RESUMEN
OBJECTIVES: To assess the feasibility of delivering and evaluating a lifestyle programme for patients with colorectal cancer undergoing potentially curative treatments. STUDY DESIGN: Non-randomised feasibility trial. SETTING: National Health Service (NHS) Tayside. PARTICIPANTS: Adults with stage I-III colorectal cancer. INTERVENTION: The programme targeted smoking, alcohol, physical activity, diet and weight management. It was delivered in three face-to-face counselling sessions (plus nine phone calls) by lifestyle coaches over three phases (1: presurgery, 2: surgical recovery and 3: post-treatment recovery). PRIMARY OUTCOME: Feasibility measures (recruitment, retention, programme implementation, achieved measures, fidelity, factors affecting protocol adherence and acceptability). SECONDARY OUTCOMES: Measured changes in body weight, waist circumference, walking and self-reported physical activity, diet, smoking, alcohol intake, fatigue, bowel function and quality of life. RESULTS: Of 84 patients diagnosed, 22 (26%) were recruited and 15 (18%) completed the study. Median time for intervention delivery was 5.5 hours. Coaches reported covering most (>70%) of the intervention components but had difficulties during phase 2. Evaluation measures (except walk test) were achieved by all participants at baseline, and most (<90%) at end of phase 2 and phase 3, but <20% at end of phase 1. Protocol challenges included limited time between diagnosis and surgery and the presence of comorbidities. The intervention was rated highly by participants but limited support from NHS staff was noted. The majority of participants (77%) had a body mass index>25 kg/m2 and none was underweight. Physical activity data showed a positive trend towards increased activity overall, but no other changes in secondary outcomes were detected. CONCLUSIONS: To make this intervention feasible for testing as a full trial, further research is required on (a) recruitment optimisation, (b) appropriate assessment tools, (c) protocols for phase 2 and 3, which can build in flexibility and (d) ways for NHS staff to facilitate the programme. TRIAL REGISTRATION NUMBER: ISRCTN52345929; Post-results.
Asunto(s)
Neoplasias Colorrectales/terapia , Promoción de la Salud/métodos , Estilo de Vida , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Peso Corporal , Dieta , Ejercicio Físico , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Resultado del Tratamiento , Reino UnidoRESUMEN
BACKGROUND AND AIMS: The six minute walk test is widely used to measure aerobic exercise capacity in older people, but lack responsiveness to change. We aimed to compare the reliability, responsiveness and completion rates of the six minute walk with a new test of aerobic exercise capacity - the endurance shuttle walk test. METHODS: Two groups were studied: 18 patients from a Medicine for the Elderly Day Hospital (study 1) receiving physiotherapy, and 15 community dwelling older people (study 2) receiving caffeine or placebo in a crossover study, followed by a weekly exercise programme. Six minute walk test and endurance shuttle walk test were performed at baseline and after interventions. Intraclass correlation coefficients were calculated for reliability, and Cohen's effect sizes were calculated to characterize responsiveness. RESULTS: 6/18 of patients in study 1 completed the baseline shuttle walk successfully. For those completing baseline and week one shuttle walk, similar intraclass correlation coefficients were seen (shuttle walk 0.97; six minute walk 0.90). In study 2, all attendees completed baseline and follow-up shuttle walk. 7/15 managed the maximum shuttle walk time at baseline. Effect sizes for caffeine intervention (0.29 for six minute walk, 0.01 for shuttle walk) and for exercise intervention (0.15 for six minute walk, 0.24 for shuttle walk) were similarly low for both tests. CONCLUSION: The endurance shuttle walk is no more responsive to change than the six minute walk in older people, is limited by ceiling effects, and cannot be performed successfully by very frail older people.
Asunto(s)
Prueba de Esfuerzo/métodos , Tolerancia al Ejercicio/fisiología , Ejercicio Físico/fisiología , Caminata/fisiología , Factores de Edad , Anciano , Estudios Cruzados , Femenino , Estudios de Seguimiento , Humanos , Masculino , Modalidades de Fisioterapia , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: People over the age of 70 carry the greatest burden of chronic disease, disability and health care use. Participation in physical activity is crucial for health, and walking accounts for much of the physical activity undertaken by sedentary individuals. Pedometers are a useful motivational tool to encourage increased walking and they are cheap and easy to use. The aim of this pilot study was to evaluate the feasibility of the use of pedometers plus a theory-based intervention to assist sedentary older women to accumulate increasing amounts of physical activity, mainly through walking. METHODS: Female participants over the age of 70 were recruited from primary care and randomised to receive either pedometer plus a theory-based intervention or a theory-based intervention alone. The theory-based intervention consisted of motivational techniques, goal-setting, barrier identification and self-monitoring with pedometers and daily diaries. The pedometer group were further randomised to one of three target groups: a 10%, 15% or 20% monthly increase in step count to assess the achievability and acceptability of a range of targets. The primary outcome was change in daily activity levels measured by accelerometry. Secondary outcome measures were lower limb function, health related quality of life, anxiety and depression. RESULTS: 54 participants were recruited into the study, with an average age of 76. There were 9 drop outs, 45 completing the study. All participants in the pedometer group found the pedometers easy to use and there was good compliance with diary keeping (96% in the pedometer group and 83% in the theory-based intervention alone group). There was a strong correlation (0.78) between accelerometry and pedometer step counts i.e. indicating that walking was the main physical activity amongst participants. There was a greater increase in activity (accelerometry) amongst those in the 20% target pedometer group compared to the other groups, although not reaching statistical significance (p = 0.192). CONCLUSION: We have demonstrated that it is feasible to use pedometers and provide theory-based advice to community dwelling sedentary older women to increase physical activity levels and a larger study is planned to investigate this further.