The effects of exercise on the bone health of people with cancer: a systematic review and meta-analysis.

PURPOSE: To determine the pooled effect of exercise on the bone health of people diagnosed with cancer. METHODS: Four electronic databases were systematically searched. Controlled trials that assessed the effect of exercise on the bone mineral density (BMD) or content (BMC) measured by dual-energy x-ray absorptiometry or peripheral quantitative computed tomography in people who had been diagnosed with cancer were included in the study. Random-effect meta-analyses of effect size (ES) were conducted. Sub-group analyses were performed to explore the influence of intervention duration, prescription and participant characteristics. RESULTS: Of 66 full-text articles screened, 22 studies, from 21 interventions, were included (primarily breast/prostate cancer, sample range n = 36-498). When all interventions were grouped, a significant pooled ES was observed for exercise on hip (ES = 0.112, 95% CI: 0.026 to 0.198; p = 0.011) and lumbar spine BMD (ES = 0.269, 95% CI: 0.036 to 0.501; p = 0.024) compared to control. There was also an influence of sex, where females had greater improvements in hip (ES = 0.120, 95% CI: 0.017 to 0.223; p = 0.022) and spine BMD (ES = 0.415, 95% CI: 0.056 to 0.774; p = 0.23) compared to males. CONCLUSION: Overall, exercise regimens of studies included in this review appear to improve bone health at the hip and spine in people diagnosed with cancer. Sub-analyses suggest some influence of sex, where females had greater improvements in BMD compared to males. It is essential that future studies evaluate the dose-response of exercise training on bone health and create exercise protocols that better align with the laws of bone modelling to enhance osteogenic potential.

Correlates of light physical activity among cancer survivors.

OBJECTIVE: Emerging evidence demonstrates the positive health benefits of light physical activity (LPA) for cancer survivors. Yet, little research has explored modifiable factors that facilitate or hinder LPA behavior in this population. Correlates of LPA among cancer survivors were examined, and stratified by moderate-to-vigorous physical activity (MVPA) status. METHODS: A cross-sectional analysis using the American Cancer Society's Studies of Cancer Survivors-I (N = 1751) was conducted. Correlates of interest were health-care provider support for physical activity, perceived health competence, perceived social support, unsupportive partner behaviors, and perceived susceptibility to cancer recurrence. The primary outcome was self-reported LPA categorized at 0, 1-59, 60-119, and 120+ minutes per week. Multivariable ordinal regressions using forced entry were conducted, stratified by MVPA status. RESULTS: Adjusted multivariable models revealed that, among those reporting no MVPA (n = 757), greater provider support for physical activity (adjusted odds ratio [aOR] = 1.51; 95% CI, 1.05-2.17; P = 0.03), greater perceived health competence (aOR = 1.44; 95% CI, 1.10-1.88; P = 0.01), and greater unsupportive partner behaviors (aOR = 1.06; 95% CI, 1.01-1.12; P = 0.03) were significantly correlated with higher LPA. No social cognitive constructs were correlated with LPA among those already engaging in MVPA (n = 994). CONCLUSIONS: LPA interventions targeting cancer survivors not engaging in any MVPA are warranted and may optimize limited intervention resources. Furthermore, interventions may be more efficacious by applying behavior change techniques that incorporate health-care provider support and improves health competence and positive interpersonal skills.

Relationship between the structure, function and endothelial damage, and vascular ageing and the biopsychological situation in adults diagnosed with persistent COVID (BioICOPER study). A research protocol of a cross-sectional study.

Background: SARS-CoV-2 infection affects the vascular endothelium, which mediates the inflammatory and thrombotic cascade. Moreover, alterations in the endothelium are related to arterial stiffness, which has been established as a marker of cardiovascular disease. The objective of this study is to analyse how the structure, vascular function, vascular ageing and endothelial damage are related to the biopsychological situation in adults diagnosed with persistent COVID and the differences by gender. Methods: This cross-sectional, descriptive, observational study will be carried out in the Primary Care Research Unit of Salamanca (APISAL) and in the BioSepsis laboratory of the University of Salamanca. The sample will be selected from the persistent COVID monographic office at the Internal Medicine Service of the University Hospital of Salamanca, and from the population of subjects diagnosed with persistent COVID in the clinical history of Primary Care. Through consecutive sampling, the study will include 300 individuals diagnosed with persistent COVID who meet the diagnosis criteria established by the WHO, after they sign the informed consent. Endothelial damage biomarkers will be measured using ELLA-SimplePlexTM technology (Biotechne). Their vascular structure and function will be analysed by measuring the carotid intima-media thickness (Sonosite Micromax); the pulse wave and carotid-femoral pulse wave velocity (cfPWV) will be recorded with Sphygmocor System®. Cardio Ankle Vascular Index (CAVI), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index will be analysed with Vasera VS-2000®. The integral assessment of the subjects with persistent COVID will be conducted with different scales that evaluate fatigue, sleep, dyspnea, quality of life, attention, nutrition state, and fragility. We will also evaluate their lifestyles (diet, physical activity, smoking habits and alcohol consumption), psychological factors, and cognitive deterioration, which will be gathered through validated questionnaires; moreover, physical activity will be objectively measured using a pedometer for 7 days. Body composition will be measured through impedance using an Inbody 230. Vascular ageing will be calculated with 10 and 90 percentiles of cfPWV and baPWV. Furthermore, we will analyse the presence of vascular injury in the retina, heart, kidneys and brain, as well as cardiovascular risk. Demographic and analytical variables will also be gathered. Discussion: Arterial stiffness reflects the mechanic and functional properties of the arterial wall, showing the changes in arterial pressure, blood flow, and vascular diameter that occur with each heartbeat. SARS-CoV-2 affects the endothelial cells that are infected with this virus, increasing the production of pro-inflammatory cytokines and pro-thrombotic factors, which can cause early vascular ageing and an increase of arterial stiffness. Persistent COVID is a complex heterogeneous disorder that affects the lives of millions of people worldwide. The identifications of potential risk factors to better understand who is at risk of developing persistent COVID is important, since this would enable early and appropriate clinical support. It is unknown whether vascular alterations caused by COVID-19 resolve after acute infection or remain over time, favouring the increase of arterial stiffness and early vascular ageing. Therefore, it is necessary to propose studies that analyse the evolution of persistent COVID in this group of patients, as well as the possible variables that influence it. Clinical Trial registration: ClinicalTrials.gov, identifier NCT05819840.

Quality of Physical Activity Participation Among Adults with Disabilities Through Pandemic Restriction.

Background. Physical activity (PA) is essential for maintaining well-being in adults with disabilities. This population experienced reduced PA during the COVID-19 pandemic; yet, the impact on quality of PA participation remains unclear. Purpose. This secondary analysis explored how pandemic restrictions impacted six experiential dimensions of quality of PA participation among adults with disabilities. Methods. An exploratory sequential mixed-methods design, including semi-structured interviews (n = 10) and self-reported surveys (n = 61), was conducted in May-2020 and February-2021. Quality of PA participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Participants included community-dwelling adults over 19 years of age (mean 59.2 ± 14.0 years) living with stroke, spinal cord injury, or other physical disabilities. Findings. Directed content analysis identified three themes related to adjusting PA participation for restrictions, motivation barriers, and valuing social support. These themes highlighted five factors, such as resilience, as potential quantitative predictors of quality of PA participation. While paired correlations with MeEAP scores were observed, these factors were not statistically predictive in multiple regression analysis (adjusted R2 = -0.14, F(10,50) = 0.92, p = .53). Implications. The interplay between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality of PA participation was complex, with an emphasized role for mental health, in adults with disabilities.

A personalized mobile app for physical activity: An experimental mixed-methods study.

Objectives: To investigate the feasibility of the be.well app and its personalization approach which regularly considers users' preferences, amongst university students. Methods: We conducted a mixed-methods, pre-post experiment, where participants used the app for 2 months. Eligibility criteria included: age 18-34 years; owning an iPhone with Internet access; and fluency in English. Usability was assessed by a validated questionnaire; engagement metrics were reported. Changes in physical activity were assessed by comparing the difference in daily step count between baseline and 2 months. Interviews were conducted to assess acceptability; thematic analysis was conducted. Results: Twenty-three participants were enrolled in the study (mean age = 21.9 years, 71.4% women). The mean usability score was 5.6 ± 0.8 out of 7. The median daily engagement time was 2 minutes. Eighteen out of 23 participants used the app in the last month of the study. Qualitative data revealed that people liked the personalized activity suggestion feature as it was actionable and promoted user autonomy. Some users also expressed privacy concerns if they had to provide a lot of personal data to receive highly personalized features. Daily step count increased after 2 months of the intervention (median difference = 1953 steps/day, p-value <.001, 95% CI 782 to 3112). Conclusions: Incorporating users' preferences in personalized advice provided by a physical activity app was considered feasible and acceptable, with preliminary support for its positive effects on daily step count. Future randomized studies with longer follow up are warranted to determine the effectiveness of personalized mobile apps in promoting physical activity.

Physical activity and urinary incontinence during pregnancy and postpartum: A systematic review and meta-analysis.

To assess the association of physical activity and urinary incontinence, or its recovery, during pregnancy and postpartum. A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Two reviewers independently selected studies, assessed quality and extracted data. Odds ratios with 95% confidence intervals were calculated using fixed effects or random effects models, for low and moderate heterogeneity between studies, respectively. Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69-1.18) and OR 1.31 (95% CI: 0.74-2.34), respectively. Due to a lack of available data, urinary incontinence recovering could not be assessed. The available low evidence does not show that physical activity during pregnancy or postpartum is associated with urinary incontinence. Moderate physical activity should therefore be encouraged for the evidence-based benefits on other obstetrical outcomes.

Protein, Creatine, and Dieting Supplements Among Adolescents: Use and Associations With Eating Disorder Risk Factors, Exercise-, and Sports Participation, and Immigrant Status.

Objective: This study aimed to estimate the number of weekly users of protein, creatine, and dieting supplements and to explore whether weekly use was related to eating disorder (ED) risk factors, exercise, sports participation, and immigrant status. Methods: In total, 629 and 1,060 high school boys and girls, respectively, self-reported weekly frequency of protein, creatine, and dieting supplement use, and weight and shape concerns, appearance internalization and pressure, self-esteem, mental distress, physical activity level, exercise context, and the type and weekly frequency of sport played. Multiple hierarchical regression analyses were performed to investigate explanatory factors for supplement use. Results: More boys than girls used protein and creatine supplements. Immigrant boys had more frequent use of all supplements than non-immigrant boys, and immigrant girls used creatine supplements more frequently than non-immigrant girls. In total, 23-40 and 5-6% of the variation in the weekly frequency of supplement use in boys and girls, respectively, was explained by immigrant status, ED risk factors, and exercise and sports participation. More frequent use of protein, creatine and dieting supplements in boys was significantly explained by more weight and shape concerns, fitness center exercise, and weight-sensitive sports participation. Depending on the type of supplement, more frequent use of supplements in girls was significantly explained by lower self-esteem, more engagement in weight-sensitive sports, and less engagement in general sport and exercise activities. Conclusion: Weekly supplement use was common and more frequent among boys than girls. The weekly use of protein, creatine, and dieting supplements was related to ED risk factors, exercise and sports participation, and immigrant status in boys but not in girls.

Influence of maturational status in the exercise-induced release of cardiac troponin T in healthy young swimmers.

OBJECTIVES: To determine the influence of maturational status on the release of cardiac troponin T (cTnT) induced by a bout of 30min, high-intensity, continuous exercise. DESIGN: Quasi-experimental, cross-sectional study. METHODS: Seventy male, young, well trained swimmers (age range 7-18 years, training experience 1-11 years) were classified by maturational stages: Tanner stage I (n=14), II (n=15), III (n=15), IV (n=13), and V (n=13). Participants underwent a distance-trial of 30min continuous swimming, and cTnT was measured before, immediately after and 3h after exercise. Changes in cTnT over time were compared among groups, and associated with exercise load. RESULTS: Basal cTnT was higher in Tanner-V (3.8-8.1ng/L) compared with I (1.5-5.5ng/L, p<0.001), II (1.5-4.5ng/L, p<0.001) and III (1.5-6.8ng/L, p=0.003), and in IV (1.5-6.3ng/L) compared with II (p=0.036). Maximal elevations of cTnT from baseline were notable (p<0.001) and comparable among maturational stages (p=0.078). The upper reference limit for myocardial injury was exceeded in 35.7% of the participants, without differences among groups (p=0.18). Baseline cTnT correlated with participant characteristics, and maximal cTnT elevations from baseline with exercise internal load (%HRpeak, rs=0.34, p= 0.003; %HRmean, rs=0.28, p=0.02). CONCLUSIONS: Maturational status influences positively absolute pre- and post-exercise cTnT but not its elevation after a bout of 30min, high-intensity, continuous exercise.

An evaluation of the training determinants of marathon performance: A meta-analysis with meta-regression.

OBJECTIVES: Marathoners rely on expert-opinion and the anecdotal advice of their peers when devising their training plans for an upcoming race. The accumulation of results from multiple scientific studies has the potential to clarify the precise training requirements for the marathon. The purpose of the present study was to perform a systematic review, meta-analysis and meta-regression of available literature to determine if a dose-response relationship exists between a series of training behaviours and marathon performance. DESIGN: Systematic review, meta-analysis and meta-regression. METHODS: A systematic search of multiple literature sources was undertaken to identify observational and interventional studies of elite and recreational marathon (42.2km) runners. RESULTS: Eighty-five studies which included 137 cohorts of runners (25% female) were included in the meta-regression, with average weekly running distance, number of weekly runs, maximum running distance completed in a single week, number of runs ≥32km completed in the pre-marathon training block, average running pace during training, distance of the longest run and hours of running per week used as covariates. Separately conducted univariate random effects meta-regression models identified a negative statistical association between each of the above listed training behaviours and marathon performance (R2 0.38-0.81, p<0.001), whereby increases in a given training parameter coincided with faster marathon finish times. Meta-analysis revealed the rate of non-finishers in the marathon was 7.27% (95% CI 6.09%-8.65%). CONCLUSIONS: These data can be used by athletes and coaches to inform the development of marathon training regimes that are specific to a given target finish time.

Use of a mobile social networking intervention for weight management: a mixed-methods study protocol.

INTRODUCTION: Obesity and physical inactivity are major societal challenges and significant contributors to the global burden of disease and healthcare costs. Information and communication technologies are increasingly being used in interventions to promote behaviour change in diet and physical activity. In particular, social networking platforms seem promising for the delivery of weight control interventions.We intend to pilot test an intervention involving the use of a social networking mobile application and tracking devices (Fitbit Flex 2 and Fitbit Aria scale) to promote the social comparison of weight and physical activity, in order to evaluate whether mechanisms of social influence lead to changes in those outcomes over the course of the study. METHODS AND ANALYSIS: Mixed-methods study involving semi-structured interviews and a pre-post quasi-experimental pilot with one arm, where healthy participants in different body mass index (BMI) categories, aged between 19 and 35 years old, will be subjected to a social networking intervention over a 6-month period. The primary outcome is the average difference in weight before and after the intervention. Secondary outcomes include BMI, number of steps per day, engagement with the intervention, social support and system usability. Semi-structured interviews will assess participants' expectations and perceptions regarding the intervention. ETHICS AND DISSEMINATION: Ethics approval was granted by Macquarie University's Human Research Ethics Committee for Medical Sciences on 3 November 2016 (ethics reference number 5201600716).The social network will be moderated by a researcher with clinical expertise, who will monitor and respond to concerns raised by participants. Monitoring will involve daily observation of measures collected by the fitness tracker and the wireless scale, as well as continuous supervision of forum interactions and posts. Additionally, a protocol is in place to monitor for participant misbehaviour and direct participants-in-need to appropriate sources of help.

Friends, physical activity, and sedentary behavior in university students: A social network analysis / Amigos, actividad física y comportamiento sedentario en estudiantes universitarios: un análisis de redes sociales

Abstract Introduction: Understanding the processes of socialization during youth and their association with healthy behaviors is crucial for university education. Objective: To explore the associations of the characteristics of friendship networks with being physically active and having a sedentary behavior in university students. Materials and methods: Cross-sectional study conducted in 475 university students and based on a social network analysis. Measurements included sociodemographic, physical activity, sedentary behavior, and friendship network variables. The associations between the characteristics of friendship networks and physical activity and sedentary behavior were explored using logistic regression models. Confidence intervals (95%) were estimated and a significance level of p<0.05 was considered. Results: In women, being part of at least a cluster of friends was significantly associated with being physically active (adjusted OR [aOR]: 2.3; 95%CI: 1.2-4.6), while being popular was significantly associated with a lower probability of being physically active (aOR: 0.3; 95%CI: 0.1-0.7). Also, a ten-percentage point increase in active friends was significantly associated with a higher probability of being physically active (aOR: 9.3; 95%CI: 3.5-24.6). Regarding sedentary behavior, a ten-percentage point increase in the number of sedentary friends was significantly associated with a higher probability of being sedentary (aOR: 5.5; 95%CI: 2.5-12.3). In men, none of the studied associations were statistically significant. Conclusion: Some characteristics of social network are relevant for female university students in relation to their physical activity levels and sedentary behaviors. These findings highlight the need to consider friendship network dynamics for designing initiatives aimed at physical activity promotion and sedentary behavior reduction.

Resumen Introducción. El entendimiento de los procesos de socialización durante la juventud y su relación con conductas saludables son cruciales para la educación universitaria. Objetivo. Explorar las asociaciones de las características de la red social de amigos con ser físicamente activo y con tener un comportamiento sedentario en estudiantes universitarios. Materiales y métodos. Estudio transversal, basado en un análisis de redes sociales, realizado en 475 estudiantes universitarios. Las mediciones realizadas incluyeron variables sociodemográficas, actividad física, conducta sedentaria y redes sociales de amigos. Las asociaciones entre las características de la red social de amigos con la actividad física y el comportamiento sedentario fueron exploradas mediante modelos de regresión logística. Se estimaron intervalos de confianza (95%) y se consideró un nivel de significancia de p<0.05. Resultados. En mujeres, ser parte de al menos un conglomerado de amigos se asoció significativamente con ser físicamente activa (OR ajustados: 2.3; IC95%: 1.2-4.6), mientras que ser popular se asoció significativamente con una menor probabilidad de ser físicamente activa (OR ajustados [aOR]: 0.3; IC95%: 0.1-0.7). Asimismo, un incremento de diez puntos porcentuales de amigos activos se asoció significativamente con una mayor probabilidad de ser físicamente activa (aOR: 9.3; IC95%: 3.5-24.6). En relación con el comportamiento sedentario, un incremento de diez puntos porcentuales de amigos sedentarios se asoció significativamente con una mayor probabilidad de ser sedentaria (aOR: 5.5; IC95%: 2.5-12.3). En hombres, ninguna de las asociaciones estudiadas fue estadísticamente significativa. Conclusión. Algunas características de las redes sociales de amigos fueron relevantes para las estudiantes universitarias en relación a sus niveles de actividad física y comportamiento sedentario. Estos hallazgos resaltan la necesidad de considerar las dinámicas de las redes sociales de amigos en el diseño de iniciativas orientadas a la promoción de la actividad física y la reducción de conductas sedentarias.

The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial.

PURPOSE: Following colorectal cancer diagnosis and anti-cancer therapy, declines in cardiorespiratory fitness and body composition lead to significant increases in morbidity and mortality. There is increasing interest within the field of exercise oncology surrounding potential strategies to remediate these adverse outcomes. This study compared 4 weeks of moderate-intensity exercise (MIE) and high-intensity exercise (HIE) training on peak oxygen consumption (V̇O2peak) and body composition in colorectal cancer survivors. METHODS: Forty seven post-treatment colorectal cancer survivors (HIE = 27 months post-treatment; MIE = 38 months post-treatment) were randomised to either HIE [85-95 % peak heart rate (HRpeak)] or MIE (70 % HRpeak) in equivalence with current physical activity guidelines and completed 12 training sessions over 4 weeks. RESULTS: HIE was superior to MIE in improving absolute (p = 0.016) and relative (p = 0.021) V̇O2peak. Absolute (+0.28 L.min(-1), p < 0.001) and relative (+3.5 ml.kg(-1).min(-1), p < 0.001) V̇O2 peak were increased in the HIE group but not the MIE group following training. HIE led to significant increases in lean mass (+0.72 kg, p = 0.002) and decreases in fat mass (-0.74 kg, p < 0.001) and fat percentage (-1.0 %, p < 0.001), whereas no changes were observed for the MIE group. There were no severe adverse events. CONCLUSIONS: In response to short-term training, HIE is a safe, feasible and efficacious intervention that offers clinically meaningful improvements in cardiorespiratory fitness and body composition for colorectal cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: HIE appears to offer superior improvements in cardiorespiratory fitness and body composition in comparison to current physical activity recommendations for colorectal cancer survivors and therefore may be an effective clinical utility following treatment.

El paciente con cefalea durante el ejercicio en urgencias / The patient with headache during exercise in emergency department

RESUMEN La cefalea relacionada con la actividad física no es infrecuente. En pacientes jóvenes suele corresponder a cefalea por esfuerzo físico primaria. Sin embargo, aun en la presencia de características típicas, el diagnóstico de cefalea primaria relacionada con el ejercicio debe hacerse luego de una investigación exhaustiva. Las causas secundarias típicas incluyen hemorragia subaracnoidea, síndrome de vasoconstricción cerebral reversible y disección arterial. Una etiología menos común es la trombosis de senos venosos durales. En esta revisión presentamos el caso de una mujer joven que experimentó cefalea durante una prueba física, en quien se documenta una trombosis de senos venosos extensa.

SUMMARY Headache related to physical activity is not uncommon. In young patients it usually corresponds to headache due to primary physical exertion. However, even in the presence of typical features, the diagnosis of primary exercise-related headache should be made after extensive investigation. Secondary causes include subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, and arterial dissection. A less common etiology is thrombosis of the dural venous sinuses. In this review we present the case of a young woman who presented with headache during a physical test in which extensive venous sinus thrombosis was documented.

Prescripción del ejercicio físico y sus implicaciones en adultos que han sufrido quemaduras / Prescription of physical activity and its implications in adults who have experienced burns

Resumen Introducción. La prescripción del ejercicio físico y sus implicaciones en pacientes que han sufrido quemaduras es objeto de estudio en diferentes investigaciones debido al impacto físico, psicológico y social que tiene en las personas. Objetivo. Describir la prescripción de ejercicio físico y sus implicaciones en la población adulta que ha sufrido quemaduras. Materiales y métodos. Se realizó una revisión de tema por medio de exploración de artículos de manera electrónica con filtros de búsqueda en distintas bases de datos con términos DeCS y MeSH. Resultados. Se seleccionaron 11 artículos con intervención de ejercicio físico en fases aguda y crónica. Se incluyeron estrategias sobre la fuerza muscular en cinco de los artículos: tres de resistencia cardiovascular; dos de rango de movimiento, flexibilidad y características tróficas de la piel, y uno de dolor. Conclusiones. Las variables de la prescripción se determinan de acuerdo a las características propias que presenta la persona con quemadura, las cuales se resumen en esta revisión.

Abstract Introduction: The prescription of physical activity and its implications in patients who have suffered burns is the object of study of different investigations due to the physical, psychological and social impact they have on people. Objective: To describe the prescription of physical activity and its implications in adults with burn injury. Materials and methods: A review of the topic was carried out by scanning articles electronically and using search filters in different databases with DeCS and MeSH terms. Results: 11 articles about physical activity intervention in acute and chronic phases were selected. Strategies on muscle strength were included in six of the articles: three on cardiovascular resistance; two on range of motion, flexibility and trophic features of the skin; and one on pain. Conclusions: The variables of the prescription are determined according to the characteristics of the person with the burn, which are summarized in this review.