Purpose : This randomized cross‐over group pilot trial assessed feasibility of recruiting survivors from a long‐term follow‐up clinic to an exercise group and measured whether outdoor or indoor exercise sessions better supported exercise motivation and behaviors in survivors of cancer. Methods : Sixteen adolescent and young adult survivors of any cancer completed indoor and outdoor exercise sessions in this randomized cross‐over pilot trial. Measures of physical activity, motivation, and fatigue were taken 2 weeks before and 2 weeks after indoor sessions and 2 weeks before and 2 weeks after outdoor sessions. Measures of physical activity and fatigue were also taken during each exercise session. Results : Initial recruiting of 19 participants met recruiting goals. Survivors who attended the most sessions lived an average of 8.7 km closer to the clinic. Objectively measured physical activity intensity was 0.63 metabolic equivalents of a task (METs) per minute greater during outdoor exercise sessions as compared to indoor exercise sessions. There were no meaningful differences in long term, habitual physical activity behavior, motivation, or fatigue in the weeks following the outdoor exercise sessions as compared to the indoor exercise sessions. Conclusions : This study shows the feasibility of recruiting survivors from a long‐term follow‐up clinic to community‐based exercise groups. Although this brief pilot intervention did not show significant effects on habitual physical activity behavior or motivation in adolescent and young adult survivors of cancer, the greater exercise intensity during the outdoor exercise sessions indicate that holding group exercise sessions for survivors outdoors may promote greater intensity during exercise.

Background and study aim Cold snare endoscopic mucosal resection (CS-EMR) can reduce some of the risks associated with electrocautery use during colon polyp resection. Data regarding efficacy have yielded variable results. We conducted a systematic review and meta-analysis to estimate the pooled efficacy and safety rates of CS-EMR. Patients and methods We conducted a literature search of multiple databases for studies addressing outcomes of CS-EMR for colon polyps from inception through March 2023. The weighted pooled estimates with the 95% confidence interval (95% CI) were calculated using the random effects model. I2 statistics was used to evaluate heterogeneity. Results 4137 articles were reviewed, and 16 studies met the inclusion criteria. 2584 polyps were removed from 1930 patients and48.9% were females. 54.4% were adenomas, 45% were sessile serrated lesions (SSLs), and 0.6% were invasive carcinoma. Polyp recurrence after CS-EMR was 6.7% (95% CI: [2.4-17.4%], I2=94%). The recurrence rate for polyps ≥ 20 mm was 12.3% (95% CI: [3.4-35.7%], I2= 94.%), 17.1% (95% CI: [4.6-46.7%], I2= 93%) for adenomas, and 5.7% (95% CI: [3.2-9.9%], I2= 50%) for SSLs. The pooled intraprocedural bleeding rate was 2.6% (95% CI: [1.5-4.4%], I2=51%), the delayed bleeding rate was 1.5% (95% CI: [0.9-2.8%], I2=20%) and no perforations or post-polypectomy syndromes were reported with estimated rates of 0.6% (95% CI: [0.3-1.2%], I2=0%) and 0.6% (95% CI: [0.2-1.3%], I2=0%), respectively. Conclusion CS-EMR demonstrated an excellent safety profile for colon polyps with variable recurrence rates based on polyp size and histology. Large prospective studies are needed to validate these findings.

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