Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study.

BACKGROUND: The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)-funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. OBJECTIVE: This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020-funded projects. METHODS: Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. RESULTS: Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. CONCLUSIONS: Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations.

Personalised and progressive neuromuscular electrical stimulation (NMES) in patients with cancer-a clinical case series.

PURPOSE: Neuromuscular electrical stimulation (NMES) may be a pragmatic short-term alternative to voluntary exercise to augment cancer rehabilitation. However, previous attempts to use NMES as an exercise modality in this cohort have been unsuccessful, largely due to the use of NMES protocols that were developed for other rehabilitation contexts. We assessed the effects of a personalised and progressive NMES exercise intervention, designed with early-stage cancer rehabilitation in mind, on exercise capacity, lower body functional strength and quality of life in (QoL) in patients who are currently undergoing or have recently completed treatment for cancer. METHODS: Ten adult patients were recruited. A personalised and progressive NMES exercise intervention was implemented in each case over a 4-8-week period. The 30-s sit-to-stand test (STS), 6-min walk test (6MWT) and EORTC QLQ C-30 were performed pre- and post-intervention. Patients completed semi-structured interviews post-intervention to explore their experiences and views on the intervention and its impact on their daily lives. RESULTS: Six of the 10 recruited patients completed the intervention and completed pre-and post-assessments. Four of 6 patients improved STS, 5 of 6 patients improved 6MWT and 4 of 6 patients improved Global QoL. Perceived benefits included improved muscle strength and more confidence when walking. CONCLUSION: A personalised and progressive NMES exercise intervention appears safe and may improve functional capacity and QoL in adults who are undergoing or have recently completed treatment for cancer. Replication of these results in a controlled prospective study is warranted prior to clinical implementation.

A Research Roadmap: Connected Health as an Enabler of Cancer Patient Support.

The evidence that quality of life is a positive variable for the survival of cancer patients has prompted the interest of the health and pharmaceutical industry in considering that variable as a final clinical outcome. Sustained improvements in cancer care in recent years have resulted in increased numbers of people living with and beyond cancer, with increased attention being placed on improving quality of life for those individuals. Connected Health provides the foundations for the transformation of cancer care into a patient-centric model, focused on providing fully connected, personalized support and therapy for the unique needs of each patient. Connected Health creates an opportunity to overcome barriers to health care support among patients diagnosed with chronic conditions. This paper provides an overview of important areas for the foundations of the creation of a new Connected Health paradigm in cancer care. Here we discuss the capabilities of mobile and wearable technologies; we also discuss pervasive and persuasive strategies and device systems to provide multidisciplinary and inclusive approaches for cancer patients for mental well-being, physical activity promotion, and rehabilitation. Several examples already show that there is enthusiasm in strengthening the possibilities offered by Connected Health in persuasive and pervasive technology in cancer care. Developments harnessing the Internet of Things, personalization, patient-centered design, and artificial intelligence help to monitor and assess the health status of cancer patients. Furthermore, this paper analyses the data infrastructure ecosystem for Connected Health and its semantic interoperability with the Connected Health economy ecosystem and its associated barriers. Interoperability is essential when developing Connected Health solutions that integrate with health systems and electronic health records. Given the exponential business growth of the Connected Health economy, there is an urgent need to develop mHealth (mobile health) exponentially, making it both an attractive and challenging market. In conclusion, there is a need for user-centered and multidisciplinary standards of practice to the design, development, evaluation, and implementation of Connected Health interventions in cancer care to ensure their acceptability, practicality, feasibility, effectiveness, affordability, safety, and equity.

Acute effects of three different stretching protocols on the wingate test performance.

The purpose of this study was to examine the acute effects of different stretching exercises on the performance of the traditional Wingate test (WT). Fifteen male participants performed five WT; one for familiarization (FT), and the remaining four after no stretching (NS), static stretching (SS), dynamic stretching (DS), and proprioceptive neuromuscular facilitation (PNF). Stretches were targeted for the hamstrings, quadriceps, and calf muscles. Peak power (PP), mean power (MP), and the time to reach PP (TP) were calculated. The MP was significantly lower when comparing the DS (7.7 ± 0.9 W/kg) to the PNF (7.3 ± 0.9 W/kg) condition (p < 0.05). For PP, significant differences were observed between more comparisons, with PNF stretching providing the lowest result. A consistent increase of TP was observed after all stretching exercises when compared to NS. The results suggest the type of stretching, or no stretching, should be considered by those who seek higher performance and practice sports that use maximal anaerobic power.

Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study.

BACKGROUND: Physical activity (PA) is the most well-established lifestyle factor associated with breast cancer (BC) survival. Even women with advanced BC may benefit from moderate PA. However, most BC symptoms and treatment side effects are barriers to PA. Mobile health coaching systems can implement functionalities and features based on behavioral change theories to promote healthier behaviors. However, to increase its acceptability among women with BC, it is essential that these digital persuasive systems are designed considering their contextual characteristics, needs, and preferences. OBJECTIVE: This study aimed to examine the potential acceptability and feasibility of a mobile-based intervention to promote PA in patients with BC; assess usability and other aspects of the user experience; and identify key considerations and aspects for future improvements, which may help increase and sustain acceptability and engagement. METHODS: A mixed methods case series evaluation of usability and acceptability was conducted in this study. The study comprised 3 sessions: initial, home, and final sessions. Two standardized scales were used: the Satisfaction with Life Scale and the International Physical Activity Questionnaire-Short Form. Participants were asked to use the app at home for approximately 2 weeks. App use and PA data were collected from the app and stored on a secure server during this period. In the final session, the participants filled in 2 app evaluation scales and took part in a short individual interview. They also completed the System Usability Scale and the user version of the Mobile App Rating Scale. Participants were provided with a waist pocket, wired in-ear headphones, and a smartphone. They also received printed instructions. A content analysis of the qualitative data collected in the interviews was conducted iteratively, ensuring that no critical information was overlooked. RESULTS: The International Physical Activity Questionnaire-Short Form found that all participants (n=4) were moderately active; however, half of them did not reach the recommended levels in the guidelines. System Usability Scale scores were all >70 out of 100 (72.5, 77.5, 95, and 80), whereas the overall user version of the Mobile App Rating Scale scores were 4, 4.3, 4.4, and 3.6 out of 5. The app was perceived to be nice, user-friendly, straightforward, and easy to understand. Recognition of achievements, the possibility of checking activity history, and the rescheduling option were positively highlighted. Technical difficulties with system data collection, particularly with the miscount of steps, could make users feel frustrated. The participants suggested improvements and indicated that the app has the potential to work well for survivors of BC. CONCLUSIONS: Early results presented in this study point to the potential of this tool concept to provide a friendly and satisfying coaching experience to users, which may help improve PA adherence in survivors of BC.

Digital Health Platform for Emotional and Self-Management Support of Caregivers of Children Receiving Growth Hormone Treatment.

In recent years there has been growing research on the combination of evidence-based behavioral change techniques with mobile-based recommender systems. In this paper, we have focused on understanding the psychological burdens experienced by caregivers of children undergoing growth hormone treatment (GHt) and the perceived barriers to and drivers of the adoption of a digital health solution. This is a mixed-methods formative research study looking into technical acceptance aspects of using digital health for the emotional support of parents of children undergoing GHt. After one month using the ADHERA CARING platform (Adhera Health, Inc., Palo Alto, CA), individual semi-structured interviews were conducted. ADHERA CARING provides tailored emotional and self-management support to caregivers of children undergoing GHt to improve adherence to treatment through positive education, personalized motivational messages, and emotional support. A preliminary thematic analysis and categorization were carried out, based on the Behavioral Intervention Technology (BIT) model. The majority of participants were female. All caregivers positively valued having the tool, especially at the beginning of treatment. Information provided in the educational module was useful and improved self-efficacy. Motivational messages contributed to commitment and reinforced the educational content, thus promoting continuity of treatment and potentially improving treatment efficacy. Most participants (n=10, 80%) accessed all educational units and completed all the 27 quiz questions. Regarding the motivational messages, the overall average rating was 4.55 out of 5.00. ADHERA CARING has the potential to help caregivers to understand the treatment journey. Nevertheless, users have identified that some types of educational content are more valuable at specific stages of the treatment journey, which suggests that personalization of educational content is required to adapt to different stages of the patient journey.

Functional, physiological and subjective responses to concurrent neuromuscular electrical stimulation (NMES) exercise in adult cancer survivors: a controlled prospective study.

The primary aim of this study was to investigate the functional, physiological and subjective responses to NMES exercise in cancer patients. Participants with a cancer diagnosis, currently undergoing treatment, and an had an Eastern Cooperative Oncology Group (ECOG) performance status (ECOG) of 1 and 2 were recommended to participate by their oncologist. Following a 2-week, no-NMES control period, each participant was asked to undertake a concurrent NMES exercise intervention over a 4-week period. Functional muscle strength [30 s sit-to-stand (30STS)], mobility [timed up and go (TUG)], exercise capacity [6-min walk test (6MWT)] and health related quality of life (HR-QoL) were assessed at baseline 1 (BL1), 2-week post control (BL2) and post 4-week NMES exercise intervention (POST). Physiological and subjective responses to LF-NMES were assessed during a 10-stage incremental session, recorded at BL2 and POST. Fourteen participants [mean age: 62 years (10)] completed the intervention. No adverse events were reported. 30STS (+ 2.4 reps, p = .007), and 6MWT (+ 44.3 m, p = .028) significantly improved after the intervention. No changes in TUG or HR-QoL were observed at POST. Concurrent NMES exercise may be an effective exercise intervention for augmenting physical function in participants with cancer and moderate and poor functional status. Implications for cancer survivors: By allowing participants to achieve therapeutic levels of exercise, concurrent NMES may be an effective supportive intervention in cancer rehabilitation.

Breast Cancer Survivors' Perspectives on Motivational and Personalization Strategies in Mobile App-Based Physical Activity Coaching Interventions: Qualitative Study.

BACKGROUND: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app-based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual's interest in the long term. OBJECTIVE: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. METHODS: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants' perspectives on potential mobile app-based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. RESULTS: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. CONCLUSIONS: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity.

A Personalized Physical Activity Coaching App for Breast Cancer Survivors: Design Process and Early Prototype Testing.

BACKGROUND: Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions. OBJECTIVE: This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies. METHODS: The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts. RESULTS: The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users' cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively. CONCLUSIONS: Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user's needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting.

Acute effects of different stretching exercises on muscular endurance.

This study aims to evaluate the acute effects of different stretching exercises on muscular endurance in men, in terms of the number of sets, set duration, and type of stretching. Two experiments were conducted; in the first one (E1), the subjects (n = 19) were evaluated to test the effect on the number of sets, and, in the second one (E2), the subjects (n = 15) were tested for the effect of set duration and type of stretching. After a warm-up of 10-15 repetitions of a bench press (BP) with submaximal effort, a one-repetition maximum (1RM) test was applied. For E1, BP endurance was evaluated after static stretching comprising one set of 20 seconds (1 x 20), two sets of 20 seconds (2 x 20), and three sets of 20 seconds (3 x 20). For E2, BP endurance was evaluated after static stretching comprising one set of 20 seconds (1 x 20), one set of 40 seconds (1 x 40), and proprioceptive neuromuscular facilitation (PNF) stretching. All tests were performed 48-72 hours apart, at which time the muscular endurance was assessed through the maximal number of repetitions (NR) of BP at 85% of 1RM until fatigue. The NR and the overload volume (OV) were compared among tests through repeated-measures analysis of variance. No significant effect of the number of sets on muscular endurance was observed because no statistically significant difference was found when comparing all stretching exercises of E1 in terms of NS (p = 0.5377) and OV (p = 0.5723). However, significant reductions were obtained in the set duration and PNF on NR (p < 0.0001) and OV (p < 0.0001), as observed in E2. The results suggest that a stretching protocol can influence BP endurance, whereas a decrease in endurance is suggested to be attributable to set duration and PNF. On the other hand, a low volume of static stretching does not seem to have a significant effect on muscular endurance.

The slope of the oxygen pulse curve does not depend on the maximal heart rate in elite soccer players.

INTRODUCTION: It is unknown whether an extremely high heart rate can affect oxygen pulse profile during progressive maximal exercise in healthy subjects. OBJECTIVE: Our aim was to compare relative oxygen pulse (adjusted for body weight) curves in athletes at their maximal heart rate during treadmill cardiopulmonary exercise testing. METHODS: A total of 180 elite soccer players were categorized in quartiles according to their maximum heart rate values (n = 45). Oxygen consumption, maximum heart rate and relative oxygen pulse curves in the extreme quartiles, Q1 and Q4, were compared at intervals corresponding to 10% of the total duration of a cardiopulmonary exercise testing. RESULTS: Oxygen consumption was similar among all subjects during cardiopulmonary exercise testing; however subjects in Q1 started to exhibit lower maximum heart rate values when 20% of the test was complete. Conversely, the relative oxygen pulse was higher in this group when cardiopulmonary exercise testing was 40% complete (p<.01). Although the slopes of the lines were similar (p = .25), the regression intercepts differed (p<.01) between Q1 and Q4. During the last two minutes of testing, a flat or decreasing oxygen pulse was identified in 20% of the soccer players, and this trend was similar between subjects in Q1 and Q4. CONCLUSION: Relative oxygen pulse curve slopes, which serve as an indirect and non-invasive surrogate for stroke volume, suggest that the stroke volume is similar in young and aerobically fit subjects regardless of the maximum heart rate reached.

The slope of the oxygen pulse curve does not depend on the maximal heart rate in elite soccer players

INTRODUCTION: It is unknown whether an extremely high heart rate can affect oxygen pulse profile during progressive maximal exercise in healthy subjects. OBJECTIVE: Our aim was to compare relative oxygen pulse (adjusted for body weight) curves in athletes at their maximal heart rate during treadmill cardiopulmonary exercise testing. METHODS: A total of 180 elite soccer players were categorized in quartiles according to their maximum heart rate values (n = 45). Oxygen consumption, maximum heart rate and relative oxygen pulse curves in the extreme quartiles, Q1 and Q4, were compared at intervals corresponding to 10 percent of the total duration of a cardiopulmonary exercise testing. RESULTS: Oxygen consumption was similar among all subjects during cardiopulmonary exercise testing; however subjects in Q1 started to exhibit lower maximum heart rate values when 20 percent of the test was complete. Conversely, the relative oxygen pulse was higher in this group when cardiopulmonary exercise testing was 40 percent complete (p<.01). Although the slopes of the lines were similar (p = .25), the regression intercepts differed (p<.01) between Q1 and Q4. During the last two minutes of testing, a flat or decreasing oxygen pulse was identified in 20 percent of the soccer players, and this trend was similar between subjects in Q1 and Q4. CONCLUSION: Relative oxygen pulse curve slopes, which serve as an indirect and non-invasive surrogate for stroke volume, suggest that the stroke volume is similar in young and aerobically fit subjects regardless of the maximum heart rate reached.

Melhoria da capacidade funcional excede à da condição aeróbica: dados de 144 pacientes de programa de exercício / Improvement in functional capacity exceeds that of aerobic fitness: data from 144 patients in an exercise program

Fundamentos: Pacientes em programas de exercício supervisionado apresentam uma melhoria proporcionalmente maior da capacidade funcional do que da condição aeróbica; contudo, as variáveis que determinam essa diferença não estão bem caracterizadas. Objetivo: Verificar se variações de flexibilidade e força/potência muscular contribuem para a diferença entre as melhorias funcional e aeróbica (DEMFA) resultantes da participação em PES. Métodos: Foram utilizados dados de 144 pacientes (96 homens) – idade 62±12 anos (média±desvio-padrão) –submetidos a testes de flexibilidade, força/potência muscular e cardiopulmonar de exercício máximo em ciclo ergômetro, após pelo menos três meses de PES. Os dados obtidos foram analisados e reportados em percentuais dos valores previstos para a idade, por fórmulas específicas. Resultados: Após uma média de 32 meses de PES, houve aumento da flexibilidade em 11,6% (p<0,01) e da potência muscular em 14,7% (p<0,01), ajustadas para a idade, com preservação da força de preensão manual (p=0,47).Houve uma relação inversa entre os resultados da primeira avaliação e a melhoria aeróbica (r=-0,28; p<0,01),mas não com a funcional (r=-0,09; p=0,27). Considerando os valores previstos para a idade, a condição aeróbica aumentou menos do que a capacidade funcional – 21%vs. 25% (p<0,01) –, resultando em um DEMFA médio de 4,1%. Apenas a melhoria na flexibilidade associou-se ao DEMFA (r=0,24; p<0,01).Conclusão: A participação em PES tende a gerar ganhos algo maiores da capacidade funcional do que da condição aeróbica. Parte dessa diferença pode ser explicada pela melhoria da flexibilidade corporal e provavelmente da eficiência mecânica, corroborando a importância de treinar essa última variável.