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IntroductionPhysical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation.Methods and analysisThe trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes.Ethics and disseminationThis study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations.Trial registration numberNCT04896580.

Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16-62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Meta-analyses have shown that physical activity has beneficial effects on cardiovascular fitness (average standardised mean difference [SMD] 0·69 [95% CI 0·31-1·01]), musculoskeletal fitness (0·59 [0·31-0·87]), cardiometabolic risk factors (0·39 [0·04-0·75]), and brain and mental health outcomes (0·47 [0·21-0·73]). These meta-analyses also show that health benefits can be achieved even with less than 150 min of physical activity per week, and suggest that some physical activity is better than none. Meta-analyses of interventions to increase physical activity for PLWD have reported effect sizes ranging from SMD 0·29 (95% CI 0·17-0·41, k=10) to 1·00 (0·46-1·53, k=10). There is increasing awareness among policy makers of the needs of PLWD for full participation in physical activity. Physical activity action plans worldwide must be adequately resourced, monitored, and enforced to truly advance the fundamental rights of PLWD to fully participate in physical activity.

The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors. [ABSTRACT FROM AUTHOR]

Children with physical impairments have low rates of physical activity when compared to children without impairments. Given the benefits that result from sport, improving participation rates among children with physical impairments is essential. Parents have a critical role in supporting their child's involvement in sport. The purpose of this article was to review research regarding psychosocial factors that determine parental support of sport participation for their child with a physical impairment, and present recommendations for future research. This will be done in two parts: first, a critical investigation of current literature using the Health Action Process Approach as a framework; and second, the presentation of a research agenda. By meeting our recommendations and developing knowledge on the determinants of parents' decision to promote sport for their child with a physical impairment, researchers could fill gaps in the literature and may aid in improving sport participation for children with physical impairments.

Purpose The objective of this study was to evaluate the effect of an intervention (Growing Resilience And CouragE; GRACE) on spiritual well-being, quality of life, and general well-being in women with metastatic cancers reporting existential or spiritual distress. Patients and Methods Prospective, randomized, wait-list control clinical trial. Women with metastatic cancer experiencing existential or spiritual concerns were randomized to GRACE or waitlist control. Survey data were collected at baseline, end of program, and 1-month follow-up. Participants included English-speaking women, 18 or older, with metastatic cancer, existential or spiritual concerns, and reasonable medical stability. Eighty-one women were assessed for eligibility; 10 were excluded (not meeting exclusion criteria, refusal to participate, and death). The primary outcome was spiritual well-being measured pre- and post-program. Secondary measures assessed quality of life, anxiety, depression, hopelessness, and loneliness. Results Seventy-one women (aged 47-72) were enrolled (GRACE n = 37, waitlist control n = 34). GRACE participants demonstrated significant improvements in spiritual well-being compared to control at end of program (parameter estimate (PE), 16.67, 95% CI, 13.17, 20.16) and 1-month follow-up (PE, 10.31, 95% CI, 6.73, 13.89). Additionally, significant improvements were demonstrated in quality of life at the end of program (PE, 8.51, 95% CI, 4.26, 12.76) and 1-month follow-up (PE, 6.17, 95% CI, 1.75, 10.58). GRACE participants also demonstrated improved depression and hopelessness at follow-up, as well as improved anxiety. Conclusions Findings suggest the value of evidence-based psychoeducational and experiential interventions for improving the well-being and quality of life of women with advanced cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02707510. [ABSTRACT FROM AUTHOR]

One of the goals of the Paralympic Games is to improve social attitudes toward individuals with physical disabilities (PD) through exposure to parasport and Paralympic mass media messaging. This study assessed whether this goal is achieved by examining changes in explicit perceptions toward Paralympians and individuals with PD over the course of the Rio 2016 Paralympics. Adults without PD (n = 119) were randomized into two groups: (1) an exposure group that was e-mailed local Paralympic Games coverage information before each day of the Games; and (2) a control group that received no e-mails about coverage. All participants completed measures assessing explicit perceptions (i.e., warmth and competence) of Paralympians and individuals with PD two weeks before, two weeks after, and three months following the Games. Exposure to Paralympic media was also assessed. No differences were present between groups for time spent watching the Games, explicit perceptions, or demographics (ps >.05). Thus, data was collapsed across groups for the main analyses. Repeated measure ANOVAs with Bonferroni adjustments indicated that explicit perceptions of warmth decreased over time for both Paralympians and individuals with PD (p ≤.005). However, Paralympians were rated as significantly more competent and warmer than individuals with PD (ps <.001) at each timepoint. Findings suggest that public exposure to the Paralympics may have more value for Paralympians than the larger disability community. Further research should explore how to disseminate communication regarding the Paralympics to improve social attitudes and optimize integration of all people with disabilities in society. [ABSTRACT FROM AUTHOR]

A gap in knowledge exists regarding how to maintain physical activity (PA) for individuals with acquired disabilities following initial introductory experiences. The current study aimed to contribute to filling this gap by exploring the PA pathways of military veterans with a physical disability, particularly those who maintain long-term PA, from impairment to the present. Veterans with a physical disability (N = 18) participated in interviews exploring their PA history and experiences. A reflexive thematic analysis was conducted to generate common pathways in PA participation, as well as to examine which elements of participation supported PA maintenance. Three long-term pathways were identified—two parasport pathways and one recreational PA pathway. Four elements of participation (i.e., mastery, challenge, belongingness, meaning) supported to maintain PA at key junctures. This knowledge provides further understanding of how to promote long-term PA for individuals with acquired disabilities and can support advancements in theory, as well as program development. [ABSTRACT FROM AUTHOR]

Physiotherapists are often important figures in the lives of people with physical disabilities and chronic conditions, yet gaps in understanding remain regarding how therapists promote physical activity and leverage existing community-based recreation programs. We used qualitative methods to explore experiences of physiotherapists as well as individuals with disabilities and chronic conditions receiving physiotherapy, with a focus on strategies to promote physical activity and the extent that therapists leverage community-based resources and programs. Semi-structured interviews were completed with nine physiotherapists (six American and three Canadian) and eight individuals with a physical disability (all Americans). Participants reflected on the salience of physical activity promotion throughout physiotherapy but also highlighted barriers. Three themes explored idealized and problematic experiences with physical activity promotion in therapy: 1) individualized promotion of physical activity; 2) increasing physical activity options for patients via engagement with the community; and 3) options for physical activity in the community. Differences were also noted between therapist and patient participants and when contrasting across countries (i.e. funding models). For instance, physiotherapists in publicly funded contexts relied more heavily on engagement with accessible community-based programming than privately funded counterparts. Therapists should further integrate patient perspectives when considering physical activity promotion. Additional research is needed to explore how therapists incorporate community-based programs into health promotion while further understanding the extent that these strategies align with the scope of physiotherapy practice in varying contexts. [ABSTRACT FROM AUTHOR]

The Invictus Games are a parasport competition for service members and veterans with illnesses and injuries. The 2014 Games were aired by the BBC, for a total of 12 hr of coverage. This study aimed to investigate what messages were conveyed regarding parasport for veterans during the BBC's Invictus Games broadcast. A content analysis was conducted. Five qualitative themes were identified: sport as rehabilitation, the promotion of ability over disability, the social environment, key outcomes of participation, and the importance of competition. Quantitative results indicated that 2 segment types accounted for the majority of the broadcast: sport coverage (50.57%) and athlete experiences (12.56%). Around half of the coverage focused on participants with a physical disability (51.62%). The findings demonstrate key similarities to and differences from previous explorations of parasport media coverage, with the needs of the event and athlete population potentially influencing the broadcast. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Many cancer survivors report issues with cognitive function following diagnosis and treatment. The purpose of this single-arm pilot study was to test the feasibility and acceptability of virtual delivery of a cognitive rehabilitation intervention for participants in virtual groups. SAMPLE & SETTING: 37 adult cancer survivors reporting impaired cognitive function following primary treatment were enrolled from Cedars-Sinai Medical Center and affiliates, the University of Kansas Cancer Center, and the Masonic Cancer Alliance. METHODS & VARIABLES: Two cohorts attended six weekly virtual sessions and completed pre- and postintervention patient-reported outcome questionnaires designed to measure perceived cognitive function, loneliness, and determinants of behavior change for exercise, sleep, and mindfulness. RESULTS: Postintervention scores for perceived cognitive function, determinants of behavior change, and loneliness ratings significantly improved. IMPLICATIONS FOR NURSING: Evidence continues to build in support of cognitive rehabilitation interventions for cancer survivors. Nurses play an important role in terms of patient identification, participation, and facilitation. [ABSTRACT FROM AUTHOR]

Background: Due to the numerous barriers people with a physical disability face to being physically active, emphasis in practice and research is often placed on creating opportunities for participation. As such, the quality of the experience is often ignored once an individual is participating. Purpose: An understanding of how to create quality physical activity experiences is critical to foster enjoyable and sustained participation. The aim of this systematic review was to identify intervention and/or program conditions that may foster key elements that shape quality participation (QP) experiences. Methods: In all, 24 qualitative and 6 quantitative studies met inclusion criteria. The results of the qualitative studies were synthesized using thematic analysis. Results: The synthesis identified two program conditions as important for fostering QP elements: (1) group-based programing: participating with peers can be linked to belongingness and mastery and (2) leadership: knowledgeable instructors may foster mastery and autonomy. The quantitative studies lacked variability in program conditions and QP elements, which precluded associating specific conditions with elements of a quality experience. Conclusions: Although the qualitative findings highlight two program conditions which may foster QP elements, overall, evaluations of physical activity interventions involving people with disabilities rarely include experiential aspects of participation. Group-based programming and leadership are two program conditions that may foster elements of quality participation. Physical activity organizers need to consider group composition. Physical activity programs should consist of peers with a disability, as appropriate, in order to promote belongingness. Physical activity programs should provide disability-specific training to leaders or seek leaders with disability-specific knowledge, in addition to physical activity knowledge and skills. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity is an important method of rehabilitation used to promote positive physical and psychosocial outcomes among military personnel, including Veterans, with a physical disability. However, minimal research has explored physical activity program implementation strategies, particularly how these strategies may foster positive rehabilitation outcomes, and quality participation experiences among Veterans post-injury. The purpose of the current study is to document strategies used to deliver physical activity programs to Veterans with a physical disability. Research methods: Semi-structured interviews were conducted with program staff from three Veteran physical activity programs, and program documentation was collected. Data were analyzed using a thematic analysis. Results: Four themes were identified representing strategies used for delivering physical activity programming: (1) foster social connections; (2) challenge participants; (3) tailor programs and outcomes to match participant needs; and (4) include knowledgeable coaches/instructors. Conclusions: The study provides researchers and practitioners (e.g., rehabilitation professionals, program facilitators, coaches) with evidence of strategies for delivering physical activity programming for Veterans post-injury, thus assisting with future program development and evaluation. The findings also provide preliminary insight regarding the potential relationships between physical activity programming and elements of quality participation. Implications for Rehabilitation: Physical activity is a popular method of rehabilitation for military personnel post-injury. Findings highlight four strategies used to deliver physical activity experiences to Veterans with a physical disability. Strategies highlighted provide insight as to how rehabilitation specialists can promote quality experiences for Veterans with a physical disability during physical activity programming. [ABSTRACT FROM AUTHOR]