Browsing by Author "Ester, Manuel"

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    Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer
    (2021-02-13) Ester, Manuel; Culos-Reed, S. N; Abdul-Razzak, Amane; Daun, Julia T; Duchek, Delaney; Francis, George; Bebb, Gwyn; Black, Jennifer; Arlain, Audra; Gillis, Chelsia; Galloway, Lyle; Capozzi, Lauren C
    Abstract Background Advanced lung cancer patients face significant physical and psychological burden leading to reduced physical function and quality of life. Separately, physical activity, nutrition, and palliative symptom management interventions have been shown to improve functioning in this population, however no study has combined all three in a multimodal intervention. Therefore, we assessed the feasibility of a multimodal physical activity, nutrition, and palliative symptom management intervention in advanced lung cancer. Methods Participants received an individually tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, behaviour change education, and nutrition and palliative care consultations. Patients reported symptom burden, energy, and fatigue before and after each class. At baseline and post-intervention, symptom burden, quality of life, fatigue, physical activity, dietary intake, and physical function were assessed. Post-intervention interviews examined participant perspectives. Results The multimodal program was feasible, with 44% (10/23) recruitment, 75% (75/100) class attendance, 89% (8/9) nutrition and palliative consult attendance, and 85% (17/20) assessment completion. Of ten participants, 70% (7/10) completed the post-intervention follow-up. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being. Conclusion A multimodal physical activity, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation in a larger cohort trial. Trial registration NCT04575831 , Registered 05 October 2020 – Retrospectively registered.
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    Staying in Motion: Using Technology to Support Physical Activity Maintenance in Exercise Oncology
    (2023-05-10) Ester, Manuel; Culos-Reed, Nicole; McDonough, Meghan H.; McNeely, Margaret L.; Brenner, Darren; Phillips, Siobhan M.
    Given the broad range of physical and psychosocial health benefits of physical activity (PA) for individuals living with cancer, experts recommend regular PA as well as structured exercise (aerobic, strength, flexibility, and balance) to improve overall well-being among this population. However, most individuals living with and beyond cancer remain insufficiently active, struggling to maintain consistent PA habits post-diagnosis. Exercise oncology behavior change interventions have been shown to increase PA post-intervention, yet challenges remain to ensure that participants stay physically active long-term (i.e. PA maintenance: continued PA up to and beyond 6 months after initial PA behavior change), and thereby continue to reap the benefits of PA. Individuals living with and beyond cancer face significant challenges to PA maintenance, including cost, lack of time, lack of equipment or access to facilities, lack of motivation, and lack of support. Those living in rural and remote locations may experience a greater impact of these PA maintenance barriers, and usually lack access to in-person exercise oncology programs, which are primarily delivered in urban settings. Some of these barriers may be addressed via PA behavior change interventions delivered using electronic health technology (eHealth). Despite increased research, few studies have explored the potential of eHealth to support PA maintenance, especially among rural cancer populations who may need greater PA support given their lower PA levels and greater PA barriers. The present PhD project addressed this knowledge gap, developing novel insights to better understand the potential of eHealth to support PA maintenance among individuals living with and beyond cancer. First, the effectiveness of eHealth to support PA behaviors in exercise oncology was systematically reviewed. Next, a survey of exercise oncology program participants explored technology use, literacy, and perceptions on the value of technology to support PA habits. The review and survey were then followed by a participant-oriented tailoring process to customize an existing self-monitoring app for use in a PA maintenance intervention. Finally, the effectiveness of the self-monitoring app to support PA maintenance was tested in a randomized controlled trial, which was evaluated using quantitative (i.e. self-report and objective PA levels) and qualitative (i.e. semi-structured 1-1 interviews) methods. The project contributed new knowledge to better understand the potential value of eHealth to support PA maintenance among individuals living with cancer, especially those in rural and remote locations, and highlighted important next steps to optimize and comprehensively evaluate its positive impact on PA behavior change.
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    The online delivery of exercise oncology classes supported with health coaching: a parallel pilot randomized controlled trial
    (2023-05-12) Eisele, Maximilian; Pohl, Andrew J.; McDonough, Meghan H.; McNeely, Margaret L.; Ester, Manuel; Daun, Julia T.; Twomey, Rosie; Culos-Reed, S. N.
    Abstract Purpose The primary objective was to investigate the feasibility of a synchronous, online-delivered, group-based, supervised, exercise oncology maintenance program supported with health coaching. Methods Participants had previously completed a 12-week group-based exercise program. All participants received synchronous online delivered exercise maintenance classes, and half were block randomized to receive additional weekly health coaching calls. A class attendance rate of ≥ 70%, a health coaching completion rate of ≥ 80%, and an assessment completion rate of ≥ 70% were set as markers of feasibility. Additionally, recruitment rate, safety, and fidelity of the classes and health coaching calls were reported. Post-intervention interviews were performed to further understand the quantitative feasibility data. Two waves were conducted — as a result of initial COVID-19 delays, the first wave was 8 weeks long, and the second wave was 12 weeks long, as intended. Results Forty participants (n8WK = 25; n12WK = 15) enrolled in the study with 19 randomized to the health coaching group and 21 to the exercise only group. The recruitment rate (42.6%), attrition (2.5%), safety (no adverse events), and feasibility were confirmed for health coaching attendance (97%), health coaching fidelity (96.7%), class attendance (91.2%), class fidelity (92.6%), and assessment completion (questionnaire = 98.8%; physical functioning = 97.5%; Garmin wear-time = 83.4%). Interviews highlighted that convenience contributed to participant attendance, while the diminished ability to connect with other participants was voiced as a drawback compared to in-person delivery. Conclusion The synchronous online delivery and assessment of an exercise oncology maintenance class with health coaching support was feasible for individuals living with and beyond cancer. Providing feasible, safe, and effective exercise online to individuals living with cancer may support increased accessibility. For example, online may provide an accessible alternative for those living in rural/remote locations as well as for those who may be immunocompromised and cannot attend in-person classes. Health coaching may additionally support individuals’ behavior change to a healthier lifestyle. Trial registration The trial was retrospectively registered (NCT04751305) due to the rapidly evolving COVID-19 situation that precipitated the rapid switch to online programming.