The acute effects of exercise on cortical excitation and psychosocial outcomes in men treated for prostate cancer: a randomized controlled trial.

PURPOSE: Regular exercise improves psychological well-being in men treated for prostate cancer (PCa). For this population and among cancer survivors in general, the effect of a single bout of exercise on self-report or objective measures of psychological well-being has not been examined. We examined the acute effect of a single bout of exercise on the cortical silent period (CSP) and on self-reported mood in men that have received treatment for PCa. METHODS: Thirty-six PCa survivors were randomly assigned to 60 min of low to moderate intensity exercise or to a control condition. Outcomes were assessed immediately before and after either the exercise or the control condition. RESULTS: No significant between-group differences were observed in CSP or mood were observed following the exercise session or control conditions. Participants with higher scores of trait anxiety had significantly shorter CSP at baseline, as well as those receiving androgen deprivation therapy. Age and baseline CSP had a low-moderate, but significant negative correlation. Changes in CSP following the exercise condition were strongly negatively correlated with changes in self-reported vigor. CONCLUSION: While we did not observe any acute effect of exercise on the CSP in this population, the associations between CSP and trait anxiety, age, and vigor are novel findings requiring further examination. IMPLICATIONS FOR CANCER SURVIVORS: Exercise did not acutely affect our participants in measures of psychological well-being. Additional mechanisms to explain the chronic psychosocial benefits of exercise previously observed in men with PCa require further exploration. Clinicaltrials.gov Identifier: NCT01715064 (http://clinicaltrials.gov/show/NCT01715064).

Age-related differences in working memory evoked gamma oscillations.

OBJECTIVE: Working memory is associated with gamma oscillations (30-50 Hz). Previous studies have demonstrated altered gamma oscillations in the elderly population that may be related to general cognitive decline. However, it is unknown how gamma oscillations change with age or if there is an age when gamma oscillations optimally mediate working memory performance. That is, gamma oscillations may be maximal in middle-aged adults compared to younger and elderly adults. The objective of this study was to evaluate working memory evoked gamma oscillations in adults aged 19-29 years (mean 23.32 ± 2.85 1 SD) compared to adults aged 30-60 years (mean 39.10 ± 8.11 1 SD). METHODS: Subjects completed the verbal N-back task administered at four working loads (0, 1, 2, 3), while electroencephalography (EEG) was collected. Gamma power was measured during correct responses. RESULTS: Reduced gamma oscillations were observed in the adults aged 19-29 compared to those aged 30-60 years. Age was found to be positively related to the power of gamma oscillations. No differences were found on N-Back accuracy. CONCLUSIONS: Increased working memory evoked gamma oscillatory activity may provide a neurophysiological marker in the healthy aging brain.

The effect of meeting physical activity guidelines for cancer survivors on quality of life following radical prostatectomy for prostate cancer.

PURPOSE: Recent literature has shown that preoperative physical activity (PA) can positively influence surgical outcomes. It is unknown whether the effect of meeting PA guidelines for cancer survivors can impact quality of life following radical prostatectomy for prostate cancer. METHODS: We reviewed our institutional database of prostate cancer outcomes and included patients that underwent radical prostatectomy and completed the Godin-Shephard Leisure Time Exercise Questionnaire (GLTEQ), the Patient-Oriented Prostate Utility Scale (PORPUS), the International Prostate Symptom Score (IPSS), and the five-item International Index of Erectile Function (IIEF). Participants were categorized as meeting or not meeting the American College of Sports Medicine physical activity guidelines for cancer survivors (150 min of moderate intensity or 75 min of vigorous intensity PA per week). Radical prostatectomy outcomes were measured preoperatively and at 6 and 26-weeks postoperatively. RESULTS: From June 2008 to August 2012, 509 men underwent curative, nerve-sparing radical prostatectomy for prostate cancer and completed the GLTEQ, of whom 46% met the PA guidelines. Prior to surgery, men that met the PA guidelines reported higher quality of life (p < 0.001) and erectile function (p = 0.049) than men that did not meet the guidelines. Quality of life at all postoperative timepoints was higher for men that met the PA guidelines after adjusting for age, preoperative body mass index, and surgical approach (p = 0.02). Men that met the PA guidelines were 19% less likely to be incontinent at 6 weeks postoperatively (p = 0.028). CONCLUSION: PA volume may be a useful marker at predicting postoperative recovery of quality of life and urinary incontinence following radical prostatectomy. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors should be encouraged to meet PA guidelines prior to surgery in an effort to attenuate the decline in HRQOL and facilitate recovery.

ColonCancerCheck primary care invitation pilot project: patient perceptions.

OBJECTIVE: To describe the perceptions of those who received invitations to the ColonCancerCheck Primary Care Invitation Pilot (the Pilot) about the mailed invitation, colorectal cancer (CRC) screening in general, and their specific screening experiences. DESIGN: Qualitative study with 6 focus group sessions, each 1.5 hours in length. SETTING: Hamilton, Ont; Ottawa, Ont; and Thunder Bay, Ont. PARTICIPANTS: Screening-eligible adults, aged 50 years and older, who received a Pilot invitation for CRC screening. METHODS: The focus groups were conducted by a trained moderator and were audiorecorded and transcribed verbatim. The transcripts were analyzed using grounded-theory techniques facilitated by the use of electronic software. MAIN FINDINGS: Key themes related to the invitation letter, the role of the family physician, direct mailing of the fecal occult blood testing (FOBT) kit, and alternate CRC screening promotion strategies were identified. Specifically, participants suggested the letter content should use stronger, more powerful language to capture the reader's attention. The importance of the family physician was endorsed, although participants favoured clarification of the physician and program roles in the actual mailed invitation. Participants expressed support for directly mailing FOBT kits to individuals, particularly those with successful previous test completion, and for communication of both negative and positive screening results. CONCLUSION: This study yielded a number of important findings including strategies to optimize letter content, support for directly mailed FOBT kits, and strategies to report results that might be highly relevant to other health programs where population-based CRC screening is being considered.

Exercise effects on adipokines and the IGF axis in men with prostate cancer treated with androgen deprivation: A randomized study.

BACKGROUND: Androgen deprivation therapy (ADT) has significant deleterious effects on body composition that may be accompanied by unfavourable changes in adipokine levels. While exercise has been shown to improve a number of side effects associated with ADT for prostate cancer, no studies have assessed the effect of exercise on adiponectin and leptin levels, which have been shown to alter the mitogenic environment. METHODS: Twenty-six men with prostate cancer treated with ADT were randomized to home-based aerobic exercise training or resistance exercise training for 24 weeks. Adiponectin, leptin, insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3) were analyzed by ELISA (enzyme-linked immunosorbent assay), in addition to physical activity volume, peak aerobic capacity, and anthropometric measurements, at baseline, 3 months and 6 months. RESULTS: Resistance exercise significantly reduced IGF-1 after 3 months (p = 0.019); however, this change was not maintained at 6 months. At 6 months, IGFBP-3 was significantly increased compared to baseline for the resistance training group (p = 0.044). In an exploratory analysis of all exercisers, favourable changes in body composition and aerobic fitness were correlated with favourable levels of leptin, and favourable leptin:adiponectin and IGF-1:IGFBP-3 ratios at 3 and 6 months. CONCLUSIONS: Home-based exercise is correlated with positive changes in adipokine levels and the IGF-axis that may be related to healthy changes in physical fitness and body composition. While the improvements of adipokine markers appear to be more apparent with resistance training compared to aerobic exercise, these findings must be considered cautiously and require replication from larger randomized controlled trials to clarify the role of exercise on adipokines and IGF-axis proteins for men with prostate cancer.

A pilot study of an exercise & cognitive behavioral therapy intervention for epithelial ovarian cancer patients.

BACKGROUND: Ovarian cancer has the highest mortality rate of all gynaecologic cancers. Faced with poor prognoses, stressful treatment effects and a high likelihood of recurrence, survivors must confront significant physical and psychological morbidities that negatively impact health-related quality of life. Frequently reported side effects include cancer-related fatigue, peripheral neuropathy, and psychological distress. Exercise and cognitive behavioral therapy interventions have counteracted such adverse effects in other cancer populations. OBJECTIVE: To investigate the feasibility and benefits of a 24-week home-based exercise intervention, coordinated with 12 weeks of cognitive behavioral therapy (two sessions per month), developed for two types of patients diagnosed with epithelial ovarian cancer: 1) those undergoing primary treatment with adjuvant chemotherapy after primary surgery; 2) those on surveillance after completing treatment within the last 2 years. METHODS: Participants were recruited from the Gynaecologic Oncology Clinic. Eligible participants completed baseline assessments and were provided with home-based exercise equipment. Cognitive behavioral therapy was provided every other week for patients via telephone. Assessments were completed at baseline (T1), 3 months (T2) and 6 months (T3). RESULTS: 19 of the 46 eligible patients approached were enrolled, with 7 patients in the treatment group and 12 in the surveillance group. There was a significant within group increase in peak VO2 from baseline to 6 months: F(2,16) = 5.531, p = 0.015, partial η2 = 0.409. CONCLUSION: The combined 6-month exercise-cognitive behavioral therapy intervention was associated with significant increases in aerobic fitness in epithelial ovarian cancer patients assessed. These improvements were similar regardless of whether the patient was receiving chemotherapy or under surveillance.

Canadian national surveys on pandemic influenza preparations: pre-pandemic and peri-pandemic findings.

BACKGROUND: Prior to the 2009 H1N1 Influenza pandemic, public health authorities in Canada and elsewhere prepared for the future outbreak, partly guided by an ethical framework developed within the Canadian Program of Research on Ethics in a Pandemic (CanPREP). We developed a telephone-based survey based on that framework, which was delivered across Canada in late 2008. In June, 2009, the WHO declared pandemic Phase 6 status and from the subsequent October (2009) until May 2010, the CanPREP team fielded a second (revised) survey, collecting another 1,000 opinions from Canadians during a period of pre-pandemic anticipation and peri-pandemic experience. METHODS: Surveys were administered by telephone with random sampling achieved via random digit dialing. Eligible participants were adults, 18 years or older, with per province stratification approximating provincial percentages of national population. Descriptive results were tabulated and logistic regression analyses used to assess whether demographic factors were significantly associated with outcomes, and to identify divergences (between the pre-pandemic and intra-pandemic surveys). RESULTS: N = 1,029 interviews were completed from 1,986 households, yielding a gross response rate of 52% (AAPOR Standard Definition 3). Over 90% of subjects indicated the most important goal of pandemic influenza preparations was saving lives, with 41% indicating that saving lives solely in Canada was the highest priority and 50% indicating saving lives globally was the highest priority. About 90% of respondents supported the obligation of health care workers to report to work and face influenza pandemic risks excepting those with serious health conditions which that increased risks. Strong majorities favoured stocking adequate protective antiviral dosages for all Canadians (92%) and, if effective, influenza vaccinations (95%). Over 70% agreed Canada should provide international assistance to poorer countries for pandemic preparation, even if resources for Canadians were reduced. CONCLUSIONS: Results suggest Canadians trust public health officials to make difficult decisions, providing emphasis is maintained on reciprocity and respect for individual rights. Canadians also support international obligations to help poorer countries and associated efforts to save lives outside the country, even if intra-national efforts are reduced.

A randomized trial of aerobic versus resistance exercise in prostate cancer survivors.

Androgen-deprivation therapy (ADT) for prostate cancer (PCa) has side effects that significantly impair health-related quality of life (HRQOL). Exercise ameliorates many side effects of ADT, but different modalities, particularly in the home-based setting, have not been well studied. In this study the authors randomly assigned 66 PCa survivors receiving ADT to 6 mo of home-based aerobic or resistance training. Psychosocial well-being and physical fitness were measured at baseline, 3 and 6 mo, and then 6 mo postintervention. Intention-to-treat analyses showed that fatigue and HRQOL were not significantly different between groups; however, in a per-protocol analysis the resistance-exercise training group demonstrated clinically significant improvements in HRQOL. Differential within-group effects on physical fitness were also observed at various time points. At all time points, the aerobic-training group engaged in significantly more physical activity than the resistance-training group, a finding that should be further examined given evidence-based guidelines for activity volume in cancer survivors.

Meditation-related increases in GABAB modulated cortical inhibition.

BACKGROUND: Recent reports suggest meditation practice improves attentional performance and emotional regulation. The process of meditation apparently increases activation in the prefrontal cortex (PFC) and stimulates the reticular nucleus of the thalamus, implicating the production and delivery of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). GABAergic inhibitory interneurons have a central role in cortical inhibition (CI), modulating cortical excitability and neural plasticity. OBJECTIVE/HYPOTHESIS: Changes in CI, after completion of a single meditation session, were investigated and compared to a non-meditating control activity. METHODS: Transcranial magnetic stimulation (TMS), a non-invasive method of examining CI, was used to evaluate changes before and after a 60 min meditation session. Seventy right-handed healthy subjects (n = 35 meditators, n = 35 non-meditators) were assessed using TMS related measures of cortical silent period (CSP) and short intra cortical inhibition (SICI), with stimulation of the motor cortex coordinated with EMG recording of peripheral hand muscles. RESULTS: For the meditators, CSP and SICI were measured before and after meditation sessions while age-sex matched healthy control subjects were identically assessed after a non-meditating activity (television watching). The meditators showed a statistically significant increase in CSP after meditation compared to non-meditators after an equivalent period of television watching (P = 0.02) while no significant between-group differences were observed in the SICI. CONCLUSION: These findings indicate meditation processes are linked to GABAergic cortical inhibition, a mechanism previously implicated in improved cognitive performance and enhanced emotional regulation.

Cognitive behavioral therapy-related increases in cortical inhibition in problematic perfectionists.

BACKGROUND: Several lines of evidence suggest that cognitive behavioral therapy (CBT) is an effective treatment for depression and anxiety disorders. Evidence suggests that the therapeutic effects of CBT are related to neurophysiologic changes in the cortex, particularly γ-aminobutyric acid (GABA) potentiation. Transcranial magnetic stimulation (TMS) represents a noninvasive method of measuring cortical inhibition, which is a neurophysiologic mechanism associated with the pathophysiology of several psychiatric disorders. OBJECTIVE/HYPOTHESIS: To demonstrate the effectiveness of a 12-week CBT intervention compared with a wait list control group measuring cortical inhibition in participants with pathologic perfectionism. Participants within the CBT group would demonstrate increases in cortical inhibition and improvements on clinical outcomes relative to the wait list control group. METHODS: Twenty-four right-handed perfectionists were randomly assigned to a 12-week CBT intervention or a wait list control group. Cortical inhibition was measured at pre- and postintervention with TMS paradigms specifically short-interval cortical inhibition and the cortical silent period, which index GABAA and GABAB receptor-mediated inhibitory neurotransmission, respectively. RESULTS: The CBT group demonstrated a significant potentiation of the cortical silent period when compared with the wait list control group. The CBT group demonstrated a decrease in anxiety sensitivity and automatic thoughts relative to the control group. CONCLUSIONS: These findings demonstrate that CBT tailored for perfectionism is accompanied by an increase in cortical inhibition of the motor cortex and positive changes on clinical outcomes. These findings provide compelling evidence for an association between positive CBT effects and a potentiation of GABAergic inhibitory neurotransmission.

A qualitative evaluation of strategies to increase colorectal cancer screening uptake.

OBJECTIVE: To obtain data that could be used to optimize the content and design of the targeted, mailed invitations that Ontario's provincewide colorectal cancer (CRC) screening program plans to use to increase screening uptake; to identify other strategies to increase CRC screening uptake; and to describe the effects of this qualitative work on a subsequent quantitative pilot study. DESIGN: Qualitative study using semistructured focus groups. SETTING: Four different Ontario communities. PARTICIPANTS: Six focus groups comprising a total of 62 participants. METHODS: Six focus groups were conducted in 4 different Ontario communities. For 3 of the communities, participants were recruited from the general population by a private marketing firm, using random-digit dialing, and received a small honorarium for participating. In Sault Ste Marie, participants were convenience samples recruited from a large primary care practice and were not offered compensation. Responses were elicited regarding various strategies for promoting CRC screening. Findings represent all responses observed as well as recommendations to program planners based on focus groups observations. MAIN FINDINGS: Key themes identified included the importance of receiving a CRC screening invitation from one's family physician; a desire for personalized, brief communications; and a preference for succinct information in mailed materials. Strong support was indicated for direct mailing of the CRC screening kit (fecal occult blood test). Our findings substantially influenced the final design and content of the envelope and letter to be mailed in the subsequent quantitative pilot study. CONCLUSION: We report strong support from our focus groups for a succinct, personalized invitation for CRC screening from one's own family physician. We have also shown that qualitative evaluation can be used to provide decision makers with pertinent and timely knowledge. Our study is highly relevant to other public health programs, particularly other Canadian jurisdictions planning organized CRC screening programs.

Physical activity and quality of life after radical prostatectomy.

BACKGROUND: There are significant post-surgical reductions in health-related quality of life (HRQOL) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Physical activity (PA) interventions have improved treatment outcomes for PCa patients undergoing radiation and hormone therapy, but PA effects have not previously been examined in the RP setting. This study examined the relationship between preoperative PA levels and postoperative HRQOL outcomes in PCa patients treated with RP. METHODS: Sixty patients were interviewed regarding lifetime PA and completed preoperative (2 weeks prior to surgery) and postoperative (4 weeks after surgery) HRQOL questionnaires. Aerobic fitness testing was conducted on a subsample of 22 patients. RESULTS: Higher levels of total past-year PA and occupational PA significantly correlated with lesser HRQOL declines from presurgery to 4 weeks post-surgery (Beta = -0.364, p = 0.037 and Beta = -0.243, p = 0.089, respectively) in models adjusted for age, postoperative questionnaire completion date, Gleason score and education. Past-year occupational PA was highly positively correlated with past-year total PA (r = 0.785, p < 0.001). Lifetime total PA was correlated with estimated VO(2) max (r = 0.486, p = 0.026) in the 22 patients who were aerobically tested. Lifetime and past-year PA volumes were not correlated with waist circumference or body mass index. INTERPRETATION: Declines in HRQOL after RP may be reduced in patients with higher preoperative levels of self-reported PA. These findings require further study with larger samples to confirm results. If confirmed, findings suggest exercise preoperatively may improve HRQOL outcomes after RP.