The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management

Objectives: Since Exercise and Sports Science Australia (ESSA) first published its position statement on exercise guidelines for people with cancer, there has been exponential growth in research evaluating the role of exercise pre-, during and post-cancer treatment. Design and Methods: The purpose of this report is to use the current scientific evidence, alongside clinical experience and exercise science principles to update ESSA’s position statement on cancer-specific exercise prescription. Results: Reported in this position statement is a summary of the benefits accrued through exercise following a cancer diagnosis and the strengths and limitations of this evidence-base. An exercise prescription framework is then proposed to enable the application of cancer-specific considerations for individualisation, specificity, safety, feasibility and progression of exercise for all patients. Additional specific exercise prescription considerations are provided for the presence of haematological, musculoskeletal, systemic, cardiovascular, lymphatic, gastrointestinal, genitourinary and neurological disease- and treatment-related concerns, as well as presence of co-morbid chronic disease. Further, we also identify and discuss cancer-specific pragmatic issues and barriers requiring consideration for exercise prescription. Conclusions: While for the majority, multimodal, moderate to high intensity exercise will be appropriate, there is no set prescription and total weekly dosage that would be considered evidence-based for all cancer patients. Targeted exercise prescription, which includes the provision of behaviour change advice and support, is needed to ensure greatest benefit (as defined by the patient) in the short and longer term, with low risk of harm

Effects of Strength Training on Postpubertal Adolescent Distance Runners

**Purpose** Strength training activities have consistently been shown to improve running economy (RE) and neuromuscular characteristics, such as force producing ability and maximal speed, in adult distance runners. However the effects on adolescent (<18 years) runners remains elusive. This randomized control trial aimed to examine the effect of strength training on several important physiological and neuromuscular qualities associated with distance running performance. **Methods** Participants (n=25, 13 female, 17.2 ±1.2 years) were paired according to their sex and RE and randomly assigned to a ten week strength training group (STG), or a control group (CG) who continued their regular training. The STG performed twice weekly sessions of plyometric, sprint and resistance training in addition to their normal running. Outcome measures included body mass, maximal oxygen uptake (V˙O2max), speed at V˙O2max, running economy (quantified as energy cost), speed at fixed blood lactate concentrations (sFBLC), 20 m sprint, and maximum voluntary contraction (MVC) during an isometric quarter-squat. **Results** Eighteen participants (STG, n=9, 16.1 ±1.1 years; CG, n=9, 17.6 ±1.2 years) completed the study. The STG displayed small improvements (3.2-3.7%, ES: 0.31-0.51) in running economy that were inferred as ‘possibly beneficial’ for an average of three submaximal speeds. Trivial or small changes were observed for body composition variables, V˙O2max and sV˙O2max, however the training period provided likely benefits to sFBLC in both groups. Strength training elicited a very likely benefit and a possible benefit to sprint time (ES: 0.32) and MVC (ES: 0.86) respectively. **Conclusion** Ten weeks of strength training added to the programme of a post-pubertal distance runner was highly likely to improve maximal speed, and enhances running economy by a small extent, without deleterious effects on body composition or other aerobic parameters

Practical suggestions for harms reporting in exercise oncology : the Exercise Harms Reporting Method (ExHaRM)

The volume of high-quality evidence supporting exercise as beneficial to cancer survivors has grown exponentially; however, the potential harms of exercise remain understudied. Consequently, the trade-off between desirable and undesirable outcomes of engaging in exercise remains unclear to clinicians and people with cancer. Practical guidance on collecting and reporting harms in exercise oncology is lacking. We present a harms reporting protocol developed and refined through exercise oncology trials since 2015. Development of the Exercise Harms Reporting Method (ExHaRM) was informed by national and international guidelines for harms reporting in clinical trials involving therapeutic goods or medical devices, with adaptations to enhance applicability to exercise. The protocol has been adjusted via an iterative process of implementation and adjustment through use in multiple exercise oncology trials involving varied cancer diagnoses (types: breast, brain, gynaecological; stages at diagnosis I–IV; primary/ recurrent), and heterogeneous exercise intervention characteristics (face to face/telehealth delivery; supervised/unsupervised exercise). It has also involved the development of terms (such as, adverse outcomes, which capture all undesirable physical, psychological, social and economic outcomes) that facilitate the harms assessment process in exercise. ExHaRM involves: step 1: Monitor occurrence of adverse outcomes through systematic and non-systematic surveillance; step 2: Assess and record adverse outcomes, including severity, causality, impact on intervention and type; step 3: Review of causality by harms panel (and revise as necessary); and step 4: Analyse and report frequencies, rates and clinically meaningful details of all-cause and exercise-related adverse outcomes. ExHaRM provides guidance to improve the quality of harms assessment and reporting immediately, while concurrently providing a framework for future refinement. Future directions include, but are not limited to, standardising exercise-specific nomenclature and methods of assessing causality

Declaración de consenso de la organización ejercicio y ciencias del deporte – Australia: el ejercicio como medicina en el manejo del cáncer

Desde la primera publicación de la declaración de consenso sobre pautas de ejercicio para personas con cáncer, de la asociación Ejercicio y Ciencias del Deporte - Australia (ESSA, Exercise and Sports Science Australia), ha ocurrido un crecimiento exponencial en las investigaciones que evalúan el papel del ejercicio antes, durante y después del tratamiento del cáncer. El propósito de este reporte es utilizar la evidencia científica actual, junto a la experiencia clínica y los principios de las ciencias del ejercicio, para poner al día la declaración de consenso de ESSA sobre la prescripción de ejercicio específica para el cáncer. En esta declaración de consenso se reporta un resumen de los beneficios alcanzados mediante el ejercicio luego de un diagnóstico de cáncer, así como las fortalezas y limitaciones de la evidencia acumulada. Se propone, entonces, un marco de prescripción del ejercicio para permitir la aplicación de consideraciones específicas para el cáncer en la individualización, especificidad, seguridad, factibilidad y progresión del ejercicio para toda clase de pacientes. Se ofrecen consideraciones adicionales específicas para la prescripción del ejercicio cuando hay presencia de enfermedades hematológicas, osteomusculares, sistémicas, cardiovasculares, linfáticas, gastrointestinales, genitourinarias y neurológicas y preocupaciones relacionadas con su tratamiento, así como la presencia crónica de comorbilidades. Además, se identifican y comentan temas prácticos específicos y barreras que deben tomarse en cuenta para la prescripción del ejercicio. Si bien es cierto que el ejercicio multimodal de intensidad moderada a intensa será apropiado para la mayoría, no hay una prescripción establecida ni una dosificación semanal, que se puedan considerar basadas en la evidencia, para todos los pacientes de cáncer. Es necesaria una prescripción del ejercicio dirigida específicamente a esta población, que asegure el mayor beneficio (conforme lo defina cada paciente) a corto y largo plazo, con un bajo riesgo de perjuicio

Effects of strength training on postpubertal adolescent distance runners

Purpose Strength training activities have consistently been shown to improve running economy (RE) and neuromuscular characteristics, such as force-producing ability and maximal speed, in adult distance runners. However, the effects on adolescent (<18 yr) runners remains elusive. This randomized control trial aimed to examine the effect of strength training on several important physiological and neuromuscular qualities associated with distance running performance. Methods Participants (n = 25, 13 female, 17.2 ± 1.2 yr) were paired according to their sex and RE and randomly assigned to a 10-wk strength training group (STG) or a control group who continued their regular training. The STG performed twice weekly sessions of plyometric, sprint, and resistance training in addition to their normal running. Outcome measures included body mass, maximal oxygen uptake (VO 2max ), speed at VO 2max , RE (quantified as energy cost), speed at fixed blood lactate concentrations, 20-m sprint, and maximal voluntary contraction during an isometric quarter-squat. Results Eighteen participants (STG: n = 9, 16.1 ± 1.1 yr; control group: n = 9, 17.6 ± 1.2 yr) completed the study. The STG displayed small improvements (3.2%-3.7%; effect size (ES), 0.31-0.51) in RE that were inferred as "possibly beneficial" for an average of three submaximal speeds. Trivial or small changes were observed for body composition variables, VO 2max and speed at VO 2max ; however, the training period provided likely benefits to speed at fixed blood lactate concentrations in both groups. Strength training elicited a very likely benefit and a possible benefit to sprint time (ES, 0.32) and maximal voluntary contraction (ES, 0.86), respectively. Conclusions Ten weeks of strength training added to the program of a postpubertal distance runner was highly likely to improve maximal speed and enhances RE by a small extent, without deleterious effects on body composition or other aerobic parameters

Internet-based information and self-help program for parents of children with burns: Study protocol for a randomized controlled trial

Background: A burn is one of the most traumatic and painful injuries a child can experience and it is also a very stressful experience for the parents. Given the great psychological distress and perceived lack of multi-professional support experienced by the parents, there is a need for support during in-hospital treatment as well as during recovery. The aim of the study is to develop and evaluate an internet-based information and self-help program for parents of children who have been hospitalized for burn injury. The program aims to decrease parents' symptoms of stress. Methods: Participants will consist of parents of children treated for burns between 2009 and 2013 at either of the two specialized Swedish Burn centers. The study is a two-armed randomized controlled trial with a six-week intervention group and an inactive control group, with a pre- and post-assessment, as well as a 3- and 12-month follow-up. The main outcome is stress (post-traumatic stress, general perceived stress and parental stress). The data will be analyzed with the intention-to-treat principle. The intervention is based on Cognitive-Behavior Therapy (CBT) and is inspired by Acceptance and Commitment Therapy (ACT). It is psycho-educational and provides basic skills training in communication and stress management. Conclusion: We believe that this program will offer parents of children with burns information and support, decrease symptoms of stress, and that parents will perceive the program as useful. If the program is found to be beneficial, it could be implemented in burn care as it is accessible and cost-effective

Saving energy in the workplace: why, and for whom?

Saving energy at work might be considered altruistic, because often no personal benefits accrue. However, we consider the possibility that it can be a form of impure-altruism in that the individual experiences some rewards. We develop a scale to measure motivations to save energy at work and test its predictive power for energy-saving intentions and sustainable choices. In two studies (N = 293 and N = 94) motivations towards helping their organization and the planet were rated as important motivations, as was warm-glow (feeling good), indicating that impure-altruism does exist in this context. Energy saving was predicted by environmental concern and the desire to help one's organization. Notably, the stronger the motivations to promote one's reputation were, the weaker was the intention to save energy. Promoting motivations, particularly those that focus on benefits to the organization, may be an effective addition to environmental messages typically used as motivations in campaigns

The Energetic Particle Detector (EPD) Investigation and the Energetic Ion Spectrometer (EIS) for the Magnetospheric Multiscale (MMS) Mission

Abstract The Energetic Particle Detector (EPD) Investigation is one of 5 fields-and-particles investigations on the Magnetospheric Multiscale (MMS) mission. MMS comprises 4 spacecraft flying in close formation in highly elliptical, near-Earth-equatorial orbits targeting understanding of the fundamental physics of the important physical process called magnetic reconnection using Earth’s magnetosphere as a plasma laboratory. EPD comprises two sensor types, the Energetic Ion Spectrometer (EIS) with one instrument on each of the 4 spacecraft, and the Fly’s Eye Energetic Particle Spectrometer (FEEPS) with 2 instruments on each of the 4 spacecraft. EIS measures energetic ion energy, angle and elemental compositional distributions from a required low energy limit of 20 keV for protons and 45 keV for oxygen ions, up to \u3e0.5 MeV (with capabilities to measure up to \u3e1 MeV). FEEPS measures instantaneous all sky images of energetic electrons from 25 keV to \u3e0.5 MeV, and also measures total ion energy distributions from 45 keV to \u3e0.5 MeV to be used in conjunction with EIS to measure all sky ion distributions. In this report we describe the EPD investigation and the details of the EIS sensor. Specifically we describe EPD-level science objectives, the science and measurement requirements, and the challenges that the EPD team had in meeting these requirements. Here we also describe the design and operation of the EIS instruments, their calibrated performances, and the EIS in-flight and ground operations. Blake et al. (The Flys Eye Energetic Particle Spectrometer (FEEPS) contribution to the Energetic Particle Detector (EPD) investigation of the Magnetospheric Magnetoscale (MMS) Mission, this issue) describe the design and operation of the FEEPS instruments, their calibrated performances, and the FEEPS in-flight and ground operations. The MMS spacecraft will launch in early 2015, and over its 2-year mission will provide comprehensive measurements of magnetic reconnection at Earth’s magnetopause during the 18 months that comprise orbital phase 1, and magnetic reconnection within Earth’s magnetotail during the about 6 months that comprise orbital phase 2

A systematic review and meta-analysis of the safety, feasibility and effect of exercise in women with stage II+ breast cancer

To systematically evaluate the safety, feasibility and effect of exercise among women with stage II+ breast cancer.CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, Science Direct and SPORTDiscus were searched for articles published prior to March 1, 2017.Randomised, controlled, exercise trials involving at least 50% of women diagnosed with stage II+ breast cancer were included.Risk of bias was assessed and adverse event severity was classified using the Common Terminology Criteria. Feasibility was evaluated by computing median (range) recruitment, withdrawal and adherence rates. Meta-analyses were performed to evaluate exercise safety and effects on health outcomes only. The influence of intervention characteristics (mode, supervision, duration and timing) on exercise outcomes were also explored.There were no differences in adverse events between exercise and usual care (risk difference

Global and local concerns: What attitudes and beliefs motivate farmers to mitigate and adapt to climate change?

In response to agriculture\u27s vulnerability and contribution to climate change, many governments are developing initiatives that promote the adoption of mitigation and adaptation practices among farmers. Since most climate policies affecting agriculture rely on voluntary efforts by individual farmers, success requires a sound understanding of the factors that motivate farmers to change practices. Recent evidence suggests that past experience with the effects of climate change and the psychological distance associated with people\u27s concern for global and local impacts can influence environmental behavior. Here we surveyed farmers in a representative rural county in California\u27s Central Valley to examine how their intention to adopt mitigation and adaptation practices is influenced by previous climate experiences and their global and local concerns about climate change. Perceived changes in water availability had significant effects on farmers\u27 intention to adopt mitigation and adaptation strategies, which were mediated through global and local concerns respectively. This suggests that mitigation is largely motivated by psychologically distant concerns and beliefs about climate change, while adaptation is driven by psychologically proximate concerns for local impacts. This match between attitudes and behaviors according to the psychological distance at which they are cognitively construed indicates that policy and outreach initiatives may benefit by framing climate impacts and behavioral goals concordantly; either in a global context for mitigation or a local context for adaptation