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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., Competing Interests: Kristin L. CampbellHonoraria: Astellas Pharma Prue CormieStock and Other Ownership Interests: Exercise Oncology EDU Pty LtdOther Relationship: EX-MED Cancer Ltd Sarah WellerResearch Funding: Astellas Pharma Shabbir M. H. AlibhaiStock and Other Ownership Interests: ResMedHonoraria: Astellas Scientific and Medical Affairs Inc Kate A. BolamStock and Other Ownership Interests: Novo Nordisk Celestia S. HiganoEmployment: CTI BioPharma Corp (I)Stock and Other Ownership Interests: CTI BioPharma Corp (I)Honoraria: Astellas PharmaConsulting or Advisory Role: Bayer, Ferring, Clovis Oncology, Blue Earth Diagnostics, Janssen, Hinova Pharmaceuticals, Pfizer, AstraZeneca, Carrick Therapeutics, Novartis, Merck Sharp & Dohme, Astellas Pharma, Myovant Sciences, Genentech, MenariniResearch Funding: Aragon Pharmaceuticals (Inst), AstraZeneca (Inst), Medivation (Inst), Emergent BioSolutions (Inst), Bayer (Inst), Pfizer (Inst), Roche (Inst), Astellas Pharma (Inst), Clovis Oncology (Inst), Ferring (Inst), eFFECTOR Therapeutics (Inst)Travel, Accommodations, Expenses: Pfizer, Janssen Oncology, Novartis, Merck Sharp & Dohme, Carrick Therapeutics Kirstin LaneStock and Other Ownership Interests: Moderna TherapeuticsTravel, Accommodations, Expenses: Astellas Pharma Robert U. NewtonHonoraria: GenesisCareResearch Funding: IpsenTravel, Accommodations, Expenses: Genesis Cancer Care Morten QuistEmployment: Zealand Pharmaceuticals (I)Honoraria: AstraZeneca Jennifer RauwHonoraria: AstraZenecaSpeakers' Bureau: GlaxoSmithKlineTravel, Accommodations, Expenses: AstraZeneca Friederike RosenbergerStock and Other Ownership Interests: BioNTech, Bristol Myers Squibb, AstraZenecaHonoraria: Bristol Myers Squibb, Hexal Kathryn H. SchmitzPatents, Royalties, Other Intellectual Property: Fees from the educational program I developed that are now offered through Klose Training and Consulting Joachim WiskemannHonoraria: Pfizer, Lilly, Novartis Jennifer GoulartResearch Funding: Astellas Pharma (Inst)No other potential conflicts of interest were reported.

Background: One of the more frequent complications following treatment for breast cancer, lymphedema is a substantial swelling of the arm, breast and chest wall that occurs on the side where lymph nodes were removed. The aim of this work is to update recommendations on the prevention, diagnosis and management of lymphedema related to breast cancer., Methods: We present the protocol for an update of the 2001 clinical practice guideline on lymphedema from the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. We will use a patient-oriented research approach with a focus on self-management and the positive health model to inform the updated guideline development. The methods proposed will be undertaken with consideration of the standards outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The literature will be appraised by evaluating existing guidelines from other countries, the evidence from systematic reviews and meta-analyses and direct evidence from clinical studies. We will manage competing interests according to Guidelines International Network principles. Recommendations will be presented using an actionable statement format and will be linked to the level of evidence along with any relevant considerations used in formulation. A draft of the guideline will be produced by the steering committee then sent out to international experts and stakeholder groups for feedback., Interpretation: The primary benefit of this clinical guideline will be to improve the quality of care of women with breast cancer-related lymphedema. Findings will be disseminated at national and international conferences and through webinars and educational videos hosted on the websites of the supporting organizations., Competing Interests: Competing interests: Lori Radke is a member of the editorial board for the Pathways Magazine of the Canadian Lymphedema Framework. Mary-Ann Dalzell receives royalties from Bia Formations for continuing professional development on the rehabilitation of patients with cancer and receives royalties from Key Clinical Skills for courses on topics including the management of bone metastasis. She has been paid by the Oncology Division of the Canadian Physiotherapy Association to teach courses that include the management of bone metastasis. Anna Kennedy has received travel support from the International Lymphedema Framework and the Canadian Lymphedema Framework and has had leadership or fiduciary roles in these organizations. Lauren Capozzi is the cofounder of Thrive Health Services, a cancer and exercise training company for fitness professionals. Anna Towers has received honoraria from the Dr. Vodder School International and is a scientific advisor of the Lymphedema Association of Quebec., (© 2022 CMA Impact Inc. or its licensors.)

Background: The diagnosis of breast cancer in young women (aged 18-45 years) has been increasing. Women are commonly left coping with treatment-related disabilities of the upper limb that can persist for > 2 years postoperatively., Patients and Methods: A total of 59 young breast cancer patients (29 in the intervention group and 30 in the control group) participated in a pilot prospective randomized controlled trial to determine whether a 12-week postradiation exercise program would improve long-term arm mobility, pain, and handgrip strength. During an 18-month period, range of motion, handgrip strength, and pain with shoulder movements were evaluated at 6 points., Results: Although the differences were not statistically significant, external rotation and horizontal abduction of the shoulder improved in the intervention group immediately after the exercise intervention (3 months) and showed a trend toward less pain on movement. However, at 18 months after radiation the control and intervention groups both retained a residual loss of range and persistent pain with movement. Radiation to the axilla and/or chest wall yielded long-term (18 months) limitations in flexion and horizontal abduction compared with hypofractionation, which resulted in greater flexion and external rotation at 18 months. The median grip strength of the study participants corresponded to the 10th percentile of healthy aged-matched white women., Conclusion: The exercise intervention timed shortly after radiation improved short-term shoulder mobility and pain; however, these gains were not sustained at 18 months after radiation., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Breast cancer (BC) diagnosis in young adults (YA) is rising, and both disease and treatments are aggressive in this population. Evidence supports the use of physical activity in reducing shoulder dysfunction, which is common among BC survivors. A pilot randomized clinical trial was performed to determine the effectiveness of a 12-week post-radiation exercise program in minimizing upper extremity dysfunction in YA with BC., Methods: Participants were randomized to either an exercise arm or a control arm receiving standard care. Data was collected over six time points using: the Disability of Arm, Shoulder, and Hand (DASH); the Metabolic Equivalent of Task-hours per week (MET-hours/week), and a post hoc questionnaire on return to work., Results: In total, 59 young women participated in the study (n = 29 exercise; n = 30 control). No statistically significant differences were found in overall DASH results between groups; however, those who underwent total mastectomy had residual upper limb dysfunction (p < 0.05). Both groups returned to pre-diagnosis activity levels by 18 months. Final evaluation showed that 86% of the women returned to work, and 89% resumed prior work activities with a decrease of 8.5 h/week., Conclusion: Although the short-term targeted exercise program had no effect on long-term upper limb function post-radiation, timing and program specificity may require consideration of tissue healing post-radiation and surgery type. The majority of participants returned to work, however not returning to pre-diagnosis work hours., Implications for Cancer Survivors: Exercise interventions alone may not reverse the long-term sequelae of breast cancer treatment and allow young adult patients to return to work.

Introduction: The Rehabilitation and Exercise Oncology model of care (ActivOnco) was established to optimize cancer survivorship through exercise prescription and active lifestyle promotion, providing a transition of care from hospital to community. Patients having any cancer diagnosis, stage of disease, and treatment were eligible for evaluation and exercise prescription upon deterioration of performance status. The team of professionals included hospital-based physiotherapists proactively screening for rehabilitation needs, loss of functional independence, and exercise eligibility, plus exercise specialists in a community-based Wellness Centre to provide follow-up or direct access for post-treatment or non-complex patients., Methods: From January 2011 to December 2015, the hospital team assessed 1635 patients representing all major cancer sites, and the Wellness Centre team evaluated and prescribed exercise for 1066 participants. Primary interventions provided were education about fatigue management, physical activity promotion, exercise prescription, fracture risk reduction, referral to specialized follow-up services (for example, occupational therapy, lymphedema clinic), and coordination for mobility aids and paratransit services., Results and Conclusions: Implementation of the ActivOnco model of care showed that exercise alone is not a panacea for all functional deterioration associated with the cancer trajectory and its treatment. However, screening to identify rehabilitation needs combined with exercise prescription can effectively improve the quality of survivorship in cancer patients. Program developments are limited by the cost of human resources, lack of hospital-based physical resources, and lack of public funding, all of which significantly limit the scope and development of appropriate services., Competing Interests: We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

Purpose: Multiple myeloma (MM) is often associated with osteolytic bone disease and anemia, resulting in skeletal fragility and persistent fatigue, pain, and reduced quality of life. Exercise is considered safe and beneficial for this population. Our objectives were to evaluate the extent to which MM patients undergoing chemotherapy complied with exercise recommendations and to identify factors associated with noncompliance., Methods: This retrospective study included 41 MM patients referred to a hospital-based rehabilitation program while undergoing chemotherapy. Variables collected at baseline (T1) and follow-up (T2) included: (a) demographics and medical history, (b) exercise levels (MET-hours/week), preferences and barriers, and (c) fatigue severity scores (0-10). Statistical analyses included logistic regression to identify factors associated with exercise noncompliance and t-tests and chi-squared tests to compare outcomes between the groups according to compliance., Results: The mean age of the participants was 61 years; 73 % were male and 81 % had bone lesions. Overall exercise compliance at T2 was 71 %, with an observed increase in exercise levels (mean group difference: 6.5 MET-hours/week; p < 0.001) and decrease in fatigue severity scores (mean group difference -1.2; p = 0.003). Factors associated with exercise noncompliance included history of pathological fracture (odds ratio [OR] 4.7; p = 0.049), spinal cord compression (SCC) (OR 14.1; p = 0.023), and radiation (OR 28.0; p < 0.001)., Conclusions: In this sample of MM patients, high compliance with exercise and associated improvements in fatigue were observed. However, participants with a history of pathological fracture, SCC, or radiation are at increased risk of noncompliance and may require additional supervision to improve exercise compliance.

A 12-year-old girl with Smith-Lemli-Opitz syndrome and gastrostomy dependency presented with multiple episodes of coffee ground vomits. An upper gastrointestinal endoscopy revealed a trichobezoar in the lower oesophagus, with a 'hidden treasure'-a retained end of a G tube at the core. Endoscopic retrieval led to resolution of symptoms. Literature is scant with only one previous report of an oesophageal trichobezoar. Techniques of removal of percutaneous endoscopic gastrostomy in children are reviewed. The pathogenesis, preventative measures and management for oesophageal trichobezoars are discussed.

Thirty Canadian police officers, divided into six groups, participated in the redesign of the interior of the patrol car. Three of the groups consisted of individuals having a history of low back disease. The effect of participating in a design process on the characteristics of the final design and on the perception of the low back pain was studied in a semi-experimental setting. The participants developed a strong commitment to the participatory design process, which was reflected in their productions. The differences between participants with and without a history of a low back disease was not marked. The former tended to stress posture-related elements in their analysis and design.

The aim of this study was to assess the effects in humans of early (2 weeks) and delayed (6 weeks) isokinetic strength training in the recovery of muscle strength following an arthroscopic partial meniscectomy. The peak torque developed in the quadriceps and hamstrings and the torque developed at a knee angle of 1.05 rad were evaluated in 16 subjects, pre-operatively (pre-op), and 2, 6, and 10 weeks post-operatively (post-op), on an isokinetic device at four different velocities (1.05, 2.09, 3.14, and 4.19 rad.s-1). The fatigue characteristics of the muscles were evaluated by having the subject perform 15 maximal contractions at 3.14 rad.s-1. Training was done on the same device (three times a week for 1-2 months), beginning either 2 or 6 weeks post-op. A repeated measures analysis of variance demonstrated a time effect but no differences between groups and no interactions. Torques developed by the knee flexors and extensors were significantly smaller 2 weeks post-op than pre-op, at all velocities tested. Torques developed in the quadriceps recovered to their pre-op values by 6 weeks, and further gained significantly in strength from 6 to 10 weeks. Quadriceps torques remained weaker than the contralateral side at 10 weeks. Hamstrings torques were either higher or similar to pre-op values by 6 weeks, and demonstrated increases from 6 to 10 weeks post-op at 1.05 and 4.19 rad.s-1 only. Total work and average power developed by the quadriceps and hamstrings during the fatigue protocol changed with time in a similar manner to torque.(ABSTRACT TRUNCATED AT 250 WORDS)