Human Performance Engineering

Ph.D. students are challenged to discover new ideas, invent new products or break through barriers on existing problems. As a Ph.D. student I am leading a new area of research in the STEM discipline. As an industrial engineer, I am attempting to extend the reach of engineering methods and tools traditionally applied in manufacturing and service-related settings to the area of human performance. Human Performance Engineering, IE 402 008, is a new creative inquiry class that Dr. Kevin Taaffe and I have created. The research includes many focus areas such as quality, decision making, perception, game theory, biology, simulation, and disciplines from engineering to psychology to management and the sciences can all potentially play a role. For the last two semesters I have guided undergraduate students in investigating the cause and effect relationships in human performance in individual or team sports. As a research group, we are challenged to learn materials that are beyond our current knowledge base and to examine psychological and biological factors that affect decisions people make in a competitive environment. Moreover, we aim to quantify the extent to which changes to our mental and physical abilities translate into an increased performance during the sporting event

The potential therapeutic effects of creatine supplementation on body composition and muscle function in cancer

Low muscle mass in individuals with cancer has a profound impact on quality of life and independence and is associated with greater treatment toxicity and poorer prognosis. Exercise interventions are regularly being investigated as a means to ameliorate treatment-related adverse effects, and nutritional/supplementation strategies to augment adaptations to exercise are highly valuable. Creatine (Cr) is a naturally-occurring substance in the human body that plays a critical role in energy provision during muscle contraction. Given the beneficial effects of Cr supplementation on lean body mass, strength, and physical function in a variety of clinical populations, there is therapeutic potential in individuals with cancer at heightened risk for muscle loss. Here, we provide an overview of Cr physiology, summarize the evidence on the use of Cr supplementation in various aging/clinical populations, explore mechanisms of action, and provide perspectives on the potential therapeutic role of Cr in the exercise oncology setting

What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes

© 2020, The Author(s). Background: Active treatments for prostate cancer are well known to result in several adverse effects such as fatigue, depression and anxiety symptoms, impacting the overall quality of life (QoL) and wellbeing of a considerable proportion of patients. Resistance-based exercise interventions have shown positive effects to reduce or mitigate these treatment-related side effects. However, the minimal dosage required to derive these benefits is unknown. We systematically reviewed the resistance training effects in prostate cancer patients to determine the minimal dosage regarding the exercise components (mode, duration, volume and intensity) on fatigue, QoL, depression and anxiety. Methods: Using PRISMA guidelines, MEDLINE, CINAHL, EMBASE, SPORTDiscus and Web of Science databases were searched. Eligible randomised controlled trials examined prostate cancer patients undertaking resistance-based exercise programs during or following treatment. Meta-analysis was undertaken when more than three studies were included. Associations between resistance exercise components and its effects were tested by meta-regression analysis. Results: Eighteen trials involving 1112 men with prostate cancer were included. Resistance-based exercise programs resulted in significant effects on fatigue (effect size = −0.3, 95% CI: −0.4 to −0.2, P \u3c 0.001) and QoL (effect size = 0.2, 95% CI: 0.0 to 0.4, P = 0.018), with significant effects in specific questionnaires and domains of these outcomes. Resistance-based exercise effects on depression (effect size = −0.3, 95% CI: −0.7 to 0.0) and anxiety symptoms (effect size = −0.3, 95% CI: −0.5 to 0.0) were positive but not significant (P = 0.071 to 0.077). Meta-regression indicated no significant association between resistance exercise components with fatigue and QoL outcomes (P = 0.186–0.689). Conclusions: Low volume resistance exercise undertaken at a moderate-to-high intensity is sufficient to achieve significant fatigue and QoL benefits for men with prostate cancer and also mitigate depression and anxiety symptoms. A lower resistance exercise dosage than usually prescribed may help enhance adherence by reducing exercise barriers

Exercise medicine for cancer cachexia: targeted exercise to counteract mechanisms and treatment side effects

Purpose Cancer-induced muscle wasting (i.e., cancer cachexia, CC) is a common and devastating syndrome that results in the death of more than 1 in 5 patients. Although primarily a result of elevated inflammation, there are multiple mechanisms that complement and amplify one another. Research on the use of exercise to manage CC is still limited, while exercise for CC management has been recently discouraged. Moreover, there is a lack of understanding that exercise is not a single medicine, but mode, type, dosage, and timing (exercise prescription) have distinct health outcomes. The purpose of this review was to examine the effects of these modes and subtypes to identify the most optimal form and dosage of exercise therapy specific to each underlying mechanism of CC. Methods The relevant literatures from MEDLINE and Scopus databases were examined. Results Exercise can counteract the most prominent mechanisms and signs of CC including muscle wasting, increased protein turnover, systemic inflammation, reduced appetite and anorexia, increased energy expenditure and fat wasting, insulin resistance, metabolic dysregulation, gut dysbiosis, hypogonadism, impaired oxidative capacity, mitochondrial dysfunction, and cancer treatments side-effects. There are different modes of exercise, and each mode has different sub-types that induce vastly diverse changes when performed over multiple sessions. Choosing suboptimal exercise modes, types, or dosages can be counterproductive and could further contribute to the mechanisms of CC without impacting muscle growth. Conclusion Available evidence shows that patients with CC can safely undertake higher-intensity resistance exercise programs, and benefit from increases in body mass and muscle mass

Effects and moderators of exercise medicine on cardiometabolic outcomes in men with prostate cancer previously or currently undergoing androgen deprivation therapy: An individual patient data meta-analysis

Purpose: To examine the effects and moderators of exercise effects on cardiometabolic outcomes in men with prostate cancer previously or currently undergoing androgen deprivation therapy (ADT). Results: Seven trials including 560 patients were examined. Exercise resulted in significant effects on whole-body and regional fat mass (P ≤ 0.001). For whole-body fat mass, significant exercise effects were observed in patients who were unmarried (−1.4 kg, P \u3c 0.05) and who presented with higher fat mass levels (−1.0 kg, P \u3c 0.05). For diastolic blood pressure and low-density lipoprotein (LDL), younger (−4.7 mmHg, P \u3c 0.05) and older patients (−0.2 mmol.l-1, P \u3c 0.10) achieved greater effects, respectively. Regarding high-density lipoprotein (HDL), patients undertaking ADT + prostatectomy + radiotherapy derived significant exercise effects (0.3 mmol.l-1, P \u3c 0.05). Conclusions: Exercise effectively reduces fat mass across subgroups of men undergoing or following ADT with different characteristics. For diastolic blood pressure, HDL and LDL, groups based on age and treatment history could be specifically targeted with exercise medicine

Moderators of resistance-based exercise programs\u27 effect on sarcopenia-related measures in men with prostate cancer previously or currently undergoing androgen deprivation therapy: An individual patient data meta-analysis

Introduction: Older men with prostate cancer are commonly affected by reductions in lean mass and physical function following androgen deprivation therapy (ADT). Resistance-based exercise programs are critical to counteract the musculoskeletal toxicities derived from prostate cancer treatment and aging. However, there is significant variability in the effects of exercise interventions. Examining demographic and clinical moderators of exercise effects in this patient group can assist in identifying which subgroups of patients benefit most. Therefore, we examined the effects and moderators of resistance-based exercise programs on sarcopenia-related outcomes that included lean mass, skeletal muscle index, physical function, and muscle strength in older men with prostate cancer. Materials and Methods: Data were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. For the present study, we included data from trials that examined the effects of supervised resistance-based exercise interventions on lean mass outcomes, muscle strength, and physical function in patients with prostate cancer previously or currently treated with ADT. Linear mixed models were undertaken to analyse the effects of resistance-based exercise programs considering the clustering of patients within studies. Effects were evaluated by regressing the study group on the post-intervention value of the outcome adjusted for the baseline value, while potential moderators were examined by adding the moderator and its interaction term into the regression model. Results: A total of 560 patients with prostate cancer (age: 69.5 ± 7.8 yrs.; body mass index: 28.6 ± 4.0 kg.m−2) previously or currently treated with ADT were included. Resistance-based exercise programs resulted in significant effects on whole-body and appendicular lean mass and the skeletal muscle index (P \u3c 0.05), with improvements observed across different characteristics. Improvements were also observed in 400-m walk and 6-m backwards tandem walk (P \u3c 0.05), with patients presenting with lower baseline levels deriving greater exercise effects on 400-m walk (−19.4 s, 95% confidence interval [CI]: −36.6 to −2.3) and 6-m backwards tandem walk tests (−3.0 s, 95% CI: −5.7 to −0.3). For relative muscle strength, significant exercise effects were observed, with greater effects in younger patients (0.35 kg.kg−1, 95% CI: 0.22 to 0.48). Discussion: Resistance-based exercise programs effectively improve well-known markers of sarcopenia in men with prostate cancer, with specific subgroups of patients, such as those younger and presenting with lower baseline levels of physical function, deriving greater effects on muscle strength and physical function, respectively

Exercise intervention and sexual function in advanced prostate cancer: A randomised controlled trial

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objectives: Treatments for prostate cancer such as androgen deprivation therapy (ADT), surgery and radiation therapy can adversely affect sexual, urinary and bowel function. Preliminary research has demonstrated the efficacy of exercise to preserve sexual function in men with localised prostate cancer receiving ADT, though this has yet to be investigated in a metastatic setting. We examined the effects of a 12-week exercise programme comprising resistance, aerobic and flexibility training on sexual health and function in men with advanced prostate cancer. Methods: Patients with prostate cancer (70.0±8.4 year; body mass index 28.7±4.0 kg/m2) with bone metastases (rib/thoracic spine, 66.7%; lumbar spine, 43.9%; pelvis, 75.4%; femur, 40.4%; humerus, 24.6%; other sites, 70.2%) were randomly assigned to supervised exercise 3 days/week (n=28) or usual care (n=29). Sexual health and function were assessed using the International Index of Erectile Function, the Expanded Prostate Cancer Index Composite and the EORTC-PR25 at baseline and 12 weeks. Results: Patients attended 89% of planned sessions and there were no adverse events. After adjusting for baseline values, there was no significant difference between groups for any measure of sexual function and activity (p \u3e 0.05). Additionally, there was no significant difference between groups for urinary and bowel function assessed by the EORTC-PR25 (p \u3e 0.05). Conclusions: A short-Term programme of supervised exercise does not appear to enhance indices of sexual health and function in men with advanced prostate cancer. Limitations of the intervention included the conservative modular exercise programme, which deliberately avoided loading bone metastatic sites

Improving the management of hospital waiting lists by using nudges in letters: a randomised controlled trial

Objective: A commonly adopted intervention to help to reduce wait times for hospital treatment is administrative validation, where administrators write to patients to check if a procedure is still required. The did not return (DNR) rate to validation letters is substantial. We tested whether the DNR rate was reduced by introducing nudges to validation letters. Methods: Participants from eight public hospitals (N = 2855; in 2017) in Ireland were randomized to receive an existing (control group) or a redesigned validation letter including nudges (intervention group). Results: Participants in the intervention group were less likely not to return it than those in the control group, OR =.756, SE =.069, p =.002. Control and intervention group DNR rates were 23.97% and 19.24%. This is equivalent to 1 in 5 non-responders changing their behaviour because of the redesigned letter. Conclusions: The redesigned letter increased patient compliance with the validation process. The redesign has subsequently been adopted by public hospitals in Ireland

Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Introduction Active surveillance is a strategy for managing low-risk, localised prostate cancer, where men are observed with serial prostate-specific antigen assessments to identify signs of disease progression. Currently, there are no strategies to support active surveillance compliance nor are there interventions that can prevent or slow disease progression, ultimately delaying transition to active treatment before it is clinically required. Recently, we proposed that exercise may have a therapeutic potential in delaying the need for active treatment in men on active surveillance. Methods and analysis A single-blinded, two arm, multicentre randomised controlled trial will be undertaken with 168 patients randomly allocated in a ratio of 1:1 to exercise or usual care. Exercise will consist of supervised resistance and aerobic exercise performed three times per week for the first 6 months in an exercise clinical setting, and during months 7-12, a progressive stepped down approach will be used with men transitioning to once a week supervised training. Thereafter, for months 13 to 36, the men will self-manage their exercise programme. The primary endpoint will be the time until the patients begin active therapy. Secondary endpoints include disease progression (prostate specific antigen), body composition and muscle density, quality of life, distress and anxiety and an economic analysis will be performed. Measurements will be undertaken at 6 and 12 months (postintervention) and at 24 and 36 months follow-up. The primary outcome (time to initiation of curative therapy) will be analysed using Cox proportional hazards regression. Outcomes measured repeatedly will be analysed using mixed effects models to examine between-group differences. Data will be analysed using an intention-to-treat approach. Ethics and dissemination Outcomes from the study will be published in peer-reviewed academic journals and presented in scientific, consumer and clinical meetings. Trial registration number ACTRN12618000225213