Publications by authors named "Sarah E Neil-Sztramko"

23 Publications

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School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18.

Cochrane Database Syst Rev 2021 09 23;9:CD007651. Epub 2021 Sep 23.

School of Nursing, McMaster University, Hamilton, Canada.

Background: Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school.

Objectives: The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population.

Search Methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information.

Selection Criteria: Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update.  DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type.

Main Results: Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias.  Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events.

Authors' Conclusions: Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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http://dx.doi.org/10.1002/14651858.CD007651.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459921PMC
September 2021

Systematic Review of Exercise Studies in Persons with Multiple Sclerosis: Exploring the Quality of Interventions According to the Principles of Exercise Training.

Neurol Ther 2021 Sep 14. Epub 2021 Sep 14.

Department of "Performance and Health (Sports Medicine)", Institute of Sport and Sport Science, Technical University Dortmund, Otto-Hahn-Str. 3, 44227, Dortmund, Germany.

Introduction: The objective of this systematic review is to explore the application and reporting of (i) the principles of exercise training in exercise trials, (ii) the components of exercise prescription, and (iii) the adherence towards the prescribed programmes in randomised controlled trials (RCTs) in persons with multiple sclerosis (pwMS).

Methods: The MEDLINE, CINAHL, SPORTDiscus, PubMed and Embase electronic databases were searched from 1 January 2000 to 16 October 2020. RCTs comprising at least 3 weeks of aerobic and/or resistance exercise intervention in pwMS that reported at least one physiological outcome and were published in peer-reviewed journals were eligible for inclusion.

Results: Out of 52 RCTs included in this review, 58 intervention arms were examined. None applied more than four principles of exercise training. Specificity was addressed by 85%, progression by 33%, overload by 59%, initial values by 26%, reversibility by 0% and diminishing returns by 2% of trials. Fifty-two percent of trials reported all components of exercise prescription, and 3% of trials reported the level of adherence to the prescribed exercise.

Conclusion: This systematic review reveals that exercise training principles were not respected in the majority of included RCTs. The weak quality of reported exercise interventions limits the interpretation of the studies' results and potentially leads to an underestimation of 'exercise as medicine' in pwMS. Also, the vague descriptions of exercise prescription and adherence impede the reproducibility of results. Future studies must attend to all principles of exercise training and provide transparent information on the prescribed and performed programmes to develop specific and valid exercise recommendations for pwMS.

Systematic Review Registration: CRD42020162671, 28/04/2020, PROSPERO.
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http://dx.doi.org/10.1007/s40120-021-00274-zDOI Listing
September 2021

Assessing the Electronic Evidence System Needs of Canadian Public Health Professionals: Cross-sectional Study.

JMIR Public Health Surveill 2021 Sep 7;7(9):e26503. Epub 2021 Sep 7.

National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON, Canada.

Background: True evidence-informed decision-making in public health relies on incorporating evidence from a number of sources in addition to traditional scientific evidence. Lack of access to these types of data as well as ease of use and interpretability of scientific evidence contribute to limited uptake of evidence-informed decision-making in practice. An electronic evidence system that includes multiple sources of evidence and potentially novel computational processing approaches or artificial intelligence holds promise as a solution to overcoming barriers to evidence-informed decision-making in public health.

Objective: This study aims to understand the needs and preferences for an electronic evidence system among public health professionals in Canada.

Methods: An invitation to participate in an anonymous web-based survey was distributed via listservs of 2 Canadian public health organizations in February 2019. Eligible participants were English- or French-speaking individuals currently working in public health. The survey contained both multiple-choice and open-ended questions about the needs and preferences relevant to an electronic evidence system. Quantitative responses were analyzed to explore differences by public health role. Inductive and deductive analysis methods were used to code and interpret the qualitative data. Ethics review was not required by the host institution.

Results: Respondents (N=371) were heterogeneous, spanning organizations, positions, and areas of practice within public health. Nearly all (364/371, 98.1%) respondents indicated that an electronic evidence system would support their work. Respondents had high preferences for local contextual data, research and intervention evidence, and information about human and financial resources. Qualitative analyses identified several concerns, needs, and suggestions for the development of such a system. Concerns ranged from the personal use of such a system to the ability of their organization to use such a system. Recognized needs spanned the different sources of evidence, including local context, research and intervention evidence, and resources and tools. Additional suggestions were identified to improve system usability.

Conclusions: Canadian public health professionals have positive perceptions toward an electronic evidence system that would bring together evidence from the local context, scientific research, and resources. Elements were also identified to increase the usability of an electronic evidence system.
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http://dx.doi.org/10.2196/26503DOI Listing
September 2021

Community-based exercise programs for cancer survivors: A scoping review of program characteristics using the Consolidated Framework for Implementation Research.

Arch Phys Med Rehabil 2021 Aug 7. Epub 2021 Aug 7.

School of Kinesiology and Health Studies, Queens University.

Objective: To describe the characteristics of exercise programs for cancer survivors conducted outside of a research laboratory (i.e., home-based, or community-based settings).

Data Sources: A systematic search of published literature was conducted using Medline, Pubmed, CINAHL, PsychINFO, SPORTdiscus, and Embase from 1980 to January 2021. Where conference abstracts were identified, authors were contacted for other articles.

Study Selection: Two independent reviewers screened titles and abstracts, and full texts of potentially relevant studies with discrepancies resolved by discussion. Included studies were reports of exercise programs or interventions in which participants exercise at home, or in a community-based setting, and including individuals diagnosed with cancer either undergoing treatment or who had completed treatment.

Data Extraction: Data were extracted using the Oxford Implementation Index and coded under the five domains of the Consolidated Framework for Implementation Research (CFIR). Extraction and coding were completed by two independent reviewers, with discrepancies resolved through discussion. Data were synthesized narratively according to CFIR.

Data Synthesis: A total of 58 publications describing 34 individual programs from around the world were included. Of these, only 14 publications had the specific goal of reporting on program implementation and development. A variety of intervention characteristics and characteristics of individuals involved in the intervention were described. Reporting of factors related to the CFIR domains of inner setting, outer setting and implementation process were minimal.

Conclusions: This review summarizes the characteristics of existing programs that have been reported in the literature and finds that partnerships and collaboration in the inner and outer setting, and as part of the process of implementation. This review highlights key knowledge gaps to be answered in order to support the development of future community-based interventions.
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http://dx.doi.org/10.1016/j.apmr.2021.06.026DOI Listing
August 2021

Attention to the Principles of Exercise Training in Exercise Studies of Persons With Lung Cancer: A Systematic Review.

J Aging Phys Act 2021 May 7:1-11. Epub 2021 May 7.

The authors systematically reviewed and summarized exercise trials in persons with lung cancer on (a) attention to the principles of exercise training (specificity, progression, overload, initial values, reversibility, and diminishing returns); (b) methodological reporting of FITT (frequency, intensity, time, and type) components; and (c) reporting on participant adherence to prescribed FITT. Randomized controlled trials of exercise that reported on ≥1 physical fitness, physical function, or body composition outcome in persons with lung cancer were included. Of 20 trial arms, none incorporated all principles of exercise training. Specificity was included by 95%, progression by 45%, overload by 75%, and initial values by 80%, while one trial arm applied reversibility and diminishing returns. Fourteen interventions reported all FITT components; however, none reported adherence to each component. Including the principles of training and reporting FITT components will contribute to better understanding of the efficacy of exercise for persons with lung cancer and inform evidence-based exercise prescriptions.
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http://dx.doi.org/10.1123/japa.2020-0269DOI Listing
May 2021

Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: a systematic review.

BMJ Open 2021 05 3;11(5):e047152. Epub 2021 May 3.

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

Background: Disasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course.

Design: A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools.

Results: A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters.

Conclusions: The findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk.

Prospero Registration Number: CRD42020186074.
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http://dx.doi.org/10.1136/bmjopen-2020-047152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098961PMC
May 2021

Where Are We Now? A Content Analysis of Canadian Master of Public Health Course Descriptions and the Public Health Agency of Canada's Core Competencies.

J Public Health Manag Pract 2021 Mar-Apr 01;27(2):201-207

Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins).

Objective: To examine the degree to which Master of Public Health (MPH) programs' course descriptions align with the Public Health Agency of Canada's (PHAC's) core competency categories in order to identify strengths and training gaps in such programs across Canada.

Methods: A content analysis of MPH programs in Canada was conducted from July 2019 to November 2019. A sampling frame of programs was obtained from a list from the PHAC Web site. Program information, including mandatory and elective course descriptions, was extracted from each program's Web site and analyzed in NVivo 12. Course descriptions were independently categorized by 2 researchers into 1 or more of the 7 categories of the core competencies outlined by the PHAC.

Results: We identified 18 universities with MPH programs with 267 courses across Canada. Thematic analysis revealed that 100% of programs had coursework that addressed the "Public Health Sciences" and "Assessment and Analysis" categories; 93% addressed "Policy and Program Planning, Implementation, and Evaluation"; 67% addressed each of "Communication," "Leadership," and "Partnerships, Collaboration, and Advocacy"; and only 56% had course descriptions addressing "Diversity and Inclusiveness."

Conclusions: We find that Canadian MPH programs may lack course offerings addressing core competency categories relating to diversity and inclusiveness, communication, and leadership. Our findings were limited in scope as we relied on program Web sites; thus, further research should explore course content in more depth than this course description analysis allowed and identify ways to close the MPH curricular gaps we identified.
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http://dx.doi.org/10.1097/PHH.0000000000001173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837747PMC
October 2021

Impact of the AGE-ON Tablet Training Program on Social Isolation, Loneliness, and Attitudes Toward Technology in Older Adults: Single-Group Pre-Post Study.

JMIR Aging 2020 Apr 20;3(1):e18398. Epub 2020 Apr 20.

Division of Geriatrics, McMaster University, Hamilton, ON, Canada.

Background: The internet and technology can help older adults connect with family and friends. However, many older adults face obstacles to internet and technology use, such as lack of knowledge or self-efficacy.

Objective: The purpose of this study was to explore the impact of the AGE-ON tablet training program on social isolation, loneliness, and quality of life.

Methods: Adults aged >60 years took part in a series of 6 weekly workshops covering the basic features of a tablet. Before and after the program, social isolation, loneliness, social support, and quality of life were assessed. In addition, data on current tablet use and attitudes toward technology use were collected. Satisfaction with the program was also assessed at the end of the study using 6 Likert scale questions.

Results: The participants (N=32; mean age 76.3, SD 8.6 years) were predominantly female (n=20, 63%) and retired (n=30, 94%). The participants reported that they were highly satisfied with the program. After completing the program, no differences in social isolation, loneliness, social support, or quality of life were found. Frequency of tablet use increased and the attitudes of the participants toward technology improved.

Conclusions: The AGE-ON program resulted in increased tablet use frequency and may improve comfort and attitudes toward tablet use among older adults. This program may assist older adults in overcoming obstacles to internet and technology use to better connect with family and friends; however, further work targeting older adults who are socially isolated or at risk of social isolation is needed to more fully understand whether tablet training programs are beneficial in this population.

Trial Registration: ClinicalTrials.gov NCT03472729; https://clinicaltrials.gov/ct2/show/NCT03472729.
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http://dx.doi.org/10.2196/18398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199129PMC
April 2020

Evaluation of an online knowledge translation intervention to promote cancer risk reduction behaviours: findings from a randomized controlled trial.

BMC Cancer 2019 Nov 21;19(1):1138. Epub 2019 Nov 21.

McMaster University, 175 Longwood Rd South, Suite 210a, Hamilton, ON, L8P 3Y2, Canada.

Background: Many cancers are preventable through lifestyle modification; however, few adults engage in behaviors that are in line with cancer prevention guidelines. This may be partly due to the mixed messages on effective cancer prevention strategies in popular media. The goal of the McMaster Optimal Aging Portal (the Portal) is to increase access to trustworthy health information. The purpose of this study was to explore if and how knowledge translation strategies to disseminate cancer prevention evidence using the Portal influence participants' knowledge, intentions and health behaviors related to cancer risk.

Methods: Adults ≥40 years old, with no cancer history were randomized to a 12-week intervention (weekly emails and social media posts) or control group. Quantitative data on knowledge, intentions and behaviors (physical activity, diet, alcohol consumption and use of tobacco products) were collected at baseline, end of study and 3 months later. Participant engagement was assessed using Google Analytics, and participant satisfaction through open-ended survey questions and semi-structured interviews.

Results: Participants (n = 557, mean age 64.9) were predominantly retired (72%) females (81%). Knowledge of cancer prevention guidelines was higher in the intervention group at end of study only (+ 0.3, p = 0.01). Intentions to follow cancer prevention guidelines increased in both groups, with no between-group differences. Intervention participants reported greater light-intensity physical activity at end of study (+ 0.7 vs. 0.1, p = 0.03), and reduced alcohol intake at follow u (- 0.2 vs. + 0.3, p < 0.05), but no other between-group differences were found. Overall satisfaction with the Portal and intervention materials was high.

Conclusions: Dissemination of evidence-based cancer prevention information through the Portal results in small increases in knowledge of risk-reduction strategies and with little to no impact on self-reported health behaviours, except in particular groups. Further tailoring of knowledge translation strategies may be needed to see more meaningful change in knowledge and health behaviours.

Trial Registration: ClinicalTrials.gov NCT03186703, June 14, 2017.
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http://dx.doi.org/10.1186/s12885-019-6361-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873728PMC
November 2019

A Mobility-Focused Knowledge Translation Randomized Controlled Trial to Improve Physical Activity: Process Evaluation of the Move4Age Study.

J Med Internet Res 2019 06 20;21(6):e13965. Epub 2019 Jun 20.

National Collaborating Centre for Methods and Tools, School of Nursing, McMaster University, Hamilton, ON, Canada.

Background: Maintaining physical activity and physical function is important for healthy aging. We recently completed a randomized controlled trial of a targeted knowledge translation (KT) intervention delivered through the McMaster Optimal Aging Portal with the goal to increase physical activity and physical mobility in middle-aged and older adults, with results reported elsewhere.

Objective: The purpose of this process evaluation study is to explore which KT strategies were used by both intervention and control group participants, as well as the intervention groups' engagement, satisfaction, and perceived usefulness of the targeted KT intervention.

Methods: Data on engagement with the intervention materials were gathered quantitatively through Google Analytics and Hootsuite throughout the intervention. Qualitative data were collected through a combination of open-ended surveys and qualitative interviews with a subset of participants at the end of the study to further understand engagement, satisfaction, and usefulness of the KT strategies.

Results: Throughout the intervention period, engagement with content delivered through weekly emails was highest, and participants rated email content most favorably in both surveys and interviews. Participants were generally satisfied with the intervention, noting the ease of participating and the distillation of information in an easy-to-access format being beneficial features. Participants who did not find the intervention useful were those with already high levels of baseline physical activity or physical function and those who were looking for more specific or individualized content.

Conclusions: This process evaluation provides insight into our randomized controlled trial findings and provides information that can be used to improve future online KT interventions.

Trial Registration: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/nct02947230 (Archived by WebCite at http://www.webcitation.org/78t4tR8tM).
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http://dx.doi.org/10.2196/13965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610468PMC
June 2019

Attention to the principles of exercise training in exercise studies on prostate cancer survivors: a systematic review.

BMC Cancer 2019 Apr 5;19(1):321. Epub 2019 Apr 5.

School of Nursing, Oregon Health and Science University, Portland, Oregon, USA.

Background: The purpose of this review is to update previously published reviews on exercise programming in exercise trials in prostate cancer survivors. We evaluated: 1) the application of the principles of exercise training in prescribed programs; 2) the reporting of the components of the exercise prescription; and 3) the reporting of adherence of participants to the prescribed programs.

Methods: Building upon a previous review, a systematic review was conducted searching OVID Medline, Embase, CINAHL, and SPORTDiscus databases from 2012-2017. Randomized controlled trials of at least four weeks of aerobic and/or resistance exercise in men diagnosed with prostate cancer that reported physical fitness outcomes, including body composition were eligible for inclusion.

Results: Specificity was appropriately applied by 93%, progression by 55%, overload by 48%, initial values by 55%, and diminishing returns by 28% of eligible studies. No study adequately applied the principle of reversibility. Most (79%) studies reported all components of the exercise prescription in the study methods, but no study reported all components of adherence to the prescribed intervention in the study results.

Conclusions: Application of standard exercise training principles is inadequate in exercise trials in men with prostate cancer and could possibly lead to an inadequate exercise stimulus. While many studies report the basic components of the exercise prescription in their study methods, full reporting of actual exercise completed is needed to advance our understanding of the optimal exercise dose for men with prostate cancer and promote translation of controlled trials to practice.
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http://dx.doi.org/10.1186/s12885-019-5520-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451299PMC
April 2019

Moving Cancer Care Ontario's Exercise for People with Cancer guidelines into oncology practice: using the Theoretical Domains Framework to validate a questionnaire.

Support Care Cancer 2019 Jun 14;27(6):1965-1968. Epub 2019 Feb 14.

McMaster University, Hamilton, ON, Canada.

Evidence supporting the benefits of exercise surrounding cancer treatment has led to internationally published guidelines, with minimal uptake by oncology care providers (OCPs). There is a need to understand how to implement research evidence into practice. Our team developed a questionnaire to assess OCPs' knowledge of exercise guidelines and barriers/facilitators to exercise counseling and program referral. We validated the questionnaire using the Theoretical Domains Framework, a knowledge translation (KT) framework used to implement evidence-based guidelines into practice. In this commentary, we describe this process and the rationale for integrating a KT framework into intervention development and implementation in oncology practice. The revised questionnaire, entitled Clinicians Perspectives on Exercise in Patients with Cancer (CliPEC), is shared to facilitate the implementation process and allow for comparison across oncology practices.
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http://dx.doi.org/10.1007/s00520-019-04689-1DOI Listing
June 2019

Predictors of attendance to an oncologist-referred exercise program for women with breast cancer.

Support Care Cancer 2018 Sep 13;26(9):3297-3306. Epub 2018 Apr 13.

Rehabilitation Sciences, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.

Purpose: While exercise is associated with numerous benefits in women with breast cancer, adherence to exercise training concurrent to cancer treatment is challenging. We aimed to identify predictors of attendance to an oncologist-referred exercise program offered during and after adjuvant breast cancer treatment.

Methods: Women with early-stage breast cancer receiving chemotherapy (n = 68) enrolled in the Nutrition and Exercise During Adjuvant Treatment (NExT) study. Supervised aerobic and resistance exercise was prescribed three times per week during treatment, then one to two times per week for 20 additional weeks. Predictors of attendance were identified using multivariate linear regression for three phases of the intervention, including during (1) adjuvant chemotherapy, (2) radiation, and (3) 20-weeks post-treatment.

Results: Higher baseline quality of life (QoL) predicted higher attendance during chemotherapy (β = 0.51%, 95 CI: 0.09, 0.93) and radiation (β = 0.85%, 95 CI: 0.28, 1.41), and higher QoL, measured at the end of treatment, predicted higher attendance post-treatment (β = 0.81%, 95 CI: 0.34, 1.28). Being employed pre-treatment (β = 34.08%, 95 CI: 5.71, 62.45) and a personal annual income > $80,000 (β = 32.70%, 95 CI: 0.85, 64.55) predicted higher attendance during radiation. Being divorced, separated or widowed (β = - 34.62%, 95 CI: - 56.33, - 12.90), or single (β = - 25.38%, 95 CI: - 40.64, - 10.13), relative to being married/common-law, and undergoing a second surgery (β = - 21.37%, 95 CI: - 33.10, - 9.65) predicted lower attendance post-treatment.

Conclusions: Demographic variables, QoL, and receipt of a second surgery significantly predicted attendance throughout the NExT supervised exercise program. These results may help identify individuals with exercise adherence challenges and improve the design of future interventions, including optimizing the timing of program delivery.
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http://dx.doi.org/10.1007/s00520-018-4180-7DOI Listing
September 2018

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

Br J Sports Med 2019 Apr 21;53(8):504-512. Epub 2017 Nov 21.

Rehabilitation Sciences Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada.

Objectives: To update our previous evaluation of the exercise interventions used in randomised controlled trials of breast cancer survivors in relation to (1) the application of the principles of exercise training in the exercise prescription; (2) the reporting of the components of the exercise prescription; and (3) the reporting of adherence of participants to the prescribed interventions.

Design: Systematic review.

Data Sources: The OVID Medline, Embase, CINAHL and SPORTDiscus electronic databases were searched from January 2010 to January 2017.

Eligibility Criteria: Randomised controlled trials of at least 4 weeks of aerobic and/or resistance exercise in women diagnosed with breast cancer, reporting on physical fitness or body composition outcomes.

Results: Specificity was appropriately applied by 84%, progression by 29%, overload by 38% and initial values by 67% of newly identified studies. Reversibility was reported by 3% anddiminishing returns by 22% of newly identified studies. No studies reported all components of the exercise prescription in the methods, or adherence to the prescribed intervention in the results. Reporting of reversibility has increased from 2010, but no other improvements in reporting were noted from the previous review.

Summary/conclusion: No studies of exercise in women with breast cancer attended to all principles of exercise training, or reported all components of the exercise prescription in the methods, or adherence to the prescription in the results. Full reporting of the exercise prescribed and completed is essential for study replication in research and translating research findings into the community, and should be prioritised in future trials.
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http://dx.doi.org/10.1136/bjsports-2017-098389DOI Listing
April 2019

If You Build It, Who Will Come? A Description of User Characteristics and Experiences With the McMaster Optimal Aging Portal.

Gerontol Geriatr Med 2017 Jan-Dec;3:2333721417737681. Epub 2017 Nov 8.

McMaster University, Hamilton, Ontario, Canada.

The McMaster Optimal Aging Portal (the Portal) aims to increase access to evidence-based health information. We would now like to understand who uses the Portal, why, and for what, and elicit feedback and suggestions for future initiatives. An online survey of users collected data on demographics, eHealth literacy, Internet use, information-seeking behavior, site acceptability and perceived impact on health behaviors, participant satisfaction, and suggestions for improvements using mixed methods. Participants ( = 163, age 69.8 ± 8.6 years) were predominantly female (76%), married (67%), retired (80%), and well-educated with very good/excellent health (55%). The Portal was easy to use (83%) and relevant (80%), with 68% intending to, and 48% having changed behavior after using the Portal. A number of suggestions for improvement were obtained. A better understanding of users' characteristics, needs, and preferences will allow us to improve content, target groups who are not engaging with the Portal, and plan future directions.
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http://dx.doi.org/10.1177/2333721417737681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680942PMC
November 2017

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

Physiother Can 2017;69(2):152-160

Department of Physical Therapy, University of British Columbia, Vancouver.

This article describes the physical activity of physiotherapists in British Columbia and examines differences across practice settings using self-report questionnaire and accelerometer-derived measures. Public and private practice physiotherapists aged 18-65 years were recruited through employee email lists and word of mouth to this cross-sectional study. Participants (=98) completed the International Physical Activity Questionnaire-Long Form (IPAQ-L) online to quantify self-reported physical activity across various domains (occupational, leisure time, domestic, and transportation). Of these, 38 agreed to wear an accelerometer for 7 days to objectively measure physical activity. Descriptive statistics were used to describe self-reported and accelerometer-measured physical activity across domains, and inferential statistics were used to compare physical activity patterns across practice sites. The correlation and agreement between self-report questionnaire and accelerometer measures were also calculated. Almost all (99%) of the physiotherapists self-reported meeting physical activity guidelines, and only 58% were classified as meeting guidelines when using accelerometers. Public practice physiotherapists self-reported more total, occupational, and domestic physical activity and had higher measured occupational physical activity than private practice physiotherapists. Overall, there was poor agreement between self-report questionnaires and accelerometers. Physiotherapists are an active group, with those in public practice reporting and participating in more physical activity than those in private practice.
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http://dx.doi.org/10.3138/ptc.2015-64DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435389PMC
January 2017

Appraising the exercise oncology literature: a reminder of the rigour needed in systematic reviews.

Br J Sports Med 2019 Aug 24;53(15):983-984. Epub 2017 Mar 24.

Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.

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http://dx.doi.org/10.1136/bjsports-2017-097697DOI Listing
August 2019

Determining activity count cut-points for measurement of physical activity using the Actiwatch2 accelerometer.

Physiol Behav 2017 05 17;173:95-100. Epub 2017 Jan 17.

Department of Physical Therapy, University of British Columbia, Canada; Centre of Excellence in Cancer Prevention, University of British Columbia, Canada. Electronic address:

Study Objectives: Sleep and physical activity are important contributors to many aspects of health. Obtaining accurate, objective measures of both behaviours is critical to health research. The Actiwatch2 is a wrist-worn sleep-monitoring device that has the potential to measure physical activity. Currently, interpretation of the Actiwatch2 physical activity data is limited by a lack of published thresholds for interpreting exercise intensity. This limits the ability to collect information on both behaviours simultaneously using one monitor. This study aims to develop thresholds to differentiate between light, moderate and vigorous-intensity physical activity and sedentary time for the Actiwatch2.

Methods: Thirty females, 40±14.9years, completed eight exercise tasks while wearing a Cosmed portable metabolic cart, the Actiwatch2 and the Actigraph GT3X+. Correlations between 1) activity counts from both the Actiwatch2 and Actigraph and metabolic equivalent (MET) values, and 2) activity counts from the two monitors were calculated. Area Under the Curve (AUC) was calculated, and cut points that maximized sensitivity and specificity were determined.

Results: The correlations between MET values and Actiwatch2 counts (r=0.69) and Actigraph (r=0.69) were strong. Correlation between the two activity monitors was very strong (r=0.84). The discrimination of sedentary behaviour was almost perfect (AUC=0.96) using a threshold of 145cpm. Discrimination of moderate (AUC=0.92) and vigorous (AUC=0.77) activity was acceptable using a threshold of 274 and 597cpm respectively.

Conclusions: The Actiwatch2 demonstrated the ability to discriminate different intensities of physical activity among adult females. With these reported cut points, the Actiwatch2 can be used to simultaneously measure sleep and physical activity - two key outcomes in health research.
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http://dx.doi.org/10.1016/j.physbeh.2017.01.026DOI Listing
May 2017

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

J Occup Environ Med 2016 Jan;58(1):94-100

School of Population and Public Health, University of British Columbia (Ms Neil-Sztramko, Dr Gotay); Centre of Excellence in Cancer Prevention, University of British Columbia (Dr Gotay); British Columbia Cancer Research Centre, Vancouver, Canada (Dr Gotay); Department of Physical Therapy, University of British Columbia (Dr Campbell); Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Canada (Dr Demers); Dalla Lanna School of Public Health, University of Toronto, Toronto, Ontario, Canada (Dr Demers).

Objectives: The aim of the study was to compare objectively measured physical activity, sedentary time, physical fitness, and body composition in shift workers (SWs) with those who work regular days.

Methods: Population-based, cross-sectional data from the Canadian Health Measures Survey (n = 4323) were used. Univariate and multivariate linear and logistic regression models were used to compare outcomes between SWs and day workers.

Results: In unweighted analyses, SWs were more likely to have poor body composition, although had fewer minutes per week of sedentary time. Despite no differences in physical activity, SWs had a lower aerobic capacity. In weighted analyses, only differences in aerobic capacity were observed.

Conclusions: This analysis confirms previous findings that SWs have poorer body composition than day workers, and suggest that SWs may need to engage in more physical activity to achieve the same aerobic capacity as day workers.
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http://dx.doi.org/10.1097/JOM.0000000000000574DOI Listing
January 2016

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

J Cardiopulm Rehabil Prev 2015 Nov-Dec;35(6):431-8

Rehabilitation Sciences Graduate Program (Ms Kirkham, Drs Campbell and Camp), Department of Physical Therapy (Mss Pauhl, Elliott, Scott, and Doria, Mr Davidson, Drs Campbell and Camp), School of Population and Public Health (Ms Neil-Sztramko), and Centre for Heart Lung Innovation (Dr Camp), University of British Columbia, Vancouver, BC, Canada.

Purpose: To determine the utility of equations that use the 6-minute walk test (6MWT) results to estimate peak oxygen uptake ((Equation is included in full-text article.)o2) and peak work rate with chronic obstructive pulmonary disease (COPD) patients in a clinical setting.

Methods: This study included a systematic review to identify published equations estimating peak (Equation is included in full-text article.)o2 and peak work rate in watts in COPD patients and a retrospective chart review of data from a hospital-based pulmonary rehabilitation program. The following variables were abstracted from the records of 42 consecutively enrolled COPD patients: measured peak (Equation is included in full-text article.)o2 and peak work rate achieved during a cycle ergometer cardiopulmonary exercise test, 6MWT distance, age, sex, weight, height, forced expiratory volume in 1 second, forced vital capacity, and lung diffusion capacity. Estimated peak (Equation is included in full-text article.)o2 and peak work rate were estimated from 6MWT distance using published equations. The error associated with using estimated peak (Equation is included in full-text article.)o2 or peak work to prescribe aerobic exercise intensities of 60% and 80% was calculated.

Results: Eleven equations from 6 studies were identified. Agreement between estimated and measured values was poor to moderate (intraclass correlation coefficients = 0.11-0.63). The error associated with using estimated peak (Equation is included in full-text article.)o2 or peak work rate to prescribe exercise intensities of 60% and 80% of measured values ranged from mean differences of 12 to 35 and 16 to 47 percentage points, respectively.

Conclusions: There is poor to moderate agreement between measured peak (Equation is included in full-text article.)o2 and peak work rate and estimations from equations that use 6MWT distance, and the use of the estimated values for prescription of aerobic exercise intensity would result in large error. Equations estimating peak (Equation is included in full-text article.)o2 and peak work rate are of low utility for prescribing exercise intensity in pulmonary rehabilitation programs.
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http://dx.doi.org/10.1097/HCR.0000000000000129DOI Listing
August 2016

Health-related physical fitness assessment in a community-based cancer rehabilitation setting.

Support Care Cancer 2015 Sep 25;23(9):2525-33. Epub 2015 Jan 25.

Rehabilitation Sciences, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada, V6T 1Z3.

Purpose: Assessment of physical fitness is important in order to set goals, appropriately prescribe exercise, and monitor change over time. This study aimed to determine the utility of a standardized physical fitness assessment for use in cancer-specific, community-based exercise programs.

Methods: Tests anticipated to be feasible and suitable for a community setting and a wide range of ages and physical function were chosen to measure body composition, aerobic fitness, strength, flexibility, and balance. Cancer Exercise Trainers/Specialists at cancer-specific, community-based exercise programs assessed new clients (n = 60) at enrollment, designed individualized exercise programs, and then performed a re-assessment 3-6 months later (n = 34).

Results: Resting heart rate, blood pressure, body mass index, waist circumference, handgrip strength, chair stands, sit-and-reach, back scratch, single-leg standing, and timed up-and-go tests were considered suitable and feasible tests/measures, as they were performed in most (≥88 %) participants. The ability to capture change was also noted for resting blood pressure (-7/-5 mmHg, p = 0.02), chair stands (+4, p < 0.01), handgrip strength (+2 kg, p < 0.01), and sit-and-reach (+3 cm, p = 0.03). While the submaximal treadmill test captured a meaningful improvement in aerobic fitness (+62 s, p = 0.17), it was not completed in 33 % of participants. Change in mobility, using the timed up-and-go was nominal and was not performed in 27 %.

Conclusion: Submaximal treadmill testing, handgrip dynamometry, chair stands, and sit-and-reach tests were feasible, suitable, and provided meaningful physical fitness information in a cancer-specific, community-based, exercise program setting. However, a shorter treadmill protocol and more sensitive balance and upper body flexibility tests should be investigated.
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http://dx.doi.org/10.1007/s00520-014-2599-zDOI Listing
September 2015

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

J Physiother 2014 Dec 5;60(4):189-200. Epub 2014 Nov 5.

University of British Colombia, Vancouver, Canada.

Question: What are typical values of physical function for women diagnosed with breast cancer and how do these compare to normative data?

Design: Systematic review with meta-analysis.

Participants: Women diagnosed with breast cancer who were before, during or after treatment.

Outcome Measures: Physical function was divided into three categories: aerobic capacity, upper and lower extremity muscular fitness, and mobility. Measures of aerobic capacity included field tests (6-minute walk test, 12-minute walk tests, Rockport 1-mile test, and 2-km walk time) and submaximal/maximal exercise tests on a treadmill or cycle ergometer. Measures of upper and lower extremity muscular fitness included grip strength, one repetition maximum (bench, chest or leg press), muscle endurance tests, and chair stands. The only measure of mobility was the Timed Up and Go test.

Results: Of the 1978 studies identified, 85 were eligible for inclusion. Wide ranges of values were reported, reflecting the range of ages, disease severity, treatment type and time since treatment of participants. Aerobic fitness values were generally below average, although 6-minute walk time was closer to population norms. Upper and lower extremity strength was lower than population norms for women who were currently receiving cancer treatment. Lower extremity strength was above population norms for women who had completed treatment.

Conclusion: Aerobic capacity and upper extremity strength in women diagnosed with breast cancer are generally lower than population norms. Assessment of values for lower extremity strength is less conclusive. As more research is published, expected values for sub-groups by age, treatment, and co-morbidities should be developed. [Neil-Sztramko SE, Kirkham AA, Hung SH, Niksirat N, Nishikawa K Campbell KL (2014) Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review.Journal of Physiotherapy60: 189-200].
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http://dx.doi.org/10.1016/j.jphys.2014.09.005DOI Listing
December 2014

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

Scand J Work Environ Health 2014 Nov 1;40(6):543-56. Epub 2014 Jul 1.

School of Population and Public Health, University of British Columbia, V2206 East Mall, Vancouver, BC, Canada, V6T 1Z3.

Objectives: Associations between shift work and chronic disease have been observed, but relatively little is known about how to mitigate these adverse health effects. This critical review aimed to (i) synthesize interventions that have been implemented among shift workers to reduce the chronic health effects of shift work and (ii) provide an overall evaluation of study quality.

Methods: MeSH terms and keywords were created and used to conduct a rigorous search of MEDLINE, CINAHL, and EMBASE for studies published on or before 13 August 2012. Study quality was assessed using a checklist adapted from Downs & Black.

Results: Of the 5053 articles retrieved, 44 met the inclusion and exclusion criteria. Over 2354 male and female rotating and permanent night shift workers were included, mostly from the manufacturing, healthcare, and public safety industries. Studies were grouped into four intervention types: (i) shift schedule; (ii) controlled light exposure; (iii) behavioral; and, (iv) pharmacological. Results generally support the benefits of fast-forward rotating shifts; simultaneous use of timed bright light and light-blocking glasses; and physical activity, healthy diet, and health promotion. Mixed results were observed for hypnotics. Study quality varied and numerous deficiencies were identified.

Conclusions: Except for hypnotics, several types of interventions reviewed had positive overall effects on chronic disease outcomes. There was substantial heterogeneity among studies with respect to study sample, interventions, and outcomes. There is a need for further high-quality, workplace-based prevention research conducted among shift workers.
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http://dx.doi.org/10.5271/sjweh.3445DOI Listing
November 2014
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