PurposeLymphoma patients commonly experience declines in physical functioning and quality of life (QoL) that may be reversed with exercise training.Patients and MethodsWe conducted a randomized controlled trial in Edmonton, Alberta, Canada, between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and randomly assigned them to usual care (UC; n = 62) or 12 weeks of supervised aerobic exercise training (AET; n = 60). Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia. Secondary end points were overall QoL, psychosocial functioning, cardiovascular fitness, and body composition.ResultsFollow-up assessment for our primary end point was 96% (117 of 122) at postintervention and 90% (110 of 122) at 6-month follow-up. Median adherence to the supervised exercise program was 92%. At postintervention, AET was superior to UC for patient-rated physical functioning (mean group difference, +9.0; 95% CI, 2.0 to 16.0; P = .012), overall QoL (P = .021), fatigue (P = .013), happiness (P = .004), depression (P = .005), general health (P < .001), cardiovascular fitness (P < .001), and lean body mass (P = .008). Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning. AET did not interfere with chemotherapy completion rate or treatment response. At 6-month follow-up, AET was still borderline or significantly superior to UC for overall QoL (P = .054), happiness (P = .034), and depression (P = .009) without an increased risk of disease recurrence/progression.ConclusionAET significantly improved important patient-rated outcomes and objective physical functioning in lymphoma patients without interfering with medical treatments or response. Exercise training to improve cardiovascular fitness should be considered in the management of lymphoma patients.

For clinical trials of acupuncture, it would be desirable to have a sham procedure that is indistinguishable from the real treatment, yet inactive. A sham needle has been designed which telescopes instead of penetrating the skin. The Park Sham Device involves an improved method of supporting the sham needle and requires validation. The objective of these studies was to test whether the sham procedure using the new device was 1) indistinguishable from the same procedure using real needles in acupuncture naïve subjects, and 2) inactive, where the specific needle sensation (de qi) is taken as a surrogate measure of activity. The studies were designed as subject and assessor blind, randomised controlled trials. Study 1) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke. Study 2) included 63 healthy, acupuncture naïve, adult volunteers. The interventions used were real or sham acupuncture using the Park Sham Device. Study 1) was set in a district general hospital, and study 2) in a university laboratory. The outcome measure in study 1) was the form of treatment that patients believed they had received. In study 2) the outcome measure was experience of de qi, as judged by three acupuncture experts. No patient in either group(study 1) believed he or she had been treated with the sham needle. In 40 volunteers (study 2) for whom experts achieved consensus, the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 (95% CI 2.26 to 104.86). The inter-rater reliability of all 13 experts (study 2), calculated from their judgements on 10 subjects selected by randomisation, was 0.52 (95% CI 0.19 to 0.61). In conclusion, the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects, and is inactive, where the specific needle sensation (de qi) is taken as a surrogate measure of activity. It is therefore a valid control for acupuncture trials. The findings also lend support to the existence of de qi, a major concept underlying traditional Chinese acupuncture.

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Preliminary evidence suggests that parkrun is attractive to non-runners, with women, older adults and overweight people well represented. The observed fitness improvements and perceived benefits indicate the scope for investigating the effectiveness of parkrun as a cost-effective community-based intervention for improving public health.

SUMMARYWhile high levels of activity and exercise training have been associated with improvements in sleep quality, minimum levels of activity likely to improve sleep outcomes have not been explored. A two-armed parallel randomized controlled trial (N=41; 30 females) was designed to assess whether increasing physical activity to the level recommended in public health guidelines can improve sleep quality among inactive adults meeting research diagnostic criteria for insomnia. The intervention consisted of a monitored program of ≥150 min of moderate-to vigorous-intensity physical activity per week, for 6 months. The principal end-point was the Insomnia Severity Index at 6 months post-baseline. Secondary outcomes included measures of mood, fatigue and daytime sleepiness. Activity and light exposure were monitored throughout the trial using accelerometry and actigraphy. At 6 months post-baseline, the physical activity group showed significantly reduced insomnia symptom severity (F 8,26 = 5.16, P = 0.03), with an average reduction of four points on the Insomnia Severity Index; and significantly reduced depression and anxiety scores (F 6,28 = 5.61, P = 0.02; and F 6,28 = 4.41, P = 0.05, respectively). All of the changes were independent of daily light exposure. Daytime fatigue showed no significant effect of the intervention (F 8,26 = 1.84, P = 0.18). Adherence and retention were high. Internationally recommended minimum levels of physical activity improve daytime and night-time symptoms of chronic insomnia independent of daily light exposure levels.

Although preliminary research is promising, there remains a significant amount of research to be done on the role of PA in PC survivors. Moreover, future research would benefit from larger samples using randomized controlled trial methodology.

Purpose: Public health guidelines emphasise the value of vigorous intensity physical activity, but participation levels are low. This study was aimed at identifying factors contributing to initial and sustained engagement in parkrun in the United Kingdom, to inform the design of community-based interventions promoting health-enhancing physical activity.Methods: Semi-structured interviews were conducted by telephone with 48 adult participants of parkrun, a national network of weekly, free, volunteer-led, timed 5km runs in public spaces. The framework approach was used for thematic analysis of transcripts.Results: Two overarching themes emerged: freedom and reciprocity. Freedom referred to the accessibility and inclusivity of events, both of which contributed to initial attendance and sustained involvement. Reciprocity related to the dual opportunity for personal gain and for helping others. Anticipation of fitness and health benefits were important for initial motivation. However, additional aspects motivating continued involvement included

Objectives-To investigate whether runners' cognitions during a marathon are related to "hitting the wall". To test a new and more comprehensive system for classifying cognition of marathon runners. Methods-Non-elite runners (n = 66) completed a questionnaire after finishing the 1996 London marathon. The runners were recruited through the charity SPARKS for whom they were raising money by running in the race. Results-Most runners reported that during the race their thoughts were internally associative, with internally dissociative thoughts being the least prevalent. Runners who "hit the wall" used more internal dissociation than other runners, indicating that it is a hazardous strategy, probably because sensory feedback is blocked. However, internal association was related to an earlier onset of "the wall", suggesting that too much attention on physical symptoms may magnifiy them, thereby exaggerating any discomfort. External dissociation was related to a later onset, probably because it may provide a degree of distraction but keeps attention on the race. Conclusions-"Hitting the wall" for recreational non-elite marathon runners is associated with their thought patterns during the race. In particular, "the wall" is associated with internal dissociation. (Br J Sports Med 1998;32:229-235)