Feasibility of an interactive patient portal in oncology : qualitative study

Background: Digital health interventions, such as the use of patient portals, have been shown to offer benefits to a range of patients including those with a diagnosis of cancer. Objective: This study aimed to explore the participant experience and perception of using an interactive Web-based portal for monitoring physical activity, remote symptom reporting, and delivering educational components. Methods: Participants who were currently under treatment or had recently completed intensive treatment for cancer were recruited to three cohorts and invited to join a Web-based portal to enhance their physical activity. Cohort 1 received Web portal access and an activity monitor; cohort 2 had additional summative messaging; and cohort 3 had additional personalized health coaching messaging. Following the 10-week intervention, participants were invited to participate in a semistructured interview. Interview recordings were transcribed and evaluated using qualitative thematic analysis. Results: A total of 17 semistructured interviews were carried out. Participants indicated that using the Web portal was feasible. Personalized messaging improved participant perceptions of the value of the intervention. There was a contrast between cohorts and levels of engagement with increasing health professional contact leading to an increase in engagement. Educational material needs to be tailored to the participants’ cancer treatment status, health literacy, and background. Conclusions: Participants reported an overall positive experience using the Web portal and that personalized messaging positively impacted on their health behaviors. Future studies should focus more on design of interventions, ensuring appropriate tailoring of information and personalization of behavioral support messaging

The feasibility and effects of Qigong intervention (mind-body exercise) in cancer patients with insomnia : a pilot qualitative study

Background: Up to 80% of cancer patients experience insomnia that significantly affects their quality of life. This pilot qualitative study investigated the feasibility and effects of a 3-week Qigong (mind-body exercise) intervention with a 1-week follow-up in cancer patients experiencing insomnia. Methods: Cancer patients with insomnia who had completed radiotherapy or chemotherapy treatment and/or were at least 8weeks post-cancer-related surgery were recruited. Primary outcomes were feasibility outcomes, which included recruitment, retention, attendance, completion of assessment, adverse events and participant feedback via a questionnaire and focus group/individual interview. Secondary outcomes on insomnia severity and sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) at baseline, mid, post-intervention and follow-up. Results: Seven participants were recruited and two withdrew from the study. The participant retention rate was 71.4% with an overall attendance rate of more than 84% and participants were able to complete all required assessments. An adverse event relating to the worsening of existing musculoskeletal condition was reported. Qualitative analysis of participant feedback identified 4 emerging themes: (1) experience from Qigong intervention; (2) class preferences; (3) barriers to participation; and (4) recommendation for improvement. Participants reported increased relaxation, improved sleep and energy level, better upper body flexibility and reduced stress. Both ISI and PSQI scores improved significantly (P<.05). Conclusion: This study demonstrated that it is feasible to employ the current clinical trial design using Qigong intervention on insomnia in cancer patients. Preliminary data suggest that the intervention may improve sleep outcomes, however, these findings need to be confirmed by future robust randomized controlled trials

Androgen deprivation in prostate cancer : benefits of home-based resistance training

Introduction: Androgen deprivation therapy (ADT) has detrimental effects on body composition, metabolic health, physical functioning, bone mineral density (BMD) and health-related quality of life (HRQOL) in men with prostate cancer. We investigated whether a 12-month home-based progressive resistance training (PRT) programme, instituted at the start of ADT, could prevent these adverse effects. Methods: Twenty-five patients scheduled to receive at least 12 months of ADT were randomly assigned to either usual care (UC) (n = 12) or PRT (n = 13) starting immediately after their first ADT injection. Body composition, body cell mass (BCM; a functional component of lean body mass), BMD, physical function, insulin sensitivity and HRQOL were measured at 6 weeks and 6 and 12 months. Data were analysed by a linear mixed model. Results: ADT had a negative impact on body composition, BMD, physical function, glucose metabolism and HRQOL. At 12 months, the PRT group had greater reductions in BCM by − 1.9 ± 0.8 % (p = 0.02) and higher gains in fat mass by 3.1 ± 1.0 % (p = 0.002), compared to the UC group. HRQOL domains were maintained or improved in the PRT versus UC group at 6 weeks (general health, p = 0.04), 6 months (vitality, p = 0.02; social functioning, p = 0.03) and 12 months (mental health, p = 0.01; vitality, p = 0.02). A significant increase in the Matsuda Index in the PRT versus UC group was noted at 6 weeks (p = 0.009) but this difference was not maintained at subsequent timepoints. Between-group differences favouring the PRT group were also noted for physical activity levels (step count) (p = 0.02). No differences in measures of BMD or physical function were detected at any time point. Conclusion: A home-based PRT programme instituted at the start of ADT may counteract detrimental changes in body composition, improve physical activity and mental health over 12 months. Trial registration: Australian and New Zealand Clinical Trials Registry, ACTRN1261600131144

Keep playing! : experiencing the joy of movement until the end of life

Creative, social and vigorous play is critical for our development as children and adolescents, and being similarly active throughout adulthood is a key attribute of those who age successfully. ‘Exercise’ can be defined most simply as ‘organised play’. There is irrefutable empirical evidence of the effectiveness of regular exercise in the primary and secondary prevention of leading chronic illnesses, including cardiometabolic risk factors and diseases, numerous cancers, and mental health disorders, just to name a few. The benefits of exercise also extend to those nearing the end of life. Many studies have shown that individuals receiving palliative care are interested in, and capable of, participating in a professionally-directed exercise program undertaken at home and/or in a group. Documented benefits after >6 weeks participation have included significant reductions in disease-related symptoms (e.g. fatigue, sleep disturbance), and improvements in a broad number of physical and psychosocial assessments, including quality of life. However, despite such evidence, exercise professional and their services remain largely peripheral to palliative care. This presentation provides an overview of the necessity of human movement to health and wellbeing across the lifespan with emphasis on the empirical evidence supporting exercise participation in people with incurable diseases, and at the end of life. From this theoretical base, two distinct case studies will be presented to highlight how an accredited exercise physiologist (AEP) could develop a tailored exercise program for an individual receiving palliative care. Programming will be complemented by broader activity and lifestyle recommendations, as per the AEP scope of practice. Strategies and technologies to facilitate engagement of clients will also be discussed, including the importance of role modelling and team care synergy. Underpinning the whole presentation are the themes of social engagement and time in nature as keys to experiencing the joy of human movement until the end of life

Resistance training in chronic renal failure

Chronic kidney disease (CKD), also known as chronic renal failure, is an irreversible disease characterized by the progressive loss of kidney function over time, usually a period of months to years.1,2 Prevalence data for CKD are difficult to ascertain given that the early stages of the disease process are typically asymptomatic,3 and given inconsistencies in diagnostic and classification systems. 4 However, recent data from the National Health and Nutrition Examination Survey (NHANES) suggest that 13.1% of adults (aged >20 years) living in the United States had Stage 1–4 CKD in 2004.5 More recent estimates by the United States Renal Data System suggest that 15.1% of the adult population in the United States has CKD.6 The prevalence of CKD has increased gradually over the past several decades within the United States5 and globally,7 and these trends are expected to continue. 7,8 Global estimates suggest that the prevalence of CKD is threatening to reach epidemic proportions in both developed and developing countries and that much of the burden can be attributed to the obesity/type 2 diabetes pandemic.7 Certain ethnic populations are severely affected by late-stage CKD. These cohorts include African-Americans9; Hispanic-Americans10; and the aboriginal people of Canada,11 the United States,12 New Zealand,13 and Australia,14 among others. The prevention and treatment of CKD globally will become a major challenge in the coming decades.

Effect of audience response system technology on learning outcomes in health students and professionals : an updated systematic review

Aim: Audience response system (ARS) technology is a recent innovation that is increasingly being used by health educators to improve learning outcomes. Equivocal results from previous systematic review research provide weak support for the use of ARS for improving learning outcomes at both short and long terms. This review sought to update and critically review the body of controlled experimental evidence on the use of ARS technology on learning outcomes in health students and professionals. Methods: This review searched using all identified keywords both electronic databases (CINAHL, Embase, ERIC, Medline, Science Direct, Scopus, and Web of Science) and reference lists of retrieved articles to find relevant published studies for review, from 2010 to April 2014. A descriptive synthesis of important study characteristics and effect estimates for learning outcomes was done. Results: Three controlled trials in 321 participants from the United States were included for review. ARS knowledge retention scores were lower than the control group in one study, higher than control group provided that immediate feedback was given about each question in one study, and equivalent between intervention and control groups in another study. Conclusion: There is an absence of good quality evidence on effectiveness of ARS technologies for improving learning outcomes in health students and professionals

Progressive resistance training in end-stage renal disease : systematic review

BACKGROUND: This systematic review provides an overview of the extant literature on progressive resistance training (PRT) in patients with end-stage renal disease (ESRD) and outlines recommendations for future trials. METHODS: A systematic review of all published literature evaluating the chronic (>6 weeks) application of PRT in patients with ESRD using electronic databases. RESULTS: The search yielded 16 clinical trials, including 11 randomized controlled trials (RCT), 4 uncontrolled trials and one trial involving a within-subjects control period plus RCT. RCT quality, assessed via the CONSORT statement, ranged from low (4/10) to high (10/10) with a mean score of 7.3/10; 7/11 RCT had a quality score ≥7.5. All trials evaluated chronic adaptation to PRT across a range of important outcomes. PRT can induce muscle hypertrophy and improve aspects of physical functioning and health-related quality of life in ESRD. There is preliminary evidence that PRT may reduce protein-energy malnutrition and cardiovascular disease risk factors, including C-reactive protein, total cholesterol, triglyceride, and measures of insulin resistance in patients with or at-risk of comorbid type 2 diabetes. The evidence base for PRT adapting some of the endpoints investigated to date remains inconsistent (e.g. physical performance tests, obesity outcomes), and many other pertinent clinical outcomes remain to be investigated. CONCLUSION: RCT are required to investigate a range of novel research questions related to the benefits and application of PRT in this cohort and its patient subgroups (e.g. diabetes, depression, dyslipidemia, etc.). Future studies must be of high methodological quality to inform clinical practice guidelines

Exercise training in high-risk ethnic populations with type 2 diabetes : a systematic review of clinical trials

In order to review clinical trials that have prescribed exercise training in high-risk, ethnic populations with type 2 diabetes mellitus (T2DM) and delineate areas for future research, a systematic review using computerized databases was performed. The systematic review located nine trials, including four uncontrolled trials, and five randomized controlled trials (RCTs) that included 521 participants. Cohorts studied included African, Indian, Polynesian, Hispanic, Arabian, and Chinese peoples and interventions included aerobic training, resistance training or a combination thereof. Several trials documented improvements in HbA1c, insulin action, body composition, blood lipids and systolic and diastolic blood pressure. In general, a longer duration and greater frequency of training resulted in greater adaptation. Studies demonstrating no effect were generally limited by an inadequate intervention. There was evidence of differential training responses between Caucasians and non-Caucasians in two studies drawing such comparisons. Robust RCTs prescribing appropriate, targeted interventions and investigating relevant outcomes may be required to stimulate greater advocacy for exercise as a therapeutic adjunct for diabetes management in these populations. Investigations should be extended to other high-risk populations, particularly indigenous peoples who suffer an extreme burden of T2DM. Translation of research into clinical application should remain the overall objective

Exercise professionals in the cancer center : experiences, recommendations, and future research

In 2018, the Clinical Oncology Society of Australia published a landmark position statement calling for exercise to be integrated as standard practice in cancer care. Efforts to implement this directive in the years ahead will come with many practical challenges. We suggest that for the successful integration of exercise therapy to occur, exercise professionals and their services will have to become a respected, visible, and promoted part of the cancer treatment center itself (i.e., “part of the woodwork”). However, we are aware of no report in the literature documenting the role or experiences of an exercise professional working within a cancer center, or practical recommendations for the implementation and evaluation of exercise services in this setting. Therefore, we detail the experiences of an accredited exercise physiologist, to our knowledge, one of the first to be employed on a full-time basis within a cancer center in Australia (M.M.). On the basis of this case study, we provide practical recommendations for exercise professionals seeking to integrate exercise services within the cancer treatment setting. In addition, we present a model of care involving a key role for the exercise professional, which could be implemented to improve patient care and health outcomes throughout cancer treatment and beyond. Although our article is written from an Australian perspective, our recommendations may be relevant to and/or adapted for health care systems in other countries

Progressive resistance training in polycystic ovary syndrome : can pumping iron improve clinical outcomes?

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and cause of subfertility in women. The etiology of PCOS has not been fully elucidated; however, insulin resistance has been shown to exacerbate the disease process due to its effect on androgen synthesis. Progressive resistance training (PRT) is an anabolic exercise modality that can improve skeletal muscle size and quality (metabolic capacity), and studies have consistently shown that PRT can increase insulin sensitivity in type 2 diabetes and other cohorts. However, PRT is not currently recommended or routinely prescribed in PCOS. The objective of this article was to provide a rationale for the application of PRT in the management and treatment of PCOS. This will be accomplished by (1) overviewing the pathophysiology of PCOS with emphasis on the etiological role of insulin resistance; (2) summarizing the effectiveness of PRT in treating insulin resistance; (3) presenting evidence that PRT is feasible to prescribe in women with PCOS; and (4) providing general recommendations for PRT to complement existing guidelines for aerobic training in this cohort. We also provide recommendations for future research