Evaluation of a Home-Based Walking Exercise Program on Fatigue and Health Related Quality of Life in Prostate Cancer Patients Undergoing Radiation Therapy: A Pilot Study

Background: Exercise could have a role in ameliorating some of the adverse effects of External Beam Radiotherapy and Androgen Deprivation Therapy (EBRT+ADT) in men with prostate cancer. The primary aim of this study was to assess the feasibility (process, resource and management) and efficacy (scientific) of a home-based moderate-to-vigorous physical activity (MVPA) walking exercise intervention for patients with localised prostate cancer (PCa) undergoing EBRT+ADT in anticipation of a future confirmatory RCT. Methods: PCa patients receiving EBRT+ADT were randomized to a home-based MVPA walking intervention (n=12) or standard care (n=12) for the duration of their EBRT. Intervention patients were prescribed 3000 steps in 30 minutes on 5 days each week, i.e. a cadence of 100 steps/minute. These 3000 steps/day were prescribed in addition to their pre-determined habitual step/day. Fatigue, health related quality of life (HRQoL), anthropometric measures and physical performance were assessed at baseline (planning CT), mid EBRT, end of EBRT, and at 1 month post EBRT. Intervention participants' satisfaction with the intervention and barriers/facilitators to exercise during EBRT were also assessed. Control group participants' exercise knowledge, attitudes and practices were assessed post EBRT. The feasibility of the intervention's processes, resources and management were assessed using quantitative and qualitative methods. Results: The exercise intervention group showed greater improvements in fatigue, quality of life, anthropometric measures and physical performance compared to standard care controls. These improvements were sustained beyond the intervention period. Exercise convenience and treatment centre environment emerged as exercise facilitators. Intervention participants' average exercise convenience and satisfaction ratings were 4.8/5 (SD=0.4) i.e. "extremely convenient" and 4.8/5 (SD=0.4) i.e. "extremely satisfied" respectively. A lack of time and poor weather emerged as exercise barriers. Standard care controls had poor exercise knowledge, attitudes and practices (KAP) post EBRT, for example only 42% of the control group were aware of the correct recommended weekly MVPA guidelines. Conclusions: This preliminary evidence suggests that a pragmatic home-based MVPA walking exercise intervention is feasible and has the potential to evoke improvements in fatigue, in addition to other important health outcomes in men with PCa undergoing EBRT+ADT. This pilot study has achieved its six feasibility criteria and should proceed to a future confirmatory RCT. Impact: This study shows for the first time that a pragmatic home-based MVPA walking exercise intervention using evidence based tailored exercise prescriptions is feasible and could have a positive impact on fatigue and other key outcomes in men with PCa receiving EBRT+ADT

Meaningful activity replacement recommendations in dementia

Exercise of meaningful activities is important for people living with dementia, both for quality of life and to maintain the necessary basic activities of daily living. A method is proposed for recommendation of replacements for lost meaningful activities that accounts for the need to maintain activities of daily living

Monitoring Activities of Daily Living for Maintaining Independent Living in Dementia

Our ability to live independent meaningful lives depends on our ability to perform various activities and to maintain our cognitive functions. Maintaining independent living is important for persons with dementia, it increases selfworth and allows to remain independent and in their own homes for longer. We describe the activities established as being important for the maintenance of independent living, and methods for monitoring these activities using technology

Co-design to support engagement in activities of daily living and meaningful activities for people living with dementia

Dementia is a chronic and progressive neurodegenerative illness, which can lead to significant difficulties in a person’s capacity to perform activities of daily living and engage in meaningful activities. The Smart Dementia Care project aims to establish an understanding of how best to design digital tools that persons with dementia and their carers will find useful and usable for care planning and goal setting. This paper discusses the first phase of this project and describes how co-design is being used to support engagement in activities of daily living and meaningful activities for people living with the early stages of dementia, with such engagement intended to extend the period of independent living for the person with dementia. It is anticipated that adopting a co-design approach and involving people living with dementia throughout the design cycle will allow for an application that is viewed as usable and intuitive while also acting as a tool of empowerment rather than a burden. At the same time, the intention is that integrating personalized goal-setting functionality focussing on individualized activities and everyday tasks will result in a system that is useful and effective

A Goal-Driven Framework for Individualised Self-Care for Early-Stage Dementia.

For people with early or moderate dementia, there are benefits to them continuing to live in their own homes for as long as possible, both in improved quality of life and associated measures such as increased social contact, increased physical activity and lower use of medication, and reduced costs and burden of care. Tools to help extend period of independent living, and to maintain quality of life in this period, are lacking. Systems exist to monitor individuals for problems, e.g. falls or wandering from the home, but there is scope for development of computerised support to help maintain activity in independent living. We aim to monitor achievement of activities, by app and by sensors, and provide recommendations on how to best maintain activities

A Goal-Driven Framework for Individualised Self-Care for Early-Stage Dementia

For people with early or moderate dementia, there are benefits to them continuing to live in their own homes for as long as possible, both in improved quality of life and associated measures such as increased social contact, increased physical activity and lower use of medication, and reduced costs and burden of care. Tools to help extend period of independent living, and to maintain quality of life in this period, are lacking. Systems exist to monitor individuals for problems, e.g. falls or wandering from the home, but there is scope for development of computerised support to help maintain activity in independent living. We aim to monitor achievement of activities, by app and by sensors, and provide recommendations on how to best maintain activities

Ethical Issues in the New Digital Era: The Case of Assisting Driving

Mobility is associated with driving a vehicle. Age-related declines in the abilities of older persons present certain obstacles to safe driving. The negative effects of driving cessation on older adults’ physical, mental, cognitive, and social functioning are well reported. Automated driving solutions represent a potential solution to promoting driver persistence and the management of fitness to drive issues in older adults. Technology innovation influences societal values and raises ethical questions. The advancement of new driving solutions raises overarching questions in relation to the values of society and how we design technology (a) to promote positive values around ageing, (b) to enhance ageing experience, (c) to protect human rights, (d) to ensure human benefit and (e) to prioritise human well-being. To this end, this chapter reviews the relevant ethical considerations in relation to assisted driving solutions. Further, it presents a new ethically aligned system concept for assisted driving. It is argued that human benefit, well-being and respect for human identity and rights are important goals for new automated driving technologies. Enabling driver persistence is an issue for all of society and not just older adult

Driver Persistence, Safety and Older Adult Self-efficacy: Addressing Driving Challenges Using Innovative Multimodal Communication Concepts

New assisted driving technology provides a solution to enabling driver persistence while also addressing older adult fitness to drive issues. The proposed driver assistance system follows a detailed literature review, an analysis of secondary data, and the specification of a solution using human machine interaction (HMI) design methods. Overall, the assisted driving concept follows from a principled/ethical perspective in relation to promoting self-efficacy and enablement for older adults. The system is conceptualized as a supportive friend or ‘co-pilot’. It is argued that the use of new car-based sensors, along with machine learning intelligence and novel multimodal HMI communication methods will enable driver persistence while also promoting older adult self-efficacy and positive ageing

CD10 − /ALDH − Cells are the Sole Cisplatin-Resistant Component of a Novel Ovarian Cancer Stem Cell Hierarchy

AbstractIt is long established that tumour-initiating cancer stem cells (CSCs) possess chemoresistant properties. However, little is known of the mechanisms involved, particularly with respect to the organisation of CSCs as stem-progenitor-differentiated cell hierarchies. Here we aimed to elucidate the relationship between CSC hierarchies and chemoresistance in an ovarian cancer model. Using a single cell-based approach to CSC discovery and validation, we report a novel, four-component CSC hierarchy based around the markers cluster of differentiation 10 (CD10) and aldehyde dehydrogenase (ALDH). In a change to our understanding of CSC biology, resistance to chemotherapy drug cisplatin was found to be the sole property of CD10−/ALDH− CSCs, while all four CSC types were sensitive to chemotherapy drug paclitaxel. Cisplatin treatment quickly altered the hierarchy, resulting in a three-component hierarchy dominated by the cisplatin-resistant CD10−/ALDH− CSC. This organisation was found to be hard-wired in a long-term cisplatin-adapted model, where again CD10−/ALDH− CSCs were the sole cisplatin-resistant component, and all CSC types remained paclitaxel-sensitive. Molecular analysis indicated that cisplatin resistance is associated with inherent- and adaptive-specific drug efflux and DNA-damage repair mechanisms. Clinically, low CD10 expression was consistent with a specific set of ovarian cancer patient samples. Collectively, these data advance our understanding of the relationship between CSC hierarchies and chemoresistance, which was shown to be CSC- and drug-type specific, and facilitated by specific and synergistic inherent and adaptive mechanisms. Furthermore, our data indicate that primary stage targeting of CD10−/ALDH− CSCs in specific ovarian cancer patients in future may facilitate targeting of recurrent disease, before it ever develops.</jats:p