consistently associated fewer side effects and should be encouraged.

Goals of work Although exercise can provide a range of benefits for women living with a breast cancer diagnosis, many impediments to exercise exist. Several psychosocial and physical capacity impediments to exercise have been investigated, but no study has systematically investigated whether bras impede breast cancer patients from exercising. This study aimed to assess the extent to which exerciseinduced breast pain and bra discomfort were reported by women living with breast cancer and whether this breast pain and bra discomfort impeded these women from participating in physical activity. Patients and methods Seventy-four women living with a breast cancer diagnosis completed a custom-designed questionnaire. Frequency data were analyzed to identify the most common barriers to exercise, and features in current bra designs causing discomfort during exercise were established. Main results When analyzed according to mean score, “bra discomfort” ranked as the fourth highest barrier to exercise behind a lack of self-discipline, procrastination, and fatigued by exercise. A significant 70.3% of the sample (p<0.001) reported experiencing bra discomfort during exercise. Over half (57.7%) of these respondents reported the band as the most uncomfortable part of the bra. Conclusions This study has clearly established that bra discomfort, particularly bra band tightness, is a barrier to participating in physical activity for women living with a breast cancer diagnosis. To further encourage exercise in women living with a diagnosis of breast cancer, potential barriers to exercise, such as inadequate bra design, need to be modified to enable these women to enjoy the health benefits of exercising in comfort.

This systematic review identifies and critically evaluates instruments that have been developed to measure clinical trial informed consent comprehension in non-cognitively-impaired adults. Literature searches were carried out on Medline (Ovid), PsycInfo, CINHAL, ERIC, ScienceDirect, and Cochrane Library for English language articles published between January 1980 and September 2008. Instruments were excluded if they focused on consent onto paediatric trials, the construct under study was primarily capacity or competency, or the instrument was developed specifically for psychiatric or cognitively-impaired populations. Instruments selected for review were evaluated against the following criteria: (1) method of item generation; (2) type and format of test items; (3) administration and interpretation of test results; and (4) psychometric properties. Three instruments met our defined inclusion criteria: the Deaconess Informed Consent Comprehension Test (DICCT), the Quality of Informed Consent (QuIC) questionnaire and the Brief Informed Consent Protocol (BICEP). Each instrument varied in terms of content measured. Significantly, these are the first standardized instruments developed to assess comprehension in non-cognitively-impaired adults. Yet, each instrument had its own set of limitations such as the lack of generalizability and the absence of details pertaining to how test results should be used to guide clinical decision-making. Standardized clinical trial informed consent comprehension assessments have been developed to identify gaps in research participants' understanding and ensure that respect for patient autonomy is satisfied.