Emilio González-Jiménez

Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis

BackgroundCancer-related fatigue (CRF) is the most common and distressing symptom in breast cancer survivors. Approximately 40% to 80% of cancer patients undergoing active treatment suffer from CRF. Exercise improves overall quality of life and CRF; however, the specific effects of the training modalities are not well understood.MethodsThis study aimed to determine the pooled effects of supervised exercise interventions on CRF in breast cancer survivors. We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL and CINAHL databases between December 2013 and January 2014 without language restrictions. Risk of bias and methodological quality were evaluated using the PEDro score. Pooled effects were calculated with a random-effects model according to the DerSimonian and Laird method. Heterogeneity was evaluated with the I2 test.ResultsNine high-quality studies (n = 1156) were finally included. Supervised aerobic exercise was statistically more effective than conventional care in improving CRF among breast cancer survivors (SMD = −0.51, 95%CI −0.81 to −0.21), with high statistical heterogeneity (P = 0.001; I2 = 75%). Similar effects were found for resistance training on CRF (SMD = −0.41, 95%CI −0.76 to −0.05; P = 0.02; I2 = 64%). Meta-regression analysis revealed that exercise volume parameters are closely related with the effect estimates on CRF. Egger’s test suggested moderate evidence of publication bias (P = 0.04).ConclusionsSupervised exercise reduces CRF and must be implemented in breast cancer rehabilitation settings. High-volume exercises are safe and effective in improving CRF and overall quality of life in women with breast cancer. Further research is encouraged.Trial RegistrationCRD42014007223

BMI Predicts Emotion‐Driven Impulsivity and Cognitive Inflexibility in Adolescents With Excess Weight

Adolescent obesity is increasingly viewed as a brain‐related dysfunction, whereby reward‐driven urges for pleasurable foods “hijack” response selection systems, such that behavioral control progressively shifts from impulsivity to compulsivity. In this study, we aimed to examine the link between personality factors (sensitivity to reward (SR) and punishment (SP), BMI, and outcome measures of impulsivity vs. flexibility in—otherwise healthy—excessive weight adolescents. Sixty‐three adolescents (aged 12–17) classified as obese (n = 26), overweight (n = 16), or normal weight (n = 21) participated in the study. We used psychometric assessments of the SR and SP motivational systems, impulsivity (using the UPPS‐P scale), and neurocognitive measures with discriminant validity to dissociate inhibition vs. flexibility deficits (using the process‐approach version of the Stroop test). We tested the relative contribution of age, SR/SP, and BMI on estimates of impulsivity and inhibition vs. switching performance using multistep hierarchical regression models. BMI significantly predicted elevations in emotion‐driven impulsivity (positive and negative urgency) and inferior flexibility performance in adolescents with excess weight—exceeding the predictive capacity of SR and SP. SR was the main predictor of elevations in sensation seeking and lack of premeditation. These findings demonstrate that increases in BMI are specifically associated with elevations in emotion‐driven impulsivity and cognitive inflexibility, supporting a dimensional path in which adolescents with excess weight increase their proneness to overindulge when under strong affective states, and their difficulties to switch or reverse habitual behavioral patterns.

Supervised exercise reduces cancer-related fatigue: a systematic review

QUESTION Does supervised physical activity reduce cancer-related fatigue? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS People diagnosed with any type of cancer, without restriction to a particular stage of diagnosis or treatment. INTERVENTION Supervised physical activity interventions (eg, aerobic, resistance and stretching exercise), defined as any planned or structured body movement causing an increase in energy expenditure, designed to maintain or enhance health-related outcomes, and performed with systematic frequency, intensity and duration. OUTCOME MEASURES The primary outcome measure was fatigue. Secondary outcomes were physical and functional wellbeing assessed using the Functional Assessment of Cancer Therapy Fatigue Scale, European Organisation for Research and Treatment of Cancer Quality of Life QUESTIONnaire, Piper Fatigue Scale, Schwartz Cancer Fatigue Scale and the Multidimensional Fatigue Inventory. Methodological quality, including risk of bias of the studies, was evaluated using the PEDro Scale. RESULTS Eleven studies involving 1530 participants were included in the review. The assessment of quality showed a mean score of 6.5 (SD 1.1), indicating a low overall risk of bias. The pooled effect on fatigue, calculated as a standardised mean difference (SMD) using a random-effects model, was -1.69 (95% CI -2.99 to -0.39). Beneficial reductions in fatigue were also found with combined aerobic and resistance training with supervision (SMD=-0.41, 95% CI -0.70 to -0.13) and with combined aerobic, resistance and stretching training with supervision (SMD=-0.67, 95% CI -1.17 to -0.17). CONCLUSION Supervised physical activity interventions reduce cancer-related fatigue. These findings suggest that combined aerobic and resistance exercise regimens with or without stretching should be included as part of rehabilitation programs for people who have been diagnosed with cancer. REGISTRATION PROSPERO CRD42013005803.

Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective. Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis. Design. A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale. Results. Nine studies (n = 772) were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (SMD = −0.23; 95% CI: −0.37 to −0.09; P = 0.001). These effects were also significant in patients undergoing chemotherapy (P < 0.0001). Nonsignificant differences were found for resistance training interventions (P = 0.30). Slight evidence of publication bias was observed (P = 0.04). The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD) ± 1.0)). Conclusion. Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments.

Effects of a multicomponent behavioral intervention on impulsivity and cognitive deficits in adolescents with excess weight.

The aim of this study was to explore the effects of a multidisciplinary behavioral intervention including cognitive behavioral therapy, structured physical activity, and dietary counseling on impulsive personality and cognitive skills and subsequent BMI loss in excess weight adolescents. Forty-two adolescents with excess weight (14 males and 28 females, range 12–17 years), as defined by the International Obesity Task Force Criteria, participated in our study. We used a longitudinal observational design with two assessments: before and after treatment. We collected baseline measures of impulsive personality (UPPS-P scale), cognitive performance (letter number sequencing, Stroop and Iowa gambling task), and biometric parameters. After 12 weeks of intervention, parallel measures were used to determine whether treatment-induced changes in impulsivity and cognition predicted changes in BMI. BMI showed a statistically significant reduction after treatment [from mean (SD) 29.36 (4.51) to 27.31 (4.41), Cohen’s d=0.5]. Greater reductions in negative urgency (negative-emotion-driven impulsivity) and greater improvement in cognitive inhibitory control skills were associated with greater reductions in BMI. Because the design was correlational and lacked a control group, future studies should clarify whether these associations reflect a causal effect or just overlapping improvements associated with a third variable (e.g. increases in attention procurement or motivation).

Insulin resistance and inflammation markers: correlations in obese adolescents

AIMS AND OBJECTIVES To ascertain whether inflammation markers also correlate with parameters related to insulin resistance and the metabolic syndrome in a group of adolescents. BACKGROUND Obesity is now considered a chronic low-grade inflammatory process, characterised by alterations in the systemic concentrations of some inflammation markers. Adiponectin, leptin and other inflammatory proteins have been shown to correlate with insulin resistance and the metabolic syndrome in adults. DESIGN Cross-sectional study in two groups of obese and normal weight adolescents. METHODS Serum levels of adiponectin, leptin, ceruloplasmin and insulin levels were determined and correlated among them and with anthropometric parameters, blood pressure body mass index and body mass index z-score. RESULTS Waist circumference, body mass index and blood pressure values correlated significantly with both homoeostasis model assessment for insulin resistance and insulin levels. Ceruloplasmin also correlated with both parameters with a high level of significance. However, leptin levels did not correlate with either homoeostasis model assessment for insulin resistance or insulin, and adiponectin correlated with homoeostasis model assessment for insulin resistance but not insulin. All inflammation markers studied correlated with the body mass index z-score. These correlations were stronger in the group of obese individuals compared to lean ones. CONCLUSIONS We found a relationship between insulin resistance and some inflammation in adolescents, which was particularly strong in obese individuals and was associated with the development of metabolic syndrome. Among the inflammation markers studied, ceruloplasmin revealed as a potential string marker of insulin resistance in obese adolescents. RELEVANCE TO CLINICAL PRACTICE The results obtained in this study imply a significant advance in the field of clinical practice of nursing. The adequate understanding by nursing personnel of the inflammatory processes inherent to obesity constitutes a key factor for the prevention of the disease and its complications in adolescents.

The Effect of Exercise Training on Mediators of Inflammation in Breast Cancer Survivors: A Systematic Review with Meta-analysis

Several sources of evidence indicate that exercise during and after breast cancer could positively modulate the tumor microenvironment. This meta-analysis aimed to determine the effects of exercise training on mediators of inflammation in breast cancer survivors. We searched for randomized controlled trials published from January 1990 to March 2014. An inverse variance method of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity. Eight high-quality trials (n = 478) were included. Exercise improved the serum concentrations of IL6 [weighted mean difference (WMD) = −0.55 pg/mL; 95% confidence interval (CI), −1.02 to −0.09], TNFα (WMD = −0.64 pg/mL; 95% CI, −1.21 to −0.06), IL8 (MD = −0.49 pg/mL; 95% CI, −0.89 to −0.09), and IL2 (WMD = 1.03 pg/mL; 95% CI, 0.40 to 1.67). No significant differences were found in the serum concentrations of C-reactive protein (WMD = −0.15; 95% CI, −0.56 to 0.25) or IL10 (WMD = 0.41; 95% CI, −0.18 to 1.02). Exercise training positively modulates chronic low-grade inflammation in women with breast cancer, which may impact upon carcinogenic mechanisms and the tumor microenvironment. These findings align with the other positive effects of exercise for breast cancer survivors, reinforcing the appropriateness of exercise prescription in this population. Cancer Epidemiol Biomarkers Prev; 25(7); 1009–17. ©2016 AACR.

Effectiveness of Controlled Breathing Techniques on Anxiety and Depression in Hospitalized Patients With COPD: A Randomized Clinical Trial

BACKGROUND: Anxiety and depression are prevalent comorbidities in patients with COPD. Breathing techniques can improve anxiety and depression in patients hospitalized for COPD exacerbation. METHODS: We conducted a randomized clinical study with 46 male subjects, 67–86 years old, hospitalized with acute COPD exacerbation. Subjects were randomly and equally divided into a control group and a controlled breathing intervention group. We measured baseline and post-intervention dyspnea, anxiety and depression, quality of life (with the St Georges Respiratory Questionnaire and the European Quality of Life questionnaire), maximum inspiratory and expiratory pressure, hand-grip strength, and sleep quality. The cohort had high dyspnea and low overall quality of life. RESULTS: Controlled breathing techniques significantly improved dyspnea, anxiety, and mobility. All the measured variables improved in the intervention group. The control group had poorer values in all the variables after the hospitalization period. CONCLUSIONS: Controlled breathing exercises improve anxiety and depression in patients hospitalized for COPD exacerbation. (ClinicalTrials.gov NCT01826682)

Alteration in sleep quality in patients with mechanical insidious neck pain and whiplash-associated neck pain.

ObjectiveThis study aimed to determine differences in sleep quality between patients with mechanical neck pain, patients with whiplash (WAD) pain, and healthy controls and to determine the relationship between the intensity of ongoing pain, disability, and sleep quality. DesignNineteen patients with mechanical neck pain (4 men, 15 women; age, 40 ± 16 yrs), 22 with WAD (4 men, 18 women; age, 38 ± 15 yrs), and 18 comparable controls (4 men, 14 women; age, 41 ± 13 yrs) completed the Pittsburgh Sleep Quality Index to assess sleep quality. A numerical pain rate scale (0–10) and the Neck Disability Index (0–50) were collected for assessing neck pain and disability. ResultsSignificant differences in sleep quality (P < 0.001), sleep latency (P = 0.005), sleep efficiency (P = 0.002), sleep disturbances (P < 0.001), use of sleeping medication (P < 0.001), daytime dysfunction (P < 0.001), and total Pittsburgh Sleep Quality Index score (P < 0.001) but not for sleep duration (P = 0.096) were found; patients with mechanical neck pain and WAD pain exhibited higher scores in all components compared with healthy controls. Seventeen (77%) patients with WAD and 13 (68%) with mechanical neck pain reported poor sleep quality (Pittsburgh Sleep Quality Index score, >8). Significant positive correlations between mean intensity of ongoing pain with sleep quality (rs = 0.693; P < 0.001); sleep duration (rs = 0.433; P = 0.044); sleep efficiency (rs = 0.644; P = 0.001) and total Pittsburgh Sleep Quality Index score (rs = 0.643; P = 0.001) were found in patients with WAD pain; the higher the intensity of ongoing pain, the worse the sleep quality. ConclusionsSleep disturbances are a common finding in individuals with neck pain and are associated with the intensity of ongoing pain in WAD. It seems essential to address the ongoing cycle of pain and sleep disturbances as an integral part of the treatment of patients with neck pain.

Performance of Two Bioelectrical Impedance Analyses in the Diagnosis of Overweight and Obesity in Children and Adolescents: The FUPRECOL Study.

This study aimed to determine thresholds for percentage of body fat (BF%) corresponding to the cut-off values for overweight/obesity as recommended by the International Obesity Task Force (IOTF), using two bioelectrical impedance analyzers (BIA), and described the likelihood of increased cardiometabolic risk in our cohort defined by the IOTF and BF% status. Participants included 1165 children and adolescents (54.9% girls) from Bogotá (Colombia). Body mass index (BMI) was calculated from height and weight. BF% of each youth was assessed first using the Tanita BC-418® followed by a Tanita BF-689®. The sensitivity and specificity of both devices and their ability to correctly classify children as overweight/obesity (≥2 standard deviation), as defined by IOTF, was investigated using receiver operating characteristic (ROC) by sex and age groups (9–11, 12–14, and 13–17 years old); Area under curve (AUC) values were also reported. For girls, the optimal BF% threshold for classifying into overweight/obesity was found to be between 25.2 and 28.5 (AUC = 0.91–0.97) and 23.9 to 26.6 (AUC = 0.90–0.99) for Tanita BC-418® and Tanita BF-689®, respectively. For boys, the optimal threshold was between 16.5 and 21.1 (AUC = 0.93–0.96) and 15.8 to 20.6 (AUC = 0.92–0.94) by Tanita BC-418® and Tanita BF-689®, respectively. All AUC values for ROC curves were statistically significant and there were no differences between AUC values measured by both BIA devices. The BF% values associated with the IOTF-recommended BMI cut-off for overweight/obesity may require age- and sex-specific threshold values in Colombian children and adolescents aged 9–17 years and could be used as a surrogate method to identify individuals at risk of excess adiposity.