ORCID Profile
0000-0001-9913-4022
Current Organisation
Edith Cowan University
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Publisher: Springer Science and Business Media LLC
Date: 15-09-2020
DOI: 10.1186/S13104-020-05284-Y
Abstract: There is substantial evidence that exercise can safely reduce the risk of cancer and improve survival in different human cancer populations. Long latency periods associated with carcinogen–induced cancers like asbestos induced mesothelioma provide an opportunity to implement exercise as an intervention to delay or prevent disease development. However, there are limited studies investigating the ability of exercise to prevent or delay cancer, and exercise as a preventive strategy has never been assessed in models with a known carcinogen. We investigated the potential of voluntary exercise (VE) to delay development of asbestos related disease (ARD) in our well-characterised, asbestos induced MexTAg model of mesothelioma. Asbestos exposed MexTAg mice were given continuous or delayed access to VE and ARD assessed over time. We found that the addition of VE did not affect ARD development in asbestos exposed MexTAg mice. However, non–asbestos exposed, aged matched control mice participated in significantly more VE behaviours, suggesting subclinical development of ARD after asbestos exposure had a greater impact on VE participation than age alone. These data highlight the importance of model choice and the potential limitation that some pre–clinical studies may not accurately represent the clinical paradigm, particularly in the context of prevention studies.
Publisher: Wiley
Date: 2007
DOI: 10.1002/CNCR.22830
Abstract: To determine the effects of preoperative exercise training on cardiorespiratory fitness in patients undergoing thoracic surgery for malignant lung lesions. Using a single-group design, 25 patients with suspected operable lung cancer were provided with structured exercise training until surgical resection. Exercise training consisted of 5 endurance cycle ergometry sessions per week at intensities varying from 60% to 100% of baseline peak oxygen consumption (VO(2 peak)). Participants underwent cardiopulmonary exercise testing, 6-minute walk (6 MW), and pulmonary function testing at baseline, immediately before, and 30 days after surgical resection. Five patients were deemed ineligible before surgical resection and were removed from the analysis. Of the remaining 20 patients follow-up assessments were obtained for 18 (90%) before resection and 13 (65%) patients postresection. The overall adherence rate was 72%. Intention-to-treat analysis indicated that mean VO(2peak) increased by 2.4 mL . kg(-1) . min(-1)(95% confidence interval [CI], 1.0-3.8 P = .002) and 6MW distance increased 40 m (95% CI, 16-64 P = .003) baseline to presurgery. Per protocol analyses indicated that patients who attended >or=80% of prescribed sessions increased VO(2peak) and 6 MWD by 3.3 mL.kg(-1).min(-1) (95% CI, 1.1-5.4 P = .006) and 49 meters (95% CI, 12-85 P = .013), respectively. Exploratory analyses indicated that presurgical exercise capacity decreased postsurgery, but did not decrease beyond baseline values. Preoperative exercise training is a beneficial intervention to improve cardiorespiratory fitness in patients undergoing pulmonary resection. This benefit may have important implications for surgical outcome and postsurgical recovery in this population. Larger randomized controlled trials are warranted.
Publisher: European Respiratory Society (ERS)
Date: 03-08-2023
DOI: 10.1183/23120541.00209-2023
Abstract: Little is known about activity behaviours and quality-of-life (QoL) of patients with parapneumonic pleural effusions (PPE) after hospital discharge. This study is a secondary analysis of a randomized trial (dexamethasone versus placebo) for hospitalised patients with PPE. We: (i) described the patients’ activity behaviour patterns and QoL measured at discharge and at 30 days post-discharge and (ii) examined the association between activity behaviours and QoL scores. Activity behaviour (7-day accelerometry Actigraph GT3X+) and QoL (Medical Outcomes Study Short-Form 36) were assessed. Repeated measures analysis of covariance controlling for baseline values and a series of linear regression models were undertaken. Thirty-six out of 53 eligible participants completed accelerometry assessments. Despite modest increases in light physical activity (+7.5%) and some domains of QoL ( points) from discharge to 30 days post-discharge, patients had persistently high levels of sedentary behaviour ( % of waking wear time) and poor QoL (≤50 out of 100 points) irrespective of treatment group (p=0.135–0.903). Increasing moderate-to-vigorous physical activity was associated with higher scores on most QoL domains (p=0.006–0.037). Linear regression indicates that a clinically important difference of 5 points in physical composite QoL score can be achieved by reallocating 16.1 min·day −1 of sedentary time to moderate-to-vigorous physical activity. Patients with PPE had low levels of physical activity and QoL at discharge and 30-days post irrespective of treatment. Moderate-to-vigorous physical activity participation was associated with higher QoL scores. Increasing moderate-to-vigorous physical activity following discharge from the hospital may be associated with improvements in QoL.
Publisher: Oncology Nursing Society (ONS)
Date: 28-04-2009
Publisher: Springer Science and Business Media LLC
Date: 24-02-2010
DOI: 10.1007/S10549-010-0793-3
Abstract: To assess the impact of air travel on swelling of the 'at risk' arm of women treated for breast cancer. Women treated for breast cancer from Canada (n = 60) and from within Australia (n = 12) attending a dragon boat regatta in Queensland, Australia participated. Women were measured within 2 weeks prior to their flight, on arrival in Queensland and, for 40 women travelling from Canada, measured again 6 weeks following return to Canada. Changes to extracellular fluid were measured using a single-frequency bioimpedance device (BIA). Each arm was measured separately using a standardized protocol to obtain the inter-limb impedance ratio. An increase in the ratio indicates accumulated fluid. Information regarding medical management of participants' breast cancer, use of compression garment and history of exercise were also obtained. For most women (95%), air travel did not adversely affect the impedance ratio. The BIA ratio of long-haul travellers was 1.007 +/- 0.065 prior to the flight and 1.006 +/- 0.087 following the flight. The ratio of short-haul travellers was 0.994 +/- 0.033 and following the flight was 1.001 +/- 0.038. Air travel did not cause significant change in BIA ratio in the 'at-risk' arm for the majority of breast cancer survivors who participated in dragon boat racing. Further research is required to determine whether these findings are generalizable to the population of women who have been treated for breast cancer.
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1016/J.LUNGCAN.2006.10.006
Abstract: The use of cardiopulmonary exercise testing (CPET) is increasing in many areas of disease management, the clinical utility of this procedure in patients with advanced cancer remains to be determined. Accordingly, we conducted a pilot study to comprehensively evaluate the safety and feasibility of CPET in 85 patients diagnosed with inoperable non-small cell lung cancer (NSCLC) or metastatic breast cancer (MBC). Using a cross-sectional design, consecutive patients with histologically or cytologically confirmed inoperable NSCLC or MBC were screened for eligibility by their attending oncologist. All consenting patients performed complete pulmonary function tests (NSCLC only) and a symptom-limited CPET on a cycle ergometer with gas exchange analysis. A total of 85 patients (NSCLC, n=46 MBC, n=39) were recruited and tested. Overall, there were a total of three (3.5%) positive exercise tests [NSCLC, n=2 (4.3%) MBC, n=1 (2.6%)] 68 (80.0%) negative tests [NSCLC, n=33 (71.7%) MBC, n=35 (89.7%)] and 14 (16.5%) indeterminate tests [NSCLC, n=11 (23.3%) MBC, n=3 (7.7%)]. Two patients experienced an adverse event during exercise testing. Mean VO(2peak) was 17.0mlkg(-1)min(-1) and 16.5mlkg(-1)min(-1) for NSCLC and MBC patients, respectively. The mean percentage of age and sex-predicted VO(2peak) maximum for both groups was 67%. A symptom-limited, in idualized CPET appears to be a relatively safe and feasible assessment tool to objectively evaluate physical functioning in selected patients with advanced cancer. This study provides important information to future investigations examining the potential role of exercise training in this patient population.
Publisher: Springer Science and Business Media LLC
Date: 27-09-2005
DOI: 10.1007/S00520-005-0805-8
Abstract: The goal of this study was to examine oncologists' attitudes towards recommending exercise to patients with cancer during treatment. Using a national survey, all 659 practicing medical and radiation oncologists in Canada were sent a brief questionnaire. The response rate was 46% (281/610). The majority of oncologists agreed that exercise was beneficial (62.0%), important (55.8%) and safe (63.1%) for patients with cancer during treatment. Forty-three percent of oncologists reported that they tried to recommend exercise to their patients when appropriate. Moreover, oncologists actually reported recommending exercise to 28% of their patients during the past month. Analyses also indicated significant differences between oncologists, with younger, female, and medical oncologists generally having more favorable attitudes towards exercise for patients with cancer than their older, male, and radiation oncology counterparts. Oncologists have a favorable attitude toward recommending exercise to patients with cancer although several important barriers may prevent oncologists from providing exercise advice to their patients. Further research is required evaluating the effectiveness of interventions and strategies designed to improve oncologists' confidence and ability to advise their patients on exercise during oncology consultations.
Publisher: Springer Science and Business Media LLC
Date: 02-2018
DOI: 10.1007/S00520-018-4069-5
Abstract: Little is known about the relationship between health-related quality of life (HRQoL), pelvic floor dysfunction (PFD), and modifiable lifestyle and physiological factors for ovarian cancer survivors (OCS). The primary aim of the study was to compare post-treatment advanced-stage OCS with age-matched controls on measures of HRQoL and PFD. The secondary aim was to examine associations between HRQoL, PFD, objective activity behaviors, physical function, and body composition in OCS. Twenty advanced-stage OCS and 20 controls completed questionnaires assessing HRQoL (SF-36) and PFD (Australian Pelvic Floor Questionnaire), and underwent objective assessments of activity behavior (7-day accelerometry), physical function (400-m walk, repeated chair rise, 6-m usual-pace walk, one-repetition maximum chest press, and single-leg extension), and body composition (dual-energy x-ray absorptiometry). Compared to controls, OCS had worse physical HRQoL (- 4.3 median difference, p = 0.013), but equivalent self-reported PFD, indicated by combined bladder, bowel, and pelvic organ prolapse symptoms (0.89 mean difference, p = 0.277). In OCS, physical HRQoL was significantly negatively associated with PFD (r = 0.468, p = 0.043). Decreased physical HRQoL and increased PFD were significantly associated with less moderate-to-vigorous physical activity in ≥ 10-min bouts (ρ = 0.627, p = 0.003 ρ = - 0.457, p = 0.049), more sedentary time (r = - 0.449, p = 0.047 r = 0.479, p = 0.038), and slower 400-m walk time (ρ = - 0.565, p = 0.022 ρ = 0.504, p = 0.028). Post-treatment advanced-stage OCS have decreased physical HRQoL, which is associated with modifiable factors such as worse PFD, less moderate-to-vigorous physical activity, more sedentary time, and decreased objective physical function. This highlights the need for ongoing supportive care and multidisciplinary interventions after first-line ovarian cancer treatment.
Publisher: American Association for Cancer Research (AACR)
Date: 10-2009
DOI: 10.1158/1055-9965.EPI-09-0504
Abstract: Background: The Healthy Exercise for Lymphoma Patients trial showed that aerobic exercise training improved important health outcomes in lymphoma patients. Here, we examine potential moderators of the exercise training response. Methods: Lymphoma patients were stratified by major disease type and current treatment status and randomly assigned to usual care (n = 62) or aerobic exercise training (n = 60) for 12 weeks. Endpoints were quality of life, cardiovascular fitness, and body composition. Moderators were patient preference for group assignment, age, sex, marital status, disease stage, body mass index, and general health. Results: Patient preference did not statistically moderate the effects of exercise training on quality of life (P for interaction = 0.36), but the interaction effect of 7.8 points favoring patients with no preference was clinically meaningful. Marital status (P for interaction = 0.083), general health (P for interaction = 0.012), and body mass index (P for interaction = 0.010) moderated the effects of aerobic exercise training on quality of life with better outcomes for unmarried versus married patients, patients in poor/fair health versus good-to-excellent health, and normal weight/obese versus overweight patients. Disease stage (P for interaction = 0.056) and general health (P for interaction = 0.012) moderated the effects of aerobic exercise training on body composition with better outcomes for patients with advanced disease versus early disease/no disease and patients in good health versus very good-to-excellent health. No variables moderated intervention effects on cardiovascular fitness. Findings were not explained by differences in adherence. Conclusions: Clinically available variables predicted quality of life and body composition responses to aerobic exercise training in lymphoma patients. If replicated, these results may inform future randomized trials and clinical practice. (Cancer Epidemiol Biomarkers Prev 2009 (10):2600–7)
Publisher: Springer Science and Business Media LLC
Date: 15-06-2008
DOI: 10.1007/S00520-007-0272-5
Abstract: The purpose of the present study was to evaluate medical, demographic, and psychosocial correlates of exercise in colorectal cancer survivors (CRC-S) using self-determination theory (SDT). Participants were 414 CRC-S who completed a mailed survey that assessed self-reported exercise, medical and demographic variables, and SDT constructs consisting of behavioral regulation for exercise, psychological needs satisfaction in exercise (PNSE), and perceived autonomy support (PAS). CRC-S with less education were significantly less likely to meet exercise guidelines (21 vs 31% p < 0.001). Path analysis indicated that SDT and education explained 16% of the variance in exercise behavior with identified regulation (beta = 0.17, p = 0.031), introjected regulation (beta = 0.14, p = 0.006), and education (beta = 0.16, p < 0.001) each making a significant independent contribution. Few medical and demographic factors are correlates of regular exercise in CRC-S, but SDT provided a good understanding of exercise behavior in this population. Exercise behavior change interventions incorporating principles of SDT may have utility for promoting exercise and improving outcomes in this important population of cancer survivors.
Publisher: Wiley
Date: 09-06-2017
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJRESP-2019-000551
Abstract: Cachexia is common in malignant mesothelioma (MM) half of patients have malnutrition and low skeletal muscle mass. Malnourished patients have worse quality of life (QoL). Weight loss is strongly associated with poor survival. Anamorelin is an oral ghrelin receptor agonist that improves appetite, body weight and QoL in advanced cancer. The aim of this study is to examine the efficacy of anamorelin in improving appendicular skeletal muscle mass (ASM) and patient-reported outcomes in patients with MM with cachexia. A single-centre, phase II, randomised, placebo-controlled cross-over pilot study with 28-day treatment periods and 3-day washout. Forty patients will be randomised. Primary outcome is change in ASM relative to height measured by dual energy X-ray absorptiometry at end of period 1. Secondary outcomes include cancer-specific and cachexia-related QoL, objective physical activity, dietary intake and adverse events. Eligible patients will have confirmed MM, Eastern Cooperative Oncology Group 0–2, expected survival months and cachexia (defined as % weight loss in 6 months or body mass index kg/m 2 with weight loss %). Ethical approval has been granted. Results will be reported in peer-reviewed publications. Australian New Zealand Clinical Trials Registry (U1111-1240-6828).
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.LUNGCAN.2011.05.026
Abstract: Lung cancer survivors exhibit poor functional capacity, physical functioning, and quality of life (QoL). Here, we report the feasibility and preliminary efficacy of a progressive resistance exercise training (PRET) intervention in post-treatment lung cancer survivors. Seventeen post-treatment lung cancer survivors (10 female), with a mean age of 67 (range 50-85), mean BMI of 25, and diagnosed with non-small cell lung cancer (94%) were recruited in Edmonton, Canada between August 2009 and August 2010 to undergo PRET. The primary outcomes focused on feasibility including eligibility and recruitment rate, loss to follow-up, measurement completion, exercise adherence, and program evaluation. Secondary outcomes addressed preliminary efficacy and included changes in muscular strength (1 repetition maximum), muscular endurance (repetitions at 70% of 1 repetition maximum), body composition (DXA scan), physical functioning (6-minute-walk-test, up-and-go, sit-to-stand, arm curls), and patient-reported outcomes including QoL (SF-36, FACT-L), fatigue (FACT-F), dyspnea (MRCD), and patient-rated function (LLFI). Forty of 389 lung cancer survivors were eligible (10%) and 17 of the 40 (43%) were recruited. Over 80% of participants were able to complete all testing two participants were lost to follow-up, and the median adherence rate was 96% (range: 25-100%). Ratings of testing burden were low (i.e., less than two out of seven for all items), and trial evaluation was high (i.e., greater than six out of seven for all measures). Paired t-tests showed significant increases in muscular strength (p<.001), muscular endurance (p<.001), six-minute walk distance (p<.001), up-and-go time (p<.05), number of arm curls (p<.001), and number of chair stands (p<.001). There were no significant changes in body composition or patient-reported outcomes. PRET is a feasible intervention with potential health benefits for a small proportion of lung cancer survivors in the post-treatment setting.
Publisher: Oxford University Press (OUP)
Date: 09-2008
DOI: 10.1634/THEONCOLOGIST.2008-0017
Abstract: Anemia in patients with solid tumors is a common problem that is associated with impaired exercise capacity, increased fatigue, and lower quality of life (QoL). Erythropoiesis-stimulating agents (ESAs) have been shown to improve these outcomes however, it is unknown if additional benefits can be achieved with aerobic exercise training. We conducted a single-center, prospective, randomized, controlled trial in 55 mild-to-moderately anemic patients with solid tumors. Patients were randomized to either darbepoetin alfa alone (DAL, n = 29) or darbepoetin alfa plus aerobic exercise training (DEX n = 26). The DEX group performed aerobic exercise training three times per week at 60%–100% of baseline exercise capacity for 12 weeks. The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy–Anemia scale. Secondary endpoints were fatigue, cardiorespiratory fitness (VO2peak), hemoglobin (Hb) response, and darbepoetin alfa dosing. Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences. The DEX group had a significantly greater VO2peak than the DAL group (mean group difference, +3.0 ml/kg per minute 95% confidence interval, 1.2–4.7 p = .001) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing. Aerobic exercise training did not improve QoL or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements. Our results may be useful to clinicians despite the more recent restrictions on the indications for ESAs.
Publisher: Springer Science and Business Media LLC
Date: 12-2011
Publisher: BMJ
Date: 03-2018
DOI: 10.1097/IGC.0000000000001197
Abstract: Ovarian cancer (OC) survivors experience many disease and treatment adverse effects. However, the impact of OC and its treatment on objective activity behaviors and physiological status have not been examined. The purpose of this study was to compare objectively measured activity behaviors and physiological characteristics of advanced-stage OC survivors to age-matched controls. Twenty stage III–IV OC survivors and 20 controls completed assessments of activity behaviors (7-day accelerometry), physical function (400-meter walk as indicator of cardiorespiratory fitness, repeated chair rise, 6-meter walking tests), muscle strength (1-repetition maximum and handgrip), body composition (dual-energy x-ray absorptiometry), and musculoskeletal morphology (peripheral quantitative computed tomography). Compared with controls, OC survivors spent more time/day in prolonged sedentary bouts ( P = 0.039, r = 0.32), had lower cardiorespiratory fitness ( P = 0.041, r = 0.33) and upper body strength ( P = 0.023, r = 0.37), had higher areal bone mineral content ( P = 0.047, r = 0.33) and volumetric trabecular density ( P = 0.048, r = 0.31), but were not different in other measures of body composition nor in muscle morphology ( P 0.050). Only 20% (n = 4) of OC survivors accrued 150 minutes/week or greater moderate and vigorous physical activity (MVPA) time in 10-minute bouts or greater. Moderate and vigorous physical activity time/day in 10-minute bouts or greater was strongly associated with cardiorespiratory fitness ( P = 0.001, ρ = −0.702) and lower extremity function ( P = 0.019, ρ = −0.519) and moderately associated with muscle cross-sectional area ( P = 0.035, ρ = 0.473). Posttreatment OC survivors spent more time in prolonged sedentary bouts and had lower cardiorespiratory fitness and upper body strength compared with controls. Moderate and vigorous physical activity was associated with physical function and muscle cross-sectional area. Future studies should test the efficacy of exercise interventions to increase MVPA, reduce sedentary behavior, and increase cardiorespiratory fitness and muscle strength in OC survivors.
Publisher: Elsevier BV
Date: 09-2004
Publisher: American Association for Cancer Research (AACR)
Date: 05-2007
DOI: 10.1158/1055-9965.EPI-06-0870
Abstract: Purpose: To evaluate the cardiovascular risk profile of a subset of patients with early-stage breast cancer treated with adjuvant taxane-anthracycline–containing chemotherapy and/or trastuzumab (Herceptin). Experimental Design: Twenty-six patients with breast cancer (mean, 20 months postchemotherapy) and 10 healthy age-matched women were studied. We measured 14 metabolic and vascular established cardiovascular disease (CVD) risk factors, body mass index, cardiorespiratory fitness, and left ventricular systolic function. All assessments were done within a 14-day period. Results: Cardiac abnormalities were suggested by left ventricular ejection fraction (LVEF) & % in 8% of patients, LVEF remained & % below pretreatment values in 38%, whereas 50% presented with resting sinus tachycardia. Brain natriuretic peptide was significantly elevated in 40% of patients and was correlated with LVEF (r = −0.72, P = & 0.001). For the majority of CVD risk factors, similar proportions of patients and controls (35-60%) were classified as “undesirable.” A significantly higher proportion of patients were classified with low cardiorespiratory fitness (46% versus 0%, P & 0.01), being overweight/obese (72% versus 50%, P & 0.05), and having resting sinus tachycardia (50% versus 0%, P & 0.01) compared with controls. Cardiorespiratory fitness and body mass index were correlated with CVD risk factors (r = −0.64 to 0.63, P & 0.05 r = −0.63 to 0.67, P & 0.05, respectively). Exploratory analyses revealed several differences between CVD risk factors based on chemotherapy regimen. Conclusion: Breast cancer survivors treated with adjuvant chemotherapy are at a higher risk of developing late-occurring CVD than age-matched controls due to direct and indirect treatment-related toxicity. (Cancer Epidemiol Biomarkers Prev 2007 (5):1026–31)
Publisher: Springer Science and Business Media LLC
Date: 19-01-2016
Publisher: Wiley
Date: 08-11-2010
DOI: 10.1002/CNCR.25513
Abstract: The findings support the use of compression garments and compression bandaging for reducing lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast cancer, a statistically significant, clinically small beneficial effect was found from the addition of manual lymph drainage massage to compression therapy for upper extremity lymphedema volume.
Publisher: Springer Science and Business Media LLC
Date: 21-08-2013
DOI: 10.1038/PCAN.2012.33
Abstract: To examine changes to whole body and regional lean mass (LM) and fat mass (FM) over 33 months of intermittent androgen suppression therapy (IAST). Phase II cohort study of 72 prostate cancer patients without metastatic bone disease. Patients received flutamide 250 mg tid and leuprolide 22.5 mg three monthly depot for the 9-month initial treatment phase (iTREAT), at which point patients ceased therapy providing PSA <4 ng ml(-1) with continued monitoring for further 2 years (POST). AST was recommenced when PSA exceeded pretreatment level or ≥ 20 ng ml(-1). Body composition was assessed using dual energy X-ray absorptiometry at baseline, completion of treatment phase, and 1 and 2 years post treatment phase (months 21 and 33). LM decreased by 1.3 kg and FM increased by 2.3 kg (P<0.001) following iTREAT. During the POST period, there were no further adverse effects on LM or FM, but also no recovery to pretreatment levels. Patients who failed to recover testosterone by month 33 experienced a significant increase in FM compared with those who recovered eugonadal levels of testosterone (10 nmol ml(-1) P = 0.019). Change in testosterone was moderately correlated to changes in % FM (r = -0.314, P<0.028) and LM (r = 0.300, P<0.036) during POST phase. Waist circumference progressively increased over time and by 2 years, POST had not recovered to baseline levels. Loss of LM and gain in FM during the 9-month iTREAT was not reversed during 2-year POST, although further deterioration was not observed. Subgroup analysis identified those recovering testosterone showed some body composition improvements. These findings suggest potential benefits of IAST, where testosterone levels are able to recover, to reduce the ongoing adverse effects on body composition, such as the acceleration of sarcopenia and risks associated with metabolic disease.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-09-2009
Abstract: Lymphoma patients commonly experience declines in physical functioning and quality of life (QoL) that may be reversed with exercise training. We conducted a randomized controlled trial in Edmonton, Alberta, Canada, between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and randomly assigned them to usual care (UC n = 62) or 12 weeks of supervised aerobic exercise training (AET n = 60). Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia. Secondary end points were overall QoL, psychosocial functioning, cardiovascular fitness, and body composition. Follow-up assessment for our primary end point was 96% (117 of 122) at postintervention and 90% (110 of 122) at 6-month follow-up. Median adherence to the supervised exercise program was 92%. At postintervention, AET was superior to UC for patient-rated physical functioning (mean group difference, +9.0 95% CI, 2.0 to 16.0 P = .012), overall QoL (P = .021), fatigue (P = .013), happiness (P = .004), depression (P = .005), general health (P .001), cardiovascular fitness (P .001), and lean body mass (P = .008). Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning. AET did not interfere with chemotherapy completion rate or treatment response. At 6-month follow-up, AET was still borderline or significantly superior to UC for overall QoL (P = .054), happiness (P = .034), and depression (P = .009) without an increased risk of disease recurrence rogression. AET significantly improved important patient-rated outcomes and objective physical functioning in lymphoma patients without interfering with medical treatments or response. Exercise training to improve cardiovascular fitness should be considered in the management of lymphoma patients.
Publisher: Wiley
Date: 26-06-2018
DOI: 10.1111/BJU.14384
Abstract: To investigate the association between lean mass (LM) and fat mass (FM) with fatigue and vitality before and after exercise in patients with prostate cancer already undergoing androgen-deprivation therapy (ADT). Cross-sectional associations between LM and FM with fatigue and/or vitality measures were examined in 229 patients (aged 43-90 years). Prospective analysis was undertaken in 129 patients who underwent a supervised 3-6 months exercise programme (predominantly resistance + aerobic). Whole body and appendicular LM, and total and trunk FM were assessed by dual X-ray absorptiometry. Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-30) and vitality using the Short Form-36. Based on the EORTC QLQ-30, 19% of patients had clinically relevant fatigue. There was no association between LM and fatigue however, total (P = 0.013), trunk (P = 0.015) and percentage (P = 0.008) FM were higher in fatigued than not fatigued patients, with total and trunk FM 5.0 and 2.6 kg higher, respectively. For quartiles of vitality, a similar pattern emerged for FM with those in the lowest quartile of vitality having the highest FM values (P = 0.014-0.034). In contrast, following supervised exercise, change in fatigue and vitality were associated with change in total LM (r = -0.182, P = 0.042 and r = 0.309, P = 0.001, respectively) but not FM. Patients fatigued at baseline but not fatigued following the exercise programme gained a median (interquartile range) of 2.1 (0.7-3.2) kg LM. In patients with prostate cancer treated with ADT, body composition is associated with fatigue, with higher total and trunk FM in those with clinically relevant fatigue. However, following exercise those no longer fatigued had an accompanying substantial increase in LM. Modifying body composition, both LM and FM, in patients with prostate cancer may favourably alter cancer-related fatigue levels and should be a target of exercise medicine in this population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Wiley
Date: 18-07-2012
DOI: 10.1002/PON.2010
Abstract: Supervised exercise is beneficial for lymphoma patients, but it needs to be maintained to optimize long-term benefits. Here, we report the predictors of follow-up exercise behavior 6 months after a randomized controlled trial in lymphoma patients. Lymphoma patients were randomly assigned to 12 weeks of supervised aerobic exercise (n = 60) or usual care (n = 62). At baseline and post-intervention, data were collected on demographic, medical, health-related fitness, quality of life, and motivational variables. At 6-month follow-up, participants were mailed a questionnaire that assessed exercise behavior and were categorized as meeting or not meeting public health exercise guidelines. At 6-month follow-up, 110 participants (90.2%) responded, of which 61 (55.5%) were meeting public health exercise guidelines. In univariate analyses, 16 variables predicted 6-month follow-up exercise behavior. In a stepwise regression analysis, five variables entered the model and explained 38% (p < 0.001) of the variance including the following: accepting a post-intervention exercise prescription (β = 0.33 p < 0.001), achieving a higher peak power output at post-intervention (β = 0.28 p = 0.001), experiencing a larger positive change in perceived behavioral control (β = 0.18 p = 0.028), having Hodgkin lymphoma (β = 0.19 p = 0.025), and having a stronger post-intervention intention (β = 0.18 p = 0.034). Exercise behavior in lymphoma patients 6 months after a randomized trial was predicted by a wide range of demographic, medical, health-related fitness, quality of life, and motivational variables. These findings may help facilitate the uptake of self-directed exercise after short-term supervised exercise in lymphoma patients.
Publisher: Springer Science and Business Media LLC
Date: 18-03-2019
DOI: 10.1038/S41430-019-0418-9
Abstract: Malignant pleural mesothelioma (MPM) is an incurable cancer and optimizing daily physical activity and quality of life are key goals of patient management. Little is known about the prevalence of pre-sarcopenia and malnutrition in MPM or their associations with patient outcomes. This study aimed to determine the prevalence of pre-sarcopenia and malnutrition in MPM and investigate if activity levels and quality of life differed according to body composition and nutritional status. Patients with a diagnosis of MPM were recruited. Pre-sarcopenia was defined as low appendicular skeletal muscle mass (≤ 7.26 kg/m Sixty-one people participated (79% male, median age 69 [IQR 62-74] years and median BMI 25.8 [IQR 24.3-28.4] kg/m Participants with MPM had high rates of pre-sarcopenia and malnutrition. Pre-sarcopenia was associated with poorer activity levels, whilst malnutrition was associated with poorer quality of life. Interventions that aim to address reduced muscle mass and weight loss, should be tested in MPM to assess their impact on patient outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2008
DOI: 10.1007/S10350-008-9324-2
Abstract: This study was designed to examine quality of life and fatigue in colorectal cancer survivors meeting and not meeting public health exercise guidelines. A Canadian provincial cancer registry identified colorectal cancer survivors who were mailed a questionnaire that assessed self-reported exercise, quality of life (Functional Assessment of Cancer Therapy - Colorectal), fatigue, medical, and demographic variables. Completed questionnaires were received from 413 (61.3 percent) eligible colorectal cancer survivors. Only 25.9 percent of colorectal cancer survivors reported meeting exercise guidelines. Colorectal cancer survivors meeting public health exercise guidelines reported clinically and significantly better quality of life (mean difference, 6 95 percent confidence interval, 2.3-9.8 P = 0.002) and fatigue (mean difference = 5.2 95 percent confidence interval, 2.9-7.5 P < 0.001). Differences remained after adjusting for medical and demographic factors. Cancer site (i.e., colon vs. rectal) was the only variable to moderate this association (P < 0.05 for interaction). Colorectal cancer survivors meeting public health exercise guidelines reported significantly and meaningfully better quality of life and fatigue scores than colorectal cancer survivors who did not meet guidelines. Prospective observational studies and randomized, controlled trials are needed to further assess the causal nature of these relationships.
Publisher: Bentham Science Publishers Ltd.
Date: 11-2006
Publisher: Elsevier BV
Date: 02-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Publisher: Wiley
Date: 17-08-2020
Abstract: This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer‐related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence‐based guidelines, systematic reviews and meta‐analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as “at risk” of malnutrition or with a high‐risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment people identified as “at risk” of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer‐related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer‐related malnutrition and sarcopenia should be in idualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer‐related malnutrition and sarcopenia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-08-2020
DOI: 10.1249/MSS.0000000000002127
Abstract: While general guidelines (such as CONSORT or Consensus on Exercise Reporting Template) exist to enhance the reporting of exercise interventions in the field of exercise science, there is inadequate detail facilitating the standardized reporting of resistance training adherence in the oncology setting. The purpose of this study was to apply a novel method to report resistance training dose, adherence, and tolerance in patients with cancer. A total of 47 prostate cancer patients (70.1 ± 8.9 yr, body mass index, 28.6 ± 4.0) with bone metastatic disease completed an exercise program for 12 wk. We assessed traditional metrics of adherence (attendance and loss to follow-up), in addition to novel proposed metrics (exercise-relative dose intensity, dose modification, and exercise interruption). Total training volume in kilograms (repetitions × sets × training load (weight)) was calculated for each patient. Attendance assessed from traditional metrics was 79.5% ± 17.0% and four patients (9%) were lost to follow-up. The prescribed and actual cumulative total dose of resistance training was 139,886 ± 69,150 kg and 112,835 ± 83,499 kg, respectively, with a mean exercise-relative dose intensity of 77.4% ± 16.6% (range: 19.4% –99.4%). Resistance training was missed (1–2 consecutive sessions) or interrupted (missed ≥3 consecutive sessions) in 41 (87%) and 24 (51%) participants, respectively. Training dose was modified (reduction in sets, repetitions, or weight) in 40 (85%) of patients. Importantly, using attendance as a traditional metric of adherence, these sessions would have all counted as adherence to the protocol. Traditional reporting metrics of resistance training in exercise oncology may overestimate exercise adherence. Our proposed metrics to capture resistance training dose, adherence, and tolerance may have important applications for future studies and clinical practice.
Publisher: Canadian Science Publishing
Date: 04-2009
DOI: 10.1139/H08-104
Abstract: Systemic inflammation plays an important role in the initiation, promotion, and progression of lung carcinogenesis. The effects of interventions to lower inflammation have not been explored. Accordingly, we conducted a pilot study to explore the effects of exercise training on changes in biomarkers of systemic inflammation among patients with malignant lung lesions. Using a single-group design, 12 patients with suspected operable lung cancer were provided with structured exercise training until surgical resection. Participants underwent cardiopulmonary exercise testing, 6 min walk testing, pulmonary function testing, and blood collection at baseline and immediately prior to surgical resection. Systemic inflammatory markers included intracellular adhesion molecule (ICAM)-1, macrophage inflammatory protein-1α, interleukin (IL)-6, IL-8, monocyte chemotactic protein-1, C-reactive protein, and tumor necrosis factor-α. The overall exercise adherence rate was 78%, with patients completing a mean of 30 ± 25 sessions. Mean peak oxygen consumption increased 2.9 mL·kg –1 ·min –1 from baseline to presurgery (p = 0.016). Results indicate that exercise training resulted in a significant reduction in ICAM-1 (p = 0.041). Changes in other inflammatory markers did not reach statistical significance. Change in cardiorespiratory fitness was not associated with change in systemic inflammatory markers. This exploratory study provides an initial step for future studies to elucidate the potential role of exercise, as well as identify the underlying mechanisms of action, as a means of modulating the relationship between inflammation and cancer pathogenesis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2018
DOI: 10.1249/MSS.0000000000001644
Abstract: In the cancer survivorship context, physical activity and sedentary behavior have been measured using different methods. To conduct a narrative review of published research in cancer survivor populations to summarize the quality and identify gaps in reporting on accelerometer data collection, data processing, and outcome measures in cancer survivors. An initial PubMed® search of articles published in English was conducted in January 2017, and a final search was conducted in May 2017. Variables extracted included study characteristics, methods for accelerometry data collection (e.g., device used), data processing (e.g., cut points used), and data reporting (e.g., time spent in different activity intensities). A total of 46 articles were eligible for inclusion in the review. The majority of studies (34 of 46) targeted a single cancer group and 18 of these 34 studies were in survivors of breast cancer. Half (54%) of the studies used an ActiGraph® accelerometer. Methods of accelerometer data processing varied across studies. Definitions of non–wear time, vectors used during processing, and filters applied during processing were reported by 51%, 60%, and 8% of studies, respectively. Most studies reported moderate and vigorous physical activity (78%), 50% reported sedentary time, and 43% reported light-intensity activity. Cut points to categorize these activities varied between studies. This narrative review highlights inconsistency in the methods used to collect, process, and report accelerometry data across cancer survivor studies. Accelerometry has potential to add detailed knowledge of the levels and patterns of physical activities and sedentary behaviors across the cancer spectrum. Recommendations are made to improve data processing and reporting methods to maximize the scientific validity of future accelerometer research in this field.
Publisher: Oxford University Press (OUP)
Date: 19-06-2010
DOI: 10.1007/S12160-010-9205-5
Abstract: Exercise improves health in lymphoma patients but the determinants of adherence in this population are unknown. The purpose of this study is to examine predictors of exercise adherence in lymphoma patients. In a randomized trial, 60 lymphoma patients were assigned to the exercise group and asked to attend three supervised exercise sessions per week for 12 weeks. Baseline data were collected on demographic, medical, fitness, psychosocial, and motivational variables. Adherence was assessed by objective attendance. Adherence was 77.8% and was significantly predicted by age (beta = 0.29 p = 0.016) and past exercise (beta = 0.27 p = 0.024) and borderline significantly predicted by previous treatments (beta = 0.22 p = 0.053), body mass index (beta = -0.21 p = 0.076), and smoking (beta = -0.19 p = 0.092). Poorer exercise adherence was experienced by lymphoma patients under age 40, insufficiently active at baseline, previously treated with radiation therapy, overweight or obese, and smokers. Findings may facilitate the development of targeted interventions to improve exercise adherence in this understudied patient population.
Publisher: Hindawi Limited
Date: 09-06-2018
DOI: 10.1111/ECC.12722
Abstract: The purpose of this study was to investigate the feasibility and preliminary efficacy of a pragmatic distance-based intervention designed to increase physical activity (PA) participation in lung cancer survivors. Fourteen lung cancer survivors were recruited via invitation from the State Cancer Registry to join a 12-week PA intervention of print materials paired with brief telephone follow-up. Outcome measures of feasibility, PA participation and quality of life (QoL) were assessed at baseline, post-intervention and follow-up via telephone interview. Eligibility, recruitment and attrition rates were 16%, 58% and 29% respectively. No adverse events were reported however, pain scores worsened following the intervention (median change -3.6, IQR -8.0, 0.0). Average intervention adherence was 91% with low median ratings of participation burden (i.e., all items 1/7) and high trial evaluation (i.e., all items 7/7). Post-intervention, median change in self-reported moderate and vigorous PA was 84 min (IQR -22, 188), and several domains of QoL improved. However, for both of these outcomes, improvements were not maintained at follow-up. Our findings suggest that this pragmatic distance-based intervention was safe, had good adherence rates, and indicate potential for improving short-term PA and QoL in lung cancer survivors. Additional strategies are needed to improve other indicators of feasibility, particularly recruitment, retention and long-term maintenance of improvements. Australian New Zealand Clinical Trials Registration: ACTRN12612000085875.
Publisher: BMJ
Date: 09-2017
DOI: 10.1097/IGC.0000000000001044
Abstract: Physical activity has become increasingly important in supportive cancer care. However, physical activity and exercise guidelines for ovarian cancer survivors remain generic. The aim of this narrative review is to summarize existing data regarding the physiological characteristics (treatment-related adverse effects, concurrent comorbidities, body weight and composition, physical fitness and function, and physical activity behavior) of ovarian cancer survivors to further understanding of their cancer-specific physical activity and exercise needs. We also highlight gaps in the current knowledge base. We undertook a narrative review of current literature on the physiological status of ovarian cancer survivors. We defined physiological status as treatment-related adverse effects, concurrent comorbidities, body weight and composition, physical fitness and function, and physical activity behavior. In addition to disease- and treatment-related symptoms and adverse effects, the majority of ovarian cancer survivors have comorbidities, which may adversely affect treatment effectiveness and safety, as well as survival. Despite high overweight and obesity rates, a large percentage of women are malnourished at diagnosis, with potentially compromised muscle mass and muscle density. Low muscle density at diagnosis and loss of muscle mass during treatment may be associated with worse survival outcomes. A small number of studies have observed impaired physical function and cardiorespiratory fitness in ovarian cancer survivors. The majority of ovarian cancer survivors are insufficiently active or sedentary. Our review suggests that ovarian cancer survivors could benefit from physical activity and exercise oncology interventions aimed at addressing detrimental changes to physiological status due to disease and treatment. However, current knowledge gaps regarding the physiological characteristics of ovarian cancer survivors throughout the entire survivorship spectrum challenge the development of tailored exercise intervention studies and exercise oncology guidelines.
Publisher: Wiley
Date: 11-02-2019
Publisher: SAGE Publications
Date: 28-06-2018
Abstract: Introduction: Women with breast cancer are often prescribed aromatase inhibitors, which can cause rapid loss of bone mass leading to significant potential for morbidity. Vibration training has been shown to be helpful in reducing bone turnover in postmenopausal women without cancer. Aim: To examine the effect of vibration stimulus on markers of bone turnover in breast cancer patients receiving aromatase inhibitors. Methods: Thirty-one breast cancer survivors undergoing treatment with aromatase inhibitors were randomized to vibration stimulus (n = 14) or usual care control (n = 17). Low-frequency and low-magnitude vibration stimulus (27-32 Hz, 0.3 g) was delivered in supervised sessions via standing on a vibration platform for 20 minutes, 3 times per week for 12 weeks. The primary outcome was blood markers of bone resorption (serum N-telopeptide X/creatine) and formation (serum type 1 procollagen N-terminal propeptide P1NP). Other study outcomes body composition as well as measures of physical functioning. Outcomes were compared between groups using analysis of covariance adjusted for baseline values as well as time on aromatase inhibitors. Outcomes: On average, participants were 61.5 years old and overweight (ie, body mass index = 28.5 kg/m 2 ). Following vibration training, there was no significant difference between groups for bone resorption (adjusted group difference 0.5, P = .929) or formation (adjusted group difference 5.3, P = .286). There were also no changes in any measure of physical functioning body composition. Conclusions: Short-term low-magnitude vibration stimulus does not appear to be useful for reducing markers of bone turnover secondary to aromatase inhibitors in breast cancer patients nor is it useful in improving physical function or symptoms. However, further investigations with larger s les and higher doses of vibration are warranted. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12611001094965).
Publisher: Wiley
Date: 15-01-2023
DOI: 10.1111/RESP.14451
Abstract: Device‐assessed activity behaviours are a novel measure for comparing intervention outcomes in patients with malignant pleural effusion (MPE). Australasian Malignant PLeural Effusion (AMPLE)‐2 was a multi‐centre clinical trial where participants with MPE treated with an indwelling pleural catheter were randomized to daily (DD) or symptom‐guided (SGD) drainage for 60‐days. Our aim was to describe activity behaviour patterns in MPE patients, explore the impact of drainage regimen on activity behaviours and examine associations between activity behaviours and quality of life (QoL). Following randomization to DD or SGD, participants enrolled at the lead site (Perth) completed accelerometry assessment. This was repeated monthly for 5‐months. Activity behaviour outcomes were calculated as percent of daily waking‐wear time and compared between groups (Mann–Whitney U test Median [IQR]). Correlations between activity behaviour outcomes and QoL were examined. Forty‐one (91%) participants provided ≥1 valid accelerometry assessment (DD n = 20, SGD n = 21). Participants spent a large proportion of waking hours sedentary (72%–74% across timepoints), and very little time in moderate‐to‐vigorous physical activity ( % across timepoints). Compared to SGD group, DD group had a more favourable sedentary‐to‐light ratio in the week following randomization (2.4 [2.0–3.4] vs. 3.2 [2.4–6.1] p = 0.047) and at 60‐days (2.0 [1.9–2.9] vs. 2.9 [2.8–6.0] p = 0.016). Sedentary‐to‐light ratio was correlated with multiple QoL domains at multiple timepoints. Patients with MPE are largely sedentary. Preliminary results suggest that even modest differences in activity behaviours favouring the DD group could be meaningful for this clinical population. Accelerometry reflects QoL and is a useful outcome measure in MPE populations.
Publisher: American Association for Cancer Research (AACR)
Date: 06-2012
DOI: 10.1158/1055-9965.EPI-12-0075
Abstract: Background: Patients with lymphoma experience sleep problems that may be managed with aerobic exercise but no previous study has examined this issue. Methods: We randomized 122 patients with lymphoma to usual care (n = 62) or 12 weeks of supervised aerobic exercise training (AET n = 60). Our primary sleep endpoint was global sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI). Secondary endpoints were the PSQI component scores. Planned subgroup analyses were also conducted. Results: Intention-to-treat analyses indicated that AET resulted in a nonsignificant (P = 0.16) improvement in global sleep quality compared with usual care [mean group difference = −0.64 95% confidence interval (CI), −1.56 to +0.27]. In planned subgroup analyses, statistically significant or borderline significant interactions were identified for type of lymphoma (Pinteraction = 0.006), current treatment status (Pinteraction = 0.036), time since diagnosis (Pinteraction = 0.010), body mass index (Pinteraction = 0.075), and baseline sleep quality (Pinteraction = 0.041). Specifically, AET improved global sleep quality in patients with lymphoma who had indolent non–Hodgkin lymphoma (P = 0.001), were receiving chemotherapy (P = 0.013), were & years post-diagnosis (P = 0.005), were obese (P = 0.025), and were poor sleepers at baseline (P = 0.007). Conclusions: AET did not significantly improve sleep quality in this heterogeneous s le of patients with lymphoma however, clinically identifiable subgroups appeared to benefit. Future exercise trials targeting these responsive subgroups are needed to confirm these findings. Impact: If replicated in larger and more focused trials, aerobic exercise may be an attractive option to manage sleep dysfunction in patients with cancer because of its favorable safety profile and other documented health benefits. Cancer Epidemiol Biomarkers Prev 21(6) 887–94. ©2012 AACR.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2019
Publisher: Springer Science and Business Media LLC
Date: 28-04-2017
DOI: 10.1007/S00520-017-3721-9
Abstract: Malignant pleural effusion (MPE) affects 1 million people worldwide annually and can significantly impair physical activity. Accelerometry is a validated method of objectively assessing physical activity. The purpose of this study was to determine the compliance in patients with MPE to accelerometry and describe their activity. Patients with MPE wore an Actigraph GT3X accelerometer over a 7-day continuous wear protocol. Compliance was measured as the percent of patients who had ≥4 valid days (i.e., 8-h/day of waking wear-time). Eastern Cooperative Oncology Group performance status was documented the day of actigraphy initialization. Forty-six patients with MPE received accelerometers 44 (95.7%) returned their device. No complications were reported on their use. Forty subjects (90.9%) had ≥4 valid days of wear-time. Patients spent most of their waking hours sedentary [mean 11.0 h (SD 1.95)], with limited participation in moderate and vigorous physical activity [mean 9.5 min (SD 14.16)]. Compared to patients with better performance status (n = 32), patients with poorer performance status (n = 11) spent significantly more hours/day sedentary [mean difference 2.1 (CI 0.86-3.32) p = 0.001], as did those who survived 12 months (n = 27) [mean difference 2.6 (CI 0.49-4.77) p = 0.013). Accelerometry was applied successfully in patients with MPE with high compliance and no adverse events. This is the first reported objectively measured physical activity in patients with MPE and revealed high sedentary behavior and low physical activity. The data reflected patient performance status and discriminated between survival groups. Accelerometry can provide a useful measure for future interventional studies in patients with MPE.
Publisher: Wiley
Date: 08-05-2022
DOI: 10.1002/PAN3.10331
Abstract: We outline the principles of the natural capital approach to decision making and apply these to the contemporary challenge of very significantly expanding woodlands as contribution to attaining net zero emissions of greenhouse gases. Drawing on the case of the UK, we argue that a single focus upon carbon storage alone is likely to overlook the other ‘net zero plus’ benefits which woodlands can deliver. A review of the literature considers the wide variety of potential benefits which woodlands can provide, together with costs such as foregone alternative land uses. We argue that decision making must consider all of these potential benefits and costs for the right locations to be planted with the right trees. The paper closes by reviewing the decision support systems necessary to incorporate this information into policy and decision making. Read the free Plain Language Summary for this article on the Journal blog.
No related grants have been discovered for Carolyn Peddle-McIntyre.