count 298Key words: Exercise, prostate cancer, quality of life, fatigue, adverse effects AbstractContext: Exercise for prostate cancer survivors could be beneficial. However, no systematic review across cancer stages and treatment types addressing potential benefits and harms exists to date.Objectives: Primarily, to assess the effects of exercise on cancer specific quality of life and adverse events in prostate cancer trials. Evidence acquisition:We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, SPORTDiscus and PEDro. We also searched grey literature databases, including trials registers. Searches were from database inception to March 2015.Standardised mean differences (SMD) were calculated for meta-analysis. Evidence synthesis:We included 16 RCTs involving 1574 men with prostate cancer. Follow-up varied from just eight weeks to 12months. RCTs involved men with stages I-IV cancers. High risk of bias was frequently due to attrition and intervention adherence. Seven trials involving 912 men measured cancer specific quality of life. No significant effect on this outcome was found from pooling the data from these seven trials (SMD = 0.13, 95% CI = -0.08, 0.34, median follow-up 12 weeks). Sensitivity analysis of studies that were judged to be of high quality indicated a moderate positive effect estimate (SMD = 0.33, 95% CI = 0.08, 0.58, median follow-up 12 weeks). Similar beneficial effects were seen in cancer specific fatigue, submaximal fitness and lower body strength. We found no evidence of benefit for disease progression, cardiovascular health or sexual function. There were no deaths attributable to exercise interventions. Other serious adverse events (e.g. myocardial infarction) were equivalent to those seen in controls. Conclusions:These results support exercise interventions for improving cancer specific quality of life, cancer specific fatigue, submaximal fitness and lower body strength.Patient summary: This review shows that exercise or physical activity interventions can improve quality of life, fatigue, fitness and function for men with prostate cancer. BackgroundProstate cancer is the primary cause of years lived with cancer disability in the Americas, North- hypercalcaemia, spinal cord compression, pathological fractures) can also adversely affect health. [7,8] Several recent systematic reviews have examined the effects of exercise in cancer survivors, in terms of quality of life outcome [9,10], exercise behaviour [11] and effects on fatigue.[12] These reviews are an amalgamation of heterogeneous primary cancers. Indeed, most evidence comes from trials in breast cancer and as such cannot be generalised to men with prostate cancer. Further, exercise therapy appears beneficial in the short term, but little is known about dose, duration and longerterm effects of such therapy, including adverse effects over an extended follow-up. Finally, despite the potential health benefits for men with prostate cancer, few clinicians are aware of the role of...
Background: Exercise programmes that can demonstrate evidence of long-lasting
(2017) A qualitative investigation of exercise perceptions and experiences in people with multiple sclerosis before, during and after participation in a personally-tailored exercise program. Archives of Physical Medicine and Rehabilitation, 98 (12 Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University's research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners. Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page. The content must not be changed in any way. Full items must not be sold commercially in any format or medium without formal permission of the copyright holder. The full policy is available online: http://nrl.northumbria.ac.uk/policies.html This document may differ from the final, published version of the research and has been made available online in accordance with publisher policies. To read and/or cite from the published version of the research, please visit the publisher's website (a subscription may be required.)
BackgroundThe National Health Service (NHS) seems appropriately placed to be an exemplar employer in providing effective and proactive workplace health and wellbeing services for its staff. However, NHS staff sickness absence costs an estimated £2.4 billion. Evidence suggests staff health and wellbeing services delivered in the NHS can improve health, productivity and sickness absence and yet the adoption of these services remains a challenge, with few examples nationally. This research aimed to explore the perceptions of NHS senior leaders and health and wellbeing practitioners regarding barriers and facilitators to implementing workplace health and wellbeing services for staff in the NHS.MethodsSemi-structured interviews were conducted with NHS staff, consisting of four senior leaders, four heads of department and three health and wellbeing practitioners in one region of the UK. Interviews were transcribed verbatim and analysed using thematic analysis.ResultsThemes describe the experience of delivering workplace health and wellbeing services in the NHS, and barriers and facilitators to implementation from senior decision makers. Barriers to implementation of services include; a busy and pressurised environment, financial constraints and reluctance to invest in staff health and wellbeing. Barriers to staff engagement were also reported and include difficulty of access to health and wellbeing services and lack of time. Initiating services were facilitated by financial incentives, a supportive organisational structure and culture that takes a preventative, rather than reactive, approach to staff health and wellbeing. Facilitators to implementing health and wellbeing services include a coherent, strategic approach to implementation, effective communication and advertisement, being creative and innovative with resources and conducting a needs analysis and evaluation before, during and after implementation.ConclusionsBarriers to the successful initiation and implementation of health and wellbeing services in the NHS are numerous and range from front-line logistical issues with implementation to high-level strategic and financial constraints. Adopting a strategic and needs-led approach to implementation and ensuring thorough staff engagement are amongst a number of factors that facilitate implementation and help overcome barriers to initiation of wellbeing programmes in the NHS. There is a need for a culture that supports staff health and wellbeing in the NHS.
The pragmatic exercise intervention is highly likely to be cost effective at current established thresholds, and there is scope for it to be tailored to particular sub-groups of patients or services to reduce its cost impact.
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