Evidence-based risk assessment and recommendations for physical activity clearance: cancer1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S101-S112 ◽  
Author(s):  
Lee W. Jones
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Exercise Training ◽  
Cancer Patients ◽  
Exercise Testing ◽  
Peer Review Process ◽  
Evaluation Criteria ◽  
Adverse Event Rate ◽  
Evidence Based ◽  
Data Reporting

Physical activity is becoming increasingly acknowledged as an integral component of in the multidisciplinary management of cancer patients. Intensive inquiry in this area is likely to increase further over the next decade; however, cancer-specific, evidence-based risk assessment and recommendations for physical activity are not available. A systematic literature review was performed of all studies conducting an exercise training intervention and (or) any form of objective exercise test among adults diagnosed with cancer. Studies were assessed according to evaluation criteria developed by a panel of experts. A total of 118 studies involving 5529 patients were deemed eligible. Overall, the results suggest that exercise training and maximal and submaximal exercise testing are relatively safe procedures with a total nonlife-threatening adverse event rate of <2%. There was only 1 exercise training-related death. However, the quality of exercise testing methodology and data reporting is less than optimal. Thus, whether the low incidence of events reflects the true safety of exercise training and exercise testing in cancer patients or less than optimal methodology and (or) data reporting remains to be determined. Evidence-based absolute and relative contraindications to physical activity and exercise training and testing are provided as well as probing decision-trees to optimize the adoption and safety of physical activity in persons diagnosed with cancer.

Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S190-S213 ◽  
Author(s):  
Scott G. Thomas ◽  
Jack M. Goodman ◽  
Jamie F. Burr
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Events ◽  
Lower Risk ◽  
Peer Review Process ◽  
Screening Tools ◽  
Systematic Evaluation ◽  
Computer Assisted ◽  
Evidence Based ◽  
Intermediate Risk

Physical activity is an effective lifestyle therapy for patients at risk for, or with, documented cardiovascular disease (CVD). Current screening tools — the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) — require updating to align with risk/benefit evidence. We provide evidence-based recommendations to identify individuals with CVD at lower risk, intermediate risk, or higher risk of adverse events when participating in physical activity. Forms of exercise and the settings that will appropriately manage the risks are identified. A computer-assisted search of electronic databases, using search terms for CVD and physical activity risks and benefits, was employed. The Appraisal of Guidelines for Research and Evaluation were applied to assess the evidence and assign a strength of evidence rating. A strength rating for the physical activity participation clearance recommendation was assigned on the basis of the evidence. Recommendations for physical activity clearance were made for specific CVD groups. Evidence indicates that those who are medically stable, who are involved with physical activity, and who have adequate physical ability can participate in physical activity of lower to moderate risk. Patients at higher risk can exercise in medically supervised programs. Systematic evaluation of evidence indicates that clinically stable individuals with CVD may participate in physical activity with little risk of adverse events. Therefore, changes in the PAR-Q should be undertaken and a process of assessment and consultation to replace the PARmed-X should be developed. Patients at lower risk may exercise at low to moderate intensities with minimal supervision. Those at intermediate risk should exercise with guidance from a qualified exercise professional. Patients at higher risk should exercise in medically supervised programs.

Evidence-based risk assessment and recommendations for physical activity clearance: an introduction1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S1-S2 ◽  
Author(s):  
Darren E.R. Warburton ◽  
Veronica K. Jamnik ◽  
Shannon S.D. Bredin ◽  
Don C. McKenzie ◽  
James Stone ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Risk Stratification ◽  
Review Process ◽  
Peer Review Process ◽  
Screening Tools ◽  
Health Conditions ◽  
Systematic Evaluation ◽  
Evidence Based ◽  
Clearance Process

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally renowned and extensively used preparticipation screening tools. However, recent feedback from end-users has identified limitations to the existing PAR-Q and PARmed-X screening process. As such, a systematic evaluation of the PAR-Q and PARmed-X forms was conducted, adhering to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Recognized experts in physical activity (PA) and prominent health conditions worked with an expert consensus panel to increase the effectiveness of the PAR-Q and PARmed-X PA participation clearance process. The systematic review process established that the health benefits of PA participation far outweigh the risks in the vast majority of asymptomatic and symptomatic individuals. A new risk continuum and decision tree process was created to allow for the effective risk stratification of prominent health conditions, reducing greatly the barriers to PA participation for the majority of individuals. The new PA participation clearance process is available in new paper and online versions (PAR-Q+) and the PARmed-X was replaced with an online interactive computer programme (ePARmed-X+). It is anticipated that this new risk stratification and PA clearance process will reduce markedly the barriers for PA participation for both asymptomatic and symptomatic individuals.

Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 20111This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S266-S298 ◽  
Author(s):  
Darren E.R. Warburton ◽  
Norman Gledhill ◽  
Veronica K. Jamnik ◽  
Shannon S.D. Bredin ◽  
Don C. McKenzie ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Risk Stratification ◽  
Chronic Conditions ◽  
Peer Review Process ◽  
Core Competencies ◽  
Screening Tools ◽  
Evidence Based ◽  
Consensus Document ◽  
Human Lifespan

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally known preparticipation screening tools developed on the basis of expert opinion. The primary purposes of this consensus document were to seek evidence-based support for the PAR-Q and PARmed-X forms, to identify whether further revisions of these instruments are warranted, to determine how people responding positively to questions on the PAR-Q can be safely cleared without medical referral, and to develop exercise clearance procedures appropriate for various clinical conditions across the human lifespan. Seven systematic reviews were conducted, examining physical-activity-related risks and effective risk-stratification procedures for various prevalent chronic conditions. An additional systematic review assessed the risks associated with exercise testing and training of the general population. Two gap areas were identified and evaluated systematically: the role of the qualified exercise professional and the requisite core competencies required by those working with various chronic conditions; and the risks associated with physical activity during pregnancy. The risks associated with being physically inactive are markedly higher than transient risks during and following an acute bout of exercise in both asymptomatic and symptomatic populations across the lifespan. Further refinements of the PAR-Q and the PARmed-X (including online versions of the forms) are required to address the unique limitations imposed by various chronic health conditions, and to allow the inclusion of individuals across their entire lifespan. A probing decision-tree process is proposed to assist in risk stratification and to reduce barriers to physical activity. Qualified exercise professionals will play an essential role in this revised physical activity clearance process.

Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease1This paper is one of a selection of papers published in the Special Issue entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer-review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S80-S100 ◽  
Author(s):  
Neil D. Eves ◽  
Warren J. Davidson
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Events ◽  
Exercise Intervention ◽  
Peer Review Process ◽  
Chronic Obstructive ◽  
Evidence Based ◽  
Screening Process ◽  
Obstructive Pulmonary Disease ◽  
Asthma Patients

The 2 most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Growing evidence supports the benefits of exercise for all patients with these diseases. Due to the etiology of COPD and the pathophysiology of asthma, there may be some additional risks of exercise for these patients, and hence accurate risk assessment and clearance is needed before patients start exercising. The purpose of this review was to evaluate the available literature regarding the risks of exercise for patients with respiratory disease and provide evidence-based recommendations to guide the screening process. A systematic review of 4 databases was performed. The literature was searched to identify adverse events specific to exercise. For COPD, 102 randomized controlled trials that involved an exercise intervention were included (n = 6938). No study directly assessed the risk of exercise, and only 15 commented on exercise-related adverse events. For asthma, 30 studies of mixed methodologies were included (n = 1278). One study directly assessed the risk of exercise, and 15 commented on exercise-related adverse events. No exercise-related fatalities were reported. The majority of adverse events in COPD patients were musculoskeletal or cardiovascular in nature. In asthma patients, exercise-induced bronchoconstriction and (or) asthma symptoms were the primary adverse events. There is no direct evidence regarding the risk of exercise for patients with COPD or asthma. However, based on the available literature, it would appear that with adequate screening and optimal medical therapy, the risk of exercise for these respiratory patients is low.

Evidence-based risk assessment and recommendations for physical activity clearance: pregnancy1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S33-S48 ◽  
Author(s):  
Sarah Charlesworth ◽  
Heather J.A. Foulds ◽  
Jamie F. Burr ◽  
Shannon S.D. Bredin
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Event ◽  
Pregnant Women ◽  
Event Rate ◽  
Scientific Information ◽  
Well Being ◽  
Adverse Event Rate ◽  
Evidence Based ◽  
Exercise During Pregnancy

Recommendations for physical activity during pregnancy have progressed significantly in the last 30 years and continue to evolve as an increasing body of scientific evidence becomes available. In addition, there is an increasing number of women who wish to either maintain physical fitness levels during the prenatal period or initiate exercise for a healthier lifestyle during pregnancy. As such, consistent evaluation of the risks associated with exercise during pregnancy is warranted for maternal and fetal well-being. The primary purpose of this systematic review was to evaluate the scientific information available regarding maternal and fetal responses as it relates to the occurrence of adverse exercise-related events in pregnant women without contraindications to exercise. A systematic and evidence-based approach was used to analyze critically the level of evidence for risks associated with acute and chronic exercise during pregnancy in healthy pregnant women. All articles were screened according to standardized evaluation criteria developed by a panel of experts. A total of 74 investigations that involved 3766 pregnant women were included in the analysis. Of the 74 studies, only 35 studies documented the presence or absence of adverse events. The serious adverse event rate for these studies was 1.4 per 10 000 h of exercise. The adverse event rate increased to 6.8 per 10 000 h of exercise when including the occurrence of more mild events and exercise-related fetal bradycardia and tachycardia. Previously inactive or active women (without contraindications) are at a low risk for adverse fetal or maternal events if they participate in routine physical activity during pregnancy.

Evidence-based risk assessment and recommendations for exercise testing and physical activity clearance in apparently healthy individuals1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S14-S32 ◽  
Author(s):  
Jack M. Goodman ◽  
Scott G. Thomas ◽  
Jamie Burr
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Exercise Testing ◽  
Clinical Event ◽  
Evidence Based ◽  
Healthy Individuals ◽  
The Impact ◽  
Apparently Healthy

Increased physical activity (PA) is associated with improved health and quality of life in the general population. A dose–response effect is evident between increasing levels of PA participation and a lower relative risk for cardiovascular disease and all-cause mortality. However, there is also clear evidence that PA acutely increases the risk of an adverse cardiovascular (CV) event and sudden cardiac death (SCD) significantly above levels expected at rest. Adverse CV events during PA may be triggered acutely by the physiological stress of exercise. This investigation will review the available literature describing the CV risks of exercise testing and PA participation in apparently healthy individuals. A systematic review of the literature was performed using electronic databases, including Medline, CINAHL, SPORT discus, EMBASE, Cochrane DSR, ACP Journal Club, and DARE; additional relevant articles were hand-picked and the final grouping was used for the review using the AGREE process to assess the impact and quality of the selected articles. Six hundred and sixteen relevant articles were reviewed with 51 being identified as describing adverse CV events during exercise and PA. Data suggests the risks of fatal and nonfatal events during maximal exercise testing in apparently healthy individuals rarely occur (approximately <0.8 per 10 000 tests or 1 per 10 000 h of testing). The incidence of adverse CV events is extremely low during PA of varying types and intensities, with data limited almost exclusively to fatal CV events, as nonfatal events are rarely reported. However, this risk is reduced by 25%–50% in those individuals who have prior experience with increased levels of PA, particularly vigorous PA. Throughout a wide age range, the risk of SCD and nonfatal events during PA remain extremely low (well below 0.01 per 10 000 participant hours), but both increasing age and PA intensity are associated with greater risk. In most cases of exercise-related SCD, undetected pre-existing disease is present and SCD is typically the first clinical event. The risks of an adverse CV event during exercise testing and PA are rare and are outweighed by the health benefits. Given this risk-benefit relationship, the PAR-Q is an appropriate method to identify those at higher risk across a wide age span and should be used in conjunction with appropriate clinical guidelines for guiding individuals towards graduated PA. There are not adequate data to describe the risks of PA in those individuals considered to be at higher risk but without cardiovascular disease.

Evidence-based risk assessment and recommendations for physical activity clearance: cognitive and psychological conditions1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S113-S153 ◽  
Author(s):  
Ryan E. Rhodes ◽  
Viviene A. Temple ◽  
Holly A. Tuokko
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Intellectual Disability ◽  
Adverse Events ◽  
Psychotic Disorders ◽  
Peer Review Process ◽  
Risk Of Bias ◽  
Psychological Disorder ◽  
Atlantoaxial Instability ◽  
Evidence Based

Physical activity has established mental and physical health benefits, but related adverse events have not received attention. The purpose of this paper was to review the documented adverse events occurring from physical activity participation among individuals with psychological or cognitive conditions. Literature was identified through electronic database (e.g., MEDLINE, psychINFO) searching. Studies were eligible if they described a published paper examining the effect of changes on physical activity behaviour, included a diagnosed population with a cognitive or psychological disorder, and reported on the presence or absence of adverse events. Quality of included studies was assessed, and the analyses examined the overall evidence by available subcategories. Forty trials passed the eligibility criteria; these were grouped (not mutually exclusively) by dementia (n = 5), depression (n = 10), anxiety disorders (n = 12), eating disorders (n = 4), psychotic disorders (n = 4), and intellectual disability (n = 15). All studies displayed a possible risk of bias, ranging from moderate to high. The results showed a relatively low prevalence of adverse events. Populations with dementia, psychological disorders, or intellectual disability do not report considerable or consequential adverse events from physical activity independent of associated comorbidities. The one exception to these findings may be Down syndrome populations with atlantoaxial instability; in these cases, additional caution may be required during screening for physical activity. This review, however, highlights the relative paucity of the reported presence or absence of adverse events, and finds that many studies are at high risk of bias toward reporting naturally occurring adverse events.

scholarly journals How to promote physical activity maintenance after an exercise-training program in cancer patients?

2016 ◽  
Vol 59 ◽  
pp. e55 ◽  
Author(s):  
Katia Reichhart ◽  
Mélissa Evesque ◽  
Marion M.C. Cavana ◽  
Pauline Muszynski ◽  
Marie-Madeleine Leclercq ◽  
...  
Keyword(s):  
Physical Activity ◽  
Exercise Training ◽  
Training Program ◽  
Cancer Patients ◽  
Exercise Training Program ◽  
Physical Activity Maintenance

scholarly journals Targeted Exercise Training for Cancer Patients: Moving beyond Generic Exercise Guidelines in Clinical Oncology

2021 ◽  
pp. 43-52
Author(s):  
Ciaran M Fairman ◽  
Jesper F Christensen
Keyword(s):  
Physical Activity ◽  
South Carolina ◽  
Exercise Training ◽  
Cancer Patients ◽  
Clinical Oncology ◽  
Exercise Prescription ◽  
Exercise Interventions ◽  
Sports Science ◽  
Exercise Guidelines ◽  
Exercise Oncology

Targeted Exercise Training for Cancer Patients: Moving beyond Generic Exercise Guidelines in Clinical Oncology Ciaran M Fairman1 and Jesper F Christensen()2,3  1Department of Exercise Science, University of South Carolina, USA 2Center for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark 3Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Denmark © The Authors   Abstract The field of exercise oncology has rapidly evolved over the past 30 years. Initial investigations of safety and feasibility have progressed towards efficacy and effectiveness trials with a variety of health-related outcomes in mind. More recently, it has been recognized that interventions aimed at modifying physical activity behavior (i.e. behavioral interventions to increase participation in un/structured physical activity) are distinctly different from those aiming to target a clinically relevant outcome (using a specific exercise prescription). There is a strong rationale for the latter, where cancer/treatment toxicities can result in musculoskeletal, cardiopulmonary, and/or hematological declines with important prognostic implications. Treatment intolerance, unfavorable tumor response and heightened risk of mortality are all consequences of leaving these impairments unaddressed. Importantly, the control/reversal of the decline in these systems is more likely to occur through a targeted exercise prescription, specifically designed to target the impairment, rather than interventions trying to change behavior. This requires careful consideration in the study design in exercise oncology in relation to the selection of clinically relevant outcomes, decisions on methods of assessments and ensuring the exercise is targeted to the outcome.     The objective of this review is to 1) conceptualize and provide a clinical rationale for targeted exercise interventions in exercise oncology, and 2) provide a framework for consideration in the design and execution in targeted exercise interventions in oncology. We hope that this framework can encourage research into targeted exercise interventions in oncology and that our framework can be used to inform the design of future trials.

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