Aerobic means "with oxygen," and anaerobic means "without oxygen." Anaerobic exercise is the type where you get out of breath in just a few moments, like when you lift weights for improving strength, when you sprint, or when you climb a long flight of stairs.
The below training fitness standards are different from the Applicant Physical Abilities Test (APAT) fitness standards.
This hand-out has been designed to educate the reader on the United States Secret Service Physical Fitness standards and the proper protocols necessary to accomplish those standards. Recruits who will be attending training at the James J. Rowley Training Center (JJRTC) are expected to arrive in good physical condition, ready to begin a functional fitness program.
The fitness evaluation measures strength, endurance, and aerobic capacity in four core elements. The core elements are Push-ups, Sit-ups, Chin-ups, and the 1.5 mile run. The fitness evaluation will be administered at the beginning, during, and end of training. Secret Service weapon carrying employees are additionally required to participate in the USSS Physical Fitness Evaluation quarterly.
The following point system will be applied to the fitness category level achieved by the student in accordance with their age and gender. The point system will be applied to the four (4) core elements of the U.S. Secret Service Individual Fitness Profile Evaluation.
low back pain is very common in population occurring at least once a lifetime in nearly 60-80% of population.
This presentation was presented as a webinar in coordination with ypta and serving hands on 12-8-2021.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Aerobic means "with oxygen," and anaerobic means "without oxygen." Anaerobic exercise is the type where you get out of breath in just a few moments, like when you lift weights for improving strength, when you sprint, or when you climb a long flight of stairs.
The below training fitness standards are different from the Applicant Physical Abilities Test (APAT) fitness standards.
This hand-out has been designed to educate the reader on the United States Secret Service Physical Fitness standards and the proper protocols necessary to accomplish those standards. Recruits who will be attending training at the James J. Rowley Training Center (JJRTC) are expected to arrive in good physical condition, ready to begin a functional fitness program.
The fitness evaluation measures strength, endurance, and aerobic capacity in four core elements. The core elements are Push-ups, Sit-ups, Chin-ups, and the 1.5 mile run. The fitness evaluation will be administered at the beginning, during, and end of training. Secret Service weapon carrying employees are additionally required to participate in the USSS Physical Fitness Evaluation quarterly.
The following point system will be applied to the fitness category level achieved by the student in accordance with their age and gender. The point system will be applied to the four (4) core elements of the U.S. Secret Service Individual Fitness Profile Evaluation.
low back pain is very common in population occurring at least once a lifetime in nearly 60-80% of population.
This presentation was presented as a webinar in coordination with ypta and serving hands on 12-8-2021.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Benefits of Physical Activities (PA) in Cancer SurvivorsRajat Chauhan
On 4th March 2012, I had the privelege of talking at Asian Breast Cancer Conference. But I wasn't planning on going there and be a yes man.
I took the oncology fraternity to task. If they have known for a long time that exercise and physical activity reduces cancer risk by 25-50% and side effects in survivors from inactivity is as bad as disease itself, then why don't they talk and promote more about it. Only a quarter bring up exercise to their patients. I was looking to get a reaction, whether it be a shoe thrown at me or saying, wow... Let's work together on this... But the audience was very sedated... courtesy the pharmaceutical industry that sponsors conferences like these. There was no response. I finished my talk by saying "my role model is Lance Armstrong, a man who did amazing things in world of sports after he was diagnosed, treated and then survived cancer."
Enjoy the presentation.
Audio and slides for this presentation are available on YouTube: http://youtu.be/f0c2vMxQtUo
Nancy Lin, MD, a breast oncologist in the Susan F. Smith Center for Women's Cancers at Dana-Farber, shares new data and research studies linking a healthy lifestyle to better treatment outcomes.
Motivações para a prática de diferentes atividades físicas: um estudo preliminarRafael Hsu
Relatório do Trabalho de Conclusão de Curso (TCC) apresentado como requisito para aprovação na disciplina Seminários em Educação Física e Saúde II e para obtenção do título de Bacharel em Educação Física e Saúde (antigo Ciências da Atividade Física)
Exercise can offer benefits for cancer patients -- even those currently undergoing treatment. Learn some tips for getting an exercise program safely started.
Análise de Comportamento Do Consumidor: Academia Para Mulheres André Manenti
Trabalho acadêmico apresentado para a matéria de Comportamento do consumidor para o curso de MBA em Marketing da Fundação Getúlio Vargas de São Paulo sob orientação do professor Helder Haddad Carneiro da Silva.
Conteúdo desenvolvido pelos alunos: André Manenti das Neves Beatriz Pimenta, Carolina Nunes Costa Deborah Teixeira de Souza Ketery Filip da Silva e Tatiana Santos tento como avaliação a empresa Contours Academia para Mulheres.
Exercise and cancer: How staying active can positively impact your health and...Inspire
In an hour-long webinar, nationally recognized exercise specialist Carol Michaels, MBA, ACE, ACSM discussed how maintaining an exercise program during cancer treatment and recovery can help patients to minimize treatment side effects, increase energy levels, and reduce stress, along with many other benefits. Inspire produced the educational webinar in partnership with the Bladder Cancer Advocacy Network, US TOO International, and ThyCa: Thyroid Cancer Survivors' Association.
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
Effects of core stability training on older.pdfOdiSan4
Studies have demonstrated that elderly people with low back pain (LBP) may have poor postural
control compared to healthy older adults. Poor postural control is associated with poor balance performance and a
high risk of serious falls. A variety of training strategies are proposed for LBP therapy, particularly core stabilization
training. But this treatment for older people with LBP remains unclear.
Get moving! Physical Activity and Colon Cancer July 2018 #CRCWebinar Fight Colorectal Cancer
Do you know the benefits of exercise during colorectal cancer treatment and survivorship? In July’s webinar, Dr. Catherine Jankowski, exercise physiologist, breaks down all the reasons why exercise is a key element during the cancer experience. She shares tips on how to stay active and offers support for those just getting started with an exercise routine.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
A methods document explaining how the NOURISHING database is kept up-to-date with implemented government policies on promoting healthy diets and reducing obesity and non-communicable diseases.
Slides from Alan Jackson's presentation on Policy for Enabling Achievement of Height at Obesity, Physical Activity & Cancer: Life course influences and mechanisms
Slides from Alan Jackson's presentation on the Cancer and Nutrition NIHR infrastructure collaboration at Obesity, Physical Activity & Cancer: Life course influences and mechanisms
To support governments as they develop national food and nutrition plans and targets, we have produced a new policy brief in collaboration with NCD Alliance.
Senior Policy & Public Affairs Manager, Bryony Sinclair's presentation, Curbing global sugar consumption, at the The Sugar Reduction Summit: Sugar, Sweetness & Obesity, 7 December 2015, London, England.
Professor Alan Jackson’s presentation, The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and Cancer, at the African Organisation for Research & Training in Cancer (AORTIC) conference, 18-22 November 2015, Marrakech, Morocco.
Professor Martin Wiseman’s presentation, The Continuous Update Project: Introduction to the Project, at the African Organisation for Research & Training in Cancer (AORTIC) conference, 18-22 November 2015, Marrakech, Morocco.
Bryony Sinclair discussed a systems approach to policymaking for obesity prevention at American Public Health Association's Annual Meeting, 31 Oct - 4 Nov 2015, Chicago, USA.
Professor Michael Leitzmann presentation on The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and Cancer at FENS European Nutrition Conference, 20-23 October 2015 Berlin (Germany).
Professor Martin Wiseman presentation on The Continuous Update Project: Introduction to the Project at FENS European Nutrition Conference, 20-23 October 2015 Berlin (Germany).
Professor Martin Wiseman presentation on The Continuous Update Project: Novel approach to reviewing mechanistic evidence on diet, nutrition, physical activity and cancer at FENS European Nutrition Conference, 20-23 October 2015 Berlin (Germany).
Operationalising World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations Using an Index Score
ISBNPA 3-6 June 2015
Giota Mitrou PhD MSc
Head of Research Funding & Science External Relations
World Cancer Research Fund International
More from World Cancer Research Fund International (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Physical exercise interventions in cancer survivors: Effects and methodological issues - Dr Anne May
1. Physical exercise interventions in
cancer survivors
Effects and methodological issues
Anne May, PhD
September 2nd, 2016 Hot Topic Conference: Life Course Influences and Mechanisms: Obesity, Physical Activity & Cancer
3. History of exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
Advice to rest
and avoid
exercise
Late 1980s
First (small)
exercise study
(n=24)
1990s
Few studies,
clinical practice
unchanged
Beneficial effects on
fitness, body
composition, nausea
2000 onwards:
Increase in # of
studies and
attention in
clinical practice
2003: cancer
exercise recom-
mendations
(American
Cancer
Society)
4. Content exercise interventions:
- Divers and no consensus about optimal intervention
• Types of interventions:
• Supervised interventions (2-3/week):
• Aerobic exercise
(30-45 mins/session, moderate-to-high intensity)
• Resistance exercise
(about 10 exercises, 60-70% of 1RM)
• Combined aerobic and resistance exercise
• Home-based interventions:
• Walking
(e.g. 5 d/week for 20-30 mins, low-to-moderate intensity)
• Resistance exercises
(body weight or elastic bands)
History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
Combination
5. History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
Effects of exercise after cancer diagnosis
• Aim:
– During treatment: Prevention of side effects (e.g., fatigue, fitness)
– After treatment: Improvement of fitness, fatigue, QoL
– Mechanistic studies: e.g., effects on bloodmarkers (immune system, etc)
• Beneficial effects on disease and treatment related side effects
– Cardiorespiratory fitness and muscle strength
– Fatigue, sleep disturbances and depression
Quality of life
– Body composition
– Inflammation
– Chemotherapy completion rate
(Courneya et al. (2007); van Waart et al. (2015))
Review and meta-analyses: van Vulpen et al. (2015), Fong et al. BMJ (2012), Cramp and Byron-Daniel Cochrane Database Syst
Rev. (2012), Duijts et al. Psychooncology (2011), Speck et al. 2010
6. History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
• Although conclusion of meta-analyses are positive, future
research needed for:
– Patients with rarer type of cancer
e.g. ongoing PERFECT study (oesophageal cancer, abstract # 17)
– Patients with advanced disease
– Specific side effects (cognitive complaints (PAM study),
osteoporosis, side-effects from novel targeted therapies)
– Focus on cancer outcomes (progression and survival)
e.g. ongoing CHALLENGE RCT (colon cancer, Courneya et al. CEBP 2016)
– Focus on optimal frequency, intensity, type, timing of
exercise
7. History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
Predicting OptimaL cAncer RehabIitation and Supportive
care
• Internationally shared database for individual patient data (IPD)
meta-analyses
• Aim:
- evaluate the effect of exercise interventions on quality of life
- identify important demographic, clinical, personal, or
intervention-related moderators of the effect;
- build and validate clinical prediction models identifying the most
relevant predictors of intervention success.
Personalised programs
Buffart et al. Cancer Treat Rev 2014
9. History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
Characteristics
Intervention
(n= 2,514)
Control
(n=2,005)
Age, mean (SD) years 54.6 (11.5) 54.5 (11.2)
Women, n (%) 1961 (78.0) 1567 (78.2)
Cancer Type, n (%)
Breast 1757 (69.9) 1406 (70.1)
Male genitourinary 326 (13.0) 248 (12.4)
Haematological 199 (7.9) 195 (9.7)
Gastrointestinal 146 (5.8) 87 (4.3)
Gynaecological 44 (1.8) 33 (1.6)
Respiratory track 28 (1.1) 29 (1.4)
Other 14 (0.6) 7 (0.3)
Timing of intervention, n (%)
Pre-during-post treatment 80 (1.8)
During treatment 2122 (47.0)
Post-treatment 2314 (51.2)
10. History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
Effects on QoL using individual patient data
• Positive effects on QoL and physical functioning
• No demographic & clinical & intervention –related moderators
were found
PA is equally effective across subgroups
• Effect of supervised exercise intervention larger when
compared to unsupervised exercise (p for interaction < 0,05)
12. History exercise-
oncology
Exercise
interventions
Effects of exercise
POLARIS project
UMBRELLA FIT
PART 2: Methodological challenges in exercise
oncology research:
Blinding not possible:
• Difficult accrual
• Drop-out after randomization to control
• Contamination between study arms (mainly non-compliance in
the control group)
13. UMBRELLA Fit study
cohort randomized controlled trial (cmRCT) on effects
of exercise on quality of life of patients with breast
cancer
Anne May, Roxanne Gal, Evelyn Monninkhof, Petra Peeters, Carla van Gils, Lenny Verkooijen, Desirée van den Bongard, Marco van Vulpen
14. UMBRELLA Fit trial
cmRCT design
(Relton et al. BMJ 2010)
Prospective cohort
(UMBRELLA breast cancer cohort)
Random selection
Exercise
group (12 wks)
Control
group
Diagnosis 3-m 6-m 12-m 18-m 24-m 36-m etc.
(Radiotherapy)
Repeated measurements
Informed consent UMBRELLA cohort
1. Collection of clinical data and patient reported outcomes
Optional:
2. Randomization to future interventions
UMBRELLA Fit inclusion and follow-up
History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
15. cmRCT design
Possible benefits
Control group unaware of the trial
Less drop-out after randomisation
Less contamination (non-compliance)
Better reflection of the real world
(pragmatic)
Study within UMBRELLA cohort
Faster recruitment
Long-term effects
Less selective population
Possible disadvantages
Higher drop-out rate intervention group
Non-compliance (decline intervention)
Drop-out during intervention
Restricted to data from cohort
Definition of subpopulation
Outcome measurements
History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
16. Present state of research (Aug 2016)
* Physical activity = cycle to work and during leisure time (moderate/fast), walking during leisure time (fast) & sports (> MET 4.0)
Randomized (N = 106 of 166 )
Age: 58.0 ± 9.2 | PA*: 16.7 ± 36.6 min/wk
Intervention group (N = 53)
Age: 58.4 ± 8.7
“Yes”
(N = 30; 57%)
Age: 58.0 ± 9.3
“Maybe later”
(N = 6; 11%)
Age: 60.7 ± 7.7
“No”
(N = 17; 32%)
Age: 58.5 ± 8.3
Control group (N = 53)
Age: 57.6 ± 9.6
History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
17. Conclusion
• Overall exercise interventions are beneficial
• Research should focus on targeted interventions,
intervention characteristics, special side-effects,
specific types of cancer, mechanisms, cancer
prognosis
• If feasible, cmRCT design might facilitate exercise
research
History exercise-
oncology
Exercise
interventions
Effects of exercise POLARIS project UMBRELLA FIT
18. Acknowledgements
Roxanne Gal, Evelyn Monninkhof
Petra Peeters, Carla van Gils
Lenny Verkooijen, Desirée van den Bongard,
Marco van Vulpen
Danny Young-Afat, Sofie Gernaat,
Madelijn Gregorowitsch
Jonna van Vulpen, Peter Siersema,
Petra Peeters, Richard van Hillegersberg
Laurien Buffart and Polaris consortium
Patients / Participants
Department of Rehabilitation, Nursing Science &
Sport, UMC Utrecht
Department of Radiotherapy, UMC Utrecht
Department of Dietetics, UMC Utrecht
Cancer Center, UMC Utrecht
Miranda Velthuis, Petra Peeters, Elsken van der
Wall, Anouk Hiensch
Sophie Kurk, Jeroen Derksen, Miriam Koopman
Funding:
Physiotherapists
Students
TU/e
And all other people/parties who make this studies
possible.
PACT-study cmRCT design Present state research Acknowledgements
