A Preliminary Study on the Efficacy of a Community-Based Physical Activity Intervention on Physical Function-Related Risk Factors for Falls Among Breast Cancer Survivors.

OBJECTIVE: The aim of this study was to examine the effects of a 6-week community-based physical activity (PA) intervention on physical function-related risk factors for falls among 56 breast cancer survivors (BCS) who had completed treatments. DESIGN: This was a single-group longitudinal study. The multimodal PA intervention included aerobic, strengthening, and balance components. Physical function outcomes based on the 4-meter walk, chair stand, one-leg stance, tandem walk, and dynamic muscular endurance tests were assessed at 6-week pre-intervention (T1), baseline (T2), and post-intervention (T3). T1 to T2 and T2 to T3 were the control and intervention periods, respectively. RESULTS: All outcomes, except the tandem walk test, significantly improved after the intervention period (P < 0.05), with no change detected after the control period (P > 0.05). Based on the falls risk criterion in the one-leg stance test, the proportion at risk for falls was significantly lower after the intervention period (P = 0.04), but not after the control period. CONCLUSIONS: A community-based multimodal PA intervention for BCS may be efficacious in improving physical function-related risk factors for falls, and lowering the proportion of BCS at risk for falls based on specific physical function-related falls criteria. Further larger trials are needed to confirm these preliminary findings.

Determinants of Physical Activity Maintenance in Breast Cancer Survivors After a Community-Based Intervention.

PURPOSE/OBJECTIVES: To determine whether empirically selected and social cognitive theory-based factors, including baseline characteristics and modifiable behavioral and psychosocial factors, were determinants of physical activity (PA) maintenance in breast cancer survivors (BCSs) six months after a PA intervention.
. DESIGN: Single-group longitudinal study.
. SETTING: The Breast Health Centre in Winnipeg, Manitoba, Canada.
. SAMPLE: 42 survivors with stage 0-III breast cancer who completed chemotherapy and/or radiation therapy.
. METHODS: The community-based PA intervention included six weekly education and practice sessions on home-based aerobic, resistance, balance, and flexibility exercises.
. MAIN RESEARCH VARIABLES: The dependent variable, PA maintenance, was determined based on PA level measurement at six months postintervention. The independent variables of baseline characteristics (age, stage of cancer, and chronic musculoskeletal symptoms) and modifiable behavioral and psychosocial factors (PA level, fatigue, PA self-efficacy in overcoming barriers and performing tasks) were assessed at baseline and postintervention.
. FINDINGS: Multivariate regression analyses revealed that baseline fatigue and chronic musculoskeletal symptoms were the only factors significantly associated with PA maintenance.
. CONCLUSIONS: Baseline fatigue level and chronic musculoskeletal symptoms were significant determinants of PA maintenance in breast cancer survivors who had completed a community-based PA intervention. However, other key factors were considered.
. IMPLICATIONS FOR NURSING: Prior to participation in community-based PA interventions, clinicians should take into account the effects of high baseline fatigue levels and chronic musculoskeletal symptoms on potential PA maintenance, and consider additional assessments and support for BCSs to sustain their PA behavioral change.
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Efficacy of walking exercise in promoting cognitive-psychosocial functions in men with prostate cancer receiving androgen deprivation therapy.

BACKGROUND: Prostate cancer is the most commonly diagnosed non-melanoma cancer among men. Androgen deprivation therapy (ADT) has been the core therapy for men with advanced prostate cancer. It is only in recent years that clinicians began to recognize the cognitive-psychosocial side effects from ADT, which significantly compromise the quality of life of prostate cancer survivors. The objectives of the study are to determine the efficacy of a simple and accessible home-based, walking exercise program in promoting cognitive and psychosocial functions of men with prostate cancer receiving ADT. METHODS: A 6-month prospective, single-blinded, randomized controlled trial will be conducted to compare the Exercise Group with the Control Group. Twenty men with prostate cancer starting ADT will be recruited and randomly assigned to one of the two groups: the Exercise Group will receive instructions in setting up an individualized 6-month home-based, walking exercise program, while the Control Group will receive standard medical advice from the attending physician. The primary outcomes will be psychosocial and cognitive functions. Cognitive functions including memory, attention, working memory, and executive function will be assessed using a battery of neurocognitive tests at baseline and 6 months. Psychosocial functions including depression, anxiety and self-esteem will be assessed at baseline, 3 and 6 months using the Center for Epidemiological Studies Depression Scale, Spielberger State-Trait Anxiety Inventory, and Rosenberg Self-Esteem Scale. DISCUSSION: The significance of the cognitive-psychosocial side effects of ADT in men with prostate cancer has only been recently recognized, and the management remains unclear. This study addresses this issue by designing a simple and accessible home-based, exercise program that may potentially have significant impact on reducing the cognitive and psychosocial side effects of ADT, and ultimately improving the health-related quality of life in men with prostate cancer receiving ADT. TRIAL REGISTRATION: NCT00856102.

The influence of pain distribution on walking velocity and horizontal ground reaction forces in patients with low back pain.

Objective. The primary purpose of this paper was to evaluate the influence of pain distribution on gait characteristics in subjects with low back problems (LBP) during walking at preferred and fastest speeds. Design. Cross-sectional, observational study. Setting. Gait analysis laboratory in a health professions university. Participants. A convenience age- and gender-matched sample of 20 subjects with back pain only (BPO), 20 with referred leg pain due to back problems (LGP), and 20 pain-free individuals (CON). Methods and Measures. Subjects completed standardized self-reports on pain and disability and were videotaped as they walked at their preferred and fastest speeds along a walkway embedded with a force plate. Temporal and spatial gait characteristics were measured at the midsection of the walkway, and peak medial, lateral, anterior, and posterior components of horizontal ground reaction forces (hGRFs) were measured during the stance phase. Results. Patients with leg pain had higher levels of pain intensity and affect compared to those with back pain only (t = 4.91, P < .001 and t = 5.80, P < 0.001, resp.) and walking had an analgesic effect in the BPO group. Gait velocity was highest in the control group followed by the BPO and LGP group and differed between groups at both walking speeds (F(2.57) = 13.62, P < .001 and F(2.57) = 9.09, P < .001, for preferred and fastest speed condition, resp.). When normalized against gait velocity, the LGP group generated significantly less lateral force at the fastest walking speed (P = .005) and significantly less posterior force at both walking speeds (P ≤ .01) compared to the control group. Conclusions. Pain intensity and distribution differentially influence gait velocity and hGRFs during gait. Those with referred leg pain tend to utilize significantly altered gait strategies that are more apparent at faster walking speeds.

A pilot study of exercise in men with prostate cancer receiving androgen deprivation therapy.

BACKGROUND: Androgen deprivation therapy (ADT) is the mainstay therapy for men with prostate cancer. However, there are musculoskeletal side effects from ADT that increase the risk for osteoporosis and fracture, and can compromise the quality of life of these individuals. The objectives of this study are to determine the efficacy of a home-based walking exercise program in promoting bone health, physical function and quality of life in men with prostate cancer receiving ADT. METHODS/DESIGN: A 12-month prospective, single-blinded, randomized controlled trial will be conducted to compare the Exercise Group with the Control Group. Sixty men with prostate cancer who will be starting ADT will be recruited and randomly assigned to one of the two groups: the Exercise Group will receive instructions in setting up an individualized 12-month home-based walking exercise program, while the Control Group will receive standard medical advice from the attending physician. A number of outcome measures will be used to assess bone health, physical function, and health-related quality of life. At baseline and 12 months, bone health will be assessed using dual-energy X-ray absorptiometry. At baseline and every 3 months up to 12 months, physical function will be evaluated using the Functional Assessment of Chronic Illness Therapy - Fatigue Scale, Activities-specific Balance Confidence Scale, Short Physical Performance Battery, and Six-Minute Walk Test; and health-related quality of life will be assessed using the Functional Assessment of Cancer Therapy Prostate Module and the Medical Outcomes Study 12-item Short Form Health Survey Version 2. A mixed multiple analysis of variance will be used to analyze the data. DISCUSSION: Musculoskeletal health management remains a challenge in men with prostate cancer receiving ADT. This study addresses this issue by designing a simple and accessible home-based walking exercise program that will potentially have significant impact on reducing the risk of fracture, promoting physical function, and ultimately improving the health-related quality of life in men with prostate cancer receiving ADT. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00834392.

Measuring health in patients with cervical and lumbosacral spinal disorders: is the 12-item short-form health survey a valid alternative for the 36-item short-form health survey?

OBJECTIVES: To determine the convergent validity of the 12-Item Short-Form Health Survey, version 2 (SF-12v2), with 36-Item Short-Form Health Survey, version 2 (SF-36v2), in patients with spinal disorders, and to determine other key factors that might further explain the variances between the 2 surveys. DESIGN: Cross-sectional study. SETTING: Orthopedic ambulatory care. PARTICIPANTS: Eligible participants (N=98; 24 with cervical, 74 with lumbosacral disorders) who were aged 18 years and older, scheduled to undergo spinal surgery, and completed the SF-36v2. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: SF-36v2 and SF-12v2 (extracted from the SF-36v2). RESULTS: The 2 summary scores, physical and mental component scores (r range, .88-.97), and most of the scale scores (r range, .81-.99) correlated strongly between the SF-12v2 and SF-36v2, except for the general health score (cervical group, r=.69; lumbosacral group, r=.76). Stepwise linear regression analyses showed the SF-12v2 general health scores (cervical: beta=.61, P<.001; lumbosacral: beta=.68, P<.001) and the level of comorbidities (cervical: beta=-.37, P=.014; lumbosacral: beta=-.18, P=.039) were significant predictors of the SF-36v2 general health score in both groups, whereas age (beta=.32, P<.001) and smoking history (beta=-.22, P=.005) were additional predictors in the lumbosacral group. CONCLUSIONS: SF-12v2 is a practical and valid alternative for the SF-36v2 in measuring health of patients with cervical or lumbosacral spinal disorders. The validity of the SF-12v2 general health score interpretation is further improved when the level of comorbidities, age, and smoking history are taken into consideration.

Influence of pain distribution on gait characteristics in patients with low back pain: part 1: vertical ground reaction force.

STUDY DESIGN: In a cross-sectional study, vertical ground reaction force (GRF) during 2 speeds of walking were compared between 3 age- and sex-matched groups: back pain only (BPO) group, back pain with referred leg pain (LGP) group, and a control group. OBJECTIVE: The purpose was to evaluate the influence of pain distribution on vertical GRF of patients with low back problems during 2 walking speed conditions: preferred and fastest speeds. SUMMARY OF BACKGROUND DATA: People with low back pain often have difficulty walking. A better understanding of how pain distribution differentially affects walking will facilitate clinicians' assessment and enhance treatment in patients with low back pain problems. METHODS: All participants walked on a 7.62-m walkway. Vertical GRF parameters were recorded during stance phase using a force platform for each walking speed condition. Multivariate analysis of covariance was used for statistical analysis, with gait velocity as the covariate. RESULTS: The BPO and control groups did not differ significantly in vertical GRF during both walking speed conditions (P > or = 0.11). All vertical GRF parameters of the LGP group, except the peak loading force (P = 0.374), were significantly less than those of the control group during preferred walking speed condition (P < or = 0.008). However, there was no significant difference in the vertical GRF components between LGP and control groups during the fastest walking speed condition (P > or = 0.07). CONCLUSIONS: Pain distribution of people with low back problems differentially influences the vertical GRF they experience during walking. When walking at preferred speed, those with referred leg pain seem to use additional strategies besides walking slowly to attenuate the amount of force imposed on their painful leg. When challenged to walk at their fastest speed, people with back pain only walk as fast and withstand comparable amount of force as their pain-free counterparts.

Physical performance tasks: what are the underlying constructs?

OBJECTIVES: To investigate the structural validity of a battery of physical performance tasks and to investigate the construct validity of the resulting factors. DESIGN: A measurement study. SETTING: A large, private orthopedic clinic and a physical therapy clinic in an urban area. PARTICIPANTS: One hundred three consecutive adult patients with low back pain who were referred for physical therapy assessment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The physical performance battery was composed of the 50-foot speed walk, 5-minute walk, repeated trunk flexion, sit to stand, loaded reach, rollover tasks, and Sorensen upper-body lift. Participants also completed 5 self-report measures. RESULTS: Two correlated (.74) factors, speed and coordination and endurance and strength, were derived from the physical performance tasks. The Sorenson upper-body lift task was the only indicator that was not useful in defining the factors. Both factors had statistically significant correlations with measures of physical disability, lack of self-efficacy, and negative affect. Both factors had a trivial correlation with a numeric rating of pain intensity. CONCLUSIONS: There is support for 2 meaningful empiric groupings (ie, the derived factors) of the performance tasks. Pain intensity had a trivial overlap with speed-coordination and endurance-strength factors.