Implementation Of Exercise Intervention Research Articles

Translating Evidence from Dutch Exercise Oncology Trials in Patients with Breast Cancer into Clinical Practice Using the RE-AIM Framework

Purpose. We aimed to evaluate the potential for implementing exercise interventions for patients with breast cancer in the Netherlands, based on findings of the Dutch randomized controlled trials in this population. Methods. We evaluated the implementation of four Dutch exercise trials retrospectively, using the five dimensions of the RE-AIM framework: Reach (exercise participation rate), Effectiveness for physical fitness, fatigue, quality of life, and physical function, Adoption (e.g., satisfaction of physical therapists guiding the exercise intervention), Implementation (cost-effectiveness and exercise adherence correlates thereof), and Maintenance (maintenance of exercise levels by individual patients and sustainability of exercise delivery at organization level). Thereby, we reflect on these results using (international) literature to gain better insight in overall barriers, facilitators, and opportunities for further implementation of exercise interventions. Results. Participation rates of 44–52% not only indicated acceptable Reach in the context of a trial but also indicated room for improvement. Effectiveness of exercise during and after treatment was demonstrated in most trials showing benefits for aerobic fitness, physical fatigue, quality of life and physical function, and high patient satisfaction. Adoption of the exercise interventions by physical therapists was adequate (satisfaction score: 7.5 out of 10). Evaluation of Implementation indicated adequate adherence to supervised exercise, inconsistent findings on potential correlates of adherence, and promising results on cost-effectiveness. Currently, reimbursement for exercise programs is lacking. Maintenance of intervention effects at the patient level was limited and inconsistent. Maintenance of intervention availability at the organizational level was facilitated by an extensive network of specially trained physical therapists, but better communication and collaboration between different healthcare professionals are desired. Conclusions. Improved implementation could particularly be achieved by increasing reach and improved focus on exercise maintenance on both the patient and organizational level.

The effectiveness of optimal exercise-based strategy for patients with hip fracture: a systematic review and Bayesian network meta-analysis

The implementation of exercise intervention (EI) presents a promising and economical way for patients with hip fracture. However, the optimal type of EI remains unclear. The objective of this study is to evaluate the efficacy of various EI approaches and identify the optimal intervention for improving the prognosis of patients with hip fracture. A comprehensive search of Medline (via PubMed), Web of Science, Embase, Cochrane Central Register of Controlled Trials, CINAHL, CNKI, Wan Fang, VIP, and CBM was conducted from their earliest records to June 2022. The included randomized controlled trials (RCTs) included at least one type of exercise for patients with hip fracture. The methodological quality of these trials was assessed using the Cochrane Collaboration Risk of Bias Tool. All direct and indirect comparisons were analyzed by Stata 14.0 and OpenBUGS 3.2.3 software. The primary outcome was hip function, and the secondary outcomes were activity of daily living (ADL), walking capacity and balance ability of patients. Based on the ranking probabilities, resistance exercise (RE) was ranked as the most effective among all exercise interventions (surface under cumulative ranking curve values [SUCRA]: 94.8%, [MD]: − 11.07, [Crl]: − 15.07 to − 7.08) in improving the efficacy of patients' hip function, followed by balance exercise (BE) ([SUCRA]:81.1%, [MD]: − 8.79, [Crl]: − 13.41 to − 4.18) and muscle strength exercise ([SUCRA]:57.6%, [MD]: − 5.35, [Crl]: − 9.70 to − 0.95). For the improvement of ADL for patients with hip fracture, BE ([SUCRA]:98.4%, [MD]: − 17.38, [Crl]: − 23.77 to − 11.04) may be the best EI. The findings of this study indicate that RE and BE might be the best approach to improve prognosis for patients with hip fracture. However, further rigorous and meticulously planned RCTs are required to substantiate the conclusions drawn from this study.

Exercise as a treatment for clinical depression in adults and progressing the physiotherapists role: A systematic review and meta-analysis

BACKGROUND: There has been extensive literature examining the efficacy of exercise interventions in the treatment of depression over the past few decades. However, there is ongoing debate regarding the optimal dosage, and the implications of utilising physiotherapists for the management of clinically depressed adults using exercise has not been examined. OBJECTIVES: This review aimed to examine the effectiveness of exercise as a treatment for depression (without comorbidities) and to determine the most effective dosage/mode to treat this population. This review strived to appraise the literature for a potential role for physiotherapists in depression management. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, a search for randomized controlled trials was conducted on the nine databases. All studies were appraised for quality using the Physiotherapy Evidence Database (PEDro) scale and Cochrane Risk of Bias Tool (RoB). Data was manually extracted, and pre- and post-intervention depression scores and program variables were analysed. RESULTS: Of the 5036 papers retrieved, 7 papers met this review’s inclusion criteria. The results of the meta-analysis reveal that exercise as a sole treatment and as an add-on is significantly effective in reducing depressive symptoms. The findings support the use of moderate intensity aerobic exercise for three sessions per week. CONCLUSIONS: Exercise was shown to significantly improve depressive symptoms in depressed adults. This review adds to the growing body of evidence regarding the important role of physiotherapists in the treatment of psychiatric disorders in the design and implementation of exercise interventions.

Exercise interventions in child and adolescent mental health care: An overview of the evidence and recommendations for implementation.

The use of physical activity interventions in mental health care for adults has a large academic evidence base and numerous examples of real-world implementation. However, the use of physical activity within mental health care for children and young people (CYP) has received less attention to date. A narrative review was conducted to summarize the relevant literature in the area. Online databases were searched using terms synonymous with CYP, exercise, physical health, and mental health. Findings from existing systematic reviews, meta-analyses, meta-syntheses, and consensus statements were reviewed, and used alongside the authors' experience to inform clinical recommendations. We first discuss the importance of applying physical health interventions in early stages of mental illness for CYP to prevent physical comorbidities and premature mortality in the long term. We then provide a brief summary of the current evidence of the benefits of exercise interventions in CYP with mental illness. We then present our top five recommendations on the implementation of exercise interventions within CYP mental health care. The key conclusions from this suggest there is an increasingly strong evidence base for the benefits of using physical activity interventions to improve, prevent, and manage physical and mental health outcomes in CYP with mental illness. However, more work needs to be done to improve the evidence base, refine its implementation into standard mental health care, and develop strategies for large-scale dissemination of such interventions across various care and cultural contexts.

Exercise interventions for people diagnosed with cancer: a systematic review of implementation outcomes

PurposeExercise is efficacious for people living after a cancer diagnosis. However, implementation of exercise interventions in real-world settings is challenging. Implementation outcomes are defined as ‘the effects of deliberate and purposive actions to implement new treatments, practices, and services’. Measuring implementation outcomes is a practical way of evaluating implementation success. This systematic review explores the implementation outcomes of exercise interventions evaluated under real-world conditions for cancer care.MethodsUsing PRISMA guidelines, an electronic database search of Medline, PsycInfo, CINAHL, Web of Science, SportsDiscus, Scopus and Cochrane Central Registry of Controlled Trials was conducted for studies published between January 2000 and February 2020. The Moving through Cancer registry was hand searched. The Implementation Outcomes Framework guided data extraction. Inclusion criteria were adult populations with a cancer diagnosis. Efficacy studies were excluded.ResultsThirty-seven articles that described 31 unique programs met the inclusion criteria. Implementation outcomes commonly evaluated were feasibility (unique programs n = 17, 54.8%) and adoption (unique programs n = 14, 45.2%). Interventions were typically delivered in the community (unique programs n = 17, 58.6%), in groups (unique programs n = 14, 48.3%) and supervised by a qualified health professional (unique programs n = 14, 48.3%). Implementation outcomes infrequently evaluated were penetration (unique programs n = 1, 3.2%) and sustainability (unique programs n = 1, 3.2%).ConclusionsExercise studies need to measure and evaluate implementation outcomes under real-world conditions. Robust measurement and reporting of implementation outcomes can help to identify what strategies are essential for successful implementation of exercise interventions.Implications for cancer survivorsUnderstanding how exercise interventions can be successful implemented is important so that people living after a cancer diagnosis can derive the benefits of exercise.

Exercise and cancer protection: from ‘prevention’ to ‘therapeutics’?

Purpose The valuable impacts of exercise-intervention in diverse type of cancer patients were rationally well-prescribed, though many experimental and review researches already performed in this fields. Generally, cancer-related fatigue and pain remains one of the most prevalent problems for cancer populations. Therefore, exercise has become increasingly significant in cancer prevention and progression. The purpose of this recent study was to analyze the combined exercise program on cancer-related fatigue, pain, quality of life and cancer prognosis in diverse type of cancer patients. This study analyses the safety and feasibility of exercise intervention in diverse stages of cancer patients such as early stage, advanced stage and even metastatic periods in cancer populations. we also wanted to know the impacts of dose-response trial of aerobic and resistance exercise on quality of life in cancer survivors. Methods we conducted a comprehensive PubMed/MEDILINE electronic database from Jan 2015 to August 2020. The reference lists of eligible experimental research articles and relevant systemic review articles were checked. Inclusion criteria were adult cancer survivors from randomized controlled trials performing well-tailored exercise intervention programs to diverse type of cancer patients, Using predefined search items ‘exercise-intervention, cancer & immunology’. Based on reference search, more than 100 articles were identified whereas 30 research papers met the inclusion criteria and were well connected with exercise-intervention and cancer progression. we analyzed the connections between physical exercise and cancer intervention in the main text. Results Moderate to vigorous exercise (aerobic and resistance exercise) revealed to decreased level of cancer-related fatigue, pain, and cancer-related symptoms, however increased level of sleep quality, activities of daily living, exercise performance and health- related quality of life. Exercise intervention reduced pro-inflammatory markers and oxidative stress as well as insomnia, fatigue, pain symptoms whereas it enhanced the antioxidant systems and immune functions. In addition, home-based aerobic physical exercise might enhance muscular strength and quality of life in many types of cancer survivors. Psychological intervention also effective for reducing cancer-related fatigue and pain during and after cancer treatment. they might be the much better intervention than available pharmaceutical options. we believe that it is the related mechanisms of immune cell mobilization and activation such as NK cells which is induced by the activation of sympathetic system during and after physical exercise. Conclusion According to the aforementioned results, it was concluded that implementation of exercise intervention appear to be the best non-pharmaceutical interventions for cancer populations, and also revealed to be safe and feasible in early and advanced stages, although not in the metastatic periods. Sometimes, psychological intervention such as mindfulness-based stress reduction (MBSR) might be useful in reducing anxiety, depression, fatigue, pain and enhancing quality of life, quality of sleep for cancer populations. we can conclude, exercise-intervention might not just be prevention effect but might be therapeutics, however more studies are urgently needed to confirm the exercise intervention on the NK-receptors activation and immune connection of cancer populations.

Safety and feasibility of exercise interventions in patients with advanced cancer: a systematic review.

The beneficial effects of exercise in cancer patients are reasonably well-established, although research in this field has predominantly investigated cancer patients in the earlier stages of disease. However, the most recent evidence surrounding exercise interventions in advanced cancer populations has yet to be systematically evaluated. This review critically analyses the safety and feasibility of exercise interventions in patients with advanced cancer. All randomised, non-randomised and prospective observational trials of exercise training interventions in patients with advanced cancer were included. 'Safety' was defined as the number and severity of reported adverse events during exercise training. 'Feasibility' was determined by participant adherence, attendance and/or study completion rates. A total of 25 studies involving 1088 patients were included: 16 randomised controlled and nine prospective observational cohort trials. Seven studies included advanced lung cancer patients exclusively, while eight involved patients with various cancer diagnoses. Aerobic exercise was investigated in five studies, resistance training in two studies and combination training (aerobic and resistance) in 14 studies. Six minor adverse events were reported due to exercise. All of these were musculoskeletal in nature, resulting in two participants' withdrawal from the study. Exercise adherence ranged from 65 to 89% but was only described in nine studies. Attendance at each exercise session was described in a further nine studies, ranging from 59 to 100%. Implementation of exercise interventions appears to be safe and feasible in advanced cancer clinical practice, although targeted studies are required to determine the optimal exercise dose for specific cancer diagnoses.

Exercise during and after curative oncological treatment – a mapping review

Background: By mapping the existing literature on exercise oncology, gaps in knowledge can be identified, and future directions for research can be pointed out. Objectives: This review aimed to map diagnoses and outcome measures targeted in reviews and describe the effects on those outcomes. Further, the aim was to map exercise intervention characteristics being reviewed and the effects depending on these characteristics, and to discuss implications for future research. Methods: A systematic search was performed in PubMed, Cinahl, PSYCHInfo, and Cochrane Library. Reviews including physical activity and exercise intervention trials in adult patients during or after curative oncological treatment were included. Reference lists were scanned in order to find additional relevant papers. Results: Twenty-three reviews were included in the present study. The majority included mixed forms of cancers. Significant improvements were reported on physical fitness, cancer-related fatigue (CRF), health-related quality of life, physical function, psychological outcomes, lymphedema-related symptoms, biological markers, and physical activity level. Four reviews targeted time point for implementation of exercise intervention. There were slightly greater effects on CRF, physical fitness, and walking distance from implementation after completed treatment. Two reviews comparing exercise types reported superior effects from combinations of aerobic exercise and resistance training compared to aerobic or resistance training alone. One review targeted exercise intensity, and the results indicated a greater effect from moderately intense exercise compared to high intense exercise. One review assessed behaviour change techniques in exercise trials and suggested the use of programme goal-setting, self-monitoring, and generalization of behaviour to promote adoption and maintenance of exercise behaviour. Conclusion: Exercise seems to be beneficial during and after curative oncological treatment in several types of cancer. A higher reporting of exercise intervention details is essential in future exercise intervention trials and there is still a need for large, randomized trials, especially in forms of cancer other than breast cancer.

Physical Therapy as Treatment for Childhood Obesity in Primary Health Care: Clinical Recommendation From AXXON (Belgian Physical Therapy Association).

Worldwide, an obesity epidemic among children and adolescents is apparent. In the care of obesity in children and adolescents, exercise therapy is considered a cornerstone. Official position statements describe and endorse the need and effect of exercise therapy and increased physical activity in children and adolescents with obesity. Physical therapists working in private and home care settings (first-line treatment) can play a key role in maximizing participation rates in exercise and physical activity programs, thereby increasing the community-scale clinical benefits of increased physical activity. However, it remains unclear how such guidelines can be efficiently applied in private practice and home care physical therapy settings given the limited equipment, infrastructure and time. In this clinical recommendation, a systematic, effective, and feasible approach for pre-participation screening and implementation of exercise interventions or increased physical activity programs in children and adolescents with obesity is provided for first-line physical therapists. This clinical recommendation aims to provide a guideline for physical therapists in private practice and home care settings to prescribe clinically effective and medically safe exercise interventions for children and adolescents with obesity, thereby contributing to better care and treatment of obesity in these children and adolescents.