Background/Objectives: Childhood cancer survivors face long-term cancer-related health risks, and daily behaviours, such as physical activity and recreational screen use, may influence their long-term overall wellbeing. Yet, little is known about survivors' knowledge and understanding of recommended guidelines or their patterns of structured and unstructured activity. This study aimed to (i) assess survivors' knowledge of physical activity and screen time guidelines, (ii) describe their self-reported (un)structured activity and screen use across weekdays and weekends, and (iii) examine associations with health-related quality of life. Methods: This secondary analysis used data from a feasibility pilot study of an intervention for survivors aged 8-13 years who had completed cancer treatment at least 12 months earlier. Participants self-reported physical activity, recreational screen use, knowledge of guidelines, and health-related quality of life (HRQoL). We used descriptive statistics and non-parametric tests to analyse behavioural patterns and associations. Results: Over one-third of survivors underestimated or overestimated the recommended physical activity and screen time (35%), whilst 23-50% reported 'don't know'. Participation in 'Physical Education' classes at school did not differ between summer and winter school terms, yet there was greater participation in structured physical activities in winter compared to summer school terms (median 270 vs. 170 min/week). For unstructured physical activities, 69% reported engaging in a median of 60 min/week at school on most days of the week in summer, whilst most survivors (96%) did not report any unstructured activity in winter. Only 19% met the recommended daily minimum of 60 min of physical activity year-round. Excessive screen use increased from school days (19%) to weekends (46%), notably handheld device screen time. We did not find any significant associations between meeting physical activity and screen time recommendations and HRQoL. Conclusions: Survivors frequently engage in irregular structured and unstructured physical activity levels and increased screen time. These findings emphasise the need for targeted, year-round interventions to improve physical activity, reduce recreational screen use, and support long-term survivorship health.

Background Poor physical fitness and fatigue are prevalent long-term issues for childhood cancer survivors. This study aimed to determine associations between childhood cancer survivors’ self-reported physical fitness domains and their perceptions of links between exercise and fatigue. Methods A cross-sectional survey assessed survivors' self-reported muscle strength, running speed and flexibility using The International Fitness Scale as well as survivors’ perceptions of exercise and fatigue. Non-parametric correlation tests were used. Results One hundred and seven childhood cancer survivors aged 8–18 years participated at a median of six years post-completion of treatment. Poor muscle strength, running speed and flexibility were self-reported by 11%, 18% and 36% of survivors, respectively. Fatigue was perceived as a barrier to exercise by 50% of survivors, while 44% of survivors perceived that exercising reduced fatigue. Poor self-reported muscle strength was significantly associated with perceiving fatigue as a barrier to exercise (rrb = −0.219) and with perceiving exercising to reduce fatigue (Tb = 0.192). Poor self-reported running speed was associated with perceiving fatigue as a barrier to exercise (rrb = −0.199) and with perceiving exercising to reduce fatigue (Tb = 0.228). Conclusions An assessment of self-reported physical fitness domains and perceptions of exercise and fatigue is needed among childhood cancer survivors to identify and support those who perceive poor physical fitness domains or believe that fatigue hinders their exercising. Implications for cancer survivors Interventions that improve confidence in a childhood cancer survivor’s own ability to exercise should be investigated to improve re-engagement with exercise.

OBJECTIVE:Elevated concentrations of circulating cell-free DNA and circulating tumor DNA (ctDNA) are often detectable in biofluid from individuals with cancer. Investigating cfDNA and ctDNA across the endometrial cancer continuum provides insight into diagnostic and prognostic potential. This systematic scoping review provides an overview of studies evaluating the utility of cell-free DNA ± circulating tumor DNA in endometrial cancer. METHODS:Databases and clinical trials registries (Embase, PubMed, CINAHL, Scopus, Open Science Framework, ClinicalTrials.gov) were searched using terms related to "Endometrial cancer", "Cell-free DNA", and "Circulating tumour DNA". Primary articles and pre-registered protocols of observational or interventional studies reporting cell-free DNA ±ctDNA measurement using biofluid from individuals with endometrial cancer of any stage, grade, or sub-type, at any time point were included. RESULTS:Ninety-three records were identified. Studies evaluated cell-free DNA ± circulating tumor DNA in endometrial cancer for 1) diagnosis; 2) monitoring disease status; 3) molecular profiling; 4) determining prognostic risk. Cell-free DNA ± circulating tumor DNA was primarily isolated from blood and analyzed using PCR-based assays or Next Generation Sequencing. Circulating tumor DNA showed promising diagnostic performance with greater potential in endometrial cancer prognosis, profiling, and monitoring, compared to cell-free DNA. Study design, sample characteristics, and data collection, analysis, and reporting were heterogeneous, limiting the strength of evidence for any given relationship. CONCLUSIONS:Cell-free DNA ± circulating tumor DNA has promising potential as a clinically valuable marker in endometrial cancer diagnosis, tumor profiling, treatment, and surveillance. However, evidence supporting the clinical use of any given cell-free DNA ± circulating tumor DNA parameter in this cohort is immature and limited by the lack of standardized methods and reporting. Addressing study design limitations, standardizing analysis methods and outcome reporting, and improving understanding of cell-free DNA physiology represent opportunities to advance this field of clinical research.

Patients with McArdle disease have reduced exercise capacity. Structured exercise programs in adults with McArdle disease can improve aerobic capacity and strength. However, structured exercise has not been evaluated in younger populations. Our aim was to determine the safety, feasibility, and acceptability of an exercise intervention in children and young adults with McArdle disease. Children and young adults aged 5–30 years with McArdle disease were recruited through metabolic clinics in New South Wales, Australia, to complete a remote, supervised 12-week exercise intervention. Pre and/or post intervention, participants completed a treadmill cardiopulmonary exercise test (CPET), strength testing, habitual physical activity monitoring, a quality-of-life questionnaire, acceptability questionnaire, muscular Near Infrared Spectroscopy (NIRS), and blood samples. Five out of 10 eligible participants, with a median age of 17 years (range 13–29), were enrolled. Four met the feasibility target of 70

Background/Objectives: Creatine monohydrate (CrM) is considered to be one of the most effective supplements for enhancing lean body mass during resistance training. However, CrM may influence body water content, potentially confounding lean body mass measurements. Therefore, this randomised controlled trial assessed the effect of CrM alone on lean body mass following a supplement wash-in, and when combined with a resistance training program. Methods: Sixty-three (34 females, 29 males, 31 ± 8 years) participants were randomised to supplement with CrM (5 g/day for 13 weeks: wash-in + 12-week resistance training) or serve as a control (received no creatine or placebo). Lean body mass was measured using dual X-ray absorptiometry at baseline, post 7-day wash-in, and post 12 weeks of resistance training. Both groups began the same training program post CrM wash-in. Results: After the 7-day wash-in, the supplement group gained 0.51 ± 1.79 kg more lean body mass than the control group (p = 0.03). Following the wash-in, both groups gained 2 kg after resistance training (p < 0.0001), with no between-group difference in lean body mass growth (p = 0.71). Sex-disaggregated analysis showed that the supplement group, only in females, gained 0.59 ± 1.61 kg more lean body mass than the controls (p = 0.04). There were no group differences in lean body mass growth following resistance training in females (p = 0.10) or males (p = 0.35). Conclusions: A 7-day CrM wash-in increased lean body mass, particularly in females. Thereafter, CrM did not enhance lean body mass growth when combined with resistance training, likely due to its short-term effects on lean body mass measurements. A maintenance dose of higher than 5 g/day may be necessary to augment lean body mass growth.

ABSTRACT:Desai, I, Wewege, MA, Jones, MD, Clifford, BK, Pandit, A, Kaakoush, NO, Simar, D, and Hagstrom, AD. The effect of creatine supplementation on resistance training-based changes to body composition: A systematic review and meta-analysis. J Strength Cond Res 38(10): 1813-1821, 2024-The purpose of this review was to determine the added effect of creatine supplementation on changes in body composition with resistance training in adults younger than 50 years. The review protocol was preregistered on the Open Science Framework (osf.io/x48a6/). Our primary outcome was lean body mass (LBM); secondary outcomes were body fat percentage (%) and body fat mass (kg). We performed a random-effects meta-analysis in R using the metafor package. Subgroup analyses were conducted to examine the effects of training status and use of a carbohydrate drink with creatine. We conducted a meta-regression to examine the moderating effect of total training volume. Statistical significance was set at p < 0.05. One thousand six hundred ninety-four records were screened, and 67 full-text articles were assessed for eligibility. Twelve studies were included in the meta-analysis. Fifty-two percentages of the studies had low risk, 41% some concerns, and 7% high risk of bias. Compared with resistance training (RT) alone, creatine supplementation increased LBM by 1.14 kg (95% CI 0.69 to 1.59), and reduced body fat percentage by -0.88% (95% CI -1.66 to -0.11) and body fat mass by -0.73 kg (95% CI -1.34 to -0.11). There were no differences between training status or carbohydrate subgroups. Training volume was not associated with effect size in all outcomes; 7 g or 0.3 g/kg of body mass of creatine per day is likely to increase LBM by 1 kg and reduce fat mass by 0.7 kg more than RT alone. Concurrent carbohydrate ingestion did not enhance the hypertrophy benefits of creatine.

Objectives Our evaluation of the pilot study- “Ballet after breast cancer”, demonstrated that a classical ballet program delivered online and/or face-to-face is feasible and acceptable, with promise for improving health and wellbeing following breast cancer. The present study aimed to explore participant experiences of the 16-week ballet intervention, and their perceptions of the future potential of ballet in the context of breast cancer. Design Qualitative analysis of focus group discussions. Methods Intervention participants were invited to take part in online focus groups to discuss: Perceived changes resulting from ballet participation, content of the ballet classes, delivery of the ballet program, suitability of ballet for future implementation during/after active cancer treatment. Themes were generated using an inductive approach, and feedback/recommendations for future implementation of “Ballet after breast cancer” were summarised. Results Seventeen women previously treated for breast cancer (54.4 ​± ​11.9 years; 54.2 ​± ​43.5 months post-diagnosis) took part in one of three focus groups. Themes generated through discussion included: Embracing normal; Connection to others; Acceptance without judgement; Engagement; Learning and progress. Participants described perceived improvements in physical, psychosocial, and cognitive wellbeing, and identified some limitations of online attendance compared to face-to-face. The personal attributes and experience of the ballet instructor were identifed as key determinants of program engagement and enjoyment. Participants reported a preference for classes specifically for people with lived experience of breast cancer. Recommendations to improve future ballet programs during/after breast cancer treatment included: Hybrid delivery model; Opportunities to socialise with classmates; Access to additional learning resources. Conclusions Participants offered novel and valuable insight into their experiences of the “Ballet after breast cancer” program, providing guidance for future delivery of ballet across the cancer continuum.

The negative impact of irradiation or diet on the metabolic and immune profiles of cancer survivors have been previously demonstrated. The gut microbiota plays a critical role in regulating these functions and is highly sensitive to cancer therapies. The aim of this study was to investigate the effect of irradiation and diet on the gut microbiota and metabolic or immune functions. We exposed C57Bl/6J mice to a single dose of 6 Gy radiation and after 5 weeks, fed them a chow or high-fat diet (HFD) for 12 weeks. We characterised their faecal microbiota, metabolic (whole body and adipose tissue) functions, and systemic (multiplex cytokine, chemokine assay, and immune cell profiling) and adipose tissue inflammatory profiles (immune cell profiling). At the end of the study, we observed a compounding effect of irradiation and diet on the metabolic and immune profiles of adipose tissue, with exposed mice fed a HFD displaying a greater inflammatory signature and impaired metabolism. Mice fed a HFD also showed altered microbiota, irrespective of irradiation status. An altered diet may exacerbate the detrimental effects of irradiation on both the metabolic and inflammatory profiles. This could have implications for the diagnosis and prevention of metabolic complications in cancer survivors exposed to radiation.

Systemic inflammation has been clearly linked to poorer health outcomes from cancer diagnosis through to survivorship. There is accumulating evidence that exercise can reduce inflammation. However, the optimal intensity of exercise to reduce systemic inflammation is unknown.

Physical activity levels among childhood cancer survivors are typically quantified as a total amount using time spent in various intensities. Yet, most analyses do not consider the transitory nature of children's behaviors and a more detailed approach could provide complimentary information. We aimed to explore various behavior profiles of survivors' daily and hourly physical activity patterns. We measured 8-18-year-old survivors' activity levels over 7 days using wrist accelerometry and cluster analysis. Of the 37 participant datasets, survivors engaged in mean (SD) 36.3 (19.0) min/day of MVPA and 4.1 (1.9) hrs/day of sedentary activity. The cluster analysis revealed five daily movement patterns: 'most active' (prevalence 11%), 'active' (22%), 'moderately active + moderately sedentary' (35%), 'moderately active + high sedentary' (5%) and 'least active' (27%). Younger survivors and those with less time since treatment completion were more likely to be in the active clusters. Hourly behaviors were characterized by short bursts of MVPA and moderate bouts of sedentary activity. Our approach provides an insightful analysis into the nature and timing of childhood cancer survivors' movement behaviours. Our findings may assist in the development of targeted interventions to improve physical activity levels.

Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment. The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM − groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire. Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = − 0.99; 95

Skeletal muscle is a dynamic organ requiring tight regulation of energy metabolism in order to provide bursts of energy for effective function. Several inborn errors of muscle energy metabolism (IEMEM) affect skeletal muscle function and therefore the ability to initiate and sustain physical activity. Exercise testing can be valuable in supporting diagnosis, however its use remains limited due to the inconsistency in data to inform its application in IEMEM populations. While exercise testing is often used in adults with IEMEM, its use in children is far more limited. Once a physiological limitation has been identified and the aetiology defined, habitual exercise can assist with improving functional capacity, with reports supporting favourable adaptations in adult patients with IEMEM. Despite the potential benefits of structured exercise programs, data in paediatric populations remain limited. This review will focus on the utilisation and limitations of exercise testing and prescription for both adults and children, in the management of McArdle Disease, long chain fatty acid oxidation disorders, and primary mitochondrial myopathies.

Cardiorespiratory fitness (CRF) is a strong, modifiable predictor of cardiovascular mortality in type 2 diabetes (T2D). Metformin is commonly prescribed for T2D management and is known to impair CRF adaptations to aerobic training, however its effect on CRF adaptations to high-intensity, high velocity resistance training (Power training; POWER) has never been studied.

Background Childhood cancer survivors are at increased risk of cardiometabolic complications that are exacerbated by poor health behaviors. Critically, many survivors do not meet physical activity guidelines. Objective The primary aim was to evaluate the feasibility and acceptability of iBounce, a digital health intervention for educating and engaging survivors in physical activity. Our secondary aims were to assess the change in survivors’ physical activity levels and behaviors, aerobic fitness, and health-related quality of life (HRQoL) after participating in the iBounce program. Methods We recruited survivors aged 8 to 13 years who were ≥12 months post cancer treatment completion. The app-based program involved 10 educational modules, goal setting, and home-based physical activities monitored using an activity tracker. We assessed objective physical activity levels and behaviors using cluster analysis, aerobic fitness, and HRQoL at baseline and after the intervention (week 12). Parents were trained to reassess aerobic fitness at home at follow-up (week 24). Results In total, 30 participants opted in, of whom 27 (90%) completed baseline assessments, and 23 (77%) commenced iBounce. Our opt-in rate was 59% (30/51), and most (19/23, 83%) of the survivors completed the intervention. More than half (13/23, 57%) of the survivors completed all 10 modules (median 10, IQR 4-10). We achieved a high retention rate (19/27, 70%) and activity tracker compliance (15/19, 79%), and there were no intervention-related adverse events. Survivors reported high satisfaction with iBounce (median enjoyment score 75%; ease-of-use score 86%), but lower satisfaction with the activity tracker (median enjoyment score 60%). Parents reported the program activities to be acceptable (median score 70%), and their overall satisfaction was 60%, potentially because of technological difficulties that resulted in the program becoming disjointed. We did not observe any significant changes in physical activity levels or HRQoL at week 12. Our subgroup analysis for changes in physical activity behaviors in participants (n=11) revealed five cluster groups: most active, active, moderately active, occasionally active, and least active. Of these 11 survivors, 3 (27%) moved to a more active cluster group, highlighting their engagement in more frequent and sustained bouts of moderate-to-vigorous physical activity; 6 (56%) stayed in the same cluster; and 2 (18%) moved to a less active cluster. The survivors’ mean aerobic fitness percentiles increased after completing iBounce (change +17, 95% CI 1.7-32.1; P=.03) but not at follow-up (P=.39). Conclusions We demonstrated iBounce to be feasible for delivery and acceptable among survivors, despite some technical difficulties. The distance-delivered format provides an opportunity to engage survivors in physical activity at home and may address barriers to care, particularly for regional or remote families. We will use these pilot findings to evaluate an updated version of iBounce. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621000259842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12621000259842

Parents are important facilitators of physical activity for children, yet little is known about the perceptions of parents of childhood cancer survivors. We investigated parent perceptions of their own and their child’s physical activity levels after cancer treatment and examined associations with clinical, demographic, and psychosocial factors. We conducted a cross-sectional survey among 125 parents and 125 survivors. Parents reported on the perceived importance of their child being physically active and concerns regarding exercising after cancer treatment. Parents and survivors self-reported median (range) of 127.5 (0–1260) and 220 (0–1470) min/week of moderate-to-vigorous physical activity. Most parents (n = 109, 98

Purpose The "Ballet after breast cancer" study sought to investigate the feasibility and acceptability of a 16-week classical ballet intervention for breast cancer survivors, delivered face-to-face and/or online. Methods Breast cancer survivors were recruited to take part in 2 x 1-h ballet classes per week for 16 weeks. Primary outcomes of feasibility and acceptability were assessed according to rates of enrolment and attendance and participant feedback via questionnaire. Secondary outcomes included quality of life (QOL), upper-body disability, shoulder range of motion (ROM), muscular strength, aerobic capacity, and physical activity levels. Associations between rate of attendance and changes in secondary measures were explored. Results Thirty-one participants (62% of eligible individuals) enrolled in the program. Twenty-nine women commenced the intervention [53.3 +/- 10.8 years (Mean +/- SD)], attending 77.6% [67.6, 87.5] (Mean [95% CI]) of sessions. Based on these rates of enrolment and attendance, and participant feedback, the program was deemed feasible and acceptable to participants. Significant improvements in shoulder ROM and reductions in sedentary behaviour were achieved. Participants also reported improvements in physical capacity and psychological, social, and cognitive wellbeing. Conclusions The "Ballet after breast cancer" program, delivered face-to-face and/ or online, was feasible and acceptable to breast cancer survivors. Improvements in shoulder ROM achieved doing ballet were pertinent given the adverse effects of upper-body morbidity on breast cancer survivor QOL. Improvements in physical activity behaviour and perceived benefits to wellbeing also support the use of ballet to mitigate QOL impairment after treatment. Implications for cancer survivors The physical demands and the fun, creative, and social characteristics of ballet promote improvement across multiple domains of health and wellbeing. Ballet shows promise as an activity to improve QOL and increase long-term engagement in health-promoting physical activity after breast cancer.

We sought to determine the effects of 12 months of power training on cognition, and whether improvements in body composition, muscle strength, and/or aerobic capacity (VO2peak) were associated with improvements in cognition in older adults with type 2 diabetes (T2D). Participants with T2D were randomized to power training or low-intensity sham exercise control condition, 3 days per week for 12 months. Cognitive outcomes included memory, attention/speed, executive function, and global cognition. Other relevant outcomes included VO2peak, strength, and whole body and regional body composition. One hundred and three adults with T2D (mean age 67.9 years; standard deviation [SD] 5.9; 50.5% women) were enrolled and analyzed. Unexpectedly, there was a nearly significant improvement in global cognition (p = .05) in the sham group relative to power training, although both groups improved over time (p < .01). There were significant interactions between group allocation and body composition or muscle strength in the models predicting cognitive changes. Therefore, after stratifying by group allocation, improvements in immediate memory were associated with increases in relative skeletal muscle mass (r = 0.38, p = .03), reductions in relative body fat (r = -0.40, p = .02), and increases in knee extension strength were directly related to changes in executive function (r = -0.41, p = .02) within the power training group. None of these relationships were present in the sham group (p > .05). Although power training did not significantly improve cognition compared to low-intensity exercise control, improvements in cognitive function in older adults were associated with hypothesized improvements in body composition and strength after power training.