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Exercise as it relates to Disease/Effects of school-based physical activity on cardiovascular disease risk factors in children

This is a critique of the journal article titled "Effects of a 2-year school-based physical activity intervention on cardiovascular disease risk factors: the Sogndal school-intervention study" by Resaland GK, Anderssen SA, Holme IM, Mamen A, Andersen LB. Effects of a 2-year school-based daily physical activity intervention on cardiovascular disease risk factors

What is the background to this research?
Cardiovascular disease (CVD) is the main cause of morbidity and premature mortality throughout the world. The underlying pathology is atherosclerosis, which is abnormal narrowing of the lumen. Coronary artery diseases, stroke and heart failure all being types of cardiovascular disease. An association between physical activity and cardiovascular health has been well established in adults. However, this association still remains unclear in children, with adequate data limited. This indistinct association may be due to the fact that cardiovascular disease is usually diagnosed in individuals 50+ years, and as a result, research is heavily focused on this population.

However, children provide a unique tracking device for cardiovascular disease risk factors throughout the lifespan. Thus, data from this population should not be overlooked. Risk factors such as blood pressure, obesity and lipids/lipoproteins are shown to track from childhood to adulthood. For example, research has found that atherosclerosis is evident in childhood and will persist through out the lifespan.

Studies have reported an inverse association between physical activity and CVD risk factors in children. However, this association should be considered with caution as many intervention studies are hampered by several methodological weaknesses including low sample size, inadequate duration and inadequate volume of moderate‐to‐vigorous physical activity (MVPA).

Where is the research from?
This particular research paper was published in the Scandinavian Journal of Medicine & Science in Sports. This is a reputable medical journal that aims to publish high quality and impactful articles in the field of health and disease relating to exercise, among many other areas of medicine and science in sports.

The primary author of this research paper, Geir K. Reasland, has been involved in the production of 11 other research articles which have been published in a variety of other reputable journals. Most of his work focuses on physical activity and cardiovascular disease and health. This can be considered advantageous as it demonstrates a wealth of knowledge in the area of research.

All co-authors, including Reasland, work in the department of sport science across a variety of universities in Norway. Therefore, it can be assumed that knowledge from these authors is reliable and reputable as it is directly related to their field of work.

What kind of research was this?
This research aimed to investigate the effect of a 2 year school-based physical activity intervention in 9 year old children on cardiovascular disease risk factors. The study compared results of the intervention school (completed daily physical activity) to the control school (completed physical activity twice weekly) to determine differences between the baseline and post intervention scores in cardiovascular disease risk factors. However, this physical intervention is not a randomised control trial (RCT). This is recognised as a limitation of the evidence as a RCT is the most appropriate study design for a school intervention study.

What did the research involve?
The study involved one intervention school that included 125 subjects and one control school that included 131 subjects. Children at the intervention school carried out 60 minutes of daily physical activity which was planned, organised and led by expert physical education teachers. Physical activity was instructed to be moderate to vigorous intensity with 15 minutes planned to be at vigorous intensity where children are sweating or out of breath. Some activities included relay racing, obstacle courses and various other active play. The control school was offered the normal curriculum prescribed amount of 45 minutes of physical activity twice weekly. Both schools participated in this study for a total of 2 years. Any child that had an absence of >15% over this time was excluded from the study in attempt to reduce random error in results.

Risk factors including blood pressure, blood lipids and lipoproteins, waist circumference, BMI, insulin resistance and VO2 peak were taken at baseline and post-intervention. All measures were taken at baseline and post-intervention via standardised procedures with the exemption of insulin resistance. Insulin resistance was estimated according to the homeostatic model assessment for insulin resistance. This model is noted as a reliable assessment for insulin resistance, hence no limitation is present. Comparison between baseline and post-intervention scores between the intervention school and control group were observed. This aimed at determining the effect of daily physical activity on cardiovascular disease risk factors in children.

What were the basic results?
The study found the following key results:
 * The school based physical activity intervention resulted in a significantly greater beneficial development of both systolic and diastolic blood pressure, lipid and lipoproteins and VO2 peak in the intervention school children than in the control school children.
 * For both blood pressure and blood lipid and lipoproteins, children in the intervention school that started with lower baseline values showed a greater positive change.
 * No significant differences were observed in changes of waist circumference, BMI and insulin resistance between the two groups.
 * No firm conclusion was possible regarding the effect of PA and insulin resistance in children due to lack of research in this area.

What conclusions can we take from this research?
Overall, this study concludes that physical activity can reduce cardiovascular disease risk factors from a young age. Furthermore, the study provides evidence to suggest that daily physical activity should be taken into consideration for the design of school polices. In particular, this daily physical activity should consist of 60 minutes at moderate to vigorous intensity with activities that are planned, organized, and controlled by expert PE teachers. This conclusion is supported with recent findings from a systemic review which showed that exercise interventions favoured a reduction in cardiovascular disease risk factors, such as waist circumference, in pre-school children.

Although the study is well designed and has many strengths, there are also a number of limitations that must be considered. In particular, the possibility that several confounding factors such as energy intake and pubertal status could partly explain results. Due to age of the subjects and length of the study it must be considered that these confounding factors could influence results, and such significance of them.

Practical advice
Schools provide an optimal setting in which to increase all children’s physical activity levels and acquire a wealth of health benefits. This includes a reduction of cardiovascular risk factors, that will potentially track and persist into adulthood. In order to do so, school based physical activity should be:
 * Daily.
 * 60 minutes in length.
 * Moderate to vigorous intensity. 15 minutes must be at vigorous intensity.

With activities being:
 * Planned, organised and controlled by trained physical education teachers.
 * Varied and fun whilst also being age appropriate to ensure adherence.
 * Examples of activities include: relay races, obstacle courses and high intensity games.

It is recommended that you look at the Australia's Physical Activity and Sedentary Behaviour Guidelines (specifically for children and young people (5-17)) published by The Department of Health prior to taking this practical advice to ensure knowledge of government guidelines are understood and also maintained. Link: [https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#:~:text=Be%20active%20on%20most%2C%20preferably,and%20vigorous%20activities%2C%20each%20week. Australia's Physical Activity and Sedentary Behaviour Guidelines ]

Further information/resources
If you are interested in further information please see the links below:
 * Australia's Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines: Australia's Physical Activity and Sedentary Behaviour Guidelines
 * World Health Organisation: Prevention of Cardiovascular Disease: World Health Organisation


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Exercise as it relates to Disease/Relationship between physical fitness, BMI and cognitive function in school children

This is a critique of the study: Castelli, Darla & Hillman, Charles & Buck, Sarah & Erwin, Heather. (2007). Physical fitness and academic achievement in 3rd and 5th grade students. Journal of sport & exercise psychology. 29. 239-52. 10.1123/jsep.29.2.239.

What is the background to this research?
This study examined the relationship between; physical fitness, body mass index (BMI) and academic achievement of a group of third and fifth grade public school children.

Existing research suggests a strong positive correlation between physical fitness and academic achievement in school children. Children who scored lower on IQ tests were also at higher risk of becoming obese. Although, there is some conflicting research. Another study found a significant positive correlation between physical fitness levels and level of mathematics proficiency, but no correlation between physical fitness level and reading percentile scores or grade point average. However, mathematics proficiency is more highly correlated with cognitive variables than language and reading literacy, which seem to be slightly more influenced by motivational and confidence factors, and therefore may be a better indicator of cognitive ability and IQ. Although research has found a strong relationship between physical fitness and cognitive ability, the evidence is inconclusive, and a causal relationship has not yet been identified. This highlights the necessity for further research in this area.

Higher levels of academic achievement are associated with better life outcomes. Higher IQ correlates to improved job performance and increased train-ability, as well as, lower mortality risk.

Where is the research from?
This study was published in the Journal of Sport and Exercise Psychology (volume 29, issue 2), a peer-reviewed academic journal, which publishes research articles and reviews, examining the relationship between psychology, sports performance and exercise. The authors of the research article; Castelli D. M., Hilman C. H., Buck S. M., and Erwin H. E., are with the Department of Kinesiology and Community Health, University of Illinois, Urbana, IL. Castelli is a professor of health behaviour, health education and physical education pedagogy at the University of Texas, with a Ph.D. from the University of South Carolina, and an expertise in the relationship between cognitive function and physical activity. Castelli and Hilman received a grant from the University of Illinois Research board to fund this study.

What kind of research was this?
The research conducted was an observational, case-control study. Students were compared according to levels of academic achievement in mathematics and reading, and various physical fitness parameters, as well as BMI. The authors hypothesized there would be a relationship between the students' physical fitness and their academic achievement, with aerobic fitness predicted to have the largest correlation. The aim of the study was merely to examine the relationship and correlation between physical fitness and academic achievement. A causal relationship cannot be inferred from this study, as there are many other, unaccounted for, variables and underlying factors to consider. A randomized controlled trial could be used to test certain hypotheses of the direct effect of physical activity on cognitive function.

What did the research involve?
A sample of 259 third and fifth grade students, from across four public schools (all within one school district) underwent fitness and academic testing, the results were then examined by the researchers. The four schools were selected from a total of eleven schools within the district. The four schools were selected specifically to represent the entire range of academic performance and socioeconomic status within the district. The mode of fitness testing implemented was the Fitnessgram test, which involves a series of tests, including; PACER (aerobic fitness test), push-ups, sit-ups and the sit and reach test (flexibility test). BMI scores were also calculated and recorded. Academic achievement was assessed utilising ISAT, which measures reading and mathematics proficiency. The individual scores of each of these tests were compared to each other (with correlations calculated), as well as, to the variables; age, sex, poverty index and school. Regression analyses were also used to determine the relationship between academic achievement and the other variables.

Possible limitations to the study include; the type of testing used, the non-random cohort, and other possible confounding variables (such as motivation) not accounted for.

What were the basic results?
A relationship between physical fitness and academic achievement was found. In particular, aerobic fitness had a strong positive correlation, and BMI had a strong negative correlation, with academic achievement. Other variables including; age, sex, socioeconomic status and school characteristics, were accounted for, and physical fitness was found to correlate with academic achievement regardless of these factors. The other fitness variables (push-ups, sit ups, and flexibility) were not significantly correlated with academic outcomes.

The authors highlighted several potential mechanisms that could explain these results, with reference to previous studies. Physiological and psychological mechanisms were proposed, as well as, neurocognitive, and alterations in brain structure, as possible related causes.

All the mechanisms proposed by the authors assume cognitive performance as being influenced by physical fitness, rather than examining the more complex interrelationship between the two variables. For example, cognitive ability and IQ may influence exercise behaviour. There may also be other confounding factors.

What conclusions can we take from this research?
There is a strong correlational relationship between physical fitness and BMI, and cognitive ability in children. Children that are physically fit tend to have better academic outcomes. The exact mechanisms and causes for this relationship have not been explained by current research. It is probable that it is not a simple causal relationship, where one variable has a direct effect on the other, but rather the two are interlinked and may be subject to other confounding variables.

One study found that socioeconomic status had a direct effect on; physical activity levels, physical health and cognitive function, with IQ acting as a potential underlying, or contributing factor. Another article proposed general intelligence and IQ as a fundamental cause of both socioeconomic status and health outcomes.

Practical advice
Given that the exact mechanism responsible for the relationship between physical fitness and cognitive function has yet to be deduced, it cannot be assumed that an increase in physical fitness will improve cognitive ability. However, based on this study, increased aerobic fitness and decreased BMI may facilitate cognitive function. Therefore, implementing a fitness program to increase aerobic fitness could be beneficial. Regular aerobic activity (at least three times a week) would be a good starting point.

Further information/resources
A recent article outlining the current research on the link between cognitive function and physical activity: Hernández-Mendo, A., Reigal, R., López-Walle, J., Serpa, S., Samdal, O., & Morales-Sánchez, V. et al. (2019). Physical Activity, Sports Practice, and Cognitive Functioning: The Current Research Status. Frontiers In Psychology, 10. doi: https://doi.org/10.3389/fpsyg.2019.02658

Another article with an overview of various potential mechanisms effecting cognitive and physical health: Hillman, Charles & Erickson, Kirk & Kramer, Arthur. (2008). Be Smart, Exercise Your Heart: Exercise Effects on Brain and Cognition. Nature reviews. Neuroscience. 9. 58-65. doi: 10.1038/nrn2298. Link:https://www.researchgate.net/publication/5753778_Be_Smart_Exercise_Your_Heart_Exercise_Effects_on_Brain_and_Cognition


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Exercise as it relates to Disease/Physical activity intervention for middle age women living with metastatic breast cancer

This article is a critique of the paper "A randomized control trial of a physical activity intervention in women with metastatic breast cancer"

What is the background to this research?
Extensive research has focused on the positive effect exercise has for early stage breast cancer patients. Less research has been conducted on metastatic breast cancer. This should change as patients are beginning to live longer after diagnosis. Patients report significant side effects to their treatment such as fatigue, pain and low physical function. This can affect a patient's quality of life which may hinder their ability to recover and live a fulfilling life. Research has proven exercise helps alleviate symptoms accompanying early stage breast cancer but, is this relationship prevalent in metastatic breast cancer.

Where is the research from?
Jennifer Ligibel et al. examined the effect of exercise on metastatic breast cancer in Boston. Subjects were acquired from the Dana-Farber Cancer Institute and the Beth Israel Deaconess Medical Center. All authors have extensive experience in medical and breast cancer oncology and are professors at the Harvard Medical School. Given this wealth of knowledge and prestige it's assumed the authors of this study are credible and reliable.

What kind of research was this?
The study was a randomized controlled trial. Research has proven this type of study design to be the gold standard in testing safety and efficacy of new treatments. However, to yield meaningful results the study must be planned, conducted and analysed very methodically.

What did the research involve?
Eligibility required, having metastatic breast cancer, a life expectancy greater than twelve months, physical activity less than 150 minutes per week, and an Eastern Cooperative Oncology Group performance status of 0–1. Subjects were excluded if any contraindications for moderate-intensity exercise were present. 101 participants were randomly divided into an exercise and control group in a 1:1 ratio.

The exercise group partook in a 16-week supervised and home-based moderate intensity aerobic exercise intervention. The control group only received regular care during the intervention. Baseline and 16-week assessments were completed to show differences between the groups. Assessments included recording weekly physical activity minutes, self-reported physical functioning and quality of life assessed through the treatment of cancer quality of life questionnaire, cardiorespiratory fitness assessed through a modified Bruce ramp treadmill test, and fatigue through the functional assessment of chronic illness therapy fatigue scale.

The program was delivered via phone calls and in-person meetings with exercise physiologists. Phone calls occurred weekly and in-person meetings occurred weekly for the first month and monthly thereafter. Sessions targeted overcoming exercise barriers, reporting injuries, developing exercise self-efficacy, and performing exercise safely. One major goal was to increase weekly moderate intensity exercise to 150 minutes. All participants were given gym memberships, heart rate monitors, pedometers, and an exercise journal. Subjects recorded their average heart rates during bouts of exercise, daily steps and weekly minutes of exercise in their journals.

What were the basic results?
Table 1 shows the exercise group increased their physical activity minutes more than the controls. However, results are non-statistically significant. It also demonstrates on average, the exercise group didn't meet the goal of 150 minutes of exercise per week.

Table 2 shows the exercise group improved more compared to the control in both assessments. The difference in the physical functioning test was 4.79 compared to 0.93 and in the Bruce ramp treadmill test 0.61 minute compared to 0.37 minute. However, results are non-statistically significant.

Table 3 shows the exercise group slightly improved and the controls slightly decreased in quality of life. Fatigue assessment improvements were equal. However, results are non-statistically significant.

All tables demonstrate trends of improvement in the exercise group compared to the control, however, results are non-statistically significant. This indicates more research should occur to statistically support the trends shown in this study. One major limitation that likely affected results was attrition. Attrition was high with only 70% of the exercise group completing the study and 84% of the controls, causing a size difference between the groups. Due to high attrition and unequal group size, results were possibly affected.

What conclusions can we take from this research?
The study showed a trend of exercise improving physical functioning and quality of life of metastatic breast cancer patients. Although, results were non-statistically significant which may be caused by attrition and unequal group sizes. This research could underpin further exploration into this relationship.

Other research has explored the relationship between aerobic exercise, resistance exercise and yoga in this population. Lidia Delrieu et al. explored the response to an aerobic walking program. They found statistically significant improvements in a 6-minute walk test p<0.001, quadriceps strength p<0.001 and maintenance of quality of life. Study attrition was 2%. Jasmine Yee et al. investigated the response to a resistance training program. The study found improved fatigue scores in the intervention group +5.6 compared to the control which decreased -1.8. James Carson et al. explored the response to a yoga program. They found women who did the yoga program reported less pain p<0.03 and fatigue p<0.05 and higher levels of relaxation p<0.03. Study attrition was 28%. This research supports the positive trend found in Jennifer Ligibel et al. study. More consideration, was needed in regards to exercise type, study duration, and frequency of in-person sessions to produce the statistically significant results seen in other studies as these were differential points.

Practical advice
Jennifer Ligibel et al. study and other research discussed have shown that exercise is safe and beneficial for metastatic breast cancer patients. Exercises proven to be safe and beneficial include walking, yoga and basic resistance exercise such as chest press, squats and lunges performed at a moderate exercise intensity. Jennifer Ligibel et al. study was mainly home-based, whereas other studies which produced statistically significant results used a group-based approach and had lower attrition. Therefore, a group-based program may be more beneficial for this population than a home-based program.

Further information/resources
For further support or information visit;

Breast Cancer Network Australia

Cancer Australia

Young Survival Coalition


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Exercise as it relates to Disease/The impact of intensive exercise on depression in young males

This page was written as an assignment for the unit Health, Disease and Exercise at the University of Canberra. It is a critique of the article “Sweating away depression? The impact of intensive exercise on depression", by Ross Balchin, Jani Linde, Dee Blackhurst, HG Laurie Rauch and Georg Schönbächler.

1.	What is the background to this research?
Depression is a common cause of morbidity and mortality all over the world. It is the most common psychiatric disorder and is thought to affect 121 million adults worldwide. It was rated the forth leading cause of disease burden in 2000. Depression is commonly treated with antidepressants and/or psychotherapy, although some people prefer alternative approaches to treatment such as exercise. This paper discusses the four basic emotion command systems in the brain and how they may contribute to depression, as well as the theory that exercise can alleviate depressive symptoms. They also acknowledge the uncertainty around specifically how much, how intense and how frequent the exercise must be. A study is then conducted on 30 young males of a range of ages suffering from moderate depression to determine the type of exercise that proves to be most effective.

2.	Where is the research from?
This research was derived from a range of papers and studies and studied by a range of professionals and institutions, namely;

Ross Balchin, neuropsychologist - Department of Psychology, University of Cape Town, South Africa Jani Linde - Division of Exercise Science and Sports Medicine, University of Cape Town, South Africa Dee Blackhurst - Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa HG Laurie Rauch - Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa Georg Schönbächler - Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland

3.	What kind of research was this?
This study was conducted as a three-armed perspective randomised control pilot study, a small study to begin the collection of data for larger study in the future.

4.	What did the research involve?
The study involved monitoring 30 moderately depressed young males and how they responded to different levels of exercise over a six week period. The participants were aged between 18 and 42 years and the average age of the participants being was 25.4 years old and the average BMI was 26.9. The level of their depression was determined before the study by using an online major depression inventory (MDI) and confirmed by an interview by a psychologist using the Hamilton rating scale of depression (HAMD) and then again at the end of the study. None of the participants were receiving antidepressant therapy, therefore any improvements in their mental health were purely based on the effects of exercise. Participants were randomly assigned to one of three exercise groups; high intensity (9 participants), moderate intensity (11 participants) and then a control group (10 participants). Only 21 participants completed the study and 12 dropped out. Dropouts were not excluded from the data.

5.	What were the basic results?
The primary results of this research found that of the 30 participants, 13 of them ended the study with no signs of depression, 13 had mild depression and four had moderate depression. Of the High intensity group, six finished with no depression, two improved to mild depression and one remained moderately depressed. Of the Moderate intensity group, six finished with no depression, four improved to mild and one remained moderate Of the control group, one participant ended the study with no depression, seven improved to mild depression and two stayed moderately depressed.

The participants in the high intensity level group showed the most improvement with the average HAM-D scores improving from 15.5 to 4.2, followed by the participants in the moderate group with average HAM-D scores improving from 16.2 to 5.7. The control group improved but not as much as the other two groups with average HAM-D scores going from 17.4 to 9.8.

6.	What conclusions can we take from this research?
The results of the study found that high and moderate intensity had positive impact on improving the mental health of those suffering moderate depression.

7.	Practical advice
This research shows that the level of Physical Activity is an individual is completing can have an effect on their mental health. It also shows that exercising at a high or moderate intensity can be used in a treatment plan for someone suffering from depression before more permanent, difficult or expensive measures need to be taken. Individuals who believe they are feeling depressed can seek help from an exercise professional such as a PT to begin an exercise program to attempt to improve their mental health or motivate themselves if they feel up to it. Joining a social sporting club or social sporting team would benefit someone suffering from depression as they get the benefits of the physical activity as well as the chance to socialise, make new friends and widen their support network. Team environments are often the most supportive.

8.	Further information/resources
If someone is struggling with their mental health, it is always important to reach out and seek help. Some links to support services as well as social physical activity organisations

Beyond Blue

Mindspot.org.au

Urban Rec Canberra

Meetup Canberra

Social League


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Exercise as it relates to Disease/Is HARP an effective intervention for individuals with serious mental illnesses?

Is HARP an effective intervention for individuals with serious mental illnesses?
Background to this research

Chronic conditions are ‘long lasting conditions with persistent effects’ (4) that impact on individuals’ quality of life. There are many different illnesses that are classified under chronic conditions however there is still the same level of needs that patients and their families experience despite these differences such as ‘altering their behaviour, to deal with the social and emotional impacts of symptoms, disabilities, approaching death, to take medicines and to interact with medical care’ (2).

People that suffer from serious mental illnesses have ‘elevated rates of comorbid medical conditions’ (1), they also struggle with effectively managing such conditions. To curve this growing issue, a program was developed. The program consisted of a six-session intervention, delivered by mental health professionals (1). The program aims to help patients become more effective in the management of their chronic diseases, 80 participants from two different clinics from their waiting rooms were recruited. Individuals with one or more chronic illness were prescribed to either the HARP program or the usual care program (1).

Chronic diseases are ‘long lasting and have persistent effects’ (5), and are ‘the leading cause of illness, disability and death in Australia’, there are many different illness and conditions that can be classified as chronic diseases (5). This rise in incidence has occurred with ‘changing lifestyles and an ageing population’ (5). Tackling chronic disease is important, as chronic diseases have social, economic and personal impacts (5). As chronic disease burden grows so does the need for effective treatment that is effective for multiple and complex chronic conditions. To achieve this, new treatments need to be developed and implemented that include ‘coordinated care and chronic disease management plans’ (5).

Where is the research from?

This research was conducted in the United States. The trial was conducted at a Community Mental Health Centre. The exact city/state has not been listed. The trial was conducted by multiple health professionals and professors. Benjamin G. Druss is a professor in the Department of Health Policy and Management, his work has included epidemiological studies, intervention trials, health policy and public health research (6). Kate Lorig is a professor at Stanford University and has been developing, evaluating and making available to the public self-management programs for people with chronic conditions (7). Both of these individuals have experience in many different mental health studies and their research has been published.

What kind of research was this?

This research is a peer lead pilot trial. It was a randomized trial with 80 participants, randomization occurred by using a computerized algorithm and patients were separated into the intervention group or into the usual care group. The Interviewers at the 6 month check in were blinded to the subject’s randomization group. As this was a pilot study the intervention designed was used to assess feasibility and effect sizes rather than to assess statistical significance on study outcomes (3). There are pros and cons to a pilot trial, cons include ‘not enough statistical power and not being able to inform decision making’ (8). Pro’s include finding the evidence needed in designing future trials, gaining information on adverse effects and adjustments on dose selections (8). There are also positives and negatives in conducting a randomized trial. Some positives include; the comparisons that the data provides, bias being minimised and statistical reliability (9). However, some negatives are the applicability and ethical limitations of the trial (9).

What did the research involve?

This study recruited 80 individuals from two separate locations. The target population for the trial was individuals over 18 years of age (3). Individuals were recruited that experienced serious mental illness ‘with or without comorbid additive disorders’ (3). This particular investigation was built on the ‘Chronic Disease Self-Management Program’ (3) which included ‘regular action planning and feedback, modelling of behaviours and problem-solving by participants, reinterpretation of symptoms and training in specific disease management techniques’ (3). Some changes were made in the HARP study such as the reading level to alter the ‘potential gaps in health literacy’ (3). A self-managed record was also added ‘to keep track of disease-specific self-management, medications, upcoming appointments, dietary intake and physical activity’ (3). The research involved questionnaires about disease management which included physical activity health services use and medication adherence (3). There are different ways that this information can be collected which was not stated, it can be collected by telephone, personal, postal and electronic (10). Each survey method has it’s own advantages and disadvantages, however in this investigation personal data would be recommended. Personal data allows for complex questions to be asked, visual aids and higher response rates. The disadvantages of this is that it is expensive, training is required to avoid bias, and it can be time inefficient depending on the number of meeting and participants (10). Physical activity questions were draw from the behavioural risk factor surveillance system. Medication adherence was assessed using a validated self-report measure of problems in adherence to medication (3). The behavioural risk factor surveillance system also has pros and cons. Some pros include the collection of data, no expertise is required to collect data and there is a nation and state data comparison (11). Cons of this system include the amount of time it takes for the data to be collected, interpreted and for policy implantation (11).

What were the basic results?

Analysis of the data was conducted using the ‘SAS MIXED procedure for continuous variables and PROC GENMOD for binary and ordinal variables’ (3). ‘The model assessed the outcome as a function of the randomization group, time since randomization and group time interaction’ (3). Out of the 80 subjects that were recruited for the study 41 for given the HARP intervention and 39 were given usual care (3). At the end of the six months ‘patient activation was clinically and statistically higher in the HARP intervention than the usual care group 52.0+/-10.1 intervention vs. 44.9+/-9.6 control, p=0.01) 7.7% improvement in the intervention vs. 5.7% decline in the usual care’ (3).

What conclusions can we take from this research?

The Health and Recovery Peer Program implemented changes which showed promise in the previous results in improving a range of ‘self-management and health outcome measure, including significant improvements in patient activation and greater likelihood of using primary care medical services’ (3). Further investigation is required into the program as the most disadvantaged groups recruited had the highest success rates. As this was a pilot study, further testing should be used with a ‘broader range of outcome measures’ (3). The use of ongoing resources are required to maintain ‘long-term outcomes and to support sustainable healthcare-community collaborations’ (12).

Practical advice

Future community health interventions in relation to mental health should aim to improve health and ‘achieve large-scale social outcomes through initiatives that address mental health, structural and social inequities’ (12). It is important to implement a coordinated model of care as many individuals suffer from one or more chronic conditions (13). The HARP program showed promising results however as it was a pilot trial more evidence and further studies are required. The socioeconomic status of participants also needs to be acknowledged due to the evidence relating to the link between status and the results gathered.

References

1. Druss B, Zhao L, von Esenwein S, Bona J, Fricks L, Jenkins-Tucker S et al. The Health and Recovery Peer (HARP) Program: A peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophrenia Research. 2010;118(1-3):264-270. 2. Wagner E. Care for chronic diseases The efficacy of coordinated and patient centred care is established, but now is the time to test its effectiveness. theBMJ. 2002;. 3. Druss B, Zhao L, Essenwein S, Bona J, Fricks L, Jenkins-Tucker S et al. The Health and Recovery Peer (HARP) Program: A Peer-Led Intervention to Improve Medical Self-Management for Persons with Serious Mental Illness [Internet]. NCBI. 2010 [cited 3 September 2020]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856811/ 4. Chronic disease Overview - Australian Institute of Health and Welfare [Internet]. Australian Institute of Health and Welfare. 2019 [cited 8 September 2020]. Available from: https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview 5. Chronic Disease - Australia's Biggest Health Challenge. Australia's Health 2014. 14th ed. Canberra: Australian Institute of Health and Welfare; 2014. 6. Rollins School of Public Health [Internet]. Sph.emory.edu. [cited 9 September 2020]. Available from: https://www.sph.emory.edu/faculty/profile/index.php?FID=58 7. K. Lorig | Evidence Based Leadership Council [Internet]. Eblcprograms.org. 2020 [cited 10 September 2020]. Available from: http://www.eblcprograms.org/about-us/eblc-directors/k.lorig-bio/ 8. Tobey R. The Pros and Cons of Using Pilot Studies in the Clinical Research Process | ClinSmart [Internet]. ClinSmart. 2020 [cited 12 September 2020]. Available from: https://www.clinsmart.com/blog/pilot-study-clinical-research-pros-and-cons-5af32 9. Yartsev A. Advantages and disadvantages of randomised control study design | Deranged Physiology [Internet]. Derangedphysiology.com. 2017 [cited 14 September 2020]. Available from: https://derangedphysiology.com/main/cicm-primary-exam/required-reading/research-methods-and-statistics/Chapter%202.0.2/advantages-and-disadvantages-randomised-control-study-design 10. Jones T, Baxter M, Khanduja V. A quick guide to survey research. The Annals of The Royal College of Surgeons of England. 2013;95(1):5-7. 11. Mokdad A. The Behavioral Risk Factors Surveillance System: Past, Present, and Future. Annual Review of Public Health. 2009;30(1):43-54. 12. Castillo E, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah M, Docherty M et al. Community Interventions to Promote Mental Health and Social Equity. Current Psychiatry Reports. 2019;21(5). 13. Department of Health | Best-practice examples of chronic disease management in Australia [Internet]. Www1.health.gov.au. 2017 [cited 16 September 2020]. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-care-homes-best-practice


text:
Annotated Republic of China Case Law/Judicial Yuan Interpretation No. 4

Date
20 June 1952 (during the Korean War)

Issue
Would the Taiwanese Associate Representative of Korean Committee of the United Nations be a government post?

Holding
The Taiwanese Associate Representative of Korean Committee of the United Nations would be a government post.

Effect
Better definition of a government post.


text:
Annotated Republic of China Case Law/Judicial Yuan Interpretation No. 6

Date
29 September 1952

Issue
May public servants also be publishers or editors of newspapers or magazines?

Holding
No, unless otherwise specified by law.

Effect
Limitation on what public servants may or may not also be.


text:
Exercise as it relates to Disease/Changes in Pulmonary Exercise Haemodynamics in Scleroderma

This is a critical analysis of the article "Changes in pulmonary exercise haemodynamics in scleroderma: a 4-year prospective study" by Gabor Kovacs, Alexander Avian, Nora Wutte, Franz Hafner, Florentine Moazedi-Fürst, Sonja Kielhauser, Elisabeth Aberer, Marianne Brodmann, Winfried Graninger, Vasile Foris, Andrea Olschewski and Horst Olschewski.

Background
Scleroderma is an autoimmune disease which causes a thickening and tightening of a variety of soft tissues, there are different classifications based on how the body is affected. These classifications are broadly broken into limited and systemic scleroderma. Limited scleroderma mainly effects the skin of the extremities, causing limited movement and poor circulation. Systemic scleroderma (SSc) additionally affects the underlying soft tissues, including main organs such as the heart, lungs, and gastrointestinal tract. Because of the nature of SSc, it causes serious complications which are often not diagnosed until after death. Most SSc patients have a survival rate of up to 5 years from diagnosis; 14% of all deaths are caused by pulmonary arterial hypertension (PAH), with 87% of all deaths attributed to scleroderma caused by heart complications . Until recently there have been limited screening processes to detect possible PAH in SSc patients . However, techniques with increased sensitivity have been developed with the potential to detect abnormalities in cardiac function which can cause serious health issues, even death . Early diagnosis of cardiac involvement in SSc patients is important as it can lead to better therapy responses and may prevent life threatening complications for many years . The article "Changes in pulmonary exercise haemodynamics in scleroderma: a 4-year prospective study" is an important step in research as it looks at using exercise and non-invasive ways to screen for PAH.

Where is this research from?
"Changes in pulmonary exercise haemodynamics in scleroderma: a 4-year prospective study" was conducted by Gabor Kovacs et al. and included in the European Respiratory Journal (ERJ), which was published online on the 13th of July 2017. The ERJ is the lead scientific journal of the European Respiratory Society (ERS) and publishes a wide array of reliable up to date, high quality peer reviewed articles and research.

The authors of this study have a wide variety of expertise in numerous disciplines such as pulmonology, statistics, angiology, rheumatology, and physiology. They are affiliated the Medical University of Graz, Graz, Austria and the Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.

What kind of research was this?
The research is a 4-year prospective cohort study which is longitudinal in design, which provides information about the relationship between exposure and outcome. Prospective cohort studies have several advantages over other types of observational studies and are considered the gold standard within this area of study. When considering other forms of research designs such as [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049418/#:~:text=the%20findings%229.-,Meta%2Danalysis%20is%20a%20quantitative%2C%20formal%2C%20epidemiological%20study%20design,on%20randomized%2C%20controlled%20clinical%20trials. meta-analysis] and systematic reviews, prospective cohort studies sit in the middle.

What did the research involve?
The research involved studying a sample of 99 individuals with systemic scleroderma to look for pulmonary arterial hypertension (PAH). Prior to commencing the study, written consent was obtained and the study was conducted in line with the Helsinki Declaration .These individuals had previously been screened and participated if they were determined not to have any pre-existing diagnosis of any heart conditions. Baseline rest and exercise data that looked at systolic pulmonary arterial pressure (sPAP), peak oxygen uptake, mean pulmonary arterial pressure, and heart rate was collected using exercise echocardiography, cardiopulmonary exercise testing and in a subgroup [https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/right-heart-catheterization#:~:text=This%20test%20is%20also%20known,tube%20into%20your%20pulmonary%20artery. right heart catheter (RHC) insertion]. The patients from this study where then followed up 4 years later on average, at this point data was collected again. To collect the exercise induced responses all patients were asked to perform a symptom-limited cardiopulmonary exercise test on a variable-load, half-recumbent, left sloping echocardiography cycle ergometer using a standard protocol with a 25 watt increment increase every 2 minutes.

What were the basic results?
The results showed that scleroderma patients without previously diagnosed cardiac diseases developed a mild but significant deterioration of pulmonary exercise haemodynamics and exercise capacity over a 4-year period indicating a progression of pulmonary vascular disease. Three out of the 99 patients developed RHC-confirmed PAH, however 41 patients did not complete the study. Exercise testing results showed that systemic pulmonary arterial pressure at 50 watts (sPAP50) increased, mean pulmonary vascular resistance increased significantly as well, indicating a possible stiffening of the pulmonary arteries which have been shown to be a predictor of PAH and is associated with decreased exercise capacity and poorer outcomes. There were significant decreases in peak oxygen uptake demonstrate a decrease in exercise capacity. At rest there was no significant change in resting systemic pulmonary arterial pressure or mean pulmonary vascular resistance, indicating that exercise can induce symptoms of pulmonary arterial pressure and a change in pulmonary haemodynamics earlier than at rest.

What conclusions can we take from this research?
The study found that exercise induced pulmonary haemodynamics can be important for recognising pulmonary vascular disease in SSc. Currently RHC insertions represent the most reliable method to assess pulmonary haemodynamics, however this procedure is invasive and cannot be performed in a healthy population for ethical reasons. This study suggests that echocardiography, could be a reliable method to assess pulmonary haemodynamics in scleroderma patients. It cannot be assumed that echocardiography is a reliable and valid tool in determining rest and exercise pulmonary haemodynamics outside of this study. Additional research is required to attempt minimise some of the limitations of the study such as using a small sample size, loss to follow up, heavy presence of selection bias and enriching of the sample with healthier patients, the lack of a healthy control group and possible interference from medicines prescribed outside of the study.

Practical advice
Using echocardiography as a screening tool can pick up on exercise pulmonary haemodynamics, and pulmonary arterial pressure which can indicate possible pulmonary arterial hypertension and the need to perform an RHC insertion. Further research could indicate the ability of using echocardiography as a diagnostic tool. New research should look at considering a broader population of SSc patients, the use of immunosuppressive medications and a healthy control group would benefit research on the use of non-invasive exercise induced PAH testing measures on SSc patients.

Further information and resources
For further support and information on scleroderma please look at the following links:

Organisations and helpful information:
 * https://sclerodermainfo.org/guide/
 * https://www.scleroderma.org/site/SPageNavigator/patients_whatis.html
 * https://www.hopkinsscleroderma.org/scleroderma/frequently-asked-questions/
 * https://www.sclerodermaaustralia.com.au/

General information on exercising with scleroderma:
 * https://www.hospitalhealth.com.au/content/aged-allied-health/article/is-it-safe-to-exercise-with-scleroderma--850099346#axzz6YAhsZ4lD
 * https://www.selfmanagescleroderma.com/lessons/exercise-guidelines-for-general-fitness.html
 * https://www.scleroderma.org/site/DocServer/Form_16c_low_res.pdf?docID=19809&AddInterest=1281


text:
Exercise as it relates to Disease/Pilates based intervention for post-menopausal women living with osteoporosis

Exercise as it relates to Disease/ Pilates based intervention for Post-Menopausal Women living with Osteoporosis.

This is a critique of the research article: N. Kucukcakir et al. Effects of Pilates exercises on pain, functional status and quality of life in women with Post-Menopausal Osteoporosis. Journal of Bodywork and Movement Therapies (2013) 17, 204-211

The critique was written as assignment in the Unit; Health, Disease and Exercise at University of Canberra, September 2020.

What is the background to this research
The Study's objective is to assess the effects of Pilates Based exercise on pain, functional status and wellbeing in postmenopausal women suffering from Osteoporosis (OP). OP is 'the most common metabolic bone disease' with symptoms causing significant detrimental effects on patient functionality and quality of life. As OP causes the bones to become weak and brittle, bone fracture is very common and contributes to risk of mortality. The main goal for OP prevention, treatment and management is to increase muscular strength, bone mineral density and balance in the older population, especially post menopausal women as well as education amongst these factors. In doing so, N. Kucukcakir et al. incorporates Pilates, as a measure to improve these outcomes. Although Pilates has been utilised as an important part in sport training, chronic low back pain, musculoskeletal disease, balance and quality of life in the elderly population, it hasn't been studied to specifically target the ever-growing issues of bone health on the ageing population and in particular, post-menopausal women.

Where is the research from?
The authors Lale Altan and Nimet Korkmaz, who took part in this study, also designed another study alongside Umit Bingol and Berna Gunay, on the 'Effect of Pilates training on people with Fibromyalgia syndrome. The study took place in 2009 and shared a very similar approach to the Pilates training on Osteoporosis Study conducted years later. By incorporating ideas from previous studies on Pilates and its effects on Musculoskeletal Disorders, this article has utilised this knowledge to determine the effects on a more targeted population of post menopausal women with OP. This supports the positive findings that Atlan found on patients with Musculoskeletal Disorders such as Fibromyalgia and Ankylosing Spondylitis.

What kind of research was this?
The study uses a randomised controlled, single blind study allowing no experimental bias when testing the subjects to take place. The person allocating the groups didn’t participate in any patient evaluation at any stage of the study, adopting a strategic approach to prevent any external factors to dictate the study’s results.

The diagnosis of the condition was measured through DEXA which is known to be a commonly used source. The procedure was well set out, starting with a flow chart detailing the enrolment process of participants. Sub-headings of 'pain, six-minute walk test, sit-to-stand test, quality of life assessment and number of falls', gives details of the tests that took place at baseline and the one-year mark of intervention involvement. The six-minute walk test and sit-to-stand test are objective measures that assess lower body endurance and are reliable in that they are well known to be associated with vertebral fracture development and falls. Alongside measuring physical outcomes, the study used quality of life assessments to subjectively evaluate the individuals mental state. This has been proven to be significantly affected with diagnosis of OP. As functionality decreases and therefore independence with OP, it is important to gauge the participants emotional state and how they rate their quality of life with improvement.

What did the research involve?
Participants were selected based on their age and diagnosis. They had to be aged between 45-65years and diagnosed with postmenopausal Osteoporosis. Subjects meeting the above criteria underwent a DEXA scan and those with a 'Bone Mineral Density score of less than -2.5 in the lumbar or femur region was valid for the study.' Participants were randomly allocated into two groups, either Group 1; Pilates based, or Group 2; Home Exercise based. Prior to the program commencing, all participants undertook baseline testing consisting of Visual Analogue Scale (VAS), to determine pain levels, a six-minute walk test, sit-to-stand test and 2 quality of life questionnaires. The intervention took place over a year. Group 1 took part in supervised sessions, twice a week which included 'postural education, focusing on a neutral position, sitting exercises, stretching exercises and proprioceptive and respiratory training' with the use of exercise balls and bands throughout the sessions. Meanwhile, Group 2 were shown exercises by a physiotherapist such as 'thoracic extension exercises and were required to be performed for 3 sets of 20 reps'. Check ins occurred for the Home-Exercise Group to ensure exercises were being performed and done correctly. After the 1 year of program intervention, the same tests at baseline were measured and recorded for improvement and comparison.

The sample group of 70 people is relatively small, with each group having 35 participants. A small group limits the study’s ability to apply its findings to the whole population group of Post-menopausal women with OP. Another limiting factor is that there was no control group to compare the full effects of the intervention to, unlike the Study completed by Oksuz and Unal. As both groups conducted exercises, and research showed that exercise had a beneficial effect, the study failed to provide context for the full effects of the program. The study doesn’t specify how or where the sample was selected from, but tests were performed to ensure eligibility criteria was met.

What were the basic results?
The results were summarised and for the Pilates group, all parameters showed significant improvements at the completion of one year from baseline (p<0.001). All parameters except the pain, functional and mental health questionnaires, showed a statistically significant improvement for the Home-Based Exercise group also. When both groups were compared to each other, the Pilates circumstance displayed more improvement in all areas of testing (p<0.05). The results were displayed and compared in table format which enabled all mean values to be displayed. Comparison of the 2 groups at pre-treatment, supported the findings in post-treatment, as all results weren’t significant in difference. Table 2 and 3 present the data on ‘differences in post-treatment evaluation parameters in comparison with pre-treatment values after 1 year’ for both Pilates and Home-Based Exercise Groups respectively. Table 4 provides comparison of the percentage of the 2 groups from pre to post-treatment, displaying the difference the intervention has caused amongst the conditions.

What conclusions can we take from this research?
It has been proven in more recent research by S. Oksuz and E. Unal (2016) that clinical pilates improves OP symptoms of kinesiophobia, pain, functional status and quality of life. This similar study incorporated a pilates experimental group and control group over a period of 6 weeks with the pilates group receiving 3 physiotherapist lead sessions per week, however, the control group received no intervention. 14 well-known, reliable tests were used to assess pain, functional state and mental health and wellbeing. All evaluated parameters exhibited significantly greater improvements (p<0.05) in the pilates group compared to the control group in post-intervention results. This supports the findings of N. Kucukcakir et al.’s (2012) study that Pilates post intervention scores also revealed significant improvements compared to the home based exercise study.

Practical advice
Although Pilates has been shown to improve functionality and quality of life for those already diagnosed with OP, little to no research has been provided for Pilates to be used as a preventative measure for predisposed conditions. One outcome of Menopause, detrimental loss in bone mineral density, already places women aged between 45-65years in a high risk category in developing this condition. As pilates is a low impact form of activity, it is ideal for patients whom are already suffering with low bone mineral density and movement. However, it could be argued that a higher intensity exercise be more beneficial for those with normal functionality about to go through menopause. Therefore, other considerations for study investigation could include assessing the benefits of Pilates prior to menopause or if other high intensity exercise intervention would be of more benefit for this target population. A study by Kannus et al., involving the beneficial effects of sport and physical activity participation on bone mineral density, suggests that 'activity should be carried out prior to and during the post-menopausal stages which is critical for bone mineral density loss'. This is supported by their findings in tennis players with significantly improved bone mineral density in the dominant extremities of their bodies. Considering the population is becoming more sedentary, identifying if pilates, a low intensity activity, is beneficial during this crucial time period, would be important to decrease rates of the disease or at least the severity of the condition.

Further information/resources

 * https://www.osteoporosis.org.au/
 * www.premiersportsmedicine.com.au/virtual-pilates-online/
 * https://www.researchgate.net/effectclinicalpilatesonkinesiophobia_osteoporosis.pdf


text:
Exercise as it relates to Disease/Reviewing the cardiac and stress response to high intensity interval training on breast cancer survivors

What is the background to this research?
- In Australia, there is an estimated 19,807 females diagnosed with breast cancer in 2020 alone. . In addition, cardiovascular disease (CVD) includes a range of conditions that affect the heart and blood vessels. It is estimated that 1.2 million Australians have one or more heart or vascular conditions (2017-2018). Sadly, CVD remains the largest cause of death for breast cancer survivors.

- Whilst there is abundant research showing the physical and psychological benefits of physical activity, research to the specific dose of exercise is still undetermined. The aim of this pilot study was to determine the impact of exercise intensity on aerobic fitness. It was the first of its kind to measure the combination cardiovascular fitness with cardiac regulation (HRV), salivary biomarkers of stress in breast cancer survivors.

Where is the research from?
- This study was conducted at the University of Canberra, Australia. The study was published online 20 August 2020. Kellie Toohey, Kate Pumpa, Andrew McKune, Julie Cooke, Marijke Welvaert, Joseph Northey, Clare Quinlan & Stuart Semple we all contributing authors in the study. All authors involved have been part of numerous research studies in this field and are considered to have great experience and knowledge in this field of work and research.

- This study was registered through the Australian New Zealand Clinical Trials Registry and was approved by The University of Canberra Human Research Ethics Committee.There were no organisations or funding linked to this research project that may cause bias or conflict in this paper.

What kind of research was this?
- This research paper was a pilot randomized control trial (RCT). The RCT is considered to have a high level of evidence as its designed to be unbiased and help reduce the risk of systematic errors.

- Being a pilot study, the research conducted was examined on a small scale and sample size. Therefore, it can be difficult to fully examine the effectiveness of the intervention on a small population. However, the research conducted provides appropriate preparation and is a fundamental phase allowing further research on a much larger scale intervention.

What did the research involve?
- This study was a pilot 3-arm intervention which took place over 12 weeks. To be considered for the study individuals had to be:

1) Females aged 50-75 years

2) Sedentary as classified by the America College Of Sports Medicine

3) Within 2 years post cancer treatment

4) Did not take blood pressure medication

5) Did not have secondary cancers or bone metastasis

6) Ability to perform exercise sessions on a stationary cycle ergometer.

- Once each participant was randomly selected to their exercise intensity group they attended the University of Canberra laboratory 3 times per week for 12 weeks (up to 36 sessions). The testing was conducted on a Monark Cycle Ergometer. Participants in the HITT group completed 7/ 30-second intervals with a 2-minute active recovery cycle between efforts.

- Participants in the CMIT group cycled for 30 minutes at 55-65% of their maximal power and workload was adjusted. All sessions were monitored by an Accredited Exercise Scientist and participants heart rate and rate of perceived exertion (RPE) was monitored throughout the session to ensure exercise was safe and effective. There was a control group used, who undertook normal daily lifestyle for the entirety of the 12 weeks.

Study limitations

→ With a sample size of only 17 participants, it is difficult to draw meaningful conclusions of the effectiveness of the finding and results of the study

→ Eligibly of the study excluded males, despite males developing breast cancer. Therefore, results and conclusions are gender selective and further research is needed to make conclusions on the male population.

→ While participants received training on saliva collection, self-collection allows for inaccuracy and human error. Saliva collection by the Accredited Exercise Physiologist may have improved data accuracy.

→ As the intervention was conducted on the Monark Cycle Ergometer, only the lower body was targeted.

Study strengths

→ Each exercise session was closely monitored by an Accredited Exercise Physiologist to ensure safety and compliance.

→ On completion of the 12-week program, participants in the control group were offered the 12-week fully supervised intervention.

→ A maximal graded incremental cycle test was conducted to determine VO2 peak.

→ Participants were also monitored with a 12 lead electrocardiogram and blood pressure was also assessed every two minutes to further ensure that the exercise intervention was safe for the breast cancer survivors.

What were the basic results?
- On completion of the 12-week intervention results showed:

Exercise intervention:

→ The average heart rate (HR) during the exercise intervals was 150 ± 9 beats per minute (bpm) in the HITT group compared to 136 ± 16 in the CMIT group. → In both exercise groups there were no adverse events from the exercise intervention, therefor the cycle ergometer was safe and effective for breast cancer survivors.

Cardiovascular Fitness:

→ There was a significant increase in cardiovascular fitness. VO2 peak increased 19.3% in the HITT group compared to a 5.6% in the CMIT group whilst showing a -2.6 decrease in the control group.

Heart rate variability:

→ There were no significant changes from pre and post for any of the groups.

Salivary biomarkers:

→ There was no significant difference over time or between groups from pre and post testing.

What conclusions can we take from this research?
- It can be concluded from this study that when comparing dose of exercise intensities HITT and CMIT. The HITT group had a higher increase in cardiovascular fitness with a 19.3% increase in V02 peak when compared to 5.6% in the CMIT. Conclusions can be made that this increase in cardiovascular fitness may help reduce the risk of developing cardiovascular disease in the group of breast cancer survivors.

- However, authors stated that due to the small sample size caution must be taken regarding the findings and further clinical trails should be conducted on a longer and larger scale to confirm results. This conclusion aligns with other research relating to HITT physical activity interventions for participants with cancer survivors.

Practical advice
- High intensity interval training is becoming a popular exercised regime. With the busy world we all live in finding the time to exercise can be challenging, and for the majority of the population knowing type, frequency and duration of exercises can be difficult and confusing. Fitness centres such as HITT Republic and F45 focus on just that, high intensity interval training; with full body workouts lasting 30 minutes to an hour. A fitness trainer that has a Certification 4 in personal training runs classes; workouts are monitored and designed by a professional with knowledge and experienced.

- Sessions can be tailored for individual exercise levels to help improve physical fitness and overall health and wellbeing. However, individuals with any prior health conditions or concerns should visit their local general practitioner before participating in any physical activity.

Further information/resources
- If interested here is some more information.

Support groups

Breast cancer support group

The Heart foundation

Related articles

High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes

Cognition in breast cancer survivors: A pilot study of interval and continuous exercise

Does low volume high-intensity interval training elicit superior benefits to continuous low to moderate-intensity training in cancer survivors?


text:
Irish/Reference/Pronouns

Table of Pronouns
Below is a table of the forms of Irish pronouns:

General
Irish personal pronouns work much the same way as they do in English, with a few exceptions:
 * Irish has no neutral pronoun equivalent to the English "it"; use the pronoun appropriate to the gender of the noun instead
 * Unlike most dialects of English, Irish makes a distinction between the second person singular and second person plural
 * Irish has a separate emphatic form used in certain situations

title: Irish/Reference/Pronouns


text:
Irish/Vocabulary

Home
House • Kitchen • Living room • Bedroom • Bathroom • Garden

Body
Body parts • Clothes

Food
Fruit • Meals • Vegetables

Travel
Nationalities • Countries

Nature
Animals

Work
Professions

Society
School subjects • Insults

Parts of speech
Verbs

title: Irish/Vocabulary


text: Talk:Irish/Vocabulary

title: Talk:Irish/Vocabulary


text: Irish/Reference

title: Irish/Reference


text:
User talk:Kingdom(Hearts)Come

Welcome
Welcome to Wikibooks, Kingdom(Hearts)Come!

 First steps tutorial Wikibooks is for collaborative development of free textbooks.

You do not need technical skills to contribute. You can easily change most books. Please introduce yourself, and let us know what interests you.

If you already contribute at other Wikimedia projects, our Wikimedia Orientation should quickly get you started. (Would you like to provide feedback on this message?)

  Getting help   Made a mistake?   Goodies, tips and tricks
 * Read the Using Wikibooks book for a friendly introduction to the project, or our help pages for more information.
 * You can get friendly help from the community in the user assistance room or our IRC channel.
 * Upload freely licensed files to Wikimedia Commons. You may request permission to upload fair use files locally. Please include author and source information and a non-free use rationale for non-free files.
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 * Need to rename a page? Use the move tab (is available once your account is 4 days old - until then, ask for help).
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Cheers Jules  (Mrjulesd) 10:33, 16 September 2020 (UTC)

title: User talk:Kingdom(Hearts)Come


text:
User talk:SevenSpheres

Belated welcome
Welcome to Wikibooks, SevenSpheresCelestia!

 First steps tutorial Wikibooks is for collaborative development of free textbooks.

You do not need technical skills to contribute. You can easily change most books. Please introduce yourself, and let us know what interests you.

If you already contribute at other Wikimedia projects, our Wikimedia Orientation should quickly get you started. (Would you like to provide feedback on this message?)

  Getting help   Made a mistake?   Goodies, tips and tricks
 * Read the Using Wikibooks book for a friendly introduction to the project, or our help pages for more information.
 * You can get friendly help from the community in the user assistance room or our IRC channel.
 * Upload freely licensed files to Wikimedia Commons. You may request permission to upload fair use files locally. Please include author and source information and a non-free use rationale for non-free files.
 * You can restore a previously saved version.
 * Pages should follow the  naming convention.
 * Need to rename a page? Use the move tab (is available once your account is 4 days old - until then, ask for help).
 * To request a page be deleted, add to the top of the page.
 * Was a page you made deleted? Please read the deletion policy, and check the deletion log to find out why. Also check the RFD archives if applicable. You can request undeletion at WB:RFU, or ask the administrator who deleted the page.
 * Please fill in the edit summary and preview your edits before saving.
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 * User scripts can make many tasks easier. Look at the Gadgets tab of my preferences; check off the boxes for the scripts you want, and hit save!

Hi I know you've been here for quite awhile, but were never welcomed, so here it is. Cheers Jules  (Mrjulesd) 10:35, 16 September 2020 (UTC)

title: User talk:SevenSpheres


text:
Exercise as it relates to Disease/Improving executive functions in children with autism spectrum disorder through mixed martial arts

This book is a critique on the study “promoting executive functioning in children with autism spectrum disorder through mixed martial arts training” studied by the authors Janice N. Phung and Wendy A. Goldberg (2019).

What is the background to this research?
Autism spectrum disorder affects about 1 in every 100 to 110 people. This is a neurodevelopmental disorder that alters these individuals social and behavioural development, affecting their approach to interact with their environment as well as other people. ASD is a chronic disorder and to this day, has no cure. Those who are diagnosed with ASD face difficulties in managing executive functions of the brain and therefore enhancing these skills leading to poor displays of planning abilities and/or cognitive flexibility. The main EFs depend on three brain functions including: 1) Working memory, which is the ability to contain and utilise information that is learnt over short periods of time. 2) Cognitive flexibility, where the brain can readily transfer or prolong attention as response to different requests or rules in certain situations. And lastly 3) Self-control, allowing the inhibition of impulsive responses or actions. On the other hand, there are also complex EFs, which involve more planning, problem solving, reasoning and verbal and nonverbal fluency. EFs are developed throughout childhood and continue to increase complexity and depth as age increases. Children with ASD have a hindered progress of EFs and tend to exhibit deficient planning abilities and cognitive flexibility in particular.

Physical activity in previous studies have proven to be beneficial in boosting executive functioning skills perhaps through the increase of neurochemical activity in the neural system. This neural activity allows for the activation of EFs. In a study done by, they discovered that moderate to lower intensity exercise generated optimal levels of neural activity. The proposed exercise mode of martial arts training has been chosen as it not only meets the optimal level of exercise intensity but also the importance of self-disciple, through behavioural emotional and cognitive control. Traditional martial arts highlights character development as well as self-control. Mixed martial arts, deriving from Jeet Kune Do, consists of many diverse techniques and elements coming from 20 different martial arts, proposes many ways of benefiting children with ASD through the enhancement of EFs. Each child with ASD has many differing strengths and weaknesses, and through the MMA intervention each of these can be catered to and targeted to become better. Moreover, as MMA is delivered as a traditional class rather than modernised and focused on sport and physical conditioning, there is an increased emphasize on character development as well as self-control with the addition of physical conditioning and fitness. Skills that are learned from this training can be generalized and adapted in order to be universally used through different situations and contexts.

Abbreviations
ASD - Autism spectrum disorder

TD - Typically developing

EFs - Executive functions

Where is this research from?
The Journal of Autism and Developmental Disorders published by Springer online June 2019.

What kind of research was this?
This research involved a randomized controlled trial study investigating the effectiveness of mixed martial arts as an intervention to enhance executive functions in children with autism spectrum disorder. Randomized controlled trial studies analyse the outcome variable being the martial arts training for the children for this case using common and trusted statistical tools.

What did the research involve?
Participants

The study involved n=34 children aged 8–11 years old with a clinical diagnosis of ASD. Participants were from a departmental database who had already consented to be contacted for studies or contacted the research team through an exclusive online survey.

Measures

A series of testing in order to distinguish where the participants intellectual and executive functioning state as well as the severity of their condition were held pre and post the intervention. These tests involved: lifetime social communication questionnaire, autism diagnostic observation schedule-second edition, Wechsler abbreviated scale of intelligence-second edition, behaviour inventory of executive function-2nd edition and finally the hearts & flowers test. Results from these tests equalled to low average from the participants as a whole indicating a moderate to high severity of the disorder.

Interventions

The participants were randomly assigned to either the MMA intervention group or the waitlist control group. The intervention duration was 13 weeks with the participants of the MMA intervention required to attend training twice a week. These classes ran for 45 minutes with a class plan designed by experienced instructors also dealing teaching other students with disabilities. On the other hand, waitlist control group participants did not participate in MMA training.

MMA Intervention 13-week curriculum

Weeks 1-4 = Punching/ kicking on mitts / kicking pads

Weeks 5-8 = Glove drills and grappling with partner taking turns of attacking and defending

Weeks 9-13 = Glove drills and grappling with partner taking turns of attacking and defending

Class plan

5 minutes Bow-in

-	Line up

-	Attention to instructor

-	Bow as respect to instructor

-	Meditation

15 minutes Warm up

-      Jogging

-	Footwork

-	Stretching

20 minutes

Main activity

-	Increasing complexity throughout duration of intervention

-	Practising with TD students -	A combination of striking and defenses

5 minutes

Cool down

-	Social game

-	Line up

-	Attention to instructor

-	Bow as respect to instructor

-	High-five as acknowledgement to other students

What conclusions can we take from this research?
The study’s findings propose that the traditional MMA style has beneficial results as an intervention for enhancing EFs due to its high suitability for children with ASD. Although martial arts is a very under looked sport, it has many to offer for the development of any children’s wellbeing. Not only does it physically condition but it also incorporates and emphasizes character development and discipline. These are qualities that children can use as a baseline to build on to succeed and become confident within themselves and further develop independence. With the complexity of martial art forms and combination activities, the children are able to optimally stimulate neural activity and increase executive functions. From there they are able to use skills gained universally throughout their daily lives and with the addition of being able to defend themselves confidently in dangerous situations.

Practical Advice
For health care professionals or parents seeking alternate therapies for children with autism spectrum disorder, it is worthwhile to introduce and train children who are diagnosed in martial arts. Preferably traditionally taught martial arts in particular. From this study, training children with ASD in mixed martial arts will not only incorporate physical conditioning improving the children’s fitness but will also assist in neural development, as this sport will optimally stimulate neurochemical activity which can lead to executive functional enhancement. Skills gained through training in MMA, can also be universal and can be used in different contexts, boost the children’s confidence as well as independence through the increased self-discipline, character development and the knowledge of self-defence.

Further Information/Resources

 * Executive functions
 * Journal of Autism and Developmental Disorders
 * MMA and benefits for ASD
 * MMA and benefits for ASD


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Exercise as it relates to Disease/Effects of exercise in children diagnosed with Cerebral Palsy

This is a critique of the original research: "Exercise Training Program in Children and Adolescents With Cerebral Palsy"

What is the background to this research?
is referred to as an umbrella term as it highlights a group of disorders affecting the movement ability of an individual. Caused by damage to the developing brain during pregnancy or just after birth, the cause of Cerebral Palsy is often unknown due to a large number of factors being possible. With statistics displaying that approximately 2 children per 1000 births are born with Cerebral Palsy worldwide and no known cure, the positives for individuals movement, quality of life, and decreased symptoms rely on medications, surgeries, and therapies, especially physical exercise. In the article, Exercise Training Program in Children and Adolescents With Cerebral Palsy, they focus on evaluating the effects of training on anaerobic and aerobic capacity in children diagnosed with Cerebral Palsy.

Where is the research from?
The research was conducted at the Rehabilitation Centre “De Hoogstraat”, Netherlands. The 16-month study began in July 2005 and was completed in October 2006. The head researcher, Olaf Verschuren, is a well-known professor focusing his study on paediatric rehabilitation, specifically Cerebral Palsy with over 150 publications and 2500 references. He was assisted by lse Oosterom, Chantal Hiddink, Radmer Schalkx, Jose Ermers, Anneleen de Pagter, Heidi Vogels, Annelies Polman, and Joep Janssen who are all commended in their line of work.

What kind of research was this?
This study was a consisting of 86 children selected from four special education schools within the Netherlands. Each child was diagnosed with cerebral palsy, aged between 7 and 18 years old. Randomized Control Trials are often referred to as the most reliable method available as it reduces the source of bias with testing and recording.

What did the research involve?
The intervention involved randomly assigning the children to either the training group (consisting of 32 kids) or the control group (consisting of 33 kids). The training group got together twice per week and trained for a 45 minute consisting of:
 * 5 minute warmup
 * 25 – 35 minute circuit which included:
 * 8 standardized aerobic exercises lasting between 3 to 6 minutes
 * 8 standardized anaerobic exercises lasting between 20 to 30 seconds
 * 5 minute cooldown.

Both groups then completed a 10 metre shuttle test for aerobic capacity and Muscle Power Sprint test for anaerobic capacity as the primary measure. Other secondary measures taken included participation, health-related quality of life, competency, agility, and strength. Programmed training sessions were delivered by 2 local paediatric physiotherapists at school, helping facilitate the progress and ensuring the children were participating. The tests were then assessed with non-biased and individuals bought in to score when needed (e.g. Health-Related Quality of Life assessment).

Limitations were mainly noticed in participation with 22 individuals not meeting criteria or discontinuing during the study due to various reasons. Also, the minimal previous information produced meant that this study was a breakthrough and was always going to have limitations.

What were the basic results?
The highlighted results showed improvements on all tests within the training group:
 * Aerobic capacity (+38%)
 * Anaerobic capacity (+25%)
 * Agility (+15%)
 * Muscle strength of the lower extremities (+20%)
 * Competency (+11%)
 * Positive participation
 * Increased health-related quality of life

With these results were deemed a success by the researches, as it identified the positives gained with the completion of functional training not only on aerobic and anaerobic factors but other important living aspects.

What conclusions can we take from this research?
In conclusion, the 8-month prescribed anaerobic and aerobic focused training program not only improved the children’s physical fitness, it enriched their health-related quality of life and participation levels. This study has created the platform for more research to be conducted in regard to the positive effects of exercise on individuals suffering from not only Cerebral Palsy but similar diseases.

Practical advice
Positive and specialised exercise plans should be developed for each individual or group and when committed to and supported correctly the program will improve individuals physical and overall wellbeing. This should not only be supported for an 8-month time period but a healthy lifestyle should be pursued continuously. The identification of further resources should be mentioned to encourage the monitoring, progression and support if needed when completing a program.

Further information/resources
For further information on the results and clarification, I encourage you to read the paper: Exercise Training Program in Children and Adolescents With Cerebral Palsy

To learn more about Cerebral Palsy visit:
 * https://cparf.org/what-is-cerebral-palsy/
 * https://www.cerebralpalsyguidance.com/cerebral-palsy/


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Exercise as it relates to Disease/Health benefits of sport and exercise on PTSD survivors

This is a critique of the research article: Ley C, Rato Barrio M, Koch A. “In the Sport I Am Here”: Therapeutic Processes and Health Effects of Sport and Exercise on PTSD. Qualitative Health Research. 2018;28(3):491-507 (1).

What is the background to this research?
Post Traumatic Stress Disorder (PTSD), defined as “a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event” (2) will affect ~7-8% of the U.S population during some stage of their lives (3). Types of PTSD can generally be categorised into three classifications: Uncomplicated PTSD, Complex PTSD and Comorbid PTSD. The former and easiest to treat is resultant of one traumatic event in contrast to Complex PTSD which is linked to multiple traumatic events. Comorbid PTSD is attributable to co-occuring mental disorders and is often the most difficult to treat (4). With stress being an inevitable common denominator at some point of most people’s lives, it is necessary to explore methods for stress alleviation in PTSD victims. The study presented aimed to contribute to a more holistic understanding of how exercise facilitates positive health benefits on PTSD symptoms (1).

Where is the research from?
Ley, Rato Barrio and Koch conducted their research at the University of Vienna, Austria in conjunction with Vienna based care centre for torture and war survivors - Hemayat. Their work was first published in Sage Journals, a leading independent academic publisher with a highly credible reputation which is reflected in their impact factor of 0.92 (5)(6). Despite the research being conducted in Vienna, the study and its findings remain relevant to Australians. Clemens Ley is a highly regarded and experienced author having contributed to over 90 publications in the health field through a variety of universities in several countries. María Rato Barrio has extensive experience in the health field also, having contributed to many publications often centered around the link between physical activity and health betterment. The remaining author, Andreas Koch has many credible publications often focussing on the influences of health at a molecular level.

What kind of research was this?
Despite the subject being selected from a pool of 14 participants, this research is classified as a holistic single-person case study due to the singular subject being the primary focus.

What did the research involve?
The research was completed in conjunction with the Movi Kune Project (7) which provided a foundation for this investigation to build upon, however to streamline the analysis, only the subsequent case study of PTSD victim Rashid will be critiqued. The processes and methods implemented were based upon three themes; “(a) a motivational–restorative, (b) a distraction, and (c) an exposure effect” (1). Through a variety of independent and group exercises/activities, Rashid’s pain sensations (both positive and negative) along with his improvement of awareness of body and self, were analysed by his therapist, who in turn would report the feedback to the researchers. The participant feedback was directed through Rashid’s therapist who had gained his trust as demonstrated through Rashid’s statement, “You are the only one I know here [in Austria] and I do not know [any other] good persons” (1). This inevitably improved accuracy and reliability in communication. Researchers also conducted observational analysis to develop descriptions of results such as “social interactions, task performance, skills, levels of activation and participation, attentional focus, and affective response” (1).

What were the basic results?
The image below demonstrates the potential for health benefits to occur and effectively depicts the intertwining relationships of various cognitive developments.

All results gained in this case study were based upon subjective observations and assessments of personal reflections facilitated by Rashid’s therapist. Through data analysis it was deduced that many of the subjects' positive affective states often had a distinct correlation to mastery experiences and accomplishments, an attentional focus on playing and positive group experiences. Additionally, positive pain sensations were frequently reported during exercising, allowing the subject to distinguish between positive and negative experiences of self. The progression of the intervention also saw a continuous increase in how often Rashid “showed [positive] emotions”(1) in situations such as scoring or catching in basketball. An associate trauma-expert was said to be amazed at the positive change demonstrated by Rashid. A further testament to the positive change initiated by the intervention was noted in Rashid’s final interview where he stated that he “only felt happy 2 days a week, either when he came to therapy or to the sport program”(1).

What conclusions can we take from this research?
This study provides a great demonstration of the potential health benefits obtainable through sport and exercise for PTSD survivors. A direct link between physical activity and improvements in various departments of cognitive health was established. Whilst the findings gained from this investigation are positive, the reliability and accuracy of the study are questionable, largely due to the unique circumstances of PTSD victims and the barriers in communication often present.

Practical advice
The single-person case study is effective in gaining sufficient data with adequate attention to detail, the study needs comparative data and repetition to improve reliability. This could be done through performing multiple single-person case studies, or alternatively widening the investigation to make it a cross-sectional study between large populations with an enhanced research team. Additionally, as is typical of most case studies, there is a lack of scientific rigour along with significant potential for researcher bias influenced data. In turn, generalisations for the wider population cannot be accurately produced, only hypothesised. In order to minimise such limitations, objective measures and multiple observers can be implemented to reduce researcher bias. The production of quantitative data through objective measures will enhance the repeatability of the investigation and also provide numerical data to be used for comparisons with normative data.

Further information/resources
For further information regarding PTSD and the influence of exercise in relation to this chronic disease, refer to the readings below.

The impact of sport and physical activity on the well-being of combat veterans

Evaluation of physical activity habits in patients with posttraumatic stress disorder

The effects of aerobic exercise on childhood PTSD, anxiety, and depression

14 CrossRef citations to date 8 Altmetric Articles The Role of Exercise in Reducing Childhood and Adolescent PTSD, Anxiety, and Depression

Exercise Intervention in PTSD

PTSD & Exercise: What every exercise professional should know

Post-traumatic stress disorder (PTSD)


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