Long-term effects of multiple concussions on prefrontal cortex oxygenation during a hypercapnic challenge in retired contact sport athletes.

This exploratory study aimed to investigate the long-term effects of multiple concussions on prefrontal cortex oxygenation during a five-minute hypercapnic challenge using Near Infrared Spectroscopy (NIRS). 55 physically active retired contact sport male athletes with three or more previous concussions (mTBI) were recruited along with 29 physically active males with no concussions history (CTRL). Participants completed five minutes of seated rest prior to the five-minute hypercapnic challenge (20-second breath-hold, 40-second recovery breathing; five times). NIRS measured right and left side oxygenated (O2Hb), deoxygenated (HHb), total (tHb) haemoglobin, and haemoglobin difference (HbDiff) with all parameters analysed through changes in average maximal and minimal values (ΔMAX), Z-scores, and standard deviations. Right prefrontal cortex HbDiff ΔMAX was significantly higher in the mTBI compared to CTRL (p = 0.045) group. Left prefrontal cortex O2Hb ΔMAX (p = 0.040), HHb Z-Scores (p = 0.008), and HbDiff ΔMAX(p = 0.014) were significantly higher in the mTBI group. Within-group right vs left analyses demonstrated significantly lower left HbDiff ΔMAX (p = 0.048) and HbDiff Z-scores (p = 0.002) in the mTBI group, while the CTRL group had significantly lower left HHb Z-scores (p = 0.003) and left tHb Z-scores (p = 0.042). This study provides preliminary evidence that athletes with a history of three or more concussions may have impaired prefrontal cortex oxygenation parameters during a hypercapnic challenge.

Long-term effects of multiple concussions on prefrontal cortex oxygenation during neurovascular coupling activation in retired male contact sport athletes.

Purpose: This study aimed to investigate the long-term effects of multiple concussions on prefrontal cortex oxygenation during a neurovascular coupling activating task using near infrared spectroscopy (NIRS). Methods: Self-reported physically active males who previously participated in contact team sports at various levels of competition and who previously had experienced at least 3 concussions (n = 55; mTBI) or had no history of concussions (n = 29; CTRL) were recruited. Participants completed a 5 min "Where's Waldo" object identification protocol which consisted of participants closing their eyes for 20-s followed by 40-s (repeated 5 times over 5-min) of searching a computer screen for "Waldo" hidden in a field of distractors. NIRS (µM) was used to measure right and left prefrontal cortex cerebral oxygenation. Oxygenated (O2Hb), deoxygenated (HHb), total (tHb) haemoglobin, and haemoglobin difference (HbDiff) were analysed through the change in average maximal and minimal values (ΔMAX), Z-scores, and standard deviations. Results: There were no significant differences in the relative change in cerebral oxygenation of the right prefrontal cortex between groups. In mTBI, left prefrontal cortex HHb ΔMAX (p = 0.031) and tHb ΔMAX (p = 0.044) were significantly lower than in the CTRL group. Within-group, right vs. left prefrontal cortex differences showed significantly lower values in left HbDiff Z-scores (p = 0.019) in only the mTBI group while the CTRL group showed significantly lower values in left HbDiff SD (p = 0.045). Conclusion: This preliminary study suggests that there are changes in prefrontal cortex oxygenation in males who had a history of experiencing multiple concussions in their past during a neurovascular coupling activating task. These changes may represent potential long-term effects in the brain's ability to adapt cerebral oxygenation during increased neural activity.

History of Brain Injury Alters Cerebral Haemodynamic Oscillations with Cardiac Influence.

(1) Background: Cerebral autoregulation is altered during acute mild traumatic brain injury, or concussion. However, it is unknown how a history of concussion can impact cerebral haemodynamic activity during a task that elicits an autoregulatory response. (2) Methods: We assessed cerebral haemodynamic activity in those with a history of three or more concussions. The study included 44 retired athletes with concussion history and 25 control participants. We recorded participants' relative changes in right and left pre-frontal cortex oxygenation collected by near-infrared spectroscopy and continuous beat-to-beat blood pressure measured by finger photoplethysmography. Participants completed a 5-min seated rest followed by a 5-min repeated squat (10-s) stand (10-s) maneuver (0.05 Hz) to elicit a cerebral autoregulatory response. Wavelet transformation was applied to the collected signals, allowing separation into cardiac interval I (0.6 to 2 Hz), respiratory interval II (0.145 to 0.6 Hz), and smooth muscle cell interval III (0.052 to 0.145 Hz). (3) Results: Significant increases at cardiac interval I were found for the wavelet amplitude of oxy-haemoglobin and haemoglobin difference at the right pre-frontal cortex. No significant difference was found at the left pre-frontal cortex or the blood pressure wavelet amplitudes. (4) Conclusions: Contributions from cardiac activity to the pre-frontal cortex oxygenation are elevated when eliciting dynamic cerebral autoregulation in those with a history of three or more concussions.

Long-term effects of multiple concussions on prefrontal cortex oxygenation during repeated squat-stands in retired contact sport athletes.

BACKGROUND: This study investigated the long-term effects of multiple concussions on prefrontal cortex oxygenation using near-infrared spectroscopy (NIRS) during a squat-stand maneuver that activated dynamic cerebral autoregulation. METHODS: Active male retired contact sport athletes with a history of 3+ concussions (mTBI; n = 55), and active retired athletes with no concussion history (CTRL; n = 29) were recruited. Participants completed a 5-min squat-stand maneuve (10-s squat, 10-s stand, 0.05 Hz; 15 times). Oxygenated (O2Hb), deoxygenated (HHb), total (tHb) hemoglobin, and hemoglobin difference (HbDiff) were analyzed through the change in maximal and minimal values during the test (∆MAX), Z-scores, and standard deviations. RESULTS: mTBI group showed left prefrontal cortex O2Hb ∆MAX (p = 0.046) and HbDiff ∆MAX (p = 0.018) were significantly higher. Within-group analyses showed significantly higher left HHb ∆MAX (p = 0.003) and lower left HbDiff Z-scores (p = 0.010) only in the mTBI group. The CTRL group demonstrated significantly lower left HbDiff SD (p = 0.039), tHb Z-scores (p = 0.030), and HbDiff ∆MAX (p = 0.037) compared to right prefrontal cortex response. CONCLUSION: These preliminary results suggest changes in prefrontal cortex oxygenation potentially affecting the brain's ability to adapt to changing cerebral perfusion pressure after multiple previous concussions.

Physical activity RX: development and implementation of physical activity counselling and prescription learning objectives for Canadian medical school curriculum.

Physical activity is an important component of health and well-being, and is effective in the prevention, management, and treatment of numerous non-communicable chronic diseases. Despite the known health benefits of physical activity in all populations, most Canadians do not meet physical activity recommendations. Physicians play a key role in assessing, counselling, and prescribing physical activity. Unfortunately, many barriers, including the lack of adequate education and training, prevent physicians from promoting this essential health behaviour. To support Canadian medical schools in physical activity curriculum development, a team of researchers, physicians, and exercise physiologists collaborated to develop a key set of learning objectives deemed essential to physician education in physical activity counselling and prescription. This commentary will review the newly developed Canadian Physical Activity Counselling Learning Objectives and give case examples of three Canadian medical schools that have implemented these learning objectives.

L'activité physique est une composante importante de la santé et du bien-être, et elle est efficace dans la prévention, la prise en charge et le traitement de nombreuses maladies chroniques non transmissibles. Malgré les bienfaits qu'on lui reconnaît pour la santé des populations, la plupart des Canadiens ne suivent pas les recommandations en matière d'exercice. Les médecins jouent un rôle clé dans l'évaluation, le counseling et la prescription de l'activité physique, mais de nombreux obstacles, dont le manque de formation adéquate, les empêchent de promouvoir cette habitude de vie essentielle pour la santé. Afin d'aider les facultés de médecine canadiennes dans l'élaboration de leur cursus sur l'activité physique, une équipe composée de chercheurs, de médecins et de physiologistes de l'exercice a collaboré à la définition d'un ensemble d'objectifs d'apprentissage jugés indispensables à la formation des médecins pour qu'ils puissent offrir des conseils sur l'activité physique et la prescrire. Ce commentaire passe en revue les nouveaux objectifs d'apprentissage en matière de counseling en activité physique et donne des exemples de cas de trois facultés de médecine canadiennes qui ont mis en œuvre ces objectifs d'apprentissage.

Effects of hydration status during heat acclimation on plasma volume and performance.

The impact of hydration status was investigated during a 5-day heat acclimation (HA) training protocol vs mild/cool control conditions on plasma volume (PV) and performance (20 km time-trial [TT]). Sub-elite athletes were allocated to one of two heat training groups (90 min/day): (a) dehydrated to ~2% body weight (BW) loss in heat (35°C; DEH; n = 14); (b) euhydrated heat (35°C; EUH; n = 10), where training was isothermally clamped to 38.5°C core temperature (Tc ). A euhydrated mild control group (22°C; CON; n = 9) was later added, with training clamped to the same relative heart rate (~75% HRmax ) as elicited during DEH and EUH; thus all groups experienced the same internal training stress (%HRmax ). Five-day total thermal load was 30% greater (P < 0.001) in DEH and EUH vs CON. There were significant differences in the average percentage of maximal work rate (%Wmax ) across all groups (DEH: 24 ± 6%; EUH: 34 ± 9%; CON: 48 ± 8%Wmax ) during training required to elicit the same %HRmax (77 ± 4% HRmax ). There were no significant differences pre-to post-HA between groups for PV (DEH: +1.7 ± 10.1%; EUH: +4.8 ± 10.2%; CON: +5.2 ± 4.0%), but there was a significant pooled group PV increase, as well as a 97% likely pooled improvement in TT performance (DEH: -1.8 ± 2.8%; EUH: -1.9 ± 2.1%, CON; -1.8 ± 2.8%; P = 0.136). Due to a lack of between-group differences for PV and TT, but pooled group increases in PV and 97% likely group increase in TT performance, over 5 days of intense training at the same average relative cardiac load suggests that overall training stress may also impact significant adaptations beyond heat and hydration stress.

Preseason Functional Movement Screen Predicts Risk of Time-Loss Injury in Experienced Male Rugby Union Athletes.

The purpose of this study was to determine the relationship between Functional Movement Screen (FMS) score and the risk of time-loss injury in experienced male rugby union athletes. A secondary purpose was to determine the relationship between FMS-determined asymmetries and the risk of time-loss injury in these athletes. Functional Movement Screen scores were collected from male rugby union athletes (n = 73) during preseason and half-way through one 8-month season. Time-loss injury data were collected throughout the full season. A receiver-operator characteristic curve was created for each half of the season to identify FMS composite and asymmetry cut-off scores associated with increased likelihood of injury and determined odds ratios, sensitivity, and specificity in evaluating FMS as a predictor of injury risk. Odds ratio analyses revealed that when compared with those scoring >14, athletes with an FMS ≤14 were 10.42 times more likely (95% confidence interval [CI]: 1.28-84.75, p = 0.007) to have sustained injury in the first half of the season and 4.97 times (95% CI: 1.02-24.19, p = 0.029) more likely in the second half of the season. The presence of asymmetries was not associated with increased likelihood of injury. Experienced male rugby union athletes with FMS composite scores ≤14 are significantly more likely to sustain time-loss injury in a competitive season than those scoring >14. The quality of fundamental movement, as assessed by the FMS, is predictive of time-loss injury risk in experienced rugby union athletes and should be considered an important preseason assessment tool used by strength and conditioning and medical professionals in this sport with inherently high injury rates.

Fall risk screening in the elderly: A comparison of the minimal chair height standing ability test and 5-repetition sit-to-stand test.

BACKGROUND: Successfully identifying older adults with a high risk of falling can be complicated, time consuming and not feasible in daily medical practice. This study compared the effectiveness of the Minimal Chair Height Standing Ability Test (MCHSAT) and 5-repetition sit-to-stand tst (5R-STS) as fall risk-screening instruments for the elderly. METHODS: 167 community-dwelling older adults (mean age=83.6±7.3years) were interviewed for demographics, fall history, cognition, and mobility status. MCHSAT performance was assessed using a chair whose seat height was modifiable by increments of 5cm, starting at 47cm and lowering after each successful attempt. 5R-STS performance was assessed by recording the time it took to rise and sit back down five consecutive times from a chair of 47cm high. Operating Receiving Characteristic (ROC) curves and Area under the Curve (AUC) were calculated for each test as well as for sub-groups of participants classified based on medical comorbidities (e.g. cardiac disease/stroke, lower limb arthritis). RESULTS: The MCHSAT and 5R-STS were equally effective fall-risk screening instruments for the overall population (AUC (95% CI)=0.72 (0.63-0.82) and 0.73(0.64-0.81) respectively). The 5R-STS was more effective than the MCHSAT for participants suffering from lower limb arthritis (AUC (95% CI)=0.81(0.70-0.92) and 0.71(0.58-0.85) respectively) while the opposite was true for participants with a history of cardiac disease or stroke (AUC (95% CI)=0.59 (0.44-0.80) and 0.65 (0.47-0.84) respectively). CONCLUSION: Due to their simplicity and quick administration time, the MCHSAT and 5R-STS are equally suitable for implementation in clinical settings.

Sensitivity and specificity of the minimal chair height standing ability test: a simple and affordable fall-risk screening instrument.

BACKGROUND AND PURPOSE: Fall-risk screening instruments have been underutilized in clinical settings because of their lengthy administration time, need of cumbersome equipment, and lack of validation. The primary objective of this study was to assess the validity (sensitivity and specificity) of the Minimal Chair Height Standing Ability Test (MCHSAT). The secondary objective was to develop guidelines to provide physical therapists with best-practice recommendations that can easily be implemented in clinical practice. METHODS: A retrospective cohort study design was used in which falling history, major medical conditions, cognitive status (Mini-Mental State Examination), and level of independence (Independent Activities of Daily Living) were obtained for 167 community-dwelling older adults (mean age = 83.6 ± 7.3 years), residents of British Columbia, Canada. Participants MCHSAT performance was assessed using a chair whose seat height was modifiable by increments of 5 cm, starting at 47 cm and lowering after each successful attempt. Sensitivity and specificity of the MCHSAT at each chair height were calculated and plotted as a receiver operating characteristic curve. A model to identify participants with history of falls was developed using a forward logistic regression (Wald). RESULTS: Mean MCHSAT performance (cm) was significantly better for participants without history of falls (30.3 cm, 95% CI: 28.1-32.5 cm) than for those with history of falls (37.7 cm, 95% CI: 35.5-40.0 cm) and was the single risk factor associated with fall status (ß= 1.087, P < .001). The optimal MCHSAT performance for identifying participants with history of falls was 34 cm (AUC = 0.72, 95% CI: 0.63-0.82). At this threshold, sensitivity and specificity values were 75% and 62%, respectively. DISCUSSION: Using 34 cm as the optimal performance, the MCHSAT correctly identified 75% of participants with history of falls and 62% of participants without history of falls. This provides evidence that the MCHSAT is a valid screening tool for use with an older Canadian population. CONCLUSION: As a simple and inexpensive testing instrument, the MCHSAT has potential to enhance the care of our elderly population, improve an understanding of patients' fall-risk status, and substantially reduce fall-related costs to the health care system.

Hydration status and fluid and sodium balance in elite Canadian junior women's soccer players in a cool environment.

Dehydration can impair mental and on-field performance in soccer athletes; however, there is little data available from the female adolescent player. There is a lack of research investigating fluid and electrolyte losses in cool temperatures. Therefore, the purpose of this study was to investigate the pretraining hydration status, fluid balance, and sweat sodium loss in 34 female Canadian junior elite soccer athletes (mean age ± SD, 15.7 ± 0.7 years) in a cool environment. Data were collected during two 90 min on-field training sessions (9.8 ± 3.3 °C, 63% ± 12% relative humidity). Prepractice urine specific gravity (USG), sweat loss (pre- and post-training body mass), and sweat sodium concentration (regional sweat patch method) were measured at each session. Paired t tests were used to identify significant differences between training sessions and Pearson's product moment correlation analysis was used to assess any relationships between selected variables (p ≤ 0.05). We found that 45% of players presented to practice in a hypohydrated state (USG > 1.020). Mean percent body mass loss was 0.84% ± 0.07% and sweat loss was 0.69 ± 0.54 L. Although available during each training session, fluid intake was low (63.6% of players consumed <250 mL). Mean sweat sodium concentration was 48 ± 12 mmol·L⁻¹. Despite low sweat and moderate sodium losses, players did not drink enough to avoid mild fluid and sodium deficits during training. The findings from this study highlights the individual variations that occur in hydration management in athletes and thus the need for personalized hydration guidelines.

Nutrition status of junior elite Canadian female soccer athletes.

CONTEXT: Adolescent female team-sport athletes are faced with the challenge of meeting nutrition requirements for growth and development, as well as sport performance. There is a paucity of evidence describing the dietary adequacy of this population in respect to these physiological demands. Therefore, the aim of this study was to comprehensively evaluate the nutrition status of junior elite female soccer athletes. METHOD: A total of 33 athletes (15.7 ± 0.7 yr) completed anthropometric assessment, 4-day food records analyzed for macro- and micronutrient intake, and hematological analysis. Energy expenditure was estimated using predictive equations. RESULTS: Mean sum of 7 skinfolds was 103.1 ± 35.2 mm, and body-mass index was 22.7 ± 2.7. Mean energy intake was 2,079 ± 460 kcal/day, and estimated energy expenditure was 2,546 ± 190 kcal/day. Of the athletes, 51.5% consumed <5g/kg carbohydrate, 27.3% consumed <1.2g/kg protein, and 21.2% consumed <25% of energy intake from fat. A large proportion of athletes did not meet Dietary Reference Intakes for pantothenic acid (54.5%), vitamin D (100%), folate (69.7%), vitamin E (100%), and calcium (66.7%). Compared with recommendations for athletes, 89.3% and 50.0% of participants had depleted iron and 25-hydroxyvitamin D, respectively. CONCLUSION: A high proportion of players were not in energy balance, failed to meet carbohydrate and micronutrient recommendations, and presented with depleted iron and vitamin D status. Suboptimal nutrition status may affect soccer performance and physiological growth and development. More research is needed to understand the unique nutrition needs of this population and inform sport nutrition practice and research.

Nutrition needs assessment of young Special Olympics participants.

BACKGROUND: Children with intellectual disability (ID) are at increased risk for obesity and nutrition-related health concerns, yet there is a paucity of data describing their nutrition status. The purpose of this study was to evaluate nutritional challenges of young participants (2?10 years of age) enrolled in Special Olympics Canada (SOC) programs. METHOD: A validated nutrition screening tool was mailed to 52 parents/caregivers of participants across 18 SOC programs in British Columbia, Canada. RESULTS: Of the 29 (55.8%) questionnaires returned, 62.1% scored as "high" nutrition risk. Nutrition concerns included feeding (84.2%), oral motor (57.9%), and dental problems (26.3%), food allergies/intolerances (26.3%), constipation (15.8%), anaemia (10.3%), and diarrhoea (5.3%). Body mass index (BMI) for age data classified 16.7% of participants as overweight/obese and 22.2% as underweight. CONCLUSIONS: This study identifies some of the unique nutrition issues faced by children with ID. These data can help inform future ID health-related nutrition, prevention, and treatment programs.

Education and training of sport dietitians in Canada: a review of current practice.

PURPOSE: The study was undertaken to evaluate the education and training background of Canadian registered dietitians (RDs) practising in sport and exercise nutrition, as well as learning opportunities in the practice area. METHODS: A secondary analysis of a 2009 Dietitians of Canada (DC) Sport Nutrition Network survey of members (n=70) was conducted to describe members' educational background. Through the use of publicly available information, Canadian dietetic internship, undergraduate, and graduate sport nutrition educational opportunities were identified. RESULTS: Most (72.9%) respondents indicated they had some type of formal education in sport nutrition; learning from undergraduate courses and conference sessions was cited most frequently. The majority (86.7%) of accredited universities offered undergraduate courses in sport/exercise nutrition. No DC-accredited internship program offered sport nutrition as a mandatory rotation, while 15.8% of graduate programs in Canada had faculty with research interests in the area. Among respondents, 91.4% felt sport nutrition education in Canada was inadequate; all expressed interest in participating in more formal learning experiences, and 97.1% were interested in a specialized credential. CONCLUSIONS: Canadian dietitians working in sport and exercise nutrition have diverse educational backgrounds and must direct their own learning. Improved career development pathways and more available formal education are desired and needed.

Cross-disciplinary thermoregulation and sweat analysis laboratory experiences for undergraduate Chemistry and Exercise Science students.

Cross-disciplinary (CD) learning experiences benefit student understanding of concepts and curriculum by offering opportunities to explore topics from the perspectives of alternate fields of study. This report involves a qualitative evaluation of CD health sciences undergraduate laboratory experiences in which concepts and students from two distinct disciplines [chemistry (CHEM) and exercise physiology (EPHE)] combined to study exercise thermoregulation and sweat analysis. Twenty-eight senior BSc Kinesiology (EPHE) students and 42 senior BSc CHEM students participated as part of their mutually exclusive, respective courses. The effectiveness of this laboratory environment was evaluated qualitatively using written comments collected from all students as well as from formal focus groups conducted after the CD laboratory with a representative cohort from each class (n = 16 CHEM students and 9 EPHE students). An open coding strategy was used to analyze the data from written feedback and focus group transcripts. Coding topics were generated and used to develop five themes found to be consistent for both groups of students. These themes reflected the common student perceptions that the CD experience was valuable and that students enjoyed being able to apply academic concepts to practical situations as well as the opportunity to interact with students from another discipline of study. However, students also reported some challenges throughout this experience that stemmed from the combination of laboratory groups from different disciplines with limited modification to the design of the original, pre-CD, learning environments. The results indicate that this laboratory created an effective learning opportunity that fostered student interest and enthusiasm for learning. The findings also provide information that could inform subsequent design and implementation of similar CD experiences to enhance engagement of all students and improve instructor efficacy.

Prospective evaluation of a 12-week walking exercise program and its effect on fatigue in prostate cancer patients undergoing radical external beam radiotherapy.

OBJECTIVE: To evaluate tolerability and compliance to a walking exercise program and its effect on fatigue during and after radical external beam radiation therapy (EBRT) for prostate cancer. METHODS: A total of 50 subjects with prostate cancer undergoing EBRT over 6 to 8 weeks were prospectively accrued to an exercise intervention group, matched for age and clinical characteristics to 30 subjects in a historical control group who underwent EBRT with no specific exercise intervention. Starting 1 week before EBRT, exercise participants performed moderate-intensity walking targeting 60% to 70% age-predicted maximum heart rate, at least 20 min/d, 3 d/wk over 12 weeks. The Brief Fatigue Inventory was administered at baseline, mid-EBRT (week 3-4), end-EBRT (week 6-8), and 6 months post-EBRT. RESULTS: Of 50, 42 (84%) of exercise participants completed the walking program. There were no cardiovascular complications, musculoskeletal injuries, or other adverse events. A total of 89% subjects reported "Good-Excellent" satisfaction during and up to 6 months post-EBRT. Fatigue in control subjects escalated from baseline to end-EBRT, remaining high at 6 months post-EBRT (P[r] = 0.03). In contrast, mean total fatigue scores in exercise subjects were stable from baseline up to 6 months post-EBRT (P = 0.52). Trends for higher fatigue interference with quality of life were observed in the control group as compared with the exercise group. CONCLUSIONS: Moderate-intensity walking exercise during radical EBRT is safe and feasible. The high convenience and satisfaction ratings, in conjunction with the observed fatigue trends, indicate that this activity has the potential to attenuate fatigue and improve quality of life for patients with localized prostate cancer undergoing curative therapy.

Habitual moderate-to-vigorous physical activity is inversely associated with insulin resistance in Canadian first nations youth.

The aim of this study was to explore the relationship between insulin resistance (IR) and objectively measured habitual moderate-to-vigorous physical activity (MVPA) in First Nations youth. A cross-sectional study was conducted in 2 rural villages in northern British Columbia, Canada. Thirty-nine healthy youth (16 males and 23 females; age = 11.8 yrs +/- 2.2; range = 8.8-18.5 yrs) participated. PA was measured with ActiGraph GT1M accelerometers. The homeostasis model assessment estimate of IR (HOMA-IR) was used to define IR. Duration of MVPA was inversely related to HOMA-IR (r = -.44, p < .01). From the regression model, 30 min of habitual MVPA corresponded to HOMA-IR levels that were 15% lower. In conclusion, these findings suggest that active First Nations youth have lower HOMA-IR values.

Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors.

PURPOSE/OBJECTIVES: To determine whether acute exercise reduces state anxiety and whether this reduction is moderated by the sample (i.e., breast cancer survivors versus those without a cancer diagnosis), exercise intensity (i.e., moderate versus light), and the potential sample times intensity interactions; and to explore whether changes in self-efficacy and state anxiety reciprocally predict each other as suggested by social cognitive theory. DESIGN: Repeated-measures, experimental pilot. SETTING: University laboratory. SAMPLE: Breast cancer survivors (n = 25) and age-matched women without a cancer diagnosis (n = 25). METHODS: Cycling for 20 minutes at light and moderate intensities on two separate occasions. State anxiety and self-efficacy measures were completed before, immediately following, and 10 minutes after exercise. MAIN RESEARCH VARIABLES: State anxiety, self-efficacy, and light and moderate exercise. FINDINGS: 2 (sample) x 2 (intensity condition) x 3 (time) repeated-measure analyses of variance revealed a main effect for time (p < 0.01, eta2 = 0.37, F[2, 86] = 24.687), but between-sample and exercise intensity interaction effects were not significant. Autoregressive path analysis using ordinary least squares multiple regression revealed significant reciprocation for self-efficacy and anxiety pre-exercise (light intensity beta = 0.49, p < 0.05; moderate intensity beta = -0.37, p < 0.05) and post-exercise (moderate intensity beta = -0.31, -0.23, p < 0.05). CONCLUSIONS: Acute exercise at light and moderate intensity decreases state anxiety for breast cancer survivors and those without a diagnosis. Additional research is warranted. IMPLICATIONS FOR NURSING: Light- and moderate-intensity exercise may be a valuable alternative anxiolytic tool that also allows for the acquisition of myriad additional known health benefits associated with exercise.

Progressive resistance training in breast cancer: a systematic review of clinical trials.

BACKGROUND: Progressive resistance training (PRT) may be effective for targeting the sequelae of breast cancer and its treatment given the unique anabolic nature of this exercise modality. Therefore, our objectives were: (1) to systematically review studies that have prescribed PRT after breast cancer surgery, (2) to summarize the efficacy of PRT in this cohort, and (3) to delineate areas for future investigations. METHOD: A systematic review using computerized databases was performed. RESULTS: The systematic review located 10 trials: Four uncontrolled trials, one controlled trial and five randomized controlled trials (RCTs). PRT was prescribed with aerobic training in 8/10 trials reviewed, and in isolation in 2/10 trials reviewed. Upper body PRT was prescribed in 7/10 trials, including 4/5 RCTs. No exacerbation of objectively measured or subjectively reported lymphedema symptoms was reported in any of these trials. Adverse events were rare, generally musculoskeletal in nature, and were managed effectively by conservative means. Overall, the studies we reviewed suggest that women surgically treated for breast cancer can derive health-related and clinical benefits by performing PRT after breast cancer surgery. Further research may be required to stimulate greater advocacy for PRT among oncologists, and in community care settings. CONCLUSIONS: Robustly designed RCTs prescribing targeted PRT regimens throughout various phases of breast cancer treatment are warranted. RCTs with thorough, standardized reporting of interventions and adverse events are required to establish the efficacy of this intervention for the post-treatment management of breast cancer patients and survivors as a means to improve health status and quality of life.

Reliability and validity testing of the Patient and Observer Scar Assessment Scale in evaluating linear scars after breast cancer surgery.

BACKGROUND: The Patient and Observer Scar Assessment Scale is a promising new method incorporating observer and patient ratings in evaluating burn scars. The authors compared this tool to the Vancouver Scar Scale in a cohort of women with linear scars from breast cancer surgery. METHODS: Twenty women with newly diagnosed breast cancer were prospectively accrued. Thirty-one scars were evaluated. The median time from surgery to scar assessment was 8 weeks (range, 3 to 25 weeks). Observer assessment was performed by three independent raters using the Vancouver scale and the observer component of the new tool. Patient self-assessment was performed using the patient component of the tool. Internal consistency, interobserver reliability, and convergent validity were examined. RESULTS: Internal consistency was acceptable for the Vancouver scale and both components of the new tool (Cronbach's alpha, 0.71, 0.74, and 0.77, respectively). Interobserver reliability was substantial with both the Vancouver scale and the observer tool (average measure intraclass coefficient correlation, 0.78 and 0.60, respectively). The observer tool and Vancouver scale correlated significantly with each other (p < 0.001), but only the observer tool correlated well with patients' ratings (p = 0.04). CONCLUSIONS: In surgical scar assessment, the new Patient and Observer Scar Assessment Scale and Vancouver Scar Scale were both associated with acceptable internal consistency and interobserver reliability. The new tool is more comprehensive and has higher correlation with patients' ratings. These findings support the use of the new tool as a reliable, valid, and comprehensive approach to assess linear surgical scars.

Prospective evaluation of the prevalence and severity of fatigue in patients with prostate cancer undergoing radical external beam radiotherapy and neoadjuvant hormone therapy.

OBJECTIVE: To prospectively evaluate the prevalence and severity of fatigue and its impact on quality of life (QOL) during and after radical external beam radiotherapy (RT) for prostate cancer. METHOD AND MATERIALS: Twenty-eight men with prostate cancer undergoing RT over 6-8 consecutive weeks were prospectively accrued. The Brief Fatigue Inventory (BFI), a validated fatigue assessment tool, was administered at five time points: baseline (week 1), middle of RT (week 3-4), end of RT (last week of RT), and follow-up (median 6.5 weeks after RT). The BFI contained nine questions, each using 0-10 ratings to quantify fatigue severity and interference with six QOL domains. The prevalence of moderate-severe fatigue was plotted as a function of time. Mean sum and subscale scores at each time point were compared to baseline scores using Wilcoxon tests. Linear regression analyses were performed to assess associations between fatigue scores and age, tumor and treatment characteristics. RESULTS: The median age was 69 years (range 57-84), Gleason score 7 (range 6-10), and presenting PSA 9.0 ng/mL (range 2.5 ng/mL-103.0 ng/mL). Patients were treated once daily to a median dose of 74 Gy (range 60 Gy-78 Gy) over a median of 37 fractions (range 30-39). Hormone therapy was used in all patients (median duration 12.2 months). The prevalence of moderate-severe present fatigue increased from 7% at baseline to 8% at mid-RT and 32% at RT completion. Compared to baseline (mean score 11.5), fatigue increased significantly mid-RT (mean score 14.6, p = 0.03) and peaked at the end of RT (mean score 23.5, p = 0.001). Fatigue significantly interfered with walking ability, normal work, daily chores, and enjoyment of life only at the end of RT. After RT completion, fatigue improved but remained higher compared to baseline at 6.5 weeks of follow-up (mean score 15.0, p = 0.02). On linear regression analysis, age, Gleason score, PSA, T-stage, hormone therapy duration, RT dose and fractions were not significantly associated with mean fatigue scores. CONCLUSION: Patients undergoing 6-8 weeks of RT experienced significant fatigue adversely affecting QOL persisting after therapy completion. Since walking ability was not affected until the end of RT, a walking exercise intervention to combat fatigue is likely feasible and is being investigated.