Sarah E. Neil-Sztramko

Health-related interventions among night shift workers: a critical review of the literature

OBJECTIVES Associations between shift work and chronic disease have been observed, but relatively little is known about how to mitigate these adverse health effects. This critical review aimed to (i) synthesize interventions that have been implemented among shift workers to reduce the chronic health effects of shift work and (ii) provide an overall evaluation of study quality. METHODS MeSH terms and keywords were created and used to conduct a rigorous search of MEDLINE, CINAHL, and EMBASE for studies published on or before 13 August 2012. Study quality was assessed using a checklist adapted from Downs & Black. RESULTS Of the 5053 articles retrieved, 44 met the inclusion and exclusion criteria. Over 2354 male and female rotating and permanent night shift workers were included, mostly from the manufacturing, healthcare, and public safety industries. Studies were grouped into four intervention types: (i) shift schedule; (ii) controlled light exposure; (iii) behavioral; and, (iv) pharmacological. Results generally support the benefits of fast-forward rotating shifts; simultaneous use of timed bright light and light-blocking glasses; and physical activity, healthy diet, and health promotion. Mixed results were observed for hypnotics. Study quality varied and numerous deficiencies were identified. CONCLUSIONS Except for hypnotics, several types of interventions reviewed had positive overall effects on chronic disease outcomes. There was substantial heterogeneity among studies with respect to study sample, interventions, and outcomes. There is a need for further high-quality, workplace-based prevention research conducted among shift workers.

Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review

QUESTION What are typical values of physical function for women diagnosed with breast cancer and how do these compare to normative data? DESIGN Systematic review with meta-analysis. PARTICIPANTS Women diagnosed with breast cancer who were before, during or after treatment. OUTCOME MEASURES Physical function was divided into three categories: aerobic capacity, upper and lower extremity muscular fitness, and mobility. Measures of aerobic capacity included field tests (6-minute walk test, 12-minute walk tests, Rockport 1-mile test, and 2-km walk time) and submaximal/maximal exercise tests on a treadmill or cycle ergometer. Measures of upper and lower extremity muscular fitness included grip strength, one repetition maximum (bench, chest or leg press), muscle endurance tests, and chair stands. The only measure of mobility was the Timed Up and Go test. RESULTS Of the 1978 studies identified, 85 were eligible for inclusion. Wide ranges of values were reported, reflecting the range of ages, disease severity, treatment type and time since treatment of participants. Aerobic fitness values were generally below average, although 6-minute walk time was closer to population norms. Upper and lower extremity strength was lower than population norms for women who were currently receiving cancer treatment. Lower extremity strength was above population norms for women who had completed treatment. CONCLUSION Aerobic capacity and upper extremity strength in women diagnosed with breast cancer are generally lower than population norms. Assessment of values for lower extremity strength is less conclusive. As more research is published, expected values for sub-groups by age, treatment, and co-morbidities should be developed. [Neil-Sztramko SE, Kirkham AA, Hung SH, Niksirat N, Nishikawa K Campbell KL (2014) Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review.Journal of Physiotherapy60: 189-200].

The Impact of Obesity in the Workplace: a Review of Contributing Factors, Consequences and Potential Solutions

This narrative review summarized findings from previous reviews and the most recently published studies, regarding the following: (1) the association between two occupational risk factors—shift work and sedentary work—and obesity, (2) the effects of obesity on workplace productivity and (3) the effectiveness of workplace interventions aimed at preventing or reducing obesity. Despite some inconsistencies in findings, there is convincing evidence that shift work increases the risk of obesity, while most studies did not show a significant association between sedentary work and obesity. Overweight and obesity were found to be associated with absenteeism, disability pension and overall work impairment, whilst evidence of their relationship with presenteeism, unemployment and early retirement was not consistent. Due to the vast heterogeneity in the types of workplace-based interventions to prevent or treat obesity, no sound conclusions can as yet be drawn about their overall effectiveness and best practice recommendations for their implementation.

Effect of aerobic exercise on cancer-associated cognitive impairment: A proof-of-concept RCT.

Change in cognitive ability is a commonly reported adverse effect by breast cancer survivors. The underlying etiology of cognitive complaints is unclear and to date, there is limited evidence for effective intervention strategies. Exercise has been shown to improve cognitive function in older adults and animal models treated with chemotherapy. This proof‐of‐concept randomized controlled trial tested the effect of aerobic exercise versus usual lifestyle on cognitive function in postmenopausal breast cancer survivors.

Physical Activity, Physical Fitness, and Body Composition of Canadian Shift Workers: Data From the Canadian Health Measures Survey Cycles 1 and 2.

Objectives: The aim of the study was to compare objectively measured physical activity, sedentary time, physical fitness, and body composition in shift workers (SWs) with those who work regular days. Methods: Population-based, cross-sectional data from the Canadian Health Measures Survey (n = 4323) were used. Univariate and multivariate linear and logistic regression models were used to compare outcomes between SWs and day workers. Results: In unweighted analyses, SWs were more likely to have poor body composition, although had fewer minutes per week of sedentary time. Despite no differences in physical activity, SWs had a lower aerobic capacity. In weighted analyses, only differences in aerobic capacity were observed. Conclusions: This analysis confirms previous findings that SWs have poorer body composition than day workers, and suggest that SWs may need to engage in more physical activity to achieve the same aerobic capacity as day workers.

Updated systematic review of exercise studies in breast cancer survivors: attention to the principles of exercise training

Objectives To update our previous evaluation of the exercise interventions used in randomised controlled trials of breast cancer survivors in relation to (1) the application of the principles of exercise training in the exercise prescription; (2) the reporting of the components of the exercise prescription; and (3) the reporting of adherence of participants to the prescribed interventions. Design Systematic review. Data sources The OVID Medline, Embase, CINAHL and SPORTDiscus electronic databases were searched from January 2010 to January 2017. Eligibility criteria Randomised controlled trials of at least 4 weeks of aerobic and/or resistance exercise in women diagnosed with breast cancer, reporting on physical fitness or body composition outcomes. Results Specificity was appropriately applied by 84%, progression by 29%, overload by 38% and initial values by 67% of newly identified studies. Reversibility was reported by 3% anddiminishing returns by 22% of newly identified studies. No studies reported all components of the exercise prescription in the methods, or adherence to the prescribed intervention in the results. Reporting of reversibility has increased from 2010, but no other improvements in reporting were noted from the previous review. Summary/Conclusion No studies of exercise in women with breast cancer attended to all principles of exercise training, or reported all components of the exercise prescription in the methods, or adherence to the prescription in the results. Full reporting of the exercise prescribed and completed is essential for study replication in research and translating research findings into the community, and should be prioritised in future trials.

Utility of Equations to Estimate Peak Oxygen Uptake and Work Rate From a 6-Minute Walk Test in Patients With COPD in a Clinical Setting.

PURPOSE: To determine the utility of equations that use the 6-minute walk test (6MWT) results to estimate peak oxygen uptake ( o2) and peak work rate with chronic obstructive pulmonary disease (COPD) patients in a clinical setting. METHODS: This study included a systematic review to identify published equations estimating peak o2 and peak work rate in watts in COPD patients and a retrospective chart review of data from a hospital-based pulmonary rehabilitation program. The following variables were abstracted from the records of 42 consecutively enrolled COPD patients: measured peak o2 and peak work rate achieved during a cycle ergometer cardiopulmonary exercise test, 6MWT distance, age, sex, weight, height, forced expiratory volume in 1 second, forced vital capacity, and lung diffusion capacity. Estimated peak o2 and peak work rate were estimated from 6MWT distance using published equations. The error associated with using estimated peak o2 or peak work to prescribe aerobic exercise intensities of 60% and 80% was calculated. RESULTS: Eleven equations from 6 studies were identified. Agreement between estimated and measured values was poor to moderate (intraclass correlation coefficients = 0.11-0.63). The error associated with using estimated peak o2 or peak work rate to prescribe exercise intensities of 60% and 80% of measured values ranged from mean differences of 12 to 35 and 16 to 47 percentage points, respectively. CONCLUSIONS: There is poor to moderate agreement between measured peak o2 and peak work rate and estimations from equations that use 6MWT distance, and the use of the estimated values for prescription of aerobic exercise intensity would result in large error. Equations estimating peak o2 and peak work rate are of low utility for prescribing exercise intensity in pulmonary rehabilitation programs.

Physical Activity Levels of Physiotherapists across Practice Settings: A Cross-Sectional Comparison Using Self-Report Questionnaire and Accelerometer Measures

Purpose: This article describes the physical activity of physiotherapists in British Columbia and examines differences across practice settings using self-report questionnaire and accelerometer-derived measures. Methods: Public and private practice physiotherapists aged 18-65 years were recruited through employee email lists and word of mouth to this cross-sectional study. Participants (n=98) completed the International Physical Activity Questionnaire-Long Form (IPAQ-L) online to quantify self-reported physical activity across various domains (occupational, leisure time, domestic, and transportation). Of these, 38 agreed to wear an accelerometer for 7 days to objectively measure physical activity. Descriptive statistics were used to describe self-reported and accelerometer-measured physical activity across domains, and inferential statistics were used to compare physical activity patterns across practice sites. The correlation and agreement between self-report questionnaire and accelerometer measures were also calculated. Results: Almost all (99%) of the physiotherapists self-reported meeting physical activity guidelines, and only 58% were classified as meeting guidelines when using accelerometers. Public practice physiotherapists self-reported more total, occupational, and domestic physical activity and had higher measured occupational physical activity than private practice physiotherapists. Overall, there was poor agreement between self-report questionnaires and accelerometers. Conclusions: Physiotherapists are an active group, with those in public practice reporting and participating in more physical activity than those in private practice.

Fee-for-service cancer rehabilitation programs improve health-related quality of life.

BACKGROUND Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates. METHODS After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session. RESULTS Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629). CONCLUSIONS Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for delivery of exercise to more cancer survivors.

Feasibility of a telephone and web-based physical activity intervention for women shift workers.

INTRODUCTION Shift work (an occupation requiring work between 2200 and 0500H) comprises approximately 20% of the workforce in Europe and North America [1]. This is likely to increase, with many shift workers (SWs) in emergency services, retail, hospitality, healthcare, transportation and manufacturing [2]. SWs are at increased risk for negative health outcomes, including cancer and other chronic diseases [3, 4]. Biological changes from poor lifestyle habits related to shift work (e.g. low physical activity (PA), poor nutrition, obesity) are thought to contribute to this risk; these factors are also amenable to lifestyle intervention [5]. PA in particular, reduces cancer risk [6], and has many positive physical and psychological benefits [7]. It is a simple, cost-effective strategy that may be implemented by individual workers or within workplaces to mitigate risk. Unfortunately, SWs are unlikely to engage in regular PA [8]. In Canada, only 15.9% of SWsmeet the PA guidelines and have lower levels of aerobic fitness than those of day workers [9]. Few behavioural interventions improving health outcomes in SWs have been published [10]. In a targeted PA intervention, nurses randomised to 4 months of supervised PA improved aerobic fitness, muscular strength, fatigue and musculoskeletal symptoms. However, authors reported low adherence and large loss to follow-up, perhaps due to the supervised scheduled sessions [11, 12]. Sustained behaviour change is a challenge and requires targeted efforts to encourage individuals to reach an adequate dose of PA to change health outcomes [13]. Due to irregular schedules and time constraints, SWs may be less likely to adhere to a traditional supervised PA intervention with face-to-face behavioural support [12]. Women SWs cite work schedule interference and lack of time as PA barriers and report scheduling flexibility as the most important in PA [14]. This highlights the need for a creative and innovative programming to promote PA in SWs. Distance-based interventions, in which individuals exercise independent of study staff or participants, may include telephone counselling and website or smart phone app-based technology. These interventions are highly flexible and may help overcome barriers related to timing and scheduling that are important for SWs. In a review of telephone-based PA interventions, 14 of 17 found evidence for behaviour change [15]. These may be a way to implement scalable, individuallytailored interventions in SWs. The primary objective of this study was to test the feasibility of a distance-based PA intervention in women SWs. Feasibility studies are important for establishing effective processes and understanding resources required before attempting a randomised controlled trial (RCT), in order to put forward interventions that are most likely to be efficacious [16]. As this work was funded by a grant to examine the role of lifestyle in reducing breast cancer risk in SWs, only women were included. A secondary objective was to conduct a preliminary evaluation of intervention efficacy, to estimate effect size for future studies.