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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.

Major surgery involving resection and free flap reconstruction is a mainstay of head and neck cancer (HNC) treatment, but postoperative morbidity and complications are common. One of the foundations for better surgical outcomes is early mobilization, which is included in enhanced recovery guidelines for all surgical specialties. However, a major unsolved challenge with early mobilization after surgery is quantifying how much a patient moves. To date, mobilization after major HNC surgery has been reported as the time to mobilization, i.e. the interval between the date of surgery and the date of the initial meaningful mobilization. Other data on postoperative mobilization in these patients are limited. Although clinicians can document mobilization via multidisciplinary progress notes, an estimate of mobilization for each postoperative day would be subjective and based on observations from several clinicians and/or the recall of the patient. Advancing research on postoperative mobilization requires the ability to objectively measure patient activity, particularly ambulatory activity, without placing a further burden on the inpatient team. Wearable activity trackers may provide a solution. Data from other surgical specialties indicate that such objective monitoring of patient ambulation in real-time to support interventions to increase mobilization may provide opportunities to improve clinical care. Objective measurement of step counts after HNC surgery would lead to an understanding of the dose-response relationship (the required quantity and frequency of mobilization that is safe and beneficial). In conclusion, the integration of wearable activity trackers in the care plan for patients undergoing HNC surgery will facilitate the measurement and improvement of postoperative mobilization to reduce complications, improve surgical outcomes and enhance patient recovery.

Across the world, young people do not have the same opportunities to develop their potential and become well-rounded adults. The world's population is approximately 1.8 billion young people aged 10 to 24, and about 90% of them live in developing countries within extreme development context. Optimal development of those generations depends on the resources for support, education and health and the means implemented to sustain this development. However, the imbalance of these resources is clearly observable throughout the world. Sport has been use in many developing countries to contribute to health and education for youth following Sustainable Development Goals (SDG) of the United Nations. More especially, sport is use as a leisure to generate resilience, the capacity of a person or group to develop well, to continue to project itself into the future despite destabilizing events, difficult living conditions, and severe trauma. Several authors emphasize the role of recreational activities such as physical activity and sport in the resilience process or for academic perseverance. The chapter explores the perspective and the potential of using sport for the sustainable development for health and education of youth as targeted in the SDG. More especially, we aim to understand how sport can contribute to health and education of youth through cases studies from various developing countries.

Background: Physical activity is recommended for the management of cancer-related fatigue (CRF), yet the evidence is primarily based on interventions delivered during cancer treatment, with no eligibility criterion for fatigue. There is a need to examine the quantity and quality of the existing literature on physical activity for clinically relevant CRF that continues after cancer treatment (post-cancer fatigue). The objective of this systematic review was to summarize and evaluate the effect of physical activity on post-cancer fatigue in adults, using randomized trials where fatigue was an eligibility criterion. Methods: Studies were included if they: included adult participants with a cancer diagnosis who had completed initial cancer treatments (e.g., surgery, chemotherapy and/or radiation therapy); explicitly stated that fatigue was a participant eligibility/inclusion criterion, regardless of how this was described or assessed; involved a physical activity intervention of any type, intensity, frequency, or duration; measured fatigue as a primary or secondary outcome. Electronic databases (Ovid MEDLINE(R), Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and CINAHL) were last searched on October 13, 2020. The risk of bias was assessed using the Cochrane Collaboration’s tool for randomized trials. Study characteristics were synthesized and a random-effects meta-analysis for the severity of fatigue across different scales at the end of the intervention was conducted. Results: A total of 1035 participants were randomized across 19 studies. We estimate that less than 10% of the randomized trials of physical activity for CRF include people with post-cancer fatigue. The effect of physical activity on post-cancer fatigue was modest and variable (Hedge’s g -0.40; p = 0.010; 95% prediction intervals -1.41 to 0.62). Discussion: Most studies had an unknown or high risk of bias, there was substantial heterogeneity between trials and evidence for the effect of physical activity on post-cancer fatigue was graded as low quality. Including people with clinically relevant fatigue is a priority for future research in cancer survivorship. Additional transparently reported randomized clinical trials are needed to better understand the benefits of physical activity for post-cancer fatigue. Funding: N/A. Registration: PROSPERO (CRD42019136492).

Tendinopathy is a chronic degenerative tendon disorder which is characterised by pain, swelling and impaired physical function and performance, presenting in both athletes and the general population. Extracorporeal shockwave therapy (ESWT) is an increasingly common treatment for tendinopathy, which can initiate tendon healing and regeneration. The review presents current understanding of mechanisms of action of ESWT and provides a brief overview of its history and development. The central purpose of the review is to synthesise research findings investigating the effectiveness of ESWT for seven common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, gluteal, hamstring and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT is effective and can be recommended in treatment for the seven tendinopathies. However, the evidence is stronger for certain tendinopathies compared to others and uncertainties remain regarding the optimal ESWT treatment parameters. The consensus from recent literature is that although ESWT can be effective in isolation it should be combined with other treatments in tendinopathy, which needs to be addressed in future research.

Purpose: The measurement of cardiorespiratory fitness (maximal oxygen uptake) using a cardiopulmonary exercise test (CPET) has several applications in oncology. A recent analysis reported that in people with cancer, the vast majority of CPETs are discontinued before the attainment of a plateau in oxygen uptake (V̇O2) or secondary criteria. The objective of this study was to describe the attainment of a V̇O2 plateau and secondary criteria from CPET in a sample of people with cancer-related fatigue.Methods: This was a retrospective and exploratory analysis of data from 51 participants who completed a CPET as part of baseline testing for a clinical trial. The CPETs were conducted in a single laboratory by the same lead experimenter, using a cycle ergometer, standard ramp protocol and breath-by-breath gas analysis. The incidence of a V̇O2 plateau was compared for ∆V̇O2 of ≤150 ml·min-1 and a more conservative ∆V̇O2 of ≤50 ml·min-1. Independent groups dichotomized using the latter criterion were compared, including for the attainment of common secondary criteria for heart rate, rating of perceived exertion and the respiratory exchange ratio.Results: A plateau in V̇O2 was observed in 100% of tests using a criterion of ∆V̇O2 ≤150 mL·min-1, and this was reduced to 57% using a more conservative criterion of ∆V̇O2 ≤50 mL·min-1. There were no differences in the attainment of secondary criteria (or any other variable) between groups dichotomized using observation of a V̇O2 plateau.Conclusion: The validity of classic plateau criteria (∆V̇O2 ≤150 mL·min-1) to verify V̇O2max in people diagnosed with cancer is questionable (100% attainment in the present study, 57% attainment with a more conservative definition of a V̇O2 plateau). Comparing our data with previous reports, we suggest that exercising maximally to elicit V̇O2max may be more tolerable in this population using a standard ramp protocol, recumbent cycle ergometer and facemask.

There is an opportunity for sports medicine to progress research ideation using synthetic datasets, maintaining research momentum when data collection is not feasible. These processes maximise the potential for application of open science practice, while retaining the commitment to privacy and ethics. Synthetic data could lead to more sustainable use of data, particularly in the form of hypothesis generation through exploratory research applied to synthetic datasets.

Head and neck cancer (HNC) surgical patients experience high symptom burden. Exercise prehabilitation has the potential to improve patient outcomes, but the perspectives of patients and healthcare providers (HCPs) must be considered to facilitate implementation. The purpose of this study was to obtain qualitative feedback from HNC surgical patients and HCPs regarding: (1) adding patient assessments across the HNC surgical timeline, and (2) the logistics and potential benefits of a future exercise prehabilitation intervention. Semi-structured interviews took place with patients and HCPs. Interview questions included satisfaction with study recruitment, measurement completion, impact on clinical workflow (HCPs), and perceptions of a future prehabilitation program. Transcripts were analyzed using a constructivist philosophy and interpretive description methodology. Ten patients and ten HCPs participated in this study. Four themes were identified: (1) the value of exercise and its importance in clinical care, (2) acceptability and necessity of assessments, (3) factors to support implementation, and (4) the components of an ideal prehabilitation program. Overall, these findings highlight the importance and value of exercise across the HNC surgical timeline from both the patient and HCPs’ perspective. These findings will inform the future implementation of a multiphasic exercise prehabilitation trial in HNC surgical patients.

Background: Education and health professionals from a range of disciplines seek alternatives to promote well-being through nature. Shinrin Yoku, originating from Japan, means “forest baths” or “taking in the forest atmosphere” and provides the opportunity to reconnect with nature and its benefits, with great potential in Canada. This brief review aims to highlight the potential for the use of Shinrin Yoku in the Canadian context of education and healthcare. Methods: We conducted a narrative literature review including a search of four French and English databases (Google Scholar, Pubmed, Scopus, Cairn) from 1985 to 2017. Then, we classified 26 articles according to three main categories that emerged from the first reading of the abstracts. Results: Benefits of Shinrin Yoku have been classified into physiological, psychological, and environmental categories. We synthesize key benefits of Shinrin Yoku and highlight opportunities to use this alternative intervention by educators and health professionals in Canada. Conclusion: A growing body of research suggests that Shinrin Yoku can have benefits on many aspects of an individual's health and well-being. Given the resources already available in Canada, Shinrin Yoku could be integrated into existing programs and interventions, and could provide another option to educators and healthcare professionals seeking low-risk educational and intervention alternatives for their students and patients.

Background: While clinical trials have demonstrated the benefits of structured exercise for prostate cancer survivors, few attempts have been made to investigate and implement sustainable community-based exercise programs supporting adoption of long-term physical activity behavior. Against this background, the aims of this study was to explore the perspectives of experts and stakeholders on the development of a training course and intervention manual used to support the delivery of community-based soccer training in men with prostate cancer (the FC Prostate Community [FCPC] trial). Methods: A two-step qualitative design including triangulation of methods, data sources, and researchers. Step 1 comprised key informant interviews with clinical and scientific experts (n = 4). Step 2 included stakeholder focus group interviews with nurses (n = 5), non-professional soccer coaches and club representatives (n = 5), and prostate cancer survivors (n = 7). Results: Four themes emerged from the analysis of the key informant interviews: The Coach’s Qualifications, Structure of the Training, Prevention of Injuries, and A Non-Patient Environment, which informed development of the training course and intervention manual. The stakeholders added the importance of clarifying the Responsibility of the Coach, the value of Positive Competition, and Social Inclusion of the prostate cancer survivors in the club. Based on these results, we present the final templates for the training course and intervention manual. Conclusions: No general set of rules or safety measures to promote or optimize the delivery of community-based exercise in cancer survivors is recommended. However, the general principles related to the necessary clarification of the coach’s responsibility in relation to the prevention and management of injuries and participant adherence through a non-patient environment may be transferable to the training and education of other groups of lay persons in charge of delivering exercise interventions to other clinical subpopulations in a non-hospital setting.

Review Objective: To synthesize the best available evidence on the effectiveness of interventions that have used a combination of extracorporeal shockwave therapy and any type of exercise to treat plantar heel pain compared to any other treatment intervention. Introduction: Recent evidence suggests combining shockwave therapy and exercise may be more effective than other treatments for plantar heel pain. However, no systematic reviews have been conducted on the topic and optimal treatment protocols and clinical recommendations are lacking.Inclusion criteria: Randomised controlled trials assessing the effectiveness of combined shockwave therapy and exercise for plantar heel pain in adults will be included. Methods: The authors will search for a wide range of sources to find both published and unpublished studies via EBSCOhost, including, but not limited to, MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and Allied and Complementary Medicine Database (AMED). Studies published in a language other than English will only be considered if a translation is available. The JBI systematic review methodology will be followed when conducting the review. Data synthesis will be conducted using meta-analysis or narrative synthesis, where appropriate. Systematic review registration number: CRD42020213286