Mental Strategies of Elite High Altitude Climbers: Overcoming Adversity on Mount Everest

The purpose of this study was to explore the mental strategies used by elite Mount Everest climbers to overcome obstacles while ascending and descending the mountain. Individual interviews were carried out with 10 climbers who have successfully reached the summit of Mount Everest. Common strategies of success were identified, as well as factors that created difficulty on the mountain. The themes of focus, mental toughness, short-term goals, drawing on past experience, connecting to one\u27s body, feeling support from other climbers, and belief in personal capacities were seen to have importance in overcoming adversity on the mountain. These results support mental training as an effective tool for overcoming obstacles in the high stress environment of high altitude climbing

High altitude climbers as ethnomethodologists making sense of cognitive dissonance: ethnographic insights from an attempt to scale Mt Everest

This ethnographic study examined how a group of high altitude climbers (N = 6)drew on ethnomethodological principles (the documentary method of interpretation, reflexivity, indexicality, and membership) to interpret their experiences of cognitive dissonance during an attempt to scale Mt. Everest. Data were collected via participant observation, interviews, and a field diary. Each data source was subjected to a content mode of analysis. Results revealed how cognitive dissonance reduction is accomplished from within the interaction between a pattern of self-justification and self-inconsistencies; how the reflexive nature of cognitive dissonance is experienced; how specific features of the setting are inextricably linked to the cognitive dissonance experience; and how climbers draw upon a shared stock of knowledge in their experiences with cognitive dissonance

Fostering Growth in the Survivorship Experience: Investigating Breast Cancer Survivors’ Lived Experiences Scaling Mt. Kilimanjaro from a Posttraumatic GrowthPerspective

The aim of this study was to use an ethnographic case study approach to explore breast cancer survivors’ experiences scaling Mt. Kilimanjaro from a posttraumatic growth perspective. Three breast cancer survivors who participated in interviews and observations during a nine-day climb on the mountain were included in this study. Findings are presented first as three individual case studies and then offered as a cross-case analysis to emphasize themes that illustrated the women’s shared experiences of growing from adversity. Participation in the climb on Mt. Kilimanjaro provided an opportunity for the women to (a) nurture priorities, (b) foster self-belief, and (c) cultivate connections. Future research should conduct investigations into the role of physical activity as a facilitator of the posttraumatic growth process

The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial

Background: Promoting quality of life (QoL) is a key priority in cancer care. We investigated the hypothesis that, in comparison to usual care, exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain, fatigue, and insomnia, and will improve physical and mental health perceptions in patients with locally advanced stage rectal cancer. Methods: In this non-randomized controlled pilot trial, patients in the supervised exercise group (EG; Mage = 64 years; 64% male) and in the control group (CG; Mage = 72 years; 69% male) completed the European Organization for Research and Treatment of Cancer core Quality of Life questionnaire and the RAND 36-Item Health Survey three times: pre-neoadjuvant chemoradiation therapy (Time 1; nEC = 24; nCG = 11), post-neoadjuvant chemoradiation therapy/pre-exercise intervention (Time 2; nEC = 23; nCG = 10), and post-exercise intervention (Time 3; nEC = 22; nCG = 10). The 6-week exercise intervention was delivered in hospital and comprised of interval aerobic training. Patients trained in pairs three times per week for 30 to 40 minutes. Data were analyzed by Mann-Whitney tests and by Wilcoxon matched-pairs signed rank tests. Results: No significant between-group differences in change were found for any of the outcomes. In both groups, fatigue levels decreased and physical health perceptions increased from pre- to post-exercise intervention. Pain levels also decreased from pre- to post-exercise intervention, albeit not significantly. Conclusions: The findings from this study can be used to guide a more definitive trial as they provide preliminary evidence regarding the potential effects of pre-operative exercise on self-reported pain, fatigue, insomnia, and health perceptions in patients with locally advanced rectal cancer. Trial registration: This study has been registered with clinicaltrials.gov (NCT01325909; March 29, 2011)

The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients (The EMPOWER Trial): Study protocol for a randomised controlled trial

Background: The standard treatment pathway for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Neoadjuvant CRT has been shown to decrease physical fitness, and this decrease is associated with increased post-operative morbidity. Exercise training can stimulate skeletal muscle adaptations such as increased mitochondrial content and improved oxygen uptake capacity, both of which are contributors to physical fitness. The aims of the EMPOWER trial are to assess the effects of neoadjuvant CRT and an in-hospital exercise training programme on physical fitness, health-related quality of life (HRQoL), and physical activity levels, as well as post-operative morbidity and cancer staging. Methods/Design: The EMPOWER Trial is a randomised controlled trial with a planned recruitment of 46 patients with locally advanced rectal cancer and who are undergoing neoadjuvant CRT and surgery. Following completion of the neoadjuvant CRT (week 0) prior to surgery, patients are randomised to an in-hospital exercise training programme (aerobic interval training for 6 to 9 weeks) or a usual care control group (usual care and no formal exercise training). The primary endpoint is oxygen uptake at lactate threshold ( V · o 2 at δ L ) measured using cardiopulmonary exercise testing assessed over several time points throughout the study. Secondary endpoints include HRQoL, assessed using semi-structured interviews and questionnaires, and physical activity levels assessed using activity monitors. Exploratory endpoints include post-operative morbidity, assessed using the Post-Operative Morbidity Survey (POMS), and cancer staging, assessed by using magnetic resonance tumour regression grading. Discussion: The EMPOWER trial is the first randomised controlled trial comparing an in-hospital exercise training group with a usual care control group in patients with locally advanced rectal cancer. This trial will allow us to determine whether exercise training following neoadjuvant CRT can improve physical fitness and activity levels, as well as other important clinical outcome measures such as HRQoL and post-operative morbidity. These results will aid the design of a large, multi-centre trial to determine whether an increase in physical fitness improves clinically relevant post-operative outcomes

Living in the mo(ve)ment: An ethnographic exploration of hospice patients’ experiences of participating in Tai Chi

Purpose: Tai Chi is increasingly being used as a complimentary therapy in hospice care to help patients self-manage multiple and complex health needs. However, currently there is limited understanding of Tai Chi from patients’ perspective, including what participation in this mindfulness based movement (MBM) exercise means to their experiences of living with an advanced, incurable disease. The purpose of this study was to explore outpatients’ lived experiences of hospice-based Tai Chi in relation to mindfulness. Methods: 19 participants (15 females; 4 males, aged between 50 and 91 years old) with a range of advanced, incurable diseases (cancer, COPD, pulmonary fibrosis, pulmonary arterial hypertension) who attended day therapy at a local hospice took part in Tai Chi sessions. Using a focused ethnographic approach, multi-methods including 17 semi-structured interviews (averaging 40 min), participant observations (equating to 200 h spent in the day therapy unit), and informal conversations were used to collect data over a 6 month period. Data was analysed using a thematic framework approach. Results: Four main themes were constructed that demonstrated participants’ lived experiences of mindfulness during participation in hospice-based Tai Chi sessions. Main themes included: (1) mind-body respite; (2) being present with others; (3) tranquil and therapeutic atmosphere and; (4) physical limitations. Conclusion: Tai Chi may be an important therapeutic strategy for helping patients with advanced, incurable disease experience mindfulness. The findings of this study support the use of MBM exercises such as Tai Chi as a non-pharmacological adjunct to conventional treatments within palliative care settings

Exploring the experience of adhering to a prescribed pre-surgical exercise program for patients with advanced rectal cancer: a phenomenological study

Objectives: the aim of this study was to explore the lived experience of patients with advanced rectal cancer as they attempted to adhere to a prescribed, hospital-based pre-surgical exercise program.Design/methods: ten patients took part in three semi-structured in-depth interviews prior to (week 0), midway (week 3), and at completion (week 6) of the exercise program. Data were analysed using a phenomenological approach.Results: main themes that were deemed important for remaining enrolled in the program included: (1) building camaraderie and peer support, (2) experiencing a sense of structure and control, and (3) feeling safe and encouraged. Patients also reported engaging in further exercise outside the program and feeling motivated to continue exercising in the future.Conclusions: this study shows the potential to integrate exercise prior to surgery as it was viewed as acceptable and feasible by patients with advanced rectal cancer. Moreover, it provides much needed information into the possible mechanisms that underpin patient's continued participation in exercise programs during treatment for advanced rectal cancer. Prescribed, hospital-based program should be implemented to promote opportunities for exercise and provide on-going supportive care options for patients awaiting surgery

Patients' perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise.

Based on these data, preoperative exercise programs can be effective in promoting QoL among patients diagnosed and treated for locally advanced rectal cancer during a particularly difficult time in the cancer trajectory. Additional research is needed to develop and evaluate implementation strategies to facilitate the delivery of preoperative exercise programs as part of routine care in this population

The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients (The EMPOWER Trial): study protocol for a randomised controlled trial.

BackgroundThe standard treatment pathway for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Neoadjuvant CRT has been shown to decrease physical fitness, and this decrease is associated with increased post-operative morbidity. Exercise training can stimulate skeletal muscle adaptations such as increased mitochondrial content and improved oxygen uptake capacity, both of which are contributors to physical fitness. The aims of the EMPOWER trial are to assess the effects of neoadjuvant CRT and an in-hospital exercise training programme on physical fitness, health-related quality of life (HRQoL), and physical activity levels, as well as post-operative morbidity and cancer staging.Methods/designThe EMPOWER Trial is a randomised controlled trial with a planned recruitment of 46 patients with locally advanced rectal cancer and who are undergoing neoadjuvant CRT and surgery. Following completion of the neoadjuvant CRT (week 0) prior to surgery, patients are randomised to an in-hospital exercise training programme (aerobic interval training for 6 to 9 weeks) or a usual care control group (usual care and no formal exercise training). The primary endpoint is oxygen uptake at lactate threshold ([Formula: see text] at [Formula: see text]) measured using cardiopulmonary exercise testing assessed over several time points throughout the study. Secondary endpoints include HRQoL, assessed using semi-structured interviews and questionnaires, and physical activity levels assessed using activity monitors. Exploratory endpoints include post-operative morbidity, assessed using the Post-Operative Morbidity Survey (POMS), and cancer staging, assessed by using magnetic resonance tumour regression grading.DiscussionThe EMPOWER trial is the first randomised controlled trial comparing an in-hospital exercise training group with a usual care control group in patients with locally advanced rectal cancer. This trial will allow us to determine whether exercise training following neoadjuvant CRT can improve physical fitness and activity levels, as well as other important clinical outcome measures such as HRQoL and post-operative morbidity. These results will aid the design of a large, multi-centre trial to determine whether an increase in physical fitness improves clinically relevant post-operative outcomes.Trial registrationClinicalTrials.gov NCT01914068 (received: 7 June 2013).SponsorUniversity Hospital Southampton NHS Foundation Trust