An 8-step approach for the systematic development of an evidence-based exercise program for patients undergoing hematopoietic stem cell transplantation.

Background: A tailored and reliable intervention program developed based on evidence is necessary for patients with serious health conditions. Objective: We describe the development of an exercise program for HSCT patients based on evidence from a systematic process. Methods: We developed the exercise program for HSCT patients using eight systematic steps: (1) a literature review, (2) understanding patient characteristics, (3) first expert group discussion, (4) development of the first draft of the exercise program, (5) a pre-test, (6) second expert group discussion, (7) a pilot randomized controlled trial (n=21), and (8) a focus group interview. Results: The developed exercise program was unsupervised and consisted of different exercises and intensities according to the patients' hospital room and health condition. Participants were provided with instructions for the exercise program, exercise videos via smartphone, and prior education sessions. In the pilot trial, the adherence to the exercise program was only 44.7%, however, some changes in physical functioning and body composition favored the exercise group despite the small sample size. Conclusion: Strategies to improve adherence to this exercise program and larger sample sizes are needed to adequately test if the developed exercise program may help patients improve physical and hematologic recovery after HSCT. This study may help researchers develop a safe and effective evidence-based exercise program for their intervention studies. Moreover, the developed program may benefit the physical and hematological recovery in patients undergoing HSCT in larger trials, if exercise adherence is improved. Clinical trial registration: https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24233&search_page=L, identifier KCT 0008269.

Exercise participation, barriers, and preferences in Korean prostate cancer survivors.

Objective: To identify patterns of physical activity (PA) participation, exercise preference, and barriers of stage 2-3 prostate cancer survivors across cancer trajectories based on selected demographic and medical variables.Design: The current study is a descriptive cross-sectional study which included data from a total of 111 prostate cancer survivors, at Shinchon Severance Hospital, Seoul, Korea. The survey includes PA levels before and after prostate cancer diagnosis, exercise barriers, and preferences.Results: Moderate- to vigorous-intensity PA levels were significantly lower after cancer diagnosis (vigorous PA:41.9 ± 123.1 min/week vs. 4.6 ± 29.8 min/week, p < 0.001; moderate PA: 159.9 ± 240.0 min/week vs. 56.8 ± 129.7 min/week, p < .001) compared to their PA level before cancer diagnosis. Perceived exercise barriers were distinctly different according to participants' age and time since surgery. The two most prevalent exercise barriers among prostate cancer survivors <65 years were lack of time (28.6%) and poor health (26.5%), whereas the exercise barriers for prostate cancer survivors aged ≥65 years were lack of exercise facilities (21.4%) and lack of exercise information (17.9%). Furthermore, within 6 months after surgery, prostate cancer survivors perceived poor health (29.5%) and pain at the surgery site (29.5%) to be the two most prevalent exercise barriers. 6 months after surgery, prostate cancer survivors perceived lack of time (21.3%) and poor health (14.8%) to be the two most prevalent exercise barriers. Walking, pelvic floor and Kegel exercises were three most preferred exercises among prostate cancer survivors in our study, which uniquely differ according to time since surgery.Conclusion: This study showed significant reduction in PA levels among prostate cancer survivors and their perceived exercise barriers were distinct according to their age and time since surgery. Therefore, PA and exercise recommendation should be specific to their personal characteristics such as age and time since surgery.

Exercise barriers and facilitators during hematopoietic stem cell transplantation: a qualitative study.

OBJECTIVE: Although exercise is beneficial in patients undergoing hematopoietic stem cell transplantation (HSCT), motivating patients to exercise is challenging. We aimed to understand exercise barriers and facilitators during HSCT treatment while participating in a daily unsupervised exercise programme. PARTICIPANTS: Patients scheduled to have HSCT. STUDY DESIGN: 6 participants were included in this descriptive qualitative study during HSCT treatment while participating in an exercise programme to identify perceived barriers and facilitators of the exercise. An average of three semi-structured interviews were conducted per patient. SETTING: Exercise during HSCT treatment in an isolated immune room. INTERVENTION: Daily unsupervised exercise. RESULTS: A total of six patients completed a 6-week exercise programme as well as all scheduled interviews, whose compliance to the exercise programme ranged from 12% to 79%. Based on interview results, three themes were identified as barriers to exercise and four themes were identified as facilitators to exercise. Patients experienced physical and psychological barriers such as nausea, vomiting, sore throat, reduced appetite, decreased willpower and anxiety due to feelings of isolation. Environmental factors included negative opinions about exercise programmes and lack of encouragement from the haematologist. Facilitators of exercise included willpower, easy and simple exercise, convincing explanations from haematologists and supervised support from exercise specialists. CONCLUSION: Our study has identified potential barriers and facilitators associated with exercise participation during HSCT. Supervised exercise recommended by a haematologist, convincing explanation on the benefit of exercise by medical personnel, positive feedback from other HSCT survivors and supervision by exercise specialists may increase compliance to the exercise programme during HSCT. TRIAL REGISTRATION NUMBER: ISRCTN61498391.

Lower Relative Handgrip Strength is Significantly Associated with a Higher Prevalence of the Metabolic Syndrome in Adults.

Purpose: In previous studies, there were debates on the association between handgrip strength (HGS) and prevalence of metabolic syndrome. Since body weight is associated with both HGS and prevalence of metabolic syndrome, whether HGS is corrected with body weight (relative HGS) or not (absolute HGS) can directly influence outcome of the study. Therefore, this study analyzed the relationship between HGS and prevalence of metabolic syndrome using both relative and absolute HGS. Methods: A total of 1009 Korean adults (488 men and 521 women) were analyzed. Participants were categorized into three groups according to HGS levels. Logistic regression analysis was used to calculate odds ratio (OR) and 95% confidence interval (CI) of metabolic syndrome associated with both relative and absolute HGS. Results: Lower absolute HGS was associated with lower prevalence of having abnormal blood pressure (OR: 0.60, 95% CI: 0.37-0.97) and glucose levels (OR: 0.54, 95% CI: 0.34-0.88) in men. However, no association was found between absolute HGS and prevalence of metabolic syndrome. However, a significant inverse association was found between relative HGS and prevalence of metabolic syndrome. Compared with participants in the highest tertile, those in the lowest tertile of relative HGS had 2.52 times (95% CI: 1.43-4.46) and 5.01 times (95% CI: 1.66-15.08) higher prevalence of metabolic syndrome in men and women, respectively. Conclusion: Lower relative HGS but not absolute HGS was associated with higher prevalence of metabolic syndrome. Our study showed that there are evident discrepancies in the association between HGS and prevalence of metabolic syndrome whether HGS is corrected by body weight or not.

Results from South Korea's 2018 Report Card on physical activity for children and youth.

BACKGROUND/OBJECTIVE: South Korea's 2018 Report Card on Physical Activity for Children and Youth is the second comprehensive evaluation of physical activity and the sources of influence based on the 10 core indicators provided by the Active Healthy Kids Global Alliance. It will serve as an advocacy tool to promote physical activity among children and youth. METHODS: Three national surveillance data (i.e., 2017 Korea Youth Risk Behavior Web-based Survey, 2016 Korea National Health and Nutrition Examination Survey, 2016 Physical Activity Promotion System) were used as main sources to evaluate the indicators. Descriptive statistics were performed to obtain prevalence estimates of physical activity-related indicators. In addition, expert opinions as well as the most recently available published or unpublished relevant sources were synthesized. RESULTS: South Korea's 2018 Report Card, compared to the 2016 Report Card, showed favourable changes in the Active Transportation (B+), Organized Sports Participation (C), Sedentary Behaviours (D), and School (D+) indicators, while unfavourable changes were shown in Overall Physical Activity (F) and Government (D). Physical Fitness was graded as D+. In parallel with the 2016 Report Card, Active Play, Family and Peers, and Community and Environment remain ungraded due to insufficient data. CONCLUSIONS: Successes as well as gaps and research needs were identified in the 2018 Report Card. Though some indicators have shown improvement, most children and youth continue to be insufficiently physically active with overall poor grades (Average of D+). To achieve substantial improvement in all grades in future Report Cards, more institutional and governmental support and investment is needed to promote physical activity. Furthermore, effort should be made to generate data pertaining to the indicators that were ungraded.

Results From South Korea's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: South Korea's 2016 Report Card on Physical Activity for Children and Youth is the first assessment of physical activity according to the indicators set by Active Healthy Kids Global Alliance. METHODS: National surveys were used as preferred sources of data. This was then supported by peer-reviewed papers and government reports identified by a systematic search of the literature written in English or Korean. A Research Working Group then graded indicators based on the collected evidence. RESULTS: Each indicator was graded as follows: Overall Physical Activity, D-; Organized Sport and Physical Activity Participation, C-; Active Transport, C+; Sedentary Behavior, F; School, D; Government and Investment, C; Active Play, Physical Literacy, Family and Peers, and Community and Built Environment were graded INC (incomplete) due to lack of available evidence. CONCLUSIONS: Though the final grades of key indicators for South Korean children and youth are not satisfactory, increasing interests and investments have been demonstrated at a national level. More evidence is required for comprehensive assessment on all indicators to better inform policy and practice. This should be accompanied by the use of consistent criteria to contribute to global efforts for active healthy kids.