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1.  Upper extremity bioimpedance before and after treadmill testing in women post breast cancer treatment 
Research on the effect of cardiorespiratory (CR) exercise on upper extremity (UE) limb volume is limited in women with breast cancer-related lymphedema (BCRL). The aim of this study was to compare changes in UE volume immediately following a symptom-limited CR treadmill test in women with and without BCRL. As part of a cross-sectional study, 133 women post unilateral BC treatment completed symptom-limited treadmill testing. Bioimpedance spectroscopy (BIS) was used to measure UE resistance before and immediately following treadmill testing. Resistance ratios >1 (unaffected side/affected side) indicate greater volume in the affected limb. T-tests and repeated measures ANOVA were performed to evaluate differences between and within groups. Mean age was 56.2 years (SD 9.4); BMI was 26.13 kg m−2 (SD 5.04). For women with previously diagnosed BCRL (n = 63), the resistance ratio was 1.116 (SD 0.160) pre-treadmill and 1.108 (SD 0.155) post-treadmill. For women without BCRL (n = 70), the resistance ratio was 0.990 (SD 0.041) pre-treadmill and 1.001 (SD 0.044) post-treadmill. Resistance ratios for women with BCRL were higher than those for women without BCRL at both time points (main effect of group: p < 0.001). No main effects were found for time (p = 0.695). A statistically significant effect was found for the time-by-group interaction (p = 0.002). 78 % of the women with BCRL wore a compression garment during testing. Following testing, the women with BCRL demonstrated a non-statistically significant decrease in the resistance ratio, suggesting an immediate decrease in interlimb volume difference. The women without BCRL demonstrated an increase in the resistance ratio.
PMCID: PMC4243702  PMID: 25338320
Breast cancer; Lymphedema; Bioimpedance; Cardiorespiratory; Exercise
2.  Cardiorespiratory Fitness in Women with and without Lymphedema following Breast Cancer Treatment 
Cancer and clinical oncology  2012;1(1):21-31.
Following breast cancer (BC) treatment, many women develop impairments that may impact cardiorespiratory (CR) fitness. The aims of this study were to 1) evaluate CR fitness in women following BC treatment, 2) evaluate differences in CR fitness in those with and without breast cancer-related lymphedema (BCRL) and compare these to age-matched norms, and 3) evaluate the contribution of predictor variables to CR fitness. 136 women post-BC treatment completed testing: 67 with BCRL, and 69 without. VO2 peak was lower in participants compared to published healthy age-matched norms. VO2 peak was statistically significantly lower in women with BCRL. Age, BMI, meeting recommended exercise criteria, and DASH scores explained 50% of the variance in VO2 peak (R=0.708, p<0.001). Following BC treatment CR fitness may be impaired, more-so in women with BCRL. This should be considered when providing rehabilitation for women following BC treatment as cardiorespiratory fitness has linked to improved health outcomes and survivorship.
PMCID: PMC3778372  PMID: 24058390
lymphedema; breast cancer; survivorship; cardiorespiratory fitness
3.  Effects of Modality Change on Health Related Quality of Life 
Patients with ESRD requiring renal replacement have impaired quality of life (HRQoL), and there is general consensus that HRQoL improves with successful transplant and evidence of improvement with frequent hemodialysis. This study reports changes in HRQoL associated with changes in treatment modality to daily hemodialysis (DHD) and transplant among patients requiring renal replacement.
This cohort study had assessments at baseline and 6-months following modality change. Subjects were non-diabetic individuals receiving conventional hemodialysis who a) remained on conventional hemodialysis (n=13), b) changed to daily hemodialysis (DHD) (n=10), or c) received a living donor transplant (n=20). Thirty-four healthy controls were assessed once for comparison. HRQoL was measured using the Kidney Disease Quality of Life Instrument. The Physical Functioning and Physical Composite Scale Scores were primary outcomes.
Transplantation resulted in significant improvements in six of eight generic scales and the physical composite scale (PCS). Those changing to DHD had significant improvements in Physical Function and PCS scales. Those remaining on dialysis remained lower than controls on all scales except for Vitality; the transplant group remained lower than controls only on the Vitality and General Health scales. Transplant resulted in significant improvements in 4 of the 7 disease-specific scales (symptoms, effects and burden of kidney disease, work). DHD resulted in improvements in the effects of kidney disease.
Modality change to transplant results in significant improvement in HRQoL, achieving levels similar to controls. Change to daily hemodialysis improves only select HRQoL domains, and remains low in disease-specific domains.
PMCID: PMC3376656  PMID: 22413899
Quality of Life; Dialysis; Transplant; Daily Dialysis
4.  Adverse Events Associated with Testosterone Administration 
The New England journal of medicine  2010;363(2):109-122.
Testosterone supplementation has been shown to increase muscle mass and strength in healthy older men. The safety and efficacy of testosterone treatment in older men who have limitations in mobility have not been studied.
Community-dwelling men, 65 years of age or older, with limitations in mobility and a total serum testosterone level of 100 to 350 ng per deciliter (3.5 to 12.1 nmol per liter) or a free serum testosterone level of less than 50 pg per milliliter (173 pmol per liter) were randomly assigned to receive placebo gel or testosterone gel, to be applied daily for 6 months. Adverse events were categorized with the use of the Medical Dictionary for Regulatory Activities classification. The data and safety monitoring board recommended that the trial be discontinued early because there was a significantly higher rate of adverse cardiovascular events in the testosterone group than in the placebo group.
A total of 209 men (mean age, 74 years) were enrolled at the time the trial was terminated. At baseline, there was a high prevalence of hypertension, diabetes, hyperlipidemia, and obesity among the participants. During the course of the study, the testosterone group had higher rates of cardiac, respiratory, and dermatologic events than did the placebo group. A total of 23 subjects in the testosterone group, as compared with 5 in the placebo group, had cardiovascular-related adverse events. The relative risk of a cardiovascular-related adverse event remained constant throughout the 6-month treatment period. As compared with the placebo group, the testosterone group had significantly greater improvements in leg-press and chest-press strength and in stair climbing while carrying a load.
In this population of older men with limitations in mobility and a high prevalence of chronic disease, the application of a testosterone gel was associated with an increased risk of cardiovascular adverse events. The small size of the trial and the unique population prevent broader inferences from being made about the safety of testosterone therapy.
PMCID: PMC3440621  PMID: 20592293
5.  Effects of Modality Change and Transplant on Peak Oxygen Uptake in Patients With Kidney Failure 
Exercise capacity as measured by VO2peak (peak oxygen uptake) is low in hemodialysis patients. The current study assesses the determinants of VO2peak in patients with chronic kidney failure who changed kidney replacement modality to either frequent hemodialysis or received a kidney transplant.
Study design
Cohort study with assessment at baseline and 6-months following modality change.
Setting & Participants
Participants included non-diabetic individuals receiving conventional hemodialysis who a) remained on conventional hemodialysis (n=13), b) changed to short daily hemodialysis (n=10), or c) received a transplant (n=5), and d) individuals who received pre-emptive transplant (n=15). Additionally, 34 healthy controls were assessed at baseline only.
Modality change
Measurement & Outcomes
Exercise capacity, assessed from the physiologic components of the Fick equation (VO2 = cardiac output x a-vO2dif, where a-vO2dif is arterial to venous oxygen difference) was determined by measurement of VO2peak and cardiac output during symptom-limited exercise testing. Analysis of covariance was used to compare the differences in changes in VO2peak, cardiac output, heart rate, stroke volume, and a-vO2dif, at peak exercise between those who remained on hemodialysis and those who underwent transplant.
Transplant was the only modality change that was associated with a significant change in VO2peak, occurring as a result of increased peak cardiac output and reflecting increased heart rate without change in peak a-vO2dif, despite increased hemoglobin levels. There were no differences in those who changed to daily hemodialysis compared to those who remained on conventional hemodialysis.
Small, non-randomized study.
VO2peak increases significantly following kidney transplant but not with daily hemodialysis; this improvement reflects increased peak cardiac output via increased peak heart rate. Despite statistical significance, the increase in VO2peak was not clinically significant, suggesting the need for interventions such as exercise training to increase VO2peak in all patients, regardless of treatment modality.
PMCID: PMC3010466  PMID: 20870330
Exercise Capacity; oxygen uptake; Fick Equation; cardiac output; ESRD; frequent hemodialysis; kidney transplantation
6.  Habitual Physical Activity Levels are Associated with Performance in Measures of Physical Function and Mobility in Older Men 
To determine whether objectively measured physical activity levels are associated with physical function and mobility in older men.
Academic research center.
Eighty-two community-dwelling men ≥ 65 years of age with self-reported mobility limitations were divided into a low activity and a high activity group based on the median average daily physical activity counts of the whole sample.
Physical activity by triaxial accelerometers; physical function and mobility by the Short Physical Performance Battery (SPPB), gait speed, stair climb time, and a lift and lower task; aerobic capacity by maximum oxygen consumption (VO2max); and leg press and chest press maximal strength and peak power.
Older men with higher compared to lower physical activity levels demonstrated a > 1.4 point higher mean SPPB score and a 0.35 m/s faster walking speed. They also climbed a standard flight of stairs 1.85 sec faster and completed 60% more shelves in a lift and lower task (all p < 0.01). Muscle strength and power measures, however, were not significantly different between the low and high activity group. Correlation analyses and multiple linear regression models showed that physical activity is positively associated with all physical function and mobility measures, leg press strength, and VO2max.
Older men with higher physical activity levels demonstrate better physical function and mobility than less active peers. Moreover, in older men physical activity levels are predictive of performance in measures of physical function and mobility. Future work is needed to determine whether modifications in physical activity levels can improve or preserve physical performance in later-life.
PMCID: PMC2945416  PMID: 20738436
aging; sarcopenia; muscle strength; disability; exercise
7.  A Randomized Controlled Trial of Home-Based Exercise for Cancer-Related Fatigue in Women during and after Chemotherapy with or without Radiation Therapy 
Cancer nursing  2010;33(4):245-257.
Few studies have evaluated an individualized home-based exercise prescription during and after cancer treatment.
The purpose was to evaluate the effectiveness of a home-based exercise training intervention, the PRO-SELF FATIGUE CONTROL PROGRAM on the management of cancer related fatigue.
Participants (N=119) were randomized into one of three groups: Group 1 (EE) received the exercise prescription throughout the study; Group 2 (CE) received their exercise prescription after completing cancer treatment; Group 3 (CC) received usual care. Patients completed the Piper Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies-Depression scale, and Worst Pain Intensity Scale.
All groups reported mild fatigue levels, sleep disturbance and mild pain, but not depression. Using multilevel regression analysis significant linear and quadratic trends were found for change in fatigue and pain (i.e., scores increased, then decreased over time). No group differences were found in the changing scores over time. A significant quadratic effect for the trajectory of sleep disturbance was found, but no group differences were detected over time. No significant time or group effects were found for depression.
Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment. The optimal timing of exercise remains to be determined.
Implications for practice
Clinicians need to be aware that some physical activity is better than none, and there is no harm in exercise as tolerated during cancer treatment. Further analysis is needed to examine the adherence to exercise. More frequent assessments of fatigue, sleep disturbance, depression, and pain may capture the effect of exercise.
PMCID: PMC2891044  PMID: 20467301
8.  Health-Related Fitness and Physical Activity in Patients with Nonalcoholic Fatty Liver Disease 
Hepatology (Baltimore, Md.)  2008;47(4):1158-1166.
Nonalcoholic fatty liver disease (NAFLD) has been referred to as the hepatic manifestation of the metabolic syndrome. There is a lower prevalence of metabolic syndrome in individuals with higher health-related fitness (HRF) and physical activity (PA) participation. The relationship between NAFLD severity and HRF or PA is unknown. Our aim was to compare measures of HRF and PA in patients with a histological spectrum of NAFLD severity. Thirty-seven patients with liver biopsy–confirmed NAFLD (18 women/19 men; age = 45.9 ± 12.7 years) completed assessment of cardiorespiratory fitness (CRF, VO2peak), muscle strength (quadriceps peak torque), body composition (%fat), and PA (current and historical questionnaire). Liver histology was used to classify severity by steatosis (mild, moderate, severe), fibrosis stage (stage 1 versus stage 2/3), necroinflammatory activity (NAFLD Activity Score; ≤4 NAS1 versus ≥5 NAS2) and diagnosis of NASH by Brunt criteria (NASH versus NotNASH). Analysis of variance and independent t tests were used to determine the differences among groups. Fewer than 20% of patients met recommended guidelines for PA, and 97.3% were classified at increased risk of morbidity and mortality by %fat. No differences were detected in VO2peak (x = 26.8 ± 7.4 mL/g/min) or %fat (x = 38.6 ± 8.2%) among the steatosis or fibrosis groups. Peak VO2 was significantly higher in NAS1 versus NAS2 (30.4 ± 8.2 versus 24.4 ± 5.7 mL/kg/min, P = 0.013) and NotNASH versus NASH (34.0 ± 9.5 versus 25.1 ± 5.7 mL/kg/min, P = 0.048).
Patients with NAFLD of differing histological severity have suboptimal HRF. Lifestyle interventions to improve HRF and PA may be beneficial in reducing the associated risk factors and preventing progression of NAFLD.
PMCID: PMC3096839  PMID: 18266250

Results 1-8 (8)