Tai Chi effects on neuropsychological, emotional, and physical functioning following cancer treatment: a pilot study

Objective

To examine the effects of a 10-week Tai Chi (TC) program on neuropsychological, psychological, and physical health of female cancer survivors.

Design

Twenty-three women with a history of cancer participated in 60-min TC classes two times/week for 10-weeks.

Main Outcome Measures

Before and after the intervention, participants completed neuropsychological tests (memory, executive functioning, language, and attention); 5 tests of balance; and self-report questionnaires of neuropsychological complaints, stress and mood, and fatigue.

Results

After the 10-week session, participants evidenced fewer neuropsychological complaints and enhanced neuropsychological functioning. They also demonstrated improved balance and reported better psychological functioning.

Conclusions

Results suggest that TC may promote gains in neuropsychological functioning, in addition to previously demonstrated improvements in physical and psychological health. These findings support the need for controlled trials examining the potential benefits of TC on neuropsychological functioning after cancer.     

Influence of habitual physical activity on body composition,fat distribution and metabolic variables in early postmenopausal women receiving hormonal therapy

Objective

To determine whether there is an association between the level of habitual physical activity, body composition and anthropometric and metabolic variables in postmenopausal patients before and after hormone replacement therapy (HRT).

Study design

Thirty-four healthy, recent postmenopausal women (50 ± 2.7 years; 23.8 ± 10 months since menopause) consulting for symptoms of estrogen deficiency were included in the study. Anthropometric assessment, percent of body fat (BF) estimated by skinfold measures, and metabolic evaluation were performed before and 4 months after the start of HRT, which included non-oral or low-dose oral preparations. The status of physical activity was defined by counting steps with a pedometer. Patients were stratified as active (6000 steps ore more per day) or inactive (fewer than 6000 steps per day). Results are expressed as mean ± SD or median and interquartile range. log 10 transformation was used to normalize the distribution of non-Gaussian variables. ANOVA for repeated measures was performed for the active and inactive groups, before and after HT. Pearson correlation coefficient was used to investigate the relationship between anthropometric and metabolic variables and habitual physical activity.

Results

BMI and BF did not change with HRT in comparison with baseline. In contrast, a decline was observed in waist circumference (WC) and waist to hip ratio (WHR) after HRT in both active and inactive women (P < 0.01). While triglycerides and glucose did not change after HRT, total and LDL-cholesterol decreased from baseline. In contrast, after HRT, active patients were found to have lower BF than inactive women (active: 25.4 ± 2.5; inactive: 26.6 ± 2, P = 0.01). There was a significant negative correlation between habitual physical activity (number of steps per day) and BF (r = −0.36, P = 0.04). After HRT, when only active patients were considered, a significant negative correlation was found between the number of steps and WC (r = −0.42, P = 0.04) and WHR (r= −0.58, P = 0.03).

Conclusion

Habitual physical activity plays a major role in preserving a favorable cardiovascular profile in postmenopausal patients using HRT.     

Mat Pilates and belly dance: Effects on patient-reported outcomes among breast cancer survivors receiving hormone therapy and adherence to exercise

BackgroundBreast cancer treatment leads to several side effects. Exercise can help to reduce these side effects. However, it is unknown whether a mat Pilates or a belly dance intervention can improve the patient-reported outcomes of these women.ObjectiveExamine the effects of a 16-week exercise intervention (mat Pilates or belly dance) on patient reported outcomes (PROs) among breast cancer survivors, at 16 weeks, six months, and 12 months; and investigate sociodemographic and clinical predictors of intervention adherence.MethodsSeventy-four breast cancer survivors who were receiving hormone therapy were randomly allocated into mat Pilates (n = 25), belly dance (n = 25) or control group (educational sessions) (n = 24). Mat Pilates and belly dance groups received a 16-week intervention, delivered three days a week and 60 min a session. The control group received three education sessions and continue usual care. The patient reported outcomes assessed were depressive symptoms (Beck Depression Inventory), stress (Perceived Stress Scale), optimism (Life Orientation Test), fatigue (FACT-F), sleep quality (Pittsburgh Sleep Quality Index) and pain (VAS), clinical and sociodemographic characteristics, and habitual physical activity (IPAQ short).ResultsAll three groups showed a significant improvement in fatigue, and this effect was maintained during follow-up. No significant effects were found for depressive symptoms, optimism, stress, or pain. A history of exercise prior to breast cancer and be inactive after diagnosis were significant predictors of adherence to interventions.ConclusionMat Pilates, belly dance and a few educational sessions can be effective in improving fatigue after 16 weeks of intervention.RegistrationClinicalTrials.gov (NCT03194997).     

Effects of Tai Chi Yunshou on upper-limb function and balance in stroke survivors: A systematic review and meta-analysis

Background and purposePhysical rehabilitation plays an important role in the recovery of motor function after a stroke. This study aimed to evaluate the effects of Tai Chi Yunshou (TCY), a form of physical therapy, on upper-limb function and balance in stroke survivors.MethodsMEDLINE, Embase, CENTRAL and five Chinese databases were retrieved from inception to July 1, 2020 (updated on March 31, 2022). Randomized controlled trials of TCY versus no-treatment for stroke were included. The RoB-2 was used to evaluate the quality of included studies. Upper-limb motor impairment, balance, and activities of daily living (ADLs) were measured by Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), Berg Balance Scale (BBS), and Barthel Index (BI), respectively. Data synthesis was performed using RevMan (v5.3), and expressed as mean difference (MD) with 95% confidence intervals (CI).ResultsSeven studies with 529 participants were included. Compared with no-treatment, TCY improved FMA-UE (MD = 7.31, 95% CI: 5.86–8.77, minimal clinically important difference [MCID]: 9–10), BBS (MD = 4.68, 95% CI: 0.28–9.07, MCID: 4), and BI (MD = 4.12, 95% CI: 3.28–4.96, MCID: 1.85) in stroke survivors.ConclusionTCY may benefit balance and ADLs in rehabilitation after a stroke, but it may not improve upper-limb function clinically.     

Tai Chi for anxiety and depression symptoms in cancer,stroke, heart failure,and chronic obstructive pulmonary disease: A systematic review and meta-analysis

BackgroundMany middle-aged and older adults have more than one chronic health condition. It is therefore important to explore the effectiveness of interventions for multiple chronic conditions. Tai Chi is widely used in China and other countries, and many studies have examined the effect of Tai Chi on anxiety and depression. However, there are no systematic reviews of the effect of Tai Chi on anxiety and depression in various chronic conditions. This systematic review and meta-analysis aimed to evaluate the effects of Tai Chi on anxiety and depression symptoms in four chronic conditions: cancer, stroke, heart failure (HF), and chronic obstructive pulmonary disease (COPD).MethodsWe searched Chinese and English databases (Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Sinomed) from inception to October 2020. Review Manager version 5.2 and Stata version 12.0 were used to perform a systematic review. The quality of the included studies was evaluated using the Cochrane risk of bias tool. The study was registered with the PROSPERO database (number CRD42020209594).ResultsOf the 596 studies identified, we included 25 randomized controlled trials involving 1819 participants. Combined analysis of the four diseases showed statistically significant differences between the Tai Chi and control groups for anxiety symptoms (SMD −0.99, 95%CI: −1.5, −0.47; P < 0.01) and depressive symptoms (SMD 0.70, 95%CI: −1.01, −0.39; P < 0.01). Subgroup analyses showed statistically significant differences between the Tai Chi and control groups for depressive symptoms in stroke (SMD −0.43, 95%CI: −0.67, −0.18; P < 0.01) and HF (SMD −0.57, 95%CI: −0.8, −0.33; P < 0.01). However, no statistically significant differences were found for depressive symptoms in COPD or cancer. There were statistically significant differences between the Tai Chi and control groups for anxiety symptoms in stroke (SMD −0.60, 95%CI: −0.88, −0.32; P < 0.01) and cancer (SMD −0.69, 95%CI: −1.22, −0.17; P < 0.01), but not in COPD or HF. Subgroup, sensitivity, meta regression, and publication bias analyses showed high heterogeneity correlated with a single study and study quality. Sensitivity analysis showed that most meta-analysis results had good stability, but those for anxiety symptoms in COPD were unstable; therefore, careful interpretation is required.ConclusionTai Chi has a positive effect on anxiety and depression, especially for patients with cancer, stroke, and HF. However, given the weak evidence, this approach is not a substitute for psychiatric treatment.     

The effects of water-based exercise on body composition: A systematic review and meta-analysis

AimsThis study aimed to investigate the effects of water-based exercise (WBE) on body composition.MethodsTrials published up to October 28, 2022 were searched using the PubMed, EMBASE, Web of Science, Cochrane, Scopus, and Ovid databases. Randomized controlled trials of healthy adults published in English, comparing WBE and control groups, were included. Other studies with different research designs and participants with medical diagnoses were excluded. The main outcome measures were body weight (BW), body fat mass (BFM), body fat percentage (BFP), lean mass (LM), and skeletal muscle mass (SMM).ResultsOverall, 17,458 potential studies were identified. After a closer inspection, 79 full-length articles were considered for further screening. Finally, 20 studies, involving 565 participants, were included in the meta-analysis. The WBE was beneficial in reducing BW, BFM, and BFP and increasing LM and SMM. Subgroup analyses were conducted based on different exercise intensities and times per week. Moderate- or moderate-vigorous-intensity exercise helped improve body composition, while lower-intensity WBE or aquatic high-intensity interval training (HIIT) seemed less helpful. Training for <120 min/week was insufficient to improve body composition. Training for >120 min/week was associated with improvements in body composition.ConclusionsModerate- or moderate-vigorous-intensity WBE helps improve body composition. Adults are encouraged to exercise for >120 min/week.     

A randomised controlled trial testing the feasibility and efficacy of a physical activity behavioural change intervention in managing fatigue with gynaecological cancer survivors

Objective

To determine the feasibility and efficacy of a physical activity behavioural change intervention in managing cancer-related fatigue among gynaecological cancer survivors during and post anti-cancer treatments.

Methods

A two arm, single blind, randomised controlled trial was conducted within the Northern Ireland regional Cancer Centre. Thirty three sedentary gynaecological cancer survivors (stage I-III; ≤ 3 years post diagnosis), experiencing cancer-related fatigue (mild-severe) took part. Participants were randomly assigned to a behavioural change, moderate intensity physical activity intervention (n = 16) or a Contact Control group (n = 17). The primary outcome was fatigue (Multidimensional Fatigue Symptom Inventory—Short Form and Functional Assessment in Chronic Illness Therapy—Fatigue subscale). Secondary outcomes included quality of life, physical functioning, positive and negative affect, depression, body composition, sleep dysfunction and self-reported physical activity. Feasibility was assessed based on the recruitment rate, programme and physical activity adherence and participants' programme evaluation, including optional focus groups (n = 16).

Results

Twenty five percent of eligible women took part (33/134). Participants were 8.7 (SD = 9.1) months post diagnosis, with a mean age of 53 (SD = 10.3) years. The majority of the sample had a diagnosis of ovarian (n = 12) or endometrial cancer (n = 11). Significant differences favouring the intervention group were observed for fatigue at 12 weeks and 6 months follow-up (12 week: mean difference = −11.06; 95% confidence interval (CI) = −21.89 to − 0.23; effect size (d) = 0.13; p = 0.046; 6 month: mean difference = −19.48; 95% CI = − 19.67 to − 19.15; effect size (d) = 0.20; p = 0.01). A mean of 10 calls (SD = 1.2 calls) were delivered to the Physical Activity Group, and 10 (SD = 1.6 calls) to the CC group. The intervention was positively perceived based on exit questionnaire and focus group findings.

Conclusions

A physical activity behavioural change intervention for gynaecological cancer survivors is feasible in terms of participants' programme adherence and evaluation, and the intervention demonstrates improvements in fatigue. However, confirmation in the form of a larger fully powered RCT is warranted.     

The effect of autogenic training on salivary immunoglobulin A in surgical patients with breast cancer: A randomized pilot trial

Psychological stress among breast cancer patients can inhibit immune function and contribute to disease progression. We investigated the effects of autogenic training (AT), a relaxation method for reducing stress, on salivary immunoglobulin A (sIgA) in breast cancer surgery patients. Thirty patients scheduled to undergo breast cancer surgery were randomly assigned to an AT or control group (usual care). Patients in the AT group underwent training for 7 days after surgery. Salivary IgA and heart rate variability were assessed on the day before surgery, and on the third and seventh postoperative days. Levels of sIgA were significantly higher on the seventh postoperative day in the AT group (n = 7) compared to the control group (n = 7) (p = 0.049). These findings suggest that AT may improve immune function in breast surgery patients.     

Body mass index,physical activity,and mortality in women diagnosed with ovarian cancer: Results from the Women's Health Initiative

Background

Ovarian cancer is often diagnosed at late stages and consequently the 5-year survival rate is only 44%. However, there is limited knowledge of the association of modifiable lifestyle factors, such as physical activity and obesity on mortality among women diagnosed with ovarian cancer. The purpose of our study was to prospectively investigate the association of (1) measured body mass index (BMI), and (2) self-reported physical activity with ovarian cancer-specific and all-cause mortality in postmenopausal women enrolled in the Women's Health Initiative (WHI).

Methods

Participants were 600 women diagnosed with primary ovarian cancer subsequent to enrollment in WHI. Exposure data, including measured height and weight and reported physical activity from recreation and walking, used in this analysis were ascertained at the baseline visit for the WHI. Cox proportional hazard regression was used to examine the associations between BMI, physical activity and mortality endpoints.

Results

Vigorous-intensity physical activity was associated with a 26% lower risk of ovarian cancer specific-mortality (HR = 0.74; 95% CI: 0.56–0.98) and a 24% lower risk of all-cause mortality (HR = 0.76; 95% CI: 0.58–0.98) compared to no vigorous-intensity physical activity. BMI was not associated with mortality.

Conclusions

Participating in vigorous-intensity physical activity, assessed prior to ovarian cancer diagnosis, appears to be associated with a lower risk of ovarian cancer mortality.     

Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: A qualitative study

Objectiveto qualitatively explore influences identified by overweight/obese pregnant women on food choices and physical activity (PA) behaviours; to determine the impact of pregnancy on these factors; and to inform development of future lifestyle interventions during pregnancy.Designcross-sectional interview study.Settingmaternity hospital, Ireland.Participantspregnant women (n=22), early pregnancy Body Mass Index > 25 kg/m²Measuresbarriers to and facilitators of healthy eating and PA in overweight/obese pregnancy. Interviews were transcribed verbatim and analysed using inductive thematic analysis.Findingsoverweight/obese women perceived the following factors to influence their food choices and PA behaviours: personal (e.g. age, enjoyment, health, aesthetic appearance, and response to fatigue); social (e.g. social support, food modelling, social facilitation and weight bias) and environmental (e.g. food salience and the obesogenic environment). These factors affected PA and food choice trajectories differently according to socio-economic and socio-cultural context.Conclusion and Implicationspersonal, social and environmental factors affect food choices and PA behaviours. Pregnancy is a powerful stimulus for positive changes in food choices particularly. This change is driven by desire for healthy pregnancy outcome, and is not intrinsically motivated. Healthy lifestyle interventions should aim to sustain positive changes beyond pregnancy through: empowerment, intrinsic motivation, family-centred approach, and behavioural goals.     

Effect of complementary Integrative Oncology on anxiety,depression and quality of life in thoracic cancer patients: A pilot study

PurposeThoracic-cancer (TC) patients have an extensive toll taken in terms of health-related quality of life (HRQL). Integrative Oncology (IO) is recognized as a valid complement to any Standard-Therapy treatment to improve outcomes in TC patients. The objective of this pilot-study was to evaluate the effect of adding IO (acupuncture, Cognitive-Behavior Therapy and mindfulness) in terms of depression, anxiety and HRQL.MethodsTC patients who attended the Thoracic Oncology-Unit from July to September 2018 were invited to participate. A total of 16 patients were included in the study, 8 patients were required to attend 5 weekly sessions of IO and 8 patients were invited as controls. Anxiety, depression and HRQL were measured at baseline and after completing 5 sessions of IO or 5 weeks, using the HADS scale and the QLQ-C30 scale.ResultsA total of 8 patients in the IO group attended the 5 sessions and 8 patients were followed as controls. Compliance with the therapies was high, none of the patients dropped out from the study. A tendency for improvement in anxiety, fatigue, pain and dyspnea was observed in patients attending IO, though not statistically significant likely due to sample size.ConclusionsIO therapies are well accepted among TC patients. Larger studies are necessary with robust sample sizes to improve conclusions regarding outcome improvements.     

Massage therapy alone and in combination with meditation for breast cancer patients undergoing autologous tissue reconstruction: A randomized pilot study

This study explored whether massage combined with meditation is more helpful than massage alone for women recovering from autologous tissue reconstruction after mastectomy for breast cancer. Forty patients were randomly assigned to either massage therapy or massage plus meditation on postoperative days 1 through 3. Outcome measures were 1) visual analog scale (VAS) scores for stress, anxiety, relaxation, insomnia, alertness, fatigue, tension, pain, mood, and energy, and 2) Perceived Stress Scale-14 scores. Nineteen patients in each group finished the study. Preintervention and postintervention mean total VAS scores improved significantly in both groups (P < .001), but no significant difference occurred between groups.     

Efficacy of proprioceptive neuromuscular facilitation in improving shoulder biomechanical parameters,functionality, and pain after axillary lymph node dissection for breast cancer: A randomized controlled study

PurposeAxillary lymph node dissection and radiotherapy have been associated with pain, physical symptoms, and decreased functional abilities in the upper extremity. This study aimed to evaluate the potential effects of the proprioceptive neuromuscular facilitation (PNF) technique on muscle strength, pain and functionality in this patient group in comparison with progressive resistance training (PRT).MethodsThe study was conducted with a randomized clinical trial design. Sixty-six women were included in the study and randomly divided into three groups: the PNF group (n = 22), the PRT group (n = 22), and the control group (n = 22). The participants were evaluated at the baseline and after eight weeks of treatment. Outcome measures were determined as pain (the Visual Analog Scale), upper extremity strength (isokinetic dynamometer), functionality (the Disabilities of the Arm, Shoulder and Hand questionnaire), and perception of change (the Global Rating of Change Scale).Trial registrationClinicalTrials.gov identifier: NCT05288036.ResultsThe results showed statistically significant changes in both treatment groups in terms of shoulder flexors/extensors, abductor/adductors, internal/external rotators strength/power/endurance measurement, pain, and functionality (p < 0.05). Concerning functionality and perception of change, the PNF group had a statistically significantly higher improvement compared to the remaining two groups (p < 0.05).ConclusionPNF is an effective technique in increasing upper extremity muscle strength, reducing pain during rest and activity, and improving functionality in patients receiving breast cancer treatment.