The COVID-19 pandemic remains a global problem that affects the health of millions of people and the world economy. Identifying how the movement of people between regions of the world, countries, and municipalities and how the close contact between individuals of different age groups promotes the spread of infectious diseases is a pressing concern for society, during epidemic outbreaks and pandemics, such as COVID-19. Networks and Graph Theory provide adequate and powerful tools to study the spread of communicable diseases. In this work, we use Graph Theory to analyze COVID-19 transmission dynamics between municipalities of Aveiro district, in Portugal, and between different age groups, considering data from 2020 and 2021, in order to better understand the spread of this disease, as well as preparing actions for possible future pandemics. We used a digraph structure that models the transmission of SARS-CoV-2 virus between Aveiro’s municipalities and between age groups. To understand how a node fits over the contact digraphs, we studied centrality measures, namely eigencentrality, closeness, degree, and betweenness. Transmission ratios were also considered to determine whether there were certain age groups or municipals that were more responsible for the virus’s spread. According to the results of this research, transmissions mostly occur within the same social groupings, that is, within the same municipalities and age groups. However, the study of centrality measures, eliminating loops, reveals that municipalities such as Aveiro, Estarreja and Ovar are relevant nodes in the transmission network of municipalities as well as the age group of 40–49 in the transmission network of age groups. Furthermore, we conclude that vaccination is effective in reducing the virus.

Purpose 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.

Surgical 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).

Surgical 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.

Background: Clinical guidelines recommend prehabilitation with exercise training to optimize recovery after lung cancer surgery. However, the lack of access to facility-based exercise programs is a major barrier to routine participation. This study aimed to assess the feasibility of a home-based exercise intervention before lung cancer resection. Methods: We conducted a prospective, two-site feasibility study, including patients scheduled for lung cancer surgery. Exercise prescription involved aerobic and resistance training with telephone-based supervision. The primary endpoint was overall feasibility (recruitment rate, retention rate, intervention adherence and acceptability). Secondary endpoints included safety and effects on health-related quality of life (HRQOL) and physical performance, evaluated at baseline, after the exercise intervention and 4–5 weeks after surgery. Results: Over three months, 15 patients were eligible, and all agreed to participate (recruitment rate: 100%). A total of 14 patients completed the exercise intervention, and 12 patients were evaluated postoperatively (retention rate: 80%). The median length of the exercise intervention was 3 weeks. Patients performed an aerobic and resistance training volume higher than prescribed (median adherence rates of 104% and 111%, respectively). A total of nine adverse events occurred during the intervention (Grade 1, n = 8; Grade 2, n = 1), the most common being shoulder pain. After the exercise intervention, significant improvements were observed in the HRQOL summary score (mean difference, 2.9; 95% confidence interval [CI], from 0.9 to 4.8; p = 0.049) and the five-times sit-to-stand test score (median difference, −1.5; 95% CI, from −2.1 to −0.9; p = 0.001). After surgery, no significant effects on HRQOL and physical performance were observed. Conclusion: A short-term preoperative home-based exercise intervention is feasible before lung cancer resection and may enhance accessibility to prehabilitation. Clinical effectiveness should be investigated in future studies.

Background. 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.

O 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.

Introdução: 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.

Purpose: 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.