Feasibility and Preliminary Effectiveness of a Tele-Prehabilitation Program in Esophagogastric Cancer Patients

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What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? : A systematic review

EP was supported by a grant from the Fonds National de la Recherche Scientifique (FRIA - FNRS). GR was supported by a grant from the Institut de Recherche Expérimentale et Clinique (Université catholique de Louvain, Brussels, Belgium). The funders had no role in the study design, collection, analysis and interpretation of data and in writing the manuscript.Peer reviewedPublisher PD

High-intensity aerobic interval training and resistance training are feasible in rectal cancer patients undergoing chemoradiotherapy: a feasibility randomized controlled study

Background: There has been growing evidence of the benefits of high-intensity aerobic interval training (HIIT) and resistance training (RES) for populations with cancer. However, these two modalities have not yet been performed alone in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT). Therefore, this study aimed to determine the feasibility of HIIT and RES in rectal cancer patients undergoing NACRT. Materials and methods: Rectal cancer patients set to undergo NACRT were randomly assigned to HIIT intervention, RES intervention, or the usual care. Feasibility of HIIT and RES was assessed by measuring recruitment rate, adherence (retention rate, attendance rate, and exercise sessions duration and intensity), and adverse events. Endpoints (changes in fatigue, health-related quality of life, depression, daytime sleepiness, insomnia, sleep quality, functional exercise capacity, and executive function) were assessed at baseline and at week 5. Results: Among the 20 eligible patients, 18 subjects were enrolled and completed the study, yielding a 90% recruitment rate and 100% retention rate. Attendance at exercise sessions was excellent, with 92% in HIIT and 88% in RES. No exercise-related adverse events occurred. Conclusion: This study demonstrated that HIIT and RES are feasible in rectal cancer patients undergoing NACRT. Trial registration: www.clinicaltrials.gov, NCT03252821 (date of registration: March 30, 2017)

ICF based assessment of spasticity treatment in stroke patients

The overal aim of this thesis is to assess the efficacy of a spasticity treatment in stroke patients within the ICF framework. Particularly, the effects of BoNT A injections in spastic lower and upper limb muscles will be investigated on impairment, activity, and social participation. The main question is to know if these injections are really effective in improving function in these patients. Indeed, no study to date has showed a benefit of spasticity treatment in terms of functional improvement in activity or participation. Spastic hemiparesis is the classical clinical picture of neurological impairment that limits locomotion and manual ability in stroke patients, which are activities essential for daily life activities and social participation. The ICF defines locomotion as the individual’s ability to move about effectively in his environment, and manual ability as the capacity to manage daily life activities requiring the use of the upper limbs, whatever the strategies involved. Locomotion and manual ability are classified in the ICF activity domain. The Rasch-built questionnaires notably allow overcoming the limitations of the ordinal scales that permit only limited computation and low power non-parametric statistics (Merbitz et al., 1989; Wright and Linacre, 1989). At present, we have new Rasch-built linear and unidimensional scales assessing manual ability (ABILHAND, Penta et al., 2001) and social participation (SATIS-Stroke, Bouffioulx et al., 2008) in stroke patients with high sensitivity. But until now, none of the existing scales available to assess locomotion ability were developed following the Rasch model and locomotion activities are frequently measured by ordinal scales. Therefore, the first stage of this thesis is to develop, using the Rasch probabilistic model, a new questionnaire (ABILOCO) assessing the walking ability of adult stroke patients focusing on the ICF activity domain. The development of this Rasch-built measure of locomotion ability is presented in Chapter 2. Chapter 2 presents the development of ABILOCO, a Rasch-built measure of locomotion ability and its validation in stroke patients. ABILOCO is a self-reporting questionnaire, focusing on the activity domain of the ICF. This questionnaire originally included 43 items representing a large sample of activities corresponding to the ICF definition of locomotion and was submitted to 100 adult stroke patients. The Rasch model selected 13 activities to define a linear and unidimensional measure of walking ability. The development and the validation of ABILOCO are presented as published in the Archives of Physical Medicine and Rehabilitation. A second section of Chapter 2 demonstrates the validity and reproducibility of the ABILOCO questionnaire when administered as either a self-assessment or third-party assessment. This section is presented as published in the Archives of Physical Medicine and Rehabilitation. With ABILOCO, we have now a questionnaire assessing the walking ability of stroke patients focusing on the ICF activity domain and presenting all Rasch psychometric qualities. ABILOCO will be very usefull in Chapter 4 to investigate the efficacy of BoNT A injections in spastic lower limb muscles in stroke patients on the activity domain. Chapter 3 presents a study concerning the reliability of lower limb kinematics, mechanics and energetics in stroke patients during gait as published in the Journal of Rehabilitation Medicine. To date, no study has yet evaluated the medium-term reliability of gait variables among adult stroke patients. This work aims thus to assess the reliability of gait variables at short (1 day) and medium (1 month) intervals and provides useful norms for the study presented in chapter 4. Indeed this observational study uses among others these gait variables to assess the efficacy of BoNT A treatment in stroke patients. It is therefore important to know when a variation between measurements of these variables is the result of a gait modification induced by the treatment and when it is related to the variability of the measurement used. Chapter 4 investigates the efficacy of BoNT A injections in several muscles on stiff-knee gait in stroke patients following the ICF framework. Stiff-knee gait is a common pattern of impaired kinematics in these patients; it is characterised by a lack of knee flexion during the swing phase of the gait cycle. The physiopathology and treatment of stiff-knee gait has not been clearly established. The overactivity of the Rectus Femoris is often cited (Riley and Kerrigan, 1998; Sung and Bang, 2000; Stoquart et al. 2008) but the altered activity of other muscles (Triceps Surae or Vasti) could also take place in the physiopathology (Goldberg et al., 2004). To our knowledge, no previous study has evaluated BoNT A injections in multiple muscles for the treatment of stiff-knee gait. In addition, the effects of BoNT A injections have only been shown to improve impairments and the effects of BoNT A injection on patient activity and participation in social activities remains uncertain. The main aim of Chapter 4 is therefore to investigate the efficacy of BoNT A injections in spastic lower limb muscles on impairment, activity, and social participation in stroke patients. The secondary aim of Chapter 4 is to analyse whether simultaneous BoNT A injections into several spastic muscles are more useful in the treatment of stiff-knee gait, as opposed to one single injection into the Rectus Femoris (Stoquart et al., 2008). This work is presented in Chapter 4 as it was published in Stroke. Chapter 5 investigates the effect of BoNT A injections in several spastic upper limb muscles in chronic stroke patients. We know that many stroke patients present with hand disability secondary to spastic hemiparesis and that these injections effectively reduce neurological impairment (Simpson et al., 2008). However, the functional consequences of these reductions on activity and participation remain unclear as in the lower limb spasticity. We would logically hypothesize that a reduction in spasticity might lead to an improvement in patient activity. But very few studies (Elovic et al., 2008; Brashear et al., 2002) have examined the effects of managing poststroke upper limb spasticity on activity. Additionally, no study has specifically addressed the effect of upper limb BoNT A injections on social participation. Therefore, our aim with this stroke patient study is to investigate the effects on impairment, activity, and participation of BoNT A injections in spastic upper limb muscles. Similarly to the previous chapter, activity (manual ability) and participation are assessed with Rasch questionnaires, ABILHAND (Penta et al., 2001) and SATIS-Stroke (Bouffioulx et al., 2008), respectively. This chapter is presented as the article published in Stroke. Finally, the Chapter 6 discusses the results of the different chapters and presents perspectives for future research.(MED 3) -- UCL, 201

Effects of preoperative combined aerobic and resistance exercise training in cancer patients undergoing tumour resection surgery: A systematic review of randomised trials

BACKGROUNG : Surgical management remains the cornerstone of treatment for many cancers, but is associated with a high rate of postoperative complications, which are linked to poor preoperative functional capacity. Prehabilitation may have beneficial effects on functional capacity and postoperative outcomes. We evaluated the effects of prehabilitation combining endurance and resistance training (CT) on physical fitness, quality of life (QoL) and postoperative outcomes in cancer patients undergoing tumour resection surgery. METHODS : We performed a literature search in PubMed, PEDro, EMBASE (via Scopus) and the Cochrane library for clinical trials until September 2017. Randomised controlled trials investigating the effects of CT in adult cancer patients undergoing surgery were included when at least one of the following outcomes was reported: physical capacity, muscle strength, QoL, length of stay (LOS), postoperative complications and mortality. RESULTS : Ten studies (360 patients) were retrieved and included patients with lung, colorectal, bladder and oesophageal cancer. No adverse effects of CT were reported. Compared with the control group, CT improved physical capacity (3 of 5 studies), muscle strength (2 of 3 studies) and some domains of QoL (2 of 4 studies), shortened LOS (1 of 6 studies) and reduced postoperative pulmonary complications (2 of 6 studies). CONCLUSIONS : The benefits of CT in cancer population are demonstrated. CT may improve physical fitness and QoL and decrease LOS and postoperative pulmonary complications. However, our conclusions are limited by the heterogeneity of the preoperative CT programs, patient characteristics and measurement tools. Future research is required to determine the optimal composition of CT

Is the peri-bariatric surgery exercise program effective in adults with obesity? A systematic review.

Background: The number of people with obesity continues to increase. Bariatric surgery is the most effective treatment for severe obesity. However, this surgery also has disadvantages, such as an increased risk of excessive loss of fat-free mass, lean body mass, and muscle mass compared to other weight-loss interventions. Methods: Pubmed and Cochrane Library database including articles in English, Dutch, French, and German were used. Results: from the 3,609 retrieved references, 20 articles were selected. Compared with the control group, physical exercise improved body mass index (5 of 13 articles), weight loss (7 of 17 articles), functional capacity (2 of 5 articles), muscle strength (1 of 1 article), fat-free mass (3 of 5 articles), cardio-respiratory endurance (4 of 6 articles), and quality of life (2 of 4 articles), in obese patients undergoing BS. Conclusion: Current data is suggestive of positive effects of exercise on body mass index, weight loss, functional capacity, muscle strength, fat-free mass, cardio-respiratory endurance, and quality of life in obese patients undergoing bariatric surgery. However, our conclusions are limited because of the heterogeneity of programs and short studies. Further research is needed to determine the most effective physical exercise program in peri-bariatric surgery

L’asthme induit à l’exercice chez l’enfant asthmatique

L’asthme est une des maladies chroniques les plus importantes chez l’enfant. La prise en charge de l’activité physique chez ces enfants nécessite une compréhension et une gestion optimale. En effet, lors de ces activités, ceux-ci peuvent potentiellement présenter un asthme induit à l’exercice. Il peut être lié à un mauvais contrôle de la maladie, à la condition physique de l’enfant mais également à l’hyperventilation liée à l’exercice et aux conditions dans lesquelles il est réalisé. Les répercussions de l’asthme induit à l’exercice vont être tant médicales que psychosociales menant souvent au déconditionnement de l’enfant. Comme pour l’asthme, la prise en charge nécessite la mise en place d’un traitement optimal associant un traitement de fond et un traitement de crise. La prévention, les programmes de reconditionnement à l’effort et l’éducation ont également rejoint l’arsenal thérapeutique et permettent à l’enfant de mieux participer aux activités physiques, de maîtriser la maladie et d’aborder les crises avec moins d’anxiété. La qualité de vie et la condition physique des enfants asthmatiques sont ainsi améliorées.[Exercise-induced asthma in child with asthma] Asthma is one of the most important chronic diseases in children. Dealing with physical activity in asthmatic children requires understanding and optimal management, as they may present exercise-induced asthma during activity. This may be related to poor control of the disease and the child's physical condition, or to exercise-induced hyperventilation related to the conditions under which the physical activity is performed. The impact of exercise-induced asthma is both medical and psychosocial, often leading to deconditioning. As for asthma itself, management requires optimal treatment with maintenance and acute therapy. Prevention, effort reconditioning programs and education are also now part of the therapeutic armamentarium, making it easier for the child to take part in physical activities, deal with the disease and handle acute attacks with less anxiety. Thus, asthmatic children's quality of life and physical fitness are improve

Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke.

OBJECTIVES: To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Adult stroke patients (N=28; 59+/-13y). The time since stroke ranged from 3 to 253 weeks. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The ABILOCO questionnaire. RESULTS: The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively). CONCLUSIONS: The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research

Is the peri-bariatric surgery exercise program effective in adults with obesity? A systematic review.

Background: The number of people with obesity continues to increase. Bariatric surgery is the most effective treatment for severe obesity. However, this surgery also has disadvantages, such as an increased risk of excessive loss of fat-free mass, lean body mass, and muscle mass compared to other weight-loss interventions. Methods: Pubmed and Cochrane Library database including articles in English, Dutch, French, and German were used. Results: from the 3,609 retrieved references, 20 articles were selected. Compared with the control group, physical exercise improved body mass index (5 of 13 articles), weight loss (7 of 17 articles), functional capacity (2 of 5 articles), muscle strength (1 of 1 article), fat-free mass (3 of 5 articles), cardio-respiratory endurance (4 of 6 articles), and quality of life (2 of 4 articles), in obese patients undergoing BS. Conclusion: Current data is suggestive of positive effects of exercise on body mass index, weight loss, functional capacity, muscle strength, fat-free mass, cardio-respiratory endurance, and quality of life in obese patients undergoing bariatric surgery. However, our conclusions are limited because of the heterogeneity of programs and short studies. Further research is needed to determine the most effective physical exercise program in peri-bariatric surgery