Predicting clinical concussion measures at baseline based on motivation and academic profile.

OBJECTIVE: The purpose of this study was to predict baseline neurocognitive and postural control performance using a measure of motivation, high school grade point average (hsGPA), and Scholastic Aptitude Test (SAT) score. DESIGN: Cross-sectional. SETTING: Clinical research center. PARTICIPANTS: Eighty-eight National Collegiate Athletic Association Division I incoming student-athletes (freshman and transfers). INTERVENTIONS: Participants completed baseline clinical concussion measures, including a neurocognitive test battery (CNS Vital Signs), a balance assessment [Sensory Organization Test (SOT)], and motivation testing (Rey Dot Counting). Participants granted permission to access hsGPA and SAT total score. MAIN OUTCOME MEASURES: Standard scores for each CNS Vital Signs domain and SOT composite score. RESULTS: Baseline motivation, hsGPA, and SAT explained a small percentage of the variance of complex attention (11%), processing speed (12%), and composite SOT score (20%). CONCLUSIONS: Motivation, hsGPA, and total SAT score do not explain a significant amount of the variance in neurocognitive and postural control measures but may still be valuable to consider when interpreting neurocognitive and postural control measures.

Perceived exercise barriers and facilitators among ethnically diverse breast cancer survivors.

PURPOSE/OBJECTIVES: To determine whether women with breast cancer were meeting current physical activity recommendations and to describe perceptions of exercise self-efficacy, exercise benefits and barriers, and perceptions of environmental supports for physical activity by race or ethnicity. DESIGN: Cross-sectional survey. SETTING: Community wellness workshops held in various locations in central and eastern North Carolina. SAMPLE: 65 breast cancer survivors in treatment or post-treatment. Caucasian women comprised 46% of the sample followed by African Americans (34%) and Hispanics/Latinas (16%). METHODS: Descriptive statistics were used to determine the percentage of women meeting physical activity guidelines and for comparing exercise-related perceptions. Spearman's rho correlation coefficient tests were conducted to identify associations between physical activity and exercise-related perceptions. MAIN RESEARCH VARIABLES: Physical activity, perceived exercise self-efficacy, exercise barriers, and benefits. FINDINGS: Hispanic/Latina women were least likely to meet physical activity recommendations. Hispanic/Latina women were more likely than Caucasian and African American women to report lack of enjoyment from exercise, lack of knowledge on how to exercise, feeling self-conscious because of looks, and discouragement as exercise barriers. CONCLUSIONS: In a sociocultural context, exercise beliefs need to be considered in the development of culturally responsive exercise interventions that may enhance the health of breast cancer survivors. IMPLICATIONS FOR NURSING: Considering the increasing number of breast cancer survivors from diverse racial or ethnic backgrounds, a need exists for culturally competent nursing interventions aimed at increasing exercise. When educating breast cancer survivors, nurses should address sociocultural factors that may hinder or facilitate engagement in exercise. KNOWLEDGE TRANSLATION: Most women were not meeting physical activity recommendations, particularly Hispanic/Latina women. Perceptions of exercise-related beliefs differed, although not significantly, across racial and ethnic groups. More perceived exercise barriers existed for Hispanic/Latina women compared to Caucasian and African American women, which may indicate sociocultural differences.

Can counseling add value to an exercise intervention for improving quality of life in breast cancer survivors? A feasibility study.

BACKGROUND: Improved survivorship has led to increased recognition of the need to manage the side effects of cancer and its treatment. Exercise and psychological interventions benefit survivors; however, it is unknown if additional benefits can be gained by combining these two modalities. OBJECTIVE: Our purpose was to examine the feasibility of delivering an exercise and counseling intervention to 43 breast cancer survivors, to determine if counseling can add value to an exercise intervention for improving quality of life (QOL) in terms of physical and psychological function. METHODS: We compared exercise only (Ex), counseling only (C), exercise and counseling (ExC), and usual care (UsC) over an 8 week intervention. RESULTS: In all, 93% of participants completed the interventions, with no adverse effects documented. There were significant improvements in VO(2)max as well as upper body and lower body strength in the ExC and Ex groups compared to the C and UsC groups (P < .05). Significant improvements on the Beck Depression Inventory were observed in the ExC and Ex groups, compared with UsC (P < .04), with significant reduction in fatigue for the ExC group, compared with UsC, and no significant differences in QOL change between groups, although the ExC group had significant clinical improvement. LIMITATIONS: Limitations included small subject number and study of only breast cancer survivors. CONCLUSIONS: These preliminary results suggest that a combined exercise and psychological counseling program is both feasible and acceptable for breast cancer survivors and may improve QOL more than would a single-entity intervention.

Comparison of body composition assessment methods in breast cancer survivors.

PURPOSE/OBJECTIVES: To examine and compare the reliability of four body composition methods commonly used in assessing breast cancer survivors. DESIGN: Cross-sectional. SETTING: A rehabilitation facility at a university-based comprehensive cancer center in the southeastern United States. SAMPLE: 14 breast cancer survivors aged 40-71 years. METHODS: Body fat (BF) percentage was estimated via bioelectric impedance analysis (BIA), air displacement plethysmography (ADP), and skinfold thickness (SKF) using both three- and seven-site algorithms, where reliability of the methods was evaluated by conducting two tests for each method (test 1 and test 2), one immediately after the other. An analysis of variance was used to compare the results of BF percentage among the four methods. Intraclass correlation coefficient (ICC) was used to test the reliability of each method. MAIN RESEARCH VARIABLE: BF percentage. FINDINGS: Significant differences in BF percentage were observed between BIA and all other methods (three-site SKF, p<0.001; seven-site SKF, p<0.001; ADP, p=0.002). No significant differences (p>0.05) in BF percentage between three-site SKF, seven-site SKF, and ADP were observed. ICCs between test 1 and test 2 for each method were BIA=1, ADP=0.98, three-site SKF=0.99, and seven-site SKF=0.94. CONCLUSIONS: ADP and both SKF methods produce similar estimates of BF percentage in all participants, whereas BIA overestimated BF percentage relative to the other measures. Caution is recommended when using BIA as the body composition method for breast cancer survivors who have completed treatment but are still undergoing adjuvant hormonal therapy. IMPLICATIONS FOR NURSING: Measurements of body composition can be implemented very easily as part of usual care and should serve as an objective outcome measure for interventions designed to promote healthy behaviors among breast cancer survivors.

Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants.

INTRODUCTION: Deficits after breast cancer treatment have been examined by comparing the surgically affected upper extremity to the unaffected extremity. It is not possible to know precisely if anti-cancer treatment such as radiation and chemotherapy had any effect on the unaffected arm. The purpose of this study was to compare ROM, strength, and shoulder function between breast cancer survivors and healthy, matched controls. METHODS: Shoulder pain and function was assessed using the Disabilities of the Arm Shoulder Hand (DASH) and the Pennsylvania Shoulder Score (PSS). Active and passive range of motion (ROM) for shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, internal rotation (IR) at 90° of abduction were measured on the affected side using a digital inclinometer. Strength was measured using a hand held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, internal rotation, ER, scaption, and horizontal adduction. RESULTS: Significant differences were found between the two groups for the DASH (p < 0.001) and PSS (p < 0.001), active flexion (p < 0.001), 90° ER (p = 0.020), extension (p = 0.004) and passive flexion (p < 0.001) and 90° ER (p = 0.012). All 7 of the shoulder girdle strength measures were significantly different between groups for abduction and upward rotation (p = 0.006), depression and adduction (p = 0.001), flexion (p < 0.001), ER (p = 0.004), IR (p = 0.001), scaption (p < 0.001), and adduction (p < 0.001). DISCUSSION/CONCLUSIONS: These results provide preliminary evidence to suggest clinicians focus on these particular ROM, strength, and shoulder function measures when treating a breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Shoulder ROM, strength, and function are important to assess in BCS.

Exercise in patients with breast cancer and healthy controls: energy substrate oxidation and blood lactate responses.

The aim of this study was to compare select aspects of exercise energy metabolism in patients with breast cancer with that of healthy controls across a variety of exercise intensities. Posttreated patients with breast cancer were matched with healthy women based on age, physical fitness level, and menopausal status. Subjects participated in low-, moderate-, and high-intensity submaximal exercise sessions that corresponded with 40% of maximal oxygen consumption (Vo(2max)), 60% Vo(2max), and 70% Vo(2max). Oxygen consumption and respiratory exchange ratio were taken during submaximal exercise sessions to determine substrate oxidation rates for carbohydrate (CHO) and fat. Blood lactate and blood glucose were also measured before and after each of the submaximal exercise sessions as indices of CHO metabolism. Results indicate that the patients with breast cancer had a significantly (P≤.05) lower CHO oxidation rate and higher fat oxidation rate at all exercise intensities compared with healthy women. The patients with breast cancer had a significantly (P≤.05) lower blood lactate response to exercise across all intensities compared with the healthy women. Glucose responses tended (P<.08) to be more elevated in patients with cancer both before and after the exercise sessions. The findings indicate that posttreated patients with breast cancer have augmented fat metabolism and a reduced CHO-based energy metabolism during submaximal exercise. It is unclear whether these changes are the result of the patient's cancer or their treatment regimen for the cancer.

The effects of an exercise program in leukemia patients.

PURPOSE: To examine the feasibility of administering an in-hospital exercise program to acute leukemia patients undergoing chemotherapy. A secondary purpose explored the impact of exercise on selected physiological, psychological, and inflammatory markers. METHODS: Ten patients, aged 18 to 50 years, diagnosed with acute leukemia or newly relapsed were assessed for body weight, height, body composition (skinfolds), cardiorespiratory endurance (total minutes on bicycle ergometer at 60% heart rate reserve), dynamic muscular endurance (Rocky Mountain Cancer Rehabilitation Institute protocol), fatigue (Revised Piper Fatigue Scale), depression (Center for Epidemiologic Studies Depression scale, National Institute of Mental Health questionnaire), and quality of life (Functional Assessment of Cancer Therapy-General) at baseline (within 3 days of diagnosis) and at the end of induction phase of treatment. Blood draws were taken at baseline, midpoint, and at the end of induction for analyses of inflammatory markers (Linco Luminex assay). Combined aerobic and strength training exercises were administered 3 times per week, twice daily, for 30 minutes. Paired-samples t-tests were used for the analyses of physiological and psychological parameters. One-way repeated measures analysis of variance was used for the analyses of inflammatory markers. RESULTS: Significant improvements in cardiorespiratory endurance (P = .009, baseline 8.9 +/- 8.8 minutes, postexercise intervention 17 +/- 14.3 minutes) with significant reductions in total fatigue scores (P = .009, baseline 4.6 +/- 1.7, postexercise intervention 1.8 +/- 1.6) and depression scores (P = .023, baseline 19 +/- 11.5, postexercise intervention 12 +/- 8.2) were observed. Marginally significant decrease in interleukin-6 (IL-6; P = .059) with no significant changes in IL-10 (P = .223) or interferon-gamma (P = .882) were observed. CONCLUSION: Administration of exercise to acute leukemia patients undergoing treatment is feasible. The exercise protocol used increased cardiovascular endurance, reduced fatigue and depression scores, and maintained quality of life. Although no significant change in inflammation was observed, a trend demonstrating a reduction in IL-6 and an increase in IL-10 warrants further investigation.

Aerobic exercise intensity in breast cancer patients: a preliminary investigation.

PURPOSE: This study compared the heart rate (HR), rate of perceived exertion (RPE), and blood lactate (BL) responses to aerobic exercise between posttreated breast cancer patients and apparently healthy, age-matched controls. METHODS: Seven patients and 7 control subjects underwent a submaximal treadmill test for the estimation of Vo(2max). Exercise intensities of 40%, 60%, and 70% of Vo(2max) were calculated from the treadmill test and randomly examined between groups during three 9-minute exercise bouts on 3 different days. Independent samples t tests were used to examine the HR, RPE, and BL responses at each intensity between groups. RESULTS: No significant differences were observed between the control and patient groups for HR, RPE, and BL at 40% (101 +/- 9 vs 101 +/- 11 bpm, P = .979; 8 +/- 1 vs 9 +/- 3, P = .237; and 1.11 +/- 0.73 vs 1.26 +/- 0.64 mmol/L, P = .188, respectively) and 60% (127 +/- 17 vs 117 +/- 13 bpm, P = .523; 12 +/- 2 vs 11 +/- 3, P = .267, and 3.83 +/- 2.48 vs 2.23 +/- 1.65 mmol/L, P = .237, respectively) of Vo(2max) . At 70% of Vo(2max), no significant differences were found for HR (151 +/- 27 vs 135 +/- 13 bpm, P = .704) and RPE (14 +/- 1 vs 13 +/- 3, P = .181), but lower BL responses were observed in the patient group (7.70 +/- 1.62 vs 3.29 +/- 1.08 mmol/L, P < .0005). CONCLUSIONS: The results suggest similar HR, RPE, and BL responses between patients and control subjects at 40%, 60%, and 70% of Vo(2max) , except for BL at 70% of Vo(2max). The lower BL response in the patient group at 70% of Vo(2max) was somewhat unexpected. Further research is needed to confirm or refute the results of this study to allow for a clearer understanding of the physiological responses of breast cancer patients to aerobic exercise at moderate or higher intensities so that safer aerobic exercise prescriptions can be developed for this population.

Influence of adapted sport on quality of life: perceptions of athletes with cerebral palsy.

PURPOSE: This study sought to examine the effect of adaptive sports participation on athletic identity and influence on quality of life (QOL) for individuals with cerebral palsy (CP) participating in the CP World Games. METHOD: Surveys were conducted with 73 international athletes competing in the 2005 CP World Championships. The survey included descriptive questions about sport involvement and socio-demographics, the Athletic Identity Measurement Scale, and the Influence on Quality of Life Scale. RESULTS: A significant relationship was found between influence on QOL and athletic identity (r = 0.505; p < 0.001). There was a moderate negative correlation between influence of adaptive sport on QOL and severity of disability (r = -0.264, p < 0.05). The majority of the sample either agreed or strongly agreed that adaptive sport positively influenced their overall health (84.9%) quality of life (80.8%), quality of family life (53.4%), and quality of social life (56.1%). Athletic identity (beta = 0.54) was the strongest predictor of influence on QOL with severity of disability (beta = -0.29) also a significant contributor. These athletes also had significantly higher mean AIMS scores when compared to collegiate non-athletes, collegiate recreational athletes, and recreational athletes with disabilities. CONCLUSIONS: The results suggest that participation in adapted sport is related to QOL and athletic identity for individuals with CP. To foster these benefits advocates for persons with disabilities should work toward increasing opportunities to compete in sports.