Transparent Development of the WHO Rapid Advice Guidelines Exercise for people with cancer: a clinical practice guideline. The Canadian National Breast Screening Study: responses to controversy. Outcomes and process evaluation of a programme integrating physical activity into the primary school mathematics curriculum: The EASY Minds pilot randomised controlled trial.
Emerging health problems require rapid advice . We describe the development and pilot testing of a systematic , transparent approach used by the World Health Organization ( WHO ) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A ( H5N1 ) virus infection . We first search ed for systematic review s of r and omized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection , including case reports and animal and in vitro studies . A panel of clinical experts , clinicians with experience in treating patients with H5N1 , influenza research ers , and method ologists was convened for a two-day meeting . Panel members review ed the evidence prior to the meeting and agreed on the process . It took one month to put together a team to prepare the evidence profiles ( i.e. , summaries of the evidence on important clinical and policy questions ) , and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting . A draft manuscript for publication was prepared within 10 days following the panel meeting . Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines . The process could be improved by shortening the time required to commission evidence profiles . Further development is needed to facilitate stakeholder involvement , and evaluate and ensure the guideline 's usefulness BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients A t least since 1985 , there has been concern in some quarters that the Canadian National Breast Screening Study ( NBSS ) results 1'2 would fail to show a benefit from combined mammographic and clinical screening for breast cancer in women age 40 - 49 years . In the United States , in the spring of 1992 , the controversy about the benefits of screening women age 40 - 49 for the early detection of breast cancer erupted in the media . 3 - 7 The center of attention was the unpublished results of the NBSS . However , the center of controversy is the conflicting guidelines on breast screening for women age 40 - 49 . The very familiar guidelines of the American Cancer Society and the American College of Radiology ( ACR ) exhort women in this age group to " do themselves a favor " and get a mammogram . Although a number of prestigious professional associations have chosen to endorse these guidelines , others have not , including the US Preventive Services Task Force , the American College of Physicians , the Canadian Workshop Group , 8 the National Cancer Institute of Canada , an expert panel in the United Kingdom , 9 and the European Group for Breast Screening . 1 ° To underst and the nature of the controversy , it is helpful to review both the NBSS and published evidence from other screening studies . The Canadian NBSS was design ed to answer two major questions J , 2 First , in women age 40 - 49 , does annual mammography combined with annual physical examination of the breast for 3 or 4 years reduce the mortality rate from breast cancer as compared with a single physical examination alone ? Second , in women age 50 - 59 , how much does mammography contribute to mortality reduction over and above that achieved by physical examination alone when the comparison is annual mammography combined with physical examination versus annual physical examination alone ? The NBSS screened 89,835 women at 15 centers across Canada from 1980 - 1988 , with each woman individually r and omized to the mammography arm or the nonmammography arm of the study . Approximately 50,000 participants were 40 - 49 on entry and the remainder were 50 - 59 years of age . To be eligible , women were required to sign informed consent forms , to never have had a diagnosis of breast cancer , © 1992 by The Jacobs Institute of Women ' s Health 1049 - OBJECTIVES This study evaluated the feasibility of the ' Encouraging Activity to Stimulate Young ( EASY ) Minds ' programme , a school-based intervention for integrating physical activity ( PA ) into mathematics lessons . DESIGN R and omised controlled trial . METHODS Two classes from a single school ( n = 54 ) were r and omised to receive either the 6-week EASY Minds intervention ( n = 27 ) or follow their usual school programme ( n = 27 ) . The intervention involved the embedding of PA across the pre-existing mathematics programme for 3 × 60 min sessions per week  . Changes in PA were measured using accelerometers and ' on task ' behaviour was measured using momentary time sampling observation . RESULTS Using intention-to-treat analysis , significant intervention effects were found for MVPA ( 9.7 % , 95%CI = 7.6 , 11.8 , p ≤ 0.001 ) and sedentary time ( -22.4 % , CI = -24.9 , -12.2 , p ≤ 0.001 ) for the intervention group during Mathematics lessons ( 9.30 am-10.30 am ) . Significant intervention effects were also shown for MVPA 8.7 % ( 95 % CI = 5.8 , 11.6 , p ≤ 0.001 and sedentary time -18.6 % ( 95 % CI = -24.9 , -12.2 , p ≤ 0.001 ) across the whole school day . Furthermore , children displayed significantly greater ' on-task ' behaviour across the intervention period with a 19.9 % ( 95%CI = 2.4 , 37.4 , p ≤ 0.03 ) mean difference between groups . CONCLUSIONS The EASY Minds programme demonstrated that integrating movement across the primary mathematics syllabus is feasible and efficacious in enhancing school based-PA and improving on-task behaviour in mathematics lessons
Conclusions These guidelines represent a sensible evolution of public health guidelines whereby optimal health is framed within the balance of movement behaviours across the whole day , while respecting preferences of end-users .
Background The Canadian Society for Exercise Physiology convened representatives of national organizations , research experts , method ologists , stakeholders , and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years ( 0–4 years ) : An Integration of Physical Activity , Sedentary Behaviour , and Sleep .
These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day ( 24-h period ) .