Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial

Physical activity is supposed to decrease mortality of colorectal cancer (CRC) and is suggested to reduce side-effects of the disease and its treatment. However, the knowledge about the influence of exercise interventions on patients suffering from CRC and metastasized CRC (mCRC) is still sparse. One frequently observed side effect in mCRC is chemotherapy-induced peripheral neuropathy (CIPN). This randomized controlled trial investigated the influence of a supervised exercise program on CIPN in mCRC. Thirty patients (stage IV) undergoing outpatient palliative treatment including a median of 23.5 chemotherapy cycles of various regimens were randomly assigned to an intervention or control group (IG, n = 17; CG, n = 13). The IG participated in an eight-week supervised exercise program, including endurance, resistance and balance training (2x/week for 60 min) whereas the CG received written standard recommendations to obtain physical fitness. CIPN was assessed using the FACT/GOG-NTX questionnaire. Moreover, endurance capacity (6MWT), strength (h1RM) and balance (GGT-Reha) were evaluated before (t (0)) and after (t (1)) the intervention as well as after 4 weeks follow-up (t(2)). Neuropathic symptoms remained stable in the IG over time, while CIPN significantly worsened in the CG from t (0) to t (1) and t (0) to t (2). In contrast to the CG, the IG significantly improved in strength and balance function. Changes in CIPN correlated with changes in balance. This is the first investigation showing positive effects of a multimodal exercise program on CIPN, balance and strength on mCRC patients in a palliative setting, thereby consequently increasing patients` quality of life. The results support earlier findings stating a positive influence of balance exercise on CIPN

Motivation and Diabetes: Time for a Paradigm Shift? - A Position Paper -

Non-adherence to treatment recommendations for patients with diabetes is widespread. This applies to medication as well as recommendations for a healthy lifestyle with appropriate physical activity, a healthy diet, and, if necessary, an end to smoking and weight control. Disregard of these recommendations has been shown to increase the risk of diabetes complications, morbidity and premature mortality. Physicians ' responses to this patient behavior include increased efforts to improve adherence to therapy and often result in a feeling of resignation in the long term. Research efforts focus on an increasing number of interventions to improve therapy adherence, with the results of meta-analyses indicating only moderate success. This position paper presents a practice-oriented approach for discussion that aims to improve the problems described. We reflect on the different roles and responsibilities of patients on the one hand and physicians and other professional groups (diabetes counsellors, nurses, and psychotherapists) on the other. A new classification of different types of non-adherence to therapy is proposed. These constitute the starting point for a practice-related algorithm for the medical handling of the different types of non-adherence, in which the roles and responsibilities of practitioners and patients are explicitly clarified. Thereby no adherence to therapy of patients is pushed. Rather, the aim is for patients to make an informed and responsible decision for or against a doctor's suggestion and for this to be accepted by the physician so that frustrations on both sides are avoided. Finally, theses regarding motivation problems in diabetes will be presented for discussion