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1.
BMJ Open ; 9(9): e030080, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31542747

RESUMO

INTRODUCTION: Creatine supplementation has consistently been demonstrated to augment adaptations in body composition, muscle strength and physical function in a variety of apparently healthy older adults and clinical populations. The effects of creatine supplementation and resistance training in individuals with cancer have yet to be investigated. This study aims to examine the effects of creatine supplementation in conjunction with resistance training on body composition, muscle strength and physical function in prostate cancer patients undergoing androgen deprivation therapy. METHODS AND ANALYSIS: This is a randomised, double-blind, placebo-controlled trial designed to examine the effects of creatine supplementation in addition to resistance training in patients with prostate cancer receiving androgen deprivation therapy. Both supplement and placebo groups will receive a 12-week supervised exercise programme comprising resistance training undertaken three times per week. The primary endpoint (fat-free mass) and secondary endpoints (fat mass, per cent body fat, physical fitness, quality of life and blood biomarkers) will be assessed at baseline and immediately following the intervention. ETHICS AND DISSEMINATION: The Human Research Ethics Committee of Edith Cowan University approved this study (ID: 22243 FAIRMAN). If the results of this trial demonstrate that creatine supplementation can augment beneficial adaptations of body composition, physical function and/or psychosocial outcomes to resistance training, this study will provide effect sizes that will inform the design of subsequent definitive randomised controlled trials. The results of this study will be published in peer-reviewed journals and presented at various national and international conferences. TRIAL REGISTRATION NUMBER: ACTRN12619000099123.

2.
Med Sci Sports Exerc ; 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31436734

RESUMO

PURPOSE: While general guidelines (such as CONSORT or CERT) exist to enhance the reporting of exercise interventions in the field of exercise science, there is inadequate detail facilitating the standardized reporting of resistance training adherence in the oncology setting. The purpose of this study was to apply a novel method to report resistance training dose, adherence and tolerance in patients with cancer. METHODS: A total of 47 prostate cancer patients (70.1 ± 8.9 yrs, body mass index, 28.6 ± 4.0) with bone metastatic disease completed an exercise program for 12 weeks. We assessed traditional metrics of adherence (attendance and loss to follow-up), in addition to novel proposed metrics (Exercise relative dose intensity (ExRDI), dose modification, and exercise interruption). Total training volume in kilograms (repetitions x sets x training load (weight)) was calculated for each patient. RESULTS: Attendance assessed from traditional metrics was 79.5±17.0% and four patients (9%) were lost to follow-up. The prescribed and actual cumulative total dose of resistance training was 139,886 ± 69,150 kg and 112,835 ± 83,499 kg, respectively, with a mean ExRDI of 77.4% ± 16.6% (range: 19.4% - 99.4%). Resistance training was missed (1-2 consecutive sessions) or interrupted (missed ≥3 consecutive sessions) in 41 (87%) and 24 (51%) participants, respectively. Training dose was modified (reduction in sets, repetitions, or weight) in 40 (85%) of patients. Importantly, using attendance as a traditional metric of adherence, these sessions would have all counted as adherence to the protocol. CONCLUSION: Traditional reporting metrics of resistance training in exercise oncology may overestimate exercise adherence. Our proposed metrics to capture resistance training dose, adherence and tolerance may have important applications for future studies and clinical practice.

4.
BMJ Open ; 9(4): e024872, 2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-30987986

RESUMO

INTRODUCTION: A potential link exists between prostate cancer (PCa) disease and treatment and increased inflammatory levels from gut dysbiosis. This study aims to examine if exercise favourably alters gut microbiota in men receiving androgen deprivation therapy (ADT) for PCa. Specifically, this study will explore whether: (1) exercise improves the composition of gut microbiota and increases the abundance of bacteria associated with health promotion and (2) whether gut health correlates with favourable inflammatory status, bowel function, continence and nausea among patients participating in the exercise intervention. METHODS AND ANALYSIS: A single-blinded, two-armed, randomised controlled trial will explore the influence of a 3-month exercise programme (3 days/week) for men with high-risk localised PCa receiving ADT. Sixty patients will be randomly assigned to either exercise intervention or usual care. The primary endpoint (gut health and function assessed via feacal samples) and secondary endpoints (self-reported quality of life via standardised questionnaires, blood biomarkers, body composition and physical fitness) will be measured at baseline and following the intervention. A variety of statistical methods will be used to understand the covariance between microbial diversity and metabolomics profile across time and intervention. An intention-to-treat approach will be utilised for the analyses with multiple imputations followed by a secondary sensitivity analysis to ensure data robustness using a complete cases approach. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Human Research Ethics Committee of Edith Cowan University (ID: 19827 NEWTON). Findings will be reported in peer-reviewed publications and scientific conferences in addition to working with national support groups to translate findings for the broader community. If exercise is shown to result in favourable changes in gut microbial diversity, composition and metabolic profile, and reduce gastrointestinal complications in PCa patients receiving ADT, this study will form the basis of a future phase III trial. TRIAL REGISTRATION NUMBER: ANZCTR12618000280202.

5.
J Strength Cond Res ; 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30707134

RESUMO

Balloch, AS, Meghji, M, Newton, RU, Hart, NH, Weber, JA, Ahmad, I, and Habibi, D. Assessment of a novel algorithm to determine change-of-direction angles while running using inertial sensors. J Strength Cond Res XX(X): 000-000, 2019-The ability to detect and quantify change-of-direction (COD) movement may offer a unique approach to load-monitoring practice. Validity and reliability of a novel algorithm to calculate COD angles for predetermined COD movements ranging from 45 to 180° in left and right directions was assessed. Five recreationally active men (age: 29.0 ± 0.5 years; height: 181.0 ± 5.6 cm; and body mass: 79.4 ± 5.3 kg) ran 5 consecutive predetermined COD trials each, at 4 different angles (45, 90, 135, and 180°), in each direction. Participants were fitted with a commercially available microtechnology unit where inertial sensor data were extracted and processed using a novel algorithm designed to calculate precise COD angles for direct comparison with a high-speed video (remotely piloted, position-locked aircraft) criterion measure. Validity was assessed using Bland-Altman 95% limits of agreement and mean bias. Reliability was assessed using typical error (expressed as a coefficient of variation [CV]). Concurrent validity was present for most angles. Left: (45° = 43.8 ± 2.0°; 90° = 88.1 ± 2.0°; 135° = 136.3 ± 2.1°; and 180° = 181.8 ± 2.5°) and Right: (45° = 46.3 ± 1.6°; 90° = 91.9 ± 2.2°; 135° = 133.4 ± 2.0°; 180° = 179.2 ± 5.9°). All angles displayed excellent reliability (CV < 5%) while greater mean bias (3.6 ± 5.1°, p < 0.001), weaker limits of agreement, and reduced precision were evident for 180° trials when compared with all other angles. High-level accuracy and reliability when detecting COD angles further advocates the use of inertial sensors to quantify sports-specific movement patterns.

6.
J Musculoskelet Neuronal Interact ; 18(4): 438-445, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30511948

RESUMO

OBJECTIVES: To quantify between-day reliability of upper-body diaphyseal measurements (radius, ulna, humerus) using peripheral Quantitative Computed Tomography (pQCT). METHODS: Fourteen males (age: 25.8±2.3 years,) underwent repeat pQCT scans (one to two days apart) at mid-shaft ulna (60%), mid-shaft radius (60%) and mid-shaft humerus (50%) cross-sections of the non-dominant limb. Intraclass correlation coefficients (ICC) and coefficients of variation (CV) were determined for musculoskeletal morphology variables. RESULTS: Reliability was excellent (ICC: 0.76-0.99; CV: 1.3-7.3) at all sites for bone mass, stress-strain index, endocortical and pericortical radius, endocortical volumetric bone mineral density (vBMD), muscle area, total area, non-cortical area, and cortical area. Reliability was good to excellent (ICC: 0.58-0.80; CV: 0.6-3.7) for polar vBMD and mid-cortical vBMD; fair to excellent (ICC: 0.30-0.88; CV: 0.5-8.0) for muscle density and cortical density; and fair to good (ICC: 0.25-0.60; CV: 3.4-7.6) for pericortical vBMD. Average reliability across the three sites was excellent (ICC ≥0.77; CV ≤8.0). CONCLUSIONS: Overall between-day reliability of pQCT was excellent for the mid-shaft ulna, radius and humerus. pQCT provides a reliable and feasible body composition and skeletal morphology assessment tool for upper limb longitudinal investigations in scientific and clinic settings.

7.
Trials ; 19(1): 695, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30572928

RESUMO

BACKGROUND: Skeletal metastases present a major challenge for clinicians, representing an advanced and typically incurable stage of cancer. Bone is also the most common location for metastatic breast carcinoma, with skeletal lesions identified in over 80% of patients with advanced breast cancer. Preclinical models have demonstrated the ability of mechanical stimulation to suppress tumour formation and promote skeletal preservation at bone sites with osteolytic lesions, generating modulatory interference of tumour-driven bone remodelling. Preclinical studies have also demonstrated anti-cancer effects through exercise by minimising tumour hypoxia, normalising tumour vasculature and increasing tumoural blood perfusion. This study proposes to explore the promising role of targeted exercise to suppress tumour growth while concomitantly delivering broader health benefits in patients with advanced breast cancer with osteolytic bone metastases. METHODS: This single-blinded, two-armed, randomised and controlled pilot study aims to establish the safety, feasibility and efficacy of an individually tailored, modular multi-modal exercise programme incorporating spinal isometric training (targeted muscle contraction) in 40 women with advanced breast cancer and stable osteolytic spinal metastases. Participants will be randomly assigned to exercise or usual medical care. The intervention arm will receive a 3-month clinically supervised exercise programme, which if proven to be safe and efficacious will be offered to the control-arm patients following study completion. Primary endpoints (programme feasibility, safety, tolerance and adherence) and secondary endpoints (tumour morphology, serum tumour biomarkers, bone metabolism, inflammation, anthropometry, body composition, bone pain, physical function and patient-reported outcomes) will be measured at baseline and following the intervention. DISCUSSION: Exercise medicine may positively alter tumour biology through numerous mechanical and non-mechanical mechanisms. This randomised controlled pilot trial will explore the preliminary effects of targeted exercise on tumour morphology and circulating metastatic tumour biomarkers using an osteolytic skeletal metastases model in patients with breast cancer. The study is principally aimed at establishing feasibility and safety. If proven to be safe and feasible, results from this study could have important implications for the delivery of this exercise programme to patients with advanced cancer and sclerotic skeletal metastases or with skeletal lesions present in haematological cancers (such as osteolytic lesions in multiple myeloma), for which future research is recommended. TRIAL REGISTRATION: anzctr.org.au , ACTRN-12616001368426 . Registered on 4 October 2016.


Assuntos
Neoplasias Ósseas/terapia , Neoplasias da Mama/terapia , Terapia por Exercício/métodos , Osteólise/terapia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Terapia por Exercício/efeitos adversos , Estudos de Viabilidade , Feminino , Nível de Saúde , Humanos , Osteólise/diagnóstico por imagem , Projetos Piloto , Dados Preliminares , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Austrália Ocidental
8.
Sports (Basel) ; 6(4)2018 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-30360580

RESUMO

Soccer is an intermittent team-sport, where performance is determined by a myriad of psychological, technical, tactical, and physical factors. Among the physical factors, endurance appears to play a key role into counteracting the fatigue-related reduction in running performance observed during soccer matches. One physiological determinant of endurance is movement economy, which represents the aerobic energy cost to exercise at a given submaximal velocity. While the role of movement economy has been extensively examined in endurance athletes, it has received little attention in soccer players, but may be an important factor, given the prolonged demands of match play. For this reason, the current review discusses the nature, impact, and trainability of movement economy specific to soccer players. A summary of current knowledge and limitations of movement economy in soccer is provided, with an insight into future research directions, to make this important parameter more valuable when assessing and training soccer players' running performance.

9.
Sports (Basel) ; 6(3)2018 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-30200182

RESUMO

In elite sporting codes, the identification and promotion of future athletes into specialised talent pathways is heavily reliant upon objective physical, technical, and tactical characteristics, in addition to subjective coach assessments. Despite the availability of a plethora of assessments, the dependence on subjective forms of identification remain commonplace in most sporting codes. More recently, genetic markers, including several single nucleotide polymorphisms (SNPs), have been correlated with enhanced aerobic capacity, strength, and an overall increase in athletic ability. In this review, we discuss the effects of a number of candidate genes on athletic performance, across single-skilled and multifaceted sporting codes, and propose additional markers for the identification of motor skill acquisition and learning. While displaying some inconsistencies, both the ACE and ACTN3 polymorphisms appear to be more prevalent in strength and endurance sporting teams, and have been found to correlate to physical assessments. More recently, a number of polymorphisms reportedly correlating to athlete performance have gained attention, however inconsistent research design and varying sports make it difficult to ascertain the relevance to the wider sporting population. In elucidating the role of genetic markers in athleticism, existing talent identification protocols may significantly improve-and ultimately enable-targeted resourcing in junior talent pathways.

10.
J Strength Cond Res ; 2018 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-30239452

RESUMO

Hart, NH, Newton, RU, Weber, J, Spiteri, T, Rantalainen, T, Dobbin, M, Chivers, P, and Nimphius, S. Functional basis of asymmetrical lower-body skeletal morphology in elite Australian footballers. J Strength Cond Res XX(X): 000-000, 2018-Bone strength is a product of its material and structural properties and is highly responsive to mechanical load. Given the measureable and adaptable features of bone, and thus relevance to medical screening, injury prevention, and injury management in athletes, this study describes the lower-body skeletal morphology of professional Australian rules footballers. Using a cross-sectional and quantitative study design, 54 professional Australian rules football players (n = 54; age: 22.4 ± 3.8 years; height: 189.0 ± 7.5 cm; body mass: 86.0 ± 8.6 kg; tibial length: 436.1 ± 29.2 mm; and body fat: 9.9 ± 1.7%) underwent tibiofibular peripheral quantitative computed tomography scans for the kicking and support limbs, and a whole-body dual-energy X-ray absorptiometry scans. The support leg was significantly stronger than the kicking leg (bone strength: p ≤ 0.001; d = 0.47) with significantly greater bone mass (p < 0.001; d = 0.28), cross-sectional areas (p ≤ 0.002; d = 0.20), and greater cortex thickness (p = 0.017; d = 0.20), owing to significantly greater periosteal apposition (p ≤ 0.001; d = 0.29) and endocortical expansion (p = 0.019; d = 0.13), despite significantly lower cortical density (p = 0.002; d = -0.25). Disparate skeletal morphology between limbs highlights context-specific adaptive responses to mechanical loads experienced during game-based tasks. Practitioners should concomitantly measure material and structural properties of musculoskeletal tissue when examining fragility or resilience to better inform medical screening, monitoring, and injury risk stratification. Support leg axial loading highlights a potential avenue for interventions aiming to remediate or optimize bone cross-sectional area.

11.
Arch Osteoporos ; 13(1): 63, 2018 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-29860609

RESUMO

Fracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to population growth. This is concerning, and interventions are required to reverse this trend. PURPOSE: Fracture incidence in 0-16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population distribution having only a single tertiary paediatric hospital (Princess Margaret Hospital, PMH, in Perth) managing the majority of children and adolescents with fractures in the Emergency Department (ED). The aims of this study were to characterise fracture presentations to PMH-ED and compare the incidence to population data. METHODS: A database audit of fracture presentations between 2005 and 2015 for fracture rates with a sub-analysis for gender, fracture site and age and a comparison to Perth Metropolitan and Western Australian population data was performed. RESULTS: Analysis included 31,340 presentations. Fracture incidence, adjusted for the annual population size, increased from 0.63% in 2005 to 0.85% in 2015 (p < 0.001). The month of May reported the highest fracture rate (p < 0.001) corresponding with the start of the winter sports season. Males had a 1.5 times higher fracture incidence than females (p < 0.001), with upper limb fractures three times more common than lower limb fractures (p < 0.001). Fracture incidence increased with age until the early teenage years (15 years for males; 12 years for females) when a decline occurred. CONCLUSIONS: Increased fracture incidence in Western Australia between 2005 and 2015 identifies a concerning trend for bone health in children and adolescents. Further research is needed to identify potential lifestyle factors that impact fracture incidence translating into evidence-based strategies to reverse these trends and improve bone health.

12.
BMJ Open ; 8(5): e022899, 2018 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-29764892

RESUMO

INTRODUCTION: Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC). METHODS AND ANALYSIS: Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation. ETHICS AND DISSEMINATION: Validation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation. TRIAL REGISTRATION NUMBER: NCT02730338.

13.
BMJ Open ; 8(4): e022331, 2018 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-29678994

RESUMO

INTRODUCTION: Active surveillance is a strategy for managing low-risk, localised prostate cancer, where men are observed with serial prostate-specific antigen assessments to identify signs of disease progression. Currently, there are no strategies to support active surveillance compliance nor are there interventions that can prevent or slow disease progression, ultimately delaying transition to active treatment before it is clinically required. Recently, we proposed that exercise may have a therapeutic potential in delaying the need for active treatment in men on active surveillance. METHODS AND ANALYSIS: A single-blinded, two arm, multicentre randomised controlled trial will be undertaken with 168 patients randomly allocated in a ratio of 1:1 to exercise or usual care. Exercise will consist of supervised resistance and aerobic exercise performed three times per week for the first 6 months in an exercise clinical setting, and during months 7-12, a progressive stepped down approach will be used with men transitioning to once a week supervised training. Thereafter, for months 13 to 36, the men will self-manage their exercise programme. The primary endpoint will be the time until the patients begin active therapy. Secondary endpoints include disease progression (prostate specific antigen), body composition and muscle density, quality of life, distress and anxiety and an economic analysis will be performed. Measurements will be undertaken at 6 and 12 months (postintervention) and at 24 and 36 months follow-up. The primary outcome (time to initiation of curative therapy) will be analysed using Cox proportional hazards regression. Outcomes measured repeatedly will be analysed using mixed effects models to examine between-group differences. Data will be analysed using an intention-to-treat approach. ETHICS AND DISSEMINATION: Outcomes from the study will be published in peer-reviewed academic journals and presented in scientific, consumer and clinical meetings.


Assuntos
Neoplasias da Próstata/terapia , Austrália , Tratamento Conservador , Progressão da Doença , Terapia por Exercício , Humanos , Masculino , Vigilância da População , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Qualidade de Vida , Projetos de Pesquisa , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
14.
Int J Gynecol Cancer ; 28(3): 604-613, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29369120

RESUMO

OBJECTIVES: Ovarian cancer (OC) survivors experience many disease and treatment adverse effects. However, the impact of OC and its treatment on objective activity behaviors and physiological status have not been examined. The purpose of this study was to compare objectively measured activity behaviors and physiological characteristics of advanced-stage OC survivors to age-matched controls. METHODS: Twenty stage III-IV OC survivors and 20 controls completed assessments of activity behaviors (7-day accelerometry), physical function (400-meter walk as indicator of cardiorespiratory fitness, repeated chair rise, 6-meter walking tests), muscle strength (1-repetition maximum and handgrip), body composition (dual-energy x-ray absorptiometry), and musculoskeletal morphology (peripheral quantitative computed tomography). RESULTS: Compared with controls, OC survivors spent more time/day in prolonged sedentary bouts (P = 0.039, r = 0.32), had lower cardiorespiratory fitness (P = 0.041, r = 0.33) and upper body strength (P = 0.023, r = 0.37), had higher areal bone mineral content (P = 0.047, r = 0.33) and volumetric trabecular density (P = 0.048, r = 0.31), but were not different in other measures of body composition nor in muscle morphology (P > 0.050). Only 20% (n = 4) of OC survivors accrued 150 minutes/week or greater moderate and vigorous physical activity (MVPA) time in 10-minute bouts or greater. Moderate and vigorous physical activity time/day in 10-minute bouts or greater was strongly associated with cardiorespiratory fitness (P = 0.001, ρ = -0.702) and lower extremity function (P = 0.019, ρ = -0.519) and moderately associated with muscle cross-sectional area (P = 0.035, ρ = 0.473). CONCLUSIONS: Posttreatment OC survivors spent more time in prolonged sedentary bouts and had lower cardiorespiratory fitness and upper body strength compared with controls. Moderate and vigorous physical activity was associated with physical function and muscle cross-sectional area. Future studies should test the efficacy of exercise interventions to increase MVPA, reduce sedentary behavior, and increase cardiorespiratory fitness and muscle strength in OC survivors.

15.
J Clin Densitom ; 21(2): 260-268, 2018 Apr - Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28801168

RESUMO

Most imaging methods, including peripheral quantitative computed tomography (pQCT), are susceptible to motion artifacts particularly in fidgety pediatric populations. Methods currently used to address motion artifact include manual screening (visual inspection) and objective assessments of the scans. However, previously reported objective methods either cannot be applied on the reconstructed image or have not been tested for distal bone sites. Therefore, the purpose of the present study was to develop and validate motion artifact classifiers to quantify motion artifact in pQCT scans. Whether textural features could provide adequate motion artifact classification performance in 2 adolescent datasets with pQCT scans from tibial and radial diaphyses and epiphyses was tested. The first dataset was split into training (66% of sample) and validation (33% of sample) datasets. Visual classification was used as the ground truth. Moderate to substantial classification performance (J48 classifier, kappa coefficients from 0.57 to 0.80) was observed in the validation dataset with the novel texture-based classifier. In applying the same classifier to the second cross-sectional dataset, a slight-to-fair (κ = 0.01-0.39) classification performance was observed. Overall, this novel textural analysis-based classifier provided a moderate-to-substantial classification of motion artifact when the classifier was specifically trained for the measurement device and population. Classification based on textural features may be used to prescreen obviously acceptable and unacceptable scans, with a subsequent human-operated visual classification of any remaining scans.

16.
Med Sci Sports Exerc ; 50(3): 393-399, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29036016

RESUMO

PURPOSE: The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases. METHODS: Between 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg·m) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention. RESULTS: There was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4-6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6-12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507). CONCLUSIONS: Multimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain. TRIAL REGISTRATION: ACTRN12611001158954.

17.
BMJ Open ; 7(5): e014458, 2017 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-28559456

RESUMO

INTRODUCTION: Exercise may positively alter tumour biology through numerous modulatory and regulatory mechanisms in response to a variety of modes and dosages, evidenced in preclinical models to date. Specifically, localised and systemic biochemical alterations produced during and following exercise may suppress tumour formation, growth and distribution by virtue of altered epigenetics and endocrine-paracrine activity. Given the impressive ability of targeted mechanical loading to interfere with metastasis-driven tumour formation in human osteolytic tumour cells, it is of equal interest to determine whether a similar effect is observed in sclerotic tumour cells. The study aims to (1) establish the feasibility and safety of a combined modular multimodal exercise programme with spinal isometric training in advanced prostate cancer patients with sclerotic bone metastases and (2) examine whether targeted and supervised exercise can suppress sclerotic tumour growth and activity in spinal metastases in humans. METHODS AND ANALYSIS: A single-blinded, two-armed, randomised, controlled and explorative phase I clinical trial combining spinal isometric training with a modular multimodal exercise programme in 40 men with advanced prostate cancer and stable sclerotic spinal metastases. Participants will be randomly assigned to (1) the exercise intervention or (2) usual medical care. The intervention arm will receive a 3-month, supervised and individually tailored modular multimodal exercise programme with spinal isometric training. Primary endpoints (feasibility and safety) and secondary endpoints (tumour morphology; biomarker activity; anthropometry; musculoskeletal health; adiposity; physical function; quality of life; anxiety; distress; fatigue; insomnia; physical activity levels) will be measured at baseline and following the intervention. Statistical analyses will include descriptive characteristics, t-tests, effect sizes and two-way (group × time) repeated-measures analysis of variance (or analysis of covariance) to examine differences between groups over time. The data-set will be primarily examined using an intention-to-treat approach with multiple imputations, followed by a secondary sensitivity analysis to ensure data robustness using a complete cases approach. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Human Research Ethics Committee (HREC) of Edith Cowan University and the Sir Charles Gairdner and Osborne Park Health Care Group. If proven to be feasible and safe, this study will form the basis of future phase II and III trials in human patients with advanced cancer. To reach a maximum number of clinicians, practitioners, patients and scientists, outcomes will be disseminated through national and international clinical, conference and patient presentations, as well as publication in high-impact, peer-reviewed academic journals. TRIAL REGISTRATION NUMBER: ACTRN 12616000179437.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Terapia por Exercício , Exercício/fisiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Idoso , Fosfatase Alcalina/sangue , Glicemia/metabolismo , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/fisiopatologia , Proteína C-Reativa/metabolismo , Teste de Esforço , Terapia por Exercício/efeitos adversos , Estudos de Viabilidade , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/sangue , Lipídeos/sangue , Imagem por Ressonância Magnética , Masculino , Força Muscular , Fragmentos de Peptídeos/sangue , Fosfopeptídeos/urina , Pró-Colágeno/sangue , Pró-Colágeno/urina , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/fisiopatologia , Qualidade de Vida , Projetos de Pesquisa , Método Simples-Cego , Fator de Crescimento Transformador beta/sangue
18.
Curr Opin Support Palliat Care ; 11(3): 247-257, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28562375

RESUMO

PURPOSE OF REVIEW: Exercise is a provocative medicine, known for its preventive, complimentary and rehabilitative role in the management of cancer. Impressively, exercise is also emerging as a synergistic and targeted medicine to enhance symptom control, modulate tumour biology and delay disease progression, with the potential to increase overall survival. Given the complex clinical presentation of advanced prostate cancer patients and their omnipresent comorbidities, this review describes the current and potential role of exercise medicine in advanced prostate cancer. RECENT FINDINGS: Exercise has been shown to be safe, feasible and effective for advanced prostate cancer patients, inclusive of patients with bone metastases; a previously excluded population due to patient and clinician fear of adverse events. Preclinical data provide insight into the ability of exercise to modulate cancer-specific outcomes, may synergistically increase the potency of chemotherapy and radiotherapy and may endogenously and/or mechanically suppress tumour formation, growth and invasion in visceral and skeletal tissue. Epidemiological studies have also shown an association between physical activity and increased survival. SUMMARY: Exercise oncology is rapidly evolving, with impressive possibilities that may directly improve patient outcomes in advanced prostate cancer. Research must focus on translating preclinical trials into human clinical trials and investigate the direct effect of exercise on overall survival.


Assuntos
Exercício/fisiologia , Músculo Esquelético/fisiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Envelhecimento/fisiologia , Antagonistas de Androgênios/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/secundário , Humanos , Masculino , Gradação de Tumores , Neutrófilos/metabolismo , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia
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J Sports Sci Med ; 15(2): 344-51, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27274674

RESUMO

Kicking a ball accurately over a desired distance to an intended target is arguably the most important skill to acquire in Australian Football. Therefore, understanding the potential mechanisms which underpin kicking accuracy is warranted. The aim of this study was to examine the relationship between leg mass, leg composition and foot velocity on kicking accuracy in Australian Football. Thirty-one Australian Footballers (n = 31; age: 22.1 ± 2.8 years; height: 1.81 ± 0.07 m; weight: 85.1 ± 13.0 kg; BMI: 25.9 ± 3.2) each performed ten drop punt kicks over twenty metres to a player target. Athletes were separated into accurate (n = 15) and inaccurate (n = 16) kicking groups. Leg mass characteristics were assessed using whole body DXA scans. Foot velocity was determined using a ten-camera optoelectronic, three-dimensional motion capture system. Interactions between leg mass and foot velocity evident within accurate kickers only (r = -0.670 to -0.701). Relative lean mass was positively correlated with kicking accuracy (r = 0.631), while no relationship between foot velocity and kicking accuracy was evident in isolation (r = -0.047 to -0.083). Given the evident importance of lean mass, and its interaction with foot velocity for accurate kickers; future research should explore speed-accuracy, impulse-variability, limb co-ordination and foot-ball interaction constructs in kicking using controlled with-in subject studies to examine the effects of resistance training and skill acquisition programs on the development of kicking accuracy. Key pointsAccurate kickers expressed a very strong inverse relationship between leg mass and foot velocity. Inaccurate kickers were unable to replicate this, with greater volatility in their performance, indicating an ability of accurate kickers to mediate foot velocity to compensate for leg mass in order to deliver the ball over the required distance.Accurate kickers exhibited larger quantities of relative lean mass and lower quantities of relative fat mass in their kicking leg. Higher relative lean mass reduces the relative muscular impulses required to produce a given action, allowing greater limb control with proportionately reduced volitional effort.Kicking accuracy was unable to be explained by either foot velocity or leg mass in isolation; rather, it was the co-contribution and interrelation of these characteristics which were the discriminatory factors between accurate and inaccurate kickers.

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