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Exercise as it relates to Disease/Pilates and Yoga group exercises to relieve neck pain

What is the background of this research?
With an ageing population in Australia, chronic neck pain (CNP) and associated back pain is becoming more prevalent, with 70-80% common for back pain, and 30-40% for neck pain in the Australian population in the last 10 years (1). CNP and back pain have several limitations, as its restricting nature reduces one’s quality of life. In recent years, more patients who suffer from chronic neck and back pain are pursuing methods to combat neck and back pain (2). Complimentary methods, such as yoga and Pilates are used in the health industry for not only a form of exercise, but also for physiotherapy treatment, post rehabilitation transition and community wellness (3). Functional Pilates and yoga combine physical and mental focus to increase relaxation and muscle strength, especially core stability (4). This is achieved through breathing control and complex movement sequences. The purpose of Dunleavy’s and his cohorts’ study is to “determine the effectiveness of Pilates and yoga group exercise interventions for individuals with chronic neck pain (CNP) (3).

Where is this research from?
This research was conducted in 2015 by K. Dunleavy, K. Kava, A. Goldburg, M.H. Malek, S.A. Talley, V. Tutag-Lehr, and J. Hildreth. These physiologist specialists are based within health-related faculties across Wayne State University, University of Florida, and University of Michigan-Flint. This study was conducted across these four locations, however, was approved by Wayne State University. Upon approval of the completion of the research, the article was published by Elservier Ltd for the Chartered Society of Physiotherapy, which is a governing body that aim to provide adequate and high quality rehabilitation services and protect the quality of physical treatment.

What kind of research was this?
To effectively gather the appropriate information, the authors used a quasi-randomised parallel controlled design, which is also known as a Randomised Controlled Trial (RCT). This is where participants are randomly and alternately categorised into groups within a controlled setting. This type of study reduces any bias that may occur during the research. RCT balances out the different attributes between participants in each group, reducing bias and provides results that can be analysed in a cause-effect relationship between an intervention and an outcome (5). It is notable that that quasi-randomised study used highlights the effectiveness that the interventions have on an individual, as well as the safety measures put into place (5).

What did the research involve?
Participants were first pre-screened to identify any previous underlying health or medical issues that may prevent restrictions when performing physical activity. These participants were recruited from various settings, physiotherapy clinics, fitness and community settings and email lists. They were then assigned either yoga, Pilates or control based on random convenience. An individual baseline measure for each participant was recorded prior to set the standard for everyone. The study was conducted over 18 weeks, with data collection being recorded after six weeks and 12 weeks. The data being collected includes: These data points are then classified into four categories; NDI, average pain, upper-extremity pain, and sustained-activity pain. All participants involved attended a 12-week intervention consisting of 1-hour sessions. Each class could be individually modified to suit each participants fitness level. Over the 12 weeks, with yoga and Pilates, instructors are educating participants about positioning, body mechanism and movement strategies, as well as mental focusing, breathing control and spinal alignment. Yoga classes specifically focused on specific postures, relaxation, and meditation, whereas the Pilates group focused on core stabilisation and spinal alignment (3). In addition to measuring pain, measuring improvements on muscle and core strength would also help create a deeper understanding on how CNP and back pain can be reduced. For example, Ulug conducted a research concerning CNP, where they compared measurements of the neck muscles and how they improved over a course of time (4).
 * Neck Disability Index (NDI) = This is a 10-question scale (0-5) which indicates the difficulty of daily activities and quality of life living due neck soreness, often used within a clinical setting.
 * Pain ratings = This 11-point numeric rating scale (NRS) helps indicate the level of soreness or pain. The questionnaire includes questions concerning overall pain, pain including daily life activities and soreness when performing overhead activities.
 * Range of Movement (ROM) = ROM and Cervical ROM is tested for adequate movement in all directions. A score is calculated by the sum of all movements in a direction, the by finding the mean of three trials. Dunleavy and Goldberg commend Cervical ROM as a moderate-to-excellent inter-rater reliability (2013).
 * Posture = Measurements were taken with a clinical setting by the participants in a neutral sitting position, with both feet on the floor and hips at a 70-degree angle. Posture measurements work in conjunction with Cervical ROM.
 * Exercise intervention = yoga and Pilates classes were instructed by qualified rehabilitation trainers in conjunction with physiotherapists with adaptive yoga training.

What were the basic results?
Overall, the results show that yoga and Pilates can decrease neck and lower back pain, as well as stiffness, tension, and disability of the spine within a moderate-to-large effect size (yoga = 1.0-1.8, Pilates = 0.7-1.0). This range was concluded that the short-term follow up. The effect size can be classified as the “magnitude of the differences between interventions and control groups” (2). The primary outcome for this study was assessing the NDI to fully understand the impact yoga and Pilates have on this region. The average NDI score improved across all classes, suggesting that relaxation and stretching techniques that are apparent in yoga and Pilates classes play a role in extinguishing neck pain. Adding to this, Uluğ and Yılmaz conducted a similar study that suggests that chronic neck and back pain sufferers opt to alternative methods of pain relief (4). No further improvements were found in the control group.

Dunleavy and his team chose parameters that increases the validity and reliability of this study. For example, the average pain appropriately measures the overall pain experienced. As chronic neck and back pain is more prevalent in older working adults, therefore measuring and evaluating comfort and stiffness in everyday activities is beneficial to this study as it provides a wider range of knowledge about this area. To improve this study, further studies concerning soreness and level of discomfort during and after exercise can broaden the research area, increasing validity and depth of research.

What conclusions can we take from this research?
In conclusion, it is possible to heal majority of chronic neck and back pain through sufficient and consistent Pilates and yoga exercise, decreasing stiffness and joint pain in these areas. There were significant improvements across all outcomes in both yoga and Pilates exercise groups, compared to the control group. The study design that was implemented helped the researchers conclude that both yoga and Pilates is a safe way of exercising to decrease other health-related risks along with neck and back pain. The study results will vary between each participant as everyone will experience different extremities of chronic neck and back pain and will participate in these interventions differently. In addition to this, yoga and Pilates are more commonly practiced my females, therefore this study is primarily based around females.

Practical advice
Brämberg et al. explain that to reduce neck and back pain sufficiently using these techniques, you should adopt these interventions in your routine two/three times per week, allowing time to fully recover between each session (1). If participating in yoga or Pilates to help relieve chronic neck and back pain, it is important to be consistent with this practice to see long-term results. In addition to this, a follow-up is advised to ensure that long-term effects of the chosen intervention are beneficial, in conjunction with a health professional such as a physiotherapist, yoga/Pilates instructor or exercise physiologist (6).

Further information/resources
Chronic Neck and Back Pain

Effects of Yoga and Pilates on an Individual

Yoga and Pilates associated with Lower back Pain


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Exercise as it relates to Disease/Video games leading to obesity among youths

Background
With remarkable technological advancements each year, video gaming has become one of the most popular leisure time activities among youths and adolescents, especially within the western world. This worldwide popularity has gotten the attention of many sweet drink producers from around the world and has created sponsored events to help increase their business and target youths and adolescents into consuming their products. The study model (Linking video gaming, sleep quality, sweet drink consumption and obesity among children and youth(1)) conducted by O.Turel, A.Romashkin and K.M. Morrison was to research the links between higher abdominal obesity and lack of sleep among the age groups of nine and seventeen which whom takes part in video gaming while consuming sweet drinks prior to sleep. Video gaming and obesity is a highly researched topic with more articles focusing on most time played during the day, but this model instead was designed to consider average gameplay prior to bedtime and impacts it may have towards sleeping quality and behaviours.

Where is this research from?
It was recorded that in Northern America, 72% of teenagers takes part in playing video games and 84% of this group are teenage boys. The participants for the research paper was gained from the paediatric lipid clinic and weight management hospitals located in Canada.

What kind of research was this?
The aim of the paper for was to; Identify the pinpoint patterns or “attributes such as timing and duration(1)” of video games and physical activity in relation to sleep quality within youths and adolescents. It was also to identify any correlations between sweet drink consumption during video gameplay and how it may be affecting abdominal adiposity.

What did the research Involve?
The research involved 125 patients from the paediatric lipid clinic and weight management hospitals and included youths and adolescent ranging from nine to seventeen years of age. All these subjects were regular video game players and did consume some type of sweet beverage during the day. With parent consent and the help from nurses, each subject went through an average of six-week self-reported questionaries on how long they spent playing video games prior to their bedtime and how many sweet drinks they consumed. Physical activity was also recorded using Fitbit devices for a one-week period. Sleep quality was recorded using the Pittsburgh sleep quality index which varies from 0-23 with lower scores being associated with increased sleep quality. After the average sex weeks has passed, each subject returned to the clinic to have their, height, weight and abdominal adiposity measured.

What were the basic results?
Pre-screening was done on all subjects and the data showed (1) that the average age for the group was 13.06 years, average height was 161.1 cm and average waist circumference was 91.57 cm. The results showed the participants played video games for 4.76 days of the week and before bed, they played for an average time of 58.39 minutes with a standard deviation of 75.65minutes. Normally during the day, they would play for an average time of 91.12minutes with an S.D. of 84.52minutes. Each participant managed to have an average of 13.94 steps per minute and scored a 4.53 on the sleep quality index. After the data was analysed, it showed good sleepers only spent around 43.80minutes gaming before bed while poor sleeper spent around 91.80minutes. Good sleepers had an average sweet drink consumption of 0.73 while poor sleepers had a consumption of 1.91 drinks per day. The Abdominal adiposity (waist to height ratio) for good sleepers were 0.55 and for poor sleepers, it was 0.60.

What conclusion can we take from these results?
The aim of the study was to identify if playing video games prior to bedtime and drinking sweet drinks had any links to sleep quality and abdominal adiposity. The results show that the majority of participants play video games for approximately 58.39minutes before bed but the standard deviation is set at 75.65minutes. The analysed data states good sleepers only played for an average of 43.80 minutes before bed. Considering most participants played above this timeframe, their gaming prior to sleep is likely linked to their poor sleep quality. There was also a 1.18 sweet drink consumption difference between the groups meaning there is evidence to prove it does affect sleep quality. However, there was only a 0.05 difference in abdominal adiposity meaning there is no evidence supporting sweet drink consumption with gaming does lead to an increase in abdominal adiposity. It's clear from the results, the research paper did achieve its aim in directly linking reduced sleep quality and video gaming but the method was flawed when trying to find out its link to abdominal adiposity. It failed in recognizing the importance of key factors such as fitness and nutrition.

For youth and adolescents, it’s clear there is a correlation between the quality of sleep and video gaming prior to bedtime while having consumed sweet beverages. However, there is an indirect link between video gaming, drinking sweet beverages and abdominal adiposity. It’s also clear there is an indirect link between abdominal adiposity and sleep quality but this paper does not contain the required research to reach a conclusion for this topic. From these findings, it's clear the paper proves the correlation between video gaming and poor sleep quality. However, this data is not taking into consideration physical activity and overall sedentary behaviours leaving questions unanswered on whether if video gaming is the only direct link to sleep quality or if there are other factors.

Further Information/resources
Video gaming is linked to poor sleep quality and lower sedentary time meaning lower physical activity; however, this does not mean it should be considered a problem. Although it may not be researched in this particular paper, children between the age of nine and seventeen are at high risk of feeling left out due to low social skills, going through high-stress periods and being overweight ultimately leading to depression(2). A meta-analysis done on depression and diabetes (2) indicate that the two are tightly linked with one another and to escape these major issues, an individual requires motivation(3). Video games provide an outlet for these individuals to escape into and relieve stress, improve social skills and increase their moods and self-confidence to help them move out of their comfort zone. Although video game might create the problem of obesity due to high sedentary time, it can also be a solution.

Practical Advice
It’s understood there is a correlation between video gaming prior to bedtime and poor sleep quality. The PSQI scored an average of 4.53 meaning the quality of sleep is okay but considering the participants are in the stages of puberty and are growing, being in the stages of 1-2 PSQI sleep index scores would be in their best interest. However, if youths and adolescents enjoy playing video games during night time, they should try and stay under the 45minute mark and drink only one sweet beverage a day to help increase sleep quality and possibly reduce abdominal adiposity. Following this guideline can also help reduce the risk of depression and can help motivate a young individual to be physically active making it very beneficial to their mental and physical wellbeing. For further clarification, the diagram to the right is a representation on how all these factors expressed above impact with one another.

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


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Exercise as it relates to Disease/Effects of short-term physical training on rheumatoid arthritis sufferers

What is the background to this research?
Rheumatoid Arthritis (RA) is a progressive and chronic inflammatory autoimmune disease which causes the body to attack its own healthy bone joints, in turn causing inflammation (1). The research attempts to analyse some of the effects on a persons’ daily living and examine whether incorporating physical training can contribute to the reduction of symptoms of Rheumatoid Arthritis. This disease has the ability to impair the skeletal system and cause swelling, tenderness, pain and stiffness (1). Over long periods of time these symptoms can damage and weaken bone and cartilage in a person’s body. Once weakened or damaged, there is a detrimental impact on the range of motion and in the long-term can potentially lead to deformed joints (1).

Where is the research from?
This study was conducted at St. Erik’s hospital in Stockholm, Sweden, by Bjorn Ekblom and four colleagues, using a sample of thirty-four volunteer patients. They were aged between 38 and 63, with a mean age of 56, split into two groups, a training group (TG) of 23 participants, and a control group (CG) of 11 participants. Each participant exhibited second or third-degree RA, for a duration from three and 18 (mean 9.6) years. The aim of this study was to examine the effects of a six-week intensive physical exercise training program on a group of RA sufferers.

What kind of research was this?
The research was a quantitate randomised control trial (RCT), using two experimental groups that looked at repeated observations of the same variable over a six-week period. RCT’s are considered the gold standard for observing results as the randomisation prevents the skewing or deliberate manipulation of results.

What did the research involve?
Over the six-week period, each participant took part in an ordinary physical rehabilitation program for between 15 and 20 minutes, five days a week, focusing on muscular strength training and joint mobility training.

Both the CG and TG participated in a walk test of 850 metres at a fast as possible speed on even ground, a stair test, again done as fast as possible, and a footstool test that measured participants ability, including different step heights.

Along with this physical exercise, the TG participants performed additional physical training between 20–40 minutes each day of the week. Additional training encompassed blocks of 3–5 minutes on a cycle ergometer and muscle strength training on the quadriceps table. This is important as when muscles are sedentary in RA populations, the bones can fuse together as the cartilage between the joints is eradicated and bones come into direct contact. As the body attempts to repair the damaged bone, bone growth fuses the two bones within the joint (2).

Each participant’s oxygen uptake was captured at the end of each training session. Heart rate was also measured each minute, and continuously at the end of maximal training. Blood lactate concentration and the participants rating of perceived exertion (RPE) was evaluated after each workload. This is important to measure as the pain and discomfort that RA can induce can limit one’s ability to perform aerobic exercise.

What were the basic results?
Walk test In the TG, time to perform the exercise decreased for all participants over the duration of the six-week trial. Heart rate (HR) at the end of the six weeks was not statistically different, similarly in the CG the work time was almost unchanged.

Stair test In both groups the average time taken for this test decreased over the observation period, yet significantly in the TG.

Foot stool test In both groups there were average increases for both “best” and “worst” leg over the observation period. However, the increases were greater and only significant in the TG.

Cardio-respiratory tests During submaximal exercise the VO2 was lower in the TG compared with pre-training values, while it was unchanged in the CG. As a result of the physical training, average heart rate on a fixed submaximal workload in the TG was reduced while stayed unchanged in the CG. In both groups, blood lactate was unchanged. Overtime, the inflammation of RA affects the lining of the lungs, causing discomfort while breathing, especially when breathing heavily during exercise in turn limiting VO2max (3).

Rate of perceived exertion (RPE) Perceived exertion during submaximal exercise was much lower in the TG following the exercise. As a result, less discomfort was experienced throughout the exercise. This demonstrates how periods of physical activity can decrease the inflammation and discomfort of RA symptoms (4).

What conclusions can we take from this research?
The intensive physical training program and study resulted in positive improvement in physical performance capacity, cardio-respiratory fitness and leg muscle strength in the TG. This indicates that a lack of physical activity could be a major reason for the low physical fitness in the RA patient. In contrast, yet similar, the CG experienced some increase in muscle strength and the different muscle groups during the six-week program of daily physical testing. However, there were no large or significant improvements in performance capacity or cardio-respiratory fitness.

The majority of these tests demonstrate a greater positive response to training in the TG group when compared to the CG group. This suggests that future research should aim to test beyond six weeks. Results then may be amplified or may be able to show more significant improvements in all areas of study, including VO2max, exercise testing results and pain perception (5). The TG positive results are not attributed to any one single physiological factor studied.

Practical advice
This study highlights the influence and benefits of physical training on joint status and the patients’ perception of physical exertion during the different tests. Regular exercise over long periods of time has the ability to increase respiratory function, circulatory function and decrease the inflammatory symptoms of RA. Greater functional capacity improves the ability to perform everyday activities and has the potential to create a better lifestyle. This can be investigated in a future study.

Further information/resources
Physical Activity for Arthritis

Physical Activity and Exercise - Rheumatoid Arthritis Support Program

Support Group - Arthritis Australia


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Exercise as it relates to Disease/The relationship metabolic syndrome has with physical activity and cardiorespiratory fitness

What is the background to this research?
Metabolic syndrome (Mets) does not have an internationally recognised definition, and as such, has caused numerous issues in diagnosing and researching the condition (Huang, 2009; Grundy, 2008; Despres & Lemieux, 2006; Chew et al., 2006; Eckel et al., 2005). In 1998, an attempt was made to solidify various definitions that were being used by clinicians and researchers (Eckel et al., 2005). Although they could not agree on a singular definition, a consensus was reached on the essential components of Mets. These components were glucose intolerance, hypertension, obesity, and dyslipidaemia. The specific range and criteria regarding these components vary among definitions. To be diagnosed with Mets individuals must have a minimum of three abnormal components (Huang, 2009; Grundy, 2008; Despres & Lemieux, 2006; Chew et al., 2006; Eckel et al., 2005).

There is a strong correlation between MetS and the risk of contracting cardiovascular disease (CVD) and diabetes (Huang, 2009; Grundy, 2008; Despres & Lemieux, 2006; Chew et al., 2006; Eckel et al., 2005). Whilst MetS is a cluster of individual risk factors, the combination of these components has exponentially increased the risk. This was demonstrated through the DECODE study (as cited in Eckel et al., 2005) that compared the mortality rate for CVD between those with and without MetS. The hazard ratios were 1.44 and 2.26 in males, while it was 1.38 and 2.78 in females. Grundy (2008) also supported these findings and went on to state that those with MetS were twice as likely to contract atherosclerotic cardiovascular disease than those without the condition. Mets is also linked to non-alcoholic hepatitis, polycystic ovary disease, cancers, and cognitive decline, Singh-Manoux et al (as cited in Rattray, 2020).

The prevalence of MetS has increased in parallel with the rise in obesity across the globe (Eckel et al., 2005). This demonstrates the relationship lifestyle factors, particularly poor nutrition and inadequate physical activity have on the development of MetS. The relationship MetS has with obesity is concerning, as obesity levels are only expected to rise in the future. Therefore, to prevent an expediential growth in MetS actions must be taken now to drastically reduce obesity levels (Huang, 2009; Grundy, 2008; Despres & Lemieux, 2006; Chew et al., 2006; Eckel et al., 2005). Preventing and appropriately managing MetS is essential in reducing the economic burden of these lifestyle diseases. As mentioned above, MetS is a large risk factor in the development of other chronic diseases. The cost of these disease places a large financial and resource burden on the health system. In Australia, CVD alone cost 5.6 billion dollars in 2015-16 (2019). With chronic illness such as diabetes also closely linked to MetS it is essential that interventions are developed to prevent the progression of diseases. Therefore, governments must invest in research to appropriately manage MetS (Huang, 2009; Grundy, 2008; Despres & Lemieux, 2006; Chew et al., 2006; Eckel et al., 2005). This research article has utilised two definitions that highlight slightly different components of MetS (Laaksonen et al., 2002). First, they have used the World Health Organisation’s (WHO) definition, which focuses primarily on diabetes or issues related to glucose and insulin. The second definition is from the National Cholesterol Education Program (NCEP), which focuses equally on the various components associated to MetS. Table 1 identifies the diagnostic criteria for MetS based on the different definitions (Huang, 2009).

Where is the research from?
This journal article was published in Diabetes Care by the American Diabetes Association. The goal of this publication is to increase the knowledge and management of individuals with diabetes (About Diabetes Care | Diabetes Care, 2020). It was established in 1978, has a monthly issue and an 11.06% acceptance rate. The articles published must undergo a heavily scrutinised process, including peer review. Thus, this article is an appropriate and well-developed research paper (About Diabetes Care | Diabetes Care, 2020). This article was designed, performed, and analysed in Eastern Finland. The authors of this article have extensive knowledge in research and public health. As demonstrated through their places of employment: Department of Physiology, University of Kuopio, Kuopio, Finland; Research Institute of Public Health, University of Kuopio, Kuopio, Finland; Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland; Department of Medicine, University of Kuopio, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland; Inner Savo Health Center, Kuopio, Finland; and Kuopio Research Institute of Exercise Medicine, Kuopio, Finland (Laaksonen et al., 2002, p. 1612) The overall background, reputation and expertise of the authors and publication has ensured a quality research article.

What kind of research was this?
Researchers collected the Vo2max (ml.kg-1.min-1) and the metabolic components (waist circumference, body mass index (BMI), fasting blood glucose, triglyceride, high density cholesterol (HDL) and blood pressure) of 612 middle-aged Finnish men without MetS. They also conducted a survey using the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) to record the leisure time physical activity (LTPA) levels of participants over the past twelve months.

What did the research involve?
The method accurately measured the cardiovascular fitness (CVF) and metabolic health of participants. It used an appropriate questionnaire to record the LTPA levels of participants. It also accounted for lifestyle differences that could impact the reliability and validity of the results. Participants were tested before the study, at the twelve-month mark and again four years later. This ensured a thorough understanding was obtained about the impact LTPA and CVF has on the development of MetS.

Whilst the method was suitable for the research being conducted, there were issues relating to the article. Firstly, the amount of LTPA conducted was recorded by the participant themselves. This causes issues with the reliability of the data collected. Secondly, the research could not account for the impact other variables, such as occupation, have on the CVF. Despite this, it is clear the research conducted was appropriate, reliable, and valid.

What were the basic results?

 * Men that did not develop MetS had a higher vo2 max and engaged in more LTPA, particularly vigorous LTPA.
 * The moderate to vigorous the exercise improved vo2 max, particularly vigorous exercise
 * At least 60 minutes of vigorous LTPA reduced the likelihood of developing METS by two-thirds
 * CVF mediates all other risk factors
 * Low fit and sedentary men are sevenfold more likely to develop MetS than fit, active men.
 * Men complying with the CDC-ACSM recommendations decrease the risk of developing MetS by one-half compared with men engaging in no more than 6 minutes of mod exercise per week.
 * Low intensity LTPA tended to decrease the likelihood of developing MetS, however, this was statistically insignificant due to inadequate data.

What conclusions can we take from this research?

This article highlights the importance of LTPA and the essential role that cardiovascular fitness has in the prevention of MetS. The evidence generated from this article is well supported by numerous journal articles (Huang, 2009; Grundy, 2008; Despres & Lemieux, 2006; Chew et al., 2006; Eckel et al., 2005). Therefore, this article has demonstrated is it appropriate and relevant in the prevention of MetS.

Practical advice

 * Follow the ACSM and CDC’s physical activity guidelines.
 * Encouraging overweight/obese individuals to participate in low intensity LTPA is both realistic and beneficial for reducing MetS risk factors (something is better than nothing).

Further information/resources
ACSM: https://www.acsm.org/read-research/newsroom/news-releases/news-detail/2018/11/12/updated-physical-activity-guidelines-now-available

CDC: https://www.cdc.gov/physicalactivity/basics/index.htm

Department of Health (Australia): https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines


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Exercise as it relates to Disease/Exercise as relief of stress-related fibromyalgia

Background
Fibromyalgia is a blanket term for generalised pain and stiffness in the muscles as well as lethargy and poor quality sleep. It is thought that the cause of Fibromyalgia originates in the brain and has been linked to sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome and multiple chemical sensitivities. Research into alleviating symptoms is crucial as it affects around 2-5% of the population with high prevalence in young to middle aged womenFibromyalgia [Internet]. Healthdirect.gov.au. 2020 [cited 17 September 2020]. Available from: https://www.healthdirect.gov.au/fibromyalgia. As this affects a large number of individuals and is a physical and psychological impairment, it is essential to look into the effects exercise as well as stress management treatment can have on relieving symptoms.

Where is the research from?
The chosen article was published in the Scandinavian Journal of Rheumatology published online in 2009 by S. H⊘rven Wigers, T. C. Stiles & P. A. Vogel. The research posted is peer reviewed and is published in a reputable journal illustrating that the content is high quality. The research was conducted at the University of Oslo, Norway in the Department of Physical Medicine and Rehabilitation, University Hospital of Trondheim, Department of Psychiatry and Behavioral Medicine, University of Trondheim, Department of Behavioral Sciences in Medicine.

What kind of research was this?
The research is a four and a half year prospective study by which sixty five fibromyalgia patients from the local patient association underwent an extensive medical history. To ensure comparability to other literature the participants had to fulfill a certain diagnostic criteria making the study more valid. The use of the four and a half year study successfully allows the study to demonstrate whether the chronic effects of fibromyalgia are still present and which intervention was more successful. Although given the layout of prospective study it relies on the participants own tenacity in regards to following their intervention which may skew results but in this case almost identical completion rate occurred.

What did the research involve?
The exercise intervention group underwent three, forty five minute sessions over fourteen weeks which equates to just under the weekly physical activity guidelines. Participants were guided by physiotherapists by which they underwent exercises to minimise whole body eccentric muscle strain, their programs then progressed via their individual biomarkers. Each individual was fitted with the same shoes as well as followed the same warm up and cooldown routines allowing the design to become more valid. The stress management treatment consisted of two clinical psychologists one working in a group setting and the other working closely with the participant. Each individual underwent ninety minutes twice a week for the first six weeks and then once a week for the remaining eight weeks, they were given cognitive behavioural stress therapy and an introduction to cognitive therapy in coping with psychological problems. As these were designed to be quickly applied to any situation the participants would likely not become overwhelmed ultimately leading to a decrease in fibromyalgia. Outcome Assessments were made to establish baseline, midway and after as well as a four year follow up after the intervention. All the assessments were made at a practitioner besides the midway assessment which consisted of a self directed questionnaire. Given both the professional and self administered evaluation the information given can meet a balance between anecdotal feedback and practitioner assessment allowing for a more accurate scope of information.

What were the basic results?
Between both the aerobic exercise groups and the stress management group there were no significant differences from each other but in comparison to the control group who continued their treatment as usual, there were a number of differences which indicate positive signs for short term relief of symptoms.

Aerobic group
The aerobic group showed consequential results reduced pain distribution, tender point pain as well as a greater capacity to work. In addition, participants also demonstrated increased energy as well as increased subjective societal improvements. Interestingly, the participants rated improved physical fitness and the positive social dimension as the most beneficial aspects of the treatment.

Stress
The Stress management showed reduced tenderness as a result of the treatment as well as decreased depression and decreased in disturbed sleep. These participants found that the most beneficial skill was learning relaxation techniques.

Conclusions
The study demonstrates that both aerobic exercise and stress management illicit positive short term effects on fibromyalgia in comparison to the regular treatment, However in more research must be done on this as when looking at each group as a whole there were no significant long term decreases in severity of symptoms. Symptoms were reduced when participants adhered to their program with exercise, which could potentially account for the lack of long term results further advising more studies to be done. In addition, given the effects of exercise are reversibile it is likely that the positive effects on fibromyalgia are also reversible which further reiterates that compliance towards one's program is crucial to reducing symptoms. Furthermore the stress management had a higher compliance rate long term than exercise as well as helping with pain management and depression which aligns with other literature. As both groups demonstrated improvements over the baseline one can deduce that there are beneficial short term consequences, but in terms of long term symptoms more research is needed. The differences between each participants everyday stressors may limit the effects of each individual's treatment.

Practical advice
Both modes of pain management have beneficial implications in the daily life of chronic sufferers. Both techniques offer a cost effective way to reduce the pain from symptoms when compared to the regular treatment and should be considered by all chronic sufferers to improve their quality of life. A combination of both exercise and stress management could have great implications in the daily life of fibromyalgia patients addressing both the physical and psychological aspects of the disease. In addition more research should be done in addressing the long term improvements but if both exercise and stress managements can dull the pain and allow patients to have a greater work capacity one should converse with their physician about potentially prescribing an intervention plan.

Here are some further supporting documents
Exercise

Stress-managment
 * Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study.
 * Exercise for Fibromyalgia: A Systematic Review
 * Exercise Therapy for Fibromyalgia
 * A Controlled Study of a Stress-Reduction, Cognitive-Behavioral Treatment Program in Fibromyalgia


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User talk:Ekc2000

Welcome, Ekc2000!

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User talk:AK3001032

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User talk:PatrickSuthern

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User talk:Benkendrick1

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User talk:CaitlinDahl

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User talk:Grace.Ronnfeldt

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User talk:76CB04

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User talk:Ronan.busing

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User talk:At9137

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User talk:Hannahrahadizad

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User talk:Anna Jane D

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User talk:Kathleen Churchill

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User talk:U3190473

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User talk:Iszacbell

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User talk:U3184384

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User talk:Lucan79

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Exercise as it relates to Disease/The effect of exercise on mental health outcomes of pre- and early-school-aged children

This is a critique of the article Exercise effects on mental health of preschool children, published in the Anales de Psicología/Annals of Psychology.

What Is The Background To This Research?
The positive effects of physical exercise on mental health are well documented in prior research. However these results are based predominantly on research examining an adult population, while children of different ages were neglected.

Meta-analysis research conducted in the last several years on the population of children and adolescents indicates a wide range of obtained results. These results range from those indicating a medium to strong correlation between engagement in physical activity and the mental health of young people, especially when anxiety and depression are concerned, to those which indicate that the correlation is weak, if there is any at all.

This paper deals with problem behaviour in terms of externalising and internalising behaviour, which is classification common in children’s psychology and psychiatry. The externalising spectrum incorporates a variety of disinhibited or externally focused behavioural symptoms including aggression; conduct problems, delinquent behaviour, oppositionality, hyperactivity, and attention problems. The internalising spectrum includes a variety of over-inhibited or internally focused symptoms including anxiety, fear, sadness/depression, social withdrawal, and somatic complaints. Studies of children often find the two positively correlated to one another. In this study, it was hypothesised that children from intervention group would express less externalising and internalising behaviour in comparison to children from the control group after 2.5-year period.

Where Is The Research From?
This study originates from the Faculty of Sport and Physical Education, at the University of Novi Sad in Serbia. The first author, Tatjana Tubić is a full professor of Psychology at the university. Tubić specialises in Sport Psychology and Teacher Education. The second, Višnja Đorđić is an Associate Professor at the University, who specialises in the areas of Physical Education, Gender Issues in Sport and Public Health. Per ResearchGate, Đorđić and Tubić have 74 and 34 items of which they have contributed, respectively. They both have an extensive history of research in the area.

What Kind Of Research Was This?
The study’s purpose was to identify effects of 2.5-year movement program on mental health of preschool children, as measured by reduction in symptoms of externalising and internalising behaviour. The trial was a cohort study that consisted of 184 children (both male and female) with 53 of the children being assigned to the intervention group, being compared to 167 other children, who were randomly chosen and tested. This ‘comparison’ or more commonly ‘control’ group participated in physical exercise only through their regular activities within the preschool curriculum. All children in the sample were enrolled in kindergartens in Novi Sad. It is important to note that preschool children in Serbia are 5 to 7 years of age.

A voluntary response sampling dictated assignment to the intervention group. Parents of the children would have to administer and maintain the 2.5-year physical activity intervention. While finding volunteers is often a relatively fast and affordable way to gather participants, it is highly susceptible to bias. This is because researchers can make little effort to control sample composition. The people who do volunteer may have more favourable characteristics that may affect the validity and reliability of the experiment. However, whether this occurs is dictated by this actual study being done.

Cohort studies look at two or more groups of people. They can be prospective (forward-looking) or retrospective (backward-looking). Prospective studies are planned in advance and carried out over a future period of time. From the researchers point of view the study was observational, as they did not administer the intervention, however just measured the results at specific intervals. The Aberrant Behaviour Questionnaire (ABC), containing 16 items (dependent variables), was the measurement tool utilised to examine the symptoms of externalising and internalising behaviour. The ABC is a 58-item questionnaire for caregivers, that is designed to assess the presence and severity of various problem behaviours commonly observed in individuals diagnosed with intellectual development disorders. Metric characteristics of this instrument were verified on the Serbian sample of 1165 children aged between 4 and 7.

In order to deeper insight into the changes of certain types of problem behaviour under the influence of the intervention movement program, the statistical significance of the differences within intervention group and the control group were analysed using a Wilcoxon Test. There were a few limitations of this study that were noted by the authors. Firstly the number of children who participated in the intervention was significantly reduced from the initial to final measurement, which doubtlessly limits the possibility of generalising the results. All of the children involved were white, and were from the territory of Novi Sad, but the groups were not matched according to socioeconomic (S.E.) status. It was theorised that those who remained may have been those families from a higher S.E. status, as the parents financed the intervention movement program themselves. Also, as the measuring instrument used was administered by the parents of the children, there is a certain level of subjectivity that cannot be eliminated.

What Were The Basic Results?
The basic results indicated that physical exercise had an influence on the reduction of problem behaviour. When looked at holistically, all indicators of externalising behaviour, without any exception, decreased in the intervention group of children. The regularity of changes was seen from the initial, through transitive to final measurement. It is important to note, that not only the tendency of decreasing of this form of behaviour measured by the appropriate indicators can be noticed, but also decreasing within much wider limits, when compared to the control group of children. For internalising behaviours, it could be noted that all variables in the final measurement had lower scores than those in the initial, but in this case, only 3 of them decrease monotonously.

Even though the results were very noticeable, the researchers could only speak on the tendencies of reducing problem behaviour through physical exercise, as there were no statistically significant differences between the intervention and control groups at the observed ages of children, save for sporadic ones. This means that the research hypothesis could only be partially confirmed.

What Conclusions Can We Take From This Research?
Based on the results of this study and those that came before, it could be concluded that sustained physical activity can help to reduce the symptoms of externalising and internalising behaviour. While the intervention was not successful in reducing all variables measured, across all groups, there remains substantial evidence to support to research hypothesis.

The results of an even longer-term exposure to maintained physical activity are seemingly yet to be documented, in my own research. It would be a potential avenue of further study on the topic.

Practical Advice
Children who exhibit problem behaviours, such as those in focus in the study, would likely find benefit from maintaining extra-curricular physical activity during their formative child and teen years. However, exercise is not the only form of treatment per se, which could be employed, especially when family S.E. status and the particular child’s tendencies may not allow for, or be suited to this type of treatment, respectively.

Further Information/Resources
Raising Children Network

Kids Help Line


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User talk:M.Hallis241

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User talk:HL1701

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User talk:U3178735

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Exercise as it relates to Disease/Transtheoretical model intervention vs standard therapy in increasing physical activity in sufferers of chronic low back pain

This is a critique of the following article: Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial (2017)

What is the background to this research?
Low back pain is considered to be an extremely common issue globally, is at the forefront of causes for work absence and inhibiting general well-being and physical activity, and was found to be the most common cause of disability in young adults. Clinical recommendations, and guidelines from the World Health Organisation on treating chronic low back pain encourage increasing patients physical activity levels, however as this paper discusses, common barriers to this include low self-efficacy and fear avoidance, as well as other physical, psychological and socio-environmental factors. The research conducted for this study aims to assess the effectiveness of utilising an enhanced transtheoretical model intervention (ETMI) to address these barriers and increase patients physical activity levels vs standard physical therapy.

Where is the research from?
The study was conducted in Israel within the Maccabi Healthcare Services physical therapy clinics with the approval of the Tel Aviv University. The research was published in the Journal of Orthopaedic & Sports Physical Therapy (2017). The authors of this study received an award for Excellence in clinical Inquiry for their work, supporting the quality of the research when it comes to assessing the treatment of chronic low back pain. Multiple authors have also conducted numerous other studies relating to physical health and chronic low back pain, supporting their experience on the topic.

What kind of research was this?
The completed study was a pragmatic clinical trial, focusing on the correlation between different treatment methods and their outcomes within the actual health practice rather than attempting to explain the reasons behind potential differences. Patients were non-randomly allocated upon arrival into either the intervention or the control group for treatment, meaning the study was performed as a non-randomised control trial. The pragmatic style of this study allows for the broader results of implementing the tested strategy in the wider community in an every day basis to be better assessed, rather than an explanatory style which would only provide results on whether a treatment could work in ideal, specific circumstances. This is one extreme of the two methods however, and a more explanatory method should also be implemented in a correlating study as well in order to develop the best possible understanding.

What did the research involve?
A total of 220 participants of both men and women between the ages of 25-55 were separated into the intervention and control groups with 109 going into intervention and 111 into control. All of these patients suffered from chronic low back pain of at least 3 months. Patients with certain conditions were excluded such as pregnancy, tumours, or fractures. Therapists were assigned to administer either standard therapy or the ETMI method. All patients received an initial 40 minute consult with follow ups limited to 20 or 30 minutes. Baseline measures were taken which included: Patients then received the therapy method in accordance with the group they were placed in, with a researcher following up at 3 months and then again at the conclusion of the study at 12 months. Those receiving the intervention treatment utilised the ETMI focusing on the following barriers to physical activity: Those in the control group received standard therapy including mobilisation, manipulation, postural training etc.
 * Body Mass Index (BMI)
 * Roland-Morris Disability Questionnaire (RMDQ)
 * Pain Intensity
 * Duration of pain
 * Health related quality of life
 * Low motivation
 * Low self-efficacy
 * Fear of movement

As the primary outcome variable (the RMDQ) was a self-reported questionnaire, this can lead to personal bias as the patients can often intentionally or sub-consciously attempt to paint a better image of themselves, which can undermine the conclusions of the research. The method also does not record or assess how much physical activity is being completed by participants from either group at any stage, which could have boosted the possibilities for analysis.

What were the basic results?
Results showed that in the ETMI 65% of patients completed treatment compared to only 45% in the control group. At 12 months the ETMI group also presented a better outcome in the primary outcome analysis, the RMDQ. Significantly more patients in the ETMI group at 84% achieved a reduction of more than 30% in disability scores from baseline versus the control group of only 64.2%. In the secondary outcome analysis the ETMI group also showed a significant improvement versus the control group in both lower ratings of worst pain and the SF-12 physical health summary, however the SF-12 mental health summary showed no significant differences between the groups. At the same 12 month point, the ETMI also had more patients be considered physically active at 58% compared to the control groups 44%.

Based on these results, authors have suggested that an intervention based on addressing patient specific obstacles to exercise may be more beneficial long term in reducing disability and increasing physical activity levels than standard physical therapy practice. However, they do caution the interpretation of these results at this stage, until they are further proven by future research

What conclusion can we take from this research?
This research has provided an alternative look into methods of treating chronic low back pain and includes promising results, suggesting there could be a more efficient treatment for those suffering from this condition. Targeting patients barriers to physical activity such as fear avoidance and self-efficacy and working to remove these barriers shows signs of being more effective than standard therapy in improving patient physical activity levels.

Adherence to both treatment programs was measured through self-reported data, bringing into question the reliability of the study due to the potential for personal bias' when reporting data.

Practical advice
This research indicates that physical therapy moving forwards may benefit from undergoing extra training in behavioural change techniques and incorporating them more in their treatment. More research should be done on why the ETMI method was more successful, as well as further exploration into the potential of a combination of the two styles providing even better results. As the authors state, more research should also be done to further support the conclusions made from these results. Further research should also objectively measure patient activity / participation in order to improve reliability as discussed in this paper. The authors suggested the use of accelerometers as one example.

Further information / resources
Causes of Lower Back Pain

Low Back Pain Fact Sheet

Chronic Low Back Pain - Physiopedia

What You Should Know About Low Back Pain


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Exercise as it relates to Disease/Physical activities effect on the development of lung cancer

What study is being critiqued?
This is a critique of the research article ‘Physical activity and risk of lung cancer’ by I M Lee, H D Sesso and R S Paffenbarger (1999). The article discusses physical activities influence on developing lung cancer.

What is the background to this research?
Lung cancer is developed when abnormal cells grow and multiply in an uncontrollable manner in the lungs (3). The symptoms can develop from minor inconveniences such as shortness of breath and general weakness all the way to death (4). Lung cancer is the leading cause of cancer death in both Australia and the United States (2, 3). A study by F.E. Speizer found that smoking is the most important risk factor in developing lung cancer in both men and women (5). This study also unveiled that healthier dietary choices will decrease the risk of lung cancer (5). The treatment for lung cancer is heavily dependent on how far the cancer cells have spread. Individuals with small cell lung cancer can be treated with surgery, chemotherapy, radiation therapy, targeted therapy (6).

Additional research has shown the benefits of physical activity and the role it plays in reducing the risk of developing lung cancer (7). It has also been found that varying intensities of physical activity help reduce the risk of lung cancer development (1, 7).

Where is the research from?

 * This was an ongoing study conducted on men entering Harvard University as undergraduates between 1916 and 1950. Multiple health questionnaires were then periodically mailed to surviving alumni over the coming decades.
 * All authors have an abundance of other research and are respected in their fields.

What kind of research was this?

 * The research conducted was a prospect cohort study
 * Participants who were identified as ‘similar’ were monitored over an extending period of time
 * Prospect cohort studies have advantages such as elimination of recall bias. While also having disadvantages such as time and resource consuming. All of these factors need to be taken into consideration (9).

What did the research involve?
A potential 17,835 alumni (male undergraduates from Harvard University between 1916 and 1950) were identified after the initial health questionnaire in 1977. Although after the men with a history of cancer or who were not providing information on physical activity data were taken out, there were only 13,905 men successfully followed in this research.

These initial questionnaires asked men to estimate the amount of blocks they walked daily, flights of stairs climbed daily, and to list sports or recreation in which they participated in the last year (frequency and duration information acquired). Using this information estimated total energy expended per week during physical activity was calculated.

Additionally, men were put into groups based on the amount of activity that was completed. These groups can be found below:

This initial 1977 questionnaire also inquired about height, weight and cigarette smoking. They were asked if they currently smoke, if so, how many cigarettes smoked daily. Smoking history details were also collected. In 1988 and again in 1993 health surveys were sent to surveying alumni. This survey inquired whether they have ever been diagnosed with cancer, if so, the site and year of initial diagnosis. Death certificates were used to identify prevalence of lung cancer in alumni who had passed away.

The main limitation of this methodology is the use of health questionnaires. The use of such questionnaires causes inevitable bias due to overestimation and underestimation. With cohorts of such a large size this is the only practical option, however, this will skew data. Another limitation is the length of the overall study. From the initial identification in 1916 to the publish date of 1999, this is a 83 year long study which is very resource and time inefficient. The last main limitation is the cohort used. This cohort is very specific and does not represent most of the world’s population as it completely neglects women and men that didn’t attend university.

What were the basic results?

 * During the follow up from 1977 through until 1993, 245 of the 13,905 men developed lung cancer.
 * Findings also showed higher levels of energy expenditure was associated with lower lung cancer incidence rates. Men who expended >12,600kj/week had a significantly lower risk of developing lung cancer compared to those expending <4,600kj/week
 * Next development of lung cancer among smokers (>20 cigarettes/day) and non-smokers (or former smokers) was analysed. It was found that roughly 0.01% of non-smokers developed lung cancer while roughly 0.07% of heavy smokers developed lung cancer.
 * In the research article they used total number of cases rather than percentages which did not distinguish the clear difference in prevalence. In the article they say the findings are ‘not significant’ although there is a 700% increase in prevalence. The use of percentages in this instance would have made it easier to identify this.
 * Lastly the different forms of physical activities effect on the development of lung cancer was assessed. Larger amounts of all modes of physical activity assessed positively correlated with a lower risk of developing lung cancer.

What conclusions can we take from this research?
The main finding from this research is that physical activity of all modes seems to be inversely associated with lung cancer among men. In addition, heavy smoking seems to significantly increase the chances developing lung cancer.

The key strength of this study is its population size, a population size of 13,905 is very strong which limits the influence of bias.

The key limitation of this study is the questionnaires used to gather information due to the heavy influence of overestimation and underestimation bias. The research is also specific to males who have attended university, which leaves out many populations including women.

There are numerous studies that have explored the correlation between lung cancer and physical activity which have come to conflicting results. Some have come to the same conclusion that they are inversely associated (7, 9). While others conclude no association at all (10, 11).

Practical advice
Using the information presented in this research, participating in physical activity in some capacity will be beneficial in lowering the chances of developing lung cancer. The research has also shown that intensity or form of exercise is not the most important factor, it’s about total energy expenditure. Finding something that suits the individual and that is enjoyable will be crucial in maintaining motivation.

Many studies have stressed the strong association between smoking and lung cancer (12). Finding a way to cut this out will be extremely beneficial.

Research has shown that survivors and people currently living with lung cancer are more depressed and physically weaker. Seeking attention from a psychologist and health professional will be extremely beneficial for such populations.

For those currently living with lung cancer seeking treatment such as surgery, chemotherapy, radiation therapy or targeted therapy will be essential in monitoring and killing the cancer cells (6).

Further information/resources
For further information on lung cancer visit these pages below:
 * https://www.cancer.org.au/cancer-information/types-of-cancer/lung-cancer
 * https://www.cdc.gov/cancer/lung/basic_info/diagnosis_treatment.htm#:~:text=it%20has%20spread.-,People%20with%20non%2Dsmall%20cell%20lung%20cancer%20can%20be%20treated,doctors%20cut%20out%20cancer%20tissue


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User talk:Riley Budd

Welcome, Riley Budd!

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User:Arnab 0990/sandbox

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User:Arnab 0990

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User talk:DrMosquito

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User talk:92.235.34.130

--Synoman Barris (discuss • contribs) 18:44, 17 September 2020 (UTC)

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User:Master Adesola

Junior secondary mathematics

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Exercise as it relates to Disease/The effect of high-intensity progressive resistance training on adiposity in children

This page is a critique of the article 'The effect of high-intensity progressive resistance training on adiposity in children'

What is the background to this research?
Obesity has become one of the most prevalent concerns in the 21st century, increasing at an alarming rate. Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat, a quarter of them classified as obese. These children are likely to stay obese into adulthood and are at greater risk of developing non-communicable diseases such as diabetes and cardiovascular diseases. The rising levels of childhood obesity can be attributed to by decreased levels of physical activity and modern diet changes of increased energy-dense foods which are high in fat and sugars but low in micronutrients.

Research has been done on Progressive resistance training (PRT) in adults and how it has been shown to reduce adiposity, reduce insulin resistance and improve glycemic control in adults. However, there are limited studies regarding PRT as an isolated intervention in children with adiposity as the primary outcome. It is essential to understand the differences between the physiological aspects of children and adults, children should not be seen as miniature adults as they are unique and have singular traits at each phase of growth.

Where is the research from?
A C Benson, M E Torode & M A Fiatarone Singh from The University of Sydney conducted this research on rural New Zealand school students. Professor Maria Fiatarone Singh is a Geriatrician with an interest to improve the care of older adults in medical practice, to prevent and treat frailty and functional decline. She has published extensively in the fields of exercise, nutrition, ageing and has assisted with several research projects on exercise and the effects it has on reducing adiposity.

What kind of research was this?
The conducted study was a randomized controlled trial of the effects of PRT on adiposity in children. Randomized control studies allow for reduced bias, as it balances out individual characteristics between groups. The goal of randomization is to improve the chance that the research groups are representative of the general target population. The use of a control group aims to prove any significant findings were the cause of the outcome variable being studied.

What did the research involve?
78 participants with at least 7-10 years at intermediate or high school were randomly selected and assigned to either the PRT or no-treatment wait-list control group. The PRT group trained twice per week for 8 weeks, completing two sets, eight repetitions per set, for each of the 11 exercises using free weights and ankle weights. The 11 exercises were split into 5 upper body exercises, 4 lower body exercises and 2 abdominal exercises. Rating of perceived exertion (RPE) 6-20 scale was used to determine training intensity and progression.

The primary outcomes measured were:
 * Central adiposity (estimated via waist circumference)
 * Bioelectrical impedance (BIA) fat mass
 * Body mass index (BMI)
 * 1 repetition maximum bench press and leg press
 * Blood analysis (lipids, insulin, glucose, estimated insulin resistance and peak oxygen consumption)

The use of Borg’s RPE scale as a means of prescribing exercise intensity and examining participants adherence to the high-intensity program was a methodical choice, Borg’s RPE is an affordable, practical and valid tool for monitoring and prescribing exercise intensity, independent of gender, age, exercise modality, physical activity level and CAD status.

What were the basic results?
Waist circumference was significantly improved (reduced) in the PRT group compared to an increase in the controls, all whole body estimates of body fat decreased with PRT compared with an increase in the controls, muscle strength significantly increased relative to the control group, increase in HDL-cholesterol approached statistical significance and other metabolic parameters and aerobic capacity did not change over the 8 weeks. The change in waist circumference in the whole cohort was greatest in those with the greatest upper body strength gains and decreases in body mass and fat mass was greater in those with the greatest increases in fat-free mass. As cardiorespiratory fitness remained unchanged, this suggests that the changes were driven by the anabolic exercise itself.

What conclusions can we take from this research?
The main conclusion that can be drawn from this research is that 8 weeks of high-intensity PRT is a feasible and effective method of reducing central adiposity and improving body composition and strength in children without the aid of dietary intervention. If exercise were to be combined with dietary intervention, however, it has been shown to result in weight loss and substantial improvements in metabolic profile over dietary intervention alone.

Practical advice
It is imperative to intervene in any stage of excessive weight gain especially at during the youth of an individual as it is likely the weight gain will carry over to their adulthood, an excessive amount of adiposity puts an individual at greater risk of developing non-communicable diseases , and this paper shows that PRT alone is effective in aiding fat loss. As long as the individual finds the intervention easier to adhere to, making a choice from aerobic training, resistance training or a diet plan matters little as long as an effort is being made to reduce weight and or adiposity.

Further information/resources
Strength training for kids: https://kidshealth.org/en/parents/strength-training.html Obesity in children: https://www.betterhealth.vic.gov.au/health/healthyliving/obesity-in-children-causes Tips to help children maintain a healthy weight: https://www.cdc.gov/healthyweight/children/index.html


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User talk:165.234.131.166

don't remove template sandbox

title: User talk:165.234.131.166


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User talk:U3203674

Welcome, U3203674!

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Exercise as it relates to Disease/Effect of structured physical activity on prevention of major mobility disability in older adults

The following is a critique of the original article Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE Study Randomized clinical trial, published by JAMA Network, 2014

What is the background to the research?
In older adults reduced and/or impaired mobility is a high risk factor for disability, hospitalisation, and sometimes death. Although the prolongation of life is an important health goal in the world, many consider the ability to live independently while still functioning well to be more important. Mobility (defined as the ability to walk without assistance in this study) is extremely important to be able to function independently. Some research suggests that physical activity may help to prevent impaired or reduced mobility in the later stages of the human life although there is no definitive evidence showing this to be the case. Due to these circumstances, this study was undertaken to test that a long-term structured physical activity program can be more successful than a health education program in reducing the risk of major mobility disability.

Where is the research from?
This research was published in the, one of the world's top rated medical journals. The study population includes 1635 sedentary men and women aged between 70–89 years old (with some physical limitations) from 8 different field centres around the US.

What kind of research was this?
The Life study was a multicenter, singleblinded, parallel randomized trial that took place at 8 centres around the US. Using a (RCT) was the best choice possible as the RCT is the gold standard for testing and evaluating the effectiveness of first-hand interventions. This is done by comparing the results of a control group to the results of an intervention group to provide more information and to achieve a greater understanding of the study taking place. Through the use of this research method, the researchers have created a unique experiment that provides sufficient data to help gain a clearer understanding into the world of major mobility disability in older adults.

Setup
Individuals who volunteered for the study were screened with the following criteria being used to select participants who were eligible: Participants who were selected were then randomly assigned to a physical activity or a health education program.
 * 1) >70-<90 years of age
 * 2) Reporting <20 mins/week of regular physical activity and <125 min/week of moderate exercise
 * 3) A score of ≤9 on the Short Physical Performance Battery
 * 4) Could walk 400m in ≤15 minutes without sitting, leaning or help from another person
 * 5) Could safely participate in the intervention determined by medical history, physical exam and resting ECG

Procedure
Each of the groups have a different intervention outlined for them. The physical activity groups' intervention involved walking, with a goal of at least 150 min/week of physical activity (strength, flexibility, & balance). The participants attended 2 center-based visits per week and 3-4 home-based activity. The main goal of these activity sessions was for the participant to be able to reach the goals of walking 30 mins daily at a moderate intensity, 10 mins of mainly lower strength training, 10 mins of balance training, and large muscle group flexibility exercises. Using Borgs scale of self-perceived exertion, participants were asked to walk at an intensity of 13 and lower strength exercises were performed at an intensity of 15-16. The Health education group focused on successful aging. This group participated in weekly workshops of health education for 26 weeks and then went onto monthly session after. These workshops covered information more than just physical fitness, with topics such as traveling safely, preventive services and screenings recommended per age, negotiating the health care system and so forth. These workshops also included 5–10 minutes of light stretching with an instructor.

Evaluation of the Study
There are some variables that have possibly skewed some of the results slightly in this near perfect experiment. One of these said variables is the fact that the participant has to make it to the clinic to partake in the walk, as many didn't have the space to do it at home. Some results were also hard to gather as the participants had been hospitalised since the intervention had started due to uncontrollable variables. This may have had an impact on the no. of people in groups and therefore on the percentage of people who improved/got worse.

What were the basic results?
The results show that participants who participated in the physical activity were less likely to show signs of mobility disability then those who participated in the health education programs (Table 1). To sum it up, participating in physical activity programs is much more efficient then learning about how to do it yourself while trying to reduce the risk of major mobility disability.

What conclusions can we take from this research?
Exercising adequately at a later age is not being promoted enough. If older adults are not exercising enough or getting enough physical activity done in the week, this greatly increases the chance of major mobility disability occurring. Although this sort of information can be useful at an older age, most of this information should be focused on the younger years of life. If a child/young adult can obtain a good, positive mental attitude towards physical activity at a younger age, they are more likely to maintain this attitude throughout their life and into their old age.

Practical advice
As mentioned previously, physical activity is crucial in preventing major mobility disability and should not be overlooked just because you may or may not be attending Health education programs. In saying that, I believe that the perfect balance can be found in attending both the health education programs and the physical activity classes. This will help achieve the best outcome for the participating person. Through the health education programs they can learn new exercises and gather more knowledge on dietary needs and so forth, and then with physical activity classes they can put their newfound knowledge to use as well as socialising with other people who are in the situation that they are in. The socialising is important as it will boost the participants mood and help link physical activity with fun and happiness.

Further information/resources
For more information on the need for exercise and recommended levels of exercise for the elderly population, visiting the World Health Organisation (WHO) page on physical activity and the elderly or the Better Health Channel (physical activity for seniors) can further inform you of other pathways and helpful tips in relation to staying healthy later on in life.


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User talk:Hammylover4000

Welcome, Hammylover4000!

If you have any questions, you can ask in the assistance reading room or possibly contact me personally. 1234qwer1234qwer4 (discuss • contribs) 08:32, 18 September 2020 (UTC)

title: User talk:Hammylover4000


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User talk:AntoneSmith

Welcome, AntoneSmith!

If you have any questions, you can ask in the assistance reading room or possibly contact me personally. 1234qwer1234qwer4 (discuss • contribs) 08:37, 18 September 2020 (UTC)

title: User talk:AntoneSmith


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User:JREverest/sandbox/Approaches to Knowledge/2020-21

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

 * Seminar group 5 (Tuesdays 11am - 12 noon)
 * Seminar group 6 (Tuesdays 3-4pm)


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User:JREverest/sandbox/Approaches to Knowledge/2020-21/Seminar group 1

Welcome to the sandbox for Approaches to Knowledge seminar group 5, which meets on Tuesdays at 11am - 12 noon.

Below are links to pages on the issues that we will be covering in the first half of term.

 * History
 * Evidence
 * Truth
 * Power


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User:JREverest/sandbox/Approaches to Knowledge/2020-21/Seminar group 2

Welcome to the sandbox for Approaches to Knowledge seminar group 6, which meets on Tuesdays at 3-4pm.

Below are links to pages on the issues that we will be covering in the first half of term.

 * History
 * Evidence
 * Truth
 * Power


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Transportation Geography and Network Science/Physical structures

Introduction
A physical structure is something that has been made or built from parts, especially a large building. It has a certain spatial function which safely withstands all kinds of normal loads in a building. In civil engineering, a structure is a system of supporting elements (beam, column, etc.) that can carry loads.

Aim of Structure
There are 3 aims for a physical structure:

(i) To serve the requirements of space applications. A building structure is not only a necessary condition for human social life but also the artificial environment of social life.

(ii) To resist the effects of natural and manual loads. Buildings are subject to various loads and other effects imposed by nature and human beings. Supporting these loads and effects is the main goal of structures. In detail, the building structure is to ensure that the building is not damaged and does not collapse, keeping the building with sufficient stability and serviceability for a long time.

(iii) To fully develop the work of building materials. A building structure is based on building materials (concrete, cement, etc.). The structure is an organic combination of various building materials.

Critical Structural Elements

Slab: Slabs are the flat-shaped components that directly bear the load on the building structure. Generally, they have larger plane sizes with small thicknesses. Slabs belong to bent components. The upper load is transferred to beam or wall through the slab. Roofs are a type of slab.

Beam: Beams are line-type components that bear perpendicular loads in the vertical direction. They are supporting components between slabs and columns. Beams also belong to the bent components, bearing the load from slabs and passing them to columns.

Column and wall: Both columns and walls are load-bearing components used to resist compression. Columns are line-type components that bear loads parallel to their vertical axis direction. Walls are the vertical-supporting components, which withstand loads parallel to the wall direction.

Footing: Footings are underground structural components, which transmit the load from upper structures, such as columns and walls, to the ground. Like the other vertical installation components, footings are also a type of compression-resistant component.

Proposes for Structure
Civil engineers design structures to satisfy the following three requirements:

(i) Stability. Stability means that the structure should be able to bear all kinds of effects that may occur in the normal design, construction and use processes. Through these effects (such as earthquakes), the structure can still maintain the necessary overall stability and safety without collapse.

(ii) Serviceability. Serviceability refers to the normal use of building structures, structural components should remain good working performance, which should not affect the use due to deformation, cracks or vibration and other phenomena.

(iii) Durability. Durability refers to the building structure under normal use and maintenance circumstances. Structural components should have sufficient durability and maintain the building's functions until the design life, without resulting in serious corrosion of materials, weathering, cracking (when components of the protective layer are too thin or too wide) and other phenomena. Durability depends on the environment in which the structure is structured and the design life.

Structure Network
There are two main types of network-shape structure: frame structure and truss structure.

Frame
In construction, a frame structure is a structure composed of many beams and columns to withstand the full load of the building. As the traditional brick-wall-supporting structure is not able to bear the load from multiple floors. Frame structures are often used in high buildings. Except for its own weight, walls in frame structure will not withstand any additional load. In order to reduce the load on the frame, the non-load-bearing walls are usually light-weight walls. Common materials to erect a frame are steel, concrete, timber, and aluminium.

The advantages of frame structure are flexible space separated, low self-weight, saving material and better seismic effect than brick structure. Differ from the traditional brick-wall-supporting structure, frame structure enable a large area to be supported by long span. It is also very flexible to separate the space. The only thing needs to do is to add a light-weight wall.

However, frame structures also have their disadvantages. With the increment of floors, the load capacity of columns and footings will become extremely large. In fact, the columns and footings have their ultimate load capacities, which indicates that the floors are not able to grow infinitely. Another aspect is that a frame structure has no effective horizontal resistance. That may cause large deformations when considering the heavy wind load. Generally, the ultimate height of the frame structure is about 40 metres. Therefore, the most important disadvantage is that it cannot be used to build super-high-rise buildings.

Truss
A truss is an assembly of beams or other elements that creates a rigid structure. In structural engineering, a truss is a structure that "consists of two-force members only, where the members are organized so that the assemblage as a whole behaves as a single object". A "two-force member" is a structural component where force is applied to only two points. The grid structure of a truss has nodes and links, which is same as the elements of a network. A truss is usually regarded as a whole structure to carry the upper loads. This usage of a truss is similar to that of a beam or a slab. In a typical context, external forces and reactions are a set of nodes. As a result, the internal forces in the members are either tension or compression.

A space frame truss is a three-dimensional framework of members pinned at their ends. Due to its spatial grid structure, it cannot be treated as a simple plate structure.

The advantages of a truss are low self-weight and material savings, compared to the concrete beam with the same loading capacity.


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Free Knowledge Culture Calendar/March 15

Today in 1985 the first (non-toplevel) Internet domain name was registered. While contributing to the success of the Internet through more human-friendly addresses, the Domain Name System also introduced a hierarchical Achilles heel to the originally decentralized Internet, since each computer holding a list of every other was considered impractical. Distributed hash tables brought a solution to this problem 16 years later.


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Free Knowledge Culture Calendar/February 24

Today in 1986 the Internet domain registration was made available to the general public.


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Free Knowledge Culture Calendar/March 21

Today in 2006 the first tweet was published.


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Free Knowledge Culture Calendar/May 9

Today in 1994 the iconic domain sex.com was registered, the most expensive Internet domain name. The associated website is often referred to as the first major commercial pornography site. Internet porn has been around for longer, initially mainly in the form of ASCII art on BBS and Gopher sites. But it was with porn that the Internet started to take off as a business platform and many online marketing innovations were developed.

title: Free Knowledge Culture Calendar/May 9