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The Effect of Recovery Enhancement Program for Patients with Rectal Cancer Surgery

ABSTRACT: Interventions: Behavioral : 1. Experimental Group 1) Week 1st: Before the day of discharge - Goal: Dietary management, symptom management, exercise - Contents: Function of the rectum, definition of low anterior resection syndrome (bowel dysfunction), disease experience of rectal cancer patients, purpose and method of pelvic floor muscle training (PFMT), diet management, postoperative management (symptom management) - Education method (strategy): face-to-face, tablet PC, exercise demonstration and practice, exercise video provision (mobile phone, USB), primary caregiver participation, exercise/diet diary education - Time: 30 minutes 2) Week 2nd: First outpatient visit - Goal: exercise check, motivation (reinforcement) - Contents: Introduction of a successful case of PFMT, Check of suitability of PFMT - Education Method (Strategy): face-to-face, introduction of a successful case (printed material), text messages, exercise/diet diary records - Time: 30 minutes 3) Week 3rd: 3 weeks after discharge - Goal: Exercise adherence check, Identification of barriers of PFMT - Contents: Identification of difficulties in performance and maintenance of PFMT, physical/psychological state check and coaching, emotional support - Education Method (Strategy): telephone coaching, text messages, exercise/diet diary records - Time: 10-20 minutes 4) Week 4th: 4 weeks after discharge - Goal: Overcoming the barriers, maintaining PFMT - Contents: Discussion on successful PFMT experience, planning of PFMT maintenance - Education Method (Strategy): telephone coaching, text messages, exercise/diet diary records - Time: 10-20 minutes 2. Control Group: Usual care Primary outcome(s): Bowel function;Health-realted quality of life Primary Purpose : Supportive Care, Intervention Model : Parallel, Blinding/Masking : Open, Allocation : RCT

DISEASE(S): Neoplasms

PROVIDER: 2511533 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Interventions: The general rehabilitation program will consist of a multidisciplinary education and exercise program, which will be provided as group sessions twice weekly for 8 weeks. The education component will include 1-hour nutritional advice and management provided by a dietitian; 1-hour exercise education regarding the importance of exercise to well-being, bladder and bowel advice, and adherence to exercise provided by a physiotherapist; 1-hour fatigue management and return to work strategies provided by an occupational therapist; and 5-hours health behavior change and self-management strategies provided by a psychologist. The exercise component will consist of a moderate intensity (Borg Rating of Perceived Exertion (RPE) Scale 12-14), physiotherapist-supervised, combined aerobic and resistance training program. The exercise program will be individualized based on the results from baseline outcome measures. Participants will be required to attend an one hour education session per week and an one hour exercise session per week over the 8-week intervention period. The home-based walking program requires participants to perform daily walking with duration and intensity individually prescribed based on the results of baseline walking tests. To encourage adherence to the home-based walking program, 6 telephone motivational coaching sessions (1 to 2 calls per month) will be provided from a physiotherapist, between data collection time-points 2 (immediately post-intervention) and 3 (6 months following baseline) . Daily feedback for participants regarding distance and number of steps taken will be encouraged with a simple pedometer. Primary outcome(s): Functional capacity as assessed using the six-minute walk test [At baseline, immediately post-intervention, and at 6 months following baseline];Feasibility as assessed by the recruitment rate, adherence, withdrawals, and adverse events. There are minimal risks associated with the rehabilitation and measurement tests. Participants may feel some general muscle discomfort after exercise, which is a normal response to exercise.[At baseline, immediately post-intervention, and at 6, 12, 24, and 60 months following baseline] Study Design: Purpose: Educational / counselling / training; Allocation: Non-randomised trial

Project description:Background: Non-alcoholic steatohepatitis (NASH) has become one of the most common liver diseases and is still without approved pharmacotherapy. Lifestyle interventions using exercise and diet change remain the current treatment of choice and even a small weight loss (5-7%) can already have a beneficial effect on NASH. However#the underlying molecular mechanisms of exercise and diet interventions remain largely elusive#and it is unclear whether they exert their health effects via similar or different pathways. Methods: Ldlr-/-.Leiden mice received a high fat diet (HFD) for 30 weeks to establish an advanced state of NASH/fibrosis with simultaneous atherosclerosis development. Groups of mice were then either left untreated (control group) or were treated for 20 weeks with exercise (running wheel)#diet change (switch to a low fat chow diet) or the combination thereof. The liver and distant organs including heart#white adipose tissue (WAT) and muscle were histologically examined. Comprehensive transcriptome analysis of liver#WAT and muscle revealed the organ-specific effects of exercise and diet and defined the underlying pathways. Results: Exercise and dietary change significantly reduced body weight#fat mass#adipocyte size and improved myosteatosis and muscle function with additive effects of combination treatment. WAT inflammation was significantly improved by diet change#tended to be reduced with exercise#and combination therapy had no additive effect. Hepatic steatosis and inflammation were almost fully reversed by exercise and diet change#while hepatic fibrosis tended to be improved with exercise and was significantly improved with diet change. Additive effects for the combination therapy were shown for liver steatosis and associated liver lipids#and atherosclerosis#but not for hepatic inflammation and fibrosis. Pathway analysis revealed complementary effects on metabolic pathways and lipid handling processes#thereby substantiating the added value of combined lifestyle treatment. Conclusions: Exercise#diet change and the combination thereof can reverse established NASH/fibrosis in obese Ldlr-/-.Leiden mice. In addition#the lifestyle interventions had beneficial effects on atherosclerosis#WAT inflammation and muscle function. For steatosis and other parameters related to adiposity or lipid metabolism#exercise and dietary change affected more distinct pathways that acted complementary when the interventions were combined resulting in an additive effect for the combination therapy on important endpoints including NASH and atherosclerosis. For inflammation#exercise and diet change shared several underlying pathways resulting in a net similar effect when the interventions were combined.

Project description:Fast food diet consumption and sedentary life style leads to energy excess, which elevates risks for obesity, metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), and cancer. Exercise training conveys many health benefits in populations with or without these chronic conditions. Diet and exercise regulate gene expression by mediating epigenetic mechanisms globally and at select loci in an array of human tissues, however, such effects are less well documented in liver tissue. To dissect the epigenetic consequences of diet and exercise in liver, we measured DNA methylation using reduced representation bisulfite sequencing (RRBS) and transcriptome using RNA-seq in mice maintained on a fast food diet with sedentary lifestyle (FFC) or exercise (FFE) compared to control diet with (NCE) and without exercise (NCC). Our analyses demonstrate genome-wide differential DNA methylation at key regulatory regions, including different classes of promoters and enhancers, and differential regulation of gene clusters in each condition group. FFE gene expression is most differentially regulated, with enrichment of carbohydrate/lipid metabolic pathways and skeletal muscle development in altered gene sets. Through evaluation of putative protective effects of exercise on diet-induced DNA methylation and gene expression, we show that hypermethylation is effectively prevented, especially at promoters and enhancers, and hypomethylation is partially attenuated. We assessed diet-induced DNA methylation changes associated with cancer-related epigenetic modifications and identified significant increases at liver-specific enhancers in FFC and FFE, suggesting a repressive effect on the epigenomic signature specifying liver identity. Gaining methylation at a subset of gene promoters was associated with inhibition of tissue development and promotion of carcinogenic process. Taken together, our study demonstrates large-scale diet- and exercise-induced effects on the epigenetic landscape, emphasizing the functional relevance of epigenetic mechanisms as an interface between life-style modifications and phenotypic alterations.

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The Effect of Recovery Enhancement Program for Patients with Rectal Cancer Surgery

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