Creatine supplementation and resistance training to preserve muscle mass and attenuate cancer progression (CREATINE-52): a protocol for a double-blind randomized controlled trial.

BACKGROUND: Muscle mass is important for metastatic prostate cancer survival and quality of life (QoL). The backbone of treatment for men with metastatic castration sensitive prostate cancer (mCSPC) is androgen deprivation therapy (ADT) with an androgen signaling inhibitor. ADT is an effective cancer treatment, but it facilitates significant declines in muscle mass and adverse health outcomes important to mCSPC survivors, such as fatigue, and reductions in physical function, independence, insulin sensitivity, and QoL. In non-metastatic CSPC survivors, resistance training (RT) preserves muscle mass and improves these related health outcomes, but the biggest barrier to RT in CSPC survivors of all stages is fatigue. Creatine monohydrate supplementation coupled with RT (Cr + RT) may address this barrier since creatine plays a critical role in energy metabolism. Cr + RT in cancer-free older adults and other clinical populations improves muscle mass and related health outcomes. Evidence also suggests that creatine supplementation can complement cancer treatment. Thus, Cr + RT is a strategy that addresses gaps in survivorship needs of people with mCSPC. The purpose of this parallel, double-blind randomized controlled trial is to test the effects of 52-weeks of Cr + RT compared with placebo (PLA) and RT (PLA + RT) on muscle mass, other related health outcomes, and markers of cancer progression. METHODS: We will carry out this trial with our team's established, effective, home-based, telehealth RT program in 200 mCSPC survivors receiving ADT, and evaluate outcomes at baseline, 24-, and 52-weeks. RT will occur twice weekly with elastic resistance bands, and an established creatine supplementation protocol will be used for supplementation delivery. Our approach addresses a major facilitator to RT in mCSPC survivors, a home-based RT program, while utilizing a supervised model for safety. DISCUSSION: Findings will improve delivery of comprehensive survivorship care by providing a multicomponent, patient-centered lifestyle strategy to preserve muscle mass, improve health outcomes, and complement cancer treatment (NCT06112990).

Factors influencing engagement in hospital-based exercise oncology programs: A narrative review.

Among cancer survivors, there are numerous health benefits of exercise engagement; however, less than 15% of survivors meet current aerobic and strength physical activity guidelines. Exercise programs provided by a cancer hospital are commonly noted as a facilitator and preference to exercise engagement. The study aimed to review the evidence and describe the barriers, facilitators, preferences, and factors associated with cancer survivors' engagement in hospital-based exercise oncology programs. Electronic databases (PubMed and Scopus) were searched to identify relevant papers published before July 1, 2021. Original research papers reporting on barriers, facilitators, preferences, or factors associated with participation in hospital-based exercise oncology programs were included. A total of 300 potentially relevant articles were identified, of which 10 met eligibility criteria. Barriers to participation in hospital-based exercise oncology programs included program accessibility, treatment-related side effects, and uncertainty about exercise. Program individualization, peer support, and staff support were reported as facilitators. Survivors also expressed that they preferred flexibility in the time, location, and mode of exercise programming. Baseline quality of life, fitness, and marital status were all identified as potential factors associated with engagement in hospital-based exercise oncology programs. These findings are useful for the development and implementation of hospital-based exercise oncology programs to optimize exercise program engagement.

Clinical and Demographic Factors Associated With Follow-Up in a Hospital-Based Exercise Oncology Program.

OBJECTIVE: Despite the numerous benefits of regular exercise participation for cancer survivors, nearly 60% of survivors do not meet current guidelines. Hospital-based exercise oncology programs may be one strategy to promote exercise engagement as survivors have expressed a preference for exercise programs associated with a cancer hospital. However, follow-up rates in hospital-based exercise oncology programs can be low. Follow-up assessments are a critical component of exercise oncology programs as they determine survivor progress, allow for revision of exercise prescriptions, and demonstrate the effectiveness of the exercise program. Therefore, the purpose of this study was to identify clinical and demographic factors associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. METHODS: We analyzed data collected from 2016 to 2019 (n = 849) from the Huntsman Cancer Institute's hospital-based exercise oncology program, the Personal Optimism with Exercise Recovery (POWER) program. Cancer survivors completed an assessment at the start of POWER and were encouraged to attend a 12-week follow-up assessment. Factors associated with not attending a 12-week follow-up assessment were identified using logistic regression. RESULTS: Multiple myeloma cancer survivors were more likely (OR 2.33; 95% CI 1.09, 4.98) to not attend a 12-week follow-up assessment, whereas endometrial cancer survivors were less likely (OR 0.39; 95% CI 0.18, 0.87). Greater travel time (OR 2.69; 95% CI: 1.83, 3.96) and distance (OR 2.37; 95% CI: 1.61, 3.49) were associated with not attending a 12-week follow-up assessment. Immunotherapy (OR 1.66; 95% CI 1.02, 2.72), waist circumference (OR 1.01; 95% CI 1.00, 1.02), overweight status per body mass index (OR 1.62; 95% CI 1.11, 2.38), and male sex (OR 1.70; 95% CI 1.23, 2.35) were associated with an increased likelihood of not attending a 12-week follow-up assessment. Survivors with a higher baseline quality of life (OR 0.96; 95% CI 0.93, 0.99) and peak oxygen consumption (OR 0.97; 95% CI 0.95, 0.99) were less likely not to attend a 12-week follow-up assessment. CONCLUSIONS: Both clinical and demographic factors were associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. Understanding factors related to follow-up assessment attendance in exercise oncology programs can inform the development of targeted interventions to improve follow-up rate thus maximizing exercise support for cancer survivors.

The association between time-of-day of habitual exercise training and changes in relevant cancer health outcomes among cancer survivors.

OBJECTIVE: To assess the relationship between time-of-day of exercise training and changes in relevant cancer health outcomes among cancer survivors. METHODS: Retrospective analysis of data collected from 2016-2019 from a hospital-based exercise oncology program. Descriptive statistics were calculated for demographic, clinical, and exercise timing characteristics (e.g. AM, PM, or mix) among survivors with available data for exercise training time (n = 233). For the total sample and a breast cancer sub-analysis, univariate analysis of covariance, adjusted for age, was carried out by exercise training time, for change in the following outcomes collected during the program's assessment sessions: cardiorespiratory fitness and muscular endurance (human performance variables), physical function, anthropometrics, self-reported fatigue, and quality of life (QoL). Change in body mass index (BMI) and body weight was included in the breast cancer analysis. RESULTS: Overall, 37.3% of survivors habitually engaged in AM exercise (e.g. ≥ 75% AM training), 34.3% in PM exercise, and 28.3% in a mix of AM and PM exercise training throughout the program. Median time in the program was 17 weeks. Significant improvements in most human performance and physical function variables were observed in the total sample regardless of exercise training time-of-day. Among breast cancer survivors, PM but not AM or mixed was associated with improvements in fitness, and lower-body muscular endurance and function. Mixed exercise timing was linked with greater increase in waist circumference (total sample: 3.02cm, 95%CI 1.55, 4.49; breast cancer: 3.57cm 95%CI 0.96, 6.18), body weight (breast cancer: 1.6kg, 95%CI 0.3, 2.8) and BMI (breast cancer: 0.6kg/m2, 95%CI 0.1, 1.0). AM and PM exercise, but not mixed, was associated with improvements in fatigue and QoL. CONCLUSION: Time-of-day of exercise training may differentially impact changes in human performance and physical function variables. Mixed exercise training time may result in less favorable outcomes related of weight management variables among cancer survivors.

The impact of a hospital-based exercise oncology program on cancer treatment-related side effects among rural cancer survivors.

PURPOSE: To assess the impact of the Personal Optimism With Exercise Recovery (POWER) program on cancer treatment-related side effects among rural cancer survivors. METHODS: In this retrospective study of data collected between 2016 and 2019, we assessed change in cardiorespiratory fitness, whole-body muscular endurance, physical function and strength, anthropometrics, fatigue, and quality of life (QoL), after participation in POWER. Descriptive statistics were calculated for demographic and clinical variables. Univariate analysis of variance was carried out with age and BMI at initial assessment as covariates. RESULTS: A total of 239 survivors, 78% rural residents, completed a follow-up assessment. Among rural cancer survivors, the most prevalent cancer sites were breast (42.5%), prostate (12.4%), and lymphoma (5.9%). The majority of survivors were female (70%), non-Hispanic (94.6%), and white (93.5%), with average age and BMI of 62.1 ± 13.2 years and 28.4 ± 6.7 kg/m2, respectively. Rural cancer survivors with cancer stages I-III exhibited significant improvements in fitness (+ 3.07 ml/kg/min, 95% CI 1.93, 4.21; + 0.88 METS, 95% CI 0.55, 1.20), physical function (30-s chair stand: + 2.2 repetitions, 95% CI 1.3, 3.1), muscular endurance (10-repetition maximum: chest press + 4.1 kg, 95% CI 2.0, 6.3; lateral pulldown + 6.6 kg, 95% CI 4.4, 8.9), self-reported fatigue (FACIT-Fatigue score: + 4.9, 95% CI 1.6, 8.1), and QoL (FACT-G7 score + 2.1, 95% CI, 0.9, 3.4). Among stage IV rural and urban cancer survivors, significant improvements were observed in muscular endurance and physical function. CONCLUSION: Participation in POWER was associated with attenuation of cancer treatment-related side effects and may serve as a model exercise oncology program for rural cancer survivors.

Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial.

INTRODUCTION: The primary aims of this Stage I pilot randomized controlled trial were to establish the feasibility of integrating exercise and nutrition counseling with Mindfulness-Oriented Recovery Enhancement (MORE), a novel intervention that unites training in mindfulness, reappraisal, and savoring skills to target mechanisms underpinning appetitive dysregulation a pathogenic process that contributes to obesity among cancer survivors; to identify potential therapeutic mechanisms of the MORE intervention; and to obtain effect sizes to power a subsequent Stage II trial. METHODS: Female overweight and obese cancer survivors (N = 51; mean age = 57.92 ± 10.04; 88% breast cancer history; 96% white) were randomized to one of two 10-week study treatment conditions: ( a) exercise and nutrition counseling or ( b) exercise and nutrition counseling plus the MORE intervention. Trial feasibility was assessed via recruitment and retention metrics. Measures of therapeutic mechanisms included self-reported interoceptive awareness, maladaptive eating behaviors, and savoring, as well as natural reward responsiveness and food attentional bias, which were evaluated as psychophysiological mechanisms. RESULTS: Feasibility was demonstrated by 82% of participants who initiated MORE receiving a full dose of the intervention. Linear mixed models revealed that the addition of MORE led to significantly greater increases in indices of interoceptive awareness, savoring, and natural reward responsiveness, and, significantly greater decreases in external eating behaviors and food attentional bias-the latter of which was significantly associated with decreases in waist-to-hip ratio. Path analysis demonstrated that the effect of MORE on reducing food attentional bias was mediated by increased zygomatic electromyographic activation during attention to natural rewards. CONCLUSIONS AND IMPLICATIONS: MORE may target appetitive dysregulatory mechanisms implicated in obesity by promoting interoceptive awareness and restructuring reward responsiveness.

Running and osteoarthritis.

The overall health benefits of cardiovascular exercise, such as running, are well established. However, it is also well established that in certain circumstances running can lead to overload injuries of muscle, tendon, and bone. In contrast, it has not been established that running leads to degeneration of articular cartilage, which is the hallmark of osteoarthritis. This article reviews the available literature on the association between running and osteoarthritis, with a focus on clinical epidemiologic studies. The preponderance of clinical reports refutes an association between running and osteoarthritis.

Comparing eccentric resistance exercise in prostate cancer survivors on and off hormone therapy: a pilot study.

OBJECTIVES: To determine the feasibility of an eccentric resistance exercise training protocol in men with prostate cancer and to assess whether men with prostate cancer who are receiving androgen deprivation therapy (ADT) have a blunted effect from the training as compared with prostate cancer survivors not receiving ADT. DESIGN: Prospective pilot study. SETTING: Academic medical center. PARTICIPANTS: Sixteen men with prostate cancer (Gleason scores 3+3 to 4+4) were initially enrolled. Ten men (mean age 66, range 48-86) completed the study, 5 were currently receiving ADT. Analysis was performed on these 10 men. INTERVENTIONS: Subjects were evaluated at baseline. All men underwent a 12-week resistance exercise training protocol using a recumbent, high-force eccentric, leg cycle ergometer 3 times per week at a "somewhat hard" perceived exertion for 12 to 15 minutes. Preexercise and postexercise training changes were examined within and between groups. MAIN OUTCOME MEASURES: Quadriceps muscle volume (magnetic resonance imaging), isometric knee extension strength, functional mobility (Timed Up and Go Test [TUG] and 6-minute walk [6MW]), health-related quality of life (FACT-P), and fatigue (FACIT-fatigue scale). RESULTS: The ADT group demonstrated significant within-group improvements in the 6MW (P = .01) and isometric knee extension strength (P = .03). This group also demonstrated a clinically relevant change in the FACT-P; however, this did not meet statistical significance. The non-ADT group demonstrated significant within-group improvements in the physical subscale of the FACT-P (P = .03) and an increase in muscle volume (P = .04). Their improvements in the TUG approached significance (P = .08). No between-group differences existed. CONCLUSIONS: Eccentric resistance exercise was well tolerated, and both groups derived some benefits in strength and functional mobility. Men receiving ADT did not appear to have a blunted response to the exercise as compared with prostate cancer survivors not receiving ADT.

Common musculoskeletal problems in the performing artist.

In this chapter we touched on a wide variety of unique musculoskeletal conditions in the musician and dancer. We outlined generalized methods of evaluation that stress the importance of the interdisciplinary approach in this highly specialized patient population and stressed the importance of specific involvement of the music or dance instructor in evaluation and management. We sought to emphasize the need to refer to specialized care early when in doubt of diagnosis or when usual first-line treatments fail. We gave examples of specific injury patterns common in these subgroups and suggestions for early management. Finally, we described some general principals for prevention of musculoskeletal injury in this group. A physician treating the performing artist must always keep in mind that in this unique patient population, their occupation is not only a means of earning a living, it is their passion. Artists make great sacrifice both physically and mentally to bring the world such immeasurable beauty. It is our responsibility to care for them in the most comprehensive and compassionate manner possible while informing them as honestly as possible about their treatment options.

Clinical utility of the flick maneuver in diagnosing carpal tunnel syndrome.

OBJECTIVE: To determine the utility of the flick maneuver (flicking motion of hands and wrists when most symptomatic) in the clinical evaluation of carpal tunnel syndrome (CTS). DESIGN: Review of standardized data collection on 142 subjects referred for electrodiagnostic evaluation of possible CTS at a university hospital electrodiagnostic clinic. Subjects were first clinically evaluated with the flick, Phalen, and Tinel maneuvers. Subsequently, they all underwent nerve conduction studies. Electrodiagnostic results were used as the gold standard for patient group assignments. Sensitivities, specificities, and predictive values for individual and combined clinical tests were determined. McNemar chi square values were calculated to determine whether one test identified more patients with CTS. The sensitivities of clinical maneuvers were also evaluated in relation to electrodiagnostic severity of CTS. RESULTS: Of the 142 subjects, 67% had CTS. The sensitivities of the flick, Tinel, and Phalen signs were 37%, 27%, and 34%, respectively. False-positive results ranged from 8% (Tinel) to 26% (flick and Phalen). Positive predictive values for the flick, Tinel, and Phalen maneuvers were 74%, 87%, and 73%, respectively, and negative predictive values were 37%, 39%, and 35%. McNemar chi square results revealed that the flick maneuver detected more subjects with CTS than the Tinel sign. With increasing electrodiagnostic severity, the sensitivity of all clinical tests tended to improve slightly. CONCLUSION: The flick sign is of limited clinical utility in diagnosing CTS, with low sensitivity and specificity.