Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals

PURPOSE: Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion. METHODS: The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement. RESULTS: Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment–related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential. CONCLUSION: Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

Parkinson’s disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.

SMARTPHONE USAGE TIME, POSTURE OF THE CERVICAL REGION, AND ASSOCIATED FACTORS IN TEENAGE UNIVERSITY STUDENTS

Objective: This study aimed to assess the relationship between smartphone usage time and postural alignment in teenage university students and the associated factors. Methods: We carried out a cross-sectional study with 133 teenage university students (18-19 years old) between April and November 2018 in Fortaleza, Ceará, Brazil. Questionnaires were used to collect information on socioeconomic status, health conditions, smartphone usage time and level of physical activity. The alignment of the cervical region was assessed using photogrammetry in anatomical position and while texting on the smartphone. Horizontal alignment of the head (HAH), horizontal alignment of the acromion (HAA) and vertical alignment of the head (VAH) were measured. Bivariate and multivariate analyses were performed to check for factors associated with smartphone usage time (>6 hours a day). Results: There were higher rates of girls (66.9%; n=89), people in the lower social class (71.4%; n=95), frequent drinkers (66.9%; n=89), people who complained of headache (83.5%; n=111) and people who used smartphones for more than 6 hours a day (72.9%; n=97). The multivariate analysis showed an association of smartphone usage time (>6 hours a day) with cervical anteriorization, estimated by measuring the VAH (OR=1.053; p=0.007 – left side), female gender (OR=2.729; p=0.046), frequent drinking (OR=2.636; p=0.038) and complaint of headache (OR=5.617; p=0.002). Conclusions: There was a high percentage of adolescents who excessively used smartphones for more than 6 hours a day. Prolonged smartphone use was associated with female gender, alcohol consumption, headache and changes in cervical alignment.

Relationships between Plantar Pressure Distribution and Rearfoot Alignment in the Taiwanese College Athletes with Plantar Fasciopathy during Static Standing and Walking

Background: Plantar fasciopathy (PF) is usually related to changes in foot arch, foot shape and rearfoot posture. However, little research has been implemented by using large-scale datasets, and even less has been conducted centering on plantar pressure distributions (PPDs) of different genders of PF athletes. This study aimed to investigate the relationships among the arch index (AI), the PPDs and the rearfoot postural alignment in hundreds of college athletes with PF during static standing and walking. Methods: Cross-sectional study of 100 male and 102 female athletes with PF was undertaken. The PF athletes’ pain assessment and self-reported health status were examined for evaluating their musculoskeletal painful areas. Results: The PF athletes’ PPDs mainly concentrated on inner feet in static standing, and transferred to lateral forefeet during the midstance phase of walking. The males’ PPDs from the static standing to the midstance phase of walking mainly transferred to anterolateral feet. The females’ PPDs mainly transferred to posterolateral feet. The PF athletes’ static rearfoot alignment matched the valgus posture pattern. The medial band of plantar fascia and calcaneus were the common musculoskeletal pain areas. Conclusions: Characteristics of higher plantar loads beneath medial feet associated with rearfoot valgus in bipedal static stance could be the traceable features for PF-related foot diagrams. Higher plantar loads mainly exerted on the lateral forefoot during the midstance phase of walking, and specifically concentrated on outer feet during the transition from static to dynamic state. Pain profiles seem to echo PPDs, which could function as the traceable beginning for the possible link among pronated low-arched feet, PF, metatarsalgia, calcanitis and Achilles tendinitis.

Effects of Task Constraints on Kinematic Characteristics of Body Segments in Children with Cerebral Palsy and Children with Typical Development during Hand-Reaching

Background: Children with cerebral palsy (CP) have difficulty in managing postural control during functional reaching tasks, although children with different postural control ability are able to come up with different motor solutions to cope with different task demands. This study examined the effect of task constraint on postural control performance in children with cerebral palsy and typical development (TD) in terms of different postural control abilities. Methods: A cross-sectional research design was used. Twelve children with spastic diplegic cerebral palsy (mean age: 107.8 months) and 16 typically developing children (mean age: 110.9 months) participated in this study. Individually, all subjects were seated in a height-adjusted chair and were requested to reach for target(s) located at three different directions (medial, anterior, and lateral). A six-camera Qualisys Motion Capture System was used to capture motion data. Kinematic data in terms of body alignment and angular changes were analyzed. Results: Children with cerebral palsy demonstrated different postural control strategies to complete different reaching tasks compared to typically developing children by preparing postural alignment in advance, coordinating different body orientation movements during reaching after showing difficulty in managing reach medially. Conclusions: Children with cerebral palsy perceive their insufficient ability and prepare their alignment in advance to adapt to the task demanded and decrease the postural challenges of the task. Even though children with cerebral palsy self-generate different motor solutions to reach without falling, these alternative strategies might not be the most efficient adaptation.

Twelve-Weeks of Virtual and In-Person Exercise Training Improve Static and Dynamic Balance in Female Cancer Patients

Background: Balance is important for maintaining activities of daily living and functional independence. Whether balance is improved in cancer patients after fitness training is unclear. The purpose of this study was to determine if 12-weeks of exercise improves balance and posture in female cancer patients. Methods: Thirty-eight female cancer patients were enrolled. Of the 16 patients who completed the program (mean age±SD: 65±10 years), 12 participants were novice and 4 were experienced exercisers. Six-weeks of exercise sessions were provided in-person and the remaining sessions were virtually delivered. The American College of Sports Medicine’s exercise recommendations were followed. Novice exercises received 36, 90-minute exercise sessions (3x/week) and experienced exercisers had 24, 90-minute sessions (2x/week). Posture was measured using the plumb line method and overhead squat test; balance was measured using the unipedal single leg stance and limits of stability (LOS). Body composition, cardiorespiratory fitness, muscular strength, and flexibility were also measured. Two-way repeated measures ANOVAs and Bonferroni’s multiple comparison tests were used to determine significant differences. Results: Balance on the left leg (eyes closed) and LOS with leftward excursion were significantly improved in experienced exercisers (P=0.0029), but not in the novice group (P=0.0013). Qualitative data showed that experienced exercisers had improved static and dynamic postural alignment of the lower body. Conclusions: While cardiorespiratory and muscular fitness significantly improved in the novice group, these patients did not show balance and postural improvements. Only the experienced exercisers had significant improvements in static and dynamic balance and lower body posture.

Gait Kinematics Analysis of Flatfoot Adults

Background: Foot postural alignment has been associated with altered gait pattern. This study aims to investigate gait kinematic differences in flatfoot subjects’ regarding all lower limb segments compared to neutral foot subjects. Methods: A total of 31 participants were recruited (age: 23.26 yo ± 4.43; height: 1.70 m ± 0.98; weight: 75.14 kg ± 14.94). A total of 15 subjects were integrated into the flatfoot group, and the remaining 16 were placed in the neutral foot group. All of the particpants were screened using the Navicular Drop Test and Resting Calcaneal Stance Position test to characterize each group, and results were submitted to gait analysis using a MOCAP system. Results: Significant kinematic differences between groups were found for the ankle joint dorsiflexion, abduction, and internal and external rotation (p < 0.05). Additionally, significant differences were found for the knee flexion, extension, abduction, and external rotation peak values (p < 0.001). Significant differences were also found for the hip flexion, extension, external rotation, pelvis rotation values (p < 0.02). Several amplitude differences were found concerning ankle abduction/adduction, knee flexion/extension and abduction/adduction, hip flexion/extension and rotation, and pelvis rotation (p < 0.01). Conclusion: Flatfooted subjects showed kinematic changes in their gait patterns. The impact on this condition on locomotion biomechanical aspects is clinically essential, and 3D gait biomechanical analysis use could be advantageous in the early detection of health impairments related to foot posture.

PREVALENCE OF NON-SPECIFIC NECK PAIN AMONG SURGEONS IN DIFFERENT HOSPITALS OF LAHORE

Objective: The objective of the study was to determine the prevalence of non-specific neck pain among Surgeons in different hospitals of Lahore and developed some guidelines to reduce the occupational hazards. Materials and Methods: It was a cross-sectional study. Non-Probability Convenient sampling technique was used. Data was collected from surgeons working in tertiary care hospitals of Lahore Inclusion criteria included Surgeons (25 years or above), both genders selected and Neck pain in cervical region, surgery of consecutive 2- 3 hours or more. Exclusion criteria included age under 25 years, any neurological disorders, cerebrovascular insufficiency, Past history of Infection and Malignancy, any Structural disorders and Trauma. Data was collected by questionnaire form set on paper. Results: Non-specific neck pain has positive statistically significant association with “Starting of Neck Pain Surgical Day”, “Starting of Neck Pain Post-Surgical Day”, “Worsening of Neck Pain Surgical Day” and “Worsening of Neck Pain Post-Surgical Day Conclusion: It concluded that the surgeons are not getting neck pain due to the surgical activities but it may worsen by their surgical activities of consecutive 3 hours if they already have some neck-related problems. Recommendations: Prolong working hours should be reduced which ultimately affect their ergonomics and posture of neck. By reducing consecutive hours of surgery neck pain can be minimized. Surgeons should be trained about their postural alignment while performing surgeries as to prevent maximum stress on neck musculature to avoid neck pain.