A scoping review examining the integration of exercise services in clinical oncology settings.

BACKGROUND: Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations. METHODS: Four thousand eight hundred sixty-three unique records identified in Embase, CINAHL, MEDLINE, Web of Science Core Collection, and ProQuest (Health and Medicine) were screened for studies that recruited cancer patients, assessed the co-location of exercise service and cancer treatment units, and reported findings on service implementation. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis. RESULTS: Service implementation was relatively modest across the included studies. Exercise services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events. CONCLUSION: Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise-based rehabilitation for individuals on cancer treatment. While this model appears feasible for patients/clinicians, efforts are required to optimize service integration both in the short and long term. Key priorities include seeking [local] actions to address issues relating to funding and organizational buy-in. Important considerations may include developing an implementation plan to guide the implementation process, expanding the patient core management team to include staff from the exercise rehabilitation unit, and exploring the role of patient feedback in increasing clinician participation (e.g., treating oncologists and nurses) in the referral process. Future research should consider effective strategies to promote patients' sense of self-efficacy and behavioral control and, further, the place of audit and feedback in improving exercise service delivery and overall service implementation.

Differential Effects of Continuous and Interval Exercise Training on the Atherogenic Index of Plasma in the Non-Obese Young Male.

BACKGROUND: The process of atherogenicity is known to be influenced by exercise. However, appropriate exercise stimulus necessary to generate the response and adaptation in sedentary non-obese individuals has not yet been investigated. The purpose of the present study was to compare the effects of an 8-week continuous training and corresponding interval training on the atherogenic index of plasma in sedentary Nigerian males. METHODS: Overall, there were 54 male university students that participated in our study, which used a pretest- posttest control group design. Participants (18 males per group) were assigned into continuous, interval and control groups respectively. During the first two weeks, training was done 3 times weekly for 30 minutes each day, and was increased by 5 minutes every 2 weeks. Continuous training was done at 70-84% of heart rate reserve. Interval training was done at 70-84%/30-39% heart rate reserve in 1:2 minutes work/rest intervals, respectively. The control group did not participate in the training. Data collected were analysed using descriptive, paired t-test, analysis of covariance and Bonferroni post-hoc analysis. RESULTS: Young sedentary non-obese males were at high risk (atherogenic index of plasma > 0.24) of cardiovascular diseases/conditions. However, continuous training led to significant reductions (p = 0.002) in the atherogenic index of plasma. In contrast, non-significant increase (p = 0.084) followed interval training. After controlling for baseline values, only continuous training still had significant effects on atherogenic index of plasma when compared with other groups. CONCLUSIONS: Continuous training of vigorous intensity is better than a corresponding interval training protocol as a natural anti-atherogenic method of reducing risk of cardiovascular event in sedentary non-obese males. KEY WORDS: Atherogenicity; Cholesterol; Exercise; Training; Vigorous.

Anthropometric measures of adiposity as correlates of atherogenic index of plasma in non-obese sedentary Nigerian males.

BACKGROUND: The increase in cardiovascular events has necessitated the identification of possible predictors that can help in predicting atherogenicity. OBJECTIVE: The study sought to identify the anthropometric measures of adiposity that are associated with atherogenic risk in sedentary, non-obese, young male adults. METHODS: A cross-sectional design was used to recruit a purposive sample of 414 sedentary males in a university campus. Anthropometric measures of adiposity, lipid parameters, and atherogenic index of plasma (AIP) were assessed. Pearson correlation and stepwise multiple regression were used to analyze the data collected. Alpha level was set at p<0.05. RESULTS: There was a high risk of cardiovascular events (AIP=0.36±0.04 SD) among the participants. A significant correlation (p=0.000) was obtained between each of the anthropometric measures (except conicity index) and AIP. Body mass index, body adiposity index, and percent body fat were significant predictors accounting for 38.9, 3.1, and 2.2% of the variance due to AIP. CONCLUSIONS: Sedentary status among young males is associated with high atherogenic risk in the presence of normal lipid and anthropometric parameters. Both central and general measures of adiposity predict less than half of the atherogenic risk in sedentary young males.

Co-morbidities and socio-demographic distribution of stroke survivors referred for physiotherapy in a Nigerian Teaching Hospital: a retrospective study.

AIMS AND OBJECTIVES: The study investigated some co-morbidities, and age, gender and occupational distribution of stroke survivors seen in the Physiotherapy clinic of University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria; A 3-year retrospective study (January, 2008 to December, 2010). PATIENTS AND METHODS: A total of 236 case notes of stroke survivors referred to the Physiotherapy clinic within the period of study were obtained and reviewed. RESULTS: Majority (50.8%) of the stroke survivors were hypertensive, type 2 diabetes mellitus accounted for 14.8%, HIV 11.4%, chronic renal and heart diseases constituted 8.1% and 3.8% respectively. Those with hperlipidaemia and obesity comprised 3.0% each, and not specified encompassed 5.1%. One hundred and forty-one (59.7%) of the cases seen were males and 95 (40.3%) were females. The average age of the male and female patients were 56.0 ± 15.8 and 49.8 ± 18.8 years respectively. Housewives (31.8%) constituted the highest occupational groups while students (5.9%) were the least. CONCLUSION: The most common co-morbidities found among the stroke survivors were hypertension (50.8%), diabetes mellitus (14.8%) and HIV (11.4%). Majority of the stroke survivors were at their peak age when they are most economically relevant and productive (below 60 years). This suggests that the disability resulting from stroke will have a great negative impact on quality of life and socio-economic lives of these patients as well as a burden on the society. To alleviate this impact and lessen the societal burden of the disease, the public should be well educated and informed on the importance of seeking prompt and appropriate health care services.