SafeFit Trial: Virtual clinics to deliver a multimodal intervention to improve psychological and physical wellbeing in people with cancer. Protocol of a COVID-19 targeted non-randomised phase III trial

Introduction: The impact of the COVID-19 pandemic (caused by the SArS-CoV-2 virus), on individuals with cancer has been profound. It has led to increased anxiety, distress and deconditioning due to reduced physical activity. We aim to investigate whether SafeFit; a multi-modal intervention of physical activity, nutrition and psychological support delivered virtually by cancer exercise specialists (CES) can improve physical and emotional functioning during the COVID-19 pandemic.Methods and analysis: A phase III non-randomised intervention trial, target recruitment of 1050 adults with suspected or confirmed diagnosis of cancer. All recruited participants will receive the multimodal intervention delivered by CES for six months. Sessions will be delivered 1-to-1 using telephone/video conferencing consultations. CES will work with each participant to devise a personalised programme of 1) physical activity, 2) basic dietary advice and 3) psychological support, all underpinned by a behaviour change intervention.Primary outcome: Physical and emotional functioning as measured by the EORTC-QLQ-C30. Secondary outcomes: Overall quality of life measured by EORTC-QLQ-C30 and EQ-5D-5L, health economics, patient activation, self-efficacy to self-manage chronic disease, distress, Impact of Covid-19 on emotional functioning, self-reported physical activity, functional capacity and nutrition. Adherence to the intervention will also be measured and a process evaluation conducted. Ethics and dissemination: Ethical approval was obtained from the Health Research Authority (reference number: 20/NW/0254). Results of this trial will be disseminated through publication of peer reviewed articles, presentations at scientific conferences and to the public and people with cancer in collaboration with our patient and public involvement representatives and partners. Trial registration: NCT0442561

Resting and exercising cardiorespiratory variables and acute mountain sickness

The incidence of AMS in our study was low reflecting a conservative ascent profile. Further larger studies are necessary to fully assess the predictive value of cardiorespiratory variables in AMS

The Young Everest Study: effects of hypoxia at high altitude on cardiorespiratory function and general well-being in healthy children

A wide range of physiological responses to altitude are evident in healthy children. This study should inform future larger studies in children to improve understanding of responses to hypoxia in health and diseas

Caudwell Xtreme Everest: An Overview

The Caudwell Xtreme Everest (CXE) expedition in the spring of 2007 systematically studied 222 healthy volunteers as they ascended from sea level to Everest Base Camp (5300 m). A subgroup of climbing investigators ascended higher on Everest and obtained physiological measurements up to an altitude of 8400 m. The aim of the study was to explore inter-individual variation in response to environmental hypobaric hypoxia in order to understand better the pathophysiology of critically ill patients and other patients in whom hypoxaemia and cellular hypoxia are prevalent. This paper describes the aims, study characteristics, organization and management of the CXE expedition

Changes in muscle proteomics in the course of the Caudwell Research Expedition to Mt. Everest

This study employed differential proteomic and immunoassay techniques to elucidate the biochemical mechanisms utilized by human muscle (vastus lateralis) in response to high altitude hypoxia exposure. Two groups of subjects, participating in a medical research expedition (A, n = 5, 19d at 5300m altitude; B, n = 6, 66d up to 8848m) underwent a 48 30% drop of muscular creatine kinase and of glycolytic enzymes abundance. Protein abundance of most enzymes of the tricarboxylic acid cycle and oxidative phosphorylation was reduced both in A and, particularly, in B. Restriction of \u3b1-ketoglutarate toward succinyl-CoA resulted in increased prolyl hydroxylase 2 and glutamine synthetase. Both A and B were characterized by a reduction of elongation factor 2alpha, controlling protein translation, and by an increase of heat shock cognate 71 kDa protein involved in chaperone-mediated autophagy. Increased protein levels of catalase and biliverdin reductase occurred in A alongside a decrement of voltage-dependent anion channels 1 and 2 and of myosin-binding protein C, suggesting damage to the sarcomeric structures. This study suggests that during acclimatization to hypobaric hypoxia the muscle behaves as a producer of substrates activating a metabolic reprogramming able to support anaplerotically the TCA cycle, to control protein translation, to prevent energy expenditure and to activate chaperone-mediated autophagy

Dataset for: Enhanced flow-motion complexity of skin microvascular perfusion in Sherpas and lowlanders during ascent to high altitude

Data for microvascular perfusion and its analysis used to produce the paper &quot;Enhanced flow-motion complexity of skin microvascular perfusion in Sherpas and lowlanders during ascent to high altitude&quot; published in Scientific Reports.</span

Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation

The use of perioperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative events and inform the perioperative management of patients undergoing surgery has increased over the last decade. CPET provides an objective assessment of exercise capacity preoperatively and identifies the causes of exercise limitation. This information may be used to assist clinicians and patients in decisions about the most appropriate surgical and non-surgical management during the perioperative period. Information gained from CPET can be used to estimate the likelihood of perioperative morbidity and mortality, to inform the processes of multidisciplinary collaborative decision making and consent, to triage patients for perioperative care (ward vs critical care), to direct preoperative interventions and optimization, to identify new comorbidities, to evaluate the effects of neoadjuvant cancer therapies, to guide prehabilitation and rehabilitation, and to guide intraoperative anaesthetic practice. With the rapid uptake of CPET, standardization is key to ensure valid, reproducible results that can inform clinical decision making. Recently, an international Perioperative Exercise Testing and Training Society has been established (POETTS www.poetts.co.uk) promoting the highest standards of care for patients undergoing exercise testing, training, or both in the perioperative setting. These clinical cardiopulmonary exercise testing guidelines have been developed by consensus by the Perioperative Exercise Testing and Training Society after systematic literature review. The guidelines have been endorsed by the Association of Respiratory Technology and Physiology (ARTP).</p