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Exercise and nutrition for head and neck cancer patients: a patient oriented, clinic-supported randomized controlled trial.

ABSTRACT: Research on physical activity and nutrition interventions aimed at positively impacting symptom management, treatment-related recovery and quality of life has largely excluded head and neck (HN) cancer populations. This translates into a lack of clinical programming available for these patient populations. HN cancer patients deal with severe weight loss, with more than 70% attributed to lean muscle wasting, leading to extended recovery times, decreased quality of life (QoL), and impaired physical functioning. To date, interventions to address body composition issues have focused solely on diet, despite findings that nutritional therapy alone is insufficient to mitigate changes. A combined physical activity and nutrition intervention, that also incorporates important educational components known to positively impact behaviour change, is warranted for this population. Our pilot work suggests that there is large patient demand and clinic support from the health care professionals for a comprehensive program.Therefore, the purpose of the present study is to examine the impact and timing of a 12-week PA and nutrition intervention (either during or following treatment) for HN cancer patients on body composition, recovery, serum inflammatory markers and quality of life. In addition, we will examine the impact of a 12-week maintenance program, delivered immediately following the intervention, on adherence, patient-reported outcomes (i.e., management of both physical and psychosocial treatment-related symptoms and side-effects), as well as return to work.This research will facilitate advancements in patient wellness, survivorship, and autonomy, and carve the path for a physical-activity and wellness-education model that can be implemented in other cancer centers.Current Controlled Trials NCT01681654.

SUBMITTER: Capozzi LC

PROVIDER: S-EPMC3551727 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Exercise and nutrition for head and neck cancer patients: a patient oriented, clinic-supported randomized controlled trial.

Capozzi Lauren C LC Lau Harold H Reimer Raylene A RA McNeely Margaret M Giese-Davis Janine J Culos-Reed S Nicole SN

BMC cancer 20121002

<h4>Background</h4>Research on physical activity and nutrition interventions aimed at positively impacting symptom management, treatment-related recovery and quality of life has largely excluded head and neck (HN) cancer populations. This translates into a lack of clinical programming available for these patient populations. HN cancer patients deal with severe weight loss, with more than 70% attributed to lean muscle wasting, leading to extended recovery times, decreased quality of life (QoL), a ...[more]

PMID: 23031071

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Project description:BackgroundNeck-specific exercises (NSE) supervised by a physiotherapist twice a week for 12 weeks have shown good results in chronic whiplash-associated disorders (WADs), but the effect of exercise delivered via the internet is unknown.ObjectiveThis study examined whether NSE with internet support (NSEIT) and 4 physiotherapy sessions for 12 weeks were noninferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE).MethodsIn this multicenter randomized controlled noninferiority trial with masked assessors, we recruited adults aged 18-63 years with chronic WAD grade II (ie, neck pain and clinical musculoskeletal signs) or III (ie, grade II plus neurological signs). Outcomes were measured at baseline and at 3- and 15-month follow-ups. The primary outcome was change in neck-related disability, measured with the Neck Disability Index (NDI; 0%-100%), with higher percentages indicating greater disability. Secondary outcomes were neck and arm pain intensity (Visual Analog Scale [VAS]), physical function (Whiplash Disability Questionnaire [WDQ] and Patient-Specific Functional Scale [PSFS]), health-related quality of life (EQ-5D-3L and EQ VAS), and self-rated recovery (Global Rating Scale [GRS]). The analyses were conducted on an intention-to-treat basis and with the per-protocol approach as sensitivity analyses.ResultsBetween April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90%) and 64 (91%), respectively, were followed up at 3 months, and 56 (80%) and 58 (83%), respectively, at 15 months. NSEIT demonstrated noninferiority to NSE in the primary outcome NDI, as the 1-sided 95% CI of the mean difference in change did not cross the specified noninferiority margin (7 percentage units). There were no significant between-group differences in change in NDI at the 3- or 15-month follow-up, with a mean difference of 1.4 (95% CI -2.5 to 5.3) and 0.9 (95% CI -3.6 to 5.3), respectively. In both groups, the NDI significantly decreased over time (NSEIT: mean change -10.1, 95% CI -13.7 to -6.5, effect size=1.33; NSE: mean change -9.3, 95% CI -12.8 to -5.7, effect size=1.19 at 15 months; P<.001). NSEIT was noninferior to NSE for most of the secondary outcomes except for neck pain intensity and EQ VAS, but post hoc analyses showed no differences between the groups. Similar results were seen in the per-protocol population. No serious adverse events were reported.ConclusionsNSEIT was noninferior to NSE in chronic WAD and required less physiotherapist time. NSEIT could be used as a treatment for patients with chronic WAD grades II and III.Trial registrationClinicalTrials.gov NCT03022812; https://clinicaltrials.gov/ct2/show/NCT03022812.

Project description:BackgroundAffective responses are increasingly recognized as potentially effective intervention targets that may facilitate exercise and physical activity behavior change. While emerging correlational evidence suggests that more pleasant affective responses are associated with higher participation and adherence, experimental evidence remains scarce. In light of this, we conducted a preregistered, pragmatic, single-blinded, superiority randomized controlled trial with two parallel groups, with the goal of determining the impact of an individualized exercise-intensity prescription targeting pleasure on exercise frequency.MethodsForty-seven non-regular exercisers were randomized into two groups. For both groups, the intervention consisted of three exercise sessions based on the Frequency-Intensity-Time-Type (FITT) principle. However, the experimental group also received an individualized intensity prescription based on prior assessment of preference for and tolerance of exercise intensity, as well as instructions emphasizing the promotion of pleasure as a basis for self-regulating exercise intensity. The primary outcome was gymnasium attendance over an eight-week follow-up period. Secondary outcomes were affective valence and arousal, post-exercise enjoyment, core affective exercise experiences, and anticipated and remembered affect.ResultsForty-six participants were retained for analysis (Mage = 32.00; SD = 8.62 years; 56.5% female). Compared to the control group, the experimental group exhibited 77% higher session attendance (14.35 vs. 8.13 sessions) over the eight-week follow-up period (group main effect p = .018, η2p = .120; Cohen's d ranged from 0.28 to 0.91 during follow-up). Also, the experimental group reported higher levels of pleasure during the intervention sessions (for all group main effects, p < .001, η2p from .33 to .37) and higher levels of remembered pleasure (group main effect p = .021, η2p = .116) and anticipated pleasure (group main effect p = .022, η2p = .114). No harm was detected.ConclusionsThese results demonstrate the practicality and effectiveness of an intervention aimed at enhancing affective responses to exercise in improving short-term session attendance.Trial registrationClinicalTrial.gov NCT05416593.

Project description:BackgroundLung or head and neck cancers are known for their high prevalence and mortality rates. Chemotherapy and radiotherapy are usually recommended as cancer treatment for these malignancies; however, they can negatively impact both the physical and mental status of patients. Hence, it is reasonable to consider resistance and aerobic exercise training to prevent these negative health outcomes. Further, several factors prevent patients from attending outpatient exercise training programs, and, therefore, a semisupervised home-based exercise training program may be seen as a well-accepted alternative.ObjectiveThe aim of this study will be to investigate the effects of a semisupervised home-based exercise training program on physical performance, body composition, and self-reported outcomes; changes in the initial cancer treatment dose prescribed; number of hospitalizations at 3, 6, and 9 months; and 12-month survival in people with primary lung or head and neck cancer.MethodsParticipants will be randomly allocated to the training group (TG) or control group (CG). The TG will undergo semisupervised home-based resistance and aerobic exercise training throughout their cancer treatment. The resistance training will be performed using elastic bands (TheraBand) twice a week. The aerobic training (ie, brisk walk) will be performed for at least 20 minutes per day outdoors. The equipment and tools used during the training sessions will be provided. This intervention will start the week before treatment commencement, will be performed throughout the duration of the treatment, and will continue for 2 weeks after treatment completion. The CG will undergo usual care (ie, cancer treatment with no formal exercise prescription). Assessments will take place 2 weeks before the beginning of the usual cancer treatment and 2 weeks after treatment completion. The measures of physical function (peripheral muscle strength, functional exercise capacity, and physical activity), body composition, and self-reported outcomes (symptoms of anxiety and depression, health-related quality of life, and symptoms related to the disease and treatment) will be collected. We will report on any change in the initial cancer treatment dose prescribed; number of hospitalizations at 3, 6, and 9 months; and 12-month survival.ResultsIn February 2021, the clinical trial registration was approved. Recruitment and data collection for the trial are ongoing (as of April 2023, 20 participants had already been randomized), and findings of this study are likely to be published late in 2024.ConclusionsThis exercise training as a complementary treatment for patients with cancer is likely to promote positive effects on the health outcomes assessed, over and above any change in the CG, and prevent the reduction of initial cancer treatment dose prescribed. If these positive effects are shown, they will likely impact long-term outcomes such as hospitalizations and 12-month survival.Trial registrationBrazilian Clinical Trials Registry (ReBEC) RBR-5cyvzh9; https://ensaiosclinicos.gov.br/rg/RBR-5cyvzh9.International registered report identifier (irrid)PRR1-10.2196/43547.

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Exercise and nutrition for head and neck cancer patients: a patient oriented, clinic-supported randomized controlled trial.

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Exercise and nutrition for head and neck cancer patients: a patient oriented, clinic-supported randomized controlled trial.

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