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- Effect of Preoperative Home-Based Exercise Training on Quality of Life After Lung Cancer Surgery: A Multicenter Randomized Controlled TrialPublication . Machado, Pedro; Pimenta, Sara; Garcia, Ana Luís; Nogueira, Tiago; Silva, Sónia; Santos, Cláudia Lares dos; Martins, Maria Vitória; Canha, André; Oliveiros, Bárbara; Martins, Raul A.; Cruz, JoanaBackground. Preoperative exercise training is recommended for improvement of clinical outcomes after lung cancer (LC) surgery. However, its efectiveness in preventing postoperative decline in quality of life (QoL) remains unknown. This study investigated the efect of preoperative home-based exercise training (PHET) on QoL after LC surgery. Methods. Patients awaiting LC resection were randomized to PHET or a control group (CG). The PHET program combined aerobic and resistance exercise, with weekly telephone supervision. Primary outcome was QoL-assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQC30) at baseline, before surgery, and 1 month after surgery. The secondary outcomes were hospital length of stay and physical performance. The main analysis included a factorial repeated-measures analysis of variance. Additionally, the proportion of patients experiencing clinical deterioration from baseline to post-surgery was assessed. Results. The study included 41 patients (68.1±9.3 years; 68.3% male) in the intention-to-treat analysis (20 PHET patients, 21 CG patients). A signifcant group × time interaction was observed for global QoL (p =0.004). Betweengroup diferences in global QoL were statistically and clinically signifcant before surgery (mean diference [MD], 13.5 points; 95% confdence interval [CI], 2.4–24.6; p =0.019) and after surgery (MD, 12.4 points; 95% CI, 1.3–23.4; p=0.029), favoring PHET. Clinical deterioration of global QoL was reported by 71.4% of the CG patients compared with 30 % of the PHET patients (p =0.003). Between-group diferences in favor of PHET were found in pain and appetite loss as well as in physical, emotional and role functions after surgery (p <0.05). Compared with CG, PHET was superior in improving preoperative fve-times sit-to-stand and postoperative exercise capacity (p <0.05). No between-group diferences in other secondary outcomes were observed. Conclusion. The study showed that PHET can efectively prevent the decline in QoL after LC surgery.
- Validade e fiabilidade teste-reteste de smartbands na monitorização da Atividade FísicaPublication . Silva, Inês; Machado, Pedro; Flora, Sofia; Cruz, JoanaIntrodução e objetivos: A crescente recomendação da prática regular de atividade física por parte dos profissionais de saúde tem levado à necessidade de monitorização da mesma fora do ambiente clínico. Os dispositivos wearables comerciais realizam medições relativas ao número de passos, permitindo ao profissional de saúde acompanhar a atividade do utente, para além de poderem funcionar como ferramentas motivacionais. No entanto, não existe informação disponível acerca da validação da maioria destes dispositivos. Este estudo pretendeu avaliar a precisão da contagem de passos de smartbands de diferente valor comercial, no lado dominante e não-dominante. Material e Métodos: 11 indivíduos saudáveis (34±11 anos, 6 mulheres, dextros) utilizaram quatro smartbands, duas Garmin Vivosmart 4 (~100€/cada) e duas Xiaomi Mi Band 4 (~20€/cada), uma de cada marca no punho esquerdo e direito, enquanto caminhavam durante 3 minutos num corredor de 10 metros a uma velocidade autodeterminada. O número de passos foi obtido através das smartbands e contagem manual. O teste foi realizado duas vezes. Foram utilizados: 1) o erro percentual absoluto médio (MAPE) e os gráficos Bland e Altman (BA) para avaliar o erro das smartbands (critério: contagem manual); 2) o coeficiente de correlação intraclasse (ICC) e os gráficos BA para avaliar a fiabilidade/acordo teste-reteste. Resultados: Foram contabilizados 380±22 passos (contagem manual). Apesar da média do MAPE dos smartbands ser inferior a 10%, o desvio padrão das smartbands Xiaomi variou entre ±7% e ±14% da Garmin entre ±3% e ±16%, com valores menores na Garmin utilizada do lado direito. O ICC variou entre 0,76 e 0,80 na smartband Xiaomi e entre 0,73 e 0,92 na smartband Garmin. Os gráficos BA apresentaram limites largos (variação ~±100 passos) em todas as smartbands (vs. contagem manual e teste-reteste), particularmente para a Xiaomi do lado esquerdo quando comparada com a contagem manual. Conclusões: Os resultados sugerem que as smartbands Garmin apresentam maior precisão e podem ser utilizadas para a monitorização do número de passos na população adulta em geral. São necessários mais estudos com amostras maiores.
- Technological features of smartphone apps for physical activity promotion in patients with COPD: A systematic reviewPublication . Silva, J.; Hipólito, N.; Machado, P.; Flora, S.; Cruz, J.Introduction: Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD. Methods: A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features). Results: Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories ‘Measuring and monitoring’ and ‘Support and Feedback’ were present in all apps. Overall, the most implemented features were ‘progress in visual format’ (n=13), ‘advice on PA’ (n=14) and ‘data in visual format’ (n=10). Only three apps included social features, and two included a web-based version of the app. Conclusions: The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients’ PA levels.
- Effect of home-based exercise prehabilitation on postoperative outcomes in colorectal cancer surgery: a systematic review and meta-analysisPublication . Machado, Pedro; Paixão, André; Oliveiros, Bárbara; Martins, Raul A.; Cruz, JoanaPurpose Home-based exercise training may improve access to surgical prehabilitation in colorectal cancer (CRC) patients, but its efficacy remains unclear. This study systematically investigated the effects of home-based exercise prehabilitation on postoperative exercise capacity, complications, length of hospital stay, and health-related quality of life (HRQoL) in CRC patients. Methods Randomized controlled trials (RCTs) comparing home-based exercise prehabilitation with control in CRC patients were eligible. We searched MEDLINE, Scopus, Web of Science, PEDro, and SPORTDiscus from their inception to June 3, 2024. Methodological quality was assessed using the PEDro scale, and certainty of evidence was assessed using GRADE. Data were synthesized using random-effects meta-analyses, with sensitivity analysis on studies with good methodological quality (PEDro score ≥ 6). Results Eight RCTs involving 1092 participants were included. The primary analysis showed a significant improvement in postoperative 6-min walk distance following home-based exercise prehabilitation compared to control (mean difference (MD) = 30.62: 95% CI: [2.94; 57.79]; low-certainty evidence). However, sensitivity analysis revealed no significant between-group differences (MD = 22.60: 95% CI: [− 6.27; 51.46]). No significant effects of home-based exercise prehabilitation were found on postoperative complications (risk ratio = 1.00: 95% CI: [− 0.78; 1.29]; moderate‐certainty evidence), length of hospital stay (MD = − 0.20: 95% CI: [− 0.65; 0.23]; moderate‐certainty evidence), and HRQoL (physical functioning: MD = 2.62: 95% CI: [− 6.16; 11.39]; mental functioning: MD = 1.35: 95% CI: [− 6.95; 9.65]; low and very-low certainty evidence). Conclusion Home-based exercise prehabilitation does not reduce postoperative complications and length of hospital stay after CRC surgery. Its effects on postoperative exercise capacity and HRQoL remain uncertain due to low-quality evidence.
- Effectiveness of exercise training on cancer-related fatigue in colorectal cancer survivors: a systematic review and meta-analysis of randomized controlled trialsPublication . Machado, Pedro; Morgado, Miguel; Raposo, João; Mendes, Marco; Silva, Cândida G.; Morais, NunoPurpose: To investigate the effects of exercise training on cancer-related fatigue (CRF) in colorectal cancer survivors. Methods: Randomized controlled trials published between 1 January 2010 and 19 October 2020, selected through online search conducted in PubMed, Scopus, Web of Science, SPORTDiscus and PEDro databases, were included. Eligible trials compared the effect of exercise training interventions, versus non-exercise controls on CRF, in colorectal cancer survivors, during or after treatment. The methodological quality of individual studies was analysed using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI) were calculated. Results: Six trials involving 330 colorectal cancer patients met the inclusion criteria and presented reasonable to good methodological quality. An overall small-to-moderate effect of exercise training on CRF was found (SMD = - 0.29: 95% CI: [- 0.53; - 0.06]; p = 0.01; PI: [- 0.63; 0.04]; low-quality evidence). Subgroup analysis revealed moderate effects of exercise interventions performed during chemotherapy (SMD = - 0.63; 95% CI: [- 1.06; - 0.21]; p = 0.003) and small, non-significant effects, when exercise training was performed after cancer treatment (SMD = - 0.14; 95% CI: [- 0.43; 0.14]; p = 0.32). Steady improvements were achieved when a combination of aerobic plus resistance exercise was used, in interventions lasting 12 to 24 weeks. Conclusion: Exercise training could be regarded as a supportive therapy for the clinical management of CRF in colorectal cancer patients undergoing chemotherapy, but further studies are necessary to clarify the effects of exercise interventions on CRF after cancer treatment.
- Precisão de duas pulseiras desportivas (smartbands) de diferente valor comercial na contagem de passos: um estudo exploratórioPublication . Silva, Inês; Machado, Pedro; Flora, Sofia; Cruz, JoanaIntrodução: A crescente recomendação da prática de atividade física tem levado à necessidade de monitorização em contexto real. As pulseiras desportivas comerciais (smartbands) são uma possibilidade, uma vez que permitem obter o número de passos realizados e servir como ferramentas motivacionais. No entanto, a maioria destes dispositivos não se encontram validados. Este estudo pretendeu avaliar a validade de duas smartbands de diferente valor comercial, no lado dominante e não-dominante, e comparar o seu desempenho. Métodos: 11 indivíduos saudáveis (33,7±11,4 anos; dominância direita n=11) utilizaram 4 smartbands de duas marcas (Garmin Vivosmart 4, Xiaomi Mi Band 4) no punho esquerdo e direito, enquanto caminhavam durante 3 minutos a uma velocidade autodeterminada. O número de passos foi obtido através das smartbands e contagem manual (critério). O erro percentual absoluto médio (MAPE) e os limites do acordo (LA) foram utilizados para avaliar a precisão das smartbands. Os LA foram também utilizados para comparar resultados entre local (direito, esquerdo) e dispositivos. Resultados: O MAPE das smartbands foi abaixo de 10%, independentemente da marca e localização. No entanto, as smartbands Garmin apresentaram valores inferiores de MAPE (Esquerdo: 3,6±2,9%; Direito: 4,6±4,7%) e LA mais restritos (Esquerdo: -35,7/9,1; Direito: -45,7/50,6 passos). A diferença dos resultados foi mais reduzida entre as smartbands Garmin (LA: -37,6/69,1 passos) e os dispositivos localizados no lado direito (LA: -72,2/96,3 passos). Conclusões: As smartbands apresentam um erro aceitável para a monitorização de passos na população em geral, embora a smartband Garmin apresente melhores resultados. Estudos futuros são necessários para suportar estes resultados.
- ASO Author Reflections: Impact of a Preoperative Home-Based Exercise Program on Quality of Life After Lung Cancer ResectionPublication . Machado, Pedro; Oliveiros, Bárbara; Martins, Raul A.; Cruz, JoanaSurgical resection is the cornerstone of curative treatment for patients with lung cancer. Nevertheless, it often leads to functional limitations and symptoms of pain, fatigue, and dyspnea, which have a detrimental impact on patients’ health-related quality of life (HRQoL).
- Efeito do exercício físico na qualidade de vida após a cirurgia para cancro do pulmão e cancro colorretal: Revisão sistemáticaPublication . Machado, Pedro; Pimenta, Sara; Oliveiros, Bárbara; Ferreira, José Pedro; Martins, Raúl A.; Cruz, JoanaIntrodução: O cancro colorretal (CCR) e o cancro do pulmão são atualmente dois dos tumores mais incidentes a nível global e os mais mortais. Apesar da resseção cirúrgica ser uma intervenção potencialmente curativa em pacientes com estes tumores, esta intervenção está associada a um declínio significativo na qualidade de vida relacionada com a saúde (QVRS). O exercício físico (EF) tem demonstrado um efeito benéfico na melhoria da capacidade funcional dos pacientes elegíveis para estes tipos de cirurgia oncológica, desconhecendo-se, no entanto, o seu efeito na recuperação da QVRS. Objectivo: O objetivo principal desta revisão sistemática foi avaliar a eficácia do EF na melhoria da QVRS após a cirurgia, em pacientes diagnosticados cancro do pulmão ou com CCR. Métodos: Foram incluídos estudos randomizados controlados, publicados até 21 de Março de 2021, selecionados através de pesquisa eletrónica, realizada nas bases de dados PubMed, Scopus, Web of Science, SPORTDiscus e PEDro. Os estudos elegíveis teriam de comparar o efeito de intervenções com EF, implementado no período pré-cirúrgico ou nos três primeiros meses após a cirurgia, com intervenções que não envolvessem exercício estruturado durante este período. A qualidade metodológica foi avaliada através da escala Physiotherapy Evidence Database (PEDro). Resultados: Dez estudos cumpriram com os critérios de elegibilidade e obtiveram uma pontuação ≥ 5 (0-10) na escala PEDro. Nove estudos incluíram pacientes com cancro do pulmão (n=651) e um estudo pacientes com CCR (n=93). Em pacientes com cancro do pulmão o exercício físico melhorou significativamente a dimensão física da QVRS após a cirurgia, com um efeito de magnitude elevada (SMD=0.89: 95% CI: [0.61; 1.15]; p=0.00) e reduziu significativamente os sintomas de fadiga, com um efeito de magnitude moderada SMD=-0.30: 95% CI: [-0.51;-0.08]; p=0.01). Em pacientes com CCR não se verificaram alterações significativas na QVRS nem nos sintomas de fadiga. Conclusão: O EF revela ser uma intervenção eficaz na recuperação da QVRS após a cirurgia em pacientes com cancro do pulmão, não havendo evidência do seu efeito benéfico em pacientes com CCR.
- OncoEnergy - Manual de exercício físico para pessoas com cancroPublication . Machado, Pedro; Morgado, Miguel; Raposo, João; Mendes, Marco; Ferreira, Luís Eva; Roque, AnaO presente manual foi desenvolvido por estudantes da Licenciatura em Fisioterapia (Unidade Curricular de Educação e Comunicação em Saúde) e investigadores do Centro de Inovação em Tecnologias e Cuidados de Saúde (ciTechCare) da Escola Superior de Saúde do Instituto Politécnico de Leiria, baseando-se num documento semelhante criado pela Associação Australiana de Ciências do Desporto. A informação apresentada baseia-se igualmente nas orientações de instituições internacionais de referência nas áreas da oncologia e do exercício, nomeadamente a European Society of Medical Oncology, American Society of Oncology, Cancer Council e o American College of Sports Medicine.
- Effect of Exercise Training on Quality of Life after Colorectal and Lung Cancer Surgery: A Meta-AnalysisPublication . Machado, Pedro; Pimenta, Sara; Oliveiros, Bárbara; Ferreira, José Pedro; Martins, Raul A.; Cruz, JoanaSurgical treatment affects health-related quality of life (HRQoL) and increases fatigue symptoms in patients with lung cancer (LC) and colorectal cancer (CRC). We aimed to systematically review the effect of exercise training on HRQoL and fatigue after LC and CRC surgery. Randomized controlled trials published before 21 March 2021, were searched in PubMed, Scopus, Web of Science, SPORTDiscus and PEDro. Eligible trials compared the effect of exercise interventions initiated preoperatively or in the first 3 months after surgery versus usual care on postoperative HRQoL and fatigue. Standardized mean differences (SMD) were pooled using random-effects models. Twelve studies with a total of 777 patients were included. In LC patients (10 studies, n = 651), exercise training in general led to a moderate improvement in the physical domain of HRQoL (0.68: 95% CI: [0.47; 0.89]) and a small reduction in fatigue levels after surgery (SMD = 0.28: 95% CI: [0.02; 0.53]), while no effects were found in other HRQoL domains. In CRC (two studies, n = 126), exercise training showed no effects on HRQoL and fatigue after surgery. Exercise training is an effective intervention to improve physical function and fatigue after LC surgery. Further studies are necessary to clarify the effects of exercise on HRQoL and fatigue after CRC surgery.