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\"Millions of people are suffering from chronic illnesses that, unbeknownst to them, are the result of exposure to environmental toxins and infectious agents such as mold and Borrelia, which causes Lyme disease. Millions. Because the symptoms of these illnesses are so varied and unusual, many of these individuals have sought medical care only to be dismissed, as if what they are experiencing is \"in their head.\" Many (if not most) have tried to tough it out and continue to function without hope of improvement. Unfortunately, their illnesses are very real. Toxic is a book of hope for these individuals, their loved ones, and the physicians who provide their care. Over many years of helping thousands of patients recover their health (even after their previous doctors had given up on them), Dr. Neil Nathan has come to understand some of the most common causes for these debilitating illnesses, which allows for the utilization of more precise and effective forms of treatment.\"--From publisher.

PurposeExercise training is an effective and safe way to counteract cancer-related fatigue (CRF) and to improve health-related quality of life (HRQoL). High-intensity interval training has proven beneficial for the health of clinical populations. The aim of this randomized controlled trial was to compare the effects of resistance and high-intensity interval training (RT–HIIT), and moderate-intensity aerobic and high-intensity interval training (AT–HIIT) to usual care (UC) in women with breast cancer undergoing chemotherapy. The primary endpoint was CRF and the secondary endpoints were HRQoL and cancer treatment-related symptoms.MethodsTwo hundred and forty women planned to undergo chemotherapy were randomized to supervised RT–HIIT, AT–HIIT, or UC. Measurements were performed at baseline and at 16 weeks. Questionnaires included Piper Fatigue Scale, EORTC-QLQ-C30, and Memorial Symptom Assessment Scale.ResultsThe RT–HIIT group was superior to UC for CRF: total CRF (p = 0.02), behavior/daily life (p = 0.01), and sensory/physical (p = 0.03) CRF. Role functioning significantly improved while cognitive functioning was unchanged for RT–HIIT compared to declines shown in the UC group (p = 0.04). AT–HIIT significantly improved emotional functioning versus UC (p = 0.01) and was superior to UC for pain symptoms (p = 0.03). RT–HIIT reported a reduced symptom burden, while AT–HIIT remained stable compared to deteriorations shown by UC (p < 0.01). Only RT–HIIT was superior to UC for total symptoms (p < 0.01).Conclusions16 weeks of resistance and HIIT was effective in preventing increases in CRF and in reducing symptom burden for patients during chemotherapy for breast cancer. These findings add to a growing body of evidence supporting the inclusion of structured exercise prescriptions, including HIIT, as a vital component of cancer rehabilitation.Trial registrationClinicaltrials.gov Registration Number: NCT02522260.

Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults and leads to severe fatigue, substantial physical functional impairment, and restricted social participation. In this study, we aimed to determine whether cognitive behavioural therapy optionally combined with graded exercise compared with standard care alone improved the health status of patients with myotonic dystrophy type 1. We did a multicentre, single-blind, randomised trial, at four neuromuscular referral centres with experience in treating patients with myotonic dystrophy type 1 located in Paris (France), Munich (Germany), Nijmegen (Netherlands), and Newcastle (UK). Eligible participants were patients aged 18 years and older with a confirmed genetic diagnosis of myotonic dystrophy type 1, who were severely fatigued (ie, a score of ≥35 on the checklist-individual strength, subscale fatigue). We randomly assigned participants (1:1) to either cognitive behavioural therapy plus standard care and optional graded exercise or standard care alone. Randomisation was done via a central web-based system, stratified by study site. Cognitive behavioural therapy focused on addressing reduced patient initiative, increasing physical activity, optimising social interaction, regulating sleep–wake patterns, coping with pain, and addressing beliefs about fatigue and myotonic dystrophy type 1. Cognitive behavioural therapy was delivered over a 10-month period in 10–14 sessions. A graded exercise module could be added to cognitive behavioural therapy in Nijmegen and Newcastle. The primary outcome was the 10-month change from baseline in scores on the DM1-Activ-c scale, a measure of capacity for activity and social participation (score range 0–100). Statistical analysis of the primary outcome included all participants for whom data were available, using mixed-effects linear regression models with baseline scores as a covariate. Safety data were presented as descriptives. This trial is registered with ClinicalTrials.gov, number NCT02118779. Between April 2, 2014, and May 29, 2015, we randomly assigned 255 patients to treatment: 128 to cognitive behavioural therapy plus standard care and 127 to standard care alone. 33 (26%) of 128 assigned to cognitive behavioural therapy also received the graded exercise module. Follow-up continued until Oct 17, 2016. The DM1-Activ-c score increased from a mean (SD) of 61·22 (17·35) points at baseline to 63·92 (17·41) at month 10 in the cognitive behavioural therapy group (adjusted mean difference 1·53, 95% CI −0·14 to 3·20), and decreased from 63·00 (17·35) to 60·79 (18·49) in the standard care group (−2·02, −4·02 to −0·01), with a mean difference between groups of 3·27 points (95% CI 0·93 to 5·62, p=0·007). 244 adverse events occurred in 65 (51%) patients in the cognitive behavioural therapy group and 155 in 63 (50%) patients in the standard care alone group, the most common of which were falls (155 events in 40 [31%] patients in the cognitive behavioural therapy group and 71 in 33 [26%] patients in the standard care alone group). 24 serious adverse events were recorded in 19 (15%) patients in the cognitive behavioural therapy group and 23 in 15 (12%) patients in the standard care alone group, the most common of which were gastrointestinal and cardiac. Cognitive behavioural therapy increased the capacity for activity and social participation in patients with myotonic dystrophy type 1 at 10 months. With no curative treatment and few symptomatic treatments, cognitive behavioural therapy could be considered for use in severely fatigued patients with myotonic dystrophy type 1. The European Union Seventh Framework Programme.

PurposeFatigue, decreased functionality, and impaired quality of life are some of the most common adverse outcomes of chemo-radiotherapy (CRT). Head and neck cancers (HNC) affect more than half a million individuals globally and its treatment takes a heavy toll on the patient, often affecting their speech, swallowing, and respiratory functions, and as a result they often develop fatigue, depression, and physical inactivity. The purpose of this study was to evaluate the effectiveness of exercise-based rehabilitation on functional capacity, quality of life, fatigue, hemoglobin, and platelet counts in patients with HNC on CRT.Patients and methodsA randomized controlled trial was conducted on 148 patients with head and neck cancer undergoing CRT to evaluate the effectiveness of exercise on functional capacity measured by the 6-min walk test, quality of life measured by the Medical Outcomes Survey Short Form 36 v2 questionnaire, fatigue by the NCCN (0–10) scale, hemoglobin, and platelets. The control group received standard physical activity recommendations while the exercise group received a structured exercise program of aerobic and active resistance exercises for a period of 11 weeks.ResultsThere was a significant improvement in the functional capacity (p < 0.001), quality of life (p < 0.001), and prevention of worsening of fatigue (p < 0.001) in the exercise group. The blood parameters did not show a significant difference between the control group and the exercise group.ConclusionOur results elucidate that an 11-week structured exercise program for HNC patients receiving CRT helps in improving their functional capacity and quality of life. It also prevents deterioration of fatigue levels in the exercise group.

Abstract Purpose To compare the effects of nurse-led multimodal rehabilitation with conventional rehabilitation on quality of life and physical recovery during adjuvant radiotherapy for postoperative esophageal cancer. Methods Seventy participants were randomized into a control group (N = 35) receiving conventional care and a multimodal group (N = 35) receiving nurse-led multimodal rehabilitation. Outcomes including quality of life, dyspnea index, fatigue, sleep quality, nutrition, anxiety, and depression status were recorded before the start of radiotherapy (T0), after completion of radiotherapy (T1), and 6 months (T2) and 12 months (T3) after completion of radiotherapy. Data were analyzed using intention-to-treat principles and linear mixed models. Results The multimodal group significantly increased the global health scores compared to the control group at T1 (p < 0.001), with differences remaining significant at T2 (p = 0.002) and T3 (p = 0.005). The weight of the multimodal group was also significantly higher than that of the control group at T1 (p = 0.008), with the difference remaining significant at T2 (p = 0.033) and T3 (p = 0.020). The fatigue score of the multimodal group decreased significantly at T1 (p < 0.001) and remained significant at T2 (p < 0.001) and T3 (p = 0.005). The anxiety and depression status of the multimodal group improved significantly at T1, and the difference remained significant at T2 (all p < 0.05). Conclusion Nurse-led multimodal rehabilitation significantly improved quality of life, sleep quality, nutrition, fatigue, anxiety, and depression status in patients undergoing postoperative radiotherapy for esophageal cancer. Graphical Abstract Graphical Abstract

ObjectivesThe aim of this report is to investigate the efficacy of an individually tailored, theory-based behavioural intervention for reducing daily sitting time, pain and fatigue, as well as improving health-related quality of life, general self-efficacy, physical function and cardiometabolic biomarkers in patients with rheumatoid arthritis (RA).MethodsIn this randomised controlled trial 150 patients with RA were randomised to an intervention or a no-intervention control group. The intervention group received three individual motivational counselling sessions and short message service or text messages aimed at reduction of sedentary behaviour during the 16-week intervention period. Primary outcome was change in daily sitting time measured objectively by ActivPAL. Secondary outcomes included change in pain, fatigue, physical function, general self-efficacy, quality of life, blood pressure, blood lipids, haemoglobin A1c, body weight, body mass index, waist circumference and waist–hip ratio.Results75 patients were allocated to each group. Mean reduction in daily sitting time was −1.61 hours/day in the intervention versus 0.59 hours/day increase in the control group between-group difference −2.20 (95% CI −2.72 to −1.69; p<0.0001) hours/day in favour of the intervention group. Most of the secondary outcomes were also in favour of the intervention.ConclusionAn individually tailored, behavioural intervention reduced daily sitting time in patients with RA and improved patient-reported outcomes and cholesterol levels.Trial registration numberNCT01969604; Results.

Purpose: Although there is a long history of use of semi-occluded vocal tract gestures in voice therapy, including phonation through thin tubes or straws, the efficacy of phonation through tubes has not been established. This study compares results from a therapy program on the basis of phonation through a flow-resistant tube (FRT) with Vocal Function Exercises (VFE), an established set of exercises that utilize oral semi-occlusions. Method: Twenty subjects (16 women, 4 men) with dysphonia and/or vocal fatigue were randomly assigned to 1 of 4 treatment conditions: (a) immediate FRT therapy, (b) immediate VFE therapy, (c) delayed FRT therapy, or (d) delayed VFE therapy. Subjects receiving delayed therapy served as a no-treatment control group. Results: Voice Handicap Index (Jacobson et al., 1997) scores showed significant improvement for both treatment groups relative to the no-treatment group. Comparison of the effect sizes suggests FRT therapy is noninferior to VFE in terms of reduction in Voice Handicap Index scores. Significant reductions in Roughness on the Consensus Auditory-Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were found for the FRT subjects, with no other significant voice quality findings. Conclusions: VFE and FRT therapy may improve voice quality of life in some individuals with dysphonia. FRT therapy was noninferior to VFE in improving voice quality of life in this study.

Background: Exercise may have beneficial effects on both well-being and walking ability in multiple sclerosis (MS). Exercise is shown to be neuroprotective in rodents and may also enhance cognitive function in humans. It may, therefore, be particularly useful for MS patients with pronounced neurodegeneration. Objective: To investigate the potential of standardized exercise as a therapeutic intervention for progressive MS, in a randomized-controlled pilot trial. Methods: Patients with progressive MS and moderate disability (Expanded Disability Status Scale (EDSS) of 4–6) were randomized to one of three exercise interventions (arm ergometry, rowing, bicycle ergometry) for 8–10 weeks or a waitlist control group. We analyzed the drop-out rate as a measure of feasibility. The primary endpoint of the study was aerobic fitness. Secondary endpoints were walking ability, cognitive function as measured by a neuropsychological test battery, depression and fatigue. Results: A total of 42 patients completed the trial (10.6% drop-out rate). Significant improvements were seen in aerobic fitness. In addition, exercise improved walking ability, depressive symptoms, fatigue and several domains of cognitive function. Conclusion: This study indicated that aerobic training is feasible and could be beneficial for patients with progressive MS. Larger exercise studies are needed to confirm the effect on cognition. Trial Registration: ISRCTN (trial number 76467492) http://isrctn.org

Objective The present study aimed to examine the efficacy of Mindfulness-Based Cancer Recovery (MBCR) training on fatigue and sleep quality of Iranian female patients with cancer. Method Thirty female patients with cancer were randomized to one of the MBCR and control groups. Subjects of the MBCR group received 8 sessions of MBCR training, while subjects of the control group received a 1-day didactic stress management seminar (SMS). All participants responded to the Cancer Fatigue Scale (CFT) and the Pittsburgh Sleep Quality Scale (PSQL) as pre- and post-test measures. Results Using MANCOVA for analyzing data revealed a significant improvement in the level of fatigue among subjects of the MBCR group compared to the controls; however, MBCR had no significant effect on the level of sleep quality. Conclusion The Mindfulness-Based Cancer Recovery program can be considered an effective approach to reducing fatigue for Iranian female patients with cancer. The clinical implications of this finding require further investigation. Trial registration The study was registered with the Iranian Registry of Clinical Trials (IRCT) on 24 June 2024; see [IRCT20240315061296N1].

Purpose Peak oxygen consumption (VO 2peak ) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer (NSCLC). The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity, as assessed by VO 2peak , and other related factors in patients with NSCLC receiving targeted therapy. Methods A total of 24 participants with adenocarcinoma were randomly assigned to either the control group ( n  = 11) or the exercise group ( n  = 13). Subjects in the exercise group participated in individualized, high-intensity aerobic interval training of exercise. The outcome measures assessed at baseline and after 8 weeks were as follows: VO 2peak and the percentage of predicted VO 2peak (%predVO 2peak ), muscle strength and endurance of the right quadriceps, muscle oxygenation during exercise, insulin resistance as calculated by the homeostasis model, high-sensitivity C-reactive protein, and quality of life (QoL) questionnaire inventory. Results No exercise-related adverse events were reported. After exercise training, VO 2peak and %predVO 2peak increased by 1.6 mL kg −1  min −1 and 5.3% ( p  < 0.005), respectively; these changes were associated with improvements in circulatory, respiratory, and muscular functions at peak exercise (all p  = 0.001). The exercise group also had less dyspnea ( p  = 0.01) and favorably lower fatigue ( p  = 0.05) than baseline. Conclusions Patients with NSCLC receiving targeted therapy have quite a low exercise capacity, even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms.