Physical ability, cervical function, and walking plantar pressure in frail and pre-frail older adults: An attentional focus approach.

Aging and increased vulnerability define the clinical condition of frailty. However, while the cervical function is recognized as a determinant of balance and walking performance, no study simultaneously physical ability, cervical function, balance, and plantar pressure distribution in walking in nursing house population. Thus, the present study aimed to compare these parameters between Frail and Pre-Frail aged people. Thirty-one (12 men and 19 women) institutionalized participants (age: 89.45 ± 5.27 years, weight: 61.54 ± 9.99 kg, height: 160.34 ± 7.93 cm) were recruited and divided into Pre-Frail and Frail groups according to SPPB (Short Physical Performance Battery) score (Frail <6, Pre-Frail ≥6). Participants performed the Timed Up and Go Test (TUGT) and a static balance evaluation. The cervical range of motion (COM), knee extensor strength, and walking plantar pressure distribution have been measured. The Pre-Frail group showed a higher gait speed (ES = 0.78, p ≤ 0.001) and a better TUGT, as well as higher knee extensor strength (ES = 0.4, p = 0.04). Furthermore, the Pre-Frail group presented a center of pressure (COP) displacement velocity on the sagittal axis (ES = 0.43, p = 0.02) and a more COP projection on this axis (ES = 0.43, p = 0.02). No significant difference has been observed between the two groups concerning the total contact time and most of the plantar pressure parameters except for the rear foot relative contact time which was lower in the Pre-Frail group. The Pre-Frail group also showed better cervical tilt mobility (ES = 0.35, p = 0.04). This study highlights the influence of some new parameters on frailty in older people, such as cervical mobility and plantar pressure distribution in walking.

Effects of an Exercise and Nutritional Intervention on Circulating Biomarkers and Metabolomic Profiling During Adjuvant Treatment for Localized Breast Cancer: Results From the PASAPAS Feasibility Randomized Controlled Trial.

PURPOSE: Exercise has been shown to improve physical and psychological conditions during cancer therapy, but mechanisms remain poorly understood. The purpose of the present study was to report the results of cancer-related biomarkers and metabolomics outcomes from the PASAPAS feasibility study. METHODS: In the PASAPAS randomized controlled trial, 61 women beginning adjuvant chemotherapy for localized breast cancer were randomized in a 6-month program of weekly aerobic exercises associated with nutritional counseling versus usual care with nutritional counseling. In the present analysis of 58 women for whom blood samples were available, first, circulating levels of biomarkers (ie, insulin, insulin-like growth factor 1, estradiol, adiponectin, leptin, interleukin-6, and tumor necrosis factor α) were measured at baseline and 6-month follow-up. Changes in biomarkers were compared between exercisers (n = 40) and controls (n = 18) using mixed-effect models. Second, serum metabolites were studied using an untargeted 1H nuclear magnetic resonance spectroscopy, and orthogonal partial least squares analyses were performed to discriminate exercisers and controls at baseline and at 6 months. RESULTS: Over the 6-month intervention, no statistically significant differences were observed between exercisers and controls regarding changes in biomarkers and metabolomic profiles. CONCLUSION: The present analysis of the PASAPAS feasibility trial did not reveal any improvement in circulating biomarkers nor identified metabolic signatures in exercisers versus controls during adjuvant breast cancer treatment. Larger studies preferably in women with poor physical activity level to avoid ceiling effect, testing different doses and types of exercise on additional biological pathways, could allow to clarify the mechanisms mediating beneficial effects of physical exercise during cancer treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1.

[Effect of activities profile variations on health-related quality of life among breast cancer patients: Secondary exploratory analysis from PASAPAS study data]. / Effet de l'évolution du profil d'activité quotidienne sur la qualité de vie chez des femmes atteintes de cancers du sein : analyse exploratoire secondaire des données de l'étude PASAPAS.

INTRODUCTION: Lifestyle changes in breast cancer patients, by physical activity increasing, are becoming a main objective in supportive care. The objective of this study was to explore the impact of the daily activity profile evolution on the quality of life among this public. METHODS: Sixty patients (18 to 75 years) with non-metastatic breast cancer were randomized to a 2:1 ratio (physical activity intervention; control) in the PASAPAS randomized clinical trial. Multiple linear regression analyzes were computed to explain quality of life scores 6 months after the start of adjuvant therapy. Variables retained were the baseline quality of life scores, the anxiety trait, the randomization arm, the variations of time spent in different physical activity classes ([3-4 [MET, [4-6 [MET, ≥6 MET) and in sedentary behaviors. RESULTS: Only the decrease in time spent in sedentary behaviors really appeared as a predictor of the quality of physical life. Participation in the intervention group appeared as a predictor of quality of mental life. DISCUSSION: Results plead in favor of sedentary life style decrease as part of the objectives of care program for women with breast cancer. It also highlights the need of collective supervised sessions implemented by competent staff. This research also suggests that the dynamics of daily activity profile variations should be studied further in association to quality of life.

[Development of a grid for characterizing structures offering adapted physical activity programs for people who have had cancer]. / Développement d'une grille de caractérisation des structures proposant des programmes d'activité physique adaptée pour les personnes ayant eu un cancer.

As the benefits of physical activity (PA) in oncology field continue to be demonstrated, multiple structures (sports clubs, associations…) develop PA programs and activities to offer cancer patients survivors the opportunity to continue adapted physical activity. Promoted in the 2014-2019 cancer plan as complementary supportive care, the practice of physical activity is legitimized by the 2016 Health Act of the Ministry of Social Affairs and Health, including the amendment 'prescription health sport', by giving it a legislative framework. In this context of development of new PA offers for cancer patients, it seems necessary to determine and evaluate the structures on their capacities to supervise physical activities for this population with specific needs. This article presents the methodological development and validation process of a tool used to characterize the different structures offering physical activity programs for people who have had cancer, and seeks to define the quality criteria that a structure should meet in the current state of knowledge. Ten of these criteria were selected according to a qualitative methodology and the final tool therefore facilitates the identification of quality programs in post-cancer PA, and could be used systematically by both users and professionals as part of the post-cancer care pathway, as well as by the sport-health platforms themselves in the current dynamics of their deployment throughout the national territory.

Éléments structurant les programmes d'activité physique dans la lutte contre le surpoids et l'obésité : état des lieux et suggestions.

To date, physical activity (PA) programs for overweight and obese people are built around recommendations established for the general population. However, these people have special characteristics that require adapted coaching. In order to begin this work of recommendations, the objective of this article was to list the criteria usually used to describe and study PA programs for overweight and obese people and its associated postprogram follow-up. A systematic review of both meta-analyses and systematic reviews related to PA programs in the management of overweight and obesity has highlighted that few descriptive elements of programs are systematically reported, and that PA programs are rarely sufficiently detailed to be able to calculate a PA dose or to compare the different programs. These convergences, disparities or gaps in the description of PA programs, led us to initiate a reflection on the interest of these criteria as well as on the interest of their systematization in weight management program design, including PA. We hope that will be a first step towards facilitating the development of recommendations for PA management of overweight and obesity. Novelty Objective: to identify criteria used to describe PA programs in the management of overweight and obesity. Criteria to systematize: data to calculate PA dose; description of program individualization strategy. Criteria to develop: drop-out rate as an indicator of program adaptation; description of fatigue management strategy.

À ce jour, les programmes d'activité physique (AP) visant les personnes atteintes de surpoids et d'obésité s'organisent autour des recommandations érigées pour la population générale. Toutefois, ces personnes présentent des caractéristiques particulières qui nécessitent un accompagnement adapté. Afin de pouvoir amorcer un travail de recommandation, l'objectif de cet article était de répertorier les critères utilisés pour décrire et étudier les programmes d'AP à destination des personnes atteintes de surpoids et d'obésité et les suivis post-programmes. Une revue systématique des méta-analyses et revues systématiques portant sur la prise en charge du surpoids et de l'obésité adulte a permis, notamment, de mettre en évidence que peu d'éléments descriptifs des programmes sont rapportés de manière systématique, et que les programmes sont rarement suffisamment détaillés pour pouvoir calculer une dose d'AP ou permettre leur comparaison. Ces convergences, disparités ou manques dans la description des programmes d'AP, ont permis d'engager une réflexion sur l'intérêt des différents critères ainsi que sur l'intérêt de leur systématisation dans les dispositifs de prise en charge de la gestion du poids incluant l'AP, pour ce que nous espérons être une première étape vers l'élaboration de recommandations en matière de prise en charge du surpoids et de l'obésité par l'AP. Les nouveautés Objectif : répertorier les critères de description des programmes d'AP dans la prise en charge du surpoids et de l'obésité. Critères à systématiser : calcul dose d'AP, individualisation programme. Critères à développer : taux d'abandon comme indicateur d'adaptation du programme, stratégie de gestion de la fatigue.

Cost-effectiveness of an exercise and nutritional intervention versus usual nutritional care during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial.

We undertook a cost-effectiveness analysis (CEA) to compare an exercise and nutritional program with the usual nutritional care concomitant to adjuvant chemotherapy in localized breast cancer patients. The CEA was designed as part of the interventional, controlled, randomized, single-center, open-label PASAPAS study. Breast cancer patients receiving first-line adjuvant chemotherapy at a French Comprehensive Cancer Center were randomized 2:1 to a 6-month exercise program of supervised indoor and outdoor group sessions in addition to usual nutritional care (exercise arm) or a usual nutritional care group receiving dietary and physical activity counseling (control arm). Costs were assessed from the French national insurance perspective (in Euros, 2012). Incremental cost-effectiveness ratios (ICERs) were calculated for four criteria: body mass index, waist circumference, body fat percentage, and estimated aerobic capacity. Uncertainty around the ICERs was captured by a probabilistic analysis using a non-parametric bootstrap method. The analysis was based on 60 patients enrolled between 2011 and 2013. Average intervention costs per participant were €412 in the exercise arm (n = 41) and €117 (n = 19) in the control arm. Total mean costs were €17,344 (standard deviation 9,928) and €20,615 (standard deviation 14,904), respectively, did not differ significantly (p = 0.51). The 6-month exercise program was deemed to be cost-effective compared with usual care for the estimated aerobic capacity. Multicenter randomized studies with long-term costs and outcomes should be done to provide additional evidence. Clinical trial: The PASAPAS study is registered under ClinicalTrials.gov. Trial registration ID: NCT01331772.

Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial.

PURPOSE: Lack of physical activity (PA), weight gain, and overweight have been associated with increased risk of recurrence and mortality after breast cancer diagnosis. We evaluated the feasibility of implementing an individualized exercise program and nutritional counseling during adjuvant treatment of localized invasive breast cancer. METHODS: Sixty-one patients eligible for adjuvant chemotherapy were randomized 2:1 to receive a 6-month program of weekly aerobic exercises associated with nutritional counseling (n = 41) or usual care with nutritional counseling (n = 20, one withdrawal). The primary endpoints were the proportion of patients compliant with two weekly supervised sessions and their overall adherence (i.e., proportion of supervised and unsupervised sessions completed versus planned sessions). RESULTS: Ten percent of patients in the intervention group were compliant with the two weekly supervised sessions for 6 months, but the overall median adherence rate was 85% of supervised and non-supervised sessions completed. Non-adherence was mainly due to intrinsic reasons (medical, organizational, psychological barriers). Adherence was positively associated with education and baseline PA level and inversely associated with baseline weight and tumor grade. No statistically significant benefits were observed in the intervention group, even if overall PA level and body composition improved and anthropometrics were maintained over time (p < 0.05). CONCLUSIONS: Overall, there was good adherence with the 6-month exercise program during adjuvant treatment for breast cancer, despite poor compliance to twice-weekly supervised sessions. This study highlights the need for flexible exercise modalities and innovative experimental design to reach patients who would most adhere and benefit from intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1.

Deterioration of Physical Activity Level and Metabolic Risk Factors After Early-Stage Breast Cancer Diagnosis.

BACKGROUND: In breast cancer patients, a lack of physical activity (PA) is 1 causative factor of weight gain during adjuvant treatment. It may increase the risk of treatment adverse effects, comorbidities, and deleterious long-term outcomes. OBJECTIVE: We aimed to describe the evolution of PA level and sedentary behavior in breast cancer patients between diagnosis and adjuvant chemotherapy onset following surgery and identify predictive factors associated with these changes early after breast cancer diagnosis. METHODS: Baseline data of 60 patients enrolled in a pilot randomized controlled trial of PA are presented. PA levels were estimated at adjuvant chemotherapy onset after surgery and retrospectively for the period at diagnosis. Height, weight, waist circumference, and bioelectrical impedance were measured at chemotherapy onset. Linear regression analysis evaluated factors associated with relative changes of PA level and sedentary behavior. RESULTS: Moderate PA decreased and sedentary behavior increased between diagnosis and chemotherapy onset. A grade III breast cancer was associated with a greater decrease in PA level. Conversely, keeping a professional occupation and adherence to nutritional guidelines were associated with maintained PA level. The majority (88%) of patients had excessive adiposity at chemotherapy onset. CONCLUSIONS: There was a significant deterioration of PA level between diagnosis and chemotherapy onset, and deleterious adiposity was present in most patients. IMPLICATIONS FOR PRACTICE: This study further emphasizes the need to motivate breast cancer patients toward engaging in a healthy lifestyle early after diagnosis and adhering to PA programs, which should be included in their clinical management.