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Value of Physical Function in Breast Cancer Survivors: A Systematic Review Nishikawa, Kei; Lo, Kenneth; Lam, Jackson; Sy, Vincent; Chu, Johnathan 2012-08

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QUICK TIPS (--THIS SECTION DOES NOT PRINT--)  This PowerPoint template requires basic PowerPoint (version 2007 or newer) skills. Below is a list of commonly asked questions specific to this template. If you are using an older version of PowerPoint some template features may not work properly.  Using the template  Verifying the quality of your graphics Go to the VIEW menu and click on ZOOM to set your preferred magnification. This template is at 100% the size of the final poster. All text and graphics will be printed at 100% their size. To see what your poster will look like when printed, set the zoom to 100% and evaluate the quality of all your graphics before you submit your poster for printing.  Using the placeholders To add text to this template click inside a placeholder and type in or paste your text. 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Data sources and searches  • Five independent search strategies for five aspects of physical function • Same terms for breast cancer survivors for all searches combined with specific terms for each component of physical function - Upper extremity strength and aerobic fitness values reported in breast cancer survivors are significantly lower than normative values - Lower extremity strength, mobility, and balance measures are less conclusive - More consistent outcome measures needed in the future to assess mobility and balance   Lower Extremity Strength - Most common outcome measure 1-RM leg press - Normative values are 1.18, 1.05, and 0.99 (units=kg/kg of body weight) for aged 40-49, 50-59, and 60+4 - Cannot compare normative values to literature as they are measured in different units4 - One study measured 1-RM in kg/kg of bodyweight, but values were extraordinarily high5 - Sit to stands are also commonly used (two types) - Repetitions in 30s: Lower than healthy population  Upper Extremity Strength - Most common outcome measure handgrip strength - Weaker handgrip strengths compared to age-matched healthy women6 - Other measures of upper extremity strength are also decreased7 - Proximal UE movements are more common in recent studies to predict UE strength  Aerobic Fitness - VO2 max measurements mostly scored below 25th percentile4 - Resting heart rate elevated - 6MWT falls within range of healthy population8  Balance - Single legged stance was longer than the normative values9,10 - Fullerton Advanced Balance Scale score lower than healthy control (36.48.) but still above cut off for the risk of falls, which is equal or below 2511  Mobility - Timed-up-and-go (TUG) test  faster than norms, but age of the population is younger11,12 - Decreased gait speed (normal and fast) despite walking for shorter distance13 - Mixed results for ascending/descending stairs13,14     Background Information In 2012, 22,700 women will be diagnosed with breast cancer in Canada1 - 5-year survival rate - 88% in Canada1 - Growing population of cancer survivors left with long term effects of the disease and its treatments2 - Declining physical function common in women who have undergone treatments3  Domains of physical function included lower extremity strength, upper extremity strength, aerobic fitness, balance, and mobility  Study Design Population - Females > 18 y.o. diagnosed with breast cancer Intervention - Any type of treatment (no treatment, chemotherapy, radiation, medications, etc.) or combination Outcomes - Primary outcome measures chosen are most commonly used among the healthy or clinical populations determined by the authors of this review a priori   Introduction Physical Function  Lower Extremity Strength – Total Studies 1-RM (measured) – Leg Press 1-RM (predicted) – Leg Press 1-RM (NA)* – Leg Press Endurance – Leg Press Sit to Stand – Time for 5 repetitions Sit to Stand – Repetitions in 30 seconds Dynamometer – Leg Extension    Upper Extremity Strength – Total Studies Dynamometer  –  Handgrip Dynamometer – Others 1-RM (measured) – Bench Press 1-RM (measured) – Shoulder Press 1-RM (measured) – Seated Row 1-RM (predicted) – Shoulder Press 1-RM (predicted) – Seated Row 1-RM (predicted) – Bench Press Endurance – Bench Press  Aerobic Fitness – Total Studies VO2 max - Measured VO2 Max (maximal test) - Measured VO2 Max (submaximal test) - Predicted VO2 Max (maximal test) - Predicted VO2 Max (submaximal test) Resting Heart Rate 6-Minute Walk Test 12-Minute Walk Test Power Output  Balance – Total Studies Timed Backward Tandem Walk Sensory Organization Test - Somatosensory - Visual - Vestibular - Preference - SOT5: - SOT6: One Legged Stance – Eyes open or Eyes closed Fullerton Advanced Balance Scale  Mobility – Total Studies Functional Independence Measure Timed Stair Climb (Ascend) Timed Stair Climb (Descend) Time Required to get up from floor Time Required to get down to floor Short Physical Performance Battery Normal Gait Speed Fast Gait Speed Timed Up and Go Test   # of Studies 18 4 4 2 3 3 3 2    33 23 7 3 1 1 1 1 3 4  42 - 1 3 4 10 6 4 10 2  5 2 2       1 1  6 1 2 2 1 1 1 1 1 2 Range of values   73.02 - 99.3 kg 24.4 - 134.8 kg 60.40 - 84.4 kg 10.1 - 16.9 reps 7.53 - 12.6 s 10 - 13.6 reps 27.3 - 27.7 peak torque/BW; 69.1 - 72.1 kg   13 - 34 kg - 15.4 - 19.5 kg 12.2 kg 32.7 kg 3.6 kg 4.5 kg 29.8 - 56 kg 0 - 10.7 reps   - 16.5 mL/kg/min 17.1-26.1 mL/kg/min 24.3 - 25.5 mL/kg/min 14.5 - 32.9 mL/kg/min 73 - 86 bpm 403 - 611 m 753 - 1128 m 1.38 - 1.43 W/kg   12.6 - 14.6s - 94.6 - 95.6 77.6 - 84.1 41.4 - 57.3 96.6 - 98.6 44.90 49.00 60.6 s / 15.7 s 33.90   97.9 - 124.4 0.25 - 0.27 m/s, 19 s 0.28 - 0.31 m/, 27.2 s 7.3 s 6.0 s 10 out of 12 0.33 - 0.33 m/s 0.43 - 0.48 m/s 5.7 – 6.7 s Normative Values   - - - - 11.4 s (60-69 y.o.) 15 reps (60-64 y.o.) -     28.6 kg (40-49) - - - - - - - -   • 29.4mL/kg/min (40- 49 y.o.)** • 26.6 mL/kg/min (50- 59 y.o.)** - 70 - 73 bpm (46-55 y.o.) 400 - 700m - -   - - - - - - - - 40.4s / 7.4s (40-49 y.o.) -   - - - - - - 1.10 m/s (50-59 y.o.) 1.47 m/s (50-59 y.o.) 8.1 s (60-99 y.o.)  Objectives Methods Results Discussions - Search strategy and methods may not have captured all relevant papers - Specific outcome measures for physical function were identified a priori - some appropriate outcome measures may have not been included - Studies had varying methods for the same outcome measures - Lack of normative values for some of the selected outcome measures and normative values vary by age Limitations The primary objective of this review is to examine the published values of physical function in breast cancer survivors in current research literature - Limited data on normative or expected values of physical function in breast cancer survivors – difficult to interpret research and clinical findings - Aim: Provide a summary of published values of physical function in breast cancer survivors and identify gaps to provide direction for future research University of British Columbia Masters of Physical Therapy Nishikawa, K., Chu, J. Y., Lam, J. B., Lo, K. K., Sy, V. S. & Campbell, K. L. Physical Function in Breast Cancer Survivors: A systematic review of published values Conclusion   Databases used:  • Medline (1990 to present + In-process & Other Non-Indexed Citations) • Embase (1990 to present, daily update) • CINAHL (1990 to present)   Study selection  Exclusion criteria: • Did not report data of females, who were 18 years of age or older and were breast cancer survivors • Did not provide the outcome measure of interest • Did not report the baseline data • If the studies were not observational, cohort, case control and random clinical trials • Not published between 1990 and February 28th, 2012  Relevant values are included if they are retrieved from a search within another aspect of physical function Data extraction  • Data extracted include: age, publication information, values of outcome measures of interest • Only baseline values of original studies were extracted • Values were calculated if original studies reported only post- intervention values and percentage of change Quality Assessment  Quality of the papers were not assessed, as primary objective of the study is to report values of physical function at baseline Data Analysis  • Relevant characteristics of the studies • Values of physical function reported • Outcome measures identified for each domain of physical function • Normative data in healthy and clinical populations identified in the literature if available • No statistical techniques were utilised Acknowledgments: The authors would like to thank Sarah Neil, Charlotte Beck, Dr. Teresa Liu-Ambrose, and Dr. Lynne Feehan for their assistance in this systematic review  • Limited to English and human studies • Duplicates taken out with Refworks • “Surgery” not explicitly searched *1-RM (NA): Methods not defined as measured or predicted **VO2 Max normative values at 25 th percentile References 1) Canadian Cancer Society. Breast cancer statistic in glance. Available from 20statistics/Stats%20at%20a%20glance/ px?sc_lang=en 2) Campbell KL. Review of exercise studies in breast cancer survivors: attention to principles of exercise training. Br J Sports Med. 2011. 3) Speck RM, et al. An update of controlled physical activity trials in cancer survivors: a systematic review and meta- analysis. J Cancer Surviv. 2011; 5 (1):112. 4) American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription (8th ed.). Philadelphia: Lippincott Williams & Wilkins; 2010. 5) Hokken JWE, et al. Impact of anthracycline dose on quality of life and rehabilitation in breast cancer treatment. The Netherlands Journal of Medicine. 2009; 67(6): 220-225. 6) Peters MJ, et al. Revised normative values for grip strength with the Jamar dynamometer. Journal of the Peripheral Nervous System. 2011: 16; 47-50. 7) Sanders AP. A safe and effective upper extremity resistive exercise program for women post breast cancer treatment. Rehabilitation Oncology. 2008: 26(3); 3-10. 8) Enright PL, Sherrill DL. Reference equations for the six- minute walk in healthy adults. Am J Respir Crit Care Med. 1998; 158: 1384-1387. 9) Springer BA et al. Normative values for the unipedal stance test with eyes open and closed. Journal of Geriatric Physical Therapy.2007; 8(15): 8-15. 10) Winters-stone KM, et al. Identifying factors associated with falls in postmenopausal breast cancer survivors: A multi- disciplinary approach. Archives of Physical Medicine & Rehabilitation. 2009: 92; 646 – 652. 11) Wampler MA, et al. Quantitative and clinical description of postural instability in women with breast cancer treated with taxane chemotherapy. Archives of Physical Medicine & Rehabilitation. 2007; 88(8): 1002-1008. 12) Damush TM, et al. The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 2006; 15(10): 884-890. 13) Winters-Stone K, et al. Identifying factors associated with falls in postmenopausal breast cancer survivors: A multi- disciplinary approach. Archives of Physical Medicine & Rehabilitation. 2011; 92(4): 646-652. 14) De Paleville, et al. Effects of aerobic training prior to and during chemotherapy in a breast cancer patient: A case study. Journal of Strength & Conditioning Research. 2007; 21(2): 635-637. 


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