Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Pulmonary rehabilitation (PR) is an important component in the management of respiratory diseases. The effectiveness of PR is dependent upon adherence to ...

Hôpital du Sacré-Coeur de Montréal

Low body fat mass and menstrual irregularities have been associated with low bone mineral density (BMD). The aim of this study was to compare the relation between BMD, lean body mass, fat mass, physical activity energy expenditure (PAEE), and menstrual status in female boxers and in physically active females with low (C1) or average (C2) fat mass. Boxers (n = 11) and controls (C1, n = 16; C2, n = 17), aged 18-38 years, were assessed for BMD and body composition with dual-energy X-ray absorptiometry. Menstrual status and PAEE were determined from questionnaires. There was no difference in anthropometric measurements between boxers and C1 subjects, except that boxers had higher arm lean mass. However, both boxers and C1 subjects had a lower percentage of fat (p < 0.001) than C2 subjects (boxers, 14.6% +/- 2.0; C1, 15.5% +/- 4.2; C2, 25.8% +/- 3.4%), and boxers had a higher (p = 0.002) lean body mass index (lean body mass/height2, where lean body mass is measured in kilograms and height is measured in metres) than C2 subjects. The PAEE of boxers was higher (p < 0.007) than that of controls (boxers, 5748 +/- 2284 ; C1, 2966 +/- 2258 ; C2, 2714 +/- 1722 kcal.week-1). Oligomenorrhea was more common in boxers than in C1 and C2 subjects (boxers, 54.6%; C1, 18.8%; C2, 35.3%). Arm, leg, and spine BMD were higher (p < 0.008) in boxers than in C1 subjects, and arm BMD was higher in boxers than in C2 subjects. BMD Z scores were also higher (p < 0.05) in boxers (boxers, 1.1+/- 0.8, C1, 0.1 +/- 0.7; C2: 0.3 +/- 1.1). High BMD in boxers, despite low fat mass, high PAEE, and an increased incidence of oligomenorrhea suggest that boxing has a positive effect on BMD.

Female boxers have high bone mineral density despite low body fat mass, high energy expenditure, and a high incidence of oligomenorrhea.

Important deteriorations in body composition and strength occur and need to be accurately measured in advanced cancer patients (ACPs). The aim of this study was to establish the relationship between a single-frequency bioimpedance analyzer (BIA) and the dual-energy X-ray absorptiometer (DXA), as well as the Jamar handgrip dynometer and the Biodex handgrip attachment, and to determine the precision of each of these instruments in ACPs. Eighty-one ACPs with non-small-cell lung cancer and gastrointestinal cancer were recruited from the McGill University Health Centre (Montreal, Que.). Consecutive paired measurements, with repositioning between measurements, were obtained for total-body DXA, BIA, Biodex handgrip, and BIA plus Jamar handgrip. The total-body percent coefficient of variation (%CV) for the BIA and DXA were 1.34 and 1.56 for fat mass (FM), respectively, and 0.42 and 0.72 for fat free mass (FFM), respectively. The %CV for the Jamar and Biodex handgrips were 6.3 and 16.7, respectively. Bland-Altman plots were used to characterize the limits of agreement between DXA and BIA for FM (4.60 +/- 7.80 (-3.19 to 12.39) kg) and FFM (-1.87 +/- 7.16 (-9.03 to 5.29) kg). Both DXA and BIA demonstrate good short-term precision in ACPs. However, given its poor accuracy, it remains to be determined if BIA can be used to monitor ACPs for changes in total-body tissue composition as a function of time, whether for observation or response to treatment. Furthermore, because of wide limits of agreement, the DXA and BIA cannot be used interchangeably in research or clinical settings. The Jamar handgrip dynamometer shows more consistency than the Biodex handgrip attachment in ACPs, and should therefore be the preferred measure of changes in strength over time.

Precision and reliability of strength (Jamar vs. Biodex handgrip) and body composition (dual-energy X-ray absorptiometry vs. bioimpedance analysis) measurements in advanced cancer patients.

Nutritional and functional outcome measures have been shown to vary in patients with chronic diseases according to the polymorphic alleles of angiotensin-converting enzyme (ACE), but little is known about the associations between ACE gene polymorphism (ACEGP) and the components of body composition, strength, and selected blood markers in advanced cancer patients (ACP).

Relationship between angiotensin-converting enzyme gene polymorphism and body composition, functional performance, and blood biomarkers in advanced cancer patients.

Male hypogonadism is commonly diagnosed on the basis of subphysiological concentrations of androgen hormones, and is associated with many symptoms present in advanced cancer. Androgen deficiency might be an important cause of muscle wasting in both cancer cachexia and sarcopenia. We did a systematic review of the clinical association of male hypogonadism in advanced cancer. We searched PubMed, Medline, and Embase for publications on the relation between male hypogonadism and functional status, nutritional status, body composition, symptoms, and quality of life in patients with advanced cancer. Of 381 publications identified, six original articles were included. We found no definitive association between nutritional, functional, or quality-of-life characteristics and male hypogonadism. Possible associations between male hypogonadism and weight loss, low albumin, low-body cell mass index, low-peripheral fat and muscle mass, higher inflammation, higher pain, higher opioid consumption, worse scores for anxiety, depression, and emotional and functional well-being need to be confirmed by better designed studies. There is no clear epidemiological data to indicate whether male hypogonadism is independently associated with clinical and biological sequelae of cancer cachexia, such as higher inflammation, fatigue, and body wasting. Standardised kits sensitive to low concentrations of free-testosterone or bioavailable testosterone are needed to diagnose androgen deficiency in women. A clearer epidemiology of androgen deficiencies in advanced cancer will help determine which patients should receive testosterone-replacement therapy for alleviating cancer cachexia symptoms and improving quality of life.

Male hypogonadism associated with advanced cancer: a systematic review.

BACKGROUND: Although exertional fatigue is directly and negatively related to skeletal muscle mass and strength, it is currently unknown if these variables are associated with cancer-related fatigue (CRF). Therefore, the purpose of this study was to determine if CRF is associated with measures of appendicular lean muscle mass and strength in advanced cancer patients (ACP). METHODS AND RESULTS: Eighty-four patients (48 men, 36 women aged 61.6 ± 13.2 year) newly diagnosed (≤6 months) with inoperable (Stages III-IV) gastrointestinal or non-small cell lung cancer participated in this study. All patients completed the Brief Fatigue Inventory (BFI). Handgrip (HGS) and quadriceps (QS) strength were assessed using isometric and isokinetic dynamometry, respectively. Skeletal muscle mass index (SMMI) was calculated from the appendicular lean mass measured via dual-energy X-ray absorptiometry divided by body height squared. Univariate analysis showed BFI to be significantly associated with body mass index, weight loss, anemia, hypoalbuminemia, activity level, pain, depression, and sarcopenia along with SMMI, HGS, and QS. HGS (r = -0.34; p = 0.018), QS (r = -0.39; p = 0.024), and SMMI (r = -0.60; p < 0.001) were negatively correlated with BFI total scores in men but not in women. When adjusted for sex, age, diagnosis, survival, along with the above characteristics, multivariate analyses showed that BFI scores were negatively associated with HGS (B = -0.90; 95% CI -1.5:-0.3), QS (-0.2; -0.3:-0.01), and SMMI (-7.5; -13.0:-2.0). There was a significant sex × SMMI interaction (10.8; 1.2:20.5), where BFI decreased with increasing SMMI in men, but did not change with SMMI in women. CONCLUSION: These results suggest that in ACP, CRF is related to muscle mass and strength, which may provide targets for future interventions.

Cancer-related fatigue: the impact of skeletal muscle mass and strength in patients with advanced cancer.

Despite the descriptive presence of cancer cachexia (CC) in clinical practice, the underlying mechanisms and diagnostic definition have not been clearly identified. Recent work, attempting to establish diagnostic and staging criteria for CC, has identified IL-6 as a biomarker. This study aimed to investigate the clinical relevance of plasma levels of four pro-inflammatory cytokines (IL-6, IL-1β, IL-8 and TNF-α) in advanced cancer patients (ACP) to further establish their potential in the diagnostic definition of CC.

Is IL-6 the best pro-inflammatory biomarker of clinical outcomes of cancer cachexia?

Few studies have focused on the metabolic profiling of patients with advanced cancer and the relationship with nutritional and inflammatory characteristics, which have important diagnostic, treatment and prognostic implications, particularly in the elderly. Our objective was to determine differences in energy expenditure during rest and activity, body composition, nutrition, and inflammatory markers between healthy elderly females and those with advanced cancer.

Metabolic, nutritional and inflammatory characteristics in elderly women with advanced cancer.

Abstract The purpose of this pilot study was to determine the impact of time of day on the acute response to incremental exercise in chronic obstructive pulmonary disease (COPD). Fourteen subjects (nine men) aged 71 ± 7 years with moderate to severe airflow obstruction (FEV1: 58 ± 13% predicted) followed a counterbalanced randomized design, performing three symptom-limited incremental cycling tests at 8:00, 12:00, and 16:00 hours on different days, each preceded by a spirometry. COPD medications were withdrawn prior to testing. No overall time effect was found for peak exercise capacity (p = 0.22) or pulmonary function (FEV1, p = 0.56; FVC, p = 0.79). However, a large effect size (f = 0.48) was observed for peak exercise capacity and several pulmonary function parameters. For peak exercise capacity, the average within-subject coefficient of variation was 5.5 ± 3.9% and the average amplitude of change was 7 ± 5W. Seven subjects (50%) showed diurnal changes at levels equal to or beyond the minimal clinically important difference for both peak exercise capacity and pulmonary function. In this sub-group, peak exercise capacity was greatest at 16:00 hours (p = 0.03, ƒ = 1.04). No systematic time-of-day effect on peak exercise capacity was obtained in COPD patients in the present pilot study. However, based on the observed effect size and on the average amplitude of change and within-subject variations seen across testing times, the guidelines recommendation that time of day be standardized for repeat exercise testing in COPD should be maintained.

Barbara Trutschnigg

Centre de Recherche,
Axe Maladies Chroniques,
Centre de Recherche, Axe Maladies Chroniques

Hôpital du Sacré-Coeur de Montréal

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Barbara Trutschnigg

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Hôpital du Sacré-Coeur de Montréal

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Centre de Recherche,
Axe Maladies Chroniques,
Centre de Recherche, Axe Maladies Chroniques