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Among cancer survivors, there are numerous health benefits of exercise engagement; however, less than 15% of survivors meet current aerobic and strength physical activity guidelines. Exercise programs provided by a cancer hospital are commonly noted as a facilitator and preference to exercise engagement. The study aimed to review the evidence and describe the barriers, facilitators, preferences, and factors associated with cancer survivors' engagement in hospital-based exercise oncology programs. Electronic databases (PubMed and Scopus) were searched to identify relevant papers published before July 1, 2021. Original research papers reporting on barriers, facilitators, preferences, or factors associated with participation in hospital-based exercise oncology programs were included. A total of 300 potentially relevant articles were identified, of which 10 met eligibility criteria. Barriers to participation in hospital-based exercise oncology programs included program accessibility, treatment-related side effects, and uncertainty about exercise. Program individualization, peer support, and staff support were reported as facilitators. Survivors also expressed that they preferred flexibility in the time, location, and mode of exercise programming. Baseline quality of life, fitness, and marital status were all identified as potential factors associated with engagement in hospital-based exercise oncology programs. These findings are useful for the development and implementation of hospital-based exercise oncology programs to optimize exercise program engagement.

The purpose of this narrative review is to highlight clinically relevant characteristics and rehabilitation interventions for aromatase inhibitor-induced musculoskeletal syndrome (AIMSS). AIMSS is a constellation of musculoskeletal symptoms including arthralgias, myalgias, and stiffness resulting from estrogen deprivation. The etiology likely relates to estrogen’s role in pain, immune, and skeletal, cartilaginous modulation. Rehabilitation strategies include medications and supplements, resistance, and aerobic exercises. Majority of the rehabilitation studies evaluated exercise interventions. AIMSS continues to be a broadly defined condition. The exact pathophysiology has not yet been discovered. Rehabilitation management is multi-dimensional and future research may consider a biopsychosocial approach. While exercise interventions are the most widely studied, there is a need to identify effective exercise protocols. Future research should also evaluate the effectiveness of occupational therapy interventions specifically for AIMSS populations.

The purpose of this narrative review was to highlight rehabilitation-relevant aspects of cancer treatment and primarily musculoskeletal impairments and rehabilitation interventions among women with breast and gynecologic cancers. For breast cancer, we reviewed post-mastectomy pain syndrome, upper quadrant dysfunction, aromatase inhibitor musculoskeletal syndrome (AIMSS), and lymphedema. For gynecologic cancers, pelvic floor dysfunction, lymphedema, and insufficiency fractures were selected. The recent breast cancer rehabilitation literature evaluates the pathophysiology of impairments such as AIMSS and osteoporosis. Studies have applied technologically advanced methods to quantify impairments such as upper quadrant dysfunction. Systematic reviews have assessed interventions across impairments. Among gynecologic cancers, pelvic floor dysfunction appears to be more commonly assessed. Small-sized pelvic floor intervention studies suggest improvement with rehabilitation. A large volume of studies describes breast cancer–related impairments. There is a need to further characterize and quantify functional impairments among gynecologic cancer survivors. For both populations, future research should robustly evaluate rehabilitation interventions.

Objective To assess the relationship between time-of-day of exercise training and changes in relevant cancer health outcomes among cancer survivors. Methods Retrospective analysis of data collected from 2016–2019 from a hospital-based exercise oncology program. Descriptive statistics were calculated for demographic, clinical, and exercise timing characteristics (e.g. AM, PM, or mix) among survivors with available data for exercise training time (n = 233). For the total sample and a breast cancer sub-analysis, univariate analysis of covariance, adjusted for age, was carried out by exercise training time, for change in the following outcomes collected during the program’s assessment sessions: cardiorespiratory fitness and muscular endurance (human performance variables), physical function, anthropometrics, self-reported fatigue, and quality of life (QoL). Change in body mass index (BMI) and body weight was included in the breast cancer analysis. Results Overall, 37.3% of survivors habitually engaged in AM exercise (e.g. ≥ 75% AM training), 34.3% in PM exercise, and 28.3% in a mix of AM and PM exercise training throughout the program. Median time in the program was 17 weeks. Significant improvements in most human performance and physical function variables were observed in the total sample regardless of exercise training time-of-day. Among breast cancer survivors, PM but not AM or mixed was associated with improvements in fitness, and lower-body muscular endurance and function. Mixed exercise timing was linked with greater increase in waist circumference (total sample: 3.02cm, 95%CI 1.55, 4.49; breast cancer: 3.57cm 95%CI 0.96, 6.18), body weight (breast cancer: 1.6kg, 95%CI 0.3, 2.8) and BMI (breast cancer: 0.6kg/m2, 95%CI 0.1, 1.0). AM and PM exercise, but not mixed, was associated with improvements in fatigue and QoL. Conclusion Time-of-day of exercise training may differentially impact changes in human performance and physical function variables. Mixed exercise training time may result in less favorable outcomes related of weight management variables among cancer survivors.

Purpose To assess the impact of the Personal Optimism With Exercise Recovery (POWER) program on cancer treatment–related side effects among rural cancer survivors. Methods In this retrospective study of data collected between 2016 and 2019, we assessed change in cardiorespiratory fitness, whole-body muscular endurance, physical function and strength, anthropometrics, fatigue, and quality of life (QoL), after participation in POWER. Descriptive statistics were calculated for demographic and clinical variables. Univariate analysis of variance was carried out with age and BMI at initial assessment as covariates. Results A total of 239 survivors, 78% rural residents, completed a follow-up assessment. Among rural cancer survivors, the most prevalent cancer sites were breast (42.5%), prostate (12.4%), and lymphoma (5.9%). The majority of survivors were female (70%), non-Hispanic (94.6%), and white (93.5%), with average age and BMI of 62.1 ± 13.2 years and 28.4 ± 6.7 kg/m2, respectively. Rural cancer survivors with cancer stages I–III exhibited significant improvements in fitness (+ 3.07 ml/kg/min, 95% CI 1.93, 4.21; + 0.88 METS, 95% CI 0.55, 1.20), physical function (30-s chair stand: + 2.2 repetitions, 95% CI 1.3, 3.1), muscular endurance (10-repetition maximum: chest press + 4.1 kg, 95% CI 2.0, 6.3; lateral pulldown + 6.6 kg, 95% CI 4.4, 8.9), self-reported fatigue (FACIT-Fatigue score: + 4.9, 95% CI 1.6, 8.1), and QoL (FACT-G7 score + 2.1, 95% CI, 0.9, 3.4). Among stage IV rural and urban cancer survivors, significant improvements were observed in muscular endurance and physical function. Conclusion Participation in POWER was associated with attenuation of cancer treatment–related side effects and may serve as a model exercise oncology program for rural cancer survivors.

Health-care policy, profoundly impacts whether a cancer survivor can access exercise programming. Coverage determinations are the most potent policy lever as they dictate the extent to which exercise programming services are covered and whether health-care providers are incentivized to offer them. However, other types of policy also influence the range and quality of exercise programming available to cancer survivors. Specifically, policies influence the availability of screening for exercise needs; provider training and competency assessments; mandated on-site clinical exercise facilities, services, and specialists; and provision of patient education at critical points in their care trajectories. This chapter provides an overview of the diverse reimbursement and nonreimbursement policies in the commercial, government, and organizational sectors that influence exercise programming for cancer survivors. The chapter emphasizes the need for multi-pronged policy initiatives with the potential to collectively raise awareness, educate providers, enhance quality, and ensure access. Policy lessons learned from experiences in Germany and with cardiac rehabilitation are outlined.

Objectives Examine the amount and nature of research activity in head and neck cancer (HNC) rehabilitation; highlight publication trends, including information about the authors, settings, and study designs; and identify gaps in the existing literature. Data Sources Eligible studies were identified using PubMed, Embase, and CINAHL databases. Study Selection Inclusion criteria included human subjects, English language, publication between 1/1/1990 and 4/30/2017, HNC patients at any timepoint in disease, and evaluation of rehabilitation outcomes as described by the International Classification of Functioning, Disability and Health (ICF) framework. Exclusion criteria included intervention or outcome not specific to rehabilitation or the HNC population, and protocols or abstracts without corresponding full manuscripts. Data Extraction An established 6-step scoping review framework was utilized to develop the review protocol. A 3-level review was then performed. Data on eligible studies were collected using a Research Electronic Data Capture (REDCap) tool. Data Synthesis Among 2201 publications, 258 met inclusion criteria. Publication rate increased by 390% over the study timeframe. Most studies were observational (n=150). Few were interventional (n=35). The most common interventions focused on chewing or swallowing (n=14), followed by exercise (n=10). Most primary outcome measures fit the ICF definition of impairment; fewer fit the definitions of activity limitation or participation restriction. Conclusions Although research volume in HNC rehabilitation is increasing, the literature is dominated by small (≤100 patients), outpatient-based observational studies involving chewing or swallowing-related impairments. More prospective studies in multidisciplinary domains across the cancer care continuum are needed. There is particular need for interventional studies and prospective observational studies. Future studies should evaluate clinically-relevant activity limitations and participation restrictions. Rehabilitation professionals have an important role in the design of future HNC rehabilitation research.

Purpose: Less time spent in sedentary behaviors is associated with improved health and disease outcomes in breast cancer survivors. However, little is known about survivors’ interest in sedentary behavior reduction interventions and how to effectively reduce this risk behavior. The purpose of this study was to explore breast cancer survivors’ interest in and preferences for technology-supported sedentary behavior reduction interventions. Methods: Breast cancer survivors (n = 279; Mage = 60.7 (SD = 9.7)) completed a battery of online questionnaires. Descriptive statistics were calculated for all data. To examine potential relationships between demographic, disease and behavioral factors, and survivors’ interest in a technology-supported sedentary behavior reduction intervention, we conducted logistic regression analyses. These same factors were examined in relation to the perceptions of the effectiveness of such intervention using multiple regression analyses. Results: On average, survivors spent 10.1 (SD = 4.3) hours/day in sedentary activity. They believed prolonged periods of sedentary behavior were harmful to their health (87.0%) and that reducing sedentary behavior could improve their health (88.4%). Survivors believed they should move around after 30–60 (56.7%) or ≥ 60 (29.9%) minutes of sedentary behavior and indicated they were most likely to replace sedentary behaviors with walking around (97.1%) or walking in place (73.4%). The majority of survivors (79.9%) was interested in participating in a technology-supported sedentary behavior reduction intervention and indicated they would use a smartphone application (61.3%) 2–3 times/day (48.0%), 6 to 7 days/week (52.0%). Most survivors (73.5%) believed reminders would help them decrease sedentary behavior and preferred they be delivered after sitting for 60 minutes (60.5%) via vibrations on a wrist worn activity tracker (77.3%) or text messages (54.4%). Conclusions: Technology-supported sedentary behavior reduction interventions may be feasible and acceptable to breast cancer survivors. Data regarding user preferences for content, features, delivery mode and design will aid researchers in developing sedentary interventions that are potentially more relevant and effective from the outset.

e23048 Background: Exercise is associated with improved symptoms and breast cancer (BC) survival. Little is known about personal and social factors that determine exercise participation in diverse BCS. The study seeks to characterize exercise trends and distinguish factors associated with initiating exercise among pre-diagnosis employed, non-exercising, ethnically and socioeconomically diverse BCS. Methods: BCS were recruited from academic and community medical centers. Women with stage I-III BC were surveyed during and 4 months post-completion of active treatment (surgery +/- chemo +/- radiation). The primary outcome was exercise initiation 4 months post treatment. Variables were self-reported except for clinical cancer variables, which were abstracted from the medical record. Results: Our sample (n = 494) included 22% black, 20% Chinese, 8% Korean, 27% Latina, and 21% non-Latina white women (3% other). 56% were born outside of the US; 30% reported an income < 200% of the federal poverty level (FPL). 72% of BCS exercised the year before diagnosis; 28% did not. Significant correlates (p < 0.05) of NOT exercising pre-diagnosis included lack of post-secondary education, Chinese or Korean ethnicity, lack of alcohol consumption, and lower acculturation level, resilience, and income. Among 138 non-exercisers, 63% reported exercising at follow-up. Significant correlates of exercise initiation are listed in table. In a multivariable model that included age, acculturation, job loss, insurance status, chemo-, and radiotherapy (RT), receipt of RT was significantly associated with exercise initiation (OR 3.1, 95% CI 1.4-7.1). Conclusions: A BC diagnosis may be an impetus to initiate exercise among previously sedentary, employed women. Patients who undergo radiotherapy appear to be more likely to start exercising. Additional research is needed to understand why some patients initiate exercise while others do not. [Table: see text]

Objective To describe gender and side-to-side differences in lateral abdominal wall muscle thickness at rest and during contraction in asymptomatic adults. Design Cross-sectional observational study. Setting Tertiary university outpatient musculoskeletal clinic. Patients Asymptomatic, healthy adults. Methods A single examiner with training in ultrasound (US) assessment evaluated all subjects and used a different hand to guide the US transducer on each side. Bilateral anteroposterior measurements of transversus abdominis (TrA) and internal oblique (IO) thickness were assessed at rest and during maximal contraction with the use of an abdominal draw-in maneuver (ADM). Three sets of data points were obtained on 12 subjects to determine intrarater reliability within a single session. Main Outcome Measurements Anteroposterior thickness of TrA and IO muscles (cm). Results A total of 20 subjects (mean age, 29.3 years; range, 23-46 years; 8 men and 12 women; mean body mass index, 24.4 kg/m 2 ; range, 18.9-34.9 kg/m 2 ) were examined. At rest, men had greater TrA and IO thickness compared with women (men, 0.55, and women, 0.35, P = .01; and men, 0.95, and women, 0.77, P = .04, respectively). At rest, there were no side-to-side differences of TrA or IO muscles for both genders. With an ADM, women demonstrated a significant percent change in thickness of their TrA muscle compared with men (women, 0.77, and men, 0.29, P = .001). No significant difference was found between men and women in the percent change of IO thickness with ADM (women, 0.20, and men, 0.12, P = .24). There was excellent intrarater reliability for measurements of the right abdominal muscles (intraclass correlation coefficient=0.92-0.95) and moderate-to-good intrarater reliability for measurements of the left abdominal muscles (intraclass correlation coefficient=0.62-0.92). Conclusions Asymptomatic men have greater TrA and IO thickness at rest compared with asymptomatic women; however, women demonstrated a greater percent change in TrA thickness with an ADM compared with men.