Evaluation of Community-Based Physical Activity Programming for Childhood Cancer Survivors

Background: Childhood cancer treatments include numerous negative physical and psychosocial outcomes. Preliminary evidence suggests cancer-related side effects may be reduced by physical activity (PA). Fortunately, early research supports the physical and psychosocial benefits of PA in childhood cancer survivors. However, only a handful of research studies have been translated into community-based PA programs. One of these community- based programs is the Pediatric Cancer Patients and Survivors Engaging in Exercise for Recovery (PEER) program. The next step in translation is to evaluate patient outcomes regarding PEER participation. Thus, the purpose of the current proposal was to determine applicable evidence-based evaluation tools for the PEER program. Methods: The knowledge- to-action framework was used to compile feasible and sustainable evaluation tools, along with an algorithm to determine which tools are appropriate in the assessment of each PEER participant. Specifically, (a) a scoping review determined evaluation tools used to date in childhood cancer PA/exercise programs and studies. Based on the results of this review, (b) interviews were conducted with key stakeholders to understand what they find valuable to evaluate in PEER. This work, along with the goals of the PEER program, (c) guided the development of the evaluation tools along with an algorithm for tool implementation based on participant age, cognitive and physical ability. Finally, (d) the evaluation tools were tested for feasibility in PEER. Conclusions: The present work was the first to establish evidence-based evaluation tools that are feasible for the community-based PEER program. Ongoing PEER evaluation may enhance program translation and support the sustainability

TOWARD A MECHANICAL MARKER OF OSTEOARTHRITIS

INTRODUCTION Anterior cruciate ligament (ACL) rupture increases an individual’s risk of developing tibiofemoral (TF) osteoarthritis (OA)[1]. Clinical radiographic assessment of OA is insensitive to early changes in TF soft tissue and currently there are no disease modifying treatments available. Given the negative implications of OA on quality of life[2], and large economic impact on the healthcare system[3] new methods for detecting pre-radiographic OA are needed. In vivo TF soft tissue compressive stiffness may be an ideal disease marker. It reflects the dynamic joint response to loading, which has been shown in vitro to deteriorate with OA. The aim of this investigation was to determine the change in TF proximity during loading and estimate in vivo TF compressive stiffness for healthy and ACL deficient (ACLD) subjects.  The hypothesis was that ACLD subjects have lower cartilage stiffness. METHODS Two subjects (S1: Healthy, 34 yrs, 82 kg; S2: ACLD 8 yrs post-injury, 44 yrs, 77.1 kg) volunteered for participation. Subjects were tested in the morning and transferred between imaging locations using a wheelchair to minimize soft tissue loading. High-resolution steady-state fast precision (SSFP) magnetic resonance (MR) scans were obtained for subject knees (General Electric, 3T MR scanner). Thereafter, subjects were transferred to the Dual Fluoroscopy (DF) imaging lab. Subjects were fitted with a custom-made knee brace and led lined apron and thyroid collar. Subjects performed a two-legged standing weight bearing task for ten minutes during which time DF images were acquired at 6Hz for the first 60s and at 30s intervals for minute 2-10.   MR data were segmented in Amira (VSG, Germany) to create subject specific 3D bone models. Unloaded cartilage thicknesses were estimated in Amira using the high resolution SSPF scan sequences. DF images were distortion corrected and calibrated using a direct linear transform. 3D bone translations and rotations were reconstructed using 2D-3D registration in Autoscoper (Brown University, USA). Here, the positions of 3D bone models were matched to the two 2D DF x-ray views. TF bone proximities were calculated as the change in the Euclidean distance between the origin of the 3D bone models. Data for the 1st 30 s of loading were used to estimate TF soft tissue compressive stiffness.RESULTS TF cartilage thickness (unloaded) and compressive stiffness values (loaded) are summarized in Table 1.   Table 1. Cartilage thickness and TF soft tissue compressive stiffness estimates S1 (Healthy) Medial (unloaded) Lateral (unloaded) Compressive stiffness 4.7 mm 5.9 mm 2.87*106 Nm-1 S2 (ACLD 8 yrs) Medial (unloaded) Lateral (unloaded) Compressive stiffness 6.7 mm 7.3 mm 1.90*106 Nm-1   DISCUSSION AND CONCLUSIONS The results indicated distinct alterations in TF proximity during loading. Although cartilage was thicker in the ACLD subject, the stiffness was reduced as anticipated. An associated increase in stiffness was not found. This suggests that cartilage swelling may have been present in S2. Additionally, the decreased stiffness suggests that the load bearing capacity of the joint may be compromised. This combined DF/MRI tool provides a novel methodology for assessing this OA mechanism in-vivo. Future work should evaluate localized changes in bone and cartilage proximities to estimate medial and lateral compartment compressive stiffness following ACL rupture and in OA

ALTERED DYNAMIC TIBIOFEMORAL CONTACT PATH LENGTH IN ACL DEFICIENT KNEES

INTRODUCTIONOsteoarthritis (OA) is a degenerative joint disease characterised by the irreversible degradation of cartilage. Ligament injuries in the knee are a known risk factor for post-traumatic OA (PTOA),1 the aetiology of which may be due to a combination of altered mechanical and biological factors.In this study, we investigated how anterior cruciate ligament (ACL) tear affects the relative motion of the subchondral bone surfaces in the knee (i.e., “surface interactions”), which is abnormal in ACL-deficient animal models.2 Tibiofemoral contact path was calculated based on the relative surface motions. We hypothesised that contact path length and shape are altered in ACL-deficient subjects. METHODSTwo  ACL-deficient subjects and one healthy control subject  (male, ages 34-55) underwent magnetic resonance (MR) imaging scans (3T FIESTA sequence) of both knees, then performed walking trials on an instrumented treadmill. During the walking trials, ground reaction force data were collected and fluoroscopy images from two separate views of the knee were taken. Using Amira (VSG, Germany), 3D models of the tibia and femur were generated from segmented MR images, and the in vivo bone alignments were determined using AutoScoper (Brown University, RI).For each in vivo frame, tibiofemoral proximity was mapped in Matlab (version R2013a, Natick, MA). Weighted centroids were calculated for each of the four tibiofemoral surfaces, with closer proximities having a higher weighting. The weighting factor used was w = (15 mm – proximity)3, counting only proximities less than 15 mm. Contact path was defined as the path that the weighted centroid made across the frames analyzed. Differences in contact path between left and right knees were assessed qualitatively for each of the subjects.RESULTSFor the healthy control subject, contact paths were similar between knees, and were in a straight line, primarily in the anterior-posterior direction. In the two ACL-deficient subjects, the unaffected limb contact path displayed a shape similar to the control limbs. In contrast, the paths in the affected knees were shorter, were not consistently in the same location, and underwent greater mediolateral excursions.DISCUSSION AND CONCLUSIONSThe qualitative results from three subjects support the hypothesis that contact path location and direction may be altered in ACL-deficient individuals. The changes in contact path show similarities to past studies with animal models.2There exist limitations in the ability to measure surface interactions, as only a small portion of the gait cycle can be analyzed using the dual-fluoroscopy system. Despite this, the dual-fluoroscopy method of bone tracking is superior to traditional marker-based motion capture systems, as it is more accurate than marker-based methods.The results suggest that there may be a correlation between ACL status and contact path shape during level walking. Future studies will increase the number of subjects and explore means of comparing contact paths quantitatively. Identification of associations between contact path shape and severity of joint damage may provide new insight into the pathogenesis of osteoarthritis

The role of social support in physical activity for cancer survivors: A systematic review

This is the peer reviewed version of the following article: "McDonough, M. H., Beselt, L. J., Daun, J. T., Shank, J., Culos-Reed, S. N., Kronlund, L. J., & Bridel, W. (2019). The role of social support in physical activity for cancer survivors: A systematic review. Psycho-Oncology, 28(10), 1945–1958. https://doi.org/10.1002/pon.5171", which has been published in final form at http://dx.doi.org/10.1002/pon.5171. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Social support is conceptualized and operationalized in many ways, making it challenging to understand what types of support best predict physical activity (PA) in cancer survivors. This review examined associations between social support and PA among cancer survivors. Methods: Following PRISMA guidelines, we searched eight databases for studies that reported an association between social support and PA among adult cancer survivors. We conducted an appraisal and a narrative synthesis of the findings from quantitative studies. Results: N=50 studies representing 28,366 participants were included. Studies collectively included concepts addressing the presence of relationships, others’ PA behavior, perceptions of being supported, and function/quality. Findings were mixed in suggesting a positive or null association with PA. Conclusions: While results are not definitive, this review takes a step toward mapping the social support literature in PA for cancer survivors. Limitations include the homogeneity of the participants in extant studies, and the secondary focus on testing the effects of social support on outcomes. Future research systematically testing the effects of social support is important for facilitating PA in this population.Social Sciences and Humanities Research Council (SSHRC)University of Calgary - Research Gran

The role of social support in physical activity for cancer survivors: A systematic review

This is the peer reviewed version of the following article: "McDonough, M. H., Beselt, L. J., Daun, J. T., Shank, J., Culos-Reed, S. N., Kronlund, L. J., & Bridel, W. (2019). The role of social support in physical activity for cancer survivors: A systematic review. Psycho-Oncology, 28(10), 1945–1958. https://doi.org/10.1002/pon.5171", which has been published in final form at http://dx.doi.org/10.1002/pon.5171. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Social support is conceptualized and operationalized in many ways, making it challenging to understand what types of support best predict physical activity (PA) in cancer survivors. This review examined associations between social support and PA among cancer survivors. Methods: Following PRISMA guidelines, we searched eight databases for studies that reported an association between social support and PA among adult cancer survivors. We conducted an appraisal and a narrative synthesis of the findings from quantitative studies. Results: N=50 studies representing 28,366 participants were included. Studies collectively included concepts addressing the presence of relationships, others’ PA behavior, perceptions of being supported, and function/quality. Findings were mixed in suggesting a positive or null association with PA. Conclusions: While results are not definitive, this review takes a step toward mapping the social support literature in PA for cancer survivors. Limitations include the homogeneity of the participants in extant studies, and the secondary focus on testing the effects of social support on outcomes. Future research systematically testing the effects of social support is important for facilitating PA in this population.Social Sciences and Humanities Research Council (SSHRC)University of Calgary - Research Gran

Perceptions of masculinity and body image in men with prostate cancer: the role of exercise

Purpose: The goal of this study was to explore the association between levels of exercise and patterns of masculinity, body image, and quality of life in men undergoing diverse treatment protocols for prostate cancer. Methods: Fifty men with prostate cancer (aged 42–86) completed self-report measures. Self-reported measures included the following: the Godin Leisure Time Exercise Questionnaire (GLTEQ), Masculine Self-esteem Scale (MSES), Personal Attributes Questionnaire (PAQ), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy–Prostate (FACT-P). Masculinity, body image, and quality of life scores were compared between men obtaining recommended levels of exercise (aerobic or resistance) and those not obtaining recommended level of exercise. Secondary outcomes included the association between masculinity, body image, and quality of life scores as they relate to exercise levels. Results: There were significantly higher scores of masculinity (p < 0.01), physical well-being (p < 0.05), prostate cancer specific well-being (p < 0.05), and overall quality of life (p < 0.05) in those obtaining at least 150 min of moderate to vigorous aerobic exercise. In the 48% of men who had never received androgen deprivation therapy, significantly higher levels of masculinity, body image, and quality of life were observed in those meeting aerobic guidelines. Conclusions: Whether treatment includes androgen deprivation or not, men who participate in higher levels of aerobic exercises report higher levels of masculinity, improved body image, and quality of life than those who are inactive. Future longitudinal research is required evaluating exercise level and its effect on masculinityand body imag