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Background. Strong evidence supports the beneficial impact of exercise on cancer patients. However, the provision of exercise programs in Germany is highly heterogeneous. Therefore, the network OnkoAktiv (OA) enables patient consultations and referrals from coordinating regional OA centers (RE) into community-based exercise programs (CBEP). Objective. The aim of this study was to identify barriers and facilitators for the implementation of OA network structures from the perspective of RE and certified CBEP. Methods. This evaluation was executed in a sequential mixed methods design. We conducted 16 qualitative interviews with each leader in RE and the certified CBEP. Then, 89 certified CBEP were invited to a quantitative, cross-sectional survey. Results. We identified 11 facilitators each for RE and certified CBEP, 7 barriers for RE and 5 for certified CBEP. Barriers dealt with, for example, financing OA network structures, a lack of knowledge of exercise trainers, inadequate patient referral, and missing collaborations by healthcare professionals (HCPs). Most of the named facilitators were adequate internal organizational resources, support and reachability of OA staffs, and collaboration with HCPs. Conclusion. Our findings indicate different challenges for the implementation of OA network structures. Future implementation efforts should consider the evaluation of individual barriers and the development of specific solutions.

Dank besserer medizinischer Versorgung, präziserer Früherkennungsmaßnahmen und neuer Behandlungsmodalitäten konnte die Prognose für viele Krebserkrankungen in den vergangenen Jahrzehnten deutlich verbessert werden. Die neuen Behandlungsoptionen gehen jedoch oft mit beträchtlichen Nebenwirkungen einher. In über 700 klinischen Studien mit insgesamt mehr als 50 000 Betroffenen hat sich gezeigt, dass durch körperliches Training und gezielte Bewegungstherapie vielen dieser Nebenwirkungen aktiv entgegengewirkt werden kann 1. Im Folgenden sollen diese Effekte in Anlehnung an die Exercise Guidelines für Krebspatienten des American College of Medicine 2 dargestellt und Schnittstellen zur psychoonkologischen Versorgung veranschaulicht werden.

The diagnosis of cancer as well as accompanying acute and late effects of treatment are influencing physical activity behavior of patients with childhood cancer and survivors. Research has shown that a pediatric cancer diagnosis is associated with impairments of physical performance, and function, as well as reduced physical, and psychosocial, health conditions. From an ethical perspective, lack of knowledge of health care providers, lack of physical activity promotion, and environmental, and structural barriers to physical activity restrict children’s right to move and actively engage in physical activities. Network ActiveOncoKids is a German-wide initiative with the main goal of enabling children, adolescents, and young adults with exercise opportunities during and after cancer treatment. Since the network’s foundation in 2012, Network ActiveOncoKids focuses on: (1) physical activity support for patients and families, (2) policy change to establish structures and guidelines, and (3) generating evidence through scientific projects. The purpose of this paper is to present an overview of Network ActiveOncoKids structure, aims, and projects. This topical review will highlight the network’s structural development, research work, and implementation progress of exercise programs for patients with pediatric cancer and survivors, link international collaborations, and discuss future directions.

ZusammenfassungOnkologischen PatientInnen wird ein regelmäßiges körperliches Training explizit empfohlen. Das Hochintensive Intervalltraining (HIIT) rückt dank steigender Evidenzlage in unterschiedlichen Diagnosegruppen vermehrt in den Fokus der onkologischen Sport- und Bewegungstherapie. Die Betrachtung der aktuellen Literatur zeigt, dass das HIIT für Krebspatienten nach Abschluss der Therapie eine potenziell sichere sowie durchführbare Trainingsmethode ist. Darüber hinaus kann das HIIT positive Effekte auf die verringerte körperliche Leistungsfähigkeit von Krebspatienten haben. In diesem Zusammenhang ist sowohl das „4×4“- als auch das „10×1“-Protokoll mit onkologischen PatientInnen nach Abschluss der Therapie auf dem Fahrradergometer durchführbar, wobei insbesondere das „4×4“-Schema zur Realisierung von intensiven Trainingsreizen geeignet ist. Trotz zunehmender Untersuchungen bezüglich der Effekte von HIIT auf onkologische PatientInnen werden in diesem Forschungsbereich weitere qualitativ hochwertige Studien mit großer Teilnehmendenzahl benötigt.

Purpose The aim of this study was to compare the effects of different exercise modes (aerobic, resistance) and intensity prescriptions (standard, polarized, undulating) on patient-reported outcomes (PROs) in cancer survivors. Methods 107 breast or prostate cancer survivors (52% females, age 58 ± 10 years, 6–52 weeks after primary therapy) performed one out of four training programs, two sessions/week, over 12 weeks: work rate-matched vigorous intensity aerobic training (ATStandard, n = 28) and polarized intensity aerobic training (ATPolarized, n = 26) as well as volume-matched moderate intensity resistance training (RTStandard, n = 26) and daily undulating intensity resistance training (RTUndulating, n = 27). Health-related quality of life (HRQoL, EORTC-QLQ-C30) and cancer-related fatigue (CRF, MFI-20) were assessed at baseline, at the end of intervention and after a 12-week follow-up without further prescribed exercise. Results Over the intervention period, HRQoL-function-scales of the EORTC-QLQ-C30 improved over time (p = .007), but no group*time interaction was observed (p = .185). Similarly, CRF values of the MFI-20 improved over time (p = .006), but no group*time interaction was observed (p = .663). When including the follow-up period and pooling the AT and the RT groups, HRQoL-function-scales developed differently between groups (p = .022) with further improvements in RT and a decline in AT. For CRF no significant interaction was found, but univariate analyses showed a non-significant trend of more sustainable effects in RT. Conclusions AT and RT with different work rate-/volume-matched intensity prescriptions elicits positive effects on HRQoL and CRF, without one regimen being significantly superior to another over the intervention period. However, RT might result in more sustainable effects compared to AT over a follow-up period without any further exercise prescription. Clinical trial registration The study was registered at clinicaltrials.gov (NCT02883699).

Zusammenfassung Hintergrund Zahlreiche Studien zeigen, dass Sport und Bewegung eine signifikant positive Wirkung auf krebstherapiebedingte Nebenwirkungen haben. Trotzdem fehlt es flächendeckend an qualifizierten, onkologischen Bewegungsangeboten. Das Netzwerk OnkoAktiv (OA) vermittelt Krebspatienten daher wohnortnah an qualitätsgeprüfte Trainings- und Therapieinstitutionen. Ziel dieser Arbeit war die erstmalige Evaluation des Netzwerkes am regionalen OA Zentrum Heidelberg aus Patientenperspektive. Methode Es wurde eine quantitative, prospektive, einarmige Längsschnittbefragung zu drei Messzeitpunkten (T1: Erstkontakt bei OA, T2: Trainingsstart, T3: Abschluss der 8. Trainingswoche) durchgeführt. Fragebogeninhalte bezogen sich auf die PRO´s: Körperliche Aktivität (KA), Lebensqualität (LQ), Patientenzufriedenheit (PZ) und Qualitätsparameter der OA-Leistungen sowie Abbruchquoten und Dauer der OA-Vermittlung. Ergebnis Es wurden 86 Patienten an 34 verschiedene OA-Trainingsinstitutionen vermittelt, wovon 60 Patienten eingeschlossen wurden. Die durchschnittliche Vermittlungsdauer betrug 42 Tage (min.5/max.110 Tage). 93% der Befragten zeigten eine hohe Patientenzufriedenheit bezogen auf die OA-Leistungen. Es zeigte sich eine signifikante Verbesserung der KA und globalen LQ nach 8 Wochen. Die Dropout- Quote lag bei 28,3% (n=17). Diskussion OA kann den hohen Anspruch onkologischer Patienten decken, allerdings müssen bestehende Qualitätsparameter hinsichtlich ihrer Effektivität und Effizienz angepasst werden. Es kann kein direkter Zusammenhang zwischen KA, LQ und Trainingsbeteiligung dargestellt werden, da bei einem Großteil der Patienten keine Anwesenheitskontrolle durchgeführt wurde. Schlussfolgerung Das Netzwerk OA ermöglicht standardisierte Rahmenbedingungen zur Qualitätssicherung wohnortnaher onkologischer Bewegungsangebote.

Pancreatic cancer patients often present with an inadequate nutritional intake. At the same time, there are no standardized recommendations for nutrition intake during and after cancer treatment. In a prospective analysis of a randomized controlled trial analyzing the effects of a 6-month resistance training in pancreatic cancer patients, we assessed the nutritional intake and the impact of a 6-month supervised resistance training or home-based resistance training vs. usual care control on the nutritional intake of the patients. Nutritional intake was assessed by 24-h recall before and after the 6-month resistance training period. At baseline low protein intake (1 g/kg body weight) was found in 33.9% of the 59 patients and low energy intake (25 kcal/kg body weight) was found in 39.0% of the patients. In all, 35.6% of the patients were classified with a risk of malnutrition (NRS ≥ 3). In the total of 46 patients who finished the 6-month intervention period, there was no difference in nutritional intake over time between resistance training and usual care control. In conclusion, it appears that the majority of our study population had an adequate protein and energy intake. A resistance training seems to have no influence on the nutritional intake of the patients.

Background A better understanding of the role of structural barriers for physical activity (PA) after a cancer diagnosis could help to increase PA among people with cancer. Thus, the present study aimed to identify determinants of structural barriers to PA in people with cancer and investigate the association between structural barriers and insufficient post-diagnosis PA, taking different PA change patterns into account. Methods A total of 1299 people with breast, prostate, or colorectal cancer completed a questionnaire assessing their socio-demographic and medical characteristics, pre- and post-diagnosis PA, and perceived PA impediment by seven structural barriers. Regression analyses were used to investigate determinants of the perception of structural barriers and to examine the association between structural barriers and insufficient post-diagnosis PA, also with regard to different pre-diagnosis PA levels. Results Overall 30–60% of participants indicated to feel impeded by structural barriers. The analyses revealed a younger age, higher BMI, lower educational level, no current work activity, co-morbidities, and lacking physicians’ exercise counseling as significant determinants of the perception of structural barriers. Individuals reporting stronger impediments by structural barriers were significantly less likely to be meeting PA guidelines post-diagnosis, particularly those with sufficient pre-diagnosis PA levels. Conclusions The study highlights the need for tailored PA programs for people with cancer as well as for more guidance and support in overcoming structural barriers to improve PA behavior. The study has been registered under NCT02678832 at clinicaltrials.gov on February 10th 2016.

Purpose To prescribe resistance training (RT) using percentages of (%) maximal strength (Smax), it is prerequisite that (I) methods for testing Smax are valid and (II) the relationship between %Smax and the corresponding number of repetitions (NOR) is known. This has never been investigated in cancer survivors (CS) and was the purpose of the present study. Methods Twenty breast (58 ± 10y) and 20 prostate CS (68 ± 6y), 3.6 ± 2.4 months after primary therapy, completed one one-repetition maximum (1-RM) test, one hypothetical 1-RM (h1-RM) test and three RT sessions (three sets at six different strength machines (SM)). H1-RM was calculated using two commonly used equations (after Brzycki and Epley), resulting in three Smax values for each SM, which were then compared to each other (1-RM as a reference). Each RT session was performed at a different intensity (92%, 69% and 47% of 1-RM/h1-RM). CS performed repetitions to fatigue and the resulting NOR were compared to the predicted NOR. Results Smax values differed between 1-RM and h1-RM values for each SM and between h1-RM values for some SM. Differences between performed and predicted NOR occurred among all intensities and methods. Conclusion Different strength tests yield different results for Smax and a certain %1-RM/h1-RM does not necessarily correspond to a specific NOR in all individuals, which questions the use of (I) h1-RM tests for determining Smax and (II) prescribing RT intensities based on %1-RM/h1-RM which is still the most common method used for RT intensity prescription in healthy individuals and patient populations, including CS.

Background Pediatric cancer leads to reduced participation in exercise and only few patients comply with national physical activity recommendations. Physically inactive behavior hinders motor development and increases physical and psychological adverse effects of therapy and incidence of sequelae. Currently, there is neither nationwide coverage nor uniform level of knowledge regarding exercise promotion. The objective of the guideline is to facilitate qualified exercise interventions through standardized procedures in addition to regular physiotherapy and overall avoid physical inactivity in pediatric cancer patients. Methods This guideline addresses the multidisciplinary treatment team and informs physiotherapists and decision-makers in tertiary care hospitals and health insurance companies. The requirements of the Association of the Scientific Medical Societies in Germany were followed. Contents were based on best practice experience of experts, patient advocates, as well as on scientific evidence. Results The guideline includes 11 recommendations. Recommendations 1-4 declare the relevance of implementing exercise interventions and address general framework conditions. Recommendations 5-11 focus on the design of exercise programs, prevention and safety issues, relative contraindications for specific training loads, and options to overcome barriers to exercise. Conclusion This guideline summarizes existing and established structures and evidence in the context of movement and exercise in pediatric oncology. It takes into consideration the rights, varying needs, and characteristics of children and adolescents as well as national and international experience in this field. In the future, relevant research gaps need to be addressed by high-quality intervention studies to provide the scientific background for a stronger evidence-based guideline.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common, unpleasant and usually long-lasting side effect of neurotoxic chemotherapeutic agents. This study aimed to investigate the preventive potential of sensorimotor- (SMT) and resistance training (RT) on CIPN. Methods Patients (N = 170) were randomised to SMT, RT or usual care (UC). Both exercise groups trained 3×/week for a total of 105 min/week during neurotoxic chemotherapy (mean length: 20 weeks). Before and 3 weeks after neurotoxic chemotherapy, CIPN signs/symptoms were assessed via Total Neuropathy Score (TNSr; primary endpoint) and EORTC QLQ-CIPN15 questionnaire. In addition, balance (centre of pressure), muscle strength (isokinetic), quality of life (QoL, EORTC QLQ-C30) and relative chemotherapy dose intensity (RDI) were investigated. The follow-up period covered 6 months after the end of chemotherapy. Results Intention-to-treat analyses (N = 159) revealed no differences regarding CIPN signs/symptoms. Exploratory per-protocol analyses (minimum training attendance rate 67%; N = 89) indicated that subjectively perceived sensory symptoms in the feet increased less during chemotherapy in the adherent exercisers (pooled group: SMT+RT) than in the UC group (−8.3 points (−16.1 to −0.4); P = 0.039, ES = 1.27). Furthermore, adherent exercisers received a higher RDI (96.6 ± 4.8 vs. 92.2 ± 9.4; P = 0.045), showed a better course of muscular strength (+20.8 Nm (11.2–30.4); P P = 0.005, ES = 0.64). During follow-up, CIPN signs/symptoms persisted in all groups. Conclusions This study demonstrates that SMT and/or RT alleviate subjectively perceived sensory CIPN symptoms in the feet and other clinically relevant cancer therapy-related outcomes, if an appropriate training stimulus is achieved. Clinical trial registration NCT02871284.

Inzwischen belegen mehr als 700 Studien die positive Wirkung körperlicher Aktivität vor, während und nach der Krebstherapie. Trotzdem sind Physios in der Therapie oft zögerlich, aus Angst, etwas falsch zu machen. Warum aber gerade Nichtstun verheerend sein kann und wie ein sicheres Training gelingt, beleuchtet dieser Artikel.

Schlüter, K, Schneider, J, Rosenberger, F, and Wiskemann, J. Feasibility of high-intensity resistance training sessions in cancer survivors. J Strength Cond Res 36(9): 2643-2652, 2022-Moderate-intensity resistance training (MIRT) is regarded as safe in cancer survivors (CS), but for high-intensity resistance training (HIRT), evidence is lacking. Hence, in the current exploratory analyses, single sessions of HIRT are compared with MIRT regarding safety and feasibility. Twenty-three of 24 included CS (14 breast and 10 prostate CS, 61.6 ± 9.5 years, body mass index 27.0 ± 4.3 kg·m -2 , 6-52 weeks after end of primary therapy) started a 12-week resistance training (RT) with a daily undulating periodization model including HIRT (90% of 1 repetition maximum [1RM]) and MIRT (67% 1RM) sessions. Parameters of safety (adverse events [AEs] and training-related pain), feasibility (physical and mental exhaustion, sensation of effort, enjoyment, and dropout rate), and adherence were assessed. An alpha level of 0.05 was applied for analyses. Nineteen of 23 training starters (83%) completed all sessions. Fourteen minor AEs occurred. A significantly higher increase for physical exhaustion appeared in HIRT ( p0.001). For 18% (HIRT) and 19% (MIRT) of the sessions, training-related pain was reported with no significant difference between intensities. In total, 34% of HIRT and 35% of MIRT sessions were perceived as overstraining or partly overstraining with no significant difference between intensities, but enjoyment (median and quartiles on a 1-7 scale) was high for both (HIRT = 5 [5;6] and MIRT = 5 [4,6]). Our analysis indicates that HIRT sessions do not differ from MIRT sessions concerning safety or feasibility, but training-related pain should be monitored. RT protocols incorporating high-intensity training loads can be applied safely in breast and prostate CS.

Evidence on the benefits of physical activity (PA) during cancer has caused a paradigm shift from people with cancer being advised to save energy (rest paradigm) to guidelines recommending them to engage in regular PA (activity paradigm). This study examined the rest and the activity paradigm among people with cancer based on the theory of planned behaviour (TPB).A cross-sectional survey was completed by N = 1244 people (58% women; M = 59.95 years) with breast, prostate and colorectal cancer, including 15 items on rest and activity attitudes. To explain the intention to engage in PA, hierarchical regression analyses were calculated.The two-dimensional structure of attitudes (rest and activity) was confirmed. The agreement with the activity paradigm (M = 4.11; SD = 0.78) was higher compared to the rest paradigm (M = 2.56; SD = 0.78, p .001). The TPB was an appropriate model to explain the intention to engage in PA (RResults indicate that the paradigm shift has successfully reached attitudes of people with cancer. Interventions focusing on the benefits of PA rather than addressing rest cognitions promise higher effectiveness in affecting PA levels.NCT02678832.

Versorgungsforschung in der Onkologie beschaftigt sich mit allen Situationen, in denen Menschen mit Krebs konfrontiert sind. Sie betrachtet die verschiedenen Phasen der Versorgung, also Pravention/Fruherkennung, Prahabilitation, Diagnostik, Therapie, Rehabilitation und Palliativversorgung ebenso wie die verschiedenen Akteure, darunter die Betroffenen, die Versorgenden und die Selbsthilfe. Sie befasst sich mit Gesunden (z. B. im Rahmen von Pravention/ Fruherkennung), Patientin-nen und Patienten und Krebs-Uberlebenden. Aus den Besonderheiten von Krebserkrankungen und den etablierten Versorgungsstrukturen ergeben sich eine Reihe von inhaltlichen Spezifika fur die Versorgungsforschung in der Onkologie im Vergleich zur allgemeinen Versorgungsforschung bei im Wesentlichen identischem Methodenkanon. Dieses Memorandum beschreibt den Gegenstand, illustriert die Versorgungsstrukturen und benennt Themenfelder der Versorgungsforschung in der Onkologie. Dieses Memorandum ist eine Ausarbeitung der Fachgruppe Onkologie des Deutschen Netzwerks Versorgungsforschung e. V. und Ergebnis intensiver Diskussionen.

Zusammenfassung Hintergrund Infolge des Einsatzes neurotoxischer Chemotherapeutika leiden viele Krebspatienten und -überlebende unter chemotherapieinduzierten peripheren Neuropathien (CIPN). Diese Nebenwirkung der Chemotherapie ist mit einem hohen Leidensdruck assoziiert und beeinträchtigt die Autonomie der Patienten. Bewegungstherapeutische Interventionsstudien können den Verlauf der CIPN positiv beeinflussen. Zur Sicherung der Ergebnisqualität in der bewegungstherapeutischen Praxis bedarf es testökonomischer und valider Assessmentverfahren. Methoden 20 Krebspatienten und –überlebende mit CIPN (Alter: 63 Jahre, SD = 9) wurden eingeschlossen. Die Patienten führten den Jebsen Taylor Handfunktionstest (JTT) als Indikator der motorischen Fähigkeiten der oberen Extremität (OE) und einen Pertubationstest in medio-laterale (MLP) sowie anterio-posteriore Richtung (APP) als Indikator der posturalen Stabilität der unteren Extremität (UE) auf dem Posturomed durch. Daneben füllten die Teilnehmer einen Fragebogen zur Erfassung der Einschränkungen der Alltagsaktivitäten (ADL-Fragebogen) sowie den EORTC-QLQ-CIPN20 aus. Zur Prüfung der konvergenten Validität wurde die prädiktive Kraft der motorischen Tests auf die korrespondierenden Fragebogenskalen mittels einfacher linearer Regressionsanalyse berechnet. Ergebnisse Zwischen der Skala zur OE des ADL-Fragebogens und dem JTT wurde ein Zusammenhang von rsp(18)= 0,507 (p = 0,023) für die nicht-dominante sowie ein Zusammenhang von rsp(18)= 0,417 (p = 0,067) für die dominante Hand gefunden. Das Regressionsmodell ergibt hierbei, dass eine ADL-Einschränkung einer Veränderung der mittleren im JTT der nicht-dominanten Hand benötigten Zeit von 2,63 s ist. Der MLP zeigte einen Zusammenhang von r(17)= 0,54 (p = 0,038) mit der Skala zur Unteren Extremität des ADL-Fragebogens. Hierbei entspricht eine ADL-Einschränkung einer Veränderung um 22,7 Punkten im Koordinationsfaktor des MLP. Diskussion Die Ergebnisse zeigen, dass sowohl der JTT als auch der MLP konvergenzvalide für den Einsatz bei Patienten mit CIPN ist und praktisch relevante Effektgrößen hinsichtlich der Bewältigung von Alltagsaktivitäten ableiten lassen. Limitationen Wegen der kleinen Stichprobe und die Limitierung der statistischen Verfahren können die gefundenen Ergebnisse zwar eine Orientierung geben, dürfen allerdings aufgrund ihrer großen Unschärfe nicht als exakte Punktschätzer angesehen werden. Es bedarf longitudinaler Daten mit größeren Stichproben.

Purpose Cardiorespiratory fitness (CRF) seems to be prognostic prior to allogeneic stem cell transplantation (allo-HSCT). Influencing factors of CRF in allo-HSCT candidates have not been studied so far. Aim was to identify potentially influencing factors on CRF. Methods To assess CRF, a maximal cardiopulmonary exercise test (CPET) was performed on average 2.6 ± 7.2 days prior to admission. A regression analysis was conducted, with the following predictors: gender, age, body mass index (BMI), time between last therapy and allo-HSCT (t_Therapies), number of cardiotoxic therapies (n_Cardiotox), number of transplantations (n_Transplantations), comorbidity index (HCT-CI), hemoglobin level of the last 3 months (area under the curve), and physical activity. Results A total of 194 patients performed a CPET. VO2peak was significantly reduced compared with reference data. In total, VO2peak was 21.4 ml/min/kg (− 27.5%, p p 2peak was significantly (p Conclusions Our study demonstrates a decreased CRF indicating the potential need of prehabilitative exercise. We revealed some influencing factors on CRF. Those patients could benefit the most from exercise.

Cancer survivors demonstrate a reduced maximal oxygen uptake, which is clinically relevant in terms of overall survival. However, it remains uncertain whether they attain their “true maximal oxygen uptake” in a cardiopulmonary exercise test (CPET). In the present study, a supramaximal verification bout (Verif) was applied in cancer survivors to confirm attainment of maximal oxygen uptake. Seventy-five participants (age, 61 ± 12 years; n = 43 females with breast cancer and n = 32 males with prostate cancer, 6–52 weeks after primary therapy) performed a CPET on a cycle ergometer and a Verif at 110% peak power output. As verification criterion, maximal oxygen uptake in Verif should not exceed maximal oxygen uptake in CPET by >3%. On average, maximal oxygen uptake was significantly lower in Verif compared with CPET (1.60 ± 0.38 L·min–1 vs. 1.65 ± 0.36 L·min–1, p = .023). On the individual level, n = 51 (68%) satisfied the verification criterion, whereas n = 24 (32%) demonstrated a higher maximal oxygen uptake in Verif. n = 69 (92%) fulfilled ≥2 secondary criteria for maximal exhaustion in the CPET. While maximal oxygen uptake was not underestimated in the CPET on average, one-third of cancer survivors did not attain their true maximal oxygen uptake. Verif appears feasible and beneficial to confirm true maximal oxygen uptake in this population. Furthermore, it might be more reliable than secondary criteria for maximal exhaustion. Novelty In about one-third of cancer survivors, maximal oxygen uptake is underestimated by a CPET. This underestimation of maximal oxygen uptake is not necessarily indicated by secondary criteria for maximal exhaustion. A supramaximal verification bout appears feasible and helpful for the determination of maximal oxygen uptake in cancer survivors.

Purpose Most studies with cancer survivors use percentages of peak oxygen uptake (VO2peak) for intensity prescription. Lactate or ventilatory thresholds might be useful submaximal alternatives, but this has never been investigated. Therefore, we aimed at comparing three training sessions prescribed using %VO2peak (reference), lactate thresholds, and ventilatory thresholds in terms of meeting the vigorous-intensity zone, physiological, and psychological responses. Methods Twenty breast (58 ± 10 years) and 20 prostate cancer survivors (68 ± 6 years), 3.6 ± 2.4 months after primary therapy, completed a maximal cardiopulmonary exercise test and three vigorous training sessions in randomized order: 38 min of cycling at 70% VO2peak (M-VO2peak), 97% of individual anaerobic lactate threshold (M-IAT), and 67% between ventilatory thresholds 1 and 2 (M-VT). Heart rate (HR), blood lactate concentration (bLa), perceived exertion, and enjoyment were assessed. Results Cancer survivors exercised at 75 ± 23, 85 ± 18, and 79 ± 19 W during M-VO2peak, M-IAT, and M-VT (p > .05). Sessions could not be completed in 3, 8, and 6 cases. Session completers showed HR of 82 ± 7, 83 ± 9, and 84 ± 8 %HRpeak and bLa of 3.7 ± 1.9, 3.9 ± 0.9, and 3.9 ± 1.5 mmol·l−1, which was not different between sessions (p > .05). However, variance in bLa was lower in M-IAT compared to M-VO2peak (p = .001) and to M-VT (p = .022). Conclusion All intensity prescription methods on average met the targeted intensity zone. Metabolic response was most homogeneous when using lactate thresholds. Implications for cancer survivors Submaximal thresholds are at least as useful as VO2peak for intensity prescription in cancer survivors. Overall, slightly lower percentages should be chosen to improve durability of the training sessions.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect deriving from neurotoxic chemotherapeutic agents. The underlying nerve injury can affect proprioception causing impaired postural control, gait difficulties and a higher risk of falling. Overall, the symptoms and functional limitations negatively affect patients’ independence and quality of life. Research question Our objective was to analyze postural control in cancer patients before and after neurotoxic chemotherapy and to compare these data to healthy controls. Methods Participants were 35 cancer patients (PAT) and 35 healthy, one-to-one gender, age, height, and weight matched controls (HMC). Postural control of HMC was tested once, whereas PAT were tested prior to (PATpre) and three weeks after completion of neurotoxic chemotherapy (PATpost). Temporal, spatial and frequency domain measures of the center of pressure (COP) were calculated using a force plate. The following balance conditions were analyzed: bipedal stance with open (BPEO) and closed eyes (BPEC), semi-tandem (STEO, STEC) and monopedal stance (MPEO). CIPN was assessed clinically (Total Neuropathy Score) and via questionnaire. Time and group differences were determined by using Wilcoxon-signed-rank tests. Spearman correlation was applied to analyze associations between severity of CIPN and postural control. Results PATpost showed significantly increased temporal and spatial measures of the COP (p Significance Three weeks after completion of neurotoxic chemotherapy, PATpost showed significant balance deficits compared to PATpre and HMC. Especially the deficits in the standing conditions with closed eyes may indicate an impaired proprioception. This hypothesis is supported by the finding that stronger CIPN symptoms were associated with poorer postural control. However, future studies need to take further influencing factors on postural control into account (e.g. strength) in order to generate efficacious rehabilitation measures.

Background Research indicates reduced physical performance from diagnosis into survivorship of pediatric cancer patients. However, there is no systematic information or guideline available on the methods to assess physical performance and function in this population. The purpose was to systematically compile and describe assessments of physical performance and function in patients and survivors of pediatric cancer, including cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait and motor performance test batteries. Methods We searched the databases PubMed, SPORTDiscus, and Cochrane Database and performed abstract and full-text selection of 2619 articles according to the Cochrane Handbook of Systematic Reviews. Information on patients characteristics, assessments, information on validity and reliability, and relevant references was extracted. Results In summary, 63 different assessments were found in 149 studies including 11639 participants. Most studies evaluated cardiorespiratory fitness and muscle strength with the majority conducted off treatment. Some outcomes (e.g. speed) and diagnoses (e.g. neuroblastoma) were severely underrepresented. With the exception of gait, leukemia patients represented the largest group of individuals tested. Conclusions Insufficient data and patient heterogeneity complicate uniform recommendations for assessments. Our results support researchers and practitioners in selecting appropriate assessment to meet their specific research questions or individual daily practice needs. Impact This systematic review includes 149 studies and provides a comprehensive summary of 63 assessments to evaluate cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait or motor performance test batteries in patients and survivors of pediatric cancer. We present the most studied fields within the pediatric cancer population, which are cardiorespiratory fitness and muscle strength, off treatment phase, and leukemia patients. We propose research priorities by identification of subgroups in terms of cancer type, phase of treatment, and outcome of interest that are underrepresented in studies currently available.

PURPOSE: Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion. METHODS: The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement. RESULTS: Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment–related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential. CONCLUSION: Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.

Background Exercise has the potential to improve physical function and quality of life in individuals with bone metastases but is often avoided due to safety concerns. This systematic review summarizes the safety, feasibility and efficacy of exercise in controlled trials that include individuals with bone metastases. Methods MEDLINE, Embase, Pubmed, CINAHL, PEDro and CENTRAL databases were searched up to July 16, 2020. Results A total of 17 trials were included incorporating aerobic exercise, resistance exercise or soccer interventions. Few (n = 4, 0.5%) serious adverse events were attributed to exercise participation, with none related to bone metastases. Mixed efficacy results were found, with exercise eliciting positive changes or no change. The majority of trials included an element of supervised exercise instruction (n = 16, 94%) and were delivered by qualified exercise professionals (n = 13, 76%). Conclusions Exercise appears safe and feasible for individuals with bone metastases when it includes an element of supervised exercise instruction.

Although physical activity (PA) is beneficial for patients with cancer, healthcare professionals (HCP) still scarcely recommend it. This study aimed to determine how HCP’ sociodemographic and professional characteristics and their subjective assessments of patient characteristics are associated with their PA recommendations to patients with cancer. A cross-sectional survey (paper-pencil or online) was completed by 929 HCP (159 general practitioners, 382 specialized physicians, and 388 oncology nurses). The survey collected information on HCP’ sociodemographic and professional characteristics, PA recommendation frequency, and the likelihood of 13 patient characteristics influencing PA recommendations (on a 7-point Likert scale). Descriptive results showed that 37.6% of HCP indicated often recommending PA and 41.7% indicated routinely recommending PA. More professional experience was associated with a higher reported PA recommendation frequency among specialized physicians and oncology nurses. Patient characteristics could be assigned to three higher-level categories. Characteristics from the categories “medical side effects” and “low affinity for PA” were more frequently judged by HCP as reasons for recommending PA and characteristics belonging to “indicators of poor general health” as reasons for not recommending PA. In all professional groups, the inclusion of patient characteristics resulted in additional variance explained in the prediction of a routine PA recommendation. HCP in this study reported that they frequently recommend PA to patients with cancer. However, HCP consider cancer patient characteristics to influence their decision whether to recommend PA. Future research and interventions should aim to enable HCP to provide adequate PA recommendations to patients with cancer having different characteristics.