Comparing the efficacy of a multi-dimensional breast cancer rehabilitation programme versus a home-based exercise programme during adjuvant cancer treatment.

BACKGROUND: Breast cancer is the most common female malignancy worldwide and a major cause of morbidity and mortality. Exercise during adjuvant treatment improves function and relieves symptoms in breast cancer survivors. However, it is unclear if an unsupervised exercise programme may be as effective as a supervised multimodal group. We investigated the feasibility and efficacy of a centre-based multidimensional rehabilitation (MDR) programme for breast cancer survivors undergoing adjuvant treatment and compared it to an unsupervised home-based exercise (HE) programme. METHODS: Participants were self-allocated to either MDR or HE group. MDR participants underwent 24 supervised exercise classes and 10 education classes over 12 weeks. HE participants were instructed on a home exercise regime. Outcome measures, including the 6-min walk test (6MWT) and Frenchay Activities Index (FAI), FACT-Cognitive Function scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, were conducted at baseline (W0), post-intervention (W12) and 6-months post-intervention (M6). Variance between time points and the 2 groups were analysed using a linear mixed model (unstructured covariance matrix) and adjusted with Bonferroni. RESULT: Twenty-five participants attended at least half of the MDR interventions, while 21 completed the HE interventions. The former showed significant improvement in 6MWT, from 406.88 m (W0) to 443.34 m (W12) to 452.81 m (M6), while the improvement in the HE group was not significant (407.67 m (W0) to 433.14 m (W12) to 430.96 m (M6)). Both groups showed a significant improvement in FAI, with earlier significant improvement noted at W12 in the MDR group (22.71 (W0) to 27.65 (W12) to 28.81 (M6)) compared to the HE group (23.16 (W0) to 26.47 (W12) to 29.85 (M6)). Dropout rate was 16% in the MDR group and 34% in HE group. Overall satisfaction with the MDR programme was high. CONCLUSION: Both MDR and HE programmes were feasible. MDR was superior in improving endurance and earlier return to instrumental activities for those who completed at least half of the sessions. Future studies could explore use of technology to improve adherence to exercise. TRIAL REGISTRATION: The study was registered with ClinicalTrial.gov on 01/04/2022 with the registration number NCT05306808.

The effect of body mass index on inpatient rehabilitation outcome after stroke in an East-Asian cohort: a prospective study.

INTRODUCTION: We examined the association between admission body mass index (BMI) and discharge rehabilitation functional outcome using the Functional Independence Measure (FIM) in an East-Asian cohort of stroke patients during inpatient rehabilitation. METHODS: A prospective observational cohort study of stroke patients admitted to a single inpatient rehabilitation unit was conducted. Using the World Health Organisation Asian standards, BMI was classified as underweight (< 18.5 kg/m2), normal (18.5-22.9 kg/m2) and overweight (≥ 23 kg/m2). The primary outcome measure was discharge FIM, and secondary outcomes included FIM gain, FIM efficiency and FIM effectiveness. RESULTS: 247 stroke subjects were enrolled (mean age 59.48 [SD 12.35] years, 64.4% [159] male, 52.6% [130] ischaemic stroke). The distributions of underweight, normal and overweight BMI were 10.9% (27), 33.2% (82), and 55.9% (138) respectively on admission and 11.7% (29), 38.1% (94), and 50.2% (124) respectively on discharge. Significant small decreases in BMI from admission (median [IQR]: 23.58 [23.40, 24.70]) to discharge (median [IQR]: 23.12 [22.99, 24.21]) (p < 0.001) were found. Similarly, clinically significant FIM gains (mean FIM 26.71 [95% CI: 24.73, 28.69], p < 0.001) were noted after 36 days of median length of stay. No significant relationships were found between BMI and discharge FIM (p = 0.600), FIM gain (p = 0.254), FIM efficiency (p = 0.412) nor FIM effectiveness (p = 0.796). CONCLUSION: Findings from this study unequivocally support the benefits of acute inpatient stroke rehabilitation. Patients in the obese BMI range tended to normalise during rehabilitation. BMI, whether underweight, normal, or overweight was not correlated with discharge FIM.