Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.
Introduction: Patients with cancer receiving radio- or chemotherapy undergo many immunological stressors. Chronic regular exercise has been shown to positively influence the immune system in several populations, while exercise overload may have negative effects. Exercise is currently recommended for all patients with cancer. However, knowledge regarding the effects of exercise on immune markers in patients undergoing chemo- or radiotherapy is limited. The aim of this study is to systematically review the effects of moderate- and high-intensity exercise interventions in patients with cancer during chemotherapy or radiotherapy on immune markers. Methods: For this review, a search was performed in PubMed and EMBASE, until March 2023. Methodological quality was assessed with the PEDro tool and best-evidence syntheses were performed both per immune marker and for the inflammatory profile. Results: Methodological quality of the 15 included articles was rated fair to good. The majority of markers were unaltered, but observed effects included a suppressive effect of exercise during radiotherapy on some proinflammatory markers, a preserving effect of exercise during chemotherapy on NK cell degranulation and cytotoxicity, a protective effect on the decrease in thrombocytes during chemotherapy, and a positive effect of exercise during chemotherapy on IgA. Conclusion: Although exercise only influenced a few markers, the results are promising. Exercise did not negatively influence immune markers, and some were positively affected since suppressed inflammation might have positive clinical implications. For future research, consensus is needed regarding a set of markers that are most responsive to exercise. Next, differential effects of training types and intensities on these markers should be further investigated, as well as their clinical implications.
Introduction Around 25% of metastatic breast cancer (mBC) patients develop brain metastases, which vastly affects their overall survival and quality of life. According to the current clinical guidelines, regular magnetic resonance imaging screening is not recommended unless patients have recognized central nervous system-related symptoms. Patient Presentation The patient participated in the EFFECT study, a randomized controlled trial aimed to assess the effects of a 9-month structured, individualized and supervised exercise intervention on quality of life, fatigue and other cancer and treatment-related side effects in patients with mBC. She attended the training sessions regularly and was supervised by the same trainer throughout the exercise program. In month 7 of participation, her exercise trainer detected subtle symptoms (e.g., changes in movement pattern, eye movement or balance), which had not been noticed or reported by the patient herself or her family, and which were unlikely to have been detected by the oncologist or other health care providers at that point since symptoms were exercise related. When suspicion of brain metastases was brought to the attention of the oncologist by the exercise trainer, the response was immediate, and led to early detection and treatment of brain metastases. Conclusion and clinical implications The brain metastases of this patient were detected earlier due to the recognition of subtle symptoms detected by her exercise trainer and the trust and rapid action by the clinician. The implementation of physical exercise programs for cancer patients requires well-trained professionals who know how to recognize possible alterations in patients and also, good communication between trainers and the medical team to enable the necessary actions to be taken.
