Instructor Social Support in the Group Physical Activity Context: Older Participants' Perspectives.

Instructors in organized physical activity classes can be a source of social support through their relationships with participants, influence on participants' interactions with each other, and design of activities. Grounded in interpretive description, the objective of this study was to examine older adults' experiences of and their perspectives on group physical activity instructors' supportive behaviors. Observations of 16 group physical activity classes (N = 295) and focus groups or interviews with N = 38 class participants aged ≥ 55 (n = 29 women) were conducted at four municipal recreation facilities in a Canadian city. Five themes shed light on how instructors provided social support: (a) supporting autonomous engagement, (b) developing caring connections, (c) fostering trust through expert instruction, (d) managing conflict directly and effectively, and (e) creating a climate where people want to go. Instructor training should consider older adults' social support needs and help instructors embody behaviors that support continued physical activity participation, thereby contributing to healthy aging.

Experiences With Social Participation in Group Physical Activity Programs for Older Adults.

Little is known about how social participation can be facilitated among older adults in group physical activity and its psychosocial benefits that contribute to successful aging. This study aimed to understand older adults' experiences with social participation in group physical activity programs. Using interpretive description methodology, 16 observations, eight focus groups, and two interviews with participants unable to attend focus groups were conducted with adults 55 years and older attending programs across four recreation facilities. Group programs were found to influence social participation through (a) a meaningful context for connecting and (b) instructors' expectations of social interaction. Social participation in these programs addressed psychosocial needs by (c) increasing social contact and interaction, (d) fostering social relationships and belonging, and (e) promoting regular engagement. Training for instructors should include balancing the physical aspects of program delivery with the social, while also considering older adults' diverse needs and preferences for social interaction.

UK consensus statement on the use of plerixafor to facilitate autologous peripheral blood stem cell collection to support high-dose chemoradiotherapy for patients with malignancy.

Plerixafor is a CXC chemokine receptor (CXCR4) antagonist that mobilizes stem cells in the peripheral blood. It is indicated (in combination with granulocyte-colony stimulating factor [G-CSF]) to enhance the harvest of adequate quantities of cluster differentiation (CD) 34+ cells for autologous transplantation in patients with lymphoma or multiple myeloma whose cells mobilize poorly. Strategies for use include delayed re-mobilization after a failed mobilization attempt with G-CSF, and rescue or pre-emptive mobilization in patients in whom mobilization with G-CSF is likely to fail. Pre-emptive use has the advantage that it avoids the need to re-schedule the transplant procedure, with its attendant inconvenience, quality-of-life issues for the patient and cost of additional admissions to the transplant unit. UK experience from 2 major centers suggests that pre-emptive plerixafor is associated with an incremental drug cost of less than £2000 when averaged over all patients undergoing peripheral blood stem cell (PBSC) transplant. A CD34+ cell count of <15 µl-1 at the time of recovery after chemomobilization or after four days of G-CSF treatment, or an apheresis yield of <1 × 106 CD34+ cells/kg on the first day of apheresis, could be used to predict the need for pre-emptive plerixafor.

Variety support and exercise adherence behavior: experimental and mediating effects.

The purpose of this study was to examine the extent to which the provision of variety (i.e., variety support) is related to exercise behavior among physically inactive adults and the extent to which the 'experience of variety' mediates those effects. One hundred and twenty one inactive university students were randomly assigned to follow a high or low variety support exercise program for 6 weeks. Assessments were conducted at baseline, 3- and 6-weeks. Participants in the high variety support condition displayed higher levels of adherence to the exercise program than those in the low variety support condition [F(1, 116) = 5.55, p = .02, η(p)(2) = .05] and the relationship between variety support and adherence was mediated by perceived variety (ß = .16, p < .01). Exercise-related variety support holds potential to be an efficacious method for facilitating greater exercise adherence behaviors of previously inactive people by fostering perceptions of variety.

Interpersonal Emotion Regulation Among Adolescent Athletes: A Bayesian Multilevel Model Predicting Sport Enjoyment and Commitment.

Efforts to regulate emotions can influence others, and interpersonal emotion regulation within teams may affect athletes' own affective and motivational outcomes. We examined adolescent athletes' (N = 451, N teams = 38) self- and interpersonal emotion regulation, as well as associations with peer climate, sport enjoyment, and sport commitment within a multilevel model of emotion regulation in teams. Results of multilevel Bayesian structural equation modeling showed that athletes' self-worsening emotion regulation strategies were negatively associated with enjoyment while other-improving emotion regulation strategies were positively associated enjoyment and commitment. The team-level interpersonal emotion regulation climate and peer motivational climates were also associated with enjoyment and commitment. Team-level factors moderated some of the relationships between athletes' emotion regulation with enjoyment and commitment. These findings extend previous research by examining interpersonal emotion regulation within teams using a multilevel approach, and they demonstrate the importance of person- and team-level factors for athletes' enjoyment and commitment.

Peri-operative massive pulmonary embolism management: is veno-arterial ECMO a therapeutic option?

Pulmonary embolism remains an important clinical problem with a high mortality rate. The potential for sudden and fatal hemodynamic deterioration highlights the need for a prompt diagnosis and appropriate intervention. The purpose of the present case report is to describe a successful peri-operative veno-arterial extra corporeal membrane oxygenation (VA-ECMO) implantation for assumed massive pulmonary embolism associated with high hemodynamic instability and severe hypoxemia. A 52-year-old female victim of a motorcycle accident had been operated on for unstable fractures that required optimal repair. Despite subcutaneous administration of 40 mg enoxaparin on day 0 and day 1, the patient developed a massive pulmonary embolism leading to peri-operative pulseless activity. As intravenous thrombolysis was strictly contraindicated, a VA-ECMO was successfully implanted and permitted to stabilize the patient's hemodynamics. The hemodynamic and respiratory status improved by day 3, and the ECMO was removed. A vena cava filter was implanted before successful and definitive stabilization of the femoral fracture and the L2 fracture on days 4 and 5. The patient was able to be mobilized 2 days after the surgery and was transferred to a rehabilitation ward on day 15. At that time, her cognitive functions had fully recovered. ECMO can provide lifesaving hemodynamic and respiratory support in patients with massive pulmonary embolism who are too unstable to tolerate other interventions, who have failed other therapies or for whom other therapies are contraindicated.

Practice and play as determinants of self-determined motivation in youth soccer players.

Based upon predictions derived from the Developmental Model of Sports Participation, we tested whether hours in domain-specific play (self-led activities) and practice (coach-led activities) during childhood (~5-12 year) in an elite group of youth soccer players from the UK (N = 144) were related to motivation. Independent analysis of three different age groups (Under 13, 15 and 17 year) did not show relations between play and practice activities during childhood and global measures of motivation. However, secondary analysis showed that when controlling for years in soccer, years in the UK Academy system were negatively related to global indices of self-determined motivation (SDI) and positively related to controlled motivation for the oldest players. Despite predictions, there was no evidence that play during childhood was positively related to more SDI. Prospective research is recommended to enable more robust conclusions about the role of early developmental practice activities, especially early specialisation in a high-performance system, on both skill and psychosocial development.

Passion and coping: relationships with changes in burnout and goal attainment in collegiate volleyball players.

This study examined the relationship between harmonious and obsessive passion and coping, and assessed whether coping mediated the relationship between passion types and changes in burnout and goal attainment. College- and university-level volleyball players (N = 421) completed measures of passion, coping, burnout, and goal attainment at the start and end of a season. Results of structural equation modeling, using a true latent change approach, supported a model whereby types of passion were indirectly related to changes in burnout and goal attainment via coping. Harmonious passion was positively related to task-oriented coping which, in turn, was positively associated with change in goal attainment. Obsessive passion was positively associated with disengagement-oriented coping which, in turn, was positively and negatively associated with changes in burnout and goal attainment, respectively. This study identifies coping as a reason why passionate athletes may experience changes in burnout and goal attainment over the course of a season.

"I think the best athletes use it": Masculinities and self-compassion among men varsity athletes.

We examined how men varsity athletes' embodiments of masculinities shaped their perceptions and experiences of self-compassion to manage sport-related challenges. Two semi-structured interviews were conducted with 11 men varsity athletes (20 interviews total). Vignettes depiciting athletes low and high in self-compassion were used as talk elicitation tools during interviews. Data were analyzed using reflexive thematic analysis and four themes were identified from the mens' accounts. Participants utilized self-compassion as a coping strategy in sport and other life-domains to maintain well-being. Self-compassion was used to balance self-criticism to support achievement striving efforts. The experience of contrasting masculine ideologies (hegemonic and inclusive) promoted and constrained the men's implementation of self-compassion. Traditional masculine narratives created tensions for participants who at times embodied the (mis)belief that self-compassion promotes complacency in the pursuit of athletic achievement. Findings contribute to understandings of men athletes' experiences of self-compassion and masculinities in relation to sport-related challenges and performance.

'You're part of something bigger': interpersonal relationships and older Canadian men's body image.

OBJECTIVE: We examined older men's body image, with a focus on the role of interpersonal relationships in shaping their psychological adaptation to age-related body changes to appearance, function, and health. DESIGN: Qualitative narrative constructionist study. MAIN OUTCOME MEASURES: We conducted semi-structured interviews with 29 men aged 65-83. Data were analysed using thematic narrative analysis; we identified and interpreted patterns in and across the men's stories about their aging bodies. RESULTS: Narratives of purpose through meaningful engagement and belonging through connection permeated the men's accounts. Participants mitigated body-related changes and challenges through pleasurable physical, leisure, and community activities. They derived purpose from these activities as they kept them physically, cognitively, and socially engaged and thus relevant with advancing age, particularly post retirement. The men derived a sense of belonging through social connections. Relationships with family, friends, and community members shaped their capacity for meaningful engagement and associated psychological adjustment to age-related body changes. CONCLUSION: The findings point to the imperative need to consider how men negotiate their constantly changing, aging bodies within the context of interpersonal relationships, and highlight the role that later life belonging and purpose play in shaping how men experience their bodies as they grow older.

Cyclophosphamide, thalidomide, and dexamethasone as induction therapy for newly diagnosed multiple myeloma patients destined for autologous stem-cell transplantation: MRC Myeloma IX randomized trial results.

BACKGROUND: Thalidomide is active in multiple myeloma and is associated with minimal myelosuppression, making it a good candidate for induction therapy prior to high-dose therapy with autologous stem-cell transplantation. DESIGN AND METHODS: Oral cyclophosphamide, thalidomide, and dexamethasone was compared with infusional cyclophosphamide, vincristine, doxorubicin, and dexamethasone in patients with newly diagnosed multiple myeloma. RESULTS: The post-induction overall response rate (≥ partial response) for the intent-to-treat population was significantly higher with cyclophosphamide-thalidomide-dexamethasone (n=555) versus cyclophosphamide-vincristine-doxorubicin-dexamethasone (n=556); 82.5% versus 71.2%; odds ratio 1.91; 95% confidence interval 1.44-2.55; P<0.0001. The complete response rates were 13.0% with cyclophosphamide-thalidomide-dexamethasone and 8.1% with cyclophos-phamide-vincristine-doxorubicin-dexamethasone (P=0.0083), with this differential response being maintained in patients who received autologous stem-cell transplantation (post-transplant complete response 50.0% versus 37.2%, respectively; P=0.00052). Cyclophosphamide-thalidomide-dexamethasone was non-inferior to cyclophosphamide-vincristine-doxorubicin-dexamethasone for progression-free and overall survival, and there was a trend toward a late survival benefit with cyclophosphamide-thalidomide-dexamethasone in responders. A trend toward an overall survival advantage for cyclophosphamide-thalidomide-dexamethasone over cyclophosphamide-vincristine-doxorubicin-dexamethasone was also observed in a subgroup of patients with favorable interphase fluorescence in situ hybridization. Compared with cyclophosphamide-vincristine-doxorubicin-dexamethasone, cyclophosphamide-thalidomide-dexamethasone was associated with more constipation and somnolence, but a lower incidence of cytopenias. CONCLUSIONS: The cyclophosphamide-thalidomide-dexamethasone regimen showed improved response rates and was not inferior in terms of survival outcomes to the standard infusional regimen of cyclophosphamide-vincristine-doxorubicin-dexamethasone. Based on its oral administration and the reduced incidence of infection and cytopenia, cyclophosphamide-thalidomide-dexa-methasone may be considered an effective induction therapy option for patients with newly diagnosed multiple myeloma. (ISRCTN: 68454111).

From minding the gap to widening the gap: Paralympic athletes' experiences of wellbeing during the postponement of the Tokyo 2020 games.

In March 2020, it was announced that the Tokyo Games would be postponed for one year due to the COVID-19 pandemic. While athletes commonly face challenges in sport such as injuries, the pandemic and rescheduling of the Games was an unexpected event that had serious potential to challenge the psychological wellbeing of athletes. Furthermore, it was an event that was simultaneously experienced by all athletes preparing for the Games. It provided a novel opportunity to explore how athletes navigated this challenging environment and the subsequent potential impact on their psychological wellbeing. It also provided a unique opportunity to engage para-athletes and explore how they experienced the pandemic and postponement. This manuscript draws on a larger qualitative study of 21 Canadian athletes (14 Olympic and seven Paralympic) who were on target to compete at the 2020 Games when the postponement was announced. For this manuscript, we focus on the accounts of seven Paralympic hopefuls and their experiences of adjusting to the postponement, while attending to the unique social identities of athletes with disabilities. Adopting a constructionist lens, semi-structured interviews were conducted at two time points. Through reflexive thematic analysis, we developed three themes. "We are all in the same boat. . . or are we?" describes the Paralympic hopefuls experiences early in the pandemic and how they felt united by the Canadian response to withdraw from the Games. It then discusses how, over time, they started to understand athletes with disabilities were being inequitably impacted by the pandemic and related public health measures. "Maybe it means more to them than us" examines how their perceptions changed as they acknowledged that although all athletes were facing a disruption to their sport careers, the implications were not the same for all. "Vulnerability and the Paralympic athlete" addresses how Paralympic athletes engaged with societal narratives about risk, vulnerability and disability and what this meant for the Paralympic Movement's response to the pandemic. "Honestly, I've experienced it before" examines how the Paralympic hopefuls drew on past experiences of injury to navigate the pandemic and the protective impact on their psychological wellbeing. Findings shed light on how systemic ableism interacted with the pandemic to magnify feelings of inferiority and further marginalization but also how para-athletes drew on past experiences to navigate challenges to their psychological wellbeing.

Emotion profiles among adolescent female athletes: Associations with flourishing.

Many girls who participate in sport struggle to negotiate the complex relationship between their desired appearance and maintaining a physique that facilitates performance. As a result, these athletes experience a range of emotions about their bodies that impact their psychological well-being. We examined appearance- and fitness-related emotions using latent profile analysis among 507 adolescent girls involved in organized sport and examined differences in flourishing across the resulting profiles. Four emotion profiles were identified: (i) Frequent Pride, (ii) Occasional Fitness Pride, (iii) Occasional Pride, Rare Guilt/Shame, and (iv) Occasional Emotions. Participants in the Occasional Emotions profile reported the lowest flourishing scores compared to every other profile while those in the Frequent Pride profile reported the highest levels of flourishing. There were no differences in flourishing between those in the Occasional Fitness Pride profile and those in the Occasional Pride, Rare Guilt/Shame profile. Our results demonstrate how subsets of athletes may characteristically experience distinct combinations of emotions that are differentially associated with flourishing. Increasing experiences of body-related pride while mitigating experiences of guilt and shame appear to be important contributors to flourishing. However, experiences of pride may do little to buffer against reductions in flourishing when guilt and shame are experienced.

Five new pedigrees with inherited RUNX1 mutations causing familial platelet disorder with propensity to myeloid malignancy.

Familial platelet disorder with propensity to myeloid malignancy (FPD/AML) is an autosomal dominant syndrome characterized by platelet abnormalities and a predisposition to myelodysplasia (MDS) and/or acute myeloid leukemia (AML). The disorder, caused by inherited mutations in RUNX1, is uncommon with only 14 pedigrees reported. We screened 10 families with a history of more than one first degree relative with MDS/AML for inherited mutations in RUNX1. Germ- line RUNX1 mutations were identified in 5 pedigrees with a 3:2 predominance of N-terminal mutations. Several affected members had normal platelet counts or platelet function, features not previously reported in FPD/AML. The median incidence of MDS/AML among carriers of RUNX1 mutation was 35%. Individual treatments varied but included hematopoietic stem cell transplantation from siblings before recognition of the inherited leukemogenic mutation. Transplantation was associated with a high incidence of complications including early relapse, failure of engraftment, and posttransplantation lymphoproliferative disorder. Given the small size of modern families and the clinical heterogeneity of this syndrome, the diagnosis of FPD/AML could be easily overlooked and may be more prevalent than previously recognized. Therefore, it would appear prudent to screen young patients with MDS/AML for RUNX1 mutation, before consideration of sibling hematopoietic stem cell transplantation.

The Posttraumatic Growth Inventory: an examination of the factor structure and invariance among breast cancer survivors.

OBJECTIVE: The present study tested the proposed five-factor structure and invariance of the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) in a sample of physically active breast cancer survivors. METHODS: A sample of breast cancer survivors (N=470, Mage=57.3, SD=7.8 years) completed the PTGI and a demographic questionnaire. The factor structure, factorial invariance, and latent mean invariance were tested using maximum likelihood structural equation modeling. RESULTS: Preliminary analyses showed acceptable reliability for the PTGI subscales (alpha<0.83). Confirmatory factor analysis (CFA) supported the five related factors corresponding to: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life (chi(2) (179)=822.53, CFI=0.97, NNFI=0.96, SRMR=0.05, RMSEA=0.09). Multigroup CFA supported the invariance of the PTGI across age groups, treatment type, time since diagnosis, and time since last treatment. CONCLUSIONS: These findings provide support for (1) the multidimensional nature and factorial validity of the PTGI, and (2) the use of the PTGI in future research examining posttraumatic growth within samples of physically active breast cancer survivors.

Invariance test of the Multidimensional Body Self-Relations Questionnaire: do women with breast cancer interpret this measure differently?

PURPOSE: To examine whether the meaning and interpretation of body image are similar for breast cancer survivors and women without breast cancer. METHOD: Women completed the Multidimensional Body Self-Relations Questionnaire--Appearance Scales as part of two studies. There were 469 women with breast cancer and 385 women without breast cancer. Invariance testing was conducted to examine whether the items assessing the body image dimensions were similar, whether the dimensions were interpreted similarly, whether the items were equally salient and meaningful, and whether there were mean differences on the body image dimensions across the two groups. RESULTS: The meaning and interpretation of body image dimensions related to appearance evaluation and appearance orientation were similar across the groups, yet some group differences were found for overweight preoccupation and body areas satisfaction (and not testable for self-classified weight). Breast cancer survivors reported a small yet significantly higher mean on appearance evaluation and lower mean on appearance orientation compared to the women without breast cancer. CONCLUSIONS: Meaningful comparisons in body image across cancer and non-cancer women can be made using two of the Multidimensional Body Self-Relations Questionnaire--Appearance Scales. The overweight preoccupation subscale could be used to assess body image but should not be used if group mean differences are desirable. Assessing satisfaction with body areas across these groups is not recommended and may introduce systematic bias.

Conditioned pain modulation in elite athletes: a systematic review and meta-analysis.

Background and aims Elite athletes reportedly have superior pain tolerances, but it is unclear if results extend to conditioned pain modulation (CPM). The aim of our study was to synthesize existing literature in order to determine whether CPM is increased in elite athletes compared to healthy controls. Methods A systematic review and random-effects meta-analysis was conducted. Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CINAHL, Web of Science, and PubMed were searched for English-language studies that examined CPM in adult elite athlete populations. Results Seven studies were identified; all were of poor to fair methodological quality. There was no overall difference in CPM between elite athletes and controls (Hedges g = 0.37, CI95 -0.03-0.76; p = 0.07). There was heterogeneity between studies, including one that reported significantly less CPM in elite athletes compared to controls. An exploratory meta-regression indicated that a greater number of hours trained per week was associated with higher CPM. Conclusions The overall number and quality of studies was low. Despite nominally favoring higher CPM in elite athletes, aggregate results indicate no significant difference compared to healthy controls. A possible factor explaining the high degree of variability between studies is the number of hours elite athletes spent training. Implications Based on available evidence, athletes do not have remarkable endogenous pain modulation compared to controls. High quality experimental studies are needed to address the effect of hours trained per week on CPM in athletes.

An examination of older men's body image: How men 65 years and older perceive, experience, and cope with their aging bodies.

We examined how older men perceived, experienced, and coped with age-related changes to their appearance, body function, and health. Data from semi-structured interviews with 28 men aged 65-83 living in a large urban Canadian city and diverse in ethnocultural background (European, East Asian, and South Asian) and sexual orientation (heterosexual and gay) were analyzed through a reflexive thematic analysis. Four overarching themes were constructed from the participants' accounts. Participants were ambivalent about their aging bodies; they were concerned about certain changes to their bodies, yet concurrently grateful for their retained health and body function. The men stressed the need to accept age-related body changes through pragmatism, awareness of challenging body-related cognitions and emotions without overidentification or suppression, and adjustments to expectations and activities. Participants engaged in upward and downward social comparisons to assess their aging bodies in relation to others and to their younger selves. Weight concerns were prominent. The men worried about their weight, with particular attention to their stomach, and were physically active and ate a healthy diet to manage their weight. This study contributes to body image theorizing by including older diverse men and can inform interventions aiming to enhance men's later life psychological adjustment.

The influence of family and culture on physical activity among female adolescents from the Indian diaspora.

In this study we explored the role of personal, familial, and cultural attitudes and social norms for physical activity (PA) on actual PA behavior among female adolescents of the Indian diaspora. Six girls, 15 to 19 years of age, from a spiritual center participated in interviews and a focus group. Data were analyzed using content analysis. Participants were high in familism, and felt that PA was important for physical and mental health, and to strengthen relationships with family. Fathers and brothers were considered most influential on PA patterns. Differentiated gender roles in PA emerged: boys were deemed more aggressive and competitive, and girls were perceived to promote fun-based learning environments. The importance of religion and spirituality as influences on PA emerged among participants with strong affinities for Indian cultures. Results show that cultural heritage impacts PA norms, attitudes, and patterns, and must be considered when evaluating adolescent PA participation in multicultural societies.