Anders Tolver

Efficacy of multimodal exercise-based rehabilitation on physical activity, cardiorespiratory fitness, and patient-reported outcomes in cancer survivors: a randomized, controlled trial

BACKGROUNDnSedentary behavior and impaired cardiovascular reserve capacity are common late effects of cancer therapy emphasizing the need for effective strategies to increase physical activity (PA) in cancer survivors. We examined the efficacy of a 12-month exercise-based rehabilitation program on self-reported PA, cardiorespiratory fitness (VO2peak), strength, and patient-reported outcomes.nnnPATIENTS AND METHODSnTwo hundred fourteen post-treatment cancer survivors were randomly assigned to a 12-month rehabilitation program consisting of individual (x3) and group-based (x6) counseling in combination with once weekly high-intensity group-based exercise training (the Copenhagen Physical Activity after Cancer Treatment, PACT; n = 108) or to a health evaluation program (HE, n = 106). Study outcomes were assessed at baseline, 6 months, and 12 months.nnnRESULTSnAfter 12 months, the percentage of patients reporting meeting PA goal behavior (≥3 h/week) was significantly increased in the PACT group versus the HE group (70.4% versus 43.4%, P = 0.001). Repeated measures analyses indicated a statistically significant improvement in VO2peak (l min(-1)) in favour of PACT (treatment effect ratio = 1.04; 95% confidence interval 1.00-1.07; P = 0.032). Significant between group differences were also observed for strength (P < 0.001), depression (P = 0.020) and mental health (P = 0.040).nnnCONCLUSIONnA 12-month exercise-based rehabilitation program is an effective strategy to promote PA and improve VO2peak in cancer survivors.

The effect of honey‐coated bandages compared with silver‐coated bandages on treatment of malignant wounds—a randomized study

Malignant wounds (MWs) occur in 5–10% of all cancer patients. Malodor and exudation are the most common side effects. The aim was to determine the influence of honey‐coated compared with silver‐coated bandages on treatment of MWs. Patients were randomly selected to enter either group A (honey‐coated bandages) or group B (silver‐coated bandages). Parameters were the following: wound size, cleanliness, malodor, exudation, and wound pain. Digital photographs, visual analog scales (VAS), and wound morphology registration were used for measurement at baseline and following the 4‐week intervention. Sixty‐nine patients with MWs and advanced cancer, aged 47–90 (median 65.6), were included. No statistically significant difference was noted between the groups with respect to wound size, degree of cleanliness, exudation, malodor, and wound pain. There was a median decrease in wound size of 15u2009cm2 and 8u2009cm2 in group A and B, respectively (pu2009=u20090.63). Based on post‐intervention pooled data from the groups, improvement was seen in 62% of the participants with respect to wound size and in 58% (nu2009=u200969) with respect to cleanliness. The VAS score for malodor (pu2009=u20090.007) and exudation (pu2009<u20090.0001) improved significantly post‐intervention.

Left atrial volume and phasic function in clinically healthy dogs of 12 different breeds.

The left atrium (LA) of the heart is a validated marker of clinical and subclinical cardiovascular disease. Since the LA is a three-dimensional structure, volume-based methods of chamber quantification might be more accurate than linear methods. The aims of this study were to establish the feasibility and reproducibility of biplane two-dimensional echocardiographic LA volume measurements and to provide reference ranges for LA volume and phasic function in adult dogs (n=237) without cardiovascular disease. The study also assessed the effects of bodyweight (BW), breed, sex, age and heart rate (HR) on LA volume and function. The biplane area-length method was used to calculate LA volumes from the left apical four- and two-chamber views. LA volume and function were correlated with body size and there were significant breed differences. For dogs of all sizes and breeds, LA maximal volume had a 95th percentile of 0.92 mL/kg. There was no correlation between age or sex and LA volume or LA reservoir function, but conduit function decreased and booster pump function increased with age. LA volume and function varied with HR. LA size was calculated using the biplane area-length method, with good reproducibility and little inter-observer variability. The reference ranges presented for LA volume and function in healthy dogs could be used to refine the diagnostic criteria for the assessment of LA enlargement and altered function by conventional echocardiography.

The emerging role of exercise and health counseling in patients with acute leukemia undergoing chemotherapy during outpatient management

This study investigates the feasibility, safety and benefits of a 6-week exercise and health counseling intervention in patients with acute leukemia undergoing consolidation chemotherapy during outpatient management. Seventeen of twenty patients completed study requirements (85%), adherence to exercise was 73% and for health counseling 92%. There were improvements in the 6-min-walk-distance (p=0.0013), sit-to-stand test (p=0.0062), the right and left biceps arm-curl tests p=0.0002 and p=0.0002, respectively; health-related quality of life (p=0.0209) (FACT-An), vitality (p=0.0015), mental health (p=0.0471) and physical component scale (p=0.0295) (SF36). Significant reduction in the symptom burden (p=0.0021) and symptom interference on daily life activities (p=0.0069) (MDASI). No adverse reactions were observed.

Pre- and postnatal nutrition in sheep affects β-cell secretion and hypothalamic control

Maternal undernutrition increases the risk of type 2 diabetes and metabolic syndrome later in life, particularly upon postnatal exposure to a high-energy diet. However, dysfunctions of, for example, the glucose-insulin axis are not readily detectable by conventional tests early in life, making it difficult to identify individuals at risk. Thus, other methods are required. We hypothesised that prenatally undernourished individuals (but not postnatally overnourished ones) are adapted to a life with limited food availability, which would be evident under conditions reflecting starvation, stress and short-term abundance of food. In this study, twin-pregnant sheep were fed diets meeting 100% (NORM) or 50% (LOW) of energy and protein requirements during the last trimester. Twin offspring were fed either a normal moderate (CONV) diet or a high-carbohydrate-high-fat (HCHF) diet from 3 days to 6 months of age (approximately puberty) and the same moderate diet thereafter until 2 years of age (young adulthood; only females), resulting in four groups: NORM-CONV, LOW-CONV, NORM-HCHF and LOW-HCHF. At the age of 6 months and 2 years respectively, they were subjected to fasting and propionate (nutrient abundance) and adrenalin challenges. At 6 months of age, postnatal HCHF diet exposure caused metabolic alterations, reflecting hypertriglyceridaemia and altered pancreatic β-cell secretion. Irrespective of postnatal diet, prenatal undernutrition was found to be associated with unexpected endocrine responses of leptin, IGF1 and cortisol during fasting (lack of or the opposite response compared with the controls) in 2-year-old adults. In conclusion, a HCHF diet interfered with β-cell function, whereas maternal undernutrition did not lead to any changes in the LOW offspring, except to abnormal hormone responses, suggesting that fetal programming interferes with hypothalamic integration of important endocrine axis.

Safety and efficacy of resistance training in germ cell cancer patients undergoing chemotherapy: a randomized controlled trial

Background:Bleomycin–etoposid–cisplatin (BEP) chemotherapy is curative in most patients with disseminated germ cell cancer (GCC) but also associated with toxic actions and dysfunction in non-targeted tissues. We investigated changes in muscle function during BEP and the safety and efficacy of resistance training to modulate these changes.Methods:Thirty GCC patients were randomly assigned to resistance training (resistance training group (INT), n=15) or usual care (CON, n=15) during 9 weeks of BEP therapy. Resistance training consisted of thrice weekly sessions of four exercises, 3–4 sets/exercise of 10–15 repetitions at 12–15 repetition maximum load. The primary endpoint was muscle fibre size, assessed in muscle biopsies from musculus vastus lateralis. Secondary endpoints were fibre phenotype composition, body composition, strength, blood biochemistry and patient-reported endpoints. Healthy age-matched subjects (REF, n=19) performed the same RT-programme for comparison purposes.Results:Muscle fibre size decreased by −322u2009μm2 (95% confidence interval (CI): −899 to 255; P=0.473) in the CON-group and increased by +206u2009μm2 (95% CI: −384 to 796; P=0.257) in the INT-group (adjusted mean difference (AMD), +625u2009μm2, 95% CI: −253 to 1503, P=0.149). Mean differences in type II fibre size (AMD, +823u2009μm2, P=0.09) and lean mass (AMD, +1.49u2009kg, P=0.07) in favour of the INT-group approached significance. The REF-group improved all muscular endpoints and had significantly superior changes compared with the INT-group (P<0.05).Conclusions:BEP was associated with significant reduction in lean mass and strength and trends toward unfavourable changes in muscle fibre size and phenotype composition. Resistance training was safe and attenuated dysfunction in selected endpoints, but BEP blunted several positive adaptations observed in healthy controls. Thus, our study does not support the general application of resistance training in this setting but larger-scaled trials are required to confirm this finding.

Quantification of symmetry for functional data with application to equine lameness classification

This paper presents a study on symmetry of repeated bi-phased data signals, in particular, on quantification of the deviation between the two parts of the signal. Three symmetry scores are defined using functional data techniques such as smoothing and registration. One score is related to the L 2-distance between the two parts of the signal, whereas the other two are constructed to specifically measure differences in amplitude and phase. Moreover, symmetry scores based on functional principal component analysis (PCA) are examined. The scores are applied to acceleration signals from a study on equine gait. The scores turn out to be highly associated with lameness, and their applicability for lameness quantification and detection is investigated. Four classification approaches turn out to give similar results. The scores describing amplitude and phase variation turn out to outperform the PCA scores when it comes to the classification of lameness.

Discussion of "analysis of spatio-temporal mobile phone data: a case study in the metropolitan area of Milan" by P. Secchi, S. Vantini, and V. Vitelli

We congratulate the authors on an interesting paper, and we are delighted to have the opportunity to comment on the paper. The authors have succesfully analyzed a large dataset with a complicated time and space structure and have obtained a dimension reduction via a spatio-temporal decomposition with clear interpretations. In order to achieve this, two algorithms from the recent litetature, treelet analysis and Voronoi tesselations, were combined in a ingenious way and accomodated to the present problem.

Engaging the older cancer patient; Patient Activation through Counseling, Exercise and Mobilization – Pancreatic, Biliary tract and Lung cancer (PACE-Mobil-PBL) - study protocol of a randomized controlled trial

BackgroundSeveral intervention studies have demonstrated that exercise training has beneficial effects among cancer patients. However, older cancer patients are underrepresented in clinical trials, and only few exercise-based studies have focused specifically onxa0older patients with cancer. In particular, research investigating the effects of exercise training among older patients with advanced cancer is lacking. The purpose of the current study is to investigate the effect of a 12-week multimodal and exercise-based intervention among older patients (≥65xa0years) with advanced pancreatic, biliary tract or lung cancer, who are treated with first-line palliative chemotherapy, immunotherapy or targeted therapy.MethodsPACE-Mobil-PBL is a two-armed randomized controlled trial. Participants will be randomized 1:1 to an intervention group (Nxa0=u200950) or a control group (Nu2009=u200950). Participants in the intervention group will receive standard oncological treatment and a 12-week multimodal intervention, comprised of: (I) supervised exercise training, twice weekly in the hospital setting, (II) home-based walking with step counts and goal-setting, (III) supportive and motivational nurse-led counseling, and (IV) protein supplement after each supervised training session. Participants in the control group will receive standard oncological treatment. The primary outcome is physical function measured by the 30-s chair stand test. Secondary outcomes include measures of feasibility, activity level, physical capacity and strength, symptom burden, quality of life, toxicity to treatment, dose reductions, inflammatory biomarkers, body weight and composition, hospitalizations and survival. Assessments will be conducted at baseline, and after 6, 12 and 16xa0weeks.DiscussionThe current study is one of the first to investigate the effect of an exercise-based intervention specifically targeting older patients with advanced cancer. PACE-Mobil-PBL supports the development of health promoting guidelines for older patients with cancer, and the study results will provide new and valuable knowledge in this understudied field.Trial registrationThe study was prospectively registered at ClinicalTrials.gov on January 26, 2018 (ID: NCT03411200).

Analysis of juggling data: Registration subject to biomechanical constraints

Abstract: We illustrate how physical constraints of a biomechanical system can be taken into account when registering functional data from juggling trials. We define an idealized model of juggling, based on a periodic joint movement in a low-dimensional space and a periodic position vector (from an undefined joint to the finger tip) of approximately constant length along the observed trajectory. Our registration procedure first warps the cycles in the trial to each other and computes a periodic average, and then estimates the joint movement and the position vector of the abovementioned model.