Richard Sloane

Physical function and associations with diet and exercise: Results of a cross-sectional survey among elders with breast or prostate cancer.

BackgroundFunctional decline threatens independent living and is common among individuals diagnosed with cancer, especially those who are elderly. The purpose of this study was to explore whether dietary and exercise practices are associated with physical function status among older cancer survivors.MethodsMailed surveys were used to ascertain data on physical function, dietary fat, fruit and vegetable (F&V) consumption, and exercise among elderly diagnosed with early stage (I-II) breast (N = 286) or prostate cancer (N = 402) within the past 18 months.ResultsSixty-one percent of respondents reported diets with <30% of energy from fat, 20.4% reported F&V intakes of 5+ daily servings, and 44.6% reported regular vigorous exercise. Significant, independent associations were found between physical functioning and reported dietary fat intake, F&V consumption, and exercise. A simultaneous multiple regression model controlled for age, race, gender, time since diagnosis and concurrent health behaviors yielded the following estimates: (1) 0.2 increase in the SF-36 physical function subscale (PFS) score with each reported 1% decrease in percent energy from fat (p < .0001); (2) 0.9 increase in the SF-36 PFS score for each reported serving of F&V/day (p = .0049); and (3) 15.4 increase in the SF-36 PFS score with a positive response for regular vigorous exercise (p < .0001).ConclusionsResults of this cross-sectional survey suggest that regular vigorous exercise and consumption of diets low in fat and rich in F&Vs are associated with higher levels of physical functioning among older cancer survivors. Interventions that promote healthful lifestyle change may deliver considerable benefit within this ever increasing and vulnerable population.

Effect of Physical Activity Guidelines on Physical Function in Older Adults

OBJECTIVES: To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa.

Association of knee and ankle osteoarthritis with physical performance

OBJECTIVEnThe direct measurement of the ability to perform physical tasks yields information about factors contributing to poor function and insights into strategies for preventing disability. Our goal was to evaluate the relationship of walking speed and balance tests with specific radiographic features of knee and ankle osteoarthritis (OA).nnnMETHODSnA timed eight foot walk and a standing balance test were performed by 138 participants of a longitudinal observational study of knee OA progression. Radiographic features of OA severity, joint space narrowing (JSN), a surrogate for cartilage loss and osteophyte (OST) formation, were assessed for the knee and ankle. The association of these performance measures with radiographic OA was evaluated using correlation analysis, adjusted for age, gender, body mass index (BMI), and number of comorbidities.nnnRESULTSnKnee and ankle JSN, but not OST, was negatively associated with specific performance tests: walking speed was associated with knee JSN (Spearman rho = -0.20, P = 0.02) and balance was associated with ankle (subtalar joint) JSN (Spearman rho = -0.22, P = 0.01). These relationships remained significant upon further control for knee and ankle pain.nnnCONCLUSIONSnStructural joint damage due to OA (JSN in contrast to OST) negatively impacted specific domains of physical performance. These results indicate that targeting specific joints for specific functional outcomes may be indicated, and suggest that prevention of cartilage damage in these joints is a sensible target for OA disease modification to prevent disability.

Long-Term Dietary Outcomes of the FRESH START Intervention for Breast and Prostate Cancer Survivors

BACKGROUNDnCancer survivors are at increased risk for secondary cancers and other diseases. Healthy dietary practices may improve cancer survivors health and well-being.nnnOBJECTIVEnThe durability of the effects of the FRESH START intervention, a program of sequentially tailored mailed materials, and standardized mailed materials (for controls) on cancer survivors dietary outcomes was assessed over a 2-year period. Greater dietary gains were expected for FRESH START participants relative to controls.nnnDESIGNnParticipants were randomized to receive tailored vs standardized 10-month mailed print interventions promoting diet and exercise behaviors. Data were collected at baseline and 1- and 2-year follow-ups.nnnPARTICIPANTS/SETTINGnBreast and prostate cancer survivors (n=543) were recruited from 39 states and two provinces within North America. A total of 489 participants completed the 2-year follow-up assessment (10% attrition).nnnINTERVENTIONnParticipants were randomly assigned to either a 10-month program of tailored mailed print materials promoting fruit and vegetable consumption, reduced total and saturated fat intake, and/or increased exercise or to a 10-month program of publicly available mailed materials on diet and exercise.nnnMAIN OUTCOME MEASURESnTelephone surveys (supported with blood biomarkers) assessed dietary habits at baseline and 1- and 2-year follow-ups.nnnSTATISTICAL ANALYSES PERFORMEDnPaired-samples t tests were conducted to examine the durability of the interventions effects on dietary outcomes within each study arm. Arm differences in follow-up outcomes were then tested with the general linear model, controlling for the baseline value of the outcomes.nnnRESULTSnBoth arms reported decreased saturated fat intake, increased servings of fruits and vegetables, and better overall diet quality at year 2 relative to baseline. However, FRESH START participants reported better overall diet quality and lower total and saturated fat intake compared to controls at the 2-year follow-up.nnnCONCLUSIONSnResults suggest that mailed material interventions, especially those that are tailored, can produce long-term dietary improvement among cancer survivors.

Impact of a pediatric quality of life program on providers' moral distress.

Purpose:To evaluate the impact of the introduction of a new pediatric palliative care program on the pattern of moral distress in pediatric healthcare providers (HCPs). Study Design and Methods:We used a before and after cross-sectional survey design to study the impact of the Pediatric Quality of Life (QoL) Program on the moral distress of pediatric HCPs at a single center. Moral distress is measured in both intensity and frequency. The sample came from lists of all pediatric providers (nurses, physicians, social workers, therapists, dieticians, chaplains, administrators) serving the inpatient and outpatient pediatric areas of a southeastern academic tertiary medical center. Results:The intensity of moral distress from situations focused on “individual responsibility” and “not in the best interest of the patient” were similar before and after program implementation, but the intensity of distress related to “work quality of life” decreased after program implementation. Situations causing moral distress when the “care given was not in the patients best interest” occurred less frequently after program implementation. Providers disagreed with statements that “work-related distress” impacted their personal or professional life. The number of providers who were considering leaving the institution within 6 months decreased following program implementation. Clinical Implications:After implementation of the Pediatric QoL Program, nurses and other providers encountered morally distressing situations less often. Providers also answered that they had greater comfort with and competence in providing care focused on patients quality of life after completing the program. As palliative care programs include many activities that reduce moral distress, nurses should actively take advantage of participation in debriefing sessions and staff education to maximize their work quality of life.

DEVELOPMENT OF A CLINICAL RATING SCALE FOR PERSONS WITH PARKINSON'S DISEASE

Primary care physicians are using proper discretion in limiting the use of neuroimaging studies. However, as I stated in the editorial, primary care physicians need a simple, quick, and valid screening tool that will help them decide which patients need more in-depth testing. I believe the evidence is clear that such in-depth testing should include a formal, standardized assessment tool (such as the MMSE). Better case finding and fewer unnecessary tests will better serve older patients.

Gender Differences in Care for Acquired Immunodeficiency Syndrome–Related Pneumocystis Carinii Pneumonia

The number of women with acquired immunodeficiency syndrome (AIDS) in the United States is increasing.1 Some reports have suggested that clinical manifestations of human immunodeficiency virus (HIV) in women may differ from those in men and that mortality rates for certain AIDS-defining illnesses are higher in women.2–6 In particular, in-hospital mortality rates for Pneumocystis carinii pneumonia (PCP), the most common severe opportunistic infection for persons with AIDS in the United States,7 have been shown to be worse for women compared with men.3 In a recent study8 of 4,500 persons with HIV infection, women were one third more likely to die earlier, without an AIDS-defining illness, than were men. Survival differences have been largely attributed to the differences between men and women with AIDS in severity of illness, degree of immunosuppression, and access to care.3,8–12

Cross-Sectional & Longitudinal Associations between Light-Intensity Physical Activity & Physical Function Among Cancer Survivors

Purpose: While moderate-vigorous intensity physical activities (MVPA) confer the greatest health benefits, evidence suggests that light-intensity activities are also beneficial, particularly for older adults and individuals with moderate-severe comorbidities. Cross-sectional and longitudinal associations between light-intensity physical activity and physical function were examined in elderly cancer survivors, who are at increased risk for age- and treatment related comorbidities, including accelerated functional decline. Methods: The analysis included 641 breast, prostate, and colorectal cancer survivors (54% female) aged 65 and older who participated in a 1-year, home-based diet and exercise intervention designed to reduce the rate of physical function decline. Pre- and post-intervention physical activity and function were assessed via the CHAMPS questionnaire, the SF-36 physical function subscale (PFS) and the Late Life Function and Disability Index basic and advanced lower-extremity function (LEF) subscales. ANCOVA was used to compare means of physical function across levels of PA intensity (low-light (LLPA): 1.0-2.0 METs; high-light (HLPA): 2.1-2.9 METs; MVPA: ≥3.0 METs). Results: After adjustment for age, sex, BMI, comorbidities, symptoms, and MVPA, increasing tertiles of baseline light-intensity activity were associated with higher scores for all 3 measures of baseline physical function (all p-values <0.005). Associations were stronger for HLPA than for LLPA. Compared with survivors who decreased or remained stable in MVPA and HLPA at the post-intervention follow-up, those who increased in HLPA, but not MVPA, reported higher physical function scores (LSMeans (95% CI): SF-36 PFS: −5.58 (−7.96, −3.20) vs. −2.54 (−5.83, 0.75), p = 0.14; basic LEF: -2.00 (−3.45, −0.55) vs. 0.28 (−1.72, 2.28), p = 0.07; advanced LEF: −2.58 (−4.00, −1.15) vs. 0.44 (-1.52, 2.40), p = 0.01). Conclusions: Our findings suggest that increasing light-intensity activities, especially HLPA, may be a viable approach to reducing the rate of physical function decline in individuals who are unable or reluctant to initiate or maintain adequate levels of moderate-intensity activities.Purpose: While moderate-vigorous intensity physical activities (MVPA) confer the greatest health benefits, evidence suggests that light-intensity activities are also beneficial, particularly for older adults and individuals with moderate-severe comorbidities. Cross-sectional and longitudinal associations between light-intensity physical activity and physical function were examined in elderly cancer survivors, who are at increased risk for age- and treatment related comorbidities, including accelerated functional decline. Methods: The analysis included 641 breast, prostate, and colorectal cancer survivors (54% female) aged 65 and older who participated in a 1-year, home-based diet and exercise intervention designed to reduce the rate of physical function decline. Pre- and post-intervention physical activity and function were assessed via the CHAMPS questionnaire, the SF-36 physical function subscale (PFS) and the Late Life Function and Disability Index basic and advanced lower-extremity function (LEF) subscales. ANCOVA was used to compare means of physical function across levels of PA intensity (low-light (LLPA): 1.0-2.0 METs; high-light (HLPA): 2.1-2.9 METs; MVPA: ≥3.0 METs). Results: After adjustment for age, sex, BMI, comorbidities, symptoms, and MVPA, increasing tertiles of baseline light-intensity activity were associated with higher scores for all 3 measures of baseline physical function (all p-values <0.005). Associations were stronger for HLPA than for LLPA. Compared with survivors who decreased or remained stable in MVPA and HLPA at the post-intervention follow-up, those who increased in HLPA, but not MVPA, reported higher physical function scores (LSMeans (95% CI): SF-36 PFS: −5.58 (−7.96, −3.20) vs. −2.54 (−5.83, 0.75), p = 0.14; basic LEF: -2.00 (−3.45, −0.55) vs. 0.28 (−1.72, 2.28), p = 0.07; advanced LEF: −2.58 (−4.00, −1.15) vs. 0.44 (-1.52, 2.40), p = 0.01). Conclusions: Our findings suggest that increasing light-intensity activities, especially HLPA, may be a viable approach to reducing the rate of physical function decline in individuals who are unable or reluctant to initiate or maintain adequate levels of moderate-intensity activities.nnThe following are the 18 highest scoring abstracts of those submitted for presentation at the 37th Annual ASPO meeting held March 10–12, 2013, in Memphis, TN.

Transition to adult care in sickle cell disease: A longitudinal study of clinical characteristics and disease severity

Sickle cell disease (SCD) is a chronic blood disorder in which mortality has increased for adolescents and young adults (AYA).