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  • Making Physical Activity Business as Usual: A Comparison of Design Features in Cancer Care Models Across the Atlantic

    by Caitlin Kinser | Feb 02, 2024
    blog_cancer programs in us and uk

    Evidence shows that physical activity is highly beneficial for people living with and beyond cancer and is one of the most effective ways to manage the side effects of treatment and improve quality of life1. Despite this, physical activity support is not routinely available within cancer care and most people diagnosed with cancer are not meeting the recommended levels of physical activity. This challenge has been recognized globally, leading to the establishment of the American College of Sports Medicine’s (ACSM) Moving Through Cancer initiative, with a mission to integrate exercise as standard practice in oncology by 20292. During the tenure of my Churchill Fellowship, I investigated exemplar exercise oncology programs in North America to gain insights into the cultural and contextual factors that have contributed to successful implementation. Exploring international perspectives can help us to overcome common barriers and make progress towards making physical activity ‘business as usual’ worldwide.

    I hypothesized that the U.S. and UK’s differing healthcare models would influence the availability of funding and thus the culture of embedding physical activity into clinical care. However, I learned that how programs are funded had very little impact on their success, and the extent to which physical activity was normalised by the design of clinical environments and processes was far more influential. Design features can significantly affect people’s perceptions and behaviors. Health professionals are more likely to talk about physical activity and refer patients to support programs if it feels like a normal part of their work. Equally, patients will be more receptive to the conversation and adhere to the physical activity support if it feels like a normal part of their cancer treatment.

    In some exemplar programs in the U.S., exercise facilities have been strategically placed next to a hospital reception and in close proximity to chemotherapy wards. This intentional design allows for a powerful message to be conveyed to all those who enter the hospital - that in the midst of cancer treatment, it is possible and encouraged to stay physically active. By being visible and easily accessible during treatment, the facilities also serve as regular prompts for both patients and clinicians to incorporate physical activity into their routine. This reduces stigma and creates the perception that exercise is an essential part of cancer care. In contrast, many exercise programs in the UK are delivered in community gyms without any visible connection to healthcare. This separation leads to the misconception that exercise is optional or only for those who are interested. Although there are advantages to offering physical activity support outside of hospital settings and closer to people’s homes, when a visual prompt for physical activity is provided within a clinical environment, it increases the likelihood that individuals will utilize these opportunities, even if they are not located within that facility. Successful programs recognize that the needs of people living with cancer can vary greatly and offer a range of options, including clinical exercise interventions, self-management advice, and community signposting. They also acknowledge that the success of any program relies on uptake and adherence by patients. Thus, it is crucial that the importance of physical activity is emphasized throughout the design of the clinical pathway to enable more people to access various forms of support.

    In the physical activity sector, we often use the ambition of programs becoming funded by healthcare systems as a marker of success, and the importance of normalising physical activity through design features is often overlooked. Of course, funding is essential to deliver programs, but the most successful interventions had sustained the program for several decades without funding from healthcare systems. In some cases, funding from the system was viewed as a disadvantage due to its volatility, and using charitable and commercial funds instead allowed awareness and trust to be grown over a longer period of time. In these examples, the healthcare systems had still committed to the program by providing space within a hospital.  As healthcare space is a premium commodity, this provision creates the perception that physical activity is prioritized by the organization, further re-enforcing its importance. In contrast, if a health organization supports a programme purely through funding, the support is unlikely to create a normalizing effect, as clinicians and patients aren’t usually aware of how the programs are funded.

    As we continue to advocate for physical activity to become part of standard care worldwide, the importance of making physical activity look and feel part of normal cancer treatment cannot be forgotten. Building new hospitals to accommodate exercise facilities is not feasible everywhere; nevertheless, there are simple and cost-effective design modifications that everyone working in cancer care could implement. For millions of people living with and beyond cancer, the benefits of physical activity could be truly life changing, and in some cases, lifesaving.

    Whether you are a clinician, exercise professional, or researcher working with cancer patients, ask yourself, how can we work together to create a culture where physical activity is ‘business as usual’?

     

    Beth Brown headshot

    Beth Brown, MPH. As the Operations Manager of the National Centre for Sport & Exercise Medicine in Sheffield, England, Beth brings over 10 years of experience developing physical activity interventions for chronic health conditions. In her current role, she is responsible for overseeing a co-location model that aims to transform the way physical activity is integrated into the National Health Service. In recognition of her expertise and dedication to this field, Beth was awarded with a Churchill Fellowship in 2020. This fellowship funded her travels across North America, where she was able to explore and learn about the latest innovations and best practices for incorporating physical activity into cancer care.

     

    References

    1. Patel, A. V., Friedenreich, C. M., Moore, S. C., Hayes, S. C., Silver, J. K., Campbell, K. L., ... & Matthews, C. E. (2019). American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Medicine and science in sports and exercise51(11), 2391.

    2. Schmitz, K. H., Stout, N. L., Maitin‐Shepard, M., Campbell, A., Schwartz, A. L., Grimmett, C., ... & Sokolof, J. M. (2021). Moving through cancer: Setting the agenda to make exercise standard in oncology practice. Cancer127(3), 476-484. 

     

  • ESSR’s Top and Cutting-Edge Content from 2023

    by Caitlin Kinser | Jan 31, 2024

    Several of the highest impact and most read articles over the last five years that have been published in Exercise and Sport Sciences Reviews (ESSR) include topics of sitting too much (2010), the effects of exercise on the gut microbiome (2019) and exercise snacks to improve cardiometabolic health (2022). The content of these articles continues to be highly relevant and are excellent examples of the research reviews regularly published in ESSR that summarize a contemporary problem and identify the most significant gaps in the knowledge base.  

    The unique focus and mission of ESSR is to provide forward-thinking and high-quality reviews on the most contemporary scientific, medical and research-based topics in sports medicine and exercise science. The charge to feature forward-thinking and cutting-edge content is accomplished by inviting authors to provide either the rationale for a novel hypothesis or to summarize work on a contemporary issue and identify the key gaps in knowledge that need to be addressed to move the field forward. The editorial board play a significant role in recruiting and inviting reviews in their areas of expertise, although we welcome unsolicited ideas and reviews. The journal publishes four issues each year: available by January, April, July and October. 

    Several metrics provide the journal with information on the success of achieving the mission of ESSR. One metric is related to the number of times the content is either read (viewed) or mentioned. The read count, either through an institutional subscription to the journal (Ovid) or from the ACSM website, will typically accumulate the longer it has been published. The article with the top read counts published in 2023 include the contemporary topics of sex differences in athletic performance and the transgender athlete, eccentric exercise to improve muscle weakness after injury, and the benefits of ketogenic diets with aging. Other highly viewed articles in 2023 include the topics of exercise as a therapy to prevent cellular aging, pain management with aging, and the neuromechanics of the rate of force development

    An additional metric to identify the most impactful articles is the number of mentions and attention of an article (Altmetric score: identified with a colorful donut symbol). The article with the most mentions in 2023 (346) was on the topic of a dietary strategy for optimizing visual range in athletes which also received high read counts, followed by exercise as a therapy to prevent cellular aging and the buffering effects of physical activity on daily stress.  

    The journal impact factor (JIF) is another metric that indicates the relative influence of our collective articles. The JIF provides a normalized citation count by calculating the ratio between the number of times articles were cited in a two-year period relative to the number of articles published by a journal in that period. The impact factor released in mid-2023 for the 2021 and 2022 citations was 5.7 which ranks ESSR as 6th of 87 among sport science journals and 8th of 79 among physiology journals.  

    ESSR aims to publish ~24-30 high impact reviews each year. For 2024 and early 2025 we currently have 35 articles in various stages of development or already published. The topics of these articles reflect many of the topical categories of the ACSM Annual Meeting. The areas with the greatest numbers of prospective articles are (1) Skeletal Muscle, Bone and Connective Tissue; (2) Physical Activity/Health Promotion Interventions; and (3) Cardiovascular, Immune, Renal, and Respiratory Physiology. Articles that are likely to generate notable interest include the following topics: 

    • Sex differences in neuromuscular ageing and muscle stem cell regulation 

    • Daily step counts as a key public health metric 

    • Neuroplasticity of the brain induced by physical activity and aging 

    • Heat tolerance 

    • Strategies to increase activity levels 

    • Epigenetics and skeletal muscle 

    • Exercise effects on gut microbiome 

    • Sleep and insulin resistance 

    • Relative energy deficiency in sport (RED-S) 

    • Aerobic training effects on metabolic disease 

    We hope our content will continue to be of interest to you and, as always, encourage you to send us suggestions on topics and authors we should consider for inclusion in the journal. Given that 2024 is an Olympic year we welcome high quality submissions that address lessons learned from research on the limits of human physical performance of all people of all ages and abilities in both males and females, as well as the importance of the health benefits of physical activity.   

    Sandra HunterSandra K. Hunter, Ph.D., FACSM, is a professor at Marquette University in the Exercise Science Program, Department of Physical Therapy, and also serves as director of the Athletic and Human Performance Research Center at Marquette. She has published more than 150 referred articles and has served as the primary advisor of >70 undergraduate students, and multiple doctoral and master’s students and postdoctoral research associates. Dr Hunter leads an active and federally-funded research program studying the sex and age differences in neuromuscular function, exercise performance and exercise training in healthy and clinical populations such as people with diabetes and Long COVID. She has received more than $16 million in grants to fund her research. Dr. Hunter joined ACSM in 2000 and became a fellow in 2005. She has served as an associate editor for Medicine & Science in Sports & Exercise® since 2013. Dr. Hunter currently serves as the editor-in-chief of Exercise and Sport Sciences Reviews

  • Clinical Highlights from Current Sports Medicine Reports

    by Caitlin Kinser | Jan 09, 2024

    Quarterly Editor's Picks, CSMR journal cover and headshot of editor Dr. Shawn KaneOne of the best parts of Current Sports Medicine Reports (CSMR) are the interesting and educational case reports that are submitted. They are informative and highlight interesting clinical cases that help to increase our knowledge base and remind us to maintain a high degree of clinical suspicion and to keep searching for answers when things just don’t add up like they should.

    I would like to highlight three not-to-be-missed cases from the past quarter:

    Blunt Ocular Trauma in Sport submitted by Daniel, et al. is an interesting (and must say scary) case of traumatic vision loss while playing soccer. Player sustained trauma to the eye from a kicked ball and had 30 minutes of monocular blindness prior to seeking medical care. The player was appropriately diagnosed and treated for traumatic iritis and commotio retinae and was able to return to play with complete resolution of symptoms. The authors of this interesting case report go on to discuss what is needed for a timely and thorough sideline assessment as well as the differential diagnosis for ocular trauma. 

    Popping Pimples or Bones? A Clinical Vignette of a Lacrosse Player on Isotretinoin with Multifocal Lower-Extremity Bone Stress Injuries submitted by D’Amico and Schroeder. This case to me highlights the importance of taking a good history, doing a thorough medication reconciliation, and searching for answers when things do not add up. I am sure many of us have a lot of patients taking isotretinoin for acne and if they have a bone stress injury would you think about stopping the use of isotretinoin? 

    Platelet-rich Plasma (PRP) Treatment of a Quadriceps Tendon Tear in a Collegiate Basketball Athlete submitted by Lutz, et al. is an interesting case using PRP to treat a quadriceps tear. Extrapolating data from the treatment of patellar tendon injuries the authors used PRP as well as traditional rehabilitation to treat the injury and return to athlete to sport. One highlight that is important for this case is the authors thoroughly and objectively describe the components of their PRP injection and rehabilitation program, so that others can replicate it. 

    We also have awesome articles that cover a variety of areas, and I would like to highlight three from the past quarter:

    Assessment of the Current State of Sports Coverage Participation, Training, and Confidence Ratings among PMR Residents and Residency Programs submitted by Stokes, et al. This is an article in our Clinical Curriculum Series, and it shows that exposure to sports medicine during training leads to confidence. While completed with PMR residencies, I am pretty sure this would be similar amongst all Sports Medicine disciplines.  Hopefully, this information can help other programs dedicate time to sports medicine interests. 

    Clinical Considerations in Returning Pediatric and Young Adults with Cancer to Physical Activity submitted by Dykowski, et al. We know that physical activity is beneficial and can be an adjunct treatment for many conditions. When and how to get patients with cancer diagnoses back to physical activity can be challenging due multiple variables. The authors of this paper do to an excellent job at providing some guidance on clinical considerations when contemplating a return to activity. As we continue to improve cancer treatments, getting patients exercising will be good for their physical and mental health. 

    Lastly, as we continue to address the conditions of pediatric obesity and inactivity, I would like to highlight the article May the Force Be with Youth: Foundational Strength for Lifelong Development submitted by Faigenbaum, et al. I would suggest that every Primary Care Sports Medicine provider read this and share it with their Primary Care Colleagues.  This article provides excellent information on not only the why this concept is important but also provides some excellent information on how to address it. This is crucial for the long-term health, wellness, and safety of our nation. 

    CSMR is ACSM’s official monthly clinical-review e-journal. Written specifically for physician and clinician members, CSMR articles provide thorough overviews of the most current sports medicine literature. ACSM physician members receive an online subscription to this journal as a member benefit.

    Shawn Kane headshot 2024Shawn F. Kane, MD, FACSM is a family physician, associate professor in the Department of Family Medicine, and adjunct assistant professor in the Department of Exercise and Sports Science at the University of North Carolina (UNC) Chapel Hill. He received his medical degree from the Uniformed Services University of the Health Sciences and served in the U.S. Army for 27 years. While in the Army he spent more than 18 years serving as a physician-leader in numerous units within the US Army Special Operations Command. He is interested in sports medicine, concussion care, veterans’ health, and primary care of patients with post-traumatic stress disorder. Dr. Kane joined ACSM in 2003 and became a fellow in 2011. He currently serves as the editor-in-chief for
    Current Sports Medicine Reports, on ACSM’s Clinical Sports Medicine Leadership Committee, ACSM’s Health & Fitness Summit Program Committee, and ACSM’s Program Committee. Outside of the office, Dr. Kane enjoys hanging out with his Leonbergers (big furry, cute German Mountain dogs), as well as working out and traveling.

  • Navigating the Impact of New Weight Loss Medications

    by Greg Margason | Dec 18, 2023
    Navigating new weight loss medications

    Ozempic™, Wegovy™, Mounjaro™, and now, Zepbound™ - everywhere you turn, you hear about these new medications that have changed the weight loss world and are making a major impact on chronic diseases. The reality is that while 2023 has been flooded with media and excitement, it will likely continue - these effective medications promote, on average, 15-20+ percent weight loss.  

    Now that these new medications are here, can we forget about diet and exercise when it comes to weight loss? 

    If you asked me 20 years ago if I would be talking to you about using medications as a strategy for weight loss – I would have said, “No.”  

    However, after working with thousands of people seeking to lose weight in both research and real-world settings, I now understand the complexity of obesity as a disease. Sometimes the path to weight loss using the traditional “eat less and exercise more” method is not enough, and additional support with medical management (like taking a medication) is needed.  

    I get how confusing this can be, especially with all the media attention these new medications are getting and all the mixed messages out there. To simplify, let’s breakdown some common misconceptions that I hear a lot. Spoiler alert: being physically active is still important! 

    #1 – Ozempic™ is the Magic Bullet for Weight Loss 

    Ozempic™ is approved for the treatment of type 2 diabetes, not weight loss. The two popular medications that are FDA (Food and Drug Administration) approved for weight loss are semaglutide (Wegovy™) and tirzepatide (Zepbound™). These medications were originally approved for type 2 diabetes and later approved for weight loss, which explains why there are different trade names.

    So, are Wegovy™ and Zepbound™ the magic bullets for weight loss?  

    These medications are called nutrient-stimulated hormone therapies, and the name gives a clue to how they work in our bodies. Here is your quick and basic physiology lesson:  

    Nutrient-stimulated hormones signal our brain in ways that impact how much food we eat – this can be anything from how hungry you feel to whether or not you have food cravings. These new medications mimic those hormones in the body to reduce hunger levels and help people feel fuller longer. With that, people that respond to these medications, typically eat less which can lead to weight loss. 

    While these new weight loss medications are an effective tool, in general they are only impacting how much you eat, not how well. They also are not helping you move more. This is why these medications need to be a part of a broader plan that includes a physical activity and healthy eating strategy, and possible behavioral counseling to help you learn about underlying feelings and strategies to support weight loss.  

    Your healthcare provider is the best person to help you understand: 

    • If, when, and which weight loss medication might be right for you;  

    • The appropriate way it should be taken, whether you qualify; and, 

    • The best comprehensive treatment approach that includes eating better and moving more. 

    #2 – Weight Loss = Willpower 

    Sure, eating healthier and exercising more takes some self-discipline. Unfortunately, life and real barriers can get in the way. In fact, there are many other factors that can impact your weight – everything from your genetics, to how you sleep, where you live, and other dynamics that may increase your drive to eat, such as emotions, hormones, or other medical treatments – to just name a few. All of this can make “eating less and moving more,” MORE difficult over time.  

    To blame weight loss failures on willpower is assuming everything mentioned above is under your control, which it’s not.  

    People taking weight loss medications report that they have better control over their hunger and no longer have intrusive thoughts related to food. That removes some of the willpower challenges (yay!). 

    But let’s get back to the healthy lifestyle strategy. Let’s face it, figuring out how to build a healthy lifestyle is not always easy, with or without a weight loss medication. This is where I encourage you to get support from a professional.  

    Rule No. 1 – if someone tells you they have “the perfect” weight loss method or program, do not engage! Whether you are seeking dietary or physical activity support, only work with professionals who spend time determining what is best FOR you, not just overlaying their method ON you. Seek out support from registered dietitians and certified exercise professionals with experience in weight management and behavior change strategies.  

    #3 You Can Use a Medication to Quickly Lose Weight and Skip Diet and Exercise  

    I hear this constantly in my work, and sadly it is promoted a lot by influencers and celebrities. It sounds like the perfect solution, especially if you have previously struggled to lose weight with diet and exercise alone. Unfortunately, talking about using the medications in this manner is not recommended for several reasons:  

    First, all these medications were tested and approved for use alongside a lifestyle program that includes healthy eating and physical activity. Using a medication without modifying diet and moving more is against what is recommended!  

    Secondly, once a person comes off the medication, those hunger signals will come back, and this can be followed by weight regain.  

    Third, any time you lose weight, you don’t just lose fat mass, but also lean mass. This is typical, but there is concern that higher levels of lean mass loss might be occurring with these newer weight loss medications.  

    A big question is whether the lean mass that is lost is actually your muscle mass.  

    Most people don’t realize this, but the terms “lean mass” and “muscle mass” are not the same. Muscle mass is only one aspect of your body’s lean mass. Researchers are currently studying the effect these medications have on lean mass loss that includes not only muscle but also bone, water, organs, and other body tissues.  

    Why does this matter to you? Some people taking these medications report feeling weaker and taking care of your muscular health may help.  

    This is where exercise may play an important role. 

    Will resistance training completely preserve lean mass or muscle mass loss? The verdict is still out, and the answer is likely no. But we do know that resistance training is still beneficial for you during weight loss, and of course can improve feelings of weakness, and your overall strength and physical function.  

    Some people taking these medications also report feeling fatigued or tired even though they have lost weight.  

    Overtime, participating in a regular exercise program can improve feelings of fatigue. Moderate-intensity physical activity, as simple as brisk walking, can be a great place to start to increase stamina.  

    Have I convinced you yet that these medications are not quick fix for weight loss?!?!  

    Bottom line – a foundation in healthy eating patterns and a physical activity plan are critically important to support your weight loss journey to have you feeling your very best! They may help you keep the weight off and provide health benefits beyond what happens on the scale.  

    ReneeJRogers Headshot
    Dr. Renee J. Rogers, Ph.D., FACSM,
     is a senior scientist at the University of Kansas Medical Center and also works as an independent healthy lifestyle consultant and strategist. She chairs ACSM’s Strategic Health Initiative on Behavioral Strategies and Summit Program Committees. Dr. Rogers is an expert in bio-behavioral intervention design with a focus on relevant engagement approaches that blends her 20+ years of experience working in exercise physiology, behavior change, and weight management.