Talk:Exercise/Archive 3

Archive 1

Archive 2

Archive 3

Exercise and cancer cachexia

This statement in the section on cancer is misinformation: "A multi-modal therapy that includes regular physical exercise is recommended for the treatment of cancer cachexia due to the established effect of exercise on skeletal muscle at the cellular level." Instead, the authors of the Cochrane review concluded this way: "There is insufficient evidence to determine the safety and effectiveness of exercise for patients with cancer cachexia." Reviewing the available clinical studies to assess the supposed benefits of exercise on cachexia, the authors also concluded: "Following an extensive literature search, we found no studies that could be included in this systematic review", i.e., there were no high-quality studies to evaluate and discuss. I'm removing this section from the article as moot, having no encyclopedic value. --Zefr (talk) 03:28, 6 August 2018 (UTC)

There’s a Cochrane review on this topic, so I disagree. Seppi333 (Insert 2¢) 03:50, 6 August 2018 (UTC)

@Zefr: I don't know why you don't just read the refs, so I'll copy/paste them, but I'm not going to bother formatting anything for readability because I'm wasting my time with you. I also don't know why you're arguing as if the paragraph doesn't clearly state that there's no published evidence on efficacy. I know you're just cutting this because you don't agree with their recommendations, but your opposition alone to a recommendation doesn't justify cutting it, much less the 3 unrelated statements that follow. That would require consensus, so I've notified WT:MED to obtain additional input.

Compare:

The follow-up to the Cochrane review by three of the authors of that review

A proactive management approach is recommended, including physical exercise to maintain function via modulation of muscle metabolism, insulin sensitivity and levels of inflammation. ... Despite a strong rationale for the use of exercise, there is insufficient evidence to determine safety and effectiveness in patients with cancer cachexia. Findings from ongoing studies are awaited. ... A proactive management approach is recommended, instigated before cachexia becomes refractory, with the aim to maintain or slow down the decline in physical function.1,4 Multimodal intervention is also considered necessary, as it is unlikely any single intervention will address the metabolic, nutritional, and functional deficits caused by cachexia concurrently.4 Three main component interventions are being developed: nutritional therapies, pharmacological agents, and exercise therapies.10 ... Using a comprehensive and systematic search strategy, we identified no randomized controlled trials of exercise for patients with cancer cachexia. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575551/

The Cochrane review

As such, it is recommended that greater emphasis be placed on applying a proactive approach, early in the course of the disease, with the aim being to maintain or slow down the loss of physical function (Fearon 2011; Muscaritoli 2010). Due to the complex nature of the condition, multimodal intervention is also considered necessary as it is unlikely that any single intervention will increase food intake, attenuate the metabolic disturbances and address the imbalance between muscle protein synthesis and breakdown (Fearon 2008). Three main component interventions are being developed alone or in combination (Solheim 2012): nutritional therapies to increase energy and protein intake (Dewey 2007); drug therapies to stimulate appetite and reduce inflammation (Berenstein 2005; Lee 2011; Reid 2012); and exercise therapies ... Exercise may attenuate the effects of cancer cachexia via several mechanisms, including the modulation of muscle metabolism, insulin sensitivity and levels of inflammation ... We found no trials that met the inclusion criteria. There is insufficient evidence to determine the safety and effectiveness of exercise for patients with cancer cachexia. - doi:10.1002/14651858.CD010804.pub2

These reviews say the same thing. Seppi333 (Insert 2¢) 17:58, 6 August 2018 (UTC)

Notice that Seppi333 has violated WP:3RR within the past 22 hr. The sentence in the current version, "As of 2018, the clinical efficacy of resistance and aerobic exercise for the treatment of cancer cachexia has not been established due to a lack of published evidence", is all that is needed to warrant removal of the content on cachexia. It is supported by the conclusions of the Grande et al. refs, 1 and 2 below (redundant, having the same content), and ref 3 which states inconclusively that "definitive regimens have to be further developed to support the efficacy and safety of exercise training for cancer cachexia patients". Refs 4 and 5 are primary research and a discussion of an upcoming clinical trial, i.e., non-MEDRS, respectively. The section on exercise for cancer cachexia is unestablished by the sources and provides no value to the article. --Zefr (talk) 20:56, 6 August 2018 (UTC)

This feels like the PSA test thing from a few months ago. Remember the saying, beloved of planning-oriented folks, that "not deciding is a decision"? Well, healthcare folks have this problem, too: "no good evidence either way" doesn't actually get you off the hook. You still have to care for your patients. Not advocating either for or against exercise is still a recommendation about exercise.

Looking at (only) these quoted sources, it appears that both of the following statements are true:

1. There is no good evidence about whether exercise is helpful for these patients.
2. It is a best practice for their oncologists to tell them to exercise, especially if the cachexia is just starting to manifest.

These are not contradictory statements. The recommendation is real, even if the recommendation is based upon something other than evidence. Since half(!) of mainstream medical practice is not evidence-based anyway, the fact of this particular recommendation not having formal evidence behind it should not present any problems.

These two statements could probably be combined into a single one, along these lines: "Although there is only limited scientific evidence on the subject, people with cancer cachexia are encouraged to engage in physical exercise." (I'd leave out the bit about trials being planned or underway; that's more "news" than "encyclopedia".) WhatamIdoing (talk) 22:15, 6 August 2018 (UTC)

generally agree w/ WAID--Ozzie10aaaa (talk) 12:02, 7 August 2018 (UTC)

@Jytdog: I don't understand your edit summary. Also, why did you delete: Individuals with cancer cachexia generally report low levels of physical activity and few engage in an exercise routine, owing to low motivation to exercise and very low exercise self-efficacy (e.g., they believe that exercising may worsen their symptoms or cause harm).? Seppi333 (Insert 2¢) 23:04, 8 August 2018 (UTC)

This is the second time I have encountered the two of you edit warring with absolute garbage sources. Oncotarget is one of the original predatory publishers. Please take your eyes off each other and pay attention to the encyclopedia. Jytdog (talk) 23:08, 8 August 2018 (UTC)

That entire paragraph is still fully cited even if that reference is removed. So again, I don't understand why you cut that sentence. Seppi333 (Insert 2¢) 23:27, 8 August 2018 (UTC)

Here is what I have to say to somebody who edit wars Oncotarget (and a very recent primary source) into WP and doesn't care about having done that: Jytdog (talk) 23:30, 8 August 2018 (UTC)

Very mature. My bad for not having memorized every single predatory open access publisher in existence. And clearly that isn't repeated by other sources, so let's just delete shit because we don't feel like referencing it. Seppi333 (Insert 2¢) 23:41, 8 August 2018 (UTC)

• btw the most helpful kind of reference in this situation would be a clinical guideline to which to attribute the recommendation, rather than using some passive "it is recommended" construction. Of course if everybody says that is what is recommended then WAID's "should" is fine there (I know you don't like "should", Seppi, but "it is recommended" is worse) Jytdog (talk) 23:20, 8 August 2018 (UTC)

  I don't care when "should" is attributed; I do when it's unattributed. "It is recommended" is vague, but not a violation of WP:WikiVoice if it's unattributed because the entity making the recommendation isn't implicitly Wikipedia. Seppi333 (Insert 2¢) 23:27, 8 August 2018 (UTC)

"These two statements could probably be combined into a single one, along these lines: "Although there is only limited scientific evidence on the subject, people with cancer cachexia are encouraged to engage in physical exercise."" – WhatamIdoing. I disagree with this suggestion. Grande's Cochrane review and his subsequent executive summary do not support this statement. Grande mentions the "encouragement" as an action undertaken by healthcare professionals, which therefore justifies the Cochrane review. However WAID's suggestion implies that physical exercise is conclusively recommended.

Perhaps an alternative might be: "Despite widespread recommendation from healthcare professionals, there is very little scientific evidence to support this."

Overall, I am inclined to agree with Zefr's analysis.

I do not know who/what is Oncotarget, and I am not inclined to review any previous edit wars. Axl ¤ [Talk] 10:25, 11 August 2018 (UTC)

Deleted content on exercise and cancer cachexia

This is the disputed content from Exercise#Cancer:

A multi-modal therapy that includes regular physical exercise is recommended for the treatment of cancer cachexia due to the established effect of exercise on skeletal muscle at the cellular level. Individuals with cancer cachexia generally report low levels of physical activity and few engage in an exercise routine, owing to low motivation to exercise and very low exercise self-efficacy (e.g., they believe that exercising may worsen their symptoms or cause harm). As of 2018, the clinical efficacy of resistance and aerobic exercise for the treatment of cancer cachexia has not been established due to a lack of published evidence; however, clinical trials that assess the effectiveness of exercise therapy – in combination with nutritional and pharmacological therapy – for the treatment of cancer cachexia are underway.

References

clinical guidelines

PMID 30053727 is a review of clinical guidelines (just published this month). According to it, PMID 27637832 published in 2017 is the most evidence-based guideline.

They give a "strong" recommendation based on a high level of evidence: for "Exercise in combination with nutrition": "We recommend maintenance or an increased level of physical activity in cancer patients to support muscle mass, physical function and metabolic pattern."

They give a "weak" recommendation based on low-level of evidence to "We suggest individualized resistance exercise in addition to aerobic exercise to maintain muscle strength and muscle mass"

They also have a weak recommendation based on low evidence for people to exercise who are getting chemo and bone marrow transplant.

-- Jytdog (talk) 23:49, 8 August 2018 (UTC)

Nutrition and recovery

This edit rambles with excessive advice (WP:NOTADVICE) and over-interpretation, with content not supported by rigorous reviews. The ADA-ACSM position statement is usable, url here, but has only limited content on recovery. Otherwise, WP:MEDRS reviews are needed for this section. A search of PubMed review literature doesn't provide any high-quality publications. --Zefr (talk) 16:16, 16 February 2019 (UTC)

Orphaned references in Exercise

I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Exercise's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "BDNF meta analysis":

• From Neuroplasticity: Szuhany KL, Bugatti M, Otto MW (January 2015). "A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor". Journal of Psychiatric Research. 60: 56–64. doi:10.1016/j.jpsychires.2014.10.003. PMC 4314337. PMID 25455510. Consistent evidence indicates that exercise improves cognition and mood, with preliminary evidence suggesting that brain-derived neurotrophic factor (BDNF) may mediate these effects. The aim of the current meta-analysis was to provide an estimate of the strength of the association between exercise and increased BDNF levels in humans across multiple exercise paradigms. We conducted a meta-analysis of 29 studies (N = 1111 participants) examining the effect of exercise on BDNF levels in three exercise paradigms: (1) a single session of exercise, (2) a session of exercise following a program of regular exercise, and (3) resting BDNF levels following a program of regular exercise. Moderators of this effect were also examined. Results demonstrated a moderate effect size for increases in BDNF following a single session of exercise (Hedges' g = 0.46, p < 0.001). Further, regular exercise intensified the effect of a session of exercise on BDNF levels (Hedges' g = 0.59, p = 0.02). Finally, results indicated a small effect of regular exercise on resting BDNF levels (Hedges' g = 0.27, p = 0.005). ... Effect size analysis supports the role of exercise as a strategy for enhancing BDNF activity in humans
• From Neurobiological effects of physical exercise: Szuhany KL, Bugatti M, Otto MW (October 2014). "A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor". J Psychiatr Res. 60C: 56–64. doi:10.1016/j.jpsychires.2014.10.003. PMC 4314337. PMID 25455510. Consistent evidence indicates that exercise improves cognition and mood, with preliminary evidence suggesting that brain-derived neurotrophic factor (BDNF) may mediate these effects. The aim of the current meta-analysis was to provide an estimate of the strength of the association between exercise and increased BDNF levels in humans across multiple exercise paradigms. We conducted a meta-analysis of 29 studies (N = 1111 participants) examining the effect of exercise on BDNF levels in three exercise paradigms: (1) a single session of exercise, (2) a session of exercise following a program of regular exercise, and (3) resting BDNF levels following a program of regular exercise. Moderators of this effect were also examined. Results demonstrated a moderate effect size for increases in BDNF following a single session of exercise (Hedges' g = 0.46, p < 0.001). Further, regular exercise intensified the effect of a session of exercise on BDNF levels (Hedges' g = 0.59, p = 0.02). Finally, results indicated a small effect of regular exercise on resting BDNF levels (Hedges' g = 0.27, p = 0.005). ... Effect size analysis supports the role of exercise as a strategy for enhancing BDNF activity in humans.

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT⚡ 02:16, 6 June 2020 (UTC)

Fixed. Schazjmd (talk) 13:16, 6 June 2020 (UTC)

Semi-protected edit request on 21 September 2020

Can I edit this page? I need to do it for a class Maddiedelcambre (talk) 03:24, 21 September 2020 (UTC)

Hi Maddiedelcambre, and welcome to Wikipedia! The exercise article is semi-protected, so that only editors who have made ten edits and whose accounts are four days old or more can edit it. If you want to make changes to exercise before you meet those criteria, then you can make an edit request like the one that you made here. Please note that edit requests should only be made for the purposes of proposing specific, unambiguous changes to the article. If you need more general help with editing you could ask at the teahouse, and I will leave a welcome message on your personal talk page with some helpful links to look at. Best wishes, Wham2001 (talk) 07:07, 21 September 2020 (UTC)

History balance

According to [1], it appears at times people have worried that exercise is harmful, for example that it would cause overheating, or make women less fertile. Or (for the Catholic Church) be bad for the soul? This could use some tracking down so this section is more balanced. -- Beland (talk) 07:38, 22 August 2021 (UTC)

What's with refs?

Is there any reason some of the refs contain part/all of the journal article abstracts? David notMD (talk) 15:51, 15 September 2021 (UTC)

Constructive Exercise

Constructive Exercise

-Intellectually performed productive labour is called constructive exercise

-Non productive exercise leads to moral deterioration

-John Ruskin (1819-1900) Mnkabra (talk) 11:16, 26 October 2021 (UTC)

And Philosophy

Please review, if okay, add new section,Arnold,45.49.226.155 (talk) 21:50, 27 November 2018 (UTC)

References

Constructive Exercise:-

-Intellectually performed productive labour is called constructive exercise

-Non productive exercise leads to moral deterioration

-John Ruskin (1819-1900) Mnkabra (talk) 11:19, 26 October 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Clarissa Perry. Peer reviewers: Clarissa Perry.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 21:01, 16 January 2022 (UTC)