Resistance Training as Therapeutic Management in Women with PCOS: What is the Evidence?

International Journal of Exercise Science 14(3): 840-854, 2021. Polycystic ovary syndrome (PCOS), the most common chronic endocrinopathy and the leading cause of infertility in women, has significant clinical consequences, including cardiovascular, endocrinological, oncological, and psychological co-morbidities. Endocrine Society Clinical Practice Guidelines on the Diagnosis and Treatment of PCOS recommend exercise and physical activity as first-line treatment to combat chronic disease risk. However, details about what type of exercise are not provided. Given the known beneficial effects of resistance training on the management of other chronic diseases, the purpose of this scoping review was to evaluate the scientific evidence about the physical and psychosocial effects of resistance training among women with PCOS. Studies were identified through a systematic search of PubMed, SPORTDiscus, and CINAHL databases. Peer-reviewed research studies published between January 2011 and January 2021 that evaluated a resistance training intervention for premenopausal women with PCOS were included. Studies that offered multi-component programs were excluded. Nine articles met the inclusion criteria of which seven were sub-studies of one larger clinical trial. One article reported findings from a small randomized controlled trial and the last article reported feasibility study findings. Each intervention yielded positive results across a wide range of outcome variables; however, the studies had small sample sizes and assessed different outcome variables. Evidence regarding the effects of resistance training on health outcomes for women with PCOS is positive but preliminary. Adequately powered clinical trials are required to confirm health benefits, answer research questions as to therapeutic dose, and discover behavioral strategies to promote resistance training for therapeutic management

Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors.

BACKGROUND: Physical activity can improve health and wellbeing after cancer and may reduce cancer recurrence and mortality. To achieve such long-term benefits cancer survivors must be habitually active. This review evaluates the effectiveness of interventions in supporting maintenance of physical activity behaviour change among adults diagnosed with cancer and explores which intervention components and contextual features are associated with effectiveness. METHODS: Relevant randomised controlled trials (RCTs) were identified by a search of Ovid Medline, Ovid Embase and PsychINFO. Trials including adults diagnosed with cancer, assessed an intervention targeting physical activity and reported physical activity behaviour at baseline and ≥ 3 months post-intervention were included. The behaviour change technique (BCT) taxonomy was used to identify intervention components and the Template for Intervention Description and Replication to capture contextual features. Random effect meta-analysis explored between and within group differences in physical activity behaviour. Standardised mean differences (SMD) describe effect size. RESULTS: Twenty seven RCTs were included, 19 were pooled in meta-analyses. Interventions were effective at changing long-term behaviour; SMD in moderate to vigorous physical activity (MVPA) between groups 0.25; 95% CI = 0.16-0.35. Within-group pre-post intervention analysis yielded a mean increase of 27.48 (95% CI = 11.48-43.49) mins/wk. of MVPA in control groups and 65.30 (95% CI = 45.59-85.01) mins/wk. of MVPA in intervention groups. Ineffective interventions tended to include older populations with existing physical limitations, had fewer contacts with participants, were less likely to include a supervised element or the BCTs of 'action planning', 'graded tasks' and 'social support (unspecified)'. Included studies were biased towards inclusion of younger, female, well-educated and white populations who were already engaging in some physical activity. CONCLUSIONS: Existing interventions are effective in achieving modest increases in physical activity at least 3 months post-intervention completion. Small improvements were also evident in control groups suggesting low-intensity interventions may be sufficient in promoting small changes in behaviour that last beyond intervention completion. However, study samples are not representative of typical cancer populations. Interventions should consider a stepped-care approach, providing more intensive support for older people with physical limitations and others less likely to engage in these interventions

Agenda for Translating Physical Activity, Nutrition, and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice.

Evidence supporting physical activity, diet, and weight management for cancer survivors has grown, leading to the development of guidelines and interventions. The next step is to identify necessary practice and policy changes and to develop a research agenda to inform how interventions can be delivered to survivors most effectively and efficiently in health care settings and by community-based organizations. Here, an agenda is proposed for research, practice, and policy that incorporates recommendations for a range of programming options, a patient-centered, tailored screening and referral approach, and training needs for survivorship care providers and providers of exercise, nutrition, and weight management services. Research needs to focus on sustainability, dissemination, and implementation. Needed policy changes are presented, as well as opportunities to leverage current health care policies

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

A compelling evidence base supports exercise as a safe, effective intervention to improve many cancer related health outcomes among cancer patients and survivors. Oncology clinicians play a key role in encouraging their patients to move more. Therefore, the oncology clinical care team is urged to do the following at regular intervals: ASSESS exercise levels, ADVISE patients to become more active, and REFER patients to specific exercise programming. It is recommended that a process be developed to incorporate these steps into the standard care of oncology patients. A simple, straightforward approach is recommended to discern whether patients should be referred to outpatient rehabilitation versus community based exercise programming. The exponential growth of exercise oncology research has driven the need for revised cancer exercise guidelines and a roadmap for oncology clinicians to follow to improve physical and psychological outcomes from cancer diagnosis and for the balance of life. This paper serves as a call to action and details pathways for exercise programming (clinical, community and self-directed) tailored to the different levels of support and intervention needed by a given cancer patient or survivor. Preserving activity and functional ability is integral to cancer care and oncology clinicians are key to providing these referrals

Mediators of physical activity outcomes in a peer-led intervention for breast cancer survivors

OBJECTIVES: Physical activity (PA) adoption can reduce treatment-related sequelae of breast cancer. Peer-led PA interventions are a promising and relatively inexpensive approach to scaling up interventions. The current study seeks to identify mediators of PA change amongst cancer survivors enrolled in a peer-led behavior change intervention. The study team partnered with the American Cancer Society\u27s Reach to Recovery program (RTR) whose volunteers\u27 provided information and support to breast cancer survivors. METHODS: Participants were 76 survivors (mean age 55.6 years, 1.1 years since diagnosis) who were randomized to PA Plus RTR (12-week PA telephone counseling delivered by RTR volunteers) or contact control. Data was collected on PA (self-reported and objectively measured) and potential mediators (self-efficacy, exercise decisional balance [ratio of the pros/advantages to the cons/disadvantages] and social support) at baseline and 12 weeks. Using a multiple mediation approach with bootstrapped standard errors, we examined mediators of the intervention effect on PA outcomes. RESULTS: Compared to control, PA Plus RTR participants had higher mean self-efficacy, lower decisional balance cons and social support at 12 weeks controlling for baseline. Higher mean self-efficacy was associated with greater minutes of self-reported PA, whereas higher decisional balance pros was associated with higher objectively measured PA at 12 weeks. There were significant indirect effects of self-efficacy on self-reported PA and decisional balance on objectively measured PA. CONCLUSIONS: PA Plus RTR increased self-reported and objectively measured PA by changing theoretical constructs hypothesized to be associated with behavior change. Peers delivering a PA intervention should focus on increasing survivors\u27 self-efficacy for exercise especially in challenging circumstances such as being on vacation, and also help to overcome disadvantages of exercise such as taking time away from family

Longitudinal shifts in employees\u27 stages and processes of exercise behavior change

Purpose. This study examines the usefulness of using the stages and processes of change model to explore exercise adoption and maintenance over time. Design. Data for this study were collected as part of the baseline and follow-up survey of participants in a worksite health promotion project. Subjects. Three hundred fourteen employees completed exercise questionnaires. The average age was 41 years, mean body mass index was 26, average years of education were 13, and 66% were women. Setting. The study was conducted in two worksites, a retail outlet and a manufacturing company. Measures. Previously validated questionnaires to determine stages and processes of exercise adoption were administered at baseline and 6-month follow-up, along with questions about demographic variables. Results. Four patterns of stage change emerged: subjects who became more active (adopters, 26%), those who became less active (relapsers, 15%), and those who did not change over time (stable sedentary, 32%; stable active, 27%). Adopters displayed increases in use of the processes of change, whereas relapses displayed decreases in process use. Stable profiles were associated with no change in process use. Conclusions. These findings have important implications for research on exercise adoption and maintenance. Interventions tailored specifically to subjects\u27 stage of readiness to be active and using specific processes to help in the change process are warranted at this time

Home-Based Physical Activity Intervention for Breast Cancer Patients

The efficacy of a home-based physical activity (PA) intervention for early-stage breast cancer patients was evaluated in a randomized controlled trial

Physical Activity Among Breast Cancer Survivors: Regular Exercisers vs Participants in a Physical Activity Intervention

Background: Secondary prevention is of great importance in the cancer survivor population, given the substantial medical risks survivors face. Consequently, researchers have begun developing interventions that target behavioral risk factors, such as sedentary lifestyle, among survivors. This study represents a novel approach for evaluating the efficacy of a physical activity intervention for breast cancer survivors