ACTivity as medicine In Oncology for Head and Neck (ACTIOHN): Protocol for a feasibility study investigating a patient-centred approach to exercise for people with head and neck cancer.

BACKGROUND AND AIM: Attempts at personalisation of exercise programmes in head and neck cancer (HaNC) have been limited. The main aim of the present study is to investigate the feasibility and acceptability of introducing a remotely delivered, fully personalised, collaborative, and flexible approach to prescribing and delivering exercise programmes into the HaNC usual care pathway. METHODS: This is a single arm, feasibility study. Seventy patients diagnosed with HaNC will be recruited from two regional HaNC centres in the United Kingdom. Patients will undertake an 8-week exercise programme designed and delivered by cancer exercise specialists. The exercise programme will start any time between the time of diagnosis and up to 8 weeks after completing treatment, depending on patient preference. The content of the exercise programme will be primarily based on patient needs, preferences, and goals, but guided by current physical activity guidelines for people with cancer. The primary outcome measure is retention to the study. Secondary quantitative outcomes are uptake to the exercise programme, different measures of exercise adherence, pre- and post-intervention assessments of fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), quality of life (SF-36), physical activity levels (International Physical Activity Questionnaire-Short Form), and various components of physical fitness. The outcomes of the nested qualitative study are acceptability and feasibility of the intervention evaluated via interviews with patients, health care professionals, and the cancer exercise specialists. Intervention and participant fidelity will be determined using checklists and scrutiny of each patient's logbook and the cancer exercise specialists' meeting notes. Analysis of quantitative data will be via standard summary statistics. Qualitative data will be analysed using thematic analysis. EXPECTED RESULTS: This feasibility study will inform the design and conduct of a future randomised controlled trial. Success will be defined according to a traffic light system for identifying the appropriateness of progression to a randomised controlled trial. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number registry (ISRCTN82505455).

Safety and feasibility of cardiopulmonary exercise testing in head and neck cancer survivors.

PURPOSE: Assess safety and feasibility of the cardiopulmonary exercise test (CPET) for evaluating head and neck cancer (HaNC) survivors. Also compare their cardiorespiratory fitness to age and sex-matched norms and establish current physical activity levels. METHODS: Fifty HaNC survivors [29 male; mean (SD) age, 62 (8) years], who had completed treatment up to 1 year previously, were recruited. Participants performed a CPET on a cycle ergometer to symptom-limited tolerance. Participants completed a questionnaire to report contributory factors they perceived as influencing test termination. Physical activity levels were determined using a self-reported physical activity questionnaire. RESULTS: Three participants did not complete the CPET because (1) poor fitting mouthpiece and naso-oral mask due to facial disfiguration from surgery; (2) knee pain elicited by cycling; and (3) early CPET termination due to electrocardiogram artefacts. Participants reached a mean peak oxygen uptake that was 34% lower than predicted and the mean (SD) CPET duration of 7:52 (2:29) min:s was significantly lower than the target test duration of 10 min (p < 0.001). Leg muscle aches and/or breathing discomfort were major contributory factors influencing test termination for 78% of participants, compared to 13% for dry mouth/throat and/or drainage in the mouth/throat. No major adverse events occurred. Participants were categorised as 26% active, 8% moderately active, and 66% insufficiently active. CONCLUSION: These preliminary data suggest the CPET appears safe and feasible for most HaNC survivors when strict exclusion criteria are applied; however, low levels of cardiorespiratory fitness should be considered when calculating an appropriate ramp rate.

Using Behavior Change Interventions in Cardiac and Pulmonary Rehabilitation: Perspectives from Healthcare Professionals in the United Kingdom.

This study explores healthcare professionals' experiences of using behavior change interventions in clinical practice. Semi-structured qualitative interviews were conducted with 11 healthcare professionals working in a cardiac and pulmonary rehabilitation National Health Service Trust in the United Kingdom. Interviews were transcribed and analyzed using inductive thematic analysis. Four overarching themes representing healthcare practitioners' perceptions of using behavior change interventions were identified: (1) reliance on experiential learning, (2) knowledge transition, (3) existing professional development programs, and (4) barriers and facilitators for continued professional development. The results are discussed in relation to the implications they may have for behavior change training in clinical healthcare practice. Healthcare professionals require bespoke and formalized training to optimize their delivery of behavior change interventions in cardiac and pulmonary rehabilitation. Doing so will enhance intervention fidelity and implementation that can potentially ameliorate patient rehabilitation outcomes.

Multi-Stakeholder Retrospective Acceptability of a Peer Support Intervention for Exercise Referral.

Perceived social support opportunities are central to successful exercise referral scheme (ERS) client experiences. However, there remains a lack of guidance on how ERSs can embed social support opportunities within their provision. This study presents retrospective acceptability findings from a 12-week social-identity-informed peer support intervention to enhance perceived social support among clients of an English ERS. Five peer volunteers were recruited, trained, and deployed in supervised ERS sessions across two sites. Peers assisted exercise referral officers (EROs) by providing supplementary practical, informational, motivational, and emotional support to ERS clients. Individual semi-structured interviews were conducted with peers (n = 4), EROs (n = 2), and clients (n = 5) and analysed thematically. The analysis identified three primary themes. The first theme detailed how EROs utilised peer volunteers to supplement the ERS client experience. This theme delineated peer roles within the ERS context and identified salient individual peer characteristics that contributed to their success. The second theme described peer acceptability among the various stakeholders. Peers were valued for their ability to reduce burden on EROs and to enhance perceptions of comfort among ERS clients. The final theme presented participant feedback regarding how the intervention may be further refined and enhanced. Peers represented a cost-effective and acceptable means of providing auxiliary social support to ERS clients. Moving forward, the structured integration of peers can improve the accessibility of social support among ERS participants, thus facilitating better rates of ERS completion.

The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes.

Although there are few high-profile cases of adolescent athletes being caught doping, up to a third of young athletes may dope. In order to generate a more accurate understanding of why adolescent athletes dope, it is important to validate models that help to explain this behavior. The aims of this study were 3-fold: firstly, to test the Sport Drug Control Model for Adolescent Athletes (SDCM-AA); secondly, to generate athlete profiles that would help quantify the proportion of athletes who are at risk of doping; and thirdly, to create norm values for the Adolescent Sport Doping Inventory (ASDI), which would allow national doping organizations, sporting organizations, and clubs to benchmark the scores of their athletes for key psycho-social variables linked to doping. A total of 2208 adolescent athletes from the United Kingdom, Australia, Hong Kong, and the United States completed the ASDI. The data presented an appropriate fit to the SDCM-AA model, in which 54% of the variance in susceptibility to doping was explained in the model, and 44.8% of attitudes toward doping was accounted for. Four distinct clusters of athletes emerged: the Susceptibles (i.e., identified with the benefits of doping, were willing to cheat, and viewed little threat), the Chancers (i.e., identified with the benefits of doping, scored high on willingness to cheat, and were highly influenced by their reference group, but had an average score for threat, self-esteem, and legitimacy), the Pragmatists (i.e., did not engage with any aspects of doping, but were more susceptible than the fair players), and Fair Players (i.e., high levels of sportspersonship, unwilling to cheat, and viewed doping as a threat). The revised SDCM-AA appears a valid model that helps explain the factors associated with doping attitudes and doping susceptibility. Adolescent athletes can be classified into one of four clusters, in relation to doping. Their cluster group could influence the content of the anti-doping education they receive.

The development and validation of the Adolescent Sport Drug Inventory (ASDI) among athletes from four continents.

A significant barrier to understanding the psychosocial antecedents of doping use among adolescent athletes is the lack of valid measures. In order to address this issue, the first aim of this paper was to develop and validate the Adolescent Sport Drug Inventory (ASDI) among adolescent athletes from Asia, Europe, North America, and Oceania. The second aim was to assess the construct validity of the ASDI. As such, this paper is divided into two parts. Part 1 relates to the development of the ASDI and contains two studies: item development (Study 1) and factorial validity (Study 2). Part 2 contains information on how the psychosocial variables measured in the ASDI are associated with situational temptation, and honesty (Study 3), maturation (Study 4), stress and coping (Study 5), and coaching (Study 6). In devising the ASDI, 19 different models were examined, which culminated in a 9-factor, 43-item ASDI. Coping, mastery-approach goals, and cognitive-social maturity were associated with doping attitudes. Caring motivational climates, strong coach-athlete relationships, and positive coach behaviors were associated with athletes being less susceptible toward doping, which provides construct validity for the ASDI. The ASDI is a valid tool to assess the psychosocial factors associated with doping among adolescent athletes. This questionnaire can be used to identify athletes who are the most at risk of doping, assess how the psychosocial factors associated with doping change over time, and to monitor the impact of antidoping interventions for adolescent athletes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An intervention for pulmonary rehabilitators to develop a social identity for patients attending exercise rehabilitation: a feasibility and pilot randomised control trial protocol.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a degenerative condition that can impair health-related quality of life (HRQoL). A number of self-management interventions, employing a variety of behavioural change techniques (BCTs), have been adopted to improve HRQoL for COPD patients. However, a lack of attention has been given to group management interventions with an emphasis on incorporating BCTs into rehabilitators' practice. This study aims to pilot and feasibly explore a social identity group management intervention, delivered by COPD rehabilitation staff to patients attending exercise pulmonary rehabilitation. Doing so will help inform the plausibility of the intervention before conducting a full trial to evaluate its effectiveness to improve HRQoL. METHODS: This is a two-centre, randomised cross-over controlled trial. Two pulmonary rehabilitation centres based in the UK will be randomly allocated to two treatment arms (standard care and intervention). Outcome measurements relating to HRQoL and social identity will be completed pre- and post-exercise rehabilitation. Focus group interviews will be conducted at the end of exercise rehabilitation to capture participants' contextualised experiences of the intervention. COPD rehabilitators will undertake semi-structured interviews at the end of the trial to garner their holistic perspectives of intervention fidelity and implementation. DISCUSSION: This is the first study to adopt a social identity approach to develop a rehabilitator-led, group management intervention for COPD patients attending exercise pulmonary rehabilitation. The results of this study will provide evidence for the feasibility and sample size requirements to inform a larger study, which can ascertain the intervention's effectiveness for improving HRQoL for COPD patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT02288039. Date 31 October 2014.

Exercise program design considerations for head and neck cancer survivors.

The present study aimed to establish exercise preferences, barriers, and perceived benefits among head and neck cancer survivors, as well as their level of interest in participating in an exercise program. Patients treated for primary squamous cell carcinoma of the head and neck between 2010 and 2014 were identified from the hospital database and sent a postal questionnaire pack to establish exercise preferences, barriers, perceived benefits, current physical activity levels, and quality of life. A postal reminder was sent to non-responders 4 weeks later. The survey comprised 1021 eligible patients of which 437 (43%) responded [74% male, median (interquartile range) age, 66 (60-73) years]. Of the respondents, 30% said 'Yes' they would be interested in participating in an exercise program and 34% said 'Maybe'. The most common exercise preferences were a frequency of three times per week, moderate-intensity, and 15-29 min per bout. The most popular exercise types were walking (68%), flexibility exercises (35%), water activites/swimming (33%), cycling (31%), and weight machines (19%). Home (55%), outdoors (46%) and health club/gym (33%) were the most common preferred choices for where to regularly exercise. Percieved exercise benefits relating to improved physical attributes were commonly cited, whereas potential social and work-related benefits were less well-acknowledged. The most commonly cited exercise barriers were dry mouth or throat (40%), fatigue (37%), shortness of breath (30%), muscle weakness (28%) difficulty swallowing (25%), and shoulder weakness and pain (24%). The present findings inform the design of exercise programs for head and neck cancer survivors.

A call to action towards an evidence-based approach to using verbal encouragement during maximal exercise testing.

By definition, maximal exercise testing inherently requires participants to give a maximal effort. This is an important practical issue as submaximal efforts can produce invalid test results. Verbal encouragement is commonly used to motivate participants to maintain or increase effort investment during maximal exercise testing. Accordingly, studies have reported significant increases in time to exhaustion of between 8% and 18% during VO2max and multistage shuttle run tests, and a significant 30·5 m mean increase in 6-min walk test distance. Significant improvements during shorter tests, such as the Wingate and 2-min walk tests, have not been observed however. Although participants typically perceive verbal encouragement positively during maximal exercise testing, around one-third have neutral or negative perceptions. Despite the ubiquity and importance of verbal encouragement during maximal exercise testing, surprisingly little research has investigated the characteristics of effective encouragement with respect to its content, timing and frequency. The only randomized controlled trial to investigate one of these issues observed that verbal encouragement delivered every 20 s increased time to exhaustion during VO2 max testing, but not every 60 or 180 s. Of particular concern is that several exercise testing guidelines have incorporated specific guidelines for the use of verbal encouragement, but not provided any theoretical or empirical justification, presumably because of the limited research to inform practice. Recent empirical research does provide some important insight into participant preference for the content and timing of verbal encouragement during maximal exercise testing; however, much more research is clearly required to establish comprehensive evidence-based guidelines.

Reconceptualizing the Link Between Screen Time When Gaming with Physical Activity and Sedentary Behavior.

With public health concerns surrounding rates of sedentary behavior (SB), there is often speculation on the role of screen time (in which "computer gaming" is commonly encompassed) as a key contributor to this epidemic. We argue that these assertions are based upon a number of problematic assumptions. Particularly, the notion that screen time necessitates inactivity or SB can be refuted based on the empirical literature. In addition, digital gaming as one so-called problematic screen-time behavior consists of a failed assumption that all games proffer equivalent physical affordances. We argue that these assumptions should be revisited, in which a reconceptualization of screen-time activities (with specific reference to gaming) and its link with inactivity and/or SB should be a key agenda. Within this, we introduce a conceptual model of how this may be realized, with the intention that this may offer a practical guide for researchers, and indeed for health professionals in this field.

Twenty Years of Stereotype Threat Research: A Review of Psychological Mediators.

This systematic literature review appraises critically the mediating variables of stereotype threat. A bibliographic search was conducted across electronic databases between 1995 and 2015. The search identified 45 experiments from 38 articles and 17 unique proposed mediators that were categorized into affective/subjective (n = 6), cognitive (n = 7) and motivational mechanisms (n = 4). Empirical support was accrued for mediators such as anxiety, negative thinking, and mind-wandering, which are suggested to co-opt working memory resources under stereotype threat. Other research points to the assertion that stereotype threatened individuals may be motivated to disconfirm negative stereotypes, which can have a paradoxical effect of hampering performance. However, stereotype threat appears to affect diverse social groups in different ways, with no one mediator providing unequivocal empirical support. Underpinned by the multi-threat framework, the discussion postulates that different forms of stereotype threat may be mediated by distinct mechanisms.

The ups and downs of coping and sport achievement: an episodic process analysis of within-person associations.

This study examined the relationship between coping and sport achievement at the within-person level of analysis. Fifty-four golfers completed diary measures of coping, stress, and sport achievement after six consecutive rounds of golf. Results of hierarchical linear modeling revealed golfers' episodic task-oriented coping and disengagement-oriented coping were associated, respectively, with their better and worst levels of subjective and objective achievement. Distraction-oriented coping was not significantly associated with achievement. These results were obtained after accounting for between-subjects differences in ability level and for within-person variations in perceived stress across both practice and competitive golf rounds. These results contribute to an emerging literature on the relationship between coping and sport achievement, and highlight the promises of an episodic process model of sport achievement to understand the transient self-regulatory factors associated with within-person variations in athletic achievement.

Stressors, coping, and coping effectiveness: gender, type of sport, and skill differences.

The aim of this study was to examine stressors, coping, and coping effectiveness as a function of gender, type of sport, and skill. The sample consisted of 749 undergraduate athletes (455 males, 294 females) aged 18-38 years (mean= 19.8 years). Skill was classified as international/national, county, university, and club standard. Participants completed a stressor and coping concept map (Novak & Gowin, 1984). The results revealed gender, type of sport, and skill differences in relation to stressor frequencies, coping strategy deployment, and coping effectiveness. In contrast to previous research, females used a variety of problem-focused (e.g. planning, communication, technique-orientated coping) strategies more frequently than males. Team sport athletes reported a variety of sport-specific stressors relating to the demands of playing in a team environment. The group of national/international athletes reported using more planning, blocking, and visualization, and also reported that their coping was more effective than that of less-skilled athletes.

Adherence to sport injury rehabilitation programmes: a conceptual review.

It is widely acknowledged that the importance of sound theoretical guidance is essential to any academic discipline. A common recommendation within the adherence literature related to sport injury rehabilitation has been the need to establish clear theoretical frameworks to guide research and practice. As such, an increasing amount of literature has employed conceptual models that include protection motivation theory, health action process approach, cognitive appraisal models, and attribution theory. Therefore, the purpose of this review is to critically evaluate these contemporary theoretical approaches that have been utilised within the sport injury rehabilitation adherence literature. Alongside this, practical implications emerging from this research base are outlined and future recommendations are suggested that may be of benefit to sports medicine practitioners and researchers alike.