Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review

AbstractQuestion: What are typical values of physical function for women diagnosed with breast cancer and how do these compare to normative data? Design: Systematic review with meta-analysis. Participants: Women diagnosed with breast cancer who were before, during or after treatment. Outcome measures: Physical function was divided into three categories: aerobic capacity, upper and lower extremity muscular fitness, and mobility. Measures of aerobic capacity included field tests (6-minute walk test, 12-minute walk tests, Rockport 1-mile test, and 2-km walk time) and submaximal/maximal exercise tests on a treadmill or cycle ergometer. Measures of upper and lower extremity muscular fitness included grip strength, one repetition maximum (bench, chest or leg press), muscle endurance tests, and chair stands. The only measure of mobility was the Timed Up and Go test. Results: Of the 1978 studies identified, 85 were eligible for inclusion. Wide ranges of values were reported, reflecting the range of ages, disease severity, treatment type and time since treatment of participants. Aerobic fitness values were generally below average, although 6-minute walk time was closer to population norms. Upper and lower extremity strength was lower than population norms for women who were currently receiving cancer treatment. Lower extremity strength was above population norms for women who had completed treatment. Conclusion: Aerobic capacity and upper extremity strength in women diagnosed with breast cancer are generally lower than population norms. Assessment of values for lower extremity strength is less conclusive. As more research is published, expected values for sub-groups by age, treatment, and co-morbidities should be developed. [Neil-Sztramko SE, Kirkham AA, Hung SH, Niksirat N, Nishikawa K Campbell KL (2014) Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review. Journal of Physiotherapy 60: 189–200

Health-related interventions among night shift workers: a critical review of the literature

This article is originally published by and is under the copyright of the Nordic Association of Occupational Safety and Health. The article can be accessed via https://dx.doi.org/10.5271/sjweh.3445.Objectives: Associations between shift work and chronic disease have been observed, but relatively little is known about how to mitigate these adverse health effects. This critical review aimed to (i) synthesize interventions that have been implemented among shift workers to reduce the chronic health effects of shift work and (ii) provide an overall evaluation of study quality. Methods: MeSH terms and keywords were created and used to conduct a rigorous search of MEDLINE, CINAHL, and EMBASE for studies published on or before 13 August 2012. Study quality was assessed using a checklist adapted from Downs & Black. Results: Of the 5053 articles retrieved, 44 met the inclusion and exclusion criteria. Over 2354 male and female rotating and permanent night shift workers were included, mostly from the manufacturing, healthcare, and public safety industries. Studies were grouped into four intervention types: (i) shift schedule; (ii) controlled light exposure; (iii) behavioral; and, (iv) pharmacological. Results generally support the benefits of fast-forward rotating shifts; simultaneous use of timed bright light and light-blocking glasses; and physical activity, healthy diet, and health promotion. Mixed results were observed for hypnotics. Study quality varied and numerous deficiencies were identified. Conclusions: Except for hypnotics, several types of interventions reviewed had positive overall effects on chronic disease outcomes. There was substantial heterogeneity among studies with respect to study sample, interventions, and outcomes. There is a need for further high-quality, workplace-based prevention research conducted among shift workers

Updated systematic review of exercise studies in breast cancer survivors : Attention to the principles of exercise training

Abstract Objectives To update our previous evaluation of the exercise interventions used in randomised controlled trials of breast cancer survivors in relation to (1) the application of the principles of exercise training in the exercise prescription; (2) the reporting of the components of the exercise prescription; and (3) the reporting of adherence of participants to the prescribed interventions. Design Systematic review. Data sources The OVID Medline, Embase, CINAHL and SPORTDiscus electronic databases were searched from January 2010 to January 2017. Eligibility criteria Randomised controlled trials of at least 4 weeks of aerobic and/or resistance exercise in women diagnosed with breast cancer, reporting on physical fitness or body composition outcomes. Results Specificity was appropriately applied by 84%, progression by 29%, overload by 38% and initial values by 67% of newly identified studies. Reversibility was reported by 3% anddiminishing returns by 22% of newly identified studies. No studies reported all components of the exercise prescription in the methods, or adherence to the prescribed intervention in the results. Reporting of reversibility has increased from 2010, but no other improvements in reporting were noted from the previous review. Summary/Conclusion No studies of exercise in women with breast cancer attended to all principles of exercise training, or reported all components of the exercise prescription in the methods, or adherence to the prescription in the results. Full reporting of the exercise prescribed and completed is essential for study replication in research and translating research findings into the community, and should be prioritised in future trials

Attention to the principles of exercise training in exercise studies on prostate cancer survivors: a systematic review

Background: The purpose of this review is to update previously published reviews on exercise programming in exercise trials in prostate cancer survivors. We evaluated: 1) the application of the principles of exercise training in prescribed programs; 2) the reporting of the components of the exercise prescription; and 3) the reporting of adherence of participants to the prescribed programs. Methods: Building upon a previous review, a systematic review was conducted searching OVID Medline, Embase, CINAHL, and SPORTDiscus databases from 2012-2017. Randomized controlled trials of at least four weeks of aerobic and/or resistance exercise in men diagnosed with prostate cancer that reported physical fitness outcomes, including body composition were eligible for inclusion. Results: Specificity was appropriately applied by 93%, progression by 55%, overload by 48%, initial values by 55%, and diminishing returns by 28% of eligible studies. No study adequately applied the principle of reversibility. Most (79%) studies reported all components of the exercise prescription in the study methods, but no study reported all components of adherence to the prescribed intervention in the study results. Conclusions: Application of standard exercise training principles is inadequate in exercise trials in men with prostate cancer and could possibly lead to an inadequate exercise stimulus. While many studies report the basic components of the exercise prescription in their study methods, full reporting of actual exercise completed is needed to advance our understanding of the optimal exercise dose for men with prostate cancer and promote translation of controlled trials to practice.Medicine, Faculty ofNon UBCPhysical Therapy, Department ofReviewedFacult

Développement et évaluation d’un cours sur les méthodes de recherche en rédaction de protocoles pour apprenants et apprenantes dans un programme de maîtrise en santé publique

Training in research methods is important for improvement of healthcare delivery and population outcomes. Graduate programs of public health play a critical role in offering such education to current and future healthcare professionals as well as entry level learners with no experience in the field. A key skill across all fields of research methods and public health practice is protocol writing. It is unknown if teaching students research methods through protocol writing is a successful strategy and whether students find it to be helpful as they pursue health professions. The objective of this study was to describe the design and evaluation of a research methods course focused on protocol writing among students enrolled a Masters of Public Health Program. A case report design including description of course content, method of evaluation, and course delivery are provided. The setting was the Population and Public Health Research Methods course at a publicly funded institution in Canada. The first three cohorts of students (2016-2018) enrolled in the course were evaluated during the course period and six months after completing the course. A total of 51 students completed the survey, and the majority were students were very or extremely satisfied with the course. Overall students expressed that the course well-prepared them for their practicum or thesis work and post-graduation plans. Findings suggest that using protocol writing as a tool for teaching research methods was well-received by students and prepared them for both their potential career paths and for future research.La formation en méthodes de recherche est importante pour l’amélioration de la prestation des soins de santé et les résultats des populations. Les programmes d’études supérieures en santé publique jouent un rôle essentiel dans la prestation de cette éducation aux professionnels et professionnelles des soins de santé actuels et futurs ainsi qu’aux apprenants et aux apprenantes qui commencent leurs études et qui n’ont aucune expérience dans ce domaine. Une compétence essentielle dans tous les domaines des méthodes de recherche et dans la pratique des soins de santé publique est la rédaction de protocoles. On ne sait pas si le fait d’enseigner aux étudiants et aux étudiantes les méthodes de recherche par le biais de rédaction de protocoles est une stratégie réussie, on ne sait pas non plus si les étudiants et les étudiantes trouvent cela utile alors qu’ils poursuivent leurs études dans les professions de la santé. L’objectif de cette recherche était de décrire la conception et l’évaluation d’un cours sur les méthodes de recherche axé sur la rédaction de protocoles parmi des étudiants et des étudiantes inscrits dans un programme de maîtrise en santé publique. L’article présente un modèle de rapport de cas comprenant la description du contenu du cours, la méthode d’évaluation et la prestation du cours. Il s’agissait du cours intitulé Population and Public Health Research Methods offert dans un établissement canadien subventionné publiquement. Les trois premières cohortes d’étudiants et d’étudiantes (2016-2018) inscrits dans ce cours ont été évalués durant la période où le cours était donné et ensuite, six mois après avoir terminé le cours. Un total de 51 étudiants et étudiantes ont répondu au sondage et la majorité d’entre eux ont indiqué qu’ils étaient très satisfaits ou extrêmement satisfaits du cours. Dans l’ensemble, les étudiants et les étudiantes ont déclaré que le cours les avaient bien préparés pour leur stage pratique ou pour leur thèse ainsi que pour leurs projets d’après l’obtention de leur diplôme. Les résultats suggèrent que l’utilisation de la rédaction de protocoles comme outil pour enseigner les méthodes de recherche avait été bien acceptée par les étudiants et les étudiantes et les avait préparés à la fois pour leur carrière potentielle et pour leurs recherches futures

Attention to the principles of exercise training in exercise studies of persons with lung cancer : A systematic review

The authors systematically reviewed and summarized exercise trials in persons with lung cancer on (a) attention to the principles of exercise training (specificity, progression, overload, initial values, reversibility, and diminishing returns); (b) methodological reporting of FITT (frequency, intensity, time, and type) components; and (c) reporting on participant adherence to prescribed FITT. Randomized controlled trials of exercise that reported on ≥1 physical fitness, physical function, or body composition outcome in persons with lung cancer were included. Of 20 trial arms, none incorporated all principles of exercise training. Specificity was included by 95%, progression by 45%, overload by 75%, and initial values by 80%, while one trial arm applied reversibility and diminishing returns. Fourteen interventions reported all FITT components; however, none reported adherence to each component. Including the principles of training and reporting FITT components will contribute to better understanding of the efficacy of exercise for persons with lung cancer and inform evidence-based exercise prescriptions

Correction to: Attention to principles of exercise training: an updated systematic review of randomized controlled trials in cancers other than breast and prostate

Medicine, Faculty ofNon UBCPhysical Therapy, Department ofReviewedFacultyResearche

Predictors of attendance to an oncologist-referred exercise program for women with breast cancer

Purpose While exercise is associated with numerous benefits in women with breast cancer, adherence to exercise training concurrent to cancer treatment is challenging. We aimed to identify predictors of attendance to an oncologist-referred exercise program offered during and after adjuvant breast cancer treatment. Methods Women with early-stage breast cancer receiving chemotherapy (n = 68) enrolled in the Nutrition and Exercise During Adjuvant Treatment (NExT) study. Supervised aerobic and resistance exercise was prescribed three times per week during treatment, then one to two times per week for 20 additional weeks. Predictors of attendance were identified using multivariate linear regression for three phases of the intervention, including during (1) adjuvant chemotherapy, (2) radiation, and (3) 20-weeks post-treatment. Results Higher baseline quality of life (QoL) predicted higher attendance during chemotherapy (β = 0.51%, 95 CI: 0.09, 0.93) and radiation (β = 0.85%, 95 CI: 0.28, 1.41), and higher QoL, measured at the end of treatment, predicted higher attendance post-treatment (β = 0.81%, 95 CI: 0.34, 1.28). Being employed pre-treatment (β = 34.08%, 95 CI: 5.71, 62.45) and a personal annual income > $80,000 (β = 32.70%, 95 CI: 0.85, 64.55) predicted higher attendance during radiation. Being divorced, separated or widowed (β = − 34.62%, 95 CI: − 56.33, − 12.90), or single (β = − 25.38%, 95 CI: − 40.64, − 10.13), relative to being married/common-law, and undergoing a second surgery (β = − 21.37%, 95 CI: − 33.10, − 9.65) predicted lower attendance post-treatment. Conclusions Demographic variables, QoL, and receipt of a second surgery significantly predicted attendance throughout the NExT supervised exercise program. These results may help identify individuals with exercise adherence challenges and improve the design of future interventions, including optimizing the timing of program delivery

Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review

Abstract Background Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. Methods Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. Results Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. Conclusions There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes

Improving Sleep Quality for Women Who Work Night Shifts : A Pilot Study of a Sleep Hygiene Intervention

Background: Sleep is a modifiable risk factor increasingly linked with cancer incidence. Disrupted sleep patterns and circadian rhythms may increase the risk of developing breast cancer in female night shift workers. This pilot study examined the impact of a sleep hygiene intervention on the sleep quality (SQ) and quality of life (QOL) in women who work night shifts. Methods: A single arm, sleep hygiene intervention was delivered by telephone to a convenience sample of 47 female shift workers (mean age=47yrs) on rotating or permanent night shifts at least 3 times per month for at least 2 years. The program was adapted from a hospital sleep clinic protocol based on cognitive behaviour therapy (CBT) principles. Women received 10 sessions and 2 booster sessions over a 40-week period. SQ was assessed at baseline, 6- and 12-months using the Pittsburgh Sleep Quality Index, a Sleep Diary, and Actigraph readings. QOL was measured by the Quality of Life Enjoyment and Satisfaction Questionnaire. Changes in SQ were examined according to chronotype (morning-type, evening-type, neither-type). Results: SQ improved significantly over the period of the study, with good sleep reported by 21%, 46% and 51% of participants at baseline, 6 months and 12 months, respectively. Consistency was seen across the different SQ measures. The intervention had significant positive effects for all chronotypes, but was more effective for both morning-types and neither-types than for evening-types. Women’s sense of well-being improved after 6 months (p=.01) and was maintained at one year. Conclusion: The CBT-based sleep hygiene intervention led to improvements in sleep quality at 6 months that were maintained at one year. Interventions to improve sleep quality for women shift workers offer a novel approach with the potential to reduce breast cancer risk.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofUnreviewedFacultyResearche