Paquito Bernard

Psychological effect of exercise in women with breast cancer receiving adjuvant therapy: what is the optimal dose needed?

BACKGROUND Several meta-analyses have examined the role of exercise interventions in improving psychological outcomes in cancer survivors but most did not focus on adjuvant therapy period and did not investigate the optimal dose of exercise needed. The present meta-analysis examines the impact of exercise interventions delivered at this particular period on fatigue, anxiety, depression, and quality of life (QoL) as well as dose-response relationships between volume of prescribed exercise and these psychological outcomes. MATERIALS AND METHODS Randomized, controlled trials that proposed an exercise intervention to patients with breast cancer undergoing chemotherapy and/or radiotherapy were systematically identified and coded. Psychological outcomes effect sizes were calculated and analyzed for trends using linear and quadratic regressions. RESULTS Pooled effects of the 17 included studies revealed improvement for all outcomes, significant for fatigue, depression, and QoL with pooled estimates ranging from 0.2 to 0.5 favoring intervention. Significant inverse associations of the volume of prescribed exercise with fatigue and QoL were observed. CONCLUSIONS Exercise intervention improved fatigue, depression, and QoL in patients with breast cancer receiving adjuvant therapy. Prescription of relatively low doses of exercise (<12 MET h/week) consisting in ∼90-120 min of weekly moderate physical exercise seems more efficacious in improving fatigue and QoL than higher doses.BACKGROUND Several meta-analyses have examined the role of exercise interventions in improving psychological outcomes in cancer survivors but most did not focus on adjuvant therapy period and did not investigate the optimal dose of exercise needed. The present meta-analysis examines the impact of exercise interventions delivered at this particular period on fatigue, anxiety, depression, and quality of life (QoL) as well as dose-response relationships between volume of prescribed exercise and these psychological outcomes. MATERIALS AND METHODS Randomized, controlled trials that proposed an exercise intervention to patients with breast cancer undergoing chemotherapy and/or radiotherapy were systematically identified and coded. Psychological outcomes effect sizes were calculated and analyzed for trends using linear and quadratic regressions. RESULTS Pooled effects of the 17 included studies revealed improvement for all outcomes, significant for fatigue, depression, and QoL with pooled estimates ranging from 0.2 to 0.5 favoring intervention. Significant inverse associations of the volume of prescribed exercise with fatigue and QoL were observed. CONCLUSIONS Exercise intervention improved fatigue, depression, and QoL in patients with breast cancer receiving adjuvant therapy. Prescription of relatively low doses of exercise (<12 MET h/week) consisting in ∼90-120 min of weekly moderate physical exercise seems more efficacious in improving fatigue and QoL than higher doses.

Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomised controlled trials

Implementing theory-based interventions is an effective way to influence physical activity (PA) behaviour in the population. This meta-analysis aimed to (1) determine the global effect of theory-based randomised controlled trials dedicated to the promotion of PA among adults, (2) measure the actual efficacy of interventions against their theoretical objectives and (3) compare the efficacy of single- versus combined-theory interventions. A systematic search through databases and review articles was carried out. Our results show that theory-based interventions (k = 82) significantly impact the PA behaviour of participants (d = 0.31, 95% CI [0.24, 0.37]). While moderation analyses revealed no efficacy difference between theories, interventions based on a single theory (d = 0.35; 95% CI [0.26, 0.43]) reported a higher impact on PA behaviour than those based on a combination of theories (d = 0.21; 95% CI [0.11, 0.32]). In spite of the global positive effect of theory-based interventions on PA behaviour, further research is required to better identify the specificities, overlaps or complementarities of the components of interventions based on relevant theories.

Smoking Cessation, Depression, and Exercise: Empirical Evidence, Clinical Needs, and Mechanisms

INTRODUCTION Smoking is significantly more common among persons with major depressive disorders (MDDs). Furthermore, smokers with MDD report more difficulties when they quit smoking (greater withdrawal symptoms, higher probability of relapse). The aim of this narrative review is to describe research on exercise and depression and exercise and smoking cessation. METHODS We have critically reviewed various smoking cessation intervention programs for depressive smokers examining (a) the protective effect of exercise against relapse for smokers with MDD and (b) the benefits of exercise for treating withdrawal symptoms. We have also reviewed the current literature investigating the mechanisms between exercise-depression and exercise-smoking. RESULTS This review suggests that exercise may reduce depressive symptoms following cessation and provide a useful strategy for managing withdrawal symptoms in smokers with MDD. Various psychological, biological, and genetic hypotheses have been tested (e.g., distraction hypothesis, expectations hypothesis, cortisol hypothesis) and few have obtained significant results. CONCLUSIONS It might be beneficial for health professionals to recommend physical activity and promote supervised exercise sessions for smokers with MDD during smoking cessation. Future research needs to examine relationships between exercise, smoking, and depression with transdisciplinary and ecological momentary assessment.

Associations between physical activity and the built environment in patients with schizophrenia: a multi-centre study

OBJECTIVE This study investigated the variance in walking, moderate and vigorous physical activity (PA), explained by neighbourhood design and other environmental variables above and beyond the variance accounted for by demographical variables. METHOD A total of 138 patients (46♀) with schizophrenia (mean age = 41.2 ± 12.5 years) from 13 different centres in Belgium were included in this 4-month cross-sectional study. The built environment was rated using the Instruments for Assessing Levels of Physical Activity and Fitness (ALPHA) environmental questionnaire, which was validated first. PA levels were assessed with the International Physical Activity Questionnaire. RESULTS Validity coefficients for the ALPHA ranged between 0.44 and 0.86 and test-retest reliability intraclass correlation coefficients ranged between 0.64 and 0.84. Regression analyses showed that environmental variables were related to all types of PA. The variance explained by the models including demographic and environmental variables ranged from 20% for vigorous PA up to 68% for walking. Minutes of walking (r=0.63, P<.001) and of moderate-intensity PA (r = 0.43, P<.001) were related to emotional satisfaction with the environment. Moderate-intensity PA was also related to the presence of PA supplies at home (r=0.49, P<.001). CONCLUSION Neighbourhood design and other environmental variables show significant associations with multiple types of PA in patients with schizophrenia.

Bénéfices des activités physiques adaptées dans la prise en charge de la schizophrénie : revue systématique de la littérature

INTRODUCTION Previous reviews of exercise and mental health have predominantly examined chronic illness and more recently, several psychiatric disorders. There is growing evidence that exercise can also be an effective treatment for major depressive disorders, anxiety disorders and alcohol dependence. Individuals with schizophrenia are more likely to be sedentary than the general population. OBJECTIVES The objectives of this systematic review are to analyse the habits of physical activity and examine the literature that has investigated the use of exercise as treatment for schizophrenia. METHOD We systematically reviewed psycINFO, Medline/PubMed, SportDiscus, Web of Sciences, and Cochrane Library. The searches of databases were conducted from database inception until September 2010, using a range of search terms to reflect both physical activity and schizophrenia. Studies were subsequently considered eligible if they reported on quantitative studies investigating the effect of physical activity upon some aspect of physical or mental health in individuals with schizophrenia. RESULTS Of the 139 articles retrieved, 19 studies met the inclusion criteria. In controlled studies, most authors have underlined the benefits of aerobic exercises. These programs may act both on positive symptoms (hallucinations) and on negative symptoms. According to certain studies, the positive effect may appear in a short time and at the end of the program. No studies assess long-term benefits. Small samples of self selected participants, inadequately selected control groups are common methodological weaknesses. A recent research has directly investigated the potential mechanism underpinning the positive benefits. The results indicated that hippocampal volume is plastic in response to aerobic exercise. DISCUSSION We discuss methodological and practical challenges to research in this area, and outline several research questions that future work should seek to address. Existing studies do suggest that lifestyles, physical activity interventions, or regular exercise programmes are possible in this population and can have beneficial effects on both the mental and physical health and well being of individuals with schizophrenia. CONCLUSION Research into the efficacy and safety of exercise as an intervention in schizophrenia is required to support the development of detailed, population-specific guidelines. Larger randomised studies are required before any definitive conclusions can be drawn. Although studies included in this review are small and used various measures of physical and mental health, results indicated that regular exercise programmes are possible in this population, and that they can have beneficial effects on both physical and mental health. Future research should address issues of programme adherence.

Associations between perceived neighbourhood environmental attributes and self-reported sitting time in patients with schizophrenia: a pilot study.

Sitting behaviours may, independent of physical activity behaviours, be a distinct risk factor for multiple adverse health outcomes in patients with schizophrenia. In order to combat sitting behaviours health care providers and policy makers require further understanding of its determinants in this population group. The aim of the present study was to investigate the variance in sitting time explained by a wide range of community design and recreational environmental variables, above and beyond the variance accounted for by demographic variables. One hundred and twenty-three patients (42♀) with schizophrenia (mean age=41.5 ± 12.6 years) were included in the final analysis. The built environment was rated using the Instruments for Assessing Levels of Physical Activity and Fitness environmental questionnaire and sitting time was assessed using the International Physical Activity Questionnaire-short (IPAQ) version. Regression analysis showed that environmental variables were related to sitting time. The body mass index (BMI) and disease stage explained 8.4% of the variance in sitting, while environmental correlates explained an additional 16.8%. Clinical practice guidelines should incorporate strategies targeting changes in sitting behaviours, from encouraging environmental changes to the availability of exercise equipment.

Prevalence and Smoking Behavior Characteristics of Nonselected Smokers With Childhood and/or Adult Self-Reported ADHD Symptoms in a Smoking-Cessation Program A Cross-Sectional Study

Background: ADHD involves impairing core symptoms of inattention and hyperactivity/impulsivity in children (childhood ADHD = CH) that may persist in adulthood (adult ADHD = AD). Conflicting findings have been found regarding AD prevalences among adult smokers, and it is unclear whether AD is associated with a more severe smoking behavior in adulthood. Objective: The aim of this article is (a) to determine CH and AD prevalences in a nonselected sample of adult smokers, (b) to describe the characteristics of smokers with ADHD symptoms versus those without, and (c) to determine whether CH and/or AD symptoms are risk factors for more severe smoking in adulthood. Method: Three hundred and seventy-three participants aged 18 years and over were prospectively recruited in a smoking-cessation unit. Participants were classified as “no ADHD symptoms,” “CH symptoms,” or “AD symptoms” according to their baseline score on the Wender Utah Rating Scale (WURS) alone (for CH symptoms) and WURS combined to the Adult Self Report Scale (ASRS) for AD symptoms. Other clinical variables were reported at first consultation. Results: (a) CH symptoms were reported in 15.3% (57/373) of the total sample, 42.1% (24/57) of whom also had persistent ADHD symptoms in adulthood (prevalence of AD was 24/373 = 6.4%). (b) In comparison with participants without ADHD symptoms, smokers with ADHD symptoms consume significantly more tobacco, but ADHD symptoms were no longer significantly associated with the daily number of smoked cigarettes after adjustment for sociodemographic variables. No significant association was found between the two groups and age at the first cigarette, age at onset daily smoking, and nicotine dependence. (c) Participants were categorized into three groups: Group 1 without ADHD symptoms lifetime (NH; n = 316), Group 2 with childhood history of ADHD symptoms (CH; n = 33), and Group 3 with Adult ADHD symptoms (AD; n = 24). The association with tobacco consumption (>20 cigarettes/day) was significant for CH only (p = .02). After adjustment for gender, age, professional status, and educational level, this association was not longer significant. Conclusion: Childhood and adult ADHD symptoms are both highly prevalent among nonselected smokers but our study failed to show more severe smoking characteristics among these participants after adjustment with sociodemographic variables.

Six minutes walk test for individuals with schizophrenia.

Abstract Purpose: The six-minute walk test (6MWT) is a sub-maximal exercise test measuring the distance that a patient can walk quickly in a period of 6 minutes (6MWD). The objectives of this systematic review are to evaluate the 6MWTs suitability for measuring the impact of an intervention, to compare the 6MWD walked by patients with schizophrenia with data for the general population or matched controls, to identify the determinants of 6MWD and to examine the measurement properties and quality procedures of the 6MWT. Methods: Using five databases, we performed a systematic review of full-text articles published through August 2013. Results: Sixteen studies met our selection criteria. The assessment of the 6MWTs suitability for measuring the impact of interventions was not made because none of the interventional studies reported a significant increase in 6MWD. The distance walked by adults with schizophrenia seemed generally shorter than that walked by healthy adults. Mean 6MWDs ranged from 421 m to 648 m in the included studies. The 6MWD is usually negatively associated with a higher Body Mass Index, increased cigarette consumption, higher doses of antipsychotic medication and lower physical self-worth in individuals with schizophrenia. The 6MWT demonstrates high reliability. To date, however, its criterion validity has not been investigated. In spite of existing guidelines, the test procedures used in the studies reviewed varied significantly. Conclusions: Future physical health monitoring recommendations for patients with schizophrenia should include the 6MWT. Future studies should investigate its predictive role and continue to assess its measurement properties. Implications for Rehabilitation The Six-Minute Walk Test reliably assesses the functional exercise capacity in patients with schizophrenia. The impact of therapeutic interventions on patients, as measured by the 6MWT, cannot be confirmed. Clinicians should take into account overweight, antipsychotic medication use and the physical self-perception when considering the functional exercise capacity in schizophrenia. Clinicians should follow International standards such as these of the American Thoracic Society when using the Six-Minute Walk Test in patients with severe mental illnesses.

Physical Activity as a Protective Factor in Relapse Following Smoking Cessation in Participants with a Depressive Disorder

The factors predicting smoking abstinence in depressive smokers, and the role of physical activity in precessation, were investigated. One hundred thirty-three smokers with current major depressive disorders (score ≥10 on the Depression subscale of Hospital Anxiety and Depression Scale) were recruited from a large prospective cohort of smokers (n = 1,119). Over a maximum period of 3 years, regression modeling, adjusted for potential confounders, showed that physical activity was associated with relapse (relapse rate = 0.54, 95% confidence interval = 0.34-0.85, p = .008). Also, antidepressants, anxiolytics, level of education, and number of attempts to quit were associated with relapse. The protective role of physical activity on relapse rate could be a modifiable factor in smoking cessation for smokers with depressive disorders.

Health-related quality of life and stages of behavioural change for exercise in overweight/obese individuals.

BACKGROUND Stages of change in exercise behaviour have been shown to be associated with health-related quality of life (HRQoL) in overweight/obese adults. However, studies examining this relationship have not used questionnaires specifically designed for such a population. The present study assessed the impact of stages of change (SOC) for exercise, using the transtheoretical model, on the HRQoL, using the quality of life, obesity and dietetics (QOLOD) scale, an obesity-specific QoL questionnaire. Our hypothesis was that the more people are in the advanced stages of behavioural change, the better their HRQoL. METHODS A total of 214 consecutive obese individuals (148 women/66 men, mean age 47.4 ± 14.0 years, BMI 37.2 ± 8.4 kg/m2) were included in the cross-sectional study, and all completed SOC and QOLOD questionnaires. RESULTS Multivariate analysis of covariance (MANCOVA) established significant effects on the overall composite of the five dimensions of the QOLOD (P < 0.001). Analysis of covariance (ANCOVA) further determined the significant effect of SOC in terms of physical impact (P < 0.001) and psychosocial impact (P < 0.01), with marginally significant effects on sex life (P = 0.07), but no impact on comfort with food (P = 0.13) or on the dieting experience (P = 0.13), two dimensions evaluating attitudes toward food. CONCLUSION In obese/overweight individuals, the HRQoL varies with the SOC, with those in the more advanced behavioural stages reporting better HRQoL. However, dimensions related to food showed no differences according to SOC, confirming the complexity of the relationship between exercise and nutrition, and the need for further studies to acquire a more complete understanding of their underlying mechanisms.