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Mikkelsen MK, Lange A, Mochref L, Madsen K, Vinther A, Lund C, Nielsen D, Jarden M. Why do older patients with advanced cancer decline participation in an exercise-based trial during oncological treatment? - A mixed methods study. Physiother Theory Pract 2025; 41:1274-1286. [PMID: 39279452 DOI: 10.1080/09593985.2024.2397567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Exercise is recommended during anti-cancer treatments. However, there is lack of knowledge about existing barriers to participation in exercise-based trials, especially among understudied groups such as older patients and those with advanced cancer. OBJECTIVE To explore reasons for refusal of participation in an exercise-based study among older patients with advanced cancer and identify factors associated with higher likelihood of declining. METHODS A mixed methods design was applied, using qualitative data from interviews and quantitative data from medical records. We investigated potential differences in characteristics between patients who accepted and declined. Qualitative data underwent thematic analysis, and findings were synthesized to generate meta-inferences. RESULTS Among 34 invited patients, 20 (59%) agreed to participate in the interviews, and 261 of 269 (97%) patients were included in quantitative analyses. Meta-inferences identified factors related to refusing exercise participation, including older age, perceptions of being sufficiently active, physical limitations, and awareness of having a poor prognosis. CONCLUSION Refusal of participation was particularly related to advanced cancer, physical limitations, and older age. To address these barriers, it is recommended to adopt a holistic and supportive approach and improve the flexibility of recruitment strategies.
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Affiliation(s)
- Marta Kramer Mikkelsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Andrea Lange
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Latifa Mochref
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Kasper Madsen
- Department of Oncology, Clinical Research Unit, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Hospital Secretariat and Communications, Research, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Cecilia Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mary Jarden
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Dunston ER, Oza S, Bai Y, Newton M, Podlog L, Larson K, Walker D, Zingg RW, Hansen PA, Coletta AM. Preliminary Effectiveness of a Telehealth-Delivered Exercise Program in Older Adults Living With and Beyond Cancer: Retrospective Study. JMIR Cancer 2025; 11:e56718. [PMID: 39814703 PMCID: PMC11745508 DOI: 10.2196/56718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 10/31/2024] [Accepted: 10/31/2024] [Indexed: 01/18/2025] Open
Abstract
Background Exercise can attenuate the deleterious combined effects of cancer treatment and aging among older adults with cancer, yet exercise participation is low. Telehealth exercise may improve exercise engagement by decreasing time and transportation barriers; however, the utility of telehealth exercise among older adults with cancer is not well established. Objective We aimed to evaluate the preliminary effectiveness of a one-on-one, supervised telehealth exercise program on physical function, muscular endurance, balance, and flexibility among older adults with cancer. Methods In this retrospective study, we analyzed electronic health record data collected from the Personal Optimism With Exercise Recovery clinical exercise program delivered via telehealth among older adults with cancer (≥65 y) who completed a virtual initial program telehealth assessment between March 2020 and December 2021. The virtual initial assessment included the following measures: 30-second chair stand test, 30-second maximum push-up test, 2-minute standing march, single leg stance, plank, chair sit and reach, shoulder range of motion, and the clock test. All baseline measures were repeated after 12-weeks of telehealth exercise. Change scores were calculated for all assessments and compared to minimal clinically important difference (MCID) values for assessments with published MCIDs. Paired samples t tests (2-tailed) were conducted to determine change in assessment outcomes. Results Older adults with cancer who chose to participate in the telehealth exercise program (N=68) were 71.8 (SD 5.3) years of age on average (range 65-92 y). The 3 most common cancer types in this sample were breast (n=13), prostate (n=13), and multiple myeloma (n=8). All cancer stages were represented in this sample with stage II (n=16, 23.5%) and III (n=18, 26.5%) being the most common. A follow-up telehealth assessment was completed by 29.4% (n=20) of older adults with cancer. Among those who completed a follow-up telehealth assessment, there were significant increases in the 30-second chair stand (n=19; mean change +2.00 repetitions, 95% CI 0.12 to 3.88) and 30-second maximum push-up scores (n=20; mean change +2.85 repetitions, 95% CI 1.60 to 4.11). There were no significant differences for the 2-minute standing march, plank, single leg stance, sit and reach, shoulder mobility, or clock test (P>.05). Nine (47.3%) older adults with cancer had a change in 30-second chair stand scores greater than the MCID of 2 repetitions. Conclusions Our findings suggest a one-on-one, supervised telehealth exercise program may positively influence measures of physical function, muscular endurance, balance, and flexibility among older adults with cancer, but more adequately powered trials are needed to confirm these findings.
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Affiliation(s)
- Emily R Dunston
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Sonal Oza
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Yang Bai
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Maria Newton
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Leslie Podlog
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, QC, Canada
- CHU Sainte-Justine Research Center, Montréal, QC, Canada
| | - Kish Larson
- Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Darren Walker
- Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Rebecca W Zingg
- Huntsman Cancer Institute, Salt Lake City, UT, United States
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Pamela A Hansen
- Huntsman Cancer Institute, Salt Lake City, UT, United States
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Adriana M Coletta
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Research South Building Rm 4747, Salt Lake City, UT, 84112, United States, 1 801-213-6012
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Hardikar S, Dunston ER, Winn M, Winterton C, Rana A, LoCastro M, Curtis M, Mulibea P, Maslana KE, Kershner K, Hurtado-Orozco J, Simon LH, McFarland MM, Casucci T, Ehlers D, Dolgoy N, Williams G, Loh KP, Coletta AM. A scoping review of diet and exercise interventions for older cancer survivors' physical function. J Geriatr Oncol 2024; 15:102050. [PMID: 39214732 PMCID: PMC11816682 DOI: 10.1016/j.jgo.2024.102050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 07/12/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Lifestyle (diet and exercise) interventions across the cancer care continuum among younger cancer survivors (<60 years of age) demonstrate utility in improving physical function, and other cancer relevant health outcomes. However, the impact of lifestyle interventions on physical function in older (≥60 years) cancer survivors is not entirely clear. This scoping review aims to map and characterize the existing literature on the effect of diet and exercise interventions on physical function in older cancer survivors. Conducted to the JBI Manual for Evidence Synthesis and reported to the PRISMA guidelines, the literature search was performed on multiple databases through March 2024. A total of 19,901 articles were identified for screening with 49 articles published between 2006 and 2024 selected for full-text review. Of these, 36 studies included an exercise intervention, two focused on diet intervention, while 11 studies included both diet and exercise intervention. These 49 studies included various cancer types, cancer stages, and timepoints across the cancer care continuum. Most studies described physical function as their primary outcome and demonstrated maintenance or improvement in physical function. We identified several gaps in the current evidence including lack of (adequately powered) trials focused only on older cancer survivors, and trials focused on dietary interventions alone or dietary interventions combined with exercise interventions within this population vulnerable for nutritional inadequacies and declining physical function. Considering the growing population of older cancer survivors, this represents an important area for further research.
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Affiliation(s)
- Sheetal Hardikar
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States of America; Cancer Control and Population Sciences Program, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Emily R Dunston
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States of America
| | - Maci Winn
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States of America
| | - Candace Winterton
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States of America
| | - Anish Rana
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY, United States of America
| | - Marissa LoCastro
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY, United States of America
| | - Maren Curtis
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States of America
| | - Pendeza Mulibea
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Kelsey E Maslana
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States of America
| | - Kyle Kershner
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, United States of America
| | - Jaime Hurtado-Orozco
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States of America
| | - Lea Haverbeck Simon
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Mary M McFarland
- Spencer S. Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, United States of America
| | - Tallie Casucci
- J. Willard Marriott Library, University of Utah, Salt Lake City, UT, United States of America
| | - Diane Ehlers
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, United States of America
| | - Naomi Dolgoy
- Department of Occupational Therapy, University of Alberta, Alberta, Canada
| | - Grant Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY, United States of America
| | - Adriana M Coletta
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America; Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States of America.
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Agirre-Elordui S, Fernández-Landa J, Olasagasti-Ibargoien J, Castañeda-Babarro A. Physical activity maintenance in colorectal cancer survivors after an exercise intervention applying behaviour change techniques: a systematic review and meta-analysis. J Cancer Surviv 2024:10.1007/s11764-024-01654-8. [PMID: 39098882 DOI: 10.1007/s11764-024-01654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis is to determine the long-term effect of combined physical activity (PA) and behaviour change techniques (BCT) interventions in PA maintenance of colorectal cancer survivors (CRCS) and identify the most frequent BCT implemented in them. METHODS PRISMA recommendations were followed. Databases were searched for randomized controlled trials up to October 2023. Studies in which CRCS completed a PA intervention based on any Theoretical Model of Behaviour Change (TMBC) and a subsequent follow-up period were included. Between-group differences at baseline and after follow-up were pooled for meta-analysis. BCT codification was performed using the BCT taxonomy v1. Methodological quality and evidence certainty were also assessed. RESULTS Five studies involving 906 CRCS met the inclusion criteria. PA interventions applying BCT showed a significant change with a small positive effect (pooled SMD = 0.22 (0.09, 0.35)) on the PA after a follow-up period between 3 and 12 months. Twenty-two different BCTs were identified (mean 17.2, range 15-19) of which 12 were common across all interventions. CONCLUSIONS PA and BCT interventions have been found to be effective in improving the long-term maintenance of PA in CRCS. Further studies with higher methodological quality are needed to confirm these findings. IMPLICATIONS FOR CANCER SURVIVORS Aerobic exercise, pedometers, PA diaries and educational materials seem to be important aspects to achieve sustainable adherence to an active lifestyle over time. Supervision, access to fitness areas and applying some BCT appear to be differentiating features to obtain more successful PA maintenance.
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Affiliation(s)
- Saioa Agirre-Elordui
- Department of Physical Activity and Sports, Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| | - Julen Fernández-Landa
- Department of Physical Activity and Sports, Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| | - Jurgi Olasagasti-Ibargoien
- Department of Physical Activity and Sports, Faculty of Education and Sport, University of Deusto, Donostia, Spain
| | - Arkaitz Castañeda-Babarro
- Department of Physical Activity and Sports, Faculty of Education and Sport, University of Deusto, Bilbao, Spain.
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Sattar S, Haase KR, Lee K, Campbell KL. Exercise interventions for frail older adults with cancer. Curr Opin Support Palliat Care 2024; 18:22-26. [PMID: 38126248 DOI: 10.1097/spc.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Frailty is prevalent in older adults with cancer and can lead to complications during cancer treatment and poor health outcomes. Exercise has been shown to be a promising strategy to mitigate frailty and slow the accumulation of functional impairment in the general geriatric population. In this review, we present a discussion on the state of the science of exercise interventions for frail older adults with cancer. This review is timely and relevant given the aging of the population and corresponding increase in proportion of older adults living with cancer. RECENT FINDINGS Existing research related to exercise interventions for frail older adults with cancer appear to show some promise in feasibility and efficacy in both surgical and systemic treatment settings. SUMMARY More research on this topic and testing rigorously structured exercise interventions for older adults with cancer may help inform cancer-specific guidelines and create a foundation of evidence to enable implementation of exercise interventions. These interventions can support cancer care to attenuate frailty-related outcomes while extending its benefit to overall health of this population.
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Affiliation(s)
- Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia
- BC Cancer Research Institute, Cancer Control
| | - Kayoung Lee
- Faculty of Applied Science, School of Nursing, University of British Columbia
| | - Kristin L Campbell
- BC Cancer Research Institute, Cancer Control
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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