Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Supportive Care in Cancer  

Purpose: This study aimed to clarify the responsiveness and minimal clinically important difference (MCID) of the 6-minute walk distance (6MWD) from before and 1 week after surgery in patients with colorectal cancer (CRC). Methods: This retrospective cohort study enrolled 97 patients with primary CRC scheduled for surgery. An anchor-based approach estimated the MCID of the 6MWD, with postoperative physical recovery and EuroQol 5-dimension 5L questionnaire assessments serving as anchors. Effect size (ES) and standardized response mean (SRM) of the 6MWD were calculated to evaluate responsiveness, and the receiver operating characteristic (ROC) curve was used to estimate the MCID of the 6MWD. Results: Of the 97 patients, 72 were included in the analysis. The absolute value of ES and SRM of the 6MWD were 0.69 and 0.91, respectively. The ROC curve indicated that the optimal cut-off values for estimating the MCID of the 6MWD were -60 m (area under the curve [AUC] = 0.753 [95% CI: 0.640−0.866]) and -75 m (AUC = 0.870 [95% CI: 0.779−0.961]) at each anchor. Conclusion: From before to 1 week after surgery, the responsiveness of the 6MWD was favorable, and the MCID of the 6MWD was -75 to -60 m in patients with CRC.

DOI： 10.1007/s00520-024-08596-y

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Society of Physical Therapy Science  

<p> [Purpose] To clarify the association between preoperative physical activity and postoperative ambulation based on physical activity intensity, and independent of functional capacity and depression, in patients with gastrointestinal cancer. [Participants and Methods] Seventy patients who underwent surgery for primary colorectal or gastric cancer were enrolled. Preoperative moderate-to-vigorous-intensity physical activity, light-intensity physical activity, and sedentary behavior were assessed using an accelerometer. The primary outcome was the days to postoperative first ambulation (capable of independently and continuously walking 150 m). Functional capacity and depression, as confounders, were evaluated by measuring the 6-minute walk distance and using the Hospital Anxiety and Depression Scale. [Results] Of the 70 patients, 28 had insufficient accelerometer data, and 42 were included in the analysis. Preoperative light-intensity physical activity, but not moderate-to-vigorous-intensity physical activity and sedentary behavior, was negatively associated with the days to postoperative first ambulation, after adjusting for age, preoperative functional capacity, and preoperative depression. [Conclusion] Preoperative light-intensity physical activity was associated with the days to postoperative ambulation independently of age, functional capacity, and depression. Hence, predicting delayed ambulation by preoperative light-intensity physical activity in patients with gastrointestinal cancer may be useful.</p>

DOI： 10.1589/jpts.36.1

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DOI： 10.1177/11795565241281334

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Supportive Care in Cancer  

Purpose: This study aimed to investigate the association between prolonged preoperative sedentary time (ST) and postoperative ileus (POI) after adjusting for confounders in patients with colorectal cancer (CRC). Methods: This single-center retrospective study enrolled 155 consecutive patients who underwent surgery for primary CRC. A diagnosis of POI was made by the surgeons if the Clavien-Dindo classification (CD) grade is ≥ 2 within 30 days after surgery. Preoperative ST was assessed using the International Physical Activity Questionnaire usual week short version (Japanese version). Patients were classified into two groups (ST < 6 h/day and ST ≥ 6 h/day) based on results from the questionnaire, and data were analyzed using a propensity score-matching strategy to adjust for confounders. In addition, receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value of preoperative ST for predicting POI. Results: Of the 155 patients, 134 were included in the analysis. POI occurred in 16 (11.9%) patients of overall patients and 11 (12.5%) of the 88 matched patients. The logistic regression analysis after propensity score-matching showed that prolonged preoperative ST (ST ≥ 6 h/day) was associated with POI (odds ratio 5.40 (95% confidence interval: 1.09 − 26.60), p = 0.038). The ROC curve analysis indicated that the optimal cutoff value of preoperative ST for predicting POI was 6 h/day. Conclusion: Prolonged preoperative ST is a risk factor for POI in patients with CRC. Therefore, reducing preoperative ST may play an important role in preventing POI.

DOI： 10.1007/s00520-023-08271-8

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：European Journal of Cancer Care  

Purpose. Skeletal muscle mass (SMM) is an important biomarker for health in older cancer patients. However, there is limited information on the recovery course of SMM after esophagectomy in older patients. This study aimed to investigate the recovery course of SMM after esophagectomy and the predictors in older cancer patients. Methods. We conducted a single-center, retrospective cohort study. Esophageal cancer patients who underwent esophagectomy were included. The skeletal muscle mass index (SMI) was calculated using computed tomography images. The loss of SMI at 4 and 12 months after surgery was calculated as [(preoperative − postoperative SMI) ÷ preoperative SMI] × 100%. Nonrecovery was defined as an SMI loss of ≥2% at 12 months after surgery, considering physiological loss with aging. One-way analysis of variance and multivariate logistic regression analysis was used for statistical analysis. Results. A total of 105 older (≥70 years) and 156 nonolder (<70 years) patients were analyzed. Older patients had a significantly larger loss of SMI 4 months (mean: 5.7% vs. 3.1%; p = 0.021) and 12 months (mean: 1.0% vs. −1.4%; p = 0.040) after surgery than nonolder patients. In older patients, the number of patients with nonrecovery of SMI at 12 months after surgery was 55 (52%). In older patients, significant predictors for the nonrecovery of SMI were preoperative sarcopenia (adjusted OR: 0.297; p = 0.012), neoadjuvant chemotherapy (adjusted OR: 0.248; p = 0.015), and loss of SMI 4 months after surgery (per 1%; adjusted OR: 1.076; p = 0.018). Conclusions. It is suggested that older esophageal cancer patients have a larger unmet need for long-term postoperative loss of SMM than nonolder patients. Continuous outpatient rehabilitation, including exercise and nutritional therapy after discharge, which targets improvement in SMM at 4 months, may improve SMI at 12 months after surgery in older esophageal cancer patients.

DOI： 10.1155/2023/6655999

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：European Geriatric Medicine  

Background: Loss of skeletal muscle mass, measured by the skeletal muscle mass index (SMI), after esophagectomy negatively impacts prognosis. However, the information to develop novel supportive care options for preventing loss of skeletal muscle mass is limited. The purpose of this retrospective cohort study was to investigate the impact of early postoperative factors on change in SMI 4 months after curative esophagectomy in older patients with esophageal cancer. Methods: This study included 113 subjects who underwent esophagectomy between 2015 and 2020. Preoperative and postoperative SMI (cm2/m2) were calculated from computed tomography images. The percentage change in SMI 4 months after surgery (SMI%) was calculated as follows: ([postoperative SMI – preoperative SMI] ÷ preoperative SMI) × 100. Potential factors affecting percentage change of SMI after surgery were analyzed by multiple regression. Results: The mean SMI% was – 5.6%. The percentage change (per 1%) in quadriceps muscle strength in the first month after surgery (standardized β = 0.190, p = 0.048) impacted the SMI%, which was independent of age, sex, preoperative SMI, comorbidity, pathological stage, and neoadjuvant chemotherapy. Conclusion: Quadriceps muscle weakness in the first month after esophagectomy impacted the SMI% in a dose-dependent relationship.

DOI： 10.1007/s41999-022-00735-0

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cancer Rehabilitation  

Background A preoperative intervention called “prehabilitation” has become increasingly important to prevent postoperative complications. Prescribing tailor-made programs according to patient characteristics is essential to enhance the benefits of this intervention. However, data on the physical characteristics of preoperative gastrointestinal cancer patients with myopenia or myosteatosis are lacking, especially for Asian individuals. This study aimed to determine the characteristics of physical function in preoperative gastrointestinal cancer patients with skeletal muscle abnormalities.Materials and Methods This single-center cross-sectional study included patients who underwent open or laparoscopic surgery for primary colorectal or gastric cancer between October 2016 and August 2020. Skeletal muscle mass and density were measured using preoperative computed tomography images at the level of the third lumbar vertebra. Skeletal muscle abnormalities (myopenia / myosteatosis) were defined using sex-and age-specific thresholds based on previous studies. The assessment of preoperative physical function included handgrip strength, isometric knee-extensor muscle force, and 6-minute walking distance. Patients were divided into the following four groups; 1) normal group; 2) myopenia / non-myosteatosis group; 3) non-myopenia / myosteatosis group; 4) myopenia / myosteatosis group. Preoperative physical functions were compared between the normal and other groups.Results Overall, 126 patients with a median age of 69 years were included in the analysis. The prevalence of myopenia and myosteatosis in the patients was 63% and 52%, respectively. Patients with both skeletal muscle abnormalities (myopenia and myosteatosis) had poorer physical function than normal patients.Conclusions More than half of the Japanese preoperative patients with gastrointestinal cancer had either myopenia or myosteatosis, and the patients with both myopenia and myosteatosis were considered as a “high risk for severe sarcopenia” population. This information can be used to prescribe an optimal, customized treatment to preoperative patients with gastrointestinal cancer.

DOI： 10.48252/JCR85

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Disability and Rehabilitation  

Purpose: The present study aimed to investigate the association between preoperative physical activity (PA) and postoperative functional recovery in gastrointestinal cancer patients. Materials and methods: In this prospective study, we included 101 patients who underwent colorectal or gastric cancer surgery. Primary outcome was 6-minute walk distance (6MWD) decline ratio ((postoperative 6MWD value–preoperative 6MWD value)/preoperative 6MWD value × 100 (%)), which was determined as postoperative functional recovery. Patients were divided into two groups according to the median of 6MWD decline ratio: above the median (non-decline group) and below the median (decline group). The International Physical Activity Questionnaire (IPAQ-SV) (the usual seven-day short version) was used to assess preoperative PA and sedentary time. Multivariate logistic regression analysis was performed to identify predictive factors of postoperative functional recovery. Results: Preoperative PA (odds ratio (OR): 3.812; 95% confidence interval (CI): 1.326–10.956; p = 0.01), 6MWD (OR: 1.006; 95% CI: 1.002–1.011; p < 0.01), C-reactive protein (OR: 4.138; 95% CI: 1.383–12.377; p = 0.01), and combined resection (OR: 3.425; 95% CI: 1.101–10.649; p = 0.03) were associated with postoperative functional recovery. Conclusions: Preoperative PA is a predictor of postoperative functional recovery in patients who undergoing gastrointestinal cancer surgery.Implications for rehabilitation The association between preoperative physical activity (PA) and postoperative functional recovery has been unclear in gastrointestinal cancer patients. We indicated that preoperative PA predicts postoperative functional recovery. Patients who low preoperative PA need to be monitored carefully in the postoperative course. Patients with low preoperative PA may need enhanced postoperative rehabilitation to reduce postoperative functional decline.

DOI： 10.1080/09638288.2021.1939447

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Annals of Surgical Oncology  

Background: The number of patients with esophageal cancer aged ≥ 70 years with a poor prognosis is increasing. In general patients with esophageal cancer, postoperative loss of skeletal muscle mass (SMM) is a prognostic factor. This study was designed to investigate the prognostic impact of postoperative loss of SMM in patients aged ≥ 70 years with esophageal cancer. Methods: This study was a single-center, retrospective cohort study. Patients with esophageal cancer who underwent R0 esophagectomy between 2016 and 2020 were included. The percentage postoperative loss of skeletal muscle mass index (SMI%) was calculated using computed tomography images before and at 4 ± 2 months after surgery. Results: The number of subjects in the ≥ 70-year and < 70-year age groups was 166 and 218, respectively. The median SMI% was 5% in all patients; thus, 5% was defined as the cutoff point to define major loss of SMI. Major loss of SMI impacted 3-year overall survival (OS) in the ≥ 70-year age group, independent of age, sex, clinical stage, pathological T and N factors, Charlson comorbidity index, and length of hospital stay (adjusted hazard ratio [HR]: 4.400; 95% confidence interval: 1.202–16.105; P = 0.025). The adjusted HR of major loss of SMI in the ≥ 70-year age group was higher than in the < 70-year age group (adjusted HR: 4.400 vs. 2.388, respectively). Conclusions: Postoperative loss of SMI in patients with esophageal cancer aged ≥ 70 years more strongly impacted 3-year OS than in patients aged < 70 years.

DOI： 10.1245/s10434-022-11801-z

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Physical Therapy  

<p><b>Objective</b>: This study aimed to investigate the characteristics of physical performance measures for people aged over 65 years who are at risk for locomotive syndrome stage 1, and to examine the cut-off value of the physical performance measures for locomotive syndrome stage 1.</p><p><b>Methods</b>: This study population consisted of 182 people aged 65 and above who participated in a medical examination project in a municipality near Nagoya University. Using the locomotive syndrome risk test, the participants were divided into groups with and without locomotive syndrome stage 1. The relationship of locomotive syndrome stage 1 with the physical performance measures was analyzed between the two groups. The cut-off values were examined for the factors that were significantly associated with locomotive syndrome stage 1.</p><p><b>Results</b>: As determined by logistic regression analysis, one-leg standing time with eyes open showed a significant association with locomotive syndrome stage 1 (p<0.01). In addition, one-leg standing time with eyes open for 17.0 s was found to be the cut-off value for locomotive syndrome stage 1 (AUC=0.66, sensitivity: 42%, specificity: 88%).</p><p><b>Conclusions</b>: It was observed that the most relevant physical performance measure for locomotive syndrome stage 1 was one-leg standing time with eyes open. It was observed that 17.0 s was the cut-off value for one-leg standing time with eyes open for locomotive syndrome stage 1.</p>

DOI： 10.15063/rigaku.12154

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Pacific Journal of Cancer Prevention  

Background: Postoperative delirium (POD) is one of the most common postoperative complications in gastrointestinal surgery patients. POD has been reported to affect long-term activities of daily living, cognitive function decline, and mortality. Previous studies have indicated that preoperative physical activity (PA) predicted POD in patients with other diseases, but we have not found any reports in patients with gastrointestinal cancer. In this retrospective study, we investigated the relationship between preoperative PA and POD in gastrointestinal cancer patients. Methods: POD was diagnosed based on the short confusion assessment method. We divided patients into active and inactive groups based on their preoperative PA assessed by the International Physical Activity Questionnaire (Japanese version). Multivariate logistic analysis was conducted to investigate the association between preoperative PA and POD. Results: POD occurred in 25 of the 151 patients (16.6%). Preoperative low PA was associated with POD after adjusting for confounders, namely, diabetes mellitus, sedentary time, and usual gait speed (odds ratio, 2.83; 95% confidence interval: 1.06-7.58; p=0.03). Conclusion: Preoperative low PA was a predictor of POD independent of the confounding factors in patients with gastrointestinal cancer.

DOI： 10.31557/APJCP.2022.23.5.1753

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Supportive Care in Cancer  

Purpose: A known barrier to getting breast cancer survivors (BCSs) to engage in habitual exercise is a lack of information on recommended physical activity levels provided to them by oncology care providers (OCPs). However, the actual situation in Japan remains unclear. This study sought to clarify OCPs’ awareness and practice related to Japan’s physical activity recommendation for BCSs and to ascertain barriers to routine information provision. Methods: We conducted a web-based survey involving members of the Japanese Breast Cancer Society (JBCS) and the Japanese Association of Cancer Rehabilitation between Dec. 2018 and Feb. 2019. Results: Of 10,830 members, 1,029 (9.5%) responded. Only 19.1% were aware of the details of the JBCS physical activity recommendation, and only 21.2% routinely provided physical activity information to BCSs. Factors related to being aware of the recommendation details were 1) availability of the guidelines, 2) experience reading relevant parts of the guidelines, and 3) involvement in multidisciplinary team case meetings. Barriers to routine information provision were 1) absence of perceived work responsibility, 2) underestimation of survivors’ needs, 3) lack of resources, 4) lack of self-efficacy about the recommendation, and 5) poor knowledge of the recommendation. Conclusions: Only one fifth of the OCPs routinely provided physical activity information. Barriers to provision were poor awareness, self-efficacy, and attitudes and unavailable resources. The physical activity recommendation needs to be disseminated to all OCPs and an information delivery system needs to be established for BCSs to receive appropriate information and support to promote their engagement in habitual physical activity.

DOI： 10.1007/s00520-021-06706-8

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Geriatric Oncology  

DOI： 10.1016/j.jgo.2021.03.006

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society for Palliative Medicine  

<p>​Objective: The purpose of this study was to clarify the characteristics of physical quality of life (QOL) and activities of daily living (ADL) in patients with advanced cancer undergoing home-visit rehabilitation. Method: In this prospective study, we included 35 patients with advanced cancer undergoing home-visit rehabilitation. Physical QOL was assessed using the Physical Functioning (PF) score on the QLQ-C15, and ADL was assessed using the Barthel Index (BI) and Functional Independence Measure (Motor FIM) scores. Changes in physical QOL and each ADL scores from the start of rehabilitation to 4 weeks later were investigated. Also, patients were divided into two groups according to the PF score and characteristics of physical QOL and ADL between the two groups were explored. Result: PF score was significantly improved after 4 weeks compared to baseline. In the PF score maintenance/improvement group, motor FIM score was significantly improved after 4 weeks compared to baseline. Conclusion: The physical QOL of patients with advanced cancer undergoing home-visit rehabilitation was maintained and improved 4 weeks after the start of rehabilitation. It was suggested that maintaining ADL may lead to maintenance and improvement of physical QOL.</p>

DOI： 10.2512/jspm.16.271

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cancer Rehabilitation  

The longitudinal relationship between cancer-related fatigue (CRF) and physical function remains unclear. This study evaluated the association between pre-treatment physical functions and CRF exacerbation following concurrent chemoradiotherapy (CCRT). Methods The study included 42 cancer patients undergoing CCRT. Poor physical function was defined as the presence of either or both low grip strength (<26 kg, <18 kg) and slow walking speed (<1.0 m/s) at the start of CCRT. CRF was assessed using the Japanese version of the Functional Assessment of Chronic Illness Therapy-Fatigue Scale at the start of CCRT and 6 weeks later. Patients were categorized into the CRF exacerbation group if their scores decreased by >3 points. A multivariate logistic regression analysis was performed to identify the association between poor physical function and exacerbation of CRF. Results Seventeen (40.5%) patients developed CRF exacerbation following CCRT. More patients had poor physical function in the CRF exacerbation group (58.8% vs. 20.0%; p=0.02). Poor physical function was an independent risk factor for exacerbation of CRF following CCRT after adjusting for confounders. Conclusions Poor physical function was a risk factor for exacerbation of CRF following CCRT. Assessing physical function may be useful in determining patients at high risk for CRF exacerbation following CCRT.

DOI： 10.48252/JCR34

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DOI： 10.31557/APJCP.2020.21.11.3405

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DOI： 10.1001/jamasurg.2020.1804

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DOI： 10.1007/s11764-019-00840-3

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DOI： 10.1161/STROKEAHA.119.026683

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DOI： 10.1186/s12885-019-5762-6

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DOI： 10.1002/jcsm.12351

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DOI： 10.4103/apjon.apjon_21_18

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DOI： 10.1016/j.gaitpost.2014.07.012

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DOI： 10.1016/j.clinbiomech.2013.08.005

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DOI： 10.7314/apjcp.2013.14.1.47

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DOI： 10.1016/j.gerinurse.2011.02.002

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