Sandy Jack

University of Southampton · Faculty of Medicine

Redox dysregulation and oxidative stress were implicated in asthma pathogenesis. Exercise interventions improve symptoms and reduce inflammation in asthma patients, but the underlying mechanisms remain unclear. We hypothesized that a personalised exercise intervention improves asthma control by reducing lung inflammation through modulating local an...

p>Acute mountain sickness (AMS) occurs when there is failure of acclimatisation to high altitude. The aim of this study was to describe the relationship between physiological variables and the incidence of AMS during ascent to 5300 m. A total of 332 lowland-dwelling volunteers followed an identical ascent profile on staggered treks. Self-reported s...

Group pre-operative education has usually been limited to conditioning expectations and providing education. Prehabilitation has highlighted modifiable lifestyle factors that are amenable to change and may improve clinical outcomes. We instituted a pre-operative 'Fit-4-Surgery School' for patients scheduled for major surgery, to educate and promote...

Background: The use of preoperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative outcomes is increasingly prevalent. CPET-derived information enables personalised perioperative care and enhances shared decision-making. Sex-related differences in physical fitness are reported in non-perioperative literature....

A video abstract is available at https://youtu.be/LYJPmWunnKE

Introduction and objectives Exercise intervention may modulate the inflammation responsible for asthma, offering clinical benefit beyond functional improvement. Interval training is tolerated in asthmatics, and may also improve symptom control. This proof of concept study has recruited sub optimally controlled, untrained asthmatics to a 12-week Int...

Purpose: We evaluate the effect of an exercised prehabilitation programme on tumour response in rectal cancer patients following neoadjuvant chemoradiotherapy (NACRT). Patients and Methods: Rectal cancer patients with (MRI-defined) threatened resection margins who completed standardized NACRT were prospectively studied in a post hoc, explorative an...

Background: People undergoing multimodal cancer treatment are at an increased risk of adverse events. Physical fitness significantly reduces following cancer treatment, which is related to poor postoperative outcome. Exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capa...

Introduction Many asthmatics remain symptomatic despite optimized medical therapy. New treatments are needed that are scalable at minimal cost. Pulmonary rehabilitation is established in respiratory disease, and emerging data suggests that prescribed exercise intervention may modulate the immune and inflammatory basis for asthma, offering clinical...

Purpose: Aerobic exercise improves prognosis and quality of life (QoL) following completion of chemotherapy. However, the safety and efficacy of aerobic exercise during chemotherapy is less certain. A systematic review was performed of randomised trials of adult patients undergoing chemotherapy, comparing an exercise intervention with standard car...

The use of perioperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative events and inform the perioperative management of patients undergoing surgery has increased over the last decade. CPET provides an objective assessment of exercise capacity preoperatively and identifies the causes of exercise limitation. T...

There is a consistent relationship between physical activity, physical fitness, and health across almost all clinical contexts, including the perioperative setting. Physiological measurements obtained during physical exercise may be used to infer the risk of adverse outcome after major surgery. In particular, data obtained from perioperative cardio...

Background: Promoting quality of life (QoL) is a key priority in cancer care. We investigated the hypothesis that, in comparison to usual care, exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain, fatigue, and insomnia, and will improve physical and mental health perceptions in patients with locally advance...

Background: In 2014 approximately 21,200 patients were diagnosed with oesophageal and gastric cancer in England and Wales, of whom 37 % underwent planned curative treatments. Potentially curative surgical resection is associated with significant morbidity and mortality. For operable locally advanced disease, neoadjuvant chemotherapy (NAC) improves...

Increasingly end-organ injury is being demonstrated late after institution of the Fontan circulation, particularly liver fibrosis and cirrhosis. The exact mechanisms for these late phenomena remain largely elusive. Hypothesizing that exercise induces precipitous systemic venous hypertension and insufficient cardiac output for the exercise demand, i...

Purpose: There is wide inter-institutional variation in the interval between neoadjuvant chemoradiotherapy (NACRT) and surgery for locally advanced rectal cancer. We aimed to assess the association of magnetic resonance imaging (MRI) at 9 and 14 weeks post-NACRT; T-staging (ymrT) and post-NACRT tumour regression grading (ymrTRG) with histopatholog...

Background: In single-centre studies, postoperative complications are associated with reduced fitness. This study explored the relationship between cardiorespiratory fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after major elective colorectal surgery. Methods: Patients underwent preoperative CPET...

Background: Patients with low fitness as assessed by cardiopulmonary exercise testing (CPET) have higher mortality and morbidity after surgery. Preoperative exercise intervention, or prehabilitation, has been suggested as a method to improve CPET values and outcomes. This trial sought to assess the capacity of a 4-week supervised exercise programm...

The standard treatment pathway for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Neoadjuvant CRT has been shown to decrease physical fitness, and this decrease is associated with increased post-operative morbidity. Exercise training can stimulate skeletal muscle adaptations such as increased mitochondria...

Neoadjuvant cancer treatment decreases physical fitness. Low levels of physical fitness are associated with poor surgical outcome. Exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity that may contribute to improving physical fitness. This systematic review evaluate...

Background: Perioperative beta-blockade is widely used, especially before vascular surgery; however, its impact on exercise performance assessed using cardiopulmonary exercise testing (CPET) in this group is unknown. We hypothesized that beta-blocker therapy would significantly improve CPET-derived physical fitness in this group. Methods: We rec...

Beta-blockers have a key role in the management of heart failure but have been under-utilised in people with COPD due to fear of bronchoconstriction and its impact on symptoms and function. Beta-blockers are also used peri-operatively in people undergoing vascular surgery due to improved cardiac function though this practice is contentious due to a...

Introduction Patients are frequently prescribed β-blockers for heart failure, ischaemic heart disease and peri-operatively, especially for vascular surgery. However, β-blockers remain under prescribed in patients with COPD despite epidemiological evidence indicating little negative impact. This reluctance to use β-blockers is due to concerns about...

Background Neoadjuvant chemotherapy (NAC) followed by surgery for resectable oesophageal or gastric cancer improves outcome when compared with surgery alone. However NAC has adverse effects. We assess here whether NAC adversely affects physical fitness and whether such an effect is associated with impaired survival following surgery. Methods We pr...

Background Patients requiring surgery for locally advanced rectal cancer often additionally undergo neoadjuvant chemoradiotherapy (NACRT), of which the effects on physical fitness are unknown. The aim of this feasibility and pilot study was to investigate the effects of NACRT and a 6 week structured responsive exercise training programme (SRETP) on...

Background: Cardiopulmonary exercise testing (CPET) assessed "poorer" fitness correlates with poorer outcomes in blinded studies. Whether this correlation will persist when CPET is utilized to stratify care as part of a multi-modal enhanced recovery after surgery (ERAS) program is unclear. This study examined whether CPET variables were associated...

Background: This study investigated the relationship between objectively measured physical fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after rectal cancer surgery. Methods: Patients scheduled for rectal cancer surgery underwent preoperative CPET (reported blind to patient characteristics) with r...

Neoadjuvant chemoradiotherapy (NACRT) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone. Our primary hypothesis was that NACRT impairs objectively-measured physical fitness. We also wished to explore the relationship between fitness and postoperative outcome. In an observational study, we...

The fully updated third edition of this popular handbook provides a concise summary of perioperative management of high-risk surgical patients. Written by an international group of senior clinicians, chapters retain the practical nature of previous editions, with concise text in a bulleted format offering rapid access to key facts and advice. Sever...

/st>Postoperative complications are associated with reduced fitness. Cardiopulmonary exercise testing (CPET) has been used in risk stratification. We investigated the relationship between preoperative CPET and in-hospital morbidity in major colonic surgery. /st>We prospectively studied 198 patients undergoing major colonic surgery (excluding neoadj...

/st>Cardiopulmonary exercise testing by cycle ergometry (CPETleg) is an established assessment tool of perioperative physical fitness. CPET utilizing arm ergometry (CPETarm) is an attractive alternative in patients with lower limb dysfunction. We aimed to determine whether oxygen uptake obtained by CPETleg could be predicted by using CPETarm alone...

The purpose of this longitudinal study was to explore advanced rectal cancer patients' perceptions of quality of life (QoL) during participation in a pre-surgery structured exercise program. Patients (n = 10) participated in repeated semi-structured in-depth interviews which covered four broad QoL domains (i.e., physical, psychological, social, and...

There have been significant advances in the management and treatment of lung cancer over the last 10–20 years, but surgical resection remains the primary treatment that results in cure and long-term survival. However, factors that predispose to the development of lung cancer also increase the incidence of chronic obstructive pulmonary disease. Phys...

Reduced physical fitness is associated with increased risk of complications after intra-cavity surgery. Aerobic exercise training interventions improve physical fitness in clinical populations. However, it is unclear whether implementing a preoperative aerobic exercise training intervention improves outcome after intra-cavity surgery. We conducted...

IntroductionChronic idiopathic hyperventilation (CIH) is a form of dysfunctional breathing that has proven hard to treat effectively. Objectives To perform a preliminary test of the hypothesis that by periodically inducing normocapnia over several weeks, it would be possible to raise the normal resting level of CO2 and achieve a reduction of sympto...

Objective: Thoraco-abdominal asynchrony (TAA), the discordant movement of the abdomen and thorax, may impact upon health-related variables. Here, we investigated the extent to which TAA is associated with health-related variables, particularly perceived asthma control and quality of life. Methods: Ambulatory respiratory data from 43 patients dia...

Introduction Cardiopulmonary Exercise Testing (CPET) is a non-invasive test that has been used to identify patients at higher perioperative risk. Studies have found that different CPET variables seem to be more predictive in different patient groups. There is little literature on the use of CPET within the HPB field, and no series concentrating on...

Introduction Rehabilitation exercise programs improve recovery from surgery and quality of life. Prehabilitation improves fitness prior to surgery. This is challenging before liver resection as patients tend to be sedentary and time is limited. Our aim was to design a 4 week program, suitable for sedentary individuals, which would yield a 1.5 ml/kg...

Introduction Hepatectomy offers the only possibility of cure to patients with colorectal liver metastases (CRLM) and although 50% of CRLM patients are >70, only 25% of those undergoing hepatectomy are >70.1 This is likely to be due to the higher perioperative mortality. Cardiopulmonary exercise testing (CPET) can identify patients at higher operati...

The increasing number of older cancer patients seen in daily practice demands reflection on how to optimize their care during the perioperative period. Optimally tailored surgical management, at present the most successful cancer treatment, firmly rests on an accurate and careful anesthesiological management.The unique peculiarities of anesthesia i...

The elderly constitute an increasingly large segment of the population and of the patients requiring medical attention. Major surgery is associated with a substantial burden of postoperative morbidity and mortality. Advancing age is a particular risk factor for these outcomes. This article reviews the current literature on the value and practical a...

The association between physical fitness and outcome following major surgery is well described - less fit patients having a higher incidence of perioperative morbidity and mortality. This has led to the idea of physical training (exercise training) as a perioperative intervention with the aim of improving postoperative outcome. Studies have started...

Household air pollution from burning biomass fuel is increasingly recognised as a major global health concern. Biomass smoke is associated with chronic obstructive pulmonary disease (COPD) in Asian and Central American countries, but there are few data from Africa. We hypothesised that reported wood smoke as compared to charcoal smoke exposure woul...

COPD patients have reduced muscle glutamate which may contribute to an impaired response of oxidative metabolism to exercise. We hypothesised that prior glutamine supplementation would enhance V(O2) peak, V(O2) at lactate threshold and speed pulmonary oxygen uptake kinetics in COPD. 13 patients (9 males, age 66±5 years, mean±SD) with severe COPD (m...

The elderly constitute an increasingly large segment of the population and of the patients requiring medical attention. Major surgery is associated with a substantial burden of postoperative morbidity and mortality. Advancing age is a particular risk factor for these outcomes. This article reviews the current literature on the value and practical a...

Patients with respiratory disease use many different expressions to describe the sensation they experience as breathlessness. Although previous analyses have identified multiple dimensions of breathlessness, there is little agreement about their number and nature. This study has applied a novel approach, principal component analysis (PCA), to under...

Little is known of the language healthcare professionals use to describe cough sounds. We aimed to examine how they describe cough sounds and to assess whether these descriptions suggested they appreciate the basic sound qualities (as assessed by acoustic analysis) and the underlying diagnosis of the patient coughing. 53 health professionals from t...

Idiopathic hyperventilation (IH) is a condition of uncertain aetiology characterized by sustained arterial and alveolar hypocapnia and a plethora of symptoms, the most commonly reported being shortness of breath, and breathlessness. We previously reported that anxiety increases respiratory frequency and minute ventilation with no change in metaboli...

Idiopathic hyperventilation (IH) is a poorly understood condition of sustained hypocapnia and controversial etiology. Although behavioral/emotional factors may contribute, it is uncertain whether chemosensitivity is altered, hyperventilation is maintained during exercise, and the associated breathlessness reflects the hyperventilation. In 39 patien...

Idiopathic hyperventilation has been defined as a respiratory-related psychophysiological complaint. This study attempted to clarify relationships between psychological and physiological variables in this condition. Participants demonstrated increased anxiety, depression, and symptoms consistent with hyperventilation. This was associated with a red...

Hyperventilation was first described in the middle of the 19th century, with soldiers in the American Civil war complaining of symptoms originally thought to be cardiac in nature1. However, these symptoms were later discovered to be identical to idiopathic hyperventilation. Since this time there has been limited published data and little consensus...

In healthy subjects exercising, ventilation increases linearly with increasing workload until the increased metabolic production of lactic acid leads to a faster rate of rise of ventilation. We observed anecdotally that this increased ventilation was not present in idiopathic hyperventilation (IH) and have examined this formally in a group of 26 pa...

In idiopathic hyperventilators (IH), subjects ventilate at a level in excess of their metabolic requirements leading to alkalosis and low PetCO2 . It is difficult in clinical studies to separate the effects of hyperventilation from those due to the chemical changes. We have designed a biased flow circuit that adds 100% carbon dioxide into the inspi...

Howell (Thorax 1997) described a disorganised pattern of breathing that was unrelated to, and in excess of metabolic demands in idiopathic hyperventilation (IH). We have assessed this phenomenon using breath by breath variations in ventilatory equivalent for oxygen (ventilation (VE)/ oxygen consumption (VO2)) in a group of 36 normal subjects (mean...

The relationship of PetCO2 and arterial PCO2 is known to vary with breathing frequency and tidal volume and a correction factor was described by Jones (1979). Other data from North America (Whipp, 1994) have been inconsistent. We have reexamined the relationship. First, serial blood gas sampling via a radial arterial line on exercise (rest, steady-...

Ten patients with idiopathic hyperventilation defined as an end-tidal CO2 (PETCO2) level of less than 30mmHg for more than 1 minute during exercise performed two maximal exercise tests (cycle ergometer) one week apart. During the second exercise test controlled CO2 replacement to keep the PETCO2 between 36 and 40mmHg throughout exercise was carried...

Aims: We aim to develop a strategy for the identification and management of high risk patients undergoing head and neck cancer surgery in order to attempt to reduce both morbidity and mortality and to identify required levels of post-operative care. Background: Head and Neck cancer affects an elderly population with significant smoking and alcohol...