Attitudes of people diagnosed with cancer and cancer care providers towards use of nicotine vaping products in high-income countries: a scoping review.

PURPOSE: To investigate the attitudes, beliefs and perceptions of people diagnosed with cancer and health practitioners on use of nicotine vaping products. METHODS: Scopus and OVID Medline were searched for papers published between 2013 and 2023. Two authors independently selected the studies and extracted data, with conflicts resolved through discussion. Nine studies were selected for further synthesis. Reporting follows the PRISMA Scoping Reviews checklist. RESULTS: E-cigarettes were commonly perceived as less harmful compared to conventional cigarettes and less detrimental to cancer treatment effectiveness among people with a current or previous cancer diagnosis. This population also cited smoking cessation, smoking in non-smoking areas and less risky alternative as the most common reasons for e-cigarette use. Nevertheless, low levels of clinician support on the effectiveness of e-cigarettes as a smoking cessation tool/alternative were identified. CONCLUSION: Findings show differences in beliefs and attitudes of e-cigarettes between clinicians and people diagnosed with cancer. Additional research into the health impacts of e-cigarettes in people with a current or previous cancer diagnosis will allow for greater congruence between patients and clinicians and assist providers in recommending effective tools for smoking cessation within this population. IMPLICATIONS FOR CANCER SURVIVORS: This study provides an overview of the attitudes, beliefs and perceptions of e-cigarette use among people with a current or previous diagnosis of cancer and health practitioners. Given the increased prevalence of e-cigarette use within this population, these findings highlight a greater need for dialogue between patients and clinicians regarding the safety and efficacy of these devices.

Submaximal isometric fatiguing exercise of the elbow flexors has no age-related effect on GABAB-mediated inhibition.

Age-related changes in the neuromuscular system can result in differences in fatigability between young and older adults. Previous research has shown that single-joint isometric fatiguing exercise of small muscle results in an age-related compensatory decrease in γ-aminobutyric acid (GABAB)-mediated inhibition. However, this has yet to be established in a larger muscle group. In 15 young (22 ± 4 yr) and 15 older (65 ± 5 yr) adults, long interval cortical inhibition [LICI; 100 ms Interstimulus interval (ISI)] and corticospinal silent period (SP) were measured in the biceps brachii during a 5% electromyography (EMG) contraction using transcranial magnetic stimulation (TMS) before, during, and after a submaximal contraction [30% of maximum voluntary contraction (MVC) force] held intermittently to task failure. Both age groups developed similar magnitude of fatigue (∼24% decline in MVC; P = 0.001) and ∼28% decline in LICI (P = 0.001) post fatiguing exercise. No change in SP duration was observed during and immediately following fatigue (P = 0.909), but ∼6% decrease was seen at recovery in both age groups (P < 0.001). Contrary to previous work in a small muscle, these findings suggest no age-related differences in GABAB-mediated inhibition following single-joint isometric fatiguing exercise of the elbow flexors, indicating that GABAB modulation with aging may be muscle group dependent. Furthermore, variations in SP duration and LICI modulation during and post fatigue in both groups suggest that these measures are likely mediated by divergent mechanisms.NEW & NOTEWORTHY Transcranial magnetic stimulation was used to examine GABAB-mediated inhibition during fatiguing exercise of large muscle group in older adults and young adults. We provide novel evidence to show that when older and young adults are faced with a similar magnitude of elbow flexor muscle fatigue, they have a similar decline in GABAB-mediated inhibition. This suggests that when measured in a large muscle group, older adults maintain the ability to modulate GABAB inhibition during fatiguing exercise.

Single joint fatiguing exercise decreases long but not short-interval intracortical inhibition in older adults.

Ageing is accompanied by neuromuscular changes which may alter fatigue in older adults. These changes may include changes in corticospinal excitatory and inhibitory processes. Previous research has suggested that single joint fatiguing exercise decreases short-(SICI) and long-(LICI) interval intracortical inhibition in young adults. However, this is yet to be established in older adults. In 19 young (23 ± 4 years) and 18 older (69 ± 5 years) adults, SICI (2 ms interstimulus interval; ISI) and LICI (100 ms ISI) were measured in a resting first dorsal interosseous (FDI) muscle using transcranial magnetic stimulation (TMS) before and after a 15 min sustained submaximal contraction at 25% of their maximum EMG. Subsequent ten 2-min contractions held at 25% EMG were also performed to sustain fatigue for a total of 30 min, while SICI and LICI were taken immediately after each contraction. There was no change in SICI post-fatiguing exercise compared to baseline in both young and older adults (P = 0.4). Although there was no change in LICI post-fatiguing exercise in younger adults (P = 1.0), LICI was attenuated in older adults immediately post-fatiguing exercise and remained attenuated post-fatigue (PF)1 and PF2 (P < 0.05). Contrary to previous studies, the lack of change in SICI and LICI in young adults following a sustained submaximal EMG contraction suggests that GABA modulation may be dependent on the type of fatiguing task performed. The reduction in LICI in older adults post-fatiguing exercise suggests an age-related decrease in GABAB-mediated activity with sustained submaximal fatiguing exercise.

Older Adults Differentially Modulate Transcranial Magnetic Stimulation-Electroencephalography Measures of Cortical Inhibition during Maximal Single-joint Exercise.

The effects of muscle fatigue are known to be altered in older adults, and age-related changes in the brain are likely to be a contributing factor. However, the neural mechanisms underlying these changes are not known. The aim of the current study was to use transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) to investigate age-related changes in cortical excitability with muscle fatigue. In 23 young (mean age ±â€¯SD: 22 ±â€¯2 years) and 17 older (mean age ±â€¯SD: 68.3 ±â€¯5.6 years) adults, single-pulse TMS-EEG was applied before, during and after the performance of fatiguing, intermittent isometric abduction of the index finger. Motor-evoked potential (MEP) measures of cortical excitability were increased during (estimated mean difference, 123.3%; P < 0.0001) and after (estimated mean difference, 117.5%; P = 0.001) fatigue and this was not different between groups (P > 0.5). For TMS-EEG, the amplitude of the P30 and P180 potentials were unaffected by fatigue in older participants (P > 0.05). In contrast, the amplitude of the N45 potential in older adults was significantly reduced both during (positive cluster: mean voltage difference = 0.7 µV, P < 0.005; negative cluster: mean voltage difference = 0.9 µV, P < 0.0005) and after (mean voltage difference = 0.5 µV, P < 0.005) fatiguing exercise, whereas this response was absent in young participants. These results suggest that performance of maximal intermittent isometric exercise in old but not young adults is associated with modulation of cortical inhibition likely mediated by activation of gamma-aminobutyric acid type A receptors.

Intermittent single-joint fatiguing exercise reduces TMS-EEG measures of cortical inhibition.

Fatiguing intermittent single-joint exercise causes an increase in corticospinal excitability and a decrease in intracortical inhibition when measured with peripherally recorded motor evoked potentials (MEPs) after transcranial magnetic stimulation (TMS). Combined TMS and electroencephalography (TMS-EEG) allows for more direct recording of cortical responses through the TMS-evoked potential (TEP). The aim of this study was to investigate the changes in the excitatory and inhibitory components of the TEP during fatiguing single-joint exercise. Twenty-three young (22 ± 2 yr) healthy subjects performed intermittent 30-s maximum voluntary contractions of the right first dorsal interosseous muscle, followed by a 30-s relaxation period repeated for a total of 15 min. Six single-pulse TMSs and one peripheral nerve stimulation (PNS) to evoke maximal M wave (Mmax) were applied during each relaxation period. A total of 90 TMS pulses and 5 PNSs were applied before and after fatiguing exercise to record MEP and TEP. The amplitude of the MEP (normalized to Mmax) increased during fatiguing exercise ( P < 0.001). There were no changes in local and global P30, N45, and P180 of TEPs during the development of intermittent single-joint exercise-induced fatigue. Global analysis, however, revealed a decrease in N100 peak of the TEP during fatiguing exercise compared with before fatiguing exercise ( P = 0.02). The decrease in N100 suggests a fatigue-related decrease in global intracortical GABAB-mediated inhibition. The increase in corticospinal excitability typically observed during single-joint fatiguing exercise may be mediated by a global decrease in intracortical inhibition. NEW & NOTEWORTHY Fatiguing intermittent single-joint exercise causes an increase in corticospinal excitability and a decrease in intracortical inhibition when measured with transcranial magnetic stimulation (TMS)-evoked potentials from the muscle. The present study provides new and direct cortical evidence, using TMS-EEG to demonstrate that during single-joint fatiguing exercise there is a global decrease in intracortical GABAB-mediated inhibition.