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Objective Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the ATOPE (Tailored Therapeutic Exercise and Recovery Strategies) program, performed before treatment (ATOPE-B), can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment (ATOPE-I) in recently diagnosed breast cancer patients. Methods The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. 120 women recently diagnosed with breast cancer, in risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomised to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of subjects, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, anthropometric outcomes, biological and hormonal variables, will be also assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends. Conclusion Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physiotherapists have an important role in this mitigation. If the ATOPE-B intervention returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program.

Physical exercise is known to be beneficial for breast cancer survivors (BCS). However, avoiding nonfunctional overreaching is crucial in this population, as they are in physiological dysregulation. These factors could decrease their exercise capacity or facilitate nonfunctional overreaching, which can increase their risk of additional morbidities and even all-cause mortality. The focus of this study is to evaluate the reliability and validity of the ATOPE+ mHealth system to estimate autonomic balance and specific wellness parameters associated with BCS’ perceived load, thereby informing nonlinear prescriptions in individualized physical exercise programs for BCS.Twenty-two BCS were included in the reliability and validity analysis. Measures were taken for four days, including morning autonomic balance by heart rate variability, self-reported perception of recovery from exercise, sleep satisfaction, emotional distress and fatigue after exertion. Measures were taken utilizing the ATOPE+ mHealth system application. The results of these measures were compared with criterion instruments to assess validity.The reliability results indicated that the intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85–0.96) and distress (0.94, 95% CI 0.89–0.97) as well as good correlation for the natural logarithm of the mean square root differences of the standard deviation (LnRMSSD) (0.87; 95% CI 0.74–0.94). Sleep satisfaction also showed an excellent correlation with a weighted kappa of 0.83. The validity results showed no significant differences, except for fatigue. ATOPE+ is reliable and valid for remotely assessing autonomic balance, perception of recovery, sleep satisfaction and emotional distress in BCS; however, it is not for fatigue. This highlights that ATOPE+ could be an easy and efficient system used to assess readiness in BCS, and could help to improve their health by supporting the prescription of optimal and safe physical exercise. Trial registration NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]. https://clinicaltrials.gov/ct2/show/NCT03787966.

BACKGROUND Heavy physical and mental loads are typical for professional soccer players during the competitive season. COVID-19 lockdowns had recently forced competitions to be interrupted and later disputed in a shrunken calendar. Wearable sensors and mobile phones could be potentially useful in monitoring players’ training load in such highly demanding environments. OBJECTIVE The aim of this study was to explore whether remote heart rate variability (HRV) monitoring and self-reported wellness of professional soccer players could be useful to monitor players’ internal training load and to estimate their performance during the continuation of the 2020 season after the COVID-19 lockdown in Spain. METHODS A total of 21 professional soccer players participated in a 6-week study. Participants used an Android or iOS-based smartphone and a Polar H10 wearable ECG monitor for the duration of the study. Every morning they recorded their HRV and answered a questionnaire about their perceived recovery, muscle soreness, stress and sleep satisfaction. Smallest worthwhile change (SWC) and coefficient of variation (CV) were calculated for the logarithm of the root mean square of the successives differences (LnRMSSD) of the HRV. Players’ in-game performance was evaluated subjectively by independent observers and classified as high, normal and low. In order to find which variables could be potentially linked to performance, we studied their correlation and tested for significant differences among distributions. We also trained random forest models with cross-validation and bootstrapping to find the wellness and HRV features with best predictive ability for performance. RESULTS We found the usability of Readiness Soccer in a real scenario to be very good, with 81.36 points in the System Usability Scale. A total of 241 measurements of HRV and self-reported wellness were recorded. For a entire training microcycle (ie, time in between matches), self-reported high recovery (Mann-Whitney U, P=.003), low muscle soreness (P=.002), high sleep satisfaction (P=.02), low stress (Anderson-Darling, P=.03), and not needing more than 30 minutes to sleep since going to bed (Chi-Squared, P=.02), were found significant to differentiate high from normal match performance. Performance estimation models achieved the highest accuracy (73.4%) when combining self-reported wellness and HRV features. CONCLUSIONS HRV and self-reported wellness data were useful to monitor the evolution of professional soccer players’ internal load and to predict match performance levels out of measures in a training microcycle. Despite the limitations, these findings highlight opportunities for long-term monitoring of soccer players during the competitive season as well as real-time interventions aimed at early management of overtraining and boosting individual performance.

BACKGROUND Physical exercise is already known to be beneficial for women who have or had breast cancer. However, avoiding overreaching or insufficient recovery in this population is important, as they are in a situation of physiological vulnerability due to cancer and its treatments, a similar state to what appears during overtraining in athletes. These alterations could lead breast cancer survivors to decrease their exercise capacity or favour overreaching, which maintained over time, would alter their homeostasis, increasing their vulnerability to illness and death. OBJECTIVE The study aims to evaluate the validity and reliability of ATOPE+ mHealth system, developed for Android/iOS mobile operating systems, to estimate autonomic balance and other wellness parameters that influence internal load, with the idea to facilitate nonlinear prescription, assessing readiness in breast cancer survivors. METHODS Twenty-two breast cancer survivors were included in the validity and reliability analysis. The participants measured during four days their morning autonomic balance, perception of recovery, sleep satisfaction, emotional distress and fatigue; with ATOPE+ mHealth system and with reliable comparison tools. RESULTS The validity results showed no significant differences, except for fatigue. The reliability results indicated an intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85-0.96) and distress (0.94, 95% CI 0.89-0.97) and good for LnRMSSD (0.87; 95% CI 0.74-0.94) and fatigue (0.86, 95% CI 0.29-0.95). Sleep satisfaction also showed excellent correlation with a Weighted kappa=0.83. CONCLUSIONS ATOPE+ is valid and reliable to remotely assess autonomic balance, perception of recovery, sleep satisfaction and emotional distress in breast cancer survivors; however, it is not for fatigue. This highlights that ATOPE+ could potentially be an easy and fast system used to measure tailored readiness in breast cancer survivors. ATOPE+ will offer a tool to improve health in this population, by helping rehabilitation professionals to prescribe optimal and safe physical exercise. Moreover, ATOPE+ may provide reliable data-driven analysis with machine learning algorithms, as originally described in its architecture. CLINICALTRIAL NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]