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Exercise as it relates to Disease/Can Table Tennis improve motor skills and executive functions in children with ADHD?

This article is a critical analysis of the paper: "Effects of Physical Exercise Intervention on Motor Skills and Executive Functions in Children With ADHD: A Pilot Study” (Pan et al, 2015).

What is the background to this research?

 * Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that causes attention issues, impulsive behaviour and hyperactivity. ADHD can interrupt a person’s ability to demonstrate age appropriate behavioural, cognitive function and can cause life-long educational, social and emotional issues. United States ADHD rates have increased in children between ages 12 and 17 according to data collected over 20 years by the National Health Interview Survey (NHIS). In 2016, the rate was 13.5% compared to 7.2% in 1997.
 * A 2011 study found children with ADHD had a higher risk of becoming obese due to high anxiety levels and poor social interactions contributing to poor cardiovascular function and physical inactivity. Medication and behavioural interventions can be effective treatments in treating ADHD, however, not all individuals will respond to pharmacological and behavioural treatments.
 * The study aimed to establish if physical activity such as table tennis which combines both cognitive and physical functions has a role in helping cognitive and executive functions in ADHD children. Earlier studies have shown physical activity can improve motor/neuropsychological performances, muscular capabilities, and social and behavioural problems. However, those studies mainly focused on aerobic exercise and the FITT principals (frequency, time and intensity) and not exercise based complex motor skills typical of an activity like table tennis.

Where is the research from?

 * The study was published in 2015 in Taiwan. It focussed on male children with and without ADHD between 7 and 12 years of age, recruited through media announcements, from local primary schools and paediatric facilities. No details about when the data collection was taken have been mentioned in the study.
 * Chien – Yu Pan is one of the authors. He is a professor at the National Kaohsiung Normal University within the Department of Physical Education in Taiwan. Pan along with his co-authors have been involved in many studies specialising in physical activity in people with autistic and neurodevelopmental disorders.
 * According to its authors, there was no conflicts of interest associated with the study to benefit on their behalf.

What kind of research was this?

 * The research was conducted as a pilot study. Pilot studies are small-scale studies conducted before a main study is executed. It is used to refine research methods, and to identify errors or issues within the project, and whether it is even feasible.

What did the research involve?

 * The study involved 3 groups of all male participants: a training group with ADHD, ADHD non-training group and non-ADHD non-training group. The study involved a 12-week table tennis program, twice a week for 70 mins with each session focusing on motor skills and executive functions.
 * The study used the TGMD-2 Test to exam motor skills of 3 to 10-year old which were broken down into locomotor (e.g. run, hop, jump) and object control skills (e.g. catch, throw, bat).
 * The Stroop colour and word test: was used to assess executive function. The aim of the task: is to name the colour but to ignore what is written. The amount of correct answers was calculated in 45 seconds.
 * To measure executive functions, a computerised version of the Wisconsin Card Sorting Test (WCST):

Limitations of the Study

 * The study only included a small sample size of all male participants aged 7 to 12 years which limits the generalisability of the results.
 * The medication dose and type were not controlled and could have varied between the participants. Controlling the medication could have provided a more accurate representation of the benefits of exercise on ADHD children.
 * The tests used in this study only explored limited assessments of motor skills and executive functions which meant a participant’s full abilities were not assessed.
 * In a future main study, these limitations could be addressed in order to provide a more useful and accurate representation of the benefits of exercise based complex motor skills on ADHD children.

What were the basic results?
*Pre and post-test = out of 48 marks

 * The ADHD training group significantly improved their locomotor and object-control baseline marks compared to the other groups, indicating exercise program had a positive effect on this population. The ADHD training group were able to increase their correct answers by 8.74 in 45 seconds in the Stroop test compared to marginal improvement in the non-training ADHD group. The ADHD training group improved significantly in total correct answers by 10.94 in the WCST test compared to 0.9 improvement achieved by other groups. In addition, it is possible at least some of the improvement in other groups may have been due to familiarity of test conditions.

What conclusions can we take from this research?

 * The study conclusions suggest sport specific physical exercise can be used as a beneficial intervention that provides a safe and positive change on motor skills and some functions in ADHD children. However, further research would be required to address the limitations of the study including the absence of females because it has been shown males and females have different strengths and weaknesses in cognitive functions.
 * A future area of study might identify if ADHD males and females react differently and if the benefits of exercise interventions are similar across genders. It also is not clear to what extent medication interfered with the results.

Practical advice
For people with ADHD:
 * Undertaking moderate intensity aerobic exercise for 40 minutes three times a week has shown to improve behavioural and cognitive responses in patients with ADHD.
 * Adopting exercise into a daily routine should help those with ADHD, however, if this amount cannot be achieved, starting with some exercise is always better than no exercise. A good starting point would be to follow the Australian Physical Activity Guidelines.

For future researchers interested in the benefits of exercise among those with ADHD there are several areas that could be explored:
 * For instance, determining if sport specific, aerobic or resistance training is more beneficial for ADHD children or whether such interventions could address other related issues such as obesity or high social anxiety. Understanding whether various ages and genders benefit from certain exercise interventions could also be explored.

Further information/resources
The following resources provide fact-sheets, further support, and research studies regarding the effects of exercise on ADHD:

 * ADHD Factsheets and infographics:

 * Exercise Improves Behavioural, Neurocognitive, and Scholastic Performance in Children with Attention-Deficit/Hyperactivity Disorder:

 * Australia's Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines:

 * Neuroelectric and Behavioural Effects of Acute Exercise on Task Switching in Children with Attention-Deficit/Hyperactivity Disorder:


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Exercise as it relates to Disease/Oxidation of fats due to green tea and sprinting intervals

This is a critique of an article on The combined effect of green tea and acute interval sprinting exercise on fat oxidation of trained and untrained males, published by Journal of exercise nutrition and biochemistry, 2016.

What is the background to this research?
The article covers the effects of green tea ingestion before short burst high intensity exercise on fat oxidation for energy use. There are many claims to the benefits of green tea including fat oxidation but this article puts these claims to the test. This is important for testing the validity of these statements and proper testing has put a broader understanding on these claims. These claims have real world importance because they may help athletes loose weight, they can help understand more about Biochemistry, it could help physical trainers to assist people with exercise related chronic diseases such as obesity and much more.

Where is the research from?
Research was conducted by a team from an Australian institutions writing in the journal of Exercise Nutrition & Biochemistry. The purpose of this was to gain a better understanding of what could be done to increase exercise performance and nutrition. All the authors are familiar to the field of exercise science and have written several articles relating to green tea and interval training between them. The focus of the journal of Exercise Nutrition & Biochemistry has bias to the idea of using nutritional evidence to help increase performance in exercise. This is good for the purpose of discovering the effects of green tea on interval training.

What kind of research was this?
The study conducted by this team on the effects of tea in interval sprint testing was a cross sectional study. This is because each male participant was given pills contains green tea while another group was given a placebo at the same time. This was further more divided into groups of trained and untrained males who where put through testing at the same time making this cross sectional study easier to handle. This is a good way to conduct this type of experiment although more participants could have been used. Cross section study was the best way to perform this type of test because only a general understanding of substance verses placebo is needed in different groups over a short period of time and does not require any long term testing and will not work if in a single group.

What did the research involve?
In the study 28 males where chosen at random half being trained individuals and the other half untrained. All of these participants where given a pill that contained green tea at different stages of the day. At a certain point they perform interval sprint tests on a bike and are compared against a placebo. This methodology was a very good approach but could have been better in some areas. Instead of just comparing fat oxidation against a placebo group they could have had other groups with different substances believed to be good for fat burning. A list of these substances include: - N-3 PUFA - Caffeine - hydroxycitrate Although the goal was to see the effects of green tea it would have been better to compare this to the above. The participants also could have been much more various and included groups such as long term smokers, males with obesity and female based groups to test a wider population.

What were the basic results?
It is stated that the fat oxidation in the group that ingested green tea pills was much higher both during and after exercise. These results are made by testing the following - power output was the same for both groups - Revolutions per minute was higher for the green tea group - pedal resistance was the same for both groups - Rate of perceived exertion was the same - lactate at seven minutes were the results that where similar - lactate at 20 minutes where the results were the same for untrained but the trained males who ingested tea had less. - heart rate which had no difference except for trained and untrained (trained having a much lower heart rate) - Vo2 was the same between green tea and placebo all the way up to 60 minutes. Although testing showed a higher fat oxidation in the green tea group the exercise was done over the course of a 20 minute period according to the results. It is very difficult to maintain a sprint for this long, meaning that data may not be accurate to the title. According to another article on Maximal Fat Oxidation During Exercise in Trained Men, an increase in intensity will see a decrease in fat oxidation. In the test conducted by using green tea versus placebo the sprint was spread over a 20 minute period making it more of an aerobic exercise meaning that sprinting after having consumed green tea may not be as effective as the title suggests. Although despite this, there is still plenty of proof that green tea enhances the effect of fat oxidation during exercise. It just may not be as efficient when done in high intensity training such as sprinting. There is no apparent over emphasis in this article and the results look to be correct.

What conclusions can we take from this research?
It is safe to say the green tea will increase fat oxidation during exercise although if people are willing to start this process they should still consider cardio and not sprint. Short burst high intensity exercises will never be as good for burning fat as moderate intensity long term exercise. Although green tea is good, there is no way to tell if it is better than other substances such as caffeine. According to the results in this article fat oxidation was increased by five times proving the point that green tea is still a reliable way to burn fat.

Practical advice
It is not clear if drinking green tea without exercise will still increase fat oxidation but anyone seeking to lose fat may want to start exercising as it is the most efficient and healthy way to lose weight with or without added substances. Long distance jogging after drinking green tea may be one of the best ways to lose weight. Weight lifting is a high intensity workout but will still be better for burning extra kilojoules than not performing exercise. There are more people who can benefit from this than just overweight populations. Green tea and exercise have many positive effects that extend beyond fat oxidation.

Further information/resources
Green tea can improve brain function, lower risk of cancer, lower risk of developing alzheimers, lower risk of type 2 diabetes and reduce the risk of cardiovascular disease.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


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Exercise as it relates to Disease/Effect of Hippotherapy on functionality in children with Cerebral Palsy

This Wikibooks critque was undertaken on the research article "Changes in Dynamic Trunk/Head Stability and Functional Reach after Hippotherapy" by Tim Shurtleff, John Standeven and Jack Engsberg. (2009)

Background to Research
Cerebral Palsy is a disease involving impaired voluntary movement or posture. This can result from Central Nervous System damage occurring perinatal or postnatal. This condition is non progressive and is discovered before the child reaches the age of 5. Ataxia, Spasticity, or involuntary movement are the symptoms presented with this disease. For children with this motor disease, functionality and movement are impaired causing everyday tasks and participation with peers to become difficult. This study explored the effect of horse riding, termed Hippotherapy has on children with Spastic Diplegia Cerebral Palsy in relation to their head and trunk stability as well as functional reach.

Where is the Research From?
This study was undertaken by Shurtleff, Standeven and Engsberg at the, Washington University School of Medicine in St. Louis as part of the Program in Occupational Therapy. It was published in Archives of Physical Medicine and Rehabilitation during 2009. Shurtleff is an instructor in Occupational Therapy and Neurosurgery. He has undertaken multiple studies on Hippotherapy and its effect on Cerebral Palsy patients. He has also undertaken research on the therapeutic effects of horse riding on other disabilities.

What Kind of Research was this?
The study design for this article was a case-control study as the design involved children who had Cerebral Palsy and a control group that did not have the disease. This article is also classified as an observational analytical design because it allows the testing of a hypothesis. The choice of type of study was efficient as it provided the researchers with a comparison of results for development of children without the disability. This ensured results were significant in decreasing the effect this disability has on the children’s lives. There were also Quasi-Experimental elements as the groups were not randomised as this was not required. The child either suffered from the disability or did not. One of the aims of this study was to develop a quantitative measure of changes to head and trunk stability after Hippotherapy intervention on children with Cerebral Palsy. Prior to this study, quantitative results had not been produced.1 This ensures a better interpretation of results produced when comparing before and after the intervention was undertaken.

What did the Research Involve?
11 children that are affected by the disability; Cerebral Palsy, aged from 5-17 years of age took part in this study. The control group, consisting of eight children were used as a comparison for children without disabilities for normative development values. This group matched the ages of the children with the disability. Occupational therapy sessions were carried out to identify specific disabilities and develop an individualised intervention for each participant. Although these assessments were done over three different locations, the same intervention tools were specified for this type of therapy which ensured normalisation. All children in this study underwent the same process to assess the effect of this therapy. The steps involved were; pre intervention test, individualised therapy routine and two post intervention tests. The pre and post intervention tests carried out the same procedure under video analysis to collect quantitative data used to determine if the therapy was successful. Pre intervention and the first post intervention were completed two weeks either side of the therapy. The second post intervention test was completed 12-14 weeks after therapy where subjects had not ridden during this period. Pre and post intervention tests were undertaken in a lab-based environment, replicating the movement of the horse using a barrel. This procedure was undertaken as motion analysis systems are not portable so would not give accurate results in a riding area. The actual Hippotherapy sessions undertaken involved; This occurs while; Subject Inclusion criteria included; Subject Exclusion criteria included;
 * 45-minute horse riding sessions, once per week for 12 continuous weeks
 * Performed in the walk and trot gait
 * The horse is directed by the handler to stop, start, change speed or gait, weave through cones, turn in circles or navigate over different terrain.
 * The child is engaged in changes in position on the saddle (eg sideways or backwards facing, kneeling and quadruped)
 * Cognitive games such as memory tasks or finding objects around the riding area
 * Catching/throwing games and placing objects on stationary surfaces
 * Functional reaching and stretching tasks through each plane of motion
 * Be able to sit on a static surface unaided, be able to communicate and follow instructions,
 * Be able to sit on the horse and testing barrel by abduction of the hip,
 * Be available for the duration of the study, specified at 26 weeks.
 * Any significant history of riding horses or participated in this type of therapy prior to this study,
 * Neuromuscular impairments such as cognitive, attentional, sensory or psychosocial
 * Uncorrected visual impairments,
 * Prior surgery or any planned therapeutic surgeries or medical interventions during the length of the study.

What Were the Basic Results?
Beneficial results were shown for children with Cerebral Palsy after the Hippotherapy undertaken in this study. Head angle and movement variability indicating muscular control improved when comparing the results of the pre and post intervention tests. This improvement was also maintained after therapy ceased, between post intervention one and post intervention two. Reduction of anterior/posterior translation and reduced horizontal translation was also seen through video analysis. This was measured by two reflective markers on the head and one on the spine at C7. Head and trunk stability and control were assessed by the amount of movement of the upper portion of the body caused by movement of the pelvis. Functional reach showed to be positively affected by therapy through time taken and Reach Path Ratio (Straightness over distance) decreasing. Although the subjects with Cerebral Palsy were significantly different to the control group, the results showed movement towards normal function after therapy. These beneficial results are also displayed by the children after the Hippotherapy has ceased. After a three month lapse in therapy increased muscular control was still evident through results of post intervention test two.

Conclusions
From the evidence of this research, this type of therapy can be beneficial for children with Cerebral Palsy. Hippotherapy has long been recognised and researched as a therapy for children suffering from this disability. This paper goes a step further by quantifying results over a time period to enable more accurate conclusions to be drawn. This type of therapy has also been shown to have a high compliance rate as it is enjoyable for the participant. This means the child has a high motivation to complete therapy as opposed to a strength and conditioning program in a gym.

Practical Advice
Further research is required on the dose-response relationship of Hippotherapy as this study only explored a once per week intervention. Results showed a movement towards normal function, but it is unclear if this is the absolute extent of improvement obtainable. Recent research that explores twice a week therapy for 24 weeks displays evidence that further improvement in muscular control is achievable. Through exclusion criteria the more severely disabled population was not represented in this study which creates limitations in the results. Overall this study provides beneficial evidence that improvement of functionality of Cerebral Palsy patients is achievable.

Further Resources
For further information on Hippotherapy and Cerebral Palsy, follow the links below;
 * Changes in Trunk and Head Stability in Children with Cerebral Palsy After Hippotherapy - A Pilot Study
 * Comparison Between the Robo-Horse and Real Horse Movements for Hippotherapy Comparison
 * Long-Term Effects of Hippotherapy on One Child with Cerebral Palsy - A Research Case Study
 * The Effects of Hippotherapy on Postural Balance and Functional Ability in Children with Cerebral Palsy


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Exercise as it relates to Disease/Effect of aerobic and nutritional intervention in overweight, obese and hypertensive adults

This wiki book critiques an article from the European Journal of Preventive Cardiology; Gorostegi-Anduaga, Corres, MartinezAguirre-Betolaza et al. Studying the effects of different aerobic exercises together with nutritional intervention among sedentary adults who are overweight/obese and suffering from hypertension.

This critique is an assignment at the University of Canberra in the unit; Health Disease and Exercise, during semester 2 2019.

Background to research
Hypertension is a worldwide health problem and it remains steadily rising. The World Health Organisation reported in 2015 it affected 1 in 4 men and 1 in 5 women In 2017-2018 the prevalence of hypertension in Australians was 1 in 10 (2.6 million or 10.6% people) There wasn’t any significant difference between males (10.5%) and females (10.7%). Ultimately this medical condition is a leading cause of premature deaths worldwide.

Hypertension is a medical disease characterised by high blood pressure over a prolonged time. Blood pressure (BP) is the force of the blood being pumped by the heart and ejected into the arteries and circulating the body,  High BP is characterised by the presence of high systolic (SBP) this is the first number. Occurs when the heart is contracting and symbolises the pressure of the blood in the blood vessels. A high reading is over 140mmHg and the norm is 120mmHg. Therefore a healthy range for BP is higher than 90/60mmHg and lower than 140/90 mmHg. The second number is the diastolic (DBP) represents the pressure between your heartbeats. Hypertension along with other factors is diagnosed when your BP presents high when tested on two or three consecutive days,

Where is the research from?
The study was conducted in Vitoria- Gasteiz, Spain. It went on for three years, starting in September 2013 and concluded in June 2016 by Araba University Hospital. This study published in the European Journal of Preventive Cardiology. Even though this study was done in Europe, the research findings are still applicable to Australia.

Some parts in this study were recognised in several different health meetings, one being the 2015 25th European meeting on Hypertension and Cardiovascular protection. This justified the findings.

What Kind of Research was this?
This was a multi-arm parallel experimental study meaning researchers compared the treatment of aerobic exercise intensities, researchers also used the method of randomisation to assign the participants into these exercise groups. These methods used were appropriate as it eliminates any bias allocation.

What did the research involve?
A multidisciplinary team of Cardiologist, Nutritionists and a fitness company (for exercise machines) to make up the team that helped do the research.

Participants:

175 non- Hispanic Caucasians; 120 Males and 55 Females. All participants had to meet the requirements of being overweight/obese, sedentary and have hypertension.

Measurements taken: Pre and Post intervention

 * Body Mass Index (BMI)
 * Blood Pressure (BP)
 * Cardio-respiratory fitness
 * Dietary Assessment
 * Prescribed Medication

Intervention:

16-week aerobic exercise program; training 2 days a week. 4 intervention groups; and 3 out of the 4 were supervised exercise groups, performing different intensity programmers.

 * Group 1: Attention Control group (AC)
 * Group 2:High-volume moderate-intensity continuous training (MICT)
 * Group 3: High-volume of High-intensity Interval Training (HIIT)
 * Group 4: Low Volume of HIIT

Each programme was tailored to each participant and A low-calorie diet, tailored to each individual.

Results
At the beginning of the research, there was no significant difference amongst the groups for anthropometric measures, cardio-respiratory and pharmacological treatments. At the end of the 16-week intervention a difference was seen in both SBP and DBP, mean BP and heart rate decreased. All groups also had an increase in their cardiorespiratory fitness. Changes to BMI, body mass, waist and hip circumference, waist to hip ratio was visible in all groups. Significant changes were seen in the high volume HIIT, and Low Volume HIIT. These results are streamlined with other studies proving that any form of exercise will positively affect risk factors of hypertension.

Conclusions
Overall the implantation of a regular exercise routine provided to be effective in improving the lifestyle of a person who is overweight, obese and presenting with hypertension. From the research, High volume HIIT exercise sessions showed to have a greater impact out of the three exercise groups. Individuals should also make some lifestyle changes and also combined with exercise the individuals diet should also change. The DASH diet has proven to be effective.

In Conclusion, we gather that it takes a combination of a low-calorie diet and exercise can be used to reduce the risk factors associated with hypertension to improve one's quality of life

Practical advice
In total roughly 45% of the participants that took part in this study were males, therefore the results are basis favouring for the male population. Further research with a larger and more diverse sample pool is needed to produce more accurate and reliable results.

Furthermore, researchers can tailor their studies focusing on if females and males will get the same benefit from such intervention and exercises. Another area of study should also look into how different ethnic groups will adhere to an intervention like this one.

Further readings/insights
When left untreated or not controlled, hypertension can result in different health complications and diseases, such as diabetes, kidney failure, heart attack, and stroke.

Below are some suggested lifestyle changes that can be implemented to reduce risk factors associated with obesity and hypertension.

Further Readings

 * Keep Your Blood Pressure Down
 * Heart foundation: Blood Pressure
 * Criticted Article
 * Diet to help prevent and control hypertension

Please consult and seek medical advice from your GP or medical professional if you think you have or are at risk of developing hypertension.


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Exercise as it relates to Disease/Aerobic training's effect on cognitive performance in elderly individuals with dementia

This wikibook article is a critical appraisal of the journal article “Effect of aerobic training on the cognitive performance of elderly patients with senile dementia of the Alzheimer type”.

What is the background to this research?
Dementia of the Alzheimer type increases with age, effecting the occupational and social skills of older individuals. It is a result of the deterioration of brain tissue, effecting the hippocampal part of the brain and the function of cortical and sub cortical regions of the brain, causing cognitive impairment. Evidence suggests that aerobic exercise can be used as a possible intervention to protect against dementia pathologies and preserve brain function by increasing cerebral blood flow.

Due to excessive sedentary behaviour in the elderly community the prevalence of dementia has increased and is estimated to effect 369,977 Australians.

The study was designed to examine how a 3-month exercise intervention plan would affect the neuropsychological performance of cognitive tasks in clinically diagnosed patients with senile dementia of the Alzheimer type.

Where is the research from?
The research was conducted at the Sapienza University of Rome in Italy by Palleschi, Vetta, De Gennaro, Idone, Sottosanti, Gianni and Marigliano. The study was published by the Archives of Gerontology and Geriatrics, which is an international journal that facilitates articles by specialists in the fields of gerontology and geriatrics. The journal is ranked 28th overall in journals of the same field Although the study was published in Rome it is still relevant to Australia.

Palleschi has focused on animal-related studies since the study was published in 1996, while Vetta has continued to undergo studies in the field of elderly health.

What kind of research was this?
The research would be categorised as an observational study as there was no variance in the intervention between subjects. It followed the cohort study procedures as it followed the same group of individuals who were assessed for the entire 3-month duration of the study. Due to the studies objective a cohort study would be an acceptable practice.

What did the research involve?
The study included 15 subjects, all male, average age being 75 and all were clinically diagnosed with SDAT. Studies took place over a 3-month period after a 3-week period of no pharmacological products that could potentially interfere with the results of the study.

The methodology as follows:
 * Patients were assessed prior to beginning of the intervention as the baseline studies included attentional matrix, verbal span test, supraverbal span test and mini mental state examination.
 * Subject underwent a training program 3 days a week, cycling on at ergometer at 70% of their maximum pulse rate with sessions lasting up to 20 minutes.
 * Exercise intervention continued for 3 weeks; at the end all baseline assessments were re-assessed to analyse.

No further interventions took place.

What were the basic results?
The results for the follow up assessment after 3 weeks of adherence to the program showed improvement in all categories of the psychometric tests, with results consistently improving among the 15 subjects.

Test improvements included:
 * Attentional matrix: +7.97
 * Verbal span test: +0.98
 * Supraverbal span test: +5.62
 * MMSE: +2.33

Although there were improvements across each stage of the study, there are still a lot of variables regarding adherence to program of this design that have gone undiscussed. Older individuals might find the program too difficult, especially as they progressively get older. The patient’s motivation is also a factor due to the monotonous aspect of the intervention and apathy effecting 50% - 70% of dementia patients. The study also doesn’t take into account disabled and handicapped dementia sufferers who would physically be unable to use a cycle ergometer.

What conclusions can we take from this research?
The research has proven that aerobic training as an intervention used in an elderly population suffering from senile dementia of the Alzheimer type can be an effective way to slow the deterioration of progressive dementia in a short term. More studies should be done before implemented into a population, testing on a larger cohort and mixing the studies so females are involved as well. The limitations of this study are that it didn’t take into account larger variables like long term memory or cortical atrophy. The study also didn’t examine the mental health and well-being of the patients, while other studies used more measures like depression, prior health conditions and lifestyle characteristics. Considering its release in 1996, a lot of the methods would be considered outdated to today’s standard.

Basing their evidence on these 4 tests alone in a 3-week time period is not sufficient evidence to claim that aerobic exercise can improve dementia in the long term. Due to the brevity of the study, further research is required to fully understand the effects of aerobic exercise on dementia.

Practical advice
To build on the methodology of the study in the assessment stage, before and after the intervention, the researchers should include wider baseline of measurements. A physical function assessment should be performed to gauge the capabilities of the participants of the study and prescribe exercise according to their capabilities. An alternative to the cycle ergometer could be aerobic swimming classes as it alleviates stress on muscles and joints. Depression could be measure by using the centre for epidemiological studies depression developed in 1977. It is also advised that the ADAS cognitive behaviour form is used to measure the severity of the dementia and participants are provided with support and motivation from researchers.

Further information/resources
https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA08-PhysicalExercise_english.pdf

https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/dementia/overview

https://www.caregiver.org/caregivers-guide-understanding-dementia-behaviors

https://www.dementia.org.au/support/services-and-programs/services-and-programs/support-groups


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Exercise as it relates to Disease/Resistance training and how it affects the pain and function among adults with osteoarthritis

What is the background of this research?
It is estimated that 80% of all adults at or over the age of 65 years exhibit radiographic evidence of osteoarthritis (OA). Pain in the knee, affected by OA, is the most common symptom of the disease and contributes to significant declines in functionality which includes ascending and descending stairs as well as getting up off the floor. Investigators had found that resistance training can reverse the decline of strength within older adults, but they had also found that exercise interventions such as resistance training could in fact slow or reverse the negative outcomes of OA.

Where is the research from?
The research contained 102 community-dwelling individuals. 74 women and 28 men that had been previously diagnosed with knee OA. The individuals were chosen if they reported a moderate degree of knee pain as evidenced by a 5 or greater on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. R. Topp is a professor from the university of San Diego that has extensive knowledge is osteoarthritis of the knee and how it affects several individuals. He has also investigated several techniques used to minimise the injuries accompanied by the disease as well as the possibility to reverse the affects. The study was conducted from the School of Nursing, Medical College of Georgia, Schools of Allied Health and Medicine and the Medical College of Ohio. The authors that conducted the study include Robert Topp, Sandra Woolley, Joseph Hornyak III, Sadik Khuder, and Bashar Kahaleh.

What kind of research was this?
This research study is a randomised-control trial, as the population gained a baseline at the beginning of the 16 weeks. Then following this, the population was split into a dynamic exercise group, an isometric exercise group and then a control group. Results were then compared again at the end of the 16 weeks.

What did the research involve?
One hundred and two men (28) and women (74) previously diagnosed with knee OA volunteered and participated in the present study. During an initial telephone interview, they reported a moderate degree of knee pain, caused by the OA and was scored by a 5 or greater on the WOMAC pain subscale. Potential subjects excluded if there were contradictions for exercise. If they made it passed the telephone interview, then a background and demographic questionnaire took place and underwent a history and physical examination. Subjects who were eligible were placed into 3 categories of assessments before being randomized into treatment groups. The participants would then complete these assessments after 16 weeks of participation in their respective groups. The first assessment included the subject reporting background information on demographics and use of medications to manage their knee pain. The second assessment included paper and pencil instruments that solicited the subject’s perceived knee pain, stiffness and functional ability. The final assessment assessed pain and functional ability while each subject performed 4 functional tasks. These tasks included getting down to and up off the floor and then ascending and descending stairs. Limitations include the use of self-report throughout the study. It is quite well known that self-reported or subjective data can impact the validity of a study. What reduces the room for error within these tests and increases the validity and reliability is the fact that the 4 functionality tests are timed. This increases the objectivity of the testing and less biasness as well. As these tests were conducted both at the beginning and end of a 16-week period, there were results to compare with.

What were the basic results?
From the beginning to the end of the study, there was a nonsignificant decrease in medication dosage. Both resistance-training groups exhibited similar significant declines in knee pain and in time to perform functional tasks while the control group remained unchanged over the duration of the study. For the dynamic group, the score dropped from 5.51 mean to 5.04 mean. The Isometric group dropped from 5.13 to 5.03. The scores did drop but not very significantly. The time to get down to the floor dropped from 4.72 seconds to 3.89 seconds for the dynamic group and then 5.56 seconds to 4.31 seconds for the isometric group. The time to get up off the floor also dropped from 7.16 seconds to 5.71 seconds for the dynamic group and 8.26 seconds to 6.37 seconds for the isometric group. The time to go upstairs decreased as well. For the dynamic group, the time decreased from 18.85 seconds down to 16.33 seconds and the isometric group dropped from 17.99 seconds down to 15.15 seconds. The time to go down the stairs dropped from 19.29 seconds to 15.96 seconds for the dynamic group and 16.86 seconds to 13.95 seconds for the isometric group.

What conclusions can we take from this research?
Both dynamic and isometric resistance training reduced perceived knee joint pain and had no effect on perceived joint stiffness. Only dynamic training reduced perceived functional limitations. The control group had no change in measures throughout the entire study. The results from the present study seem to support the efficacy of prescribing various resistance-training programs as a method to enhance their functional ability and to reduce their knee joint pain. The conclusion I have come to from the study is slightly different. Even though there seems to be a pattern that knee joint pain and functionality has improved, it still has the biasness caused by the individual’s interpretations which can change from person to person. This means it is quite hard to determine the reliability and validity of the tests being produced. In saying that, by using the times to compare between the start and end of the 16-week intervention period, the validity does increase quite significantly. I believe that a longer study period should be used to determine whether the testing has any long term, positive or negative effects on individuals that are being tested. Hopefully from a longer study period, more of a pattern I’ll be produced that will show a stronger correlation of time decreasing in the 4 functionality tests that challenge the individuals.

Practical advice
This study is very useful for individuals in similar situations as well as health practitioners and researchers that are interested in this area of study. For those individuals that struggle with OA in the knee or other areas of their body, it is a good interpretation of ways and exercises that are needed to reduce and possibly reverse the effects of OA. Performing some form of resistance training has been shown to improve the functionality of the knee joint and can decrease pain within the joint. Researchers can take the next step and identify whether specific resistance training affects different parts of the body. By continuing with controlled clinical trial testing, it helps determine whether the controls improve over time and/or whether the intervention groups improve and if so, by how much. It is important that the use of time is continued on top of subjective questioning as it allows other researchers to compare results much easier than having to interpret subjective results.

Further information/Resources
Osteoarthritis.  Osteoarthritis.


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Exercise as it relates to Disease/PTSD: moving forward with exercise

Critique of Article: Exercise augmentation compared with usual care for post-traumatic stress disorder: a randomised controlled trial Rosenbaum S, Sherrington C, Tiedemann A.

What is the background to this research?
Post traumatic stress disorder (PTSD) is a psychiatric condition occurring with people who have witnessed or experienced a traumatic event including but not limited to, natural disasters, war, acts of terrorism, serious accidents or personal assault. Veterans are at the highest risk of developing PTSD with between 5-20% experiencing it at some stage, first responders are also at a high risk being placed above the general population PTSD rate of between 5-10%.

The symptomology of PTSD can be classed into four main categories with varying degrees of severity across sufferers:
 * Intrusive or unwanted thoughts can be shown through repeated unsolicited memories manifesting in the forms of dreams and flashbacks that can be vivid the individual feels as like they are reliving the trauma.
 * Avoidance of reminders may come in the form of avoiding people, places, objects and activities associated with the traumatic event, including avoidance of discussing the traumatic event.
 * Negative feelings and thoughts present with a focus on both the self and on those around individual, emotionally this can manifest in the forms of anger, guilt, shame and/or fear as well as lower propensity to feel joy and happiness through activities that previously elicited such responses.
 * The final symptomology category is arousal and reactive symptoms, this is can be demonstrated by changes to the individual’s behaviour often expressed through anger, irritability, recklessness, self-destructive behaviour, insomnia and concentration issues.

Until this article there had been no research into the effect of exercise on the physical health outcomes of PTSD. Due to positive effects of physical activity on cognition and overall mental health it was hypothesised that this study would prove exercise as a positive aspect of future care for PTSD sufferers.

Where is the research from?
This study was conducted in 2014 from the Musculoskeletal division, The George Institute for Global Health and School of Public Health, University of Sydney, Sydney, NSW and St John God of Health Care Richmond Hospital, Sydney, NSW, Australia.

Dr Simon Rosenbaum was funded by St John God of Healthcare, Richmond Hospital. Dr Tiedemann and Prof. Sherrington are supported by fellowships from the Australian National Health and Medical Research Council. There were no competing interests declared or any role played by the funders in the study design or conduct.

What kind of research was this?
This study was an assessor blinded randomised controlled trial which makes it the gold standard of study design. It consisted of a decent sized population with 81 participants who had been diagnosed with primary PTSD by the DSM-IV-TR. The intervention was 12 weeks in duration involved usual care for both groups as well as resistance training and walking programme for the group receiving the intervention.

What did the research involve?
The 81 participants in the study were randomly allocated into one of two groups, 42 were selected as the control receiving usual care while the remaining 39 received an exercise intervention of 3 30-minute resistance training sessions per week and a walking program. The resistance training session protocols consisted of 1 exercise physiologist supervised exercise session per week in the hospital gymnasium and 2 non-supervised home-based sessions. The protocol was designed within the guidelines of the ACSM and consisted of a 3x10 sets to repetitions protocol for up to 6 exercises with 30-60 second rest intervals. Intensity was determined by the IPAQ and the Borg RPE with the session intensity goal  being a rating of between 12-17. These protocols were employed to accommodate for hypothesised adherence issues with individuals presenting higher severity PTSD. The walking programme required the individuals to aim for a daily goal of 10,000 steps per day to be recorded in an exercise diary, however, this was adjusted for the individuals to make realistically achievable goals.

The usual care that both groups received was a combination of medication, psychologist led group therapy and psychotherapy. Access to these therapies was identical for both groups across the full intervention. The primary outcomes assessed were the PTSD symptoms as outlined by the PCL-C, secondary outcomes were symptoms of depression, physical activity, strength, mobility, anthropometry and sleep.

The methodology for this study was excellent however there were some issues. These flaws are largely regarding the high percentage of males and the geographical similarities between participants. The intervention group only consisted of 3 female participants (8%) and the usual care group contained 10 females (24%), this provided limited data as to the overall applicability of the study’s findings in regard to women. Another flaw in the study is in its geographical constraints. All the participants were residing in or near Sydney, making these findings potentially irrelevant to other populations. As part of the exclusion criteria, participants did not qualify if their trauma was from childhood, therefore making these findings irrelevant for PTSD sufferers whom fall into that category.

What were the basic results?
The study showed that the exercise intervention group improved significantly better in multiple assessments and approached statistical significance in several other categories. The primary outcome measure (PCL-C) showed a significant improvement when compared to the usual care group with 71% of participants completing follow up assessment for this outcome.

Furthering this many of the secondary outcomes displayed statistically significant improvements. This is evidenced primarily through the DASS combined measurements of depression, stress and anxiety. The intervention group greatly reduced their time spent sitting and sleep quality as measured by the PSQIA total score also demonstrated an improvement. Furthermore, the study found the reduction of BMI approached significance in the exercise intervention group. There were no significant differences in any of the following:
 * Cardiorespiratory fitness
 * Resting heart rate
 * Systolic blood pressure
 * Diastolic blood pressure
 * Grip strength
 * Total physical activity

What conclusions can we take from this research?
There are significant mental health and physical health outcomes that can be gained by patients with a PTSD diagnosis when compared to usual care alone. By including exercise in a treatment plan for individuals with PTSD there are potential benefits for reduced PTSD specific symptoms, lowered levels of depression and anxiety, lessened insomnia and improvements in BMI.

Practical advice
With the many benefits of exercise being shown to improve mental health across a range of conditions it should be a consideration for any mental health intervention. This study adds to the evidence and provides the first statistically relevant findings for PTSD specific exercise interventions.

Further information/resources
For further information on PTSD please see:
 * Beyond blue
 * Black dog institute
 * Health direct
 * Different brains

For those with someone afflicted with PTSD in their lives please see:
 * PTSD help guide
 * Mayo clinic - helping a loved one

For those in urgent need of assistance please contact:
 * Lifeline 13 11 14 (Australia)
 * The Samaritans 135 247 (Australia)
 * Suicide call back service 1300 659 467 (Australia)


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User:Nicola.georgiou/sandbox

This is Nicola Georgiou's sandbox for Approaches to Knowledge - please click on the relevant link to access the sandbox for your seminar group.

 * Seminar group 7 (Wednesday 11am-12pm)
 * Seminar group 13 (Thursday 1-2pm)
 * Seminar group 16 (Thursday 3-4pm)

title: User:Nicola.georgiou/sandbox


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Exercise as it relates to Disease/The better Ageing Project and sustaining mental well-being of elderly people through physical activity

This is a critical analysis of the paper: “Physical activity and mental well-being in older people participating in the Better Ageing Project” (Kenneth R. Fox, et al. 2007)

What is the background to this research?
Growing evidence advocates for participation in physical activity amongst the elderly for the prevention of mental illnesses such as depression, Alzheimer’s disease, and dementia. The research is not limited to the prevention of mental illnesses; as undergoing regular physical activity was linked to the improvement of mood and psychological well-being in elderly people. Rise physical activity within the elderly community is also linked to an increase and preservation of muscular strength, independent living and a decrease in falls risk with an overall increase in quality of life.

Where is the research from?
This article was published in the European journal of applied physiology, 2007.

The primary author of this research paper, Kenneth R. Fox. Fox held an honorary position at the University of Bristol; and, although in retirement, he continues to work closely with the university as a consultant and trusted advisor. His time on projects is spent within the division of weight management and physical activity for mental health; focusing on older adults.

As the study was a self-reported account through questionnaires, participants may have a form of bias; however, any bias is unseen from Fox et al. in the original article.

What kind of research was this?
The Better Aging Project conducted research into the quality of life of 176 older adults, aged 70 and over. Accelerometry, objectively assessed the day to day energy expenditure of differing intensities.

This study was conducted using a mixture of methods. Fox et al. utilised a combination of new and standardized questionnaires; as well as objective measurements of physical activity and interviews to obtain a quantitative and qualitative perspective.

What did the research involve?
The study conducted was a standardised 12-month programme that consisted of structured exercise. The programme included 78 males aged between 75–79 years and 98 females aged between 75–80 years. There were 64 control participants (f=38, m=26); while 112 participants were part of the intervention. The programme was held within three different countries: UK, France, and Italy.

The research involved a selection of objectives to assess both the reliability and validity of a range of contemporary psychological evaluations for differing aspects of well-being and quality of life. The research aimed to investigate the relationship between activity completed in the daily life of elderly people; while, also assessing the link between sedentary behaviours and mental well-being. Physical activity was assessed minute-by-minute during the walking time of each participant over a duration of 7-days using an accelerometry. The amount of physical activity completed by each participant was used to determine their individual level of independency and daily mobility.

Fox. Et al. collected four variables to assess the level of physical activity being preformed by each participant. These variables included:

1. Daily physical activity and energy expenditure (in joules per day) (PAEE)

2. Minuets of light activity preformed each day (LPA)

3. Minutes of moderate activity preformed each day (MVPA)

4. Minuets spent sedentary each day (SED)

What were the basic results?
At the end of the 12-month programme the results of the questionnaires and interviews were all positive. Participants recorded feeling a high level of enjoyment in the activity incorporated within the programme. Many participants stated that they felt empowered and used the programme to prevent themselves from falling in lethargic routines and habits. An overall increase in mental state and well-being was also observed in all participants.

Using Persons correlation coefficients, the relationship between PAEE, LPA, MVPA, SED and quality of life for both males and females was determined.
 * Significant at 0.05, **significant at 0.01

What conclusions can we take from this research?
Through the Better Aging Project, a vital opportunity for the development and application of procedures used to assess psychological well-being and physical activity in elderly adults over the age of 70 has been devised. This article has facilitated important groundwork for further studies concerning physical activity and participants over the age of 70. Previously, the use of accelerometry has never been applied with this age group; appearing to be a sufficient method for assessing the amount of physical activity. Stronger associations were seen between the level of physical activity, physical self-perception, health, and wellbeing. However, further research should be conducted into the assessment of factors such as physical functions, disabilities, poor-health, and body weight with the effects these variables have on physical activity and mental health.

Practical advice
Evidence advocates that physical activity can be the key to prevention for various types of mental illnesses; such as, depression, Alzheimer’s disease, and dementia within the elderly community. The article indicates that elderly people who spend more time being active and participate in daily physical activities experience higher levels of self-rated mental health and quality of life; compared to those who spend more time sedentary. An increase in walking has been found to be a major contributor in rising physical activity amongst elderly people. The WHO recommends that elderly people complete a minimum of 150 minuets of moderate-intensity activity like walking, or 75 minutes of high-intensity activity each week. When completed in organized social groups, higher levels of enjoyment during physical activity have been recorded.

Five Ideas for social activity groups:
 * 1) Dance classes
 * 2) Water aerobics classes
 * 3) Swimming classes
 * 4) Walking groups
 * 5) Cycle groups

Further information/resources
The articles below can provide further information into mental health of older adults.
 * Mental health of older adults
 * Signs and symptoms of declining mental health
 * Who can assist you in improving your mental health
 * Mental health services and programs for older people


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Exercise as it relates to Disease/The effects of outpatient rehabilitation on quality of life and exercise tolerance in COPD

This Wiki Facts Sheet critiques the article Out-patient rehabilitation improves activities of daily living, quality of life and exercise tolerance in chronic obstructive pulmonary disease, published in the European Respiratory Journal in 1997.

What is the background to the research?
Chronic Obstructive Pulmonary Disease (COPD) is a disease that causes an obstruction in the bronchial tubes. In most cases of COPD there are two related diseases, emphysema and chronic bronchitis.

The management of COPD can be difficult, but exercise programs have been implemented which can benefit patients whether it be to maintain exercise tolerance or dyspnea. The maintenance of lung function and exercise capacity for a COPD patient is an important factor for daily living as deterioration of these will lead to a rapid mortality rate.

Pulmonary rehabilitation is a program that has been found to be effective in educating and physically training COPD patients on how to rehabilitate breathlessness, exercise capacity and infer strategies to maintain dyspnea to improve the quality of living.

Where is the research from?
The research was corresponded by Bendstrup, K.E, supported by the allowances from The Foundation for Medical Research of Ribe, Ringøbing, and Southern Jutland countries and The National Association Against Lung Disease at the department of Medicine, in a hospital setting located in Esbjerg, Denmark. The article was published in 1997. Bendstrup, K.E, has completed and has been a part of further research on articles relating to respiratory function and diseases,. Despite the date and location of the research it shows relevant data in regard to recent outpatient COPD rehabilitation worldwide.

What kind of research was this?
The research was a randomised and controlled trial consisting of 2 groups a controlled group and an intervention group.

The research measured the outcome of the activates of daily living (ADL), quality of life and the exercise tolerance for patients with moderate to severe chronic obstructive pulmonary disease. In this study there were forty-seven patients who were eligible to participate from 140 patients diagnosed with COPD. The specific criteria for the research involved the forced vital capacity in one second/forced vital capacity (FEV1/FVC) ratio to be less than 70%, an FEV1 between 25%-50 and no changes in medication and exercise status for at least 4 weeks.

An approximate decrease of thirty-two percent in the participation rate was due to factors such as an unrelated death to the study, incompletion of the programme, dropping out of the programme and unrelated medical procedures.

What the research involve?
The treatment group and controlled group consisted of 16 patients each. Lung function/spirometry, activities of daily living and exercise tolerance related assessments were conducted at the start of the trial to measure the baseline of the patients.

These assessments were:

 * Activates of daily living (ADL) score (specified for the COPD patients)
 * York Quality of Life Questionnaire (YQLQ)
 * 6-minute walking distance (6MWD) score
 * Chronic Respiratory Disease Questionnaire (CRDQ) Forced expiratory volume in one second (FEV1)
 * Forced vital capacity (FVC)

The trial lasted for 12 weeks, with an assessment at the start middle (week 6) and end (week 12) of the trial, followed by a follow up appointment 12 weeks post finishing the trial on the 24th week.

The intervention group attended the pulmonary rehabilitation sessions, these sessions were held for 1 hour, three times per week for the period of the 12 weeks run by a physiotherapist and an auxiliary nurse. Exercise thought out the programme consisted of upper limb and lower limb, strength and endurance training as well as coordination, and balance.

An education session was also held once a week for 12 sessions. The patients were educated on the lungs, pathophysiology, complications with COPD and management and coping with dyspnea.

An additional smoking sensation therapy class held by an occupational therapist was held for those who wished to quit smoking.

What were the basic results?
The improvements of the activities of daily living in the COPD patients who attended the intervention pulmonary rehabilitation sessions showed significant improvements in comparison to the control group. This improvement could have been due to the fact that the exercise tolerance had increased. This increase was shown in the ADL questionnaire where strenuous activities such as shopping, and cleaning were presented to have improvement. There were positive results to the Chronic Respiratory Disease Questionnaire which included questions related to breathlessness, emotional function, and fatigue. After the 24-week assessment, there was no significant change in comparison to the control group in the FEV1 and FVC meaning that lung function did not significantly improve when comparing the two groups.

Smoking sensation therapy was provided for the patients who wished to discontinue smoking. The therapy including free nicotine patches, education sessions of the benefits and problems of smoking sensations as well advice which was provided by an occupational therapist. None of the patients who wished to partake in the smoking sensation therapy succeeded, tobacco consumption stayed the same.

What conclusions can we make?
This study shows that a well thought out rehabilitation programme can improve the activities of daily living and exercise tolerance in patients with COPD. Incorporating fitness, lung function and ADL type-based rehabilitation will help in increasing the exercise tolerance in moderate to severe COPD patients.

Practical advice
To have a greater understanding of COPD and the effects of pulmonary rehabilitation, further research is required with larger sample sizes, as well as a range of economical statuses should be considered for further studies. For a more accurate measure of the results, extra physiotherapists and auxiliary nurses should be present to assist in the data collection.

Additional follow up appointments every 6 months for a further understanding of the effectiveness of the programme would also be beneficial. Having follow up appointments will provide evidence on how the patient is maintaining their ADL with COPD. Offering a long-term rehabilitation by referring an exercise physiologist may be useful COPD patients ADL and exercise tolerance for maintaining.

Further information and resources
For further understanding of pulmonary rehabilitation presents information on guidelines and assessments for pulmonary rehabilitation. The European Repository Journals provides studies on a range of topics regarding respiratory and lung function. To look into resent research, is a recent study showing research on the relationship between pulmonary rehabilitation and the dependency in COPD.


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Exercise as it relates to Disease/Progressive resistance training improves gait initiation in individuals with Parkinson's disease

This aim of this article is to critique a study titled "Progressive resistance training improves gait initiation in individuals with Parkinson's disease", investigating the effects of resistance training on gait in individuals with Parkinson's disease.

Background to this research
This study investigated the effects of progressive resistance training (PRT) on the gait initiation of individuals afflicted with Idiopathic Parkinson’s disease (IDP). Prior to the conduction of this study, there had been few randomized controlled trials evaluating the effectiveness of resistance training. More prominently, this is the first study of its kind to evaluate the effects of PRT on gait initiation. The importance of this research is evident through the opportunity it offers to individuals afflicted with IDP to improve their quality of life through the demonstration of the effectiveness of a potential intervention.

Where is this research from
This research was conducted by professionals from 4 prestigious institutions including the University of Florida, Georgia Southern University, Columbia university and the Mount Sinai School of Medicine. It was published on Elsevier, a global information analytics business on the 21st of December in 2011. This study included an important exclusion criterion regarding the selection of participants. The participants were required to have no history of, or ongoing cardiovascular, musculoskeletal, vestibular or other neurological conditions. This is to ensure the results were not skewed as a result of these afflictions. The research was published through an independent entity. This removes the risk of any potential bias from sponsors or organisations that may benefit from the results of this investigation, in addition, the paper includes a statement from the authors declaring that there are no conflicts of interest.

What kind of research was this
This study was a randomized control trial. So far it is the only one of its kind to investigate the effects of PRT on gait initiation within Parkinson’s patients. However, multiple studies have evaluated the effectiveness of PRT as an intervention for improving qualities of life in other areas. For instance an investigation conducted by Leland E. Dibble PhD, Tessa F. Hale BS, Robin L. Marcus PhD, John Droge MS, J. Parry Gerber PhD, Paul C. LaStayo PhD investigated the effects of resistance training on functional gains in patients with Parkinson’s disease. The variables included muscle volume, muscle torque, mobility task performance etc. Both studies involved controlled selection of participants subject to exclusion criteria and involved independent variables as well as a control group. The levels of evidence do not differ between studies as although the overarching aims of the investigations are different, both demonstrate PRT as an effective intervention to improve quality of life in individuals with Parkinson’s disease.

What did the research involve
This study involved a select group of 18 individuals afflicted with IDP. The participants first undertook 5 repeat trials of gait initiation, from which the results were recorded. Following this, participants were randomly assigned to a PRT group or a control group. Those assigned to the PRT then conducted two sessions of 1 repetition maximum testing, separated by 72 hours, for knee extension and knee flexion-based exercises. The initial load for exercises was set at 70% of 1RM. The PRT intervention consisted of 2 rounds of 6 exercises with 12-20 repetitions and 5 minutes rest between circuits. These exercises included: seated leg press, knee extension, knee flexion, abdominal curl, back extension, seated calf raise and multi directional ankle mobility exercises. A minimum of 18 sessions were completed by each participant over a 10-week period. 1RM testing was conducted once more at the end of the trial period and variables of interest were re-calculated. The methodology applied to this investigation took adequate measures to ensure reliability and validity were maintained throughout the 10-week period. The pre-screening and exclusion criteria for participants effectively ensured that the data collected was not subject to any bias from additional unforeseen variables. In addition, all processes conducted throughout the investigation, such as 1RM testing which included 2 repeat trials and pre-intervention gait initiation which included 5 repeat trials for each participant. Furthermore, the investigation included a control group who did not undertake a PRT program, thus ensuring the results could not be attributed to other factors. In terms of validity, the investigation distinguishes clear variables to be assessed such as displacement of centre of pressure and initial stride length, both common variables in a biomechanical analysis of gait initiation (GI). The re-testing of these variables post intervention demonstrates that the investigation effectively examines PRT as a means of improving GI. Finally, as stated above, the results from this randomized control trial are consistent with similar studies that examine the effectiveness of PRT as an intervention. Despite this, the study involved only a small group of participants. A larger group of participants would improve the reliability of this investigation. Further limitations to this study include a lack of 1RM testing from the control group as well as the use of only 1 specific rep range for the prescribed exercises. The addition of more groups of participants may have allowed for an investigation into the benefits of higher intensity exercise.

What were the basic results
The results from this research indicated that PRT serves as an effective intervention for increasing GI in individuals with IDP 29% performance increase was observed in displacement of centre of pressure, an 11% increase was noted in stride length, knee extension 1RM strength increased by 76% and knee flexion 1RM strength increased by 57%. No changes in performance were observed in the control group. The researches therefore established a strong correlation between PRT and improvement of physical functionality, quality of life and gait speed and initiation. The authors own implications of this research are succinct and include limitations of the paper. As such, the implications do not appear over-emphasized.

What conclusions can take from this research
My personal insights regarding this paper do not differ from those of the authors. Having conducted extensive past research of the benefits of PRT in other areas in addition to comparing these findings with those of other studies I strongly agree with the conclusions drawn from this investigation. The study under examination was conducted in 2011, however, more recent studies, such as a two‐year randomized controlled trial of similar nature conducted in 2013 and an investigation into non-pharmacological treatments for this disease which examined PRT also produced similar results.

Practical applications
This evidence establishes the importance of resistance training not only in patients with IDP but also those at risk of developing the disease. Furthermore, this research highlights specific exercises necessary for effective results in addition to providing parameters that can be used to measure the progress of individuals. Given this, establishments that cater to the needs of patients with IDP such as aged care facilities should take measures to raise awareness for PRT as a potential intervention. However, individuals must be subjected to industry standard pre-screening and risk assessments prior to the commencement of an exercise program.

Further resources
Further reading on this subject may be beneficial to both individuals afflicted with IDP as well as aged care workers attempting to encourage physical activity within elderly populations. These sources do not substitute professional medical advice.

For individuals afflicted with IDP:

https://www.parkinsons.org.au/

https://www.inspireeducation.net.au/blog/parkinsons-services-and-resources-for-patients-and-carers-in-australia/

For aged care workers:

https://www.wikihow.com/Encourage-Independence-in-Clients-in-Residential-Care

https://www.betterhealth.vic.gov.au/health/healthyliving/physical-activity-for-seniors


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User talk:HamishJeff

I see that you had a problem creating Exercise as it relates to Disease/Progressive resistance training improves gait initiation in individuals with Parkinson's disease as the spam filter detected the number of URLs you were adding and assumed it was a bad edit. I've created the page for you - you should now be able to edit it. QuiteUnusual (discuss • contribs) 12:08, 18 September 2019 (UTC)

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Exercise as it relates to Disease/The importance of exercise during pregnancy to decrease the likelihood of hypertension and gestational weight gain

This is a review of the original research "Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial". (Barakat R, Pelaez M, Cordero Y, Perales M, Lopez C, Coteron J et al. 2016)

What is the background to this research?
Gestational hypertension is defined as blood pressure measuring 140/90 mmHg or higher. Hypertension is typically seen at >20 weeks gestation and it has been reported up to 10% of pregnancies experience some form of hypertension, increasing the risk for both mother and child during pregnancy and during birth. Hypertension is only becoming a more common feature in pregnancy. Obesity during pregnancy, Gestational Weight Gain (GWG), Gestational Diabetes Mellitus (GDM), pre-eclampsia and pregnancy induced hypertension can be linked to macrosomia (>4000g) and low birth weight (<2500g) in infants.

There have previously been a low number of studies investigating exercise programs in a large group of pregnant women with high adherence rates. Barakat et.al carried out this study to determine if exercise during pregnancy will protect against hypertension and macrosomia. These findings are shared globally to the medical and health industries to fill the gap. It is important to determine how effective exercise is during pregnancy to encourage expecting mothers to take care of themselves physically, and more importantly, to determine the risks when exercise is not undertaken whilst pregnant.

Where is the research from?
The research was conducted through the Technical University of Madrid, Spain over a period from December 2011 through to January 2015. All the authors, especially Ruben Barakat PhD, are apart of Physical Activity and Sports in Specific Populations (AFIPE) Research Group, and together have a strong reputation in the field of physical activity amongst pregnant populations. The study was reviewed by the ethics board at Hospital Severo Ochoa, Madrid Spain. It was published through the online Journal ‘Elsiver’ and through the American Obstetrics and Gynaecology journal - which is one of the most referenced journals by health professionals in the obstetrics and gynaecology industry. No obvious bias is apparent in the study or through organisational links, and there were no conflicts of interest mentioned.

What kind of research was this?
This study was a randomised controlled trial (RCT) where the subjects were randomly allocated into two groups; the control group and the exercise group. This method is useful in determining if the intervention is effective and differences amongst the two groups. Studies typically struggle with participation amongst subjects however the exercise group in this study had a high adherence rate.

Various studies examine the benefits of exercise whilst pregnant specifically looking at GDM or GWG but it is not common to assess them all together. Barakat et.al provides evidence of the successful effects exercise during pregnancy has on a variety of risks associated with pregnancy.

What did the research involve?
The study focused on a supervised exercise intervention during the early to late stages of pregnancy to determine if frequent exercise would lower the risk of chronic health diseases, which are proving to be quite common in pregnancy. A sample of 765 Spanish pregnant women were assessed for eligibility to participant in a RCT which was a well suited methodology for this intervention. The exercise intervention was made up of 10-12 participants per group, 3 days per week for 55 minutes. Music during exercise, a well air conditioned and well-lit room were features to maintain participant adherence. The main exercises for the intervention were:
 * aerobic exercise
 * aerobic dance
 * muscular strength
 * pelvic floor exercises
 * flexibility.

Heart rate monitors were required every session and each participant used a RPE scale.

Women in the control group were educated from their health care provider about the benefits of physical activity during pregnancy and were asked once per trimester what their exercise regime had been. All participants had their diastolic and systolic arterial blood pressure measures once each trimester to determine the risk of hypertension, defined as a diastolic blood pressure of >90mmHg and systolic blood pressure of >140mmHg.

What were the basic results?
Between the two groups, the exercise group significantly: Overall, participants in the exercise group gained less weight during their pregnancy compared to the control group (P = .01). Although the incidence of low birth weight did not change, the exercise group was found to have a lower incidence of macrosomia (P = .03) and the control group who did not exercise were 2.5 times more likely to give birth to a macrosomic infant (P = .04). Pregnant women in the control group were:
 * reduced hypertension in pregnancy (P = .009),
 * reduced preeclampsia in pregnancy (P = .03),
 * reduced GDM (P = .03).
 * 3 times more likely to develop hypertension during pregnancy
 * 1.5 times more likely to gain excessive weight.

Blood pressure results were not individually graphed, which would have been useful to see the decrease in hypertension in the exercise group overtime and the steady state or increase in hypertension for the control group. Specific exercise routines were not explicitly mentioned, which limits the option for other to replicate this intervention.

What conclusions can we take from this research?
Conclusions from this research can be applied to health professionals and pregnant women globally about the importance of exercise during pregnancy. This was a large study and could be applied and replicated by others to monitor exercise benefits in pregnant populations. Aerobic exercises and muscular strength exercises that begin in early gestation and frequently continued through to the end of the third trimester may be a strong preventative tool for decreasing the risk of developing hypertension, GWG, preeclampsia, GDM and macrosomia in infants.

In comparison to other studies, high adherence rates when exercising in a pregnant population is limited. From this study, enjoyable group exercising conditions seem to promote adherence and therefore should be taken into account when conducting future studies and applying to general population. Pre-exercise screening was not explicitly mentioned which is an extremely important step to take before starting an intervention, especially with high risk individuals who are pregnant. This is so appropriate care and monitoring is available in exercise interventions. Future studies could combine exercise regimes in pregnancy with food intake and determine what effects healthy eating combined with exercise could help with in pregnancy.

Practical advice
When prescribing an exercise regime in general but especially in pregnant populations, they must be tailored to the individual’s needs, including consideration frequency, intensity, duration and mode. It is important to check in regularly with your health professional or exercise coach in case exercises need to be modified or ceased for medical reasons. Exercise will not cure all co-morbidities of pregnancy but will help reduce them. Maintaining a healthy lifestyle inclusive of exercise and healthy eating pre, during and post pregnancy will increase the likelihood of a safer pregnancy.

Both the American College of Obstetrics and Gynaecology and Royal Australian and New Zealand College of Obstetrics and Gynaecology guidelines recommend at least 150-300 minutes of moderate intensity aerobic activity per week. Both guidelines suggest physical activity during pregnancy will assist with decreasing risk of hypertension, pre-eclampsia and GWG.

Further information/resources

 * The Royal Australian and New Zealand College of Obstetrics and Gynaecology
 * The American College of Obstetrics and Gynaecology
 * Adult Exercise Pre-Screening
 * Australian Government Department of Health
 * Physical Activity Australia
 * Healthy Eating During Pregnancy


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Exercise as it relates to Disease/Pulmonary Function and Response to Exercise in Cystic Fibrosis

What study is being critiqued?
This (https://adc.bmj.com/content/archdischild/46/246/144.full.pdf) study investigated the effects of exercise on pulmonary function in patients who have been diagnosed with cystic fibrosis.

What background research led to this study?

 * Cystic fibrosis is now recognised as the most common cause of chronic pulmonary disease in children.
 * it is accepted that the earlier diagnosis and treatment of the disease occurs, the greater the improvement and results of the patient.
 * Studies by (Doershuk et al., 1965;Beier et al., 1966; Mearns, 1968; Featherby et al.,1969) which look into lung mechanics reveal that airways of these patients are obstructed, and this effect increases as the patients condition deteriorates with time.
 * Studies have been undertaken before on children, however they have been somewhat disturbing and it may be argued that the procedures used may not be clinically justifiable.
 * New techniques have since been unearthed which allow children with cystic fibrosis to have their pulmonary function analysed during exercise, the indirect fick method (Godfrey and Davies, 1970) does not involve cardiac or systematic catheterisation, allowing the method to be acceptable by children.

Where is this research from?
This study was conducted at the Institute of Diseases of the Chest, and the Queen Elizabeth Hospital for Children in London. It is a part of the Archives of Disease in Childhood. The authors, S. Godfrey and Margaret Mearns have both produced additional studies relating to pulmonary diseases, with S. Godfrey also releasing studies relating to asthma based populations. The Institute of Diseases of the Chest has an impeccable record for research, and the Queen Elizabeth Hospital for Children had a good record of research before it's closing down in 2014. Both institutes show credibility and validity, thus showing this study to be valid and credible.

What kind of Research was this?
The study was a cross-sectional study. The patients were split into three groups, depending on which health outcome they were determined to be in at the time. All participants completed the same exercise testing.

What did the research involve?

 * 41 patients (24 males, 17 females) who had been diagnosed with cystic fibrosis spent a full day as outpatients at a department where the testing was conducted.
 * The patients participated in a series of spirometry tests pre and post exercise, as well as other physiological recordings including height, weight, lung volume, residual volume and the transfer factor for carbon dioxide.
 * Patients were assigned to two exercises, the first being a progressive exercise on the cycle ergometer, where pulse and ventilation were recorded. The second exercise was a steady state exercise also conducted on the cycle ergometer, this involved cycling at a steady state at one-third and two-thirds of maximum intensity. For this test gas was analysed (Co2 and O2) along with an electrocardiograph and the patients arterialised ear lobe blood.
 * After the exercise study, maximal ventilation rate was measured via a 15-second sprint method.

Limitations to methodology include biases in design, populations and data analysis. This cannot be avoided in the real world and is inevitable, meaning that the results are only relevant to certain aspects that the study is trying to find. The study is now almost 50 years old, so methodology may be outdated with science methodology changing over time. It is also slightly unclear as to what variables are going to be assessed and measured pre and post exercise testing.

What were the overall results?

 * Overall, the differences between groups 1, 2 and 3 were significantly different. correlating with their different physiological abilities and problems.
 * Maximal work and transfer factor of CO deteriorated when looking at results from group 1,2,3
 * Maximal voluntary ventilation (MVV) results showed groups 1 and 2 had no significant difference before and after exercise, however grade 3 showed large deterioration of restricted airways.
 * Physiological dead space was considerably enlarged in almost all children at a rate of 200% compared to normal.
 * MVV correlated directly with maximal work as intensity increased over time, whilst also correlating with Force Expired Volume in 1 second.
 * Almost all parameters showed little significant change between groups 1 and 2, however group 3 saw large changes in their results from pre and post exercise.

What conclusions were taken from this research?

 * The ability of patients with different levels of cystic fibrosis symptoms to exercise is commonly found to be extremely low due to their pulmonary functions deteriorating, however, this study aims to find if exercise can be beneficial to a patient, or if the exercise is further declining their condition.
 * Research indicates that patients who have somewhat good general health, although still being diagnosed with cystic fibrosis (possible in early stages), have improvements in variables including ventilation rate and forced expired volume in one second. Research also indicates that these variables decrease within patients who have extremely obstructed airways.
 * Due to the large amounts of variables seeing significant drops in results from groups one and two compared to group 3, it might be possible that grouping may have not been even from grades one through to grade 3.
 * The study believes based on its findings that adequate physiological assessment can be achieved in children with cystic fibrosis, being able to measure multiple variables during exercise which in turn, allowed the conductors to find the connection between exercise and pulmonary function in these patients.
 * No clear physiological differences were documented after the testing was conducted, meaning that the exercise did not have an effect on the children in the long term. However, the study does give indication to the levels of exercise which could help these patients if they were to continue with the exercise process.
 * Other more recent studies using exercise programs to try and increase exercise tolerance and overall pulmonary fitness suggest that exercise can have an effect on respiratory muscle strength, however, no additional adverse effects have been found.
 * Overall, exercise has yet to show a full improvement in pulmonary function in patients with cystic fibrosis, however, there is data to suggest that a long enough exercise program may have benefits.

Practical advice for the future

 * Participating in exercise routines and functional activities is beneficial to the body when tailored to the individuals needs.
 * In the case of patients with cystic fibrosis, whilst studies suggest that the effect of exercise may not increase pulmonary functions significantly, exercise has been shown to have an adverse effect on other areas such as bone density, sleep improvement, mental health and more.
 * Programs written by exercise professionals which are long term and ongoing may help these patients improve their overall quality of life.
 * Depending on level of symptoms, lower intensity an resistance may be necessary to keep the patient engaged, but also make sure the exercise is being detrimental to their health.


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Exercise as it relates to Disease/Effects of aerobic endurance and strength training in obese adults

This is a systematic review of the paper “Both aerobic endurance and strength training programs improve cardiovascular health in obese adults” by Inga E. Schjerve et al.

What is the background to this research?
The number of obese and overweight individuals has risen at an alarming rate over the last few decades. The young male (18-24) population has risen from 5.1% obese and 24% overweight to 13.8% overweight and 29.3% overweight. While the young female population (18-24) has increased from 13.2% overweight and 5.8% obese to 20.6% overweight and 20.6% obese in the same time period. . Internationally, 312 million people in 2008 were classified as being obese with a BMI (body mass index) greater than 30 and 1.1 billion people overweight with a BMI of 25-29.9 with worldwide prevalence of obesity almost tripling since 1975 .The aim of this study was to look at the efficiency of moderate and high intensity level aerobic training and strength training on improving cardiovascular health in obese and overweight populations. This paper looks to answer the question “which of high-intensity aerobic exercise, moderate-intensity aerobic exercise or strength training is the optimal mode of exercise” in obese adults. This research is important due to the rapidly increasing population size. Overweight and obesity has now been not only nationally classified but also internationally as an epidemic. Due to this it is now, more than ever before, critical that research is conducted to find out the best way to safely and more efficiently slim down this population to improve national and international health. In doing so, this will reduce the additional health problems caused by obesity such as some forms of cancer, osteoarthritis, respiratory complications such as obstructive sleep apnoea and coronary heart disease.

Where is the research from?
This study was conducted in Norway, and while Norway has a lower obesity prevelence than most countries, this study is based on an epidemic that has a similar methodology of classifying obesity to most countries. The study was assisted by multiple organisations and sponsors; however, these organisations and sponsors do not have any economical investment into this study allowing there to be an un-bias lead on the research conducted or the results published

What kind of research was this?
This study was a randomised clinical trial in which subjects were randomly given a treatment method for the course of 12 weeks. The subjects were, however, encouraged to continue normal nutritional habits leaving the possibility for this data to be slightly skewed depending on whether the subjects maintained their regular eating habits or if they increased or decreased. This evidence from this study does not dramatically differ from other similar research papers but does inherently have a slight difference in results.

What did the research involve?
This research was comprised of several different procedures involving samples and tests. Each week, subjects would participate in three exercise sessions. Two of these were monitored in a lab and one was conducted in a home environment. This leaves the possibility of subjects not appropriately participating in the study program whilst at home by either not completing, not completing to the required level or exceeding the required level. These included aerobic training where subjects exposed to high intensity had a warm up period of 50-60% max HR (heart rate) with 4x4 minute intervals at 85-95% max HR with 3-minute active breaks consisting of jogging or walking at 50-60% max HR. Moderate intensity subjects were exposed to continuous walking at 60-70% max HR for 47 minutes. Subjects exposed to strength training started each session with a 15-minute treadmill work out by walking at 40-50% of max HR. This creates the possibility for some error in the overall results as the strength participants completed 45 minutes of aerobic training each week. The subjects completed four series of five repetition using a leg press machine at approximately 90% of 1RM (one maximum repetition). Subjects also performed abdominal and back exercises of three series of 30 repetitions with 30 seconds of rest between series. In the home environment subjects walked to warm up and used either a leg press machine or squats with weighted backpacks. The procedures involved included: This research invasive but necessary for the extremely thorough and deep data that was extracted. The exact protocols that were used were identified in the paper and used with international guidelines to produce the most accurate and consistent data. The biggest limitations for this data are the self-administered exercise and nutritional factor. The data cannot be completely valid and reliable while subjects perform part of the treatment without supervision and while a key factor such as nutritional consumption in exercise-based research is left unmonitored.
 * endothelial function measured as FMD (flow-mediated dilation)
 * Blood profiling, where blood samples were taking after 8 hours of fasting to analyse Serum ferritin, triacylglycerols, HDL (high-density lipoprotein)-cholesterol, total cholesterol, haemoglobin, high-sensitive CRP (C-reactive protein), Na+, K+, creatinine, HbA1c (glycated haemoglobin), glucose and insulin C-peptide.
 * V˙o2max, measured on a treadmill.
 * Maximal leg strength using a leg press machine.
 * Biochemistry of muscle biopsies to analyse protein levels.
 * Skeletal muscle SERCA (sarcoplasmic/ endoplasmic reticulum Ca2+ ATPase) activity to measure maximal rate of Ca2+ into the sarcoplasmic reticulum. This was performed due to the re-uptake is inversely related to fatigue in skeletal muscle. A decreased maximal rate indicates a low aerobic capacity.
 * Finally, results were analysed using a two-way ANOVA test. Combined with using Shapiro-Wilk W test to normalise the data as well as the Bonferroni post-hoc test was used to adjust results for comparison of multiple data sets..

What were the basic results?

 * Vo2max increased in all subjects by 10, 16 and 33% in strength training, moderate-intensity and high-intensity aerobic training respectively..
 * 1RM increased by 25% for subjects exposed to strength training whereas there was no significant increase for moderate or intensive aerobic training subjects.
 * PGC-1α (peroxisome-proliferator activated receptor γ co-activator 1α), There was an increased in both strength and high-intensity aerobic training for PGC-1α protein levels with moderate-intensity level intensity seeing no significant change.
 * SERCA was affected in strength and high-intensity aerobic training with maximal Ca2+ increasing by 72% and 73% respectively while moderate-level aerobic again had no significant effect.
 * FMD was significantly improved in all subject groups with high-intensity aerobic training having a significantly higher effect on FMD then the other two subject groups.
 * Body composition was affected a small yet significant change. Body weight decreased by 3% for moderate-intensity and 2% for high-intensity aerobic training, however, strength training saw no change on body weight.

What conclusions can we take from this research?
These results definitively demonstrate the differences between the three subject groups. It highlights the body’s adaptations to various forms of exercise and the clear benefits from each of these forms. The results were so critically analysed and moderated to produce the highest quality of results from these tests to be as valid and reliable as possible. These tests clearly demonstrate that there is some correlation between the three forms of exercise and obviously show that some exercise is always better than none no matter form that it is classified under. As the title of the paper suggests, both moderate and high-intensity aerobic and strength training programs improve cardiovascular health in obese adults. This paper then does meet its aim of looking at the efficiency of moderate and high-intensity level aerobic training and strength training on improving cardiovascular health in obese and overweight populations but demonstrates that while high-intensity aerobic exercise is the optimal mode exercise, strength training is just as effective in most aspects. Papers such as “The addition of muscle strength to aerobic interval training: effects on muscle strength and body composition in CHF patients” have benefited form this study and its correlation between aerobic interval training such as the high-intensity training and strength training allowing them to base some of their research from the facts found in the paper.

Practical advice
This paper allows EPs (Exercise Physiologists) to create diversity within their programs to help individuals who are suffering from obesity, are overweight or heading to becoming overweight in order to help with participation by giving training programs some diversity or to create programs based on ability. For example, an obese person who suffers from chronic osteoarthritis may not be able to participate in high-intensity aerobic training but could participate in short duration strength training could be an alternative training method.

Research such as the paper Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults is a continuation of the research conducted in this paper and addresses the issues related to self monitored nutritional intake that would have a significant impact on the results in this paper. It also adresses the concerns of unmonitored exercise that is assumed to be completed at a set level or completed at all.

Further information/resources

 * "Both aerobic endurance and strength training programs improve cardiovascular health in obese adults” by Inga E. Schjerve et al.

 * The addition of muscle strength to aerobic interval training: effects on muscle strength and body composition in CHF patients”

 * Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults

 * Effects of aerobic and strength-based training on metabolic health indicators in older adults