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Background The primary objective of this systematic review was to update our previous review on randomized controlled trials (RCTs) of exercise in cancers other than breast or prostate, evaluating: 1) the application of principles of exercise training within the exercise prescription; 2) reporting of the exercise prescription components (i.e., frequency, intensity, time, and type (FITT)); and 3) reporting of participant adherence to FITT. A secondary objective was to examine whether reporting of these interventions had improved over time. Methods MEDLINE, EMBASE, CINAHL and SPORTDiscus databases were searched from 2012 to 2020. Eligible studies were RCTs of at least 4 weeks of aerobic and/or resistance exercise that reported on physiological outcomes relating to exercise (e.g., aerobic capacity, muscular strength) in people with cancer other than breast or prostate. Results Eighty-six new studies were identified in the updated search, for a total of 107 studies included in this review. The principle of specificity was applied by 91%, progression by 32%, overload by 46%, initial values by 72%, reversibility by 7% and diminishing returns by 5%. A significant increase in the percentage of studies that appropriately reported initial values (46 to 80%, p p = 0.039) was found for studies published after 2011 compared to older studies. All four FITT prescription components were fully reported in the methods in 58% of all studies, which was higher than the proportion that fully reported adherence to the FITT prescription components in the results (7% of studies). Reporting of the FITT exercise prescription components and FITT adherence did not improve in studies published after 2011 compared to older studies. Conclusion Full reporting of exercise prescription and adherence still needs improvement within exercise oncology RCTs. Some aspects of exercise intervention reporting have improved since 2011, including the reporting of the principles of progression and initial values. Enhancing the reporting of exercise prescriptions, particularly FITT adherence, may provide better context for interpreting study results and improve research to practice translation.

Purpose\ud Cancer-related fatigue (CRF) is a common and distressing symptom of cancer that may persist for years following treatment completion. However, little is known about the pathophysiology of CRF. Using a comprehensive group of gold-standard physiological and psychosocial assessments, this study aimed to identify correlates of CRF in a heterogenous group of cancer survivors.\ud \ud Methods\ud Using a cross-sectional design to determine the physiological and psychosocial correlates of CRF, ninety-three cancer survivors (51 fatigued, 42 non-fatigued) completed assessments of performance fatigability (i.e. the decline in muscle strength during cycling), cardiopulmonary exercise testing, venous blood samples for whole blood cell count and inflammatory markers and body composition. Participants also completed questionnaires measuring demographic, treatment-related, and psychosocial variables.\ud \ud Results\ud Performance fatigability, time-to-task-failure, peak oxygen uptake (V̇O2peak), tumor necrosis factor-α (TNF-α), body fat percentage, and lean mass index were associated with CRF severity. Performance fatigability, V̇O2peak, TNF-α, and age explained 35% of the variance in CRF severity. Those with clinically-relevant CRF reported more pain, more depressive symptoms, less perceived social support, and were less physically active than non-fatigued cancer survivors.\ud \ud Conclusions\ud The present study utilised a comprehensive group of gold-standard physiological and psychosocial assessments and the results give potential insight into the mechanisms underpinning the association between physical inactivity, physical deconditioning and CRF.\ud \ud Implications for Cancer Survivors\ud Given the associations between CRF and both physiological and psychosocial measures, this study identifies targets that can be measured by rehabilitation professionals and used to guide tailored interventions to reduce fatigue.

Introduction \ud Cancer-related fatigue (CRF) is a debilitating symptom that affects around one-third of people for months or years after cancer treatment. In a recent study, we found that people with posttreatment CRF have greater neuromuscular fatigability. The aim of this secondary analysis was to examine the etiology of neuromuscular fatigability in people with posttreatment CRF.\ud \ud Methods \ud Ninety-six people who had completed cancer treatment were dichotomized into two groups (fatigued and nonfatigued) based on a clinical cut point for fatigue. Alterations in neuromuscular function (maximal voluntary contraction peak force, voluntary activation, potentiated twitch force, and EMG) in the knee extensors were assessed across three common stages of an incremental cycling test. Power outputs during the fatigability test were expressed relative to gas exchange thresholds to assess relative exercise intensity.\ud \ud Results \ud The fatigued group had a more pronounced reduction in maximal voluntary contraction peak force and potentiated twitch force throughout the common stages of the incremental cycling test (main effect of group: P < 0.001, ηp2 = 0.18 and P = 0.029, ηp2 = 0.06, respectively). EMG was higher during cycling in the fatigued group (main effect of group: P = 0.022, ηp2 = 0.07). Although the relative intensity of cycling was higher in the fatigued group at the final common stage of cycling, this was not the case during the initial two stages, despite the greater impairments in neuromuscular function.\ud \ud Conclusions \ud Our results suggest that the rapid impairments in neuromuscular fatigability in people with CRF were primarily due to disturbances at the level of the muscle rather than the central nervous system. This could affect the ability to tolerate daily physical activities.

Cancer-related fatigue can continue long after curative cancer treatment. The aim of this study was to investigate sleep and rest–activity cycles in fatigued and non-fatigued cancer survivors. We hypothesized that sleep and rest–activity cycles would be more disturbed in people experiencing clinically-relevant fatigue, and that objective measures of sleep would be associated with the severity of fatigue in cancer survivors. Cancer survivors (n = 87) completed a 14-day wrist actigraphy measurement to estimate their sleep and rest–activity cycles. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F). Participants were dichotomised into two groups using a previously validated score (fatigued n = 51 and non-fatigued n = 36). The participant’s perception of sleep was measured using the Insomnia Severity Index (ISI). FACIT-F score was correlated with wake after sleep onset (r = −0.28, p = 0.010), sleep efficiency (r = 0.26, p = 0.016), sleep onset latency (r = −0.31, p = 0.044) and Insomnia Severity Index (ISI) score (r = −0.56, p &lt, 0.001). The relative amplitude of the rest–activity cycles was lower in the fatigued vs. the non-fatigued group (p = 0.017, d = 0.58). After treatment for cancer, the severity of cancer-related fatigue is correlated with specific objective measures of sleep, and there is evidence of rest–activity cycle disruption in people experiencing clinically-relevant fatigue.

Over one-third of college students are overweight or obese and rates are rising. Whole body vibration (WBV) training could prevent weight gain but has not been tested in college students. Methods: ...

Background Lung cancer survivors are at risk of accelerated declines in physical functioning attributed to cancer treatment. However, it is unknown whether patients experience the same rate of functional decline and how symptoms may contribute to different trajectories. Objectives The aims of this study were to identify interindividual differences in the pattern and rate of change in self-reported functioning in lung cancer survivors and examine whether and how symptoms are related to physical functioning over time. Methods This was a secondary data analysis in 72 lung cancer survivors. Multilevel modeling was used to estimate trajectories of self-reported physical functioning over 1 year and assess the relation between functioning, fatigue, depressive symptoms, and pain severity across time. Results Within the sample, average physical functioning did not significantly decrease (coefficient, -0.46; 95% confidence interval [CI] = -2.85 to 0.94) over time. However, among individual lung cancer survivors, baseline physical functioning varied significantly (SD, 20.76; 95% CI, 16.84-25.59) and changed at significantly different rates over 1 year (SD, 3.50; 95% CI, 2.13-5.68). Fatigue, assessed over 1 year, was the only significant symptom predictor of physical functioning changes over time (coefficient = 1.03; 95% CI, 0.79-1.27). Conclusions In this sample of lung cancer survivors, not all survivors experienced the same rate of self-reported functional decline and those with lower levels of fatigue reported better physical functioning. Implications for practice Nurses should recognize that some lung cancer survivors may have faster rates of functional declines than others, which may be related to fatigue severity. Early identification and management of fatigue could help avoid or delay future disability.

Cancer-related fatigue (CRF) is a debilitating symptom that affects around one-third of people for months or years after cancer treatment. In a recent study, we found that people with posttreatment CRF have greater neuromuscular fatigability. The aim of this secondary analysis was to examine the etiology of neuromuscular fatigability in people with posttreatment CRF.Ninety-six people who had completed cancer treatment were dichotomized into two groups (fatigued and nonfatigued) based on a clinical cut point for fatigue. Alterations in neuromuscular function (maximal voluntary contraction peak force, voluntary activation, potentiated twitch force, and EMG) in the knee extensors were assessed across three common stages of an incremental cycling test. Power outputs during the fatigability test were expressed relative to gas exchange thresholds to assess relative exercise intensity.The fatigued group had a more pronounced reduction in maximal voluntary contraction peak force and potentiated twitch force throughout the common stages of the incremental cycling test (main effect of group: P0.001, ηp2 = 0.18 and P = 0.029, ηp2 = 0.06, respectively). EMG was higher during cycling in the fatigued group (main effect of group: P = 0.022, ηp2 = 0.07). Although the relative intensity of cycling was higher in the fatigued group at the final common stage of cycling, this was not the case during the initial two stages, despite the greater impairments in neuromuscular function.Our results suggest that the rapid impairments in neuromuscular fatigability in people with CRF were primarily due to disturbances at the level of the muscle rather than the central nervous system. This could affect the ability to tolerate daily physical activities.

Background: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF. Methods: We prospectively enrolled adults with class I–IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used. Results: The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81–11.84], P =0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non–physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non–physically frail men. Conclusions: Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics.

OBJECTIVES: Older breast cancer survivors (BCS) consistently report more functional limitations than women without cancer, but whether or not these differences remain when using objective measures of physical functioning and the correlates of these measures is unknown. METHODS: Cross-sectional study comparing older (≥60 years old) BCS (n=84) to similarly aged women without cancer (n=40). Patient-reported physical function was assessed by the SF-36 physical function (SF-36PF) subscale and the Late Life Function & Disability Instrument (LLFDI). Objective measures included the short Physical Performance Battery (sPPB), usual walk speed (m/s), chair stand time (sec) and, grip strength (kg). Potential predictors included age, comorbidities, symptom severity, fatigue and skeletal muscle index (SMI; kg/m(2)). RESULTS: Patient-reported physical function was significantly lower in BCS than controls using SF-36PF (47.3±0.1 vs. 52.9±4.0, p

Background Falls are a major public health concern in older adults, and the proportion of older adults that has been diagnosed with cancer is growing. Yet, while falls, peripheral neuropathy, and postural instability are more common in aging cancer survivors, it is unclear how these factors interact. Research question Our objective was to examine how components of sway related to self-reported neuropathy and falls. Methods Postural sway during static stance was recorded with an inertial sensor (APDM Opal), placed on the lumbar spine region in 434 older female cancer survivors (mean age 63) and 49 healthy older female control subjects (mean age 63). Measures of sway were resolved into principal components that were compared between women with and women without self-reported falls in the previous 6 months and between those with and without self-reported symptoms of peripheral neuropathy. Results Cancer survivors had worse sway than healthy control subjects in components related to sway magnitude and mediolateral frequency of sway, but no difference in the component related to resultant / AP sway jerk and frequency. Cancer survivors who reported neuropathy were more likely to have higher resultant / AP sway frequencies and jerk than asymptomatic survivors, while survivors who reported a fall were more likely to have lower frequencies of mediolateral sway than non-fallers. Falls were more strongly associated with mediolateral sway in survivors with more severe neuropathy; whereas falls were more strongly associated with resultant / AP sway frequency in survivors with less severe neuropathy Significance Postural stability, falls, and neuropathy have complex interactions that can vary across components of postural sway. While the frequency of mediolateral sway was associated with falls across our entire cohort, neuropathy influenced the associations between specific characteristics of sway and falls, which may have implications for fall prevention interventions.

The authors systematically reviewed and summarized exercise trials in persons with lung cancer on (a) attention to the principles of exercise training (specificity, progression, overload, initial values, reversibility, and diminishing returns); (b) methodological reporting of FITT (frequency, intensity, time, and type) components; and (c) reporting on participant adherence to prescribed FITT. Randomized controlled trials of exercise that reported on ≥1 physical fitness, physical function, or body composition outcome in persons with lung cancer were included. Of 20 trial arms, none incorporated all principles of exercise training. Specificity was included by 95%, progression by 45%, overload by 75%, and initial values by 80%, while one trial arm applied reversibility and diminishing returns. Fourteen interventions reported all FITT components; however, none reported adherence to each component. Including the principles of training and reporting FITT components will contribute to better understanding of the efficacy of exercise for persons with lung cancer and inform evidence-based exercise prescriptions.

Objective Patients with lung cancer experience significant declines in psychosocial and physical function during and after treatment that impact quality of life (QOL) and survival. Yoga is a potential strategy to mitigate functional decline among patients with lung cancer. Methods A single group 12-week pilot trial of low-moderate intensity yoga among patients with stage I-IV lung cancer and their partners (n = 46; 23 patient-partner dyads) during cancer treatment from two hospital systems. Feasibility, acceptability, descriptive statistics, and Cohen d effect sizes were calculated at 6 and 12-weeks for psychosocial and physical outcomes using validated questionnaires and assessments. Results At 6 and 12-weeks, retention was 65% and withdrawals were mainly due to disease progression. Among study completers (n = 26; 13 dyads) adherence was 80%. Comparing baseline to 12-week measurements, fatigue, depression symptoms, and sleep disturbance improved in 54% of participants for all three measures (Cohen's d = 0.40-0.53). QOL improved in 77% of participants (Cohen's d = 0.34). Upper and lower body flexibility, and lower body strength improved in 92%, 85% and 77% of participants, respectively (Cohen's d = 0.39-1.08). Six-minute walk test improved in 62% of participants an average of 32 meters (SD = 11.3; Cohen's d = 0.17). No serious adverse events were reported. Conclusions Among patients with stage I-IV lung cancer including active treatment, a 12-week partner-supported yoga program is feasible, acceptable, and improved psychosocial and physical function. Low-intensity yoga may be a complimentary approach to reduce the effects of cancer treatment, however, more research is needed to determine the efficacy of partner-supported yoga to mitigate functional decline.

Cancer-related fatigue (CRF) is a common and distressing symptom of cancer that may persist for years following treatment completion. However, little is known about the pathophysiology of CRF. Using a comprehensive group of gold-standard physiological and psychosocial assessments, this study aimed to identify correlates of CRF in a heterogenous group of cancer survivors.Using a cross-sectional design to determine the physiological and psychosocial correlates of CRF, ninety-three cancer survivors (51 fatigued, 42 non-fatigued) completed assessments of performance fatigability (i.e. the decline in muscle strength during cycling), cardiopulmonary exercise testing, venous blood samples for whole blood cell count and inflammatory markers and body composition. Participants also completed questionnaires measuring demographic, treatment-related, and psychosocial variables.Performance fatigability, time-to-task-failure, peak oxygen uptake (V̇OThe present study utilised a comprehensive group of gold-standard physiological and psychosocial assessments and the results give potential insight into the mechanisms underpinning the association between physical inactivity, physical deconditioning and CRF.Given the associations between CRF and both physiological and psychosocial measures, this study identifies targets that can be measured by rehabilitation professionals and used to guide tailored interventions to reduce fatigue.

Physical activity can help mitigate the long-term symptoms and side effects of cancer and its treatment, but most cancer survivors are not active enough to achieve these benefits. An evidence-based strategy to promote physical activity among adults is a community group-based walking program. However, many evidence-based programs do not achieve intended population health outcomes because of the challenges of real-world implementation. We used the Interactive Systems Framework for Dissemination and Implementation to conceptualize implementation of a capacity-building intervention to support delivery of a community group-based walking program. We adapted an evidence-based guide for community group-based walking programs for cancer survivors and their support network. We provided a capacity-building intervention (technical assistance and small-grant funding) and evaluated this implementation intervention. We assessed effectiveness of the intervention by measuring adoption, acceptability, appropriateness, feasibility, fidelity, implementation costs, and penetration through monthly progress reports, site visit observations, interviews, and a final report. Eight organizations received a small grant and technical assistance and implemented Step It Up! Survivors (SIUS). SIUS helped cancer survivors increase their physical activity, establish social connections, and be part of a supportive environment. Despite receiving monthly technical assistance, some grantees experienced challenges in recruiting participants, developing community partnerships, and adhering to the prescribed implementation plan. Implementation facilitators included community partners and specific components (eg, incentives for participants, webinars). Organizations needed different amounts and types of assistance with adaptation and implementation. Overall fidelity to SIUS ranged from 64% to 88%. Some integrated SIUS within existing organizational programming for sustainability. The provision of funding and technical assistance was a successful implementation intervention. Our results suggest a need to better tailor technical assistance while organizations are in the process of adapting, implementing, and sustaining an evidence-based program in their local communities.

Introduction: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this gender difference are poorly understood. The purpose of this study was to characterize gender differences in physical frailty phenotypes in HF with a focus on physiological, clinical, and symptom characteristics. Methods: We prospectively enrolled adults with Class I-IV HF. Physical frailty was measured with the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity; those who met 0-2 criteria were not physically frail, and those who met 3-5 criteria were physically frail. Body composition was measured using dual energy x-ray absorptiometry. Clinical data were extracted from the medical record. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Simple comparative statistics and multivariate logistic regression were used to identify gender differences in physical frailty. Results: The average age of the sample (n = 115) was 63.6±15.7 years, 49% were women, and 73% had non-ischemic etiology. About 43% of the sample was physically frail. Women were 4.5 times as likely to be physically frail compared with men, adjusting for covariates (OR = 4.52, 95%CI [1.69, 12.08], p = 0.003). Both physically frail men and women had significantly more type 2 diabetes and worse dyspnea symptoms compared with non-physically frail men and women, respectively. Physically frail men had significantly lower appendicular muscle mass, higher percent body fat, trunk fat, and appendicular fat, and lower hemoglobin compared with non-physically frail men (all p < 0.05). Physically frail women had significantly higher comorbidity burden and worse sleep-related impairment, pain interference, and depressive symptoms compared with non-physically frail women (all p < 0.05). Conclusions: Women are significantly more likely to be physically frail in HF. Physical frailty in men with HF may be primarily characterized by comorbidities and sarcopenic obesity; whereas physical frailty in women with HF may be predominantly characterized by comorbidities and worse symptoms.

Cancer-related fatigue (CRF) is a common and distressing symptom of cancer and its treatments that may persist for years following treatment completion in approximately one-third of cancer survivors. Despite its high prevalence, little is known about the pathophysiology of CRF. Using a comprehensive group of physiological and psychosocial variables, the aim of the present study was to identify correlates of CRF in a heterogenous group of cancer survivors. Ninety-three cancer survivors (51 fatigued, 42 non-fatigued, with grouping based on validated cut-off scores derived from The Functional Assessment of Chronic Illness Therapy - Fatigue scale) completed assessments of performance fatigability (i.e. the change in maximal force-generating capacity, contractile function and capacity of the central nervous system to activate muscles caused by cycling exercise), cardiopulmonary exercise testing, venous blood samples for whole blood cell count and inflammatory markers and body composition. Participants also completed questionnaires measuring demographic, treatment-related, and psychosocial variables. The results showed that performance fatigability (decline in muscle strength during exercise), time-to-task-failure, peak oxygen uptake , tumor necrosis factor-α (TNF-α), body fat percentage and lean mass index were associated with CRF severity. Performance fatigability, , TNF-α and age explained 35% of the variance in CRF severity. Furthermore, those with clinically-relevant CRF reported more pain, more depressive symptoms, less social support, and were less physically active than non-fatigued cancer survivors. Given the association between CRF and numerous physical activity related measures, including performance fatigability, cardiorespiratory fitness, and anthropometric measures, the present study identifies potential biomarkers by which the mechanisms underpinning the effect of physical activity interventions on CRF can be investigated.

Lung cancer survivors are at risk of accelerated declines in physical functioning attributed to cancer treatment. However, it is unknown whether patients experience the same rate of functional decline and how symptoms may contribute to different trajectories.The aims of this study were to identify interindividual differences in the pattern and rate of change in self-reported functioning in lung cancer survivors and examine whether and how symptoms are related to physical functioning over time.This was a secondary data analysis in 72 lung cancer survivors. Multilevel modeling was used to estimate trajectories of self-reported physical functioning over 1 year and assess the relation between functioning, fatigue, depressive symptoms, and pain severity across time.Within the sample, average physical functioning did not significantly decrease (coefficient, -0.46; 95% confidence interval [CI] = -2.85 to 0.94) over time. However, among individual lung cancer survivors, baseline physical functioning varied significantly (SD, 20.76; 95% CI, 16.84-25.59) and changed at significantly different rates over 1 year (SD, 3.50; 95% CI, 2.13-5.68). Fatigue, assessed over 1 year, was the only significant symptom predictor of physical functioning changes over time (coefficient = 1.03; 95% CI, 0.79-1.27).In this sample of lung cancer survivors, not all survivors experienced the same rate of self-reported functional decline and those with lower levels of fatigue reported better physical functioning.Nurses should recognize that some lung cancer survivors may have faster rates of functional declines than others, which may be related to fatigue severity. Early identification and management of fatigue could help avoid or delay future disability.

When assessing neuromuscular fatigue (NMF) from dynamic exercise using large muscle mass (e.g., cycling), most studies have delayed measurement for 1 to 3 min after task failure. This study aimed to determine the reliability of an innovative cycling ergometer permitting the start of fatigue measurement within 1 s after cycling.Twelve subjects participated in two experimental sessions. Knee-extensor NMF was assessed by electrical nerve and transcranial magnetic stimulation with both a traditional chair setup (PRE- and POST-Chair, 2 min postexercise) and the new cycling ergometer (PRE, every 3 min during incremental exercise and POST-Bike, at task failure).The reduction in maximal voluntary contraction force POST-Bike (63% ± 12% PRE; P0.001) was not different between sessions and there was excellent reliability at PRE-Bike (intraclass correlation coefficient [ICC], 0.97; coefficients of variation [CV], 3.2%) and POST-Bike. Twitch (Tw) and high-frequency paired-pulse (Db100) forces decreased to 53% ± 14% and 62% ± 9% PRE, respectively (P0.001). Both were reliable at PRE-Bike (Tw: ICC, 0.97; CV, 5.2%; Db100: ICC, 0.90; CV, 7.3%) and POST-Bike (Tw: ICC, 0.88; CV, 11.9; Db100: ICC, 0.62; CV, 9.0%). Voluntary activation did not change during the cycling protocol (P0.05). Vastus lateralis and rectus femoris M-wave and motor-evoked potential areas showed fair to excellent reliability (ICC, 0.45-0.88). The reduction in maximal voluntary contraction and Db100 was greater on the cycling ergometer than the isometric chair.The innovative cycling ergometer is a reliable tool to assess NMF during and immediately postexercise. This will allow fatigue etiology during dynamic exercise with large muscle mass to be revisited in various populations and environmental conditions.

The immediate-posttreatment period covers the time period from the completion of primary adjuvant treatment to the first year of recovery. This chapter will provide an overview of the incorporation of exercise into the care and management of cancer survivors during the immediate posttreatment period when it could lessen or ameliorate many of the side effects and symptoms that linger after treatment ends. To effectively and safely program exercise in the immediate posttreatment period, the fitness professional must know the treatment(s) he/she has received and what limitations this may present for their exercise program. Ideally an initial fitness evaluation would be performed to tailor an exercise program to the survivor’s initial exercise capacity. In general, a moderate-intensity aerobic, resistance, or combined aerobic and resistance exercise training program, performed at least three times per week for at least 30 minutes per session, can improve many lingering symptoms, restore physical functioning, and return quality of life during the immediate posttreatment period.

e24068 Background: Patients with lung cancer suffer from depression symptoms, reduced quality of life (QOL), and declines in physical function during and after cancer treatment. Since yoga is a low energy demand form of exercise, we hypothesized that yoga is a feasible, safe, and efficacious strategy to mitigate these problems in lung cancer patients. Purpose: 1) Determine the feasibility, acceptability, and safety of a yoga program in patients (pts) with lung cancer during or soon after cancer treatment; 2) Determine the preliminary efficacy of yoga to improve depressive symptoms, quality of life, and physical function among pts with lung cancer. Methods: This study was a single group 12-week (wk) pilot trial of low-moderate intensity yoga among pts with stages I-IV lung cancer (n = 20) during (n = 14) or after (n = 6) cancer treatment. Assessments conducted at baseline, 6- and 12-wks included the Patient Health Questionnaire-8, Functional Assessment of Chronic Illness Therapy-Lung (FACT-L), 6-minute walk distance (6MWD), hand grip strength, chair stand time, and flexibility (back scratch and sit-reach) tests. Results: At baseline, 20 pts, including those with metastatic disease (n = 8), enrolled and 7 pts (35%) withdrew by 6-wks due to poor/worsening health. No further withdrawals occurred at 12-wks. Among pts (n = 13) who completed the study, adherence to the intervention was 75% and 78% at 6 and 12-wks, respectively. No moderate or serious adverse events were reported. Over 12 wks, depressive symptoms (average = -1.8 ±1.23, 43.9% change) decreased, improvements in QOL improved (average = +4 ±2.9, 6.5% change),6MWD (average = +22.6m ±15.9, 6.5% change), hand grip strength (average = +1.6kg ±1.2, 5.7% change), chair stand time (average = -3sec ±2.1, 5.8% change), and upper (average = -10.8cm ±7.5, 49.4% change) and lower (average = -11.9cm ±8.4, 74.6% change) body flexibility occurred. Conclusions: In this sample of lung cancer pts, a 12-week yoga program was modestly feasible, was shown to be safe and potentially beneficial for psychosocial and physical function. Though retention was lower than expected due to early pt withdrawal for poor health, adherence to supervised practice among those pts who were able to complete the intervention exceeded the target goal. Among pts with stage I-IV lung cancer yoga may be a useful strategy to improve psychosocial outcomes and physical functioning, though alternate delivery approaches for pts with advanced disease deserves further exploration. Clinical trial information: NCT03649737 .

Background The purpose of this review is to update previously published reviews on exercise programming in exercise trials in prostate cancer survivors. We evaluated: 1) the application of the principles of exercise training in prescribed programs; 2) the reporting of the components of the exercise prescription; and 3) the reporting of adherence of participants to the prescribed programs. Methods Building upon a previous review, a systematic review was conducted searching OVID Medline, Embase, CINAHL, and SPORTDiscus databases from 2012-2017. Randomized controlled trials of at least four weeks of aerobic and/or resistance exercise in men diagnosed with prostate cancer that reported physical fitness outcomes, including body composition were eligible for inclusion. Results Specificity was appropriately applied by 93%, progression by 55%, overload by 48%, initial values by 55%, and diminishing returns by 28% of eligible studies. No study adequately applied the principle of reversibility. Most (79%) studies reported all components of the exercise prescription in the study methods, but no study reported all components of adherence to the prescribed intervention in the study results. Conclusions Application of standard exercise training principles is inadequate in exercise trials in men with prostate cancer and could possibly lead to an inadequate exercise stimulus. While many studies report the basic components of the exercise prescription in their study methods, full reporting of actual exercise completed is needed to advance our understanding of the optimal exercise dose for men with prostate cancer and promote translation of controlled trials to practice.

Fatigue is a troublesome symptom for breast cancer patients, which might be mitigated with exercise. Cancer patients often prefer their oncologist recommend an exercise program, yet a recommendation alone may not be enough to change behavior. Our study determined whether adding an exercise DVD to an oncologist’s recommendation to exercise led to better outcomes than a recommendation alone. Ninety breast cancer patients, at varying phases of treatment and stages of disease, were randomized to receive the following: an oncologist verbal recommendation to exercise (REC; n = 43) or REC plus a cancer-specific yoga DVD (REC + DVD; n = 47). Fatigue, vigor, and depression subscales of the Profile of Mood States, and physical activity levels (MET-min/week), exercise readiness, and self-efficacy were assessed at baseline, 4, and 8 weeks. Analyses controlled for age, time since diagnosis, and metastatic disease. Over 8 weeks, women in REC + DVD used the DVD an average of twice per week. The REC + DVD group had greater reductions in fatigue (− 1.9 ± 5.0 vs. − 1.0 ± 3.5, p = 0.02), maintained exercise readiness (− 0.1 ± 1.1 vs. − 0.3 ± 1.3; p = 0.03), and reported less of a decrease in physical activity (− 420 ± 3075 vs. − 427 ± 5060 MET-min/week, p = 0.06) compared to REC only. A low-cost, easily distributed, and scalable yoga-based DVD could be a simple booster to an oncologist’s advice that motivates breast cancer patients, even those with advanced disease and/or in treatment, to engage in self-care, e.g., exercise, to manage fatigue. ClinicalTrials.gov Identifier: NCT03120819

Cancer-related fatigue (CRF) is a commonly reported and debilitating side effect of cancer and/or cancer treatment. Sleep disorders are also highly reported in the cancer population; however it is unknown if sleep is associated with fatigue. In the general population, exercise has been shown to improve sleep, however in the cancer population this idea is under investigation. The primary purposes of this review were to: (i) review the prevalence and causes of sleep disorders in cancer patients and survivors, (ii) examine the relationship between sleep and CRF and (iii) review the impact of exercise interventions on sleep in cancer patients and survivors. A scoping review of the literature was conducted regarding exercise interventions in cancer patients and survivors with sleep as at least one outcome measure. A search of the literature revealed limited studies (n=21) assessing the effect of exercise on sleep disorders in the cancer population. Methodological issues are evident because assessing sleep is often not the main outcome of interest. The reviewed studies revealed that exercise positively impacts sleep quality and quantity. There seems to be possible relationship between sleep disorders, exercise and CRF. Further investigation of this relationship is necessary, specifically using objective measurement tools, in large, controlled studies, focusing on sleep as the primary outcome.

With a median age at lung cancer diagnosis of 70 years, patients may be at risk of poor physical functioning that is accelerated by cancer treatment. However, it is unknown whether all patients experience the same rate of functional decline during treatment or if some patients have more or less severe trajectories. The purpose of this study was to identify trajectories of self-reported physical function in lung cancer survivors and examine whether mental health and fatigue influenced the rate of change. In a sample of 72 newly diagnosed lung cancer survivors (mean age = 71 + 10 years) we used multilevel modeling to assess trajectories of self-report physical functioning and the influence of mental health and fatigue assessed five times over one year. Self-report physical function did not change significantly over the year (□=-0.46, p=0.53); however, there was significant variability within the sample around the average rate of change (p