scholarly journals Who Makes It All The Way? Participants Vs. Decliners, And Completers Vs. Drop-Outs, In A 6-Month Exercise Trial During Cancer Treatment. Results From The Phys-Can RCT

2021 ◽  
Author(s):  
Emelie Strandberg ◽  
Christopher Bean ◽  
Karianne Vassbakk-Svindland ◽  
Hannah L Brooke ◽  
Katarina Sjövall ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Exercise Intervention ◽  
Outcome Expectations ◽  
University Education ◽  
Physically Active ◽  
Exercise Interventions ◽  
Cancer Related Fatigue ◽  
Oncology Trial ◽  
Intervention Trials ◽  
Drop Outs

Abstract Purpose: To compare sociodemographic, health- and exercise-related characteristics of participants vs decliners, and completers vs drop-outs, in an exercise intervention during cancer treatment. Methods: Patients with newly diagnosed breast, prostate or colorectal cancer were invited to participate in a 6-month exercise intervention. Questionnaire, medical record and physical testing data were analyzed for between-group differences using independent t-tests and Chi2-tests. Results: Trial participants (n=577) were younger (59±12 yrs vs 64±11 yrs, p<.001), included more women (80% vs 75%, p=.012) and were scheduled for chemotherapy treatment (54% vs 34%, p<.001) compared to decliners (n=1391). A greater proportion had university education (60% vs 40%, p<.001), reported more anxiety (5.5±4.4 vs 4.3±3.7, p<.001), cancer-related fatigue, exercise self-efficacy (49.9±16.2 vs 45.0±20.1, p<.001), higher outcome expectations and less kinesiophobia (23.5±5.1 vs 24.5±5.0, p=.001) compared to decliners who completed baseline questionnaires (n=436). A greater proportion of participants were classified as ‘not physically active’, however, within the group who participated, more intervention completers were classified as ‘physically active’ at baseline compared to drop-outs. Completers also reported less kinesiophobia than drop-outs. Conclusion: Participants in a comprehensive exercise oncology trial differ in several sociodemographic, health and exercise-related aspects from those declining to participate, while differences between completers and drop-outs are less pronounced. A lack of health-enhancing exercise habits at baseline may be an incentive for accepting participation, while having such habits at baseline may increase the chances of completing exercise intervention trials. The findings provide useful insight for translating research results and planning future exercise interventions for cancer survivors.

scholarly journals Who makes it all the way? Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT

2021 ◽  
Author(s):  
Emelie Strandberg ◽  
Christopher Bean ◽  
Karianne Vassbakk-Svindland ◽  
Hannah L. Brooke ◽  
Katarina Sjövall ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Self Efficacy ◽  
Additional Data ◽  
Exercise Intervention ◽  
Outcome Expectations ◽  
University Education ◽  
Physically Active ◽  
Additional Data Collection ◽  
Drop Outs ◽  
Trial Participants

Abstract Purpose To compare sociodemographic, health- and exercise-related characteristics of participants vs. decliners, and completers vs. drop-outs, in an exercise intervention trial during cancer treatment. Methods Patients with newly diagnosed breast, prostate, or colorectal cancer were invited to participate in a 6-month exercise intervention. Background data for all respondents (n = 2051) were collected at baseline by questionnaire and medical records. Additional data were collected using an extended questionnaire, physical activity monitors, and fitness testing for trial participants (n = 577). Moreover, a sub-group of decliners (n = 436) consented to additional data collection by an extended questionnaire . Data were analyzed for between-group differences using independent t-tests and chi2-tests. Results Trial participants were younger (59 ± 12yrs vs. 64 ± 11yrs, p < .001), more likely to be women (80% vs. 75%, p = .012), and scheduled for chemotherapy treatment (54% vs. 34%, p < .001), compared to decliners (n = 1391). A greater proportion had university education (60% vs 40%, p < .001), reported higher anxiety and fatigue, higher exercise self-efficacy and outcome expectations, and less kinesiophobia at baseline compared to decliners. A greater proportion of trial participants were classified as ‘not physically active’ at baseline; however, within the group who participated, being “physically active” at baseline was associated with trial completion. Completers (n = 410) also reported less kinesiophobia than drop-outs (n = 167). Conclusion The recruitment procedures used in comprehensive oncology exercise trials should specifically address barriers for participation among men, patients without university education and older patients. Individualized efforts should be made to enroll patients with low exercise self-efficacy and low outcome expectations of exercise. To retain participants in an ongoing exercise intervention, extra support may be needed for patients with kinesiophobia and those lacking health-enhancing exercise habits at baseline.

scholarly journals Adherence to an Exercise Intervention Among Older Women Post Hip Fracture

2008 ◽  
Vol 2 (1) ◽  
pp. 41-56 ◽  
Author(s):  
Barbara Resnick ◽  
Christopher D’Adamo ◽  
Michelle Shardell ◽  
Denise Orwig ◽  
William Hawkes ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older Women ◽  
Exercise Intervention ◽  
Fear Of Falling ◽  
Outcome Expectations ◽  
Routine Care ◽  
Care Group ◽  
Exercise Interventions ◽  
Home Based ◽  
Recovery Trajectory

The purpose of this study was to evaluate adherence to home-based exercise interventions among older women post hip fracture that were randomized to one of three exercise intervention groups or a routine care group. A total of 157 female hip fracture patients provided data for the intervention analysis. Factors evaluated baseline, 2, 6, and 12 months post hip fracture included demographic variables, adherence to treatment visits, self-efficacy, outcome expectations, stage of change for exercise, social support for exercise, mood, health status, pain, and fear of falling. The hypothesized model tested the direct and indirect impact of all study variables on adherence to exercise intervention sessions. Different factors appeared to influence adherence to visits across the recovery trajectory.

scholarly journals Evaluation of Web-Based and In-Person Methods to Recruit Adults with Type 1 Diabetes for a Technology-Based Exercise Intervention: Prospective Observational Study (Preprint)

2021 ◽  
Author(s):  
Garrett I Ash ◽  
Stephanie Griggs ◽  
Laura Nally ◽  
Matthew Stults-Kolehmainen ◽  
Sangchoon Jeon ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Exercise Intervention ◽  
Snowball Sampling ◽  
Physically Active ◽  
Web Based ◽  
Exercise Interventions ◽  
Recruitment Methods ◽  
Personnel Costs

BACKGROUND Exercise is essential self-management for type 1 diabetes (T1D), but there are limited data on effective strategies for promoting it. We evaluated a technology-based exercise intervention for adults 18-65 years old with T1D. The COVID-19 social distancing restrictions prompted us to test web-based recruitment methods previously underexplored for this demographic. OBJECTIVE (1) evaluate the effectiveness and cost of using social media news feed advertisements, clinic-based approach, and web-based snowball sampling to reach inadequately active adults with T1D, and (2) compare characteristics of enrollees against normative data and between the different methods. METHODS Participants were recruited between November 2019 and August 2020 for a technology-based exercise intervention study. Method #1: Facebook news feed advertisements ran for five 1-8 day windows targeting adults (18-64yr) in the greater New Haven and Hartford, CT areas with at least one diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them. Method #2: In-person approach of patients 18-24yr with T1D at clinical visits prior to March 2020. Those interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. Method #3: Snowball sampling by physically active individuals with T1D contacting their peers on Facebook and emails for 48 days with details to contact the research staff to express interest and complete eligibility screening. RESULTS Method #1: Advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%), of whom 20 (7.3%) volunteered, of whom 8 (40%) were eligible. Fees averaged US $1.20 per click, US $16.44 per volunteer, and US $41.11 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%, P < .001) but their responsiveness and eligibility rates did not differ. Method #2: We approached 40 patients of whom 32 (80%) inquired about the study, of whom 20 (63%) volunteered, of whom 2 (10%) were eligible. Personnel costs for arranging in-person approaches averaged US $12.50 per candidate approached, US $15.63 per inquirer, US $25.00 per volunteer, and US $250.00 per eligible volunteer. Method #3: Free snowball sampling generated 13 inquirers, of whom 12 (92%) volunteered, of whom 8 (67%) were eligible. The final enrollees overrepresented usage of continuous glucose monitors and insulin pumps, obesity, and in-target glycemic control. Obesity and above-target glycemic control were more common among those referred by news feed advertisements than snowball sampling (both 88% vs 25%, P = .04). CONCLUSIONS Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, costs comparing favorably to prior trials despite targeting an uncommon condition (i.e., T1D) and commitment to an intervention. Paid news feed advertisements increased access to higher-risk participants, enabling greater diversity in subject recruitment.

scholarly journals Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031220 ◽  
Author(s):  
George A Kelley ◽  
Kristi S Kelley ◽  
Russell R Pate
Keyword(s):  
Strength Training ◽  
Children And Adolescents ◽  
Body Fat ◽  
Fat Mass ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Randomised Trial ◽  
Obese Children ◽  
Exercise Interventions ◽  
Intervention Trials

ObjectivesDetermine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m2, fat mass and per cent body fat) in overweight and obese children and adolescents.DesignNetwork meta-analysis of randomised exercise intervention trials.SettingAny setting where a randomised trial could be conducted.ParticipantsOverweight and obese male and/or female children and adolescents 2–18 years of age.InterventionsRandomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training.Primary outcomesChanges in BMI in kg/m2, fat mass and per cent body fat.ResultsFifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training (X- ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to −0.6; fat mass -2.1, –3.3 to −1.0 kg; per cent fat -1.5, –2.2 to −0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, –1.4 to −0.1; fat mass -2.5, –4.1 to −1.0 kg; per cent fat, -2.2, –3.2 to −1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,–2.5 to −0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI.ConclusionsAerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents.PROSPERO registration numberCRD42017073103.

Exercise is an effective treatment modality for reducing cancer-related fatigue and improving physical capacity in cancer patients and survivors: a meta-analysis

2011 ◽  
Vol 36 (6) ◽  
pp. 892-903 ◽  
Author(s):  
Elliott M. McMillan ◽  
Ian J. Newhouse
Keyword(s):  
Effect Size ◽  
Fixed Effects ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Fixed Effects Model ◽  
Control Groups ◽  
Exercise Interventions ◽  
Cancer Related Fatigue ◽  
Effective Treatment Modality ◽  
Underlying Mechanisms

The use of exercise interventions to manage cancer-related fatigue (CRF) is a rapidly developing field of study. However, results are inconsistent and difficult to interpret across the literature, making it difficult to draw accurate conclusions regarding the true effectiveness of exercise interventions for CRF management. The aims of this study were to apply a meta-analysis to quantitatively assess the effects of exercise intervention strategies on CRF, and to elucidate appropriate exercise prescription guidelines. A systematic search of electronic databases and relevant journals and articles was conducted. Studies were eligible if subjects were over the age of 18 years, if they had been given a diagnosis of or had been treated for cancer, if exercise was used to treat CRF as a primary or secondary endpoint, and if the effects of the intervention were evaluated quantitatively and presented adequate statistical data for analysis. A total of 16 studies, representing 1426 participants (exercise, 759; control, 667) were included in a meta-analysis using a fixed-effects model. The standardized mean difference effect size (SMD) was used to test the effect of exercise on CRF between experimental and control groups. The results indicate a small but significant effect size in favour of the use of exercise interventions for reducing CRF (SMD 0.26, p < 0.001). Furthermore, aerobic exercise programs caused a significant reduction in CRF (SMD 0.21, p < 0.001) and overall, exercise was able to significantly improve aerobic and musculoskeletal fitness compared with control groups (p < 0.01). Further investigation is still required to determine the effects of exercise on potential underlying mechanisms related to the pathophysiology of CRF.

scholarly journals Heart Rate Variability and Cardiovascular Adaptations Among Cancer-Survivors Following a 26-Week Exercise Intervention

2020 ◽  
Vol 19 ◽  
pp. 153473542096981
Author(s):  
Silvie Grote ◽  
Jeanette M. Ricci ◽  
Salem Dehom ◽  
Naomi Modeste ◽  
Diadrey-Ann Sealy ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Cardiorespiratory Fitness ◽  
Autonomic Dysfunction ◽  
Exercise Intervention ◽  
Survival Prognosis ◽  
Exercise Interventions ◽  
At Home

Cardiotoxicity as a result of cancer treatment contributes to autonomic dysfunction and decreased cardiorespiratory fitness among cancer survivors. These deleterious cardiovascular outcomes reduce the survival prognosis for cancer patients and contribute to poor quality of life among survivors. Exercise interventions have been shown as effective in mitigating treatment-related side effects. However, previously published interventions have not explored the potential for improvement in autonomic dysfunction (heart rate variability, HRV). This study examined cardiovascular adaptations in cancer survivors (n = 76) who participated in a 26-week intervention consisting of combined aerobic and resistance training (CART). The most noteworthy improvements occurred during the first 13 weeks of training and were maintained throughout the end of the 26-week period. HRrest improved from baseline (PRE) to the midpoint (MID) ( P = .036) and from PRE to POST timepoints ( P = .029). HRV and VO2max did not initially appear to change in response to CART. However, after stratification on time since treatment, participants who were 5 or more years from their last treatment experienced improvements (ie increase) in the HRV characteristic of HF power ( P = .050) and also in VO2max ( P =.043), when compared to those experiencing less than 5 years of time since their last treatment. These findings highlight a need for more attention to address the cardiorespiratory deficits experienced by those who have recently completed cancer treatment. In conclusion, the CART intervention is effective in improving cardiorespiratory fitness and autonomic dysfunction. The structure of the intervention is feasible for cancer survivors to continue with at home, using minimal resources, and without supervision. This at-home model may be even more acceptable to recent survivors that may be homebound immediately following treatment.

scholarly journals Effects of exercise on cancer related fatigue in adults: A literature review and meta-analysis of randomized controlled trials

2018 ◽  
Vol 9 (1) ◽  
pp. 6
Author(s):  
Suma Vijayakumar ◽  
Mi-Yeon Kim ◽  
Eric Chan ◽  
Ayman Allam
Keyword(s):  
Literature Review ◽  
Randomized Controlled Trials ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Exercise Interventions ◽  
Randomized Controlled ◽  
Cancer Related Fatigue ◽  
Study Heterogeneity ◽  
Cancer Trajectory

Cancer related fatigue (CRF) is one among the common distressing symptoms experienced by cancer patients. Evidence showed that exercise interventions are effective in decreasing CRF. This review is to evaluate the evidence of the effectiveness of exercise interventions on CRF among adults with varied types of cancer in all phases of the cancer trajectory. A literature review with meta-analysis of randomized controlled trials (RCTs) was conducted. The results of RCTs (n = 20) that examined the effects of exercise on CRF were combined using two approaches: meta-analysis (n = 18) and summative analysis (n = 2). A summary effects size of the standardized mean difference (SMD) with 95% confidence intervals was calculated using random effects model and heterogeneity was assessed with the I2 statistic. The results showed overall, a small but significant decrease in the level of CRF (SMD, -0.32; 95% CI, -0.51 to -0.12; p = .002) was observed following exercise intervention. Subgroup analyses showed that both mixed modes (combination of resistance and aerobic exercises) and aerobic exercises were effective in significantly reducing CRF (p = .033; p = .046 respectively). The results indicated substantial heterogeneity between studies (I2 = 79%; p ≤ .0001). Summative analysis also suggested that exercise may be effective in reducing CRF. In conclusion, both resistance and aerobic exercises may be effective in decreasing CRF in adult patients. The result needs to be interpreted with caution due to considerable between-study heterogeneity.

Iyengar yoga compared to exercise in women with stage I-III breast cancer: Feasibility of therapeutic interventions during adjuvant cytotoxic or endocrine therapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20623-e20623 ◽  
Author(s):  
Florian Wiedemann ◽  
Arndt Buessing ◽  
Martin Halle ◽  
Marion Kiechle ◽  
Nikola Kohls ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Endocrine Therapy ◽  
Exercise Intervention ◽  
Therapeutic Interventions ◽  
Exercise Session ◽  
Breast Cancer Patients ◽  
Cytotoxic Therapy ◽  
Exercise Interventions ◽  
Home Based

e20623 Background: Exercise and mind/body intervention studies have shown benefits when undertaken during cancer treatment. This ongoing trial aims to elucidate the different effects of yoga and conventional exercise on physical and psychological factors in breast cancer patients undergoing endocrine or cytotoxic therapy. This first interim analysis presents feasibility data comparing the two mentioned interventions. Methods: Patients are randomly assigned to receive Iyengar-yoga or conventional exercise on a 1:1 ratio during adjuvant therapy. The intervention consists of a weekly 60-minute yoga or physiotherapy exercise session together with individual home-based, self-contained 20-minute sessions twice a week. Data assessments via questionnaires are done at baseline, right after the 12-week intervention period and 2 months after the end of intervention. Patient accrual within two breast care units started in April 2011 with 66 patients being on study to date (2013, Jan 25). Results: So far, 57 patients (yoga: n=28; exercise: n=29) have completed the trial, while 9 patients dropped out (yoga: 5 patients; exercise: 4 patients). 46 patients received cytotoxic therapy (mean age: 48 y) and 11 patients received endocrine therapy (mean age: 60 y). 8 women participating either in yoga or exercise intervention were younger than 35 years (14%) and 6 women were older than 65 years (11%). Mean number of attended sessions is 9.0 (yoga: 9.3; exercise: 8.8; age >65: 10.3). Overall 19 patients (33%) attended 11-12 out of 12 sessions (yoga: 32%; exercise: 35%; age >65: 67%), 20 patients (35%) attended 8-10 sessions (yoga: 54%; exercise: 17%; age >65: 17%), while 18 women (32%) participated only in 5-7 sessions (yoga: 14%; exercise: 48%; age >65: 17%). 10 out of 51 participants accomplished 40 minutes of home-based training per week (yoga: 11%; exercise: 29%; age >65: 50%). Conclusions: Yoga and exercise interventions are feasible during cancer treatment, although amount and frequency of training should be accommodated to individual condition. Both interventions seem to be practicable for elderly (> 65 years) patients and for patients undergoing cytotoxic therapy.

scholarly journals Adverse Events During Supervised Exercise Interventions in Pediatric Oncology—A Nationwide Survey

2021 ◽  
Vol 9 ◽  
Author(s):  
Gabriele Gauß ◽  
Ronja Beller ◽  
Joachim Boos ◽  
Julia Däggelmann ◽  
Hannah Stalf ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Pediatric Cancer ◽  
Exercise Intervention ◽  
Exercise Programs ◽  
Exercise Interventions ◽  
Supervised Exercise ◽  
Pediatric Cancer Patients ◽  
Safety Procedures

Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors.Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2–5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text.Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% (n = 24). Representatives working for Universities (n = 6), rehabilitation clinics (n = 3), acute cancer clinics (n = 12), and activity camps (n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2–3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential.Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors.

scholarly journals Remote interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review and meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saïd Ibeggazene ◽  
Rebecca Turner ◽  
Derek Rosario ◽  
Liam Bourke
Keyword(s):  
Systematic Review ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Exercise Interventions ◽  
Exercise Behaviour ◽  
Cancer Services ◽  
The Social ◽  
Intervention Adherence ◽  
Randomised Controlled ◽  
Exercise Guidelines

Abstract Background The COVID-19 pandemic has forced many cancer services to consider a transition to a remote format of delivery that is largely untested. Accordingly, we sought to perform a systematic review of the effects of remotely delivered interventions to improve exercise behaviour in sedentary adults living with and beyond cancer. Methods Eligible studies were randomised controlled trials comparing a remotely delivered exercise intervention to a usual care comparison in sedentary people over 18 years old with a primary cancer diagnosis. Nine electronic databases were searched from inception to November 2020. Results The review included three trials, totalling 186 participants. Two of the included trials incorporated prescriptions that meet current aerobic exercise recommendations, one of which also meets the guidelines for resistance exercise. No trials reported an intervention adherence of 75% or more for a set prescription that meets current exercise guidelines. Conclusion There is little evidence suggesting that remote exercise interventions promote exercise behaviours or improve physical function in sedentary adults living with and beyond cancer. The development and evaluation of novel remote exercise interventions is needed to establish their usefulness for clinical practice. Given the social response to the COVID-19 pandemic, further research in this area is urgently needed.

Sign in / Sign up

Export Citation Format

Share Document