RESUMEN
This study investigated the association between long-term adherence to football training and retaining bone mineralization and physical capacity in men with prostate cancer (PCa) managed with androgen deprivation therapy (ADT). Patients completing follow-up at 32 weeks in the FC Prostate Randomized Controlled Trial (RCT) in 2012 or 2013 were invited to 5-year follow-up assessments in May 2017 (n = 30). Changes in physiological outcomes over time between the football participants (FTG) and nonparticipants (CON) were examined. Twenty-two men accepted the invitation of which 11, aged 71.3 ± 3.8 years, had continued to play self-organized football 1.7 (SD 0.5) times per week for 4½ years (±8 months). At 5 years, right femoral neck bone mineral density (BMD) had improved significantly in the FTG compared to CON (P = .028). No other significant between-group differences were observed. In FTG, RHR decreased by 4.3 bpm (P = .009) with no changes in CON. Muscle mass, knee-extensor muscle strength, VO2 max, and postural balance decreased in both groups. In FTG, the fraction of training time with HR between 80%-90% or >90% of HRmax was 29.9% (SD 20.6) and 22.8% (SD 28.7), respectively. Average distance covered during 3 × 20 minutes of football training was 2524 m (SD 525). Football training over a 5-year period was associated with preserved femoral neck BMD in elderly men with PCa managed on ADT. Intensity during football training was >80% of HRmax for 51% of training time after 5 years. Body composition and physical capacity deteriorated over 5 years regardless of football participation.
Asunto(s)
Densidad Ósea , Neoplasias de la Próstata/fisiopatología , Fútbol , Anciano , Presión Sanguínea , Composición Corporal , Fémur , Estudios de Seguimiento , Frecuencia Cardíaca , Humanos , Lípidos/sangre , Masculino , Fuerza Muscular , Músculo Esquelético/fisiología , Consumo de Oxígeno , Equilibrio PosturalRESUMEN
UNLABELLED: Androgen deprivation therapy (ADT) for prostate cancer (PCa) impairs musculoskeletal health. We evaluated the efficacy of 32-week football training on bone mineral density (BMD) and physical functioning in men undergoing ADT for PCa. Football training improved the femoral shaft and total hip BMD and physical functioning parameters compared to control. INTRODUCTION: ADT is a mainstay in PCa management. Side effects include decreased bone and muscle strength and increased fracture rates. The purpose of the present study was to evaluate the effects of 32 weeks of football training on BMD, bone turnover markers (BTMs), body composition, and physical functioning in men with PCa undergoing ADT. METHODS: Men receiving ADT >6 months (n = 57) were randomly allocated to a football training group (FTG) (n = 29) practising 2-3 times per week for 45-60 min or to a standard care control group (CON) (n = 28) for 32 weeks. Outcomes were total hip, femoral shaft, femoral neck and lumbar spine (L2-L4) BMD and systemic BTMs (procollagen type 1 amino-terminal propeptide, osteocalcin, C-terminal telopeptide of type 1 collagen). Additionally, physical functioning (postural balance, jump height, repeated chair rise, stair climbing) was evaluated. RESULTS: Thirty-two-week follow-up measures were obtained for FTG (n = 21) and for CON (n = 20), respectively. Analysis of mean changes from baseline to 32 weeks showed significant differences between FTG and CON in right (0.015 g/cm(2)) and left (0.017 g/cm(2)) total hip and in right (0.018 g/cm(2)) and left (0.024 g/cm(2)) femoral shaft BMD, jump height (1.7 cm) and stair climbing (-0.21 s) all in favour of FTG (p < 0.05). No other significant between-group differences were observed. CONCLUSIONS: Compared to standard care, 32 weeks of football training improved BMD at clinically important femoral sites and parameters of physical functioning in men undergoing ADT for PCa.
Asunto(s)
Antagonistas de Andrógenos/efectos adversos , Antineoplásicos Hormonales/efectos adversos , Densidad Ósea/fisiología , Enfermedades Óseas Metabólicas/prevención & control , Neoplasias de la Próstata/terapia , Fútbol , Anciano , Antagonistas de Andrógenos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Composición Corporal/efectos de los fármacos , Composición Corporal/fisiología , Densidad Ósea/efectos de los fármacos , Enfermedades Óseas Metabólicas/inducido químicamente , Enfermedades Óseas Metabólicas/fisiopatología , Terapia por Ejercicio/efectos adversos , Terapia por Ejercicio/métodos , Fémur/fisiopatología , Estudios de Seguimiento , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Músculo Esquelético/fisiopatología , Cooperación del Paciente , Aptitud Física/fisiología , Equilibrio Postural/efectos de los fármacos , Equilibrio Postural/fisiología , Neoplasias de la Próstata/fisiopatología , Terapia Recreativa/métodosRESUMEN
BACKGROUND: Patients with rheumatoid arthritis (RA) spend a high proportion of their waking time in sedentary behaviour (SB) and have an increased risk of cardiovascular disease. Reduction of SB and increase in light intensity physical activity has been suggested as a means of improvement of health in patients with mobility problems. Short-term intervention studies have demonstrated that SB can be reduced by behavioural interventions in sedentary populations. To evaluate descriptively the feasibility of recruitment, randomisation, outcome assessments, retention and the acceptability of an individually tailored, theory-based behavioural intervention targeting reduction in daily sitting time in patients with RA. METHODS: A randomised, controlled trial with two parallel groups. RA patients >18 years of age and Health Assessment Questionnaire (HAQ) score < 2.5 were consecutively invited and screened for daily leisure time sitting > 4 h. The 16-week intervention included 1) three individual motivational counselling sessions and 2) individual text message reminders aimed at reducing daily sitting time. The control group was encouraged to maintain their usual lifestyles. Outcomes were assessed at baseline and after the 16 week intervention. Daily sitting time was measured using an ActivPAL3TM activity monitor. The study was not powered to show superiority; rather the objective was to focus on acceptability among patients and clinical health professionals. RESULTS: In total, 107 patients were invited and screened before 20 met eligibility criteria and consented; reasons for declining study participation were mostly flares, lack of time and co-morbidities. One patient from the control group dropped out before end of intervention (due to a RA flare). Intervention participants completed all counselling sessions. All procedures regarding implementation of the trial protocol were feasible. The daily sitting time was reduced on average by 0.30 h in the intervention group unlike the control group that tended to increase it by 0.15 h after 16 weeks. CONCLUSIONS: This study shows that an individually tailored behavioural intervention targeting reduction of SB was feasible and acceptable to patients with RA. TRIAL REGISTRATION: The Danish Data Protection Agency (ref.nb. 711-1-08 - 20 March 2011), the Ethics Committee of the Capital Region of Denmark (ref.nb. H-2-2012-112- 17 October 2012), clinicaltrials.gov ( NCT01969604 - October 17 2013, retrospectively registered).
Asunto(s)
Artritis Reumatoide/complicaciones , Terapia Conductista/métodos , Enfermedades Cardiovasculares/prevención & control , Entrevista Motivacional , Conducta Sedentaria , Adulto , Anciano , Artritis Reumatoide/psicología , Enfermedades Cardiovasculares/etiología , Dinamarca , Ejercicio Físico , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Postura , Envío de Mensajes de TextoRESUMEN
The aim of this study was to examine physical activity behavior in patients with rheumatoid arthritis and to identify potential correlates of regular physical activity including fatigue, sleep, pain, physical function and disease activity. A total of 443 patients were recruited from a rheumatology outpatient clinic and included in this cross-sectional study. Physical activity was assessed by a four-class questionnaire, in addition to the Physical Activity Scale. Other instruments included the Multidimensional Fatigue Inventory (MFI), the Pittsburgh Sleep Quality Index and the Health Assessment Questionnaire. Disease activity was obtained from a nationwide clinical database. Of the included patients, 80 % were female and mean age was 60 (range 21-88 years). Hereof, 22 % (n = 96) were regularly physically active, and 78 % (n = 349) were mainly sedentary or having a low level of physical activity. An inverse univariate association was found between moderate to vigorous physical activity, and fatigue (MFI mental, MFI activity, MFI physical and MFI general), sleep, diabetes, depression, pain, patient global assessment, HAQ and disease activity. The multivariate prediction model demonstrated that fatigue-related reduced activity and physical fatigue were selected in >95 % of the bootstrap samples with median odds ratio 0.89 (2.5-97.5 % quantiles: 0.78-1.00) and 0.91 (2.5-97.5 % quantiles: 0.81-0.97), respectively, while disease activity was selected in 82 % of the bootstrap samples with median odds ratio 0.90. Moderate to vigorous physical activity in patients with rheumatoid arthritis is associated with the absence of several RA-related factors with the most important correlates being reduced activity due to fatigue, physical fatigue and disease activity.
Asunto(s)
Artritis Reumatoide/fisiopatología , Fatiga/fisiopatología , Actividad Motora/fisiología , Sueño/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/complicaciones , Estudios Transversales , Dinamarca , Fatiga/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors representing seven cancer types. Data were generated through a 5-month fieldwork study comprising participant observations, semi-structured individual interviews and informal conversations. The analyses revealed two overarching findings shedding light on male cancer survivors' barriers to rehabilitation: 'Fear of losing control' and 'Striving for normality'. While 'Fear of losing control' signified what the men believed rehabilitation would invoke: 'Reduced manliness', 'Sympathy and dependency' and 'Confrontation with death', 'Striving for normality' was based on what the men believed rehabilitation would hinder: 'Autonomy and purpose', 'Solidarity and fellowship' and 'Forget and move on'. This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation. The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation.
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Hombres/psicología , Neoplasias/rehabilitación , Aceptación de la Atención de Salud/psicología , Sobrevivientes/psicología , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Masculinidad , Persona de Mediana Edad , Neoplasias/psicología , Autonomía Personal , Investigación CualitativaRESUMEN
Evidence is accumulating that exercise-based rehabilitation improves physical capacity and quality of life in cancer survivors. However, recruitment and persistence of male cancer patients in rehabilitation and physical activity are low and novel health promotion strategies are warranted. The purpose of this study was to gain an understanding of the meaning of recreational football as a team and interaction-oriented health-promoting activity in men with prostate cancer (n = 26). Qualitative data were collected through six focus group interviews (n = 4-6) and 20 h of participant observations. The two data sets were analyzed using framework analysis. The analysis produced 11 subthemes that were structured into three overarching themes: (a) motivational drivers; (b) united in sport; and (c) confirmation of own capacity. The findings indicated that participants regarded football as a welcome opportunity to regain control and acquire a sense of responsibility for own health without assuming the patient role, and football training legitimized and promoted mutual caring behavior in a male-oriented context. In conclusion, the study suggests that football, due to its cultural representation of masculine ideals, may be a potent and unique strategy for increasing recruitment and adherence to physical activity in prostate cancer patients.
Asunto(s)
Actitud Frente a la Salud , Promoción de la Salud/métodos , Relaciones Interpersonales , Motivación , Neoplasias de la Próstata/rehabilitación , Autoeficacia , Fútbol/psicología , Anciano , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/psicología , Investigación CualitativaRESUMEN
Androgen deprivation therapy (ADT) remains a cornerstone in the management of patients with prostate cancer (PCa) despite adverse effects on body composition and functional parameters. We compared the effects of football training with standard care in PCa patients managed with ADT (> 6 months). Fifty-seven men aged 67 (range: 43-74) were randomly assigned to a football group (FG, n = 29) or a usual care control group (CON, n = 28). The primary outcome was change in lean body mass (LBM) assessed by dual-energy X-ray absorptiometry scanning. Secondary outcomes included changes in knee-extensor muscle strength (one repetition maximum), fat percentage, and maximal oxygen uptake (VO2max ). Mean heart rate during training was 137.7 (standard deviation 13.7) bpm or 84.6 (3.9)% HRmax. In FG, LBM increased by 0.5 kg [95% confidence interval (CI) 0.1-0.9; P = 0.02] with no change in CON (mean group difference 0.7 kg; 95% CI 0.1-1.2; P = 0.02). Also, muscle strength increased in FG (8.9 kg; 95% CI 6.0-11.8; P < 0.001) with no change in CON (mean group difference 6.7 kg; 95% CI 2.8-10.7; P < 0.001). In FG, VO2max increased (1.0 mL/kg/min; 95% CI 0.2-1.9; P = 0.02) and fat percentage tended to decrease (0.7%; 95%CI 1.3-0.0; P = 0.06), but these changes were not significantly different from CON. In conclusion, football training over 12 weeks improved LBM and muscle strength compared with usual care in men with prostate cancer receiving ADT.
Asunto(s)
Antagonistas de Andrógenos/efectos adversos , Antineoplásicos/efectos adversos , Composición Corporal , Terapia por Ejercicio/métodos , Orquiectomía/efectos adversos , Neoplasias de la Próstata/rehabilitación , Fútbol/fisiología , Absorciometría de Fotón , Adiposidad/efectos de los fármacos , Adulto , Anciano , Antagonistas de Andrógenos/uso terapéutico , Antineoplásicos/uso terapéutico , Composición Corporal/efectos de los fármacos , Terapia Combinada , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular/efectos de los fármacos , Fuerza Muscular/fisiología , Consumo de Oxígeno/efectos de los fármacos , Consumo de Oxígeno/fisiología , Aptitud Física , Neoplasias de la Próstata/terapia , Método Simple Ciego , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe the experience of physical activity maintenance in patients with rheumatoid arthritis. DESIGN: A qualitative salutogenic-oriented interview study. SETTING: A rheumatology outpatient clinic. SUBJECTS: A purposive sample of 16 physically active patients (mean age 50, range 37-67) diagnosed with rheumatoid arthritis on average 21 years previously (range 4-46 years). METHODS: In-depth interviews were conducted using a semi-structured interview guide to illuminate how the phenomenon 'physical activity maintenance' was experienced by patients with rheumatoid arthritis. The interviews were analysed using systematic text condensation, inspired by Giorgi's descriptive phenomenological methodology. RESULTS: The analysis revealed three categories: (1) knowing and enjoying the body; (2) responsibility and challenges; (3) autonomy and social belonging. On the basis of these categories, the essential meaning of the phenomenon of physical activity maintenance for patients with rheumatoid arthritis was summarized into 'striving for a transparent body and participation', pointing to experiences of sensations of wellbeing, liberation from restrictions and social participation on equal terms with non-arthritis populations. CONCLUSION: This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life.
Asunto(s)
Artritis Reumatoide/fisiopatología , Actividad Motora/fisiología , Adulto , Anciano , Instituciones de Atención Ambulatoria , Artritis Reumatoide/psicología , Artritis Reumatoide/rehabilitación , Dinamarca , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación CualitativaRESUMEN
BACKGROUND: Sedentary behavior and impaired cardiovascular reserve capacity are common late effects of cancer therapy emphasizing the need for effective strategies to increase physical activity (PA) in cancer survivors. We examined the efficacy of a 12-month exercise-based rehabilitation program on self-reported PA, cardiorespiratory fitness (VO2peak), strength, and patient-reported outcomes. PATIENTS AND METHODS: Two hundred fourteen post-treatment cancer survivors were randomly assigned to a 12-month rehabilitation program consisting of individual (x3) and group-based (x6) counseling in combination with once weekly high-intensity group-based exercise training (the Copenhagen Physical Activity after Cancer Treatment, PACT; n = 108) or to a health evaluation program (HE, n = 106). Study outcomes were assessed at baseline, 6 months, and 12 months. RESULTS: After 12 months, the percentage of patients reporting meeting PA goal behavior (≥3 h/week) was significantly increased in the PACT group versus the HE group (70.4% versus 43.4%, P = 0.001). Repeated measures analyses indicated a statistically significant improvement in VO2peak (l min(-1)) in favour of PACT (treatment effect ratio = 1.04; 95% confidence interval 1.00-1.07; P = 0.032). Significant between group differences were also observed for strength (P < 0.001), depression (P = 0.020) and mental health (P = 0.040). CONCLUSION: A 12-month exercise-based rehabilitation program is an effective strategy to promote PA and improve VO2peak in cancer survivors.
Asunto(s)
Ejercicio Físico , Estado de Salud , Neoplasias/rehabilitación , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Aptitud Física , Calidad de Vida , Rehabilitación/métodos , Sobrevivientes , Resultado del TratamientoRESUMEN
OBJECTIVES: To map which factors have been considered, explored, and found to influence physical activity (PA) promotion by oncology physicians and nurses (OPN). METHODS: A scoping review of empirical studies was conducted using Arksey and O'Malley's framework and the PRISMA-ScR guideline. The quality of the studies was evaluated using the QATSDD tool. RESULTS: Twenty-nine publications were included. The methodological quality of the studies was low to moderate. Studies have shown a positive attitude towards PA and recommending PA. PA knowledge seems to influence PA promotion by OPNs to some extent. Structural barriers for PA promotion are the most endorsed barriers but to what extent they influence PA promotion is unclear. The demographic and professional characteristics of OPNs and their PA behavior do not seem to influence PA promotion to a greater extent. Patients' PA interest, health characteristics, and medical conditions are additional factors. Their implications for PA promotion are not fully elucidated. CONCLUSIONS: The varied results across the studies, together with the methodological limitations of the studies, make it unclear to what extent the explored factors influence PA promotion by OPNs. PRACTICE IMPLICATIONS: More research into what influences OPNs' engagement in PA promotion is warranted to support clinical PA promotion.
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Promoción de la Salud , Médicos , Humanos , Ejercicio Físico , Promoción de la Salud/métodos , Oncología Médica , Actividad MotoraRESUMEN
Fatigue is frequent in cancer patients undergoing chemotherapy. Erythropoietins (EPO) have shown well-documented effects on these patients, and administered in pharmacological doses, may reduce the need for transfusion of blood cells and improve quality of life (QoL). An explorative, descriptive, non-randomised intervention study using semi-structured interviews was conducted with the aim to gain an insight into the effects and experiences associated with EPO treatment in combination with a structured 6-week physical exercise intervention. Sixteen cancer patients with evidence of disease, who had received at least one cycle chemotherapy, participated. Participants received 500 µg Darbepoetin Alfa (DA) every 3 weeks during the intervention. Four typologies of patients were identified with regard to DA effects. The interviews revealed that eleven patients experienced some kind of immediate improvement in cognitive and emotional functioning, and subjective daily well-being. Furthermore physical improvement and changes in QoL outcomes showed no significant differences between the study group and a reference group. A significant increase in the hemoglobin concentration (7.14-7.87 mmol/L, P<0.05) was found in the study group. The future use of EPO in cancer patients is hampered by the reported negative influence of EPO on the prognosis in some diagnoses and should be based on randomized studies.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Eritropoyetina/análogos & derivados , Terapia por Ejercicio , Fatiga/tratamiento farmacológico , Hematínicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Adolescente , Adulto , Anciano , Darbepoetina alfa , Eritropoyetina/uso terapéutico , Fatiga/etiología , Fatiga/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: More than half of patients with rheumatoid arthritis complain of insomnia, which is predominantly treated with hypnotic drugs. However, cognitive behavioural therapy for insomnia is recommended as the first-line treatment in international guidelines on sleep. Patients with rheumatoid arthritis suffer from debilitating symptoms, such as fatigue and pain, which can also be linked to sleep disturbance. It remains to be determined whether cognitive behavioural therapy for insomnia can be effective in patients with rheumatoid arthritis. The aim of the Sleep-RA trial is to investigate the efficacy of cognitive behavioural therapy for insomnia on sleep and disease-related symptoms in patients with rheumatoid arthritis. The primary objective is to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep efficiency from baseline to week 7 in patients with rheumatoid arthritis. The key secondary objectives are to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep onset latency, wake after sleep onset, total sleep time, insomnia, sleep quality, fatigue, impact of rheumatoid arthritis and depressive symptoms from baseline to week 26 in patients with rheumatoid arthritis. METHODS: The Sleep-RA trial is a randomised controlled trial with a two-group parallel design. Sixty patients with rheumatoid arthritis, insomnia and low-to-moderate disease activity will be allocated 1:1 to treatment with cognitive behavioural therapy for insomnia or usual care. Patients in the intervention group will receive nurse-led, group-based cognitive behavioural therapy for insomnia once a week for 6 weeks. Outcome assessments will be carried out at baseline, after treatment (week 7) and at follow-up (week 26). DISCUSSION: Data on treatment of insomnia in patients with rheumatoid arthritis are sparse. The Sleep-RA trial is the first randomised controlled trial to investigate the efficacy of cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis. Because symptoms of rheumatoid arthritis and insomnia have many similarities, we also find it relevant to investigate the secondary effects of cognitive behavioural therapy for insomnia on fatigue, impact of rheumatoid arthritis, depressive symptoms, pain, functional status, health-related quality of life and disease activity. If we find cognitive behavioural therapy for insomnia to be effective in patients with rheumatoid arthritis this will add weight to the argument that evidence-based non-pharmacological treatment for insomnia in rheumatological outpatient clinics is eligible in accordance with the existing international guidelines on sleep. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03766100. Registered on 30 November 2018.
Asunto(s)
Artritis Reumatoide/complicaciones , Terapia Cognitivo-Conductual/métodos , Psicoterapia de Grupo/métodos , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Dinamarca , Depresión/etiología , Depresión/terapia , Fatiga/etiología , Humanos , Estudios Multicéntricos como Asunto , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Método Simple Ciego , Sueño , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
The site of impulse initiation is crucial for the integrative actions of mammalian central neurons, but this question is currently controversial. Some recent studies support classical evidence that the impulse always arises in the soma-axon hillock region, with back-propagation through excitable dendrites, whereas others indicate that the dendrites are sufficiently excitable to initiate impulses that propagate forward along the dendrite to the soma-axon hillock. This issue has been addressed in the olfactory mitral cell, in which excitatory synaptic input is restricted to the distal tuft of a single primary dendrite. In rat olfactory bulb slices, dual whole cell recordings were made at or near the soma and from distal sites on the primary dendrite. The results show that the impulse can be initiated in either the soma-axon hillock or in the distal primary dendrite, and that the initiation site is controlled physiologically by the excitatory synaptic inputs to the distal tuft and inhibitory synaptic inputs near the soma.
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Dendritas/fisiología , Bulbo Olfatorio/citología , Células Piramidales/fisiología , Sinapsis/fisiología , Potenciales de Acción , Animales , Estimulación Eléctrica , Potenciales Evocados , Potenciales Postsinápticos Excitadores , Técnicas In Vitro , Bulbo Olfatorio/fisiología , Técnicas de Placa-Clamp , Ratas , Ratas Sprague-DawleyRESUMEN
Cancer and treatment can negatively affect the body's performance and appearance. Exercise has been tested in a few studies for altered body image among middle-aged women with breast cancer. The aim of the study was to explore how young pre-cancer athletes of both genders experience disease- and treatment-related physical fitness and appearance changes while undergoing chemotherapy and participating in a 6-week group exercise intervention. A prospective, explorative study using semi-structured interviews was conducted before and at termination of the intervention. The study included 22 cancer patients (median age 28 years). The young athletes experienced a change from a high level of physical activity, body satisfaction and a positive self-identity to a low level of physical activity, body denial and a negative self-identity. In the program, the patients experienced increased physical strength and recapture of certain aspects of their former positive body perception. Deterioation of muscle functions caused by chemotherapy was particularly painful to these patients, independent of gender and age. Young physically active patients are heavily dependent on their physical capacity, body satisfaction and self-identity. This should be taken into account when designing programs to rehabilitate and encourage these patients through the often-strenuous antineoplastic treatments.
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Ejercicio Físico/fisiología , Neoplasias/tratamiento farmacológico , Desempeño Psicomotor/fisiología , Deportes , Sobrevivientes , Adolescente , Adulto , Imagen Corporal , Dinamarca , Femenino , Procesos de Grupo , Humanos , Entrevistas como Asunto , Masculino , Fuerza Muscular , Neoplasias/rehabilitación , Estudios Prospectivos , Adulto JovenRESUMEN
OBJECTIVE: To explore the patients' experiences of a minimal home-based psychoeducative intervention aimed at reducing symptoms of anxiety. BACKGROUND: In a randomised controlled trial (RCT) we have shown that a minimal home-based and nurse-led psychoeducative intervention has a significant effect in reducing symptoms of anxiety and increasing mastery of dyspnoea in patients with advanced chronic obstructive pulmonary disease (COPD). However, we do not know if the intervention is perceived as meaningful and applicable in the everyday life of patients with advanced COPD. METHODS: We conducted a nested post-trial qualitative study. The study methodology was Interpretive Description as described by Thorne. The study was based on semi-structured interviews with twenty patients from the RCT intervention group i.g. home-living people with a diagnosis of advanced COPD and symptoms of anxiety. RESULTS: The patients described that making anxiety visible makes it manageable and provides relief. The patients described a feeling of being alone with managing anxiety and dyspnea, and the only way to gain in control of their cognitions was to mobilise internal resources. The intervention was appreciated by patients because it strengthened their internal resources. Further, it was perceived as a relief that the intervention insisted on talking about anxiety and thereby invited patients to verbalise worries related to end-of-life. CONCLUSION: This study offers knowledge to better understand the patients' experiences of a psychoeducative intervention. The intervention was perceived as comprehensible and applicable in the patients' everyday life and contributed to the patients' ability to self-manage their condition.
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Servicios de Atención de Salud a Domicilio , Enfermedad Pulmonar Obstructiva Crónica/psicología , Anciano , Anciano de 80 o más Años , Ansiedad/complicaciones , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Investigación CualitativaRESUMEN
Most synapses on a neuron are distributed along the dendrites. Inputs from different types of presynaptic neurons often distribute to different dendritic compartments. This provides an anatomical framework for spatial synaptic integration. At the same time, a plethora of time- and voltage-dependent responses are present, usually with a distinct distribution over the somato-dendritic membrane. These intrinsic conductances shape the local dendritic response to ligand-gated conductances, and provide the dendrites with a dynamic way of regulating the interaction between synapses. Recent results from neurons in the vertebrate CNS exemplify these mechanisms of dendritic integration.
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Sistema Nervioso Central/citología , Dendritas/fisiología , Neuronas/fisiología , Transmisión Sináptica/fisiología , 6-Ciano 7-nitroquinoxalina 2,3-diona , Animales , Bicuculina/farmacología , Calcio/fisiología , Sistema Nervioso Central/fisiología , Modelos Neurológicos , Neuronas/efectos de los fármacos , Neuronas/ultraestructura , Picrotoxina/farmacología , Células de Purkinje/fisiología , Células Piramidales/efectos de los fármacos , Células Piramidales/fisiología , Quinoxalinas/farmacología , Transmisión Sináptica/efectos de los fármacos , Vertebrados/fisiologíaRESUMEN
BACKGROUND: Anxiety is a common comorbidity in patients with advanced Chronic Obstructive Pulmonary Disease (COPD) with major impact on quality of life and associated with increased risk of death. The objective of this randomised controlled trial was to test the efficacy of a minimal home-based psychoeducative intervention versus usual care for reducing symptoms of anxiety in patients with advanced COPD. METHODS: The trial included 66 participants with advanced COPD and symptoms of anxiety. The primary outcome was anxiety assessed by the Hospital Anxiety and Depression scale (HADS) subscale for anxiety (HADS-A). The secondary outcome was mastery assessed by the Chronic Respiratory Questionnaire (CRQ) domain of mastery (CRQ-M). Assessments were performed at baseline and one and three months post-intervention. RESULTS: The intervention group had a lower post intervention HADS-A score on average, compared with the control group (p = 0.005), indicating a significant effect of the intervention. The average difference between the groups in HADS-A was 2.16 points (CI = [0.62; 3.71]) at one month and 2.32 points (CI = [0.74; 3.89]) at three months follow-up. The intervention group had a higher post intervention CRQ-M score on average compared with the control group (p = 0.016). The average differences between the groups were 0.58 points (CI = [0.09; 1.06]) after one month and 0.67 points (CI = [0.18; 1.17]) after three months. CONCLUSIONS: The psychoeducative intervention provided sustainable symptom relief and improved the patients' self-management abilities.
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Ansiedad/etiología , Ansiedad/prevención & control , Terapia Cognitivo-Conductual/métodos , Servicios de Atención de Salud a Domicilio/organización & administración , Enfermedad Pulmonar Obstructiva Crónica/psicología , Anciano , Ansiedad/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Escalas de Valoración Psiquiátrica , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Resultado del TratamientoRESUMEN
The objective of this study is to examine sleep quality and correlates of poor sleep in patients with rheumatoid arthritis (RA). Five hundred patients with RA were recruited from a rheumatology outpatient clinic and included in this cross-sectional study. Sleep quality and disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI). Other instruments included the Multidimensional Fatigue Inventory, the Epworth Sleepiness Scale, and the Health Assessment Questionnaire. Disease activity was assessed according to disease activity score DAS28-CRP-based. Complete scores on PSQI were obtained from 384 patients (77 %). In those, the prevalence of poor sleep (PSQI >5) was 61 %, and the mean global PSQI score was 7.54 (SD 4.17). A linear association was found between poor sleep and mental fatigue, reduced activity related to fatigue, physical fatigue, and general fatigue. Mental fatigue and general fatigue were independently associated with sleep quality, sleep latency, sleep duration, sleep efficiency, and daytime dysfunction. However, in the linear multivariate analysis, only general fatigue 1.06 (95 % CI 1.03-1.09) and mental fatigue 1.03 (95 % CI 1.01-1.05) were found to be significant correlates for reporting poor sleep. This study shows that a majority of patients with RA experience poor sleep and that general fatigue and mental fatigue are associated with poor sleep.
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Actividades Cotidianas , Artritis Reumatoide/epidemiología , Trastornos del Sueño-Vigilia/epidemiología , Sueño , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/fisiopatología , Estudios Transversales , Fatiga/epidemiología , Femenino , Humanos , Modelos Lineales , Masculino , Fatiga Mental/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/fisiopatología , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
Synaptic integration occurs within a framework of synaptic connections, and cell type-specific, intrinsic and transmitter-gated ion channels. These components are differentially distributed over the somato-dendritic membrane. Recent results from Purkinje cells and pyramidal cells exemplify some of these mechanisms of spatial synaptic integration. This paper focusses on the cerebellar Purkinje cell. In these neurons, the amplitude and distribution of single climbing fibre and parallel fibre EPSP-evoked Ca2+ influx were regulated by the transient outward, IA-like current in the distal (spiny) dendrites. The synaptically evoked Ca2+ influx was graded from a local response involving only a few terminal spiny dendrites to a propagated Ca2+ spike. The climbing fibre-evoked Ca2+ influx in the spiny dendrites was finely graded by parallel fibre-induced depolarization. Climbing fibre and parallel fibre-evoked Ca2+ influx elicited a short lasting afterhyperpolarization that affected subsequent dendritic Ca2+ influx. In addition, inhibitory synaptic input controlled dendritic Ca2+ influx. Interaction between information from different sources along the dendrites is thus controlled by intrinsic potassium conductances and IPSPs. Different electrophysiological properties are found in the cerebellar neurons. Thus, Golgi cells, stellate cells and granule cells seem to integrate on a shorter intrinsic timescale than do Purkinje cells, the output neuron of the cerebellar cortex. The specific mechanisms by which different types of presynaptic neurons specifically innervate a given dendritic compartment remain to be elucidated, but recent results provide some experimental evidence of a differential distribution of cell adhesion molecules between the axonal and the somato-dendritic membrane, suggesting one mechanism contributing to the ordered distribution of synapses during synaptogenesis.