The functional capacity and quality of life of women with advanced breast cancer

The rehabilitation needs of patients with metastatic breast cancer (MBC) are poorly studied. The primary aim of the study was to evaluate the functional capacity of women with MBC and quality of life (QoL). The present study is an open, non-randomized, prospective cross-sectional observation study. The functional capacity of 128 MBC patients with ongoing cancer treatments, were studied in Helsinki University Hospital (HUS): Peak expiratory flow (PEF), dynamic and static balance, 6 minute walking distance (6MWD), 10 meter walking, sit-to-stand test, repeated squat, grip strength, shoulder movement, pain, and QoL by Beck's depression scale (BDI), health assessment questionnaire (HAQ), RAND SF-36 and EORTC QLQ-30 items. The walking capacity was compromised in half and the strength of the lower extremities in one-third of the patients. PEF was below the normal reference in 55 %, static balance in 62 % and dynamic balance in 73 % (= 61 year olds). The grip power was lowered in 44/30 % of the patients (right/left) and the shoulder movement was restricted in 30 %. Some disability in physical functioning experienced 55 % (HAQ) and 37 % felt depressive (BDI). The QoL (RAND SF-36) was poor especially in the field of physical, role and social functioning and bodily pain (<0.001). Pain, depression, and a poor 6MWD results independently determined the physical component of QoL (p <0.001). The functional capacity of patients with MBC was significantly lowered. This, in association with distressing symptoms like pain and depression causes a vicious circle further leading to functional disabilities and impaired QoL.Peer reviewe

CD4CD8αα Lymphocytes, A Novel Human Regulatory T Cell Subset Induced by Colonic Bacteria and Deficient in Patients with Inflammatory Bowel Disease

It has become evident that bacteria in our gut affect health and disease, but less is known about how they do this. Recent studies in mice showed that gut Clostridium bacteria and their metabolites can activate regulatory T cells (Treg) that in turn mediate tolerance to signals that would ordinarily cause inflammation. In this study we identify a subset of human T lymphocytes, designated CD4CD8αα T cells that are present in the surface lining of the colon and in the blood. We demonstrate Treg activity and show these cells to be activated by microbiota; we identify F. prausnitzii, a core Clostridium strain of the human gut microbiota, as a major inducer of these Treg cells. Interestingly, there are fewer F. prausnitzii in individuals suffering from inflammatory bowel disease (IBD), and accordingly the CD4CD8αα T cells are decreased in the blood and gut of patients with IBD. We argue that CD4CD8αα colonic Treg probably help control or prevent IBD. These data open the road to new diagnostic and therapeutic strategies for the management of IBD and provide new tools to address the impact of the intestinal microbiota on the human immune system

Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

Abstract Background Lumbar spine fusion (LSF) effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes. Methods/design In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after surgery and consist of six individual guidance sessions with a physiotherapist and a home-based exercise program. The primary outcome measures are low back pain, lower extremity pain, disability and quality of life. Secondary outcomes are back function and kinesiophobia. Exercise adherence will also be evaluated. The outcome measurements will be assessed at baseline (3&#8201;months postoperatively), at the end of the exercise intervention period (15&#8201;months postoperatively), and after a 1-year follow-up. Discussion The present RCT will evaluate the effectiveness of a long-term rehabilitation program after LSF. To our knowledge this will be the first study to evaluate a combination of strength training, control of the neutral lumbar spine position and aerobic training principles in rehabilitation after LSF. Trial registration ClinicalTrials.gov Identifier NCT00834015peerReviewe

Self-reported health-enhancing physical activity recommendation adherence among 64,380 finnish adults

The Finnish recommendations for health-enhancing physical activity (PA) for adults (≥18 years) recommend: (i) ≥150 minutes of moderate-to-vigorous-intensity physical activity (MVPA) and (ii) activities that develop muscle strength and balance ≥2 days/week. However, adherence to these recommendations among the Finnish adults is currently unknown. This study reports on the self-reported adherence to the PA recommendations and associations with sociodemographic factors among Finnish adults. Data were used from the Finnish 'Regional Health and Well-being Study'. In 2013-2014, postal questionnaires were sent to 132,560 persons, with 69,032 responding (response rate =52.1%). The weighted proportions adhering to the: (i) MVPA recommendation, (ii) sufficient muscle-strengthening activity (≥2 days/week), (iii) sufficient balance training (≥2 days/week), and (iv) Finnish health-enhancing PA recommendations (Finnish recommendations) were calculated. Associations with sociodemographic variables (eg, age, education level, self-rated health) were assessed using multiple logistic regression analyses. Of 69,032 respondents, 92.6% (n=64,380, response rate =48.6%, 18-98 years) reported on their physical activity levels. A total of 31.2% (95% CI: 30.8%-31.6%) met the aerobic MVPA recommendation, 17.2% (95% CI: 16.9%-17.6%) reported sufficient muscle-strengthening activity, 6.7% (95% CI: 6.4%-6.9%) reported sufficient balance training, and 10.8% (95% CI: 10.5%-11.1%) met the Finnish recommendations. In the adjusted analysis, those with poorer self-rated health, older age, lower education levels, and those classified overweight or obese were independently associated with lower odds of meeting the Finnish recommendations. The vast majority of Finnish adults do not meet the full PA recommendations. Public health action is needed to increase PA in Finland

Changes in motor control and muscle performance after a short-term body mass reduction program in obese subjects

Two hundred and thirty obese subjects (age: 18-77 yr, BMI: 31.1-65.8 kg/m2) were studied before and after a 3-week body mass reduction (BMR) program, coupling restricted energy diet (1200-1500 kcal/day) with low intensity exercise prescription. It involved 5 days per week (consisting of one-hour dynamic aerobic standing and floor exercise plus 30 min of cycloergometer exercise at 60 W or, alternatively, 4 km outdoor leisure walking on flat terrain) and psychological counseling. One-leg standing balance test (OLSB) and stair climbing test (SCT) were employed to assess motor control and maximal lower limb muscle power, respectively. The BMR program induced a significant weight loss (4.1%; p<0.001), a higher reduction of body mass index (BMI) being observed in males than in females (p<0.001). OLSB performance time increased by 20.5% (p<0.001) after treatment, the improvement being evident in both genders. A 20.8% reduction in SCT time (p<0.05) was also observed and corresponded to a 13.2% increase (p<0.001) in average absolute muscle power and 15.0% increase (p<0.001) in specific muscle power (i.e. the power output per kg of body mass), with no differences between genders. In conclusion, in spite of the moderate reduction of body mass after restricted energy diet and low intensity physical conditioning, significant improvements in motor control and performance, likely to ameliorate the execution of simple daily activities, were observed in obese subjects. \ua92001, Editrice Kurtis