Effects of early exercise training following severe burn injury: a randomized controlled trial.

Background: Despite being a stable component of burn rehabilitation at later stages of recovery, exercise training is not commonly provided during the acute phase of burns. A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care. The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life. Methods: Adults <65 years of age with burns ≥40% total burn surface area (TBSA) were randomly allocated to either receive early exercise (n = 29) in addition to standard care or standard care alone (n = 29). Early exercise involved resistance and aerobic training, which commenced as early as possible and lasted for a duration of 6 to 12 weeks, in line with burn center length of stay. Ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), lower limb muscle force, Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief (BSHS-B) were assessed 6 and 12 weeks after baseline. Mixed models were fitted to compare between-group changes over time. Results: A total of 58 adults [42 (95% confidence interval 40-45) years old; 40-94% TBSA range, 86% previously mechanically ventilated] participated in this study. Exercise commenced 7 days [IQR (interquartile range) 5-9] after burn center admission with an attendance rate of 93%. Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up (QMLT: ß-coefficient: 0.05 cm, p = 0.010; RF-CSA: ß-coefficient: 0.05 cm2, p = 0.045), and resulted in an improved recovery from 6 to 12 weeks (QMLT: ß-coefficient: 0.04 cm, p = 0.01; RF-CSA: ß-coefficient: 0.06 cm2, p < 0.001). Muscle force increased significantly more in the exercise group than in the control group (ß-coefficient: 3.102 N, p < 0.001) between 6 and 12 weeks. Besides a marginally significant effect for the BSHS-B domains 'affect' and 'interpersonal relationships' between 6 and 12 weeks, no benefits were observed in the other assessed quality-of-life measures. No serious adverse events were reported in the exercise group. Conclusions: The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.

Resting energy expenditure, body composition, and metabolic alterations in breast cancer survivors vs. healthy controls: a cross-sectional study.

PURPOSE: This study aimed to investigate the difference in absolute and fat free mass (FFM)-adjusted resting energy expenditure (mREE) and body composition (body weight, fat mass (FM), FFM) between breast cancer survivors (BCs) and controls. Correlations with body composition were analyzed. We examined if survival year, or being metabolically dysfunctional were predictive variables. METHODS: A cross-sectional analysis was conducted on 32 BCs ≤5 years post treatment and 36 healthy controls. Indirect calorimetry measured absolute mREE. Body composition was determined by BOD POD. FFM-adjusted mREE was calculated (mREE/FFM). The Harris-Benedict equation was used to predict REE and determine hyper-/hypometabolism (mREE/pREE). The database of the multidisciplinary breast clinic of the University Hospital of Antwerp was consulted for survival year and metabolic dysfunctions. RESULTS: BCs have similar absolute mREE and greater FFM-adjusted mREE compared to controls. Absolute mREE and body composition between BCs differed; adjusted mREE was similar. FFM correlated significantly with absolute mREE in BCs. A significant interaction term was found between survival year and FM for absolute mREE. CONCLUSION: BCs have similar absolute mREE, but higher FFM-adjusted mREE. Differences in body composition between BCs are suggested to cause inter-individual variations. We suggest that increased FFM-adjusted mREE is caused by metabolic stress related to cancer/treatment. Accurate measurement of REE and body composition is advised when adapting nutritional strategies, especially in patients at risk for developing metabolic dysfunctions.

Comparison of energy expenditure measurements by a new basic respiratory room vs. classical ventilated hood.

BACKGROUND: Nutritional support is often based on predicted resting energy expenditure (REE). In patients, predictions seem invalid. Indirect calorimetry is the gold standard for measuring EE. For assessments over longer periods (up to days), room calorimeters are used. Their design makes their use cumbersome, and warrants improvements to increase utility. Current study aims to compare data on momentary EE, obtained by a basic respiration room vs. classical ventilated hood. The objective is to compare results of the basic room and to determine its 1)reliability for measuring EE and 2)sensitivity for minute changes in activity. METHODS: Two protocols (P1; P2)(n = 62; 25 men/37 women) were applied. When measured by hood, participants in both protocols were in complete rest (supine position). When assessed by room, participants in P1 were instructed to stay half-seated while performing light desk work; in P2 participants were in complete rest mimicking hood conditions. The Omnical calorimeter operated both modalities. Following data were collected/calculated: Oxygen uptake ([Formula: see text] O2(ml/min)), carbon dioxide production ([Formula: see text] CO2ml/min), 24h_EE (kcal/min), and respiratory exchange ratio (RER). Statistical analyses were done between modalities and between protocols. The agreement between 24h_EE, [Formula: see text] O2 and [Formula: see text] CO2 obtained by both modalities was investigated by linear regression. Reliability analysis on 24h_EE determined ICC. RESULTS: No significant differences were found for 24h_EE and [Formula: see text] O2. [Formula: see text] CO2 significantly differed in P1 + P2, and P2 (hood > room). RER was significantly different (hood > room) for P1 + P2 and both protocols individually. Reliability of 24h_EE between modalities was high. Modality-specific results were not different between protocols. DISCUSSION/CONCLUSION: The room is valid for assessing momentary EE. Minute changes in activity lead to a non-significant increase in EE and significant increase in RER. The significant difference in [Formula: see text] CO2 for hood might be related to perceived comfort. More research is necessary on determinants of RER, type (intensity) of activity, and restlessness. The design of the room facilitates metabolic measurements in research, with promising results for future clinical use.

The effects of chemotherapy on resting energy expenditure, body composition, and cancer-related fatigue in women with breast cancer: a prospective cohort study.

BACKGROUND: Breast cancer (BC) is the most prevalent tumor in women. Improvements in treatment led to declined mortality, resulting in more survivors living with cancer- or therapy-induced comorbidities. In this study, we investigated the impact of neoplasia and chemotherapy on resting energy expenditure (REE) and body composition, in relation to cancer-related fatigue. Inflammatory parameters were checked as possible explanation for changes in REE. METHODS: Fifty-six women participated: 20 women with BC and 36 healthy controls. Patients were assessed at baseline (T0) and follow-up (T1) after 12 weeks of chemotherapy. Controls were measured once. REE was assessed with indirect calorimetry: body composition (body weight, fat mass, fat-free mass) by air plethysmography. The multidimensional fatigue index (MFI-20) was used to analyze fatigue. Baseline measurements of patients were compared to results of the healthy controls with the independent-samples T-test. The paired-samples T-test investigated the effects of chemotherapy from T0 to T1. A Pearson correlation analysis was conducted between REE, body composition, and fatigue and between REE, body composition, and inflammatory parameters. A linear regression analysis was fitted to estimate the contribution of the significantly correlated parameters. The measured REE at T0 and T1 was compared to the predicted REE to analyze the clinical use of the latter. RESULTS: At baseline, patients with BC had significantly higher REE in the absence of differences in body composition. From baseline to T1, REE and body weight did not change. In contrast, fat-free mass declined significantly with concordant increase in fat mass. Fatigue deteriorated significantly. C-reactive protein at baseline predicted the change in energy expenditure. Predicted REE significantly underestimated measured REE. CONCLUSIONS: Women with BC have higher REE in the tumor-bearing state compared to healthy controls. Chemotherapy does not affect REE but alters body composition. Predictive equations are invalid in the BC population. Results of our study can be used to implement personalized nutritional interventions to support energy expenditure and body composition and minimize long-term comorbidities.

Skeletal muscle wasting after burn is regulated by a decrease in anabolic signaling in the early flow phase.

Following burns a sustained catabolic stress response is activated, resulting in skeletal muscle wasting. A better understanding of the underlying mechanisms of postburn skeletal muscle wasting is essential for the development of preventive and/or therapeutic strategies. Six weeks old female rats underwent a sham, 10% or 40% total body surface area scald burn. Ten days post-injury, severely burned animals gained significantly less weight compared to sham treated and minor burned animals, reflected in a significantly lower ratio of muscle to total body weight for Soleus (SOL) and Extensor Digitorum Longus (EDL) in the severely burned group. Postburn, total fiber number was significantly lower in EDL, while in SOL the amount of type1 fibers significantly increased and type2 fibers significantly decreased. No signs of mitochondrial dysfunction (COX/SDH) or apoptosis (caspase-3) were found. In SOL and EDL, eEF2 and pAKT expression was significantly lower after severe burn. MURF1,2,3 and Atrogin-1 was significantly higher in SOL, whilst in EDL MURF1,2,3 was significantly lower postburn. In both muscles, FOXO3A was significantly lower postburn. This study identified postburn changes in muscle anthropomorphology and proteins involved in pathways regulating protein synthesis and breakdown, with more pronounced catabolic effects in SOL.

Effects of exercise training on muscle wasting, muscle strength and quality of life in adults with acute burn injury.

OBJECTIVES: Exercise training during the acute phase of burns is difficult to implement but offers potential benefits. This multicenter trial explored the effects of an exercise program on muscular changes and quality of life during burn center stay. METHODS: Fifty-seven adults with burns ranging between 10% and 70% TBSA were allocated to receive either standard of care (n = 29), or additionally exercise (n = 28), consisting of resistance and aerobic training, commenced as early as possible according to safety criteria. Muscle wasting (primary outcome), quantified by ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), muscle strength and quality of life (Burn Specific Health Scale-Brief (BSHS-B) and EQ-5D-5L) were assessed at baseline, four and eight weeks later, or hospital discharge. Mixed models were used to analyze between-group changes over time with covariates of interest added in stepwise forward modeling. RESULTS: The addition of exercise training to standard of care induced significant improvements in QMLT, RF-CSA, muscle strength and the BSHS-B subscale hand function (ß-coefficient. 0.055 cm/week of QMLT, p = 0.005). No added benefit was observed for other quality-of-life measures. CONCLUSIONS: Exercise training, administered during the acute phase of burns, reduced muscle wasting, and improved muscle strength throughout burn center stay.

Molecular mechanisms of post-burn muscle wasting and the therapeutic potential of physical exercise.

After a severe burn injury, a systemic stress response activates metabolic and inflammatory derangements that, among other, leads to muscle mass loss (muscle wasting). These negative effects on skeletal muscle continue for several months or years and are aggravated by short-term and long-term disuse. The dynamic balance between muscle protein synthesis and muscle protein breakdown (proteolysis) is regulated by complex signalling pathways that leads to an overall negative protein balance in skeletal muscle after a burn injury. Research concerning these molecular mechanisms is still scarce and inconclusive, understanding of which, if any, molecular mechanisms contribute to muscle wasting is of fundamental importance in designing of therapeutic interventions for burn patients as well. This review not only summarizes our present knowledge of the molecular mechanisms that underpin muscle protein balance but also summarizes the effects of exercise on muscle wasting post-burn as promising strategy to counteract the detrimental effects on skeletal muscle. Future research focusing on the pathways causing post-burn muscle wasting and the different effects of exercise on them is needed to confirm this hypothesis and to lay the foundation of therapeutic strategies.

Reliability and feasibility of skeletal muscle ultrasound in the acute burn setting.

OBJECTIVES: Despite the impact of muscle wasting after burn, tools to quantify muscle wasting are lacking. This multi-centre study examined the utility of ultrasound to measure muscle mass in acute burn patients comparing different methodologies. METHODS: B-mode ultrasound was used by two raters to determine feasibility and inter-rater reliability in twenty burned adults following admission. Quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA) were measured, comparing the use of i) a single versus average measurements, ii) a proximal versus distal location for QMLT, and iii) a maximum- versus no-compression technique for QMLT. RESULTS: Analysis of twenty burned adults (50 years [95%CI 42-57], 32%TBSA [95%CI 23-40]) yielded ICCs of> 0.97 for QMLT (for either location and compression technique) and> 0.95 for RF-CSA, using average measurements. Relative minimal detectable changes were smaller using no-compression than maximum-compression (6.5% vs. 15%). Using no-compression to measure QMLT was deemed feasible for both proximal and distal locations (94% and 96% of attempted measurements). In 9.5% of cases maximum-compression was not feasible. 95% of RF-CSA measurements were successfully completed. CONCLUSION: Ultrasound provides feasible and reliable values of quadriceps muscle architecture that can be adapted to clinical scenarios commonly encountered in acute burn settings.

Pressure Curves, Static and Dynamic Stiffness of Different Two-Component Compression Systems for the Treatment of Chronic Edema of the Lower Limbs.

Background: Compression is a cornerstone modality in edema treatment. Different types of bandages are available in clinical practice. Short-stretch bandages are commonly used; however, newer technologies such as the two-component compression system are available as well. This study assesses the pressure curves and static and dynamic stiffness (Static Stiffness Index [SSI] and Dynamic Stiffness Index [DSI]) of two different two-component compression systems, Coban and CoFlex, for edema treatment. Methods and Results: For this prospective cohort study, 12 healthy volunteers were recruited. The healthy volunteers wore both two-component compression systems for 48 hours. Pressure sensors (PicoPress®; Microlab, Italy) were placed at 10 and 25 cm above the internal malleolus and 10 pressure readings were used to obtain pressure curves. The SSI and DSI were assessed. Additionally, comfort (ICC compression questionnaire) and adverse events were assessed as well. Both two-component compression systems exert a sufficient amount of sub-bandage pressure, although CoFlex exerts systematically significantly lower pressure in comparison with Coban. This difference in sub-bandage pressure remains constant over 48 hours. Both two-component compression systems are sufficiently stiff (stiffness >15 mmHg) and remain stiff over time. Conclusions: Both two-component compression systems have pressure curves that are high enough to motivate their use in the treatment of chronic edema. Additionally, both systems were found to be comfortable and have clinically effective SSI and DSI values.

Status of adult inpatient burn rehabilitation in Europe: Are we neglecting metabolic outcomes?

BACKGROUND: Hypermetabolism, muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns. In the absence of concrete practice guidelines, however, it remains unclear how these metabolic targets are currently managed. This study aimed to describe the current practice of inpatient rehabilitation across Europe. METHODS: An electronic survey was distributed by the European Burn Association to burn centres throughout Europe, comprising generic and profession-specific questions directed at therapists, medical doctors and dieticians. Questions concerned exercise prescription, metabolic management and treatment priorities, motivation and knowledge of burn-induced metabolic sequelae. Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae. RESULTS: Fifty-nine clinicians with 12.3 ± 9 years of professional experience in burns, representing 18 out of 91 burn centres (response rate, 19.8%) across eight European countries responded. Resistance and aerobic exercises were only provided by 42% and 38% of therapists to intubated patients, 87% and 65% once out-of-bed mobility was possible and 97% and 83% once patients were able to leave their hospital room, respectively. The assessment of resting energy expenditure by indirect calorimetry, muscle wasting and insulin resistance was carried out by only 40.7%, 15.3% and 7.4% respondents, respectively, with large variability in employed frequency and methods. Not all clinicians changed their care in cases of hypermetabolism (59.3%), muscle wasting (70.4%) or insulin resistance (44.4%), and large variations in management strategies were reported. Significant interdisciplinary variation was present in treatment goal importance ratings, motivation and knowledge of burn-induced metabolic sequelae. The prevention of metabolic sequelae was regarded as the least important treatment goal, while the restoration of functional status was rated as the most important. Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal (odds ratio, 4.63; 95% CI, 1.50-14.25; p < 0.01). CONCLUSION: This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care, including, most notably, a potential neglect of metabolic outcomes. The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.

The effects of chemotherapy on energy metabolic aspects in cancer patients: A systematic review.

BACKGROUND & AIMS: Cancer survival rates have increased significantly creating more awareness for comorbidities affecting the Quality of Life. Chemotherapy may induce serious metabolic alterations. These complications can create an energy imbalance, worsening prognosis. The effect of chemotherapy on energy metabolism remains largely unknown. The purpose of this systematic review is to determine the impact of chemotherapy on energy metabolism, creating more insight in a patients' energy requirements. METHODS: We identified relevant studies up to May 2nd, 2019 using PubMed and Web of Science. Studies including all types of cancer and stages were selected. Only patients that underwent chemotherapy whether or not followed by surgery or radiotherapy were selected. Maximum follow-up was set at 6 months. Resting energy expenditure (REE), measured by indirect calorimetry (IC) or predicted by the Harris-Benedict equation (HBEq), was our primary outcome. Results regarding body composition were considered as secondary outcome parameter. RESULTS: 16 studies were selected, including 267 patients. Overall, a significant decrease in REE [-1.5% to -24.91%] 1-month post-chemotherapy was reported. Two studies on breast cancer conducted a 3 and 6-month follow-up and found an increase in REE of 4.01% and 5.72% (p < .05), revealing a U-shaped curve in the expression of REE. Changes are accompanied by (non)significant variations in body composition (Fatmass (FM) and Fatfree Mass (FFM)). HBEq tends to underestimate REE by 4.03%-27.1%. CONCLUSION: Alterations in REE, accompanied by changes in body composition, are found during and after chemotherapy in all cancer types and stages, revealing a U-shaped curve. Changes in FFM are suggested to induce variations in REE concomitant to catabolic effects of the disease and administered drug. HBEq tends to underestimate REE, stressing the need for adequate assessment to meet patients' energy requirements and support dietary needs.

Vibrotactile Feedback During Physical Exercise: Perception of Vibrotactile Cues in Cycling.

The aim of this study was to investigate the perception of vibrotactile signals during physical exercise by comparing differences in recognition between stationary and cycling positions. The impact of physical exercise on the ability to perceive vibrotactile cues is unknown, whereas the recognition in stationary position has been shown previously. Vibrating elements were positioned at 3 locations on the thighs and spine of 9 athletes to apply various vibrotactile cues. Subjects performed at 0, 50, 70 and 90% of their maximal cycling power output and denoted the interpretation of the vibration signals on a touchscreen. The results show a similarity in correct recognition between stationary position and physical exercise for the thighs and spine (p>0.1) and demonstrate a decrease in response time for 70 and 90% levels of physical exercise compared to 0 and 50% (p<0.001). Furthermore, vibrotactile signals at the spine are noticed more accurately and more rapidly compared to the thighs (p<0.01). These results suggest that vibrotactile feedback also has potential in applications during physical exercise. The potential use of vibrotactile feedback can be in cycling for, among other, correcting the aerodynamic position. Applications in other sports and health-related domains are feasible as well.

The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis.

BACKGROUND: In patients with frequent migraine, prophylactic treatments are used. Patients often request non-pharmacological alternatives. One treatment option can be aerobic exercise. The value of aerobic exercise as prophylactic treatment however needs to be determined. METHODS: A systematic review and meta-analysis was performed to investigate the result of aerobic exercise on the number of migraine days, duration and pain intensity in patients with migraine. After screening three online databases, PubMed, Cochrane library and Web of Science, using predefined in- and exclusion criteria, six studies were retained. Pooling of data was performed when possible. RESULTS: Significant reductions in the number of migraine days after aerobic exercise treatment were found with a mean reduction of 0.6 ± 0.3 migraine days/month. Other outcomes were too variable to pool due to heterogeneity of outcome measurements. Unpooled data revealed small to moderate reductions in attack duration (20-27%) and pain intensity (20-54%) after aerobic exercise intervention. Various exercise intensities are applied. CONCLUSION: There is moderate quality evidence that in patients with migraine aerobic exercise therapy can decrease the number of migraine days. No conclusion for pain intensity or duration of attacks can be drawn. Effect sizes are small due to a lack of uniformity. For future studies, we recommend standardized outcome measures and sufficiently intense training programs. TRIAL REGISTRATION: CRD42018091178 .

Test-retest variability of VO2max using total-capture indirect calorimetry reveals linear relationship of VO2 and Power.

This study aimed to analyze the intra-individual variation in VO2max of human subjects using total-capture and free-flow indirect calorimetry. Twenty-seven men (27 ± 5 year; VO2max 49-79 mL•kg-1 •min-1 ) performed two maximal exertion tests (CPETs) on a cycle ergometer, separated by a 7 ± 2 day interval. VO2 and VCO2 were assessed using an indirect calorimeter (Omnical) with total capture of exhalation in a free-flow airstream. Thirteen subjects performed a third maximal exertion test using a breath-by-breath calorimeter (Oxycon Pro). On-site validation was deemed a requirement. For the Omnical, the mean within-subject CV for VO2max was 1.2 ± 0.9% (0.0%-4.4%) and for ergometer workload P max 1.3 ± 1.3% (0%-4.6%). VO2max values with the Oxycon Pro were significantly lower in comparison with Omnical (P < 0.001; t test) with mean 3570 vs 4061 and difference SD 361 mL•min-1 . Validation results for the Omnical with methanol combustion were -0.05 ± 0.70% (mean ± SD; n = 31) at the 225 mL•min-1 VO2 level and -0.23 ± 0.80% (n = 31) at the 150 mL•min-1 VCO2 level. Results using gas infusion were 0.04 ± 0.75% (n = 34) and -0.99 ± 1.05% (n = 24) over the respective 500-6000 mL•min-1 VO2 and VCO2 ranges. Validation results for the Oxycon Pro in breath-by-breath mode were - 2.2 ± 1.6% (n = 12) for VO2 and 5.7 ± 3.3% (n = 12) for VCO2 over the 1000-4000 mL•min-1 range. On a Visual analog scale, participants reported improved breathing using the free-flow indirect calorimetry (score 7.6 ± 1.2 vs 5.1 ± 2.7, P = 0.008). We conclude that total capturing free-flow indirect calorimetry is suitable for measuring VO2 even with the highest range. VO2max was linear with the incline in P max over the full range.

Short and long-term impairments of cardiopulmonary fitness level in previous childhood cancer cases: a systematic review.

PURPOSE: To describe the impairments in physical fitness in individuals who were previously diagnosed and treated for childhood cancer. METHODS: Using the PRISMA-guidelines, a systematic search was performed in PubMed, Web of Science, and Embase using a combination of the following predefined keywords: "exercise capacity" OR "aerobic capacity" OR "fitness" OR "cardiorespiratory fitness" OR "cardiopulmonary fitness" OR "physical fitness" OR "exercise testing" OR "exercise tolerance" OR "exercise" OR "oxygen consumption" AND "leukemia" OR "childhood cancer" OR "childhood cancer survivors (CCS)". Studies that met our inclusion criteria were reviewed on methodological quality, while the Newcastle-Ottawa Scale was used for evidence synthesis. RESULTS: A total of 2644 articles were identified from the database search. After screening based on the eligibility (abstracts) and inclusion (full texts) criteria, 49 articles remained. Even though the risk-of-bias scores in the studies were generally low, yet the results from those with high-quality studies revealed that poor fitness levels were prevalent in individuals with acute lymphoblastic leukemia, brain tumor, and mixed cancer histories, compared to healthy controls. CONCLUSIONS: A global glance at CCS shows poor levels of fitness that is continuous and life-long even after active cancer treatment has ended. Nevertheless, the results presented in this review were based on a limited number of high-quality studies suggesting the need to for additional clinical trials in the topic area.

The effect of training interventions on physical performance, quality of life, and fatigue in patients receiving breast cancer treatment: a systematic review.

OBJECTIVES: The primary purpose of this systematic review is to structure the available evidence concerning physical exercise programs and their effects on (1) physical performance outcomes, (2) experienced fatigue, and (3) quality of life (QoL) in patients during the initial treatment for breast cancer. DATA SOURCES: A systematic literature search, based upon the PRISMA guideline, up to January 1, 2018, was performed using four databases (Web of Science, Cochrane Library for Clinical Trials, PubMed, and Medline). STUDY SELECTION: Inclusion criteria were as follows: (1) adults > 18 years; (2) patients with breast cancer undergoing initial treatment; (3) interventions with the aim to influence the patient's physical activity, QoL, or fatigue; (4) randomized controlled trials (RCTs) of all ages. The selected studies were scored for methodological quality, and data concerning physical performance, QoL, and fatigue were extracted. Twenty-eight RCTs were included. DATA EXTRACTION: Different treatment modalities during initial treatment were identified (radiation therapy, chemotherapy, and combination therapy), as well as different types of physical training interventions (cardiovascular endurance exercise, strengthening programs, or a combination of both). Therefore, the results were clustered with regard to the above-mentioned grouping; extracting every relevant outcome related to physical performance (6 MWT or VO2peak; grip/muscle strength), QoL (questionnaires), and fatigue (questionnaires). DATA SYNTHESIS: Different training programs (endurance, resistance, or a combination of both) were found. These programs were applied during different phases of initial treatment. Some programs were supervised while others were home based. Overall, most training interventions provided an improvement in physical performance and a decrease in perceived fatigue. QoL was the outcome variable least susceptible to improvement. CONCLUSION: Different types of exercise programs are available for rehabilitation purposes of breast cancer patients during adjuvant therapy. Overall resistance training or resistance training in combination with CV endurance training provides the best results, especially on physical performance and perceived fatigue.

Vibrotactile feedback as a tool to improve motor learning and sports performance: a systematic review.

BACKGROUND: Evidence concerning the use of vibrotactile feedback for acquiring and learning new motor skills is limited. Although various concepts and applications for tactile feedback have been proposed, little is known about the suitability of this feedback mechanism in sports training. AIM: The goal of this systematic review was to gather knowledge on the efficacy of the use of vibrotactile feedback in improving sports performance skills. DESIGN: Systematic review. METHODS: Comprehensively searched databases were: PubMed, Cochrane and Web of Science. Studies investigating the effects of using vibrotactile feedback in sports training in healthy subjects were included in this review. RESULTS: No consensus was found regarding the positive effectiveness on performance using vibrotactile feedback in a sports context. No evidence was found that the addition of tactile feedback is effective for acquiring new motor skills. None of the studies show a significant learning effect.