Recruitment, adherence, and retention of endometrial cancer survivors in a behavioural lifestyle programme: the Diet and Exercise in Uterine Cancer Survivors (DEUS) parallel randomised pilot trial

Objective: Healthy eating and physical activity may help endometrial cancer survivors (ECS) improve their quality of life. However, most ECS do not meet the relevant guidelines. This pilot trial aimed to test the study feasibility procedures for a definitive trial of a behavioural lifestyle programme. Design and setting: This 24-week parallel two-arm randomised pilot trial took place in two hospitals in London, UK (April 2015–June 2016). Participants: Sixty disease-free ECS within 3 years of diagnosis. Interventions: Participants were randomised using minimisation to receive the intervention or care as usual. The ‘Shape-Up following cancer treatment’ programme used self-monitoring, goal-setting, self-incentives, problem-solving and group social support for 12 hours over 8 weeks to help survivors improve their eating and physical activity. Outcome measures: The main outcome measures were recruitment, adherence, and retention rates. Further outcomes included barriers to participation and feedback on programme satisfaction. Results: Of the 296 potentially eligible ECS, 20% (n=60) were randomly allocated to the active intervention (n=29) or control group (n=31). Three participants in each arm were deemed ineligible after randomisation and excluded from analysis. Twenty participants (77%; 95% CI 61% to 93%) adhered to the intervention and provided generally favourable feedback. At 24 weeks, 25/26 (96%; 95% CI 89% to 100%) intervention and 24/28 (86%; 95% CI 73% to 99%) control participants completed their assessment. No intervention-related adverse events were reported. Among eligible survivors who declined study participation (n=83), inconvenience (78%; 95% CI 69% to 87%) was the most common barrier. Conclusions: The trial was feasible to deliver based on the a priori feasibility criteria. Enhancing recruitment and adherence in a definitive trial will require designs that promote convenience and consider ECS-reported barriers. Trial registration number: NCT02433080; Pre-results. Trial funding: University College London, St. Bartholomew’s Hospital Nurses League, and NIHR University College London Hospitals Biomedical Research Centre

Obesity, Diet, Physical Activity and Health-Related Quality of Life in Endometrial Cancer Survivors: A Systematic Review

Obesity, low-quality diet and inactivity are prevalent among endometrial cancer survivors. A systematic review was conducted to assess if they are associated with health-related quality of life (HRQoL). Search included electronic databases, conference abstracts, reference lists, and contacting experts. Methodological and reporting quality was evaluated with appropriate checklists. Standardised mean differences were calculated and data were synthesised narratively. Eight from the 4385 retrieved reports were included. Four of eight studies were cross-sectional, one retrospective, one prospective and two were randomised-controlled trials. Obesity was negatively associated with overall HRQoL in 4/4 studies and with physical well-being in 6/6 studies, while positively associated with fatigue in 2/4 studies. Meeting the recommendations for being physically active, eating a diet high in fruit and vegetables, and/or abstaining from smoking were positively associated with overall HRQoL in 2/2 studies, with physical well-being in 2/3 studies and with fatigue in 1/3 studies. Improvements in fatigue and physical well-being were evident after lifestyle interventions. Healthy lifestyle is positively associated with HRQoL. Trials need to test interventions promoting healthy lifestyle in this population

Feasibility and Acceptability of Qigong Exercise in Community-Dwelling Older Adults in the United States

Objectives:Qigong exercise has been shown to improve physical and psychological well-being in adults with chronic conditions, but little is known about the feasibility and acceptability of engaging in a qigong exercise program in community-dwelling older adults in the United States. The purpose of this study was to explore the feasibility, acceptance, and adherence to an 8-week qigong exercise intervention in community-dwelling American older adults. Design: An exploratory study design. Setting: Two senior centers in southern Connecticut. Subjects: Forty-five community-dwelling older adults aged 65 to 85 years enrolled. Intervention: A supervised 1-h health qigong exercise session twice weekly for 8 weeks. Outcome measures: An investigator-designed questionnaire with seven items that were rated on a 1 to 6 scale, with higher scores indicating better results, and nine open-ended questions were used to obtain data on feasibility and acceptability. Adherence was calculated as the proportion of the 16 planned sessions attended. Results: Of the 45 older adults enrolled, 6 never started and 6 withdrew, with 33 evaluable at the end of the intervention. The mean age of the sample was 74.8 years; the majority were female (84.4%) and white (91.1%). Mean scores on aspects of difficulty, acceptability, suitability, or effectiveness of qigong exercise were all ≥5. Participants identified benefits of qigong exercise, such as calming and relaxing feelings, inner peace, better balance, and flexibility. Attendance rate was 78.8%, with 94% performing qigong exercise at least once weekly outside the class. All participants indicated that they would recommend qigong exercise to others. No adverse events occurred. Conclusion: An 8-week qigong exercise program was feasible, acceptable, and safe for American older adults. Future robust randomized controlled trials are needed to confirm these findings

Physical and Psychological Health Outcomes of Qigong Exercise in Older Adults: A Systematic Review and Meta-Analysis

Physical limitations, depression and anxiety are prevalent among older adults. Mild to moderate exercise can promote physical and psychological health and reduce the risk of chronic diseases. Qigong, a type of Chinese traditional medicine exercise, has demonstrated beneficial effects on physical ability and mental health in adults with chronic conditions. The purpose of this review was to systematically assess the effects of Qigong exercise on physical and psychological health outcomes in older adults. A total of 1282 older adults aged 62 to 83 years with depressive symptoms, frailty or chronic medical illnesses were included in this review. The meta-analysis showed that Qigong exercise resulted in significantly improved physical ability compared with active control or usual care (standardized mean difference [SMD] = 1.00 and 1.20, respectively). The pooled effects of studies with thrice weekly Qigong sessions had the greatest effect (SMD=1.65) on physical ability in older adults. Lower quality studies demonstrated larger effect sizes than those of higher quality. Although Qigong exercise showed favorable effects on depression, balance and functioning, the overall effects did not reach statistical significance. No significant adverse events were reported. The findings suggest that the Qigong exercise may be an option for older adults to improve physical ability, functional ability, balance and to lessen depression and anxiety. However, the number of RCTs that enroll older adults is limited. More methodologically sound RCTs are needed to confirm the efficacy of Qigong exercise on physical and psychological health in older adults with chronic illnesses

Physical and Psychological Effects of Qigong Exercise in Community-Dwelling Older Adults: An Exploratory Study

Older adults need exercise programs that correspond to age-related changes. The purpose of this study was to explore preliminary effects of an 8-week Qigong exercise intervention on the physical ability, functional and psychological health, and spiritual well-being of community-dwelling older adults. Forty-five community-dwelling adults with the mean age of 74.8 years participated a 1-h Health Qigong exercise session twice weekly for 8 weeks. The majority were female (84%) and white (91%), and lived with their spouse (49%). Physical ability (p < 0.001), functional health (p = 0.001), balance (p < 0.001), functional reach (p < 0.001), depression (p = 0.005), and spiritual well-being (p = 0.004) improved significantly after the 8-week intervention. Most participants perceived physical ability, mental health, and spiritual well-being benefits. No adverse events were reported. A twice weekly Qigong exercise program over 8 weeks is feasible and has potential to improve physical ability, functional health, balance, psychological health, and spiritual well-being in older adults

Accreditation Standard Guideline Initiative for Tai Chi and Qigong Instructors and Training Institutions.

Evidence of the health and wellbeing benefits of Tai Chi and Qigong (TQ) have emerged in the past two decades, but TQ is underutilized in modern health care in Western countries due to lack of promotion and the availability of professionally qualified TQ instructors. To date, there are no government regulations for TQ instructors or for training institutions in China and Western countries, even though TQ is considered to be a part of Traditional Chinese medicine that has the potential to manage many chronic diseases. Based on an integrative health care approach, the accreditation standard guideline initiative for TQ instructors and training institutions was developed in collaboration with health professionals, integrative medicine academics, Tai Chi and Qigong master instructors and consumers including public safety officers from several countries, such as Australia, Canada, China, Germany, Italy, Korea, Sweden and USA. In this paper, the rationale for organizing the Medical Tai Chi and Qigong Association (MTQA) is discussed and the accreditation standard guideline for TQ instructors and training institutions developed by the committee members of MTQA is presented. The MTQA acknowledges that the proposed guidelines are broad, so that the diversity of TQ instructors and training institutions can be integrated with recognition that these guidelines can be developed with further refinement. Additionally, these guidelines face challenges in understanding the complexity of TQ associated with different principles, philosophies and schools of thought. Nonetheless, these guidelines represent a necessary first step as primary resource to serve and guide health care professionals and consumers, as well as the TQ community

i Sexual function in breast cancer patients: a prospective study from Iran

Background: Sexual function in patients with breast cancer especially in younger patients is an important issue from clinical and psychosocial perspectives. This study aimed to assess sexual function among Iranian breast cancer patients. Methods: This was a prospective study of sexual function in breast cancer patients attending the Cancer Institute of Iran. Sexual function was assessed using the Female Sexual Function Index (FSFI) at two points in time: baseline (pre-treatment) and after completion of cancer treatment at follow-up visits (post-treatment). Pre- and posttreatment data were compared. In addition logistic regression analysis was performed to find out factors that contributing to post-treatment sexual dysfunction. Results: In all 277 breast cancer patients were approached. Of these, 231 patients (83%) were sexually active and data for 216 patients (93.5 % of sexually active patients) were available at pre-and post-treatment. Overall pre- and post-treatment sexual dysfunction was found to be 52 % and 84%, respectively indicating a significant deterioration in sexual function among breast cancer patients. The results obtained from multiple logistic regression analysis indicated that younger age [OR = 0.95, 95 % CI = 0.93-0.98; P = 0.04], receiving endocrine therapy [OR = 3.34, 95% CI = 1.37-7.91; P = 0.007] and poor sexual function at pre-treatment [OR = 12.3, 95 % CI = 3.93-39.0; P &lt; 0.0001