Intervenciones con actividad física supervisada en el manejo de la fatiga relacionada con el cáncer: Una revisión sistemática

Metodology: Systematic review of randomized controlled trials. Adults (>20 years old) diagnosed with any type of cancer regardless of treatment or diagnosis stage. Physical activity interventions (aerobic and resistance training) supervised by health professionals. CRF was the primary outcome measure, whilst secondary outcomes included depression, the comparison between supervised and non-supervised interventions, physical and functional wellbeing. Risk of bias and methodological quality were evaluated using the PEDro scale.Background: Cancer-related fatigue is the most common and distressing symptom among cancer survivors; physical activity has been proposed as a safe and effective intervention to control it. Objective: This study aimed to determine the effectiveness of supervised physical activity interventions for the management of cancer-related fatigue (CRF).Results: Fourteen studies (n=14) were included (n=1638) with low risk of bias (PEDro mean score=6,5±1). Supervised physical activity significantly improved CRF; similar results were found for resistance training. Further, supervised physical activity was more effective than conventional care for improving CRF among breast cancer.Conclusion: Supervised physical activity interventions provide an overall reduction on CRF. These findings suggest that guidelines of aerobic and resistance training should be included in oncologic rehabilitation programs. © 2014, Grupo Aula Medica S.A. All rights reserved

Evidence to decision frameworks enabled structured and explicit development of healthcare recommendations

Altres ajuts: Universidad Santo Tomás, Bogotá, Colombia (FODEIN project code: 2115005).Objective: The aim of this study is to identify and describe the processes suggested for the formulation of healthcare recommendations in healthcare guidelines available in guidance documents. Methods: We searched international databases in May 2020 to retrieve guidance documents published by organizations dedicated to guideline development. Pairs of researchers independently selected and extracted data about the characteristics of the guidance document, including explicit or implicit recommendation-related criteria and processes considered, as well as the use of evidence to decision (EtD) frameworks. Results: We included 68 guidance documents. Most organizations reported a system for grading the strength of recommendations (88%), half of them being the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Two out of three guidance documents (66%) proposed the use of a framework to guide the EtD process. The GRADE-EtD framework was the most often reported framework (19 organizations, 42%), whereas 20 organizations (44%) proposed their own multicriteria frameworks. Using any EtD framework was related with a more comprehensive set of recommendation-related criteria compared to no framework, especially for criteria like values, equity, and acceptability. Conclusion: Although limited, the use of EtD frameworks was associated with the inclusion of relevant recommendation criteria. Among the EtD structured frameworks, the GRADE-EtD framework offers the most comprehensive perspective for evidence-informed decision-making processes

Pulmonary rehabilitation for acute exacerbations of COPD: A systematic review

Introduction and objectives: This systematic review summarized the evidence on the effects (benefits and harms) of pulmonary rehabilitation for individuals with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Material and methods: We included randomized controlled trials comparing pulmonary rehabilitation to either active interventions or usual care regardless of setting. In March 2022, we searched MEDLINE, Scopus, CENTRAL, CINAHL and Web of Sciences, and trial registries. Record screening, data extraction and risk of bias assessment were undertaken by two reviewers. We assessed the certainty of the evidence using the GRADE approach. Results: This systematic review included 18 studies (n = 1465), involving a combination of mixed settings (8 studies), inpatient settings (8 studies), and outpatient settings (2 studies). The studies were at high risk of performance, detection, and reporting biases. Compared to usual care, pulmonary rehabilitation probably improves AECOPD-related hospital readmissions (relative risk 0.56, 95% CI 0.36 to 0.86; moderate certainty evidence) and cardiovascular submaximal capacity (standardized mean difference 0.73, 95% CI 0.48 to 0.99; moderate certainty evidence). Low certainty evidence suggests that pulmonary rehabilitation may be beneficial on re-exacerbations, dyspnoea, and impact of disease. The evidence regarding the effects of pulmonary rehabilitation on health-related quality of life and mortality is very uncertain (very low certainty evidence). Conclusion: Our results indicate that pulmonary rehabilitation may be an effective treatment option for individuals with AECOPD, irrespective of setting. Our certainty in this evidence base was limited due to small studies, heterogeneous rehabilitation programs, numerous methodological weaknesses, and a poor reporting of findings that were inconsistent with each other. Trialists should adhere to the latest reporting standards to strengthen this body of evidence. Registration: The study protocol was registered in Open Science Framework (https://osf.io/amgbz/)publishe

Modulación de factores de crecimiento similares a la insulina después del ejercicio en el cáncer de mama: un metanálisis de ensayos controlados aleatorios

Background: Insulin resistance,Insulin-like growth factor 1 (IGF-1), IGF-2 and IGF binding protein-3 (IGFBP-3) are associated with breast cancer risk, cell growing, apoptosis and other tumoral mechanisms. This study aimed to determine the changes on IGF system following exercise in women with breast cancer. Methods: PRISMA statement and the Cochrane Handbook were followed. We searched MEDLINE, Ovid, EMBASE and Cochrane Central Registers to identify randomized controlled trials published between 1990 and October 2014. Primary outcomes measures were: Insulin resistance,IGF1, IGF-2 and IGFBP-3, whilst waist circumference was evaluated as a measure of body composition. For pooled analysis, mean difference (MD) (p < 0.05 with 95% Confidence interval). Results: Seven studies (n = 321) were included. There was high quality and a low risk of bias. Pooled analyses demonstrated that exercise training resulted in significant changes on IGF-I (MD = -12.9, 95%CI -16.73 to -9.14), IGF-II (MD = -43.4, 95%CI -58.5 to -28.3), IGFBP-3 (MD = -0.61, 95%CI -0.69 to -0.53) and waist circumference (MD = -1.13, 95%CI -2.20 to -0.05). Conversely, non-significant differences were found for Insulin Resistance (MD = 0.64, 95%CI -0.01 to 1.29), Insulin (MD = 0.04, 95%CI -0.24 to 0.34) and Glucose (MD = 0.22, 95%CI -0.32 to 0.78). Reporting bias was not observed. Conclusions: The serum levels of insulin like growth factors (IGF1-IGF2) and IGFBP3 were positively modulated by exercise training in breast cancer survivors, enhancing the physiological basis of exercise in regulating cellular proliferation and other tumoral mechanisms in breast cancer

Inflamación de bajo grado y entrenamiento físico en mujeres con cáncer de mama: un metanálisis con metarregresión.

Background: Strong evidence has demonstrated that exercise training reduces breast cancer risk by 10-25%, and several biological mechanisms have been proposed to explain the positive modulation of inflammatory mediators associated with the tumor microenvironment. This study aims to determine the effects of exercise training on markers of low-grade inflammation in breast cancer survivors. Methods: A systematic literature review of randomized controlled trials (RCTs) evaluating the changes in inflammatory mediators in breast cancer survivors after exercise training was performed. The PubMed, Embase, Scopus and CENTRAL databases and other gray literature resources were searched without language restrictions from January 1990 to March 2014. Two investigators screened and identified the studies that met the inclusion criteria. An inverse of variance model of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity (I2< 50%). Publication bias was evaluated using Egger’s test (p < 0.05). Results: Nine high-quality RCTs (n = 349) were ultimately included. Exercise training improved the serum concentrations of IL-6 (mean difference (MD) = -0.37, 95%CI -0.61 to -0.12), IL-2 (MD = 1.03, 95%CI 0.39 to 1.66), IL-8 (MD = -0.49, 95%CI -0.89 to-0.08) and TNF-? (MD = -0.48, 95%CI -0.96 to -0.003, p = 0.04). Conversely, no significant differences were found in the serum concentrations of C-reactive protein (CRP) or IL-10. There was no evidence of publication bias (p= 0.06). Conclusions: Exercise training positively modulates low-grade inflammation in women with breast cancer, impacting carcinogenic mechanisms and the tumor microenvironment. Additional RCTs are required to further elucidate the anti-inflammatory effects of exercise on breast cancer survivors.Background: Strong evidence has demonstrated that exercise training reduces breast cancer risk by 10-25%, and several biological mechanisms have been proposed to explain the positive modulation of inflammatory mediators associated with the tumor microenvironment. This study aims to determine the effects of exercise training on markers of low-grade inflammation in breast cancer survivors. Methods: A systematic literature review of randomized controlled trials (RCTs) evaluating the changes in inflammatory mediators in breast cancer survivors after exercise training was performed. The PubMed, Embase, Scopus and CENTRAL databases and other gray literature resources were searched without language restrictions from January 1990 to March 2014. Two investigators screened and identified the studies that met the inclusion criteria. An inverse of variance model of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity (I2< 50%). Publication bias was evaluated using Egger’s test (p < 0.05). Results: Nine high-quality RCTs (n = 349) were ultimately included. Exercise training improved the serum concentrations of IL-6 (mean difference (MD) = -0.37, 95%CI -0.61 to -0.12), IL-2 (MD = 1.03, 95%CI 0.39 to 1.66), IL-8 (MD = -0.49, 95%CI -0.89 to-0.08) and TNF-? (MD = -0.48, 95%CI -0.96 to -0.003, p = 0.04). Conversely, no significant differences were found in the serum concentrations of C-reactive protein (CRP) or IL-10. There was no evidence of publication bias (p= 0.06). Conclusions: Exercise training positively modulates low-grade inflammation in women with breast cancer, impacting carcinogenic mechanisms and the tumor microenvironment. Additional RCTs are required to further elucidate the anti-inflammatory effects of exercise on breast cancer survivors

Conocimientos, actitudes y prácticas de las estudiantes universitarias sobre el autoexamen de mamas y los factores de riesgo relacionados con el comportamiento para el cáncer de mama: un análisis transversal.

Background: Breast cancer is a growing public health problem worldwide. Breast-self examination (BSE) is an inexpensive strategy proposed to improve early detection behaviors. Behavioral risk factors are crucial for cancer control. More than half of breast cancer cases can be prevented through behavior change. This study aimed to describe and establish assocations between the knowledge, attitudes and practices of breast-self examination, the knowledge about breast cancer risk and behavioral-related risk factors for breast cancer among female college students in Bogotá, Colombia. Methods: A cross-sectional study was carried out involving data from 628 young female students. Data for BSE were collected using a validated tool and the Behavioral Risk Factors Surveillance System (BRFSS) was used for lifestyle-related variables. Results: Women were a mean age of 21.7±11.8 years old. Fifty-seven percent of the women knew how to carry out BSE, although only 26.3% perfom it monthly. Further, a sedentary lifestyle was found in 53.3% of women and similar prevalences were observed for other behavioral variables. BSE was associated with age (p = 0.02), socioeconomic status (p < 0.001), knowledge about risk factors (p < 0.001) and unhealthy lifestyles (p < 0.001). Conclusions: There exists a low level of knowledge and practice of BSE among female college students. This population is at a high-risk of breast cancer beacuse of the critical prevalences of some behaviors related to unhealthy lifestyles found in this study. Further health-promotion strategies are warranted

Intervenciones con actividad física supervisada en el manejo de la fatiga relacionada con el cáncer: Una revisión sistemática

"Metodology: Systematic review of randomized controlled trials. Adults (>20 years old) diagnosed with any type of cancer regardless of treatment or diagnosis stage. Physical activity interventions (aerobic and resistance training) supervised by health professionals. CRF was the primary outcome measure, whilst secondary outcomes included depression, the comparison between supervised and non-supervised interventions, physical and functional wellbeing. Risk of bias and methodological quality were evaluated using the PEDro scale.Background: Cancer-related fatigue is the most common and distressing symptom among cancer survivors; physical activity has been proposed as a safe and effective intervention to control it. Objective: This study aimed to determine the effectiveness of supervised physical activity interventions for the management of cancer-related fatigue (CRF).Results: Fourteen studies (n=14) were included (n=1638) with low risk of bias (PEDro mean score=6,5±1). Supervised physical activity significantly improved CRF; similar results were found for resistance training. Further, supervised physical activity was more effective than conventional care for improving CRF among breast cancer.Conclusion: Supervised physical activity interventions provide an overall reduction on CRF. These findings suggest that guidelines of aerobic and resistance training should be included in oncologic rehabilitation programs. © 2014, Grupo Aula Medica S.A. All rights reserved.