Introduction: With the increased usage of complementary approaches in oncology comes the need for its integration into healthcare professional (HCP) education. The purpose of this single-arm, mixed-methods study was to examine the feasibility and benefits of a brief complementary and alternative medicine (CAM) learning intervention for improving HCP knowledge, attitudes, and practices regarding CAM use in cancer care, and explore the experiences of participating HCPs. Methods: HCPs from the Tom Baker Cancer Centre in Alberta, Canada, were invited to participate in 3 online interactive learning modules that reviewed: (1) basic CAM information, (2) HCP-patient CAM communication, and (3) evidence-based CAM decision support. The study survey consisted of attitude (n = 14), knowledge (n = 31), and practice (n = 31) items, administered at baseline and two-months post-intervention. Semi-structured interviews were conducted with a subset of participants. Results: Approximately 300 HCPs were invited to participate, of which 105 expressed interest in the study (35%), and 83 of them consented to participate (79%). The intervention completion rate was 73% (61/83 HCPs). There was a significant pre-post change in HCPs’ attitudes and, to a lesser extent, knowledge and practices related to CAM (8/14 attitude items changed pre-post compared to 13/31 knowledge items and 5/31 practice items), in which more HCPs reported patients should be assisted in making complementary therapy (CT) decisions, exhibited greater knowledge about CAM, and more often engaged in a CAM-related clinical practice. Qualitative findings supported the beneficial effects of the modules, with HCPs describing themselves as being more likely to ask patients about their CAM use and referring them to credible CAM resources. Nonetheless, the majority did not feel adequately prepared to make recommendations about specific CTs, even after the intervention. Conclusion: The current study suggests that online CAM learning offers a feasible and potentially promising intervention for improving oncology HCP knowledge, attitudes, and practices regarding CAM, warranting further investigation. This study highlights a need for institutional resources to help HCPs fully integrate CT decision support into cancer patient care. A coordinated evidence-based CAM program at cancer centers may help ensure that all patients’ CAM-related needs are properly attended to.

PURPOSE:Gastrointestinal (GI) cancer patients often suffer high rates of distress and social isolation, partially due to symptoms that are embarrassing or difficult to discuss with family or friends. Group support therapies mitigate illness-related stigma and standardization; however, men, in particular, are more averse to joining. Through an ongoing men-only GI cancer support group, this study sought to understand who joined the groups, what facilitated group uptake, and explore men's reasons for enrolling in the group.METHODS:A mixed-methods study design and analysis were used. A qualitative design utilizing open-ended, semi-structured interviews and thematic analysis were used; Theory of Planned Behavior (TPB) directed the inquiry towards facets of group uptake. Standardized measures were also used to assess distress, coping, and quality of life (QoL) and compared with normative values for cancer and general population. Data from qualitative and quantitative findings were triangulated.RESULTS:Participants included 35 male GI cancer patients, aged 28-72, at varying stages of illness and treatment. Themes related to group uptake and enrollment were endorsement; composition; and attitudes, and reasons for joining were learning new coping techniques and affiliations with similar others. Men's QoL and psychological distress scores were on par with cancer patient norms. The scores obtained from quantitative scales corroborated with our qualitative findings.CONCLUSIONS:Despite psychosocial, demographic, and clinical variations, participants were keen on joining a male-only Supportive-Expressive Therapy (SET) group to address their emotional, informational, and supportive care needs and express their solidarity for other patients.IMPLICATIONS FOR CANCER SURVIVORS:Findings bear clinical relevance for designing GI male-centered group formats that endorse men's needs and facilitate their accessibility to group support interventions.

This three-arm feasibility controlled trial examined whether different exercise modalities provide reductions in depression symptoms to cancer survivors with elevated depression.

Background/purpose: Many people living with cancer experience depression. Research suggests that the therapeutic effect of exercise on depression is similar to pharmacotherapy or psychological intervention, yet cancer survivors are under-exercising compared to recommended doses. Self-efficacy may be a factor to explain exercise engagement. This cross-sectional study investigated whether exercise task self-efficacy (ETSE) was associated with exercise engagement, further examining differences between cancer survivors with and without elevated depressive symptoms. Methods: Ninety-seven cancer survivors (60.8 ±9.9 years) were mailed self-report questionnaires on ETSE, exercise engagement, and depressive symptoms. A Hospital Anxiety and Depression Scale D cutoff score (≥8) was used to assign participants to a symptomatic (n = 34) or non-symptomatic group (n = 63). An independent t-test was used to examine differences in ETSE between groups. Correlational analyses were used to examine relationships between exercise task self-efficacy and exercise engagement. Results: There was a significant difference in the degree of exercise task self-efficacy between cancer survivors with (M=35.74, SD= 31.47) and without (M=57.30, SD= 26.71) depressive symptoms, t(95) =_3.56, pu003c0.01, with a large effect size (d =0.74). A positive association was found between ETSE and exercise engagement, r(95)= 0.49, pu003c0.01, which was similar for both groups. Conclusions: Exercise task self-efficacy appears to influence exercise engagement independently of mood status, but people with higher levels of depression symptoms tend to have lower self-efficacy. Therefore, future research should examine interventions to enhance exercise task self-efficacy, thereby potentially increasing exercise engagement in cancer survivors. Research Implications: These findings demonstrated that cancer survivors with depressive symptoms have low ETSE and that ETSE can predict exercise engagement. This suggests a role for enhancing ETSE to influence exercise engagement in cancer survivors. Future research could investigate causality between ETSE and exercise engagement and interventions to enhance ETSE. The findings of the present study could assist with more definitive research which could aid clinicians interested in behavioral change with regard to exercise engagement and improvement of depressive symptomatology in cancer survivors. Practice Implications: The findings illustrate that exercise self-efficacy predicts exercise engagement, independently of mood. Therefore, clinicians working with depressed or non-depressed cancer survivors should initially target increasing exercise self-efficacy as opposed to reinforcing the positive health benefits of increased physical activity.

Background Malignant brain tumors are unpredictable and incurable, with 5-year survival rates less than 30%. The poor prognosis combined with intensive treatment necessitates the inclusion of complementary and supportive therapies that optimize quality of life and reduce treatment-related declines in health. Exercise therapy has been shown to be beneficial in other cancer populations, but no evidence is available for brain cancer survivors. Therefore, we report results from 2 preliminary cases. Methods Two female patients diagnosed with glioblastoma multiforme and oligodendroglioma participated in a structured and supervised 12-week exercise program. The program consisted of two 1-hour resistance and aerobic exercise sessions per week and additional self-managed aerobic sessions. Outcome measures of strength, cardiovascular fitness, and several psychological indicators (depression, anxiety, and quality of life) were recorded at baseline, after 6 weeks and at the conclusion of the intervention. Results Exercise was well tolerated; both participants completed all 24 sessions and the home-based component with no adverse effects. Objective outcome measures displayed positive responses relating to reduced morbidity. Similar positive responses were found for psychological outcomes. Scores on the Hospital Anxiety and Depression Scale showed clinically meaningful improvements in depression and total distress. Conclusion These findings provide initial evidence that, despite the difficulties associated with brain cancer treatment and survivorship, exercise may be safe and beneficial and should be considered in the overall management of patients with brain cancer.

Background. Complementary therapies (CTs) are increasingly utilized by cancer patients. Nonetheless, patients report insufficient support from health care practitioners (HCPs) and there is a general lack of patient-practitioner communication about CT use. Best care practices suggest that HCPs should address the needs of patients, including CT use. This study examined current practices of patients and HCPs as well as their interactions relating to CTs. Methods. A total of 481 cancer outpatients and 100 HCPs completed questionnaires. Patient questions addressed CT use and information needs; HCP questions addressed knowledge, opinions and beliefs about complementary and alternative medicine. Patient-practitioner communication around CT was also examined. Results. 47% of patients reported using CTs since diagnosis. Many commenced CT use to improve quality of life (65%) based on recommendations from family or friends. Patients acknowledged the need for trusted sources of information and would attend a hospital-based education program (72%). HCPs reported limited training about CTs but most (90%) expressed interested in receiving more training. The majority of HCPs (>80%) reported limited knowledge about the role of CTs in cancer care or evidence to support CT use. Questions about communication and interactions revealed that 80% of patients reported not having had an HCP speak to them about CTs. However, 63% of HCPs reported addressing CT use. Conclusion. Results demonstrate a need for improved CT education and training for patients and HCPs. increasing HCP knowledge and clinical skills will ensure patients’ information needs about CTs are acknowledged and attended to, thereby providing safer and comprehensive cancer care.

PURPOSE:To assess the reliability of a 5-min-stage graded exercise test (GXT) and determine the association between physiological attributes and performance over stochastic cycling trials of varying distance.METHODS:Twenty-eight well-trained male cyclists performed 2 GXTs and either a 30-km (n = 17) or a 100-km stochastic cycling time trial (n = 9). Stochastic cycling trials included periods of high-intensity efforts for durations of 250 m, 1 km, or 4 km depending on the test being performing.RESULTS:Maximal physiological attributes were found to be extremely reliable (maximal oxygen uptake [VO2max]: coefficient of variation [CV] 3.0%, intraclass correlation coefficient [ICC] .911; peak power output [PPO]: CV 3.0%, ICC .913), but a greater variability was found in ventilatory thresholds and economy. All physiological variables measured during the GXT, except economy at 200 W, were correlated with 30-km cycling performance. Power output during the 250-m and 1-km efforts of the 30-km trial were correlated with VO2max, PPO, and the power output at the second ventilatory threshold (r = .58-.82). PPO was the only physiological attributed measured during the GXT to be correlated with performance during the 100-km cycling trial (r = .64).CONCLUSIONS:Many physiological variables from a reliable GXT were associated with performance over shorter (30-km) but not longer (100-km) stochastic cycling trials.

Chaouachi, A, Brughelli, M, Chamari, K, Levin, GT, Ben Abdelkrim, N, Laurencelle, L, and Castagna, C. Lower limb maximal dynamic strength and agility determinants in elite basketball players. J Strength Cond Res 23(5): 1570-1577, 2009-The aims of this study were to examine the relationship between squat 1 repetition maximum (1RM) and basketball-relevant tests and the variables that influence agility (T-test) in elite male professional basketball players (n = 14, age 23.3 ± 2.7 years, height 195.6 ± 8.3 cm, body mass 94.2 ± 10.2 kg). T-test performance was significantly related to body mass (r = 0.58, p = 0.03) and to percentage of body fat (r = 0.80, p < 0.001). A significant negative correlation was observed between t-test and 5-jump test performance (r = -0.61, p = 0.02). Squat 1RM was significantly related to 5-, 10-, and 30-m sprint times. Stepwise correlation analysis showed percentage of body fat was the best single predictor factor (p < 0.05) of agility. Squat 1RM performance was the best single predictor of 5-m and 10-m sprint times (p < 0.05). In light of the present study's findings, agility should be regarded as a per se physiological ability for elite basketball players. Consequently, basketball-specific agility drills should be stressed in elite basketball training. Given the association between squat 1RM performance and short sprint times, squat exercises should be a major component of basketball conditioning.

Levin, GT, Mcguigan, MR, and Laursen, PB. Effect of concurrent resistance and endurance training on physiologic and performance parameters of well-trained endurance cyclists. J Strength Cond Res 23(8): 2280-2286, 2009-The purpose of this study was to investigate the effect of concurrent resistance and endurance cycle training on physiologic and performance parameters of cyclists. Before and after a 6-week training intervention period, 14 well-trained male cyclists completed a maximal graded exercise test, a 30-km dynamic cycling test with 3 intermittent 250-m and 1-km sprints, and a 1 repetition maximum (1RM) squat test for the assessment of lower-limb strength. Subjects were allocated into 2 groups: a resistance training group (RT; n = 7) that completed a 6-week undulating, periodized resistance training program (3/wk) in conjunction with their regular cycle training and a control group (CON; n = 7) that maintained their usual cycle training. Upon completion of the training intervention, there was no change in graded exercise test parameters in either group, but the RT group showed a significantly greater increase in 1RM squat strength compared with CON (p < 0.05). Moreover, the change in 30-km time trial and sprinting performance did not differ between RT and CON, except for the final 1-km sprint where the percent change in 1-km final sprint performance was greater in CON (+11%) compared with RT (−5%). In conclusion, although concurrent resistance and endurance training in well-trained cyclists enhanced 1RM strength, it did not improve overall cycle time trial performance and in fact was shown to reduce 1-km final cycle sprint performance compared with a CON group performing their normal cycle training.

Background Androgen deprivation therapy (ADT) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1) bone mineral density; 2) cardiorespiratory function and maximal oxygen capacity; 3) body composition (lean mass and fat mass); 4) blood pressure and cardiovascular function; 5) lipids and glycemic control; and 6) quality of life and psychological distress. Methods/Design Multi-site randomized controlled trial of 195 men (65 subjects per arm) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia. Participants will be randomized to (1) resistance/impact loading exercise, (2) resistance/cardiovascular exercise groups and (3) usual care/delayed exercise. Participants will then undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline, 6 and 12 months (end of the intervention). Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal, cardiovascular and insulin metabolism side effects of androgen deprivation in prostate cancer patients. As this project is much longer term than previous investigations in the area of exercise and cancer, we will gain knowledge as to the continuing effects of exercise in this patient population specifically targeting bone density, cardiovascular function, lean and fat mass, physical function and falls risk as primary study endpoints. In terms of advancement of prostate cancer care, we expect dissemination of the knowledge gained from this project to reduce fracture risk, improve physical and functional ability, quality of life and ultimately survival rate in this population. Clinical Trial Registry A Phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer; ACTRN12609000200280

The objective of this study was to provide anthropometric, physiological, and performance characteristics of an elite international handball team. Twenty-one elite handball players were tested and categorized according to their playing positions (goalkeepers, backs, pivots, and wings). Testing consisted of anthropometric and physiological measures of height, body mass, percentage body fat and endurance (VO(2max)), performance measures of speed (5, 10, and 30 m), strength (bench press and squat), unilateral and bilateral horizontal jumping ability, and a 5-jump horizontal test. Significant differences were found between player positions for some anthropometric characteristics (height and percentage body fat) but not for the physiological or performance characteristics. Strong correlations were noted between single leg horizontal jumping distances with 5-, 10-, and 30-m sprint times (r = 0.51-0.80; P < 0.01). The best predictors of sprint times were single leg horizontal jumping with the dominant leg and the distance measured for the 5-jump test, which when combined accounted for 72% of the common variance associated with sprint ability. In conclusion, performance abilities between positions in elite team-handball players appear to be very similar. Single leg horizontal jumping distance could be a specific standardized test for predicting sprinting ability in elite handball players.

The purpose of this study was to determine the accuracy of the Velotron cycle ergometer and the SRM power meter using a dynamic calibration rig over a range of exercise protocols commonly applied in laboratory settings. These trials included two sustained constant power trials (250 W and 414 W), two incremental power trials and three high-intensity interval power trials. To further compare the two systems, 15 subjects performed three dynamic 30 km performance time trials. The Velotron and SRM displayed accurate measurements of power during both constant power trials (<1% error). However, during high-intensity interval trials the Velotron and SRM were found to be less accurate (3.0%, CI = 1.6-4.5% and -2.6%, CI = -3.2- -2.0% error, respectively). During the dynamic 30 km time trials, power measured by the Velotron was 3.7 +/- 1.9% (CI = 2.9-4.8%) greater than that measured by the SRM. In conclusion, the accuracy of the Velotron cycle ergometer and the SRM power meter appears to be dependent on the type of test being performed. Furthermore, as each power monitoring system measures power at various positions (i.e. bottom bracket vs. rear wheel), caution should be taken when comparing power across the two systems, particularly when power is variable.

Chaouachi, A, Brughelli, M, Chamari, K, Levin, GT, Ben Abdelkrim, N, Laurencelle, L, and Castagna, C. Lower limb maximal dynamic strength and agility determinants in elite basketball players. J Strength Cond Res 23(5): 1570–1577, 2009—The aims of this study were to examine the relationship between squat 1 repetition maximum (1RM) and basketballrelevant tests and the variables that influence agility (T-test) in elite male professional basketball players (n = 14, age 23.3 6 2.7 years, height 195.6 6 8.3 cm, body mass 94.2 6 10.2 kg). T-test performance was significantly related to body mass (r = 0.58, p = 0.03) and to percentage of body fat (r = 0.80, p , 0.001). A significant negative correlation was observed between t-test and 5-jump test performance (r = –0.61, p = 0.02). Squat 1RM was significantly related to 5-, 10-, and 30-m sprint times. Stepwise correlation analysis showed percentage of body fat was the best single predictor factor (p , 0.05) of agility. Squat 1RM performance was the best single predictor of 5-m and 10-m sprint times (p , 0.05). In light of the present study’s findings, agility should be regarded as a per se physiological ability for elite basketball players. Consequently, basketball-specific agility drills should be stressed in elite basketball training. Given the association between squat 1RM performance and short sprint times, squat exercises should be a major component of basketball conditioning.

Background Androgen deprivation therapy leads to a number of adverse effects including deterioration of the musculoskeletal system and increased risk factors for cardiovascular and metabolic complications. The purpose of this study is to determine the effects, efficacy, retention and compliance of a physical exercise intervention in a large established cohort of prostate cancer patients from the Randomised Androgen Deprivation and Radiotherapy (RADAR) study. Specifically, we aim to compare short- and long-term effects of a prostate cancer-specific supervised exercise program to a standard public health physical activity strategy utilizing printed resources on cardiovascular and metabolic risk factors. Our primary outcomes are cardiorespiratory capacity, abdominal obesity, and lipid and glycemic control, while secondary outcomes include self-reported physical activity, quality of life and psychological distress. Methods/Design Multi-site randomized controlled trial of 370 men from the RADAR study cohort undergoing treatment or previously treated for prostate cancer involving androgen deprivation therapy in the cities of Perth and Newcastle (Australia), and Wellington (New Zealand). Participants will be randomized to (1) supervised resistance/aerobic exercise or (2) printed material comprising general physical activity recommendations. Participants will then undergo progressive training for 6 months. Measurements for primary and secondary endpoints will take place at baseline, 6 months (end of intervention), and at 6 months follow-up. Discussion This study uses a large existent cohort of patients and will generate valuable information as to the continuing effects of exercise specifically targeting cardiovascular function and disease risk, insulin metabolism, abdominal obesity, physical function, quality of life and psychological distress. We expect dissemination of the knowledge gained from this project to reduce risk factors for the development of co-morbid diseases commonly associated with androgen deprivation therapy such as cardiovascular disease, obesity, metabolic disease and diabetes, as well as improvements in physical and functional ability, and quality of life. Trial Registration ACTRN12609000729224