Cardio-Oncology for the Primary Care Provider.

Cardiovascular disease is a major cause of mortality among oncologic patients. As cancer therapies continue to evolve and advance, cancer survival rates have been increasing and so has the burden of cardiovascular disease within this population. For this reason, cardio-oncology plays an important role in promoting multidisciplinary care with the primary care provider, oncology, and cardiology. In this review, we discuss the roles of different providers, strategies to monitor patients receiving cardiotoxic therapies, and summarize cancer therapy class-specific toxicities. Continued collaboration among providers and ongoing research related to cardiotoxic cancer therapies will enable patients to receive maximal, evidence-based, comprehensive care.

Perceptions and Utilization of Strength Training and Conditioning in Collegiate Contemporary and Ballet Dancers: A Qualitative Approach.

AIMS: Research demonstrates that dancers benefit from reduced injury risk and improved health by engaging in strength training and conditioning (STC). Historic bias within the discipline of dance, however, establishes a long-standing stigma that gains in muscle mass and strength lessen a dancer's aesthetic appearance, and thus many dancers rebuff STC as a supplement to dance training. However, there is growing evidence that dancers and dance educators are beginning to under¬stand the importance of additional resistance training and cardiovascular conditioning. This study explored dancers' perceptions and utilization of STC using a general qualitative approach. METHODS: Twenty-three female collegiate dancers (13 contemporary dancers, 10 ballet dancers, mean age 19.95 ± 0.97 yrs) volunteered to participate in this study. The principal investigator conducted individual, semi-structured interviews. RESULTS: Inductive analysis revealed three major themes: 1) evolving body image, 2) motivation, and 3) education. Trustworthiness was established using member checks, peer debriefing, and journaling. This study concluded collegiate dancers utilized STC as a means to enhance the individual's body image. This was driven by a continuum of motivating factors. Although collegiate dancers are utilizing STC, education on STC techniques and practices was minimal. CONCLUSIONS: While further research is needed, results from this study suggest STC could be initiated and promoted in the discipline of dance to further enhance physical fitness and general well-being. Dancers and dance instructors should receive education about the importance of STC within dance training as well as how to safely implement STC exercise into training regimens.

Ground Reaction Forces in Ballet Differences Resulting from Footwear and Jump Conditions.

In the research devoted to ballet, ground reaction force (GRF) and shoe condition have been identified as possible risk factors for injury. Shoe conditions vary immensely between dancers and could indeed have significant impact on biomechanics and injury rates. Therefore, the objectives of this study were: 1. to investigate the maximal ground reaction force (GRFmax) when ballet dancers land from two jump conditions in pointe shoes, in flat technique shoes, and barefoot; and 2. to explore the effects that specific pointe shoe characteristics (shoe age, shank style) have on GRFmax. Twenty-one healthy female ballet majors in an elite college program volunteered for the study. All participants had similar years of classical ballet training (12.85 ± 2.37). For the study, they performed two ballet jumps, assemblé and grand jeté. Each jump was performed in the three shoe conditions mentioned previously. A total of 18 trials per subject were completed, with the order of jump type and shoe condition randomized. Each jump was landed on a force plate, and maximal GRFs were recorded. A repeated measures analysis of variance was calculated with two within subject factors, shoe type at three levels and jump type at two levels. Tukey's post hoc test was applied to significant findings. Alpha level was set a priori at p = 0.05. Results demonstrated no significant differences in GRFmax between the three shoe conditions; however, significant differences in GRFmax between the jump types were identified. Post-hoc testing revealed that when dancers performed the grand jeté jump, higher GRFmax was obtained compared to the assemblé jump. In conclusion, results of this study indicate that GRFmax varies between ballet jumps; however, it does not appear that shoe condition significantly affects GRFmax.

Quantitative Measures Utilized in Determining Pointe Readiness in Young Ballet Dancers.

While an important step in a young dancer's ballet career is the transition to pointe work, there is much controversy as to when her body is physically prepared to meet the increased demands of this development. Pointe screening protocols are being used by many in both the dance studio and dance science communities, but these protocols have not yet been standardized. The purpose of this study was to evaluate objectively the attributes of ballet dancers who are pre-pointe compared to those who have recently begun pointe training, and secondarily to correlate these quantitative findings with qualitative evaluations by the dancers' teachers. Participants were 49 healthy young female dancers with at least 1 year of formal ballet training. Twentyeight were pre-pointe students (age: 10.21 ± 1.17 years; height: 124.05 ± 13.45 cm; weight: 39.13 ± 13.18 kg; and 6.04 ± 1.84 years dance experience), and 21 were pointe students (age: 11.42 ± 0.81 years; height: 136.91 ± 16.04 cm; weight: 40.79 ± 8.77 kg; and 6.45 ± 2.07 years dance experience). Six dependent variables were evaluated: non-weightbearing (NWB) plantar flexion (PF) and dorsiflexion (DF) range of motion (ROM); weightbearing lunge test (WBL); relevé endurance (heel raise test); PF isometric strength; Airplane test; and Star Excursion Balance Test (SEBT) in three directions. These tests were broken into three categories for statistical analysis: ROM (NWB PF and DF, WBL), muscular capacity (relevé endurance, PF isometric strength), and balance (Airplane, SEBT). The analysis demonstrated that the pointe group performed significantly better than the pre-pointe group on the muscular capacity and balance testing (p < 0.01). Calculations for both tests indicated that 15 continuous single-leg relevés and two repetitions of the Airplane test may be the best cut-off levels when using these tests as part of a pre-pointe screening protocol. In conclusion, the relevé endurance test and the Airplane test are appropriate for use in differentiating between pre-pointe and pointe dancers.

Competition Level Not Associated With Diet Quality in Marching Artists.

Marching artists are a unique group of athletes whose performance can be influenced by nutrition. Because physical demands are thought to be moderate to high, adequate energy and a variety of nutrient-dense foods are needed. The purpose of this study was to examine diet quality, physical activity, and eating behavior of marching artists across elite and nonelite competition levels. This cross-sectional analysis used the validated National Cancer Institute Diet History Questionnaire II, International Physical Activity Questionnaire, and Eating Behavior Patterns Questionnaire. Diet quality was assessed using the Healthy Eating Index (HEI) 2010. Marching artists who participated in marching band in 2015 were eligible. Those in Drum Corps International (DCI) were considered part of the elite level; all others were considered nonelite. Chi-square analyses assessed associations between categorical variables and competition level, and independent sample t-tests assessed differences between continuous variables among competition level. Participants (n = 323) included 228 (71%) DCI members and 95 (29%) non-DCI members who reported a mean age of 19.8 ± 1.9 years. DCI members reported higher physical activity levels (p < 0.001) and fewer meal-skipping behaviors compared to non-DCI members (p < 0.001). The overall mean HEI score was 58.8 ± 10.3, with no difference between competition levels. Only one participant overall (<1%) met the recommended intake level of whole grains. Additionally, 2% of participants met the sodium restriction recommendation and 7% met the empty calorie upper limit. Suboptimal diet quality combined with high levels of physical activity is a problem for marching artists that should be addressed through carefully planned interventions.