OCPs have low knowledge regarding exercise counseling, but believe that discussing exercise is a multidisciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.

Spatial chromatin organization is emerging as an important mechanism to regulate the expression of genes. However, very little is known about genome architecture at high-resolution in vivo. Here, we mapped the three-dimensional organization of the human Hox clusters with chromosome conformation capture (3C) technology. We show that computational modeling of 3C data sets can identify candidate regulatory proteins of chromatin architecture and gene expression. Hox genes encode evolutionarily conserved master regulators of development which strict control has fascinated biologists for over 25 years. Proper transcriptional silencing is key to Hox function since premature expression can lead to developmental defects or human disease. We now show that the HoxA cluster is organized into multiple chromatin loops that are dependent on transcription activity. Long-range contacts were found in all four silent clusters but looping patterns were specific to each cluster. In contrast to the Drosophila homeotic bithorax complex (BX-C), we found that Polycomb proteins are only modestly required for human cluster looping and silencing. However, computational three-dimensional Hox cluster modeling identified the insulator-binding protein CTCF as a likely candidate mediating DNA loops in all clusters. Our data suggest that Hox cluster looping may represent an evolutionarily conserved structural mechanism of transcription regulation.

An interdisciplinary rehabilitation program may be beneficial to patients with head and neck cancer after treatment, but its effects should be evaluated in a controlled trial.

Background. People with metastatic cancers experience poor quality of life (QoL), fatigue, and decreased physical function. Exercise improves these symptoms in the curative setting, but the efficacy and safety of exercise in the metastatic setting is uncertain.Methods. Prospective, randomized trials of moderate/high-intensity aerobic exercise or resistance training vs. control in patients with advanced/metastatic solid cancers were identified from prior reviews and updated using a search of PubMed. The mean and SD for validated outcome measures (QoL, physical function, and fatigue) were extracted for intervention and control groups at baseline and postintervention. The Mann-Whitney test was used to evaluate the effect of exercise on the pooled change between baseline and postintervention. Safety was evaluated qualitatively.Results. Sixteen trials were analyzed. Among patients with scores at the mean or 2SD above, exercise was not associated with significant or clinical difference in QoL or fatigue. In patients with baseline scores 2SD below mean, exercise was associated with nonsignificant difference meeting minimal clinical important difference in QoL (À2.8 vs. 4.6, P ¼ 0.28). For function, patients at the mean had nonstatistically significant, but clinically meaningful difference in the six-minute walk test (6-MWT) (14.7 vs. 29.0 m, P ¼ 0.44). In patients 2 SD below the mean, there was a clinically meaningful difference in two patient-reported functional subscales (0.1 vs. 5.3, P ¼ 0.076 and 0.44 vs. 8.5, P ¼ 0.465) and a clinically meaningful improvement in the 6-MWT (À7.5 vs. 27.0 m, P ¼ 0.34), although none of these associations met statistical significance. There were no differences in falls, fractures, or pain.Discussion. Exercise is associated with clinically meaningful improvements in QoL, function, and 6-MWT in some patients with metastatic cancer. Despite poor reporting of safety, there was no signal of increased harm from exercise in this setting.

What's known on the subject? and What does the study add?• There is an increase in use and duration of androgen-deprivation therapy (ADT) in patients with prostate cancer. ADT can cause decreased bone mineral density and lean muscle loss, putting these patients at increased risk of fracture. Guidelines exist for the prevention and management of bone loss in this population; however, data suggests that most patients are not receiving proper screening, evaluation, or treatment for bone loss. Research to date suggests that patients on ADT are unaware of the risks and side-effects of ADT and that most are not engaging in important preventative behaviours, e.g. calcium and vitamin D intake.• To our knowledge, there are no studies in patients on ADT specifically assessing patients' osteoporosis (OP) knowledge, self-efficacy, and feelings of susceptibility towards OP and their relationships to engagement in recommended healthy bone behaviours. We think that these data will aid in the development of health promotion uptake strategies that are directly targeted to this patient population. Objectives• To describe in patients with prostate cancer, receiving androgen-deprivation therapy (ADT): (i) knowledge, self-efficacy (SE), and health beliefs about osteoporosis (OP); (ii) current engagement in healthy bone behaviours (HBBs).• To explore the relationships between knowledge, SE, and health beliefs, and engagement in HBBs. Patients and Methods• 175 patients receiving ADT by injection completed questionnaires assessing current HBBs, OP knowledge, SE, and health beliefs (motivation, perceived susceptibility, and seriousness).• Descriptive statistics and independent samples t-tests were used to assess relationships between knowledge, SE, health beliefs, and engagement in HBBs. Results• Only 38% of patients had undergone a dual X-ray absorptiometry scan in the past 2 years. OP knowledge was low (mean [SD, range] 9.6 [4.4,[0][1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]) and perceived SE moderate (84.7 [24.5, 0-120] • Few patients met the recommendations for vitamin D intake (42%) and exercise (31%), and 15% were at risk of over-supplementation of calcium.• Patients taking calcium supplements (P = 0.04), and meeting guidelines for vitamin D (P = 0.008) and for exercise (P = 0.002) had significantly greater knowledge than those who did not.• Patients who were engaging in less than four of five HBBs had lower knowledge (P < 0.001) and health motivation (P = 0.01) than those who were engaging in four or all five HBBs. Conclusions• Most patients who are receiving ADT are not receiving appropriate screening, lack basic information about bone health, and are not engaging in the appropriate HBBs.• These findings support the application of the Health Belief Model in this population: interventions that teach patients about the implications of bone loss, encourage proper uptake of HBBs, and promote feelings of SE could increase engagement in HBBs to prevent and manage bone loss.

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Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.

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