Early detection of brain metastases in a supervised exercise program for patients with advanced breast cancer : A case report

Introduction Around 25% of metastatic breast cancer (mBC) patients develop brain metastases, which vastly affects their overall survival and quality of life. According to the current clinical guidelines, regular magnetic resonance imaging screening is not recommended unless patients have recognized central nervous system–related symptoms. Patient Presentation The patient participated in the EFFECT study, a randomized controlled trial aimed to assess the effects of a 9-month structured, individualized and supervised exercise intervention on quality of life, fatigue and other cancer and treatment-related side effects in patients with mBC. She attended the training sessions regularly and was supervised by the same trainer throughout the exercise program. In month 7 of participation, her exercise trainer detected subtle symptoms (e.g., changes in movement pattern, eye movement or balance), which had not been noticed or reported by the patient herself or her family, and which were unlikely to have been detected by the oncologist or other health care providers at that point since symptoms were exercise related. When suspicion of brain metastases was brought to the attention of the oncologist by the exercise trainer, the response was immediate, and led to early detection and treatment of brain metastases. Conclusion and clinical implications The brain metastases of this patient were detected earlier due to the recognition of subtle symptoms detected by her exercise trainer and the trust and rapid action by the clinician. The implementation of physical exercise programs for cancer patients requires well-trained professionals who know how to recognize possible alterations in patients and also, good communication between trainers and the medical team to enable the necessary actions to be taken

Co-creation of an ICT-supported cancer rehabilitation application for resected lung cancer survivors: design and evaluation

Background Lung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of telehealthcare applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this article is to report on this process of co-creation and evaluation of a multimodal ICT-supported cancer rehabilitation program with and for lung cancer patients treated with lung resection and their healthcare professionals (HCPs). Methods A user-centered design approach was used. Through semi-structured interviews (n = 10 LC patients and 6 HCPs), focus groups (n = 5 HCPs), and scenarios (n = 5 HCPs), user needs and requirements were elicited. Semi-structured interviews and the System Usability Scale (SUS) were used to evaluate usability of the telehealthcare application with 7 LC patients and 10 HCPs. Results The developed application consists of: 1) self-monitoring of symptoms and physical activity using on-body sensors and a smartphone, and 2) a web based physical exercise program. 71 % of LC patients and 78 % of HCPs were willing to use the application as part of lung cancer treatment. Accessibility of data via electronic patient records was essential for HCPs. LC patients regarded a positive attitude of the HCP towards the application essential. Overall, the usability (SUS median score = 70, range 35–95) was rated acceptable. Conclusions A telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicine

A pilot randomized controlled trial of exercise to improve cognitive performance in patients with stable glioma:A proof of concept

BACKGROUND: Patients with glioma often suffer from cognitive deficits. Physical exercise has been effective in ameliorating cognitive deficits in older adults and neurological patients. This pilot randomized controlled trial (RCT) explored the possible impact of an exercise intervention, designed to improve cognitive functioning in glioma patients, regarding cognitive test performance and patient-reported outcomes (PROs). METHODS: Thirty-four clinically stable patients with World Health Organization grades II/III glioma were randomized to a home-based remotely coached exercise group or an active control group. Patients exercised 3 times per week for 20-45 minutes, with moderate to vigorous intensity, during 6 months. At baseline and immediate follow-up, cognitive performance and PROs were assessed with neuropsychological tests and questionnaires, respectively. Linear regression analyses were used to estimate effect sizes of potential between-group differences in cognitive performance and PROs at 6 months. RESULTS: The exercise group (n = 21) had small- to medium-sized better follow-up scores than the control group (n = 11) on several measures of attention and information processing speed, verbal memory, and executive function, whereas the control group showed a slightly better score on a measure of sustained selective attention. The exercise group also demonstrated small- to medium-sized better outcomes on measures of self-reported cognitive symptoms, fatigue, sleep, mood, and mental health-related quality of life. CONCLUSIONS: This small exploratory RCT in glioma patients provides a proof of concept with respect to improvement of cognitive functioning and PROs after aerobic exercise, and warrants larger exercise trials in brain tumor patients

Nonexercise Interventions for Prevention of Musculoskeletal Injuries in Armed Forces: A Systematic Review and Meta-Analysis

Context: This study evaluates the effect of nonexercise interventions on the reduction of risk for musculoskeletal injuries in armed forces. Evidence acquisition: A database search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, CINAHL, SPORTdiscus, Greylit, Open Grey, the WHO trial registry, and the reference lists of included articles up to July 2019. RCTs and cluster RCTs evaluating nonexercise interventions for the prevention of musculoskeletal injuries in armed forces compared with any other intervention(s) or no intervention were eligible for inclusion. Data extraction and risk of bias assessment were done by 2 authors independently, followed by meta-analysis and Grading of Recommendations Assessment, Development,

Social and Economic Challenges of Implementing Sustainable Materials on Buildings in Kuwait

Many factors affect attaining the required credits for LEED materials and Many factors affect attaining the required credits for LEED materials and resources (MR) section. There are disadvantages in obtaining credits and LEED certifying an existing building in Kuwait to become a sustainable green building. LEED is still relatively new in Kuwait and the Gulf region, therefore, when certifying an existing governmental building, difficultly is faced with obtaining complete building owners, building upper management and occupant cooperation. This raises challenges when requiring cooperation from building occupants and cleaning staff for the solid waste management credits which require dedication to reduce the amount of waste going to landfills and incinerating facilities. The mindset of the contractor and subcontractor has to change to gain full understanding and cooperation in the waste management of construction materials when constructing new buildings and performing facility alterations on site. The selection of sustainable materials is more challenging as many materials are not available in Kuwait and the surrounding Gulf countries. Transportation from aboard should be decreased as much as possible to reduce cost as well as decreasing negative environmental impacts. Green certified materials are more expensive, therefore decision maker have to be willing to pay the extra cost. This paper discusses the challenges faced by KISR team as a consultancy body to certify an existing building according to LEED rating system from the material and resources aspect. It discusses the acceptance of the building owners, building upper management and the building occupants to this change and their understanding and cooperation. Many materials for MR credits 2 and 3 were found difficult to be obtained in Kuwait and the surrounding gulf region. Some materials were found to be available in the resources (MR) section. There are disadvantages in obtaining credits and LEED certifying an existing building in Kuwait to become a sustainable green building. LEED is still relatively new in Kuwait and the Gulf region, therefore, when certifying an existing governmental building, difficultly is faced with obtaining complete building owners, building upper management and occupant cooperation. This raises challenges when requiring cooperation from building occupants and cleaning staff for the solid waste management credits which require dedication to reduce the amount of waste going to landfills and incinerating facilities. The mindset of the contractor and subcontractor has to change to gain full understanding and cooperation in the waste management of construction materials when constructing new buildings and performing facility alterations on site. The selection of sustainable materials is more challenging as many materials are not available in Kuwait and the surrounding Gulf countries. Transportation from aboard should be decreased as much as possible to reduce cost as well as decreasing negative environmental impacts. Green certified materials are more expensive, therefore decision maker have to be willing to pay the extra cost. This paper discusses the challenges faced by KISR team as a consultancy body to certify an existing building according to LEED rating system from the material and resources aspect. It discusses the acceptance of the building owners, building upper management and the building occupants to this change and their understanding and cooperation. Many materials for MR credits 2 and 3 were found difficult to be obtained in Kuwait and the surrounding gulf region. Some materials were found to be available in th

Physical Activity and Cardiac Function in Long-Term Breast Cancer Survivors:A Cross-Sectional Study

Background: Higher levels of physical activity are associated with a lower risk of cardiovascular disease in the general population. Whether the same holds for women who underwent treatment for breast cancer is unclear. Objectives: The aim of this study was to evaluate the association between physical activity in a typical week in the past 12 months and cardiac dysfunction in breast cancer survivors. Methods: We used data from a cohort of breast cancer survivors who were treated at ages 40 to 50 years (N = 559). The association between physical activity and global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF) was evaluated using both linear and modified Poisson regression analyses adjusted for relevant confounders. Results: In total, 559 breast cancer survivors were included, with median age of 55.5 years and a median time since treatment of 10.2 years. GLS was less favorable in inactive survivors (−17.1%) than in moderately inactive (−18.4%), moderately active (−18.2%), and active survivors (−18.5%), with an adjusted significant difference for active versus inactive survivors (β = −1.31; 95% CI: −2.55 to −0.06)). Moderately active (n = 57/130) and active survivors (n = 87/124) had significantly lower risks of abnormal GLS (defined as >−18%) compared with inactive survivors (n = 17/26) (RR: 0.65 [95% CI: 0.45-0.94] and RR: 0.61 [95% CI: 0.43-0.87], respectively). LVEF, in normal ranges in all activity categories, was not associated with physical activity. Conclusions: In long-term breast cancer survivors, higher physical activity levels were associated with improved GLS but not LVEF, with the relatively largest benefit for doing any activity versus none. This finding suggests that increasing physical activity may contribute to cardiovascular health benefits, especially in inactive survivors