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Exercise as it relates to Disease/Is exercise making children smarter?

This Wiki page is a critical analysis of the paper: Effects of Aerobic Exercise on Overweight Children's Cognitive Functioning: A Randomized Controlled Trial. Written by Davis, Catherine L; Tomporowski, Phillip D; Boyle, Colleen A; Waller, Jennifer L; Miller, Patricia H; et al.

What is the background to this research?
Obesity is defined by the World Health Organisation as abnormal or excessive fat accumulation that presents a risk to health. Childhood obesity has been recognised as one the most serious public health challenges of the 21st century. With the growing seriousness of the health issue further investigation is needed into the health epidemic. Not only does obesity have many different effects on the body it has a negative impact on executive function. Obesity can be linked to cognitive defects. With approximately one quarter (24.9%) of children aged 5–17 years were overweight or obese in 2017-18. Due to the overwhelming number of children in Australia and the fear of cognitive function being impacted as a result of obesity, the need for further surveillance is needed. Exercise can be used a treatment and a prevention of obesity. While treating obesity cognitive deficits are being prevented and the children will result in a greater capacity to be able to learn.

The article itself is investigating the effects of aerobic training on cognitive function of overweight, sedentary children. The trial also looks at the relationship between low dose exercise and high dose exercise and their effect on cognitive function.

Where is the research from?
The research article is published in what is currently known as Research Quarterly for Exercise. It was previously known as Research Quarterly. American Alliance for Health, Physical Education, Recreation and Dance. This specific article was Vol. 78, No. 5 pp. 510–519. The research took place in Augusta, Georgia, USA. The Human Assurance Committee of the Medical College of Georgia reviewed and approved the study. The study was conducted in concert with a larger study that is evaluating the effects of exercise training on the metabolism of overweight children. The authors of the article are from a wide range of recognized fields such as paediatrics, Kinesiology, Nutrition, Biostatistics and Psychology.

What kind of research was this?
The study was a randomized controlled trial. A randomized control study is considered the gold standard largely to the fact that they deliver a high level of evidence with a limit influence of any sorts of bias

What did the research involve?
The research analysed 94 school children ranging from 7 to 11 years old, fifty-six girls and thirty-eight boys. The trial did not excluded children who were overweight they were encouraged to participate in the study. Some children within the participation where taking medication for attention-deficit disorder and where encouraged to continue to do so and participate in the study even when the cognitive testing was being conducted, this maximized the generalization of results. The children were randomly assigned to three different groups. The groups were; low-dose exercise treatment, which consisted of 20 min of aerobic exercise per session; a high- dose exercise treatment, which consisted of 40 min of exercise; or a no-exercise control group. Having a control group allows for accurate comparison of results. Each group participated in the exercise treatment programs which met 5 days per week for 15 weeks. Three cohorts participated successively in the study over 2 years to allow a larger sample size than could be accommodated at one time. The Cognitive Assessment System (CAS), a standardized test of cognitive processes, was used to test the cognitive function of the participants. This was administered individually before and following intervention. The CAS is an effective test to examine the cognitive function of children as it is based on the PASS theory (planning, attention, stimulation and successive). When compared to an IQ test the CAS measure an important dimension of children’s cognitive function of creativity due to creativity and planning having a strong relationship.

Limitations

 * The study was limited to overweight sedentary children
 * Children were not blinded to their group assignment, nor were the interventionists blind to condition or the hypotheses of the study. On the other hand, the evaluators were blinded to group assignment in order to obtain unbiased assessment of cognitive outcomes.

Strengths

 * Randomized control trial
 * Limitations are minimal and where negated
 * Length of the study (2 years)
 * Larger and diverse cohort
 * Use of appropriate test for cognitive function

What were the basic results?
The results were as predicted the planning results of the CAS test where statistically significant between the groups. The control group had a significantly lower post test score than then high dose exercise group. Meanwhile the low dose group had a lower post test score than the high dose group.

What conclusions can we take from this research?
This research has paved a way to combat the ever-growing concern of obesity in children also along with, increasing their cognitive function through 40 minutes of vigorous physical activity. Due to the growing concern around childhood obesity along with the lack of research surrounding the hypothesis that exercise has a positive influence on cognitive function in children. The study has brought forward the positive impacts that physical exercise has on improving cognitive function within children and treating childhood obesity.

Practical advice
The research has shown that 20 minutes of exercise five times a week has some improvement in a child’s executive function. But when compared to 40 minutes of exercise five times a week a child’s executive function increases significantly when compared to a sedentary child.

Simple things can be changed to achieve this, increasing physical activity classes at school, increasing lunch and recess play time and encourage children to be active during recess and lunch times. After school activities and sports By doings these things the potential for learning is increased.

Further information/resources

 * https://www.schoolsportact.asn.au/Home/JustPlay
 * https://www.pcycnsw.org.au/activities/
 * https://www.nsw.gov.au/improving-nsw/premiers-priorities-2015-2019/tackling-childhood-obesity/


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Exercise as it relates to Disease/Obesity and the rise in the incidence of Rheumatoid Arthritis

This is a critique of the research article: Cynthia S. Crowson, Eric L. Matteson, John M. Davis III, and Sherine E. Gabriel for 'The Contribution of Obesity to the Rise in Incidence of Rheumatoid Arthritis': An inception cohort study. Arthritis Care & Research. American College of Rheumatology. Vol.65, No.1, January 2012, pp. 71–77.

The critique was written as an assignment in the unit: Health, Disease and Exercise at University of Canberra, September 2019.

Background to this research
Rheumatoid Arthritis (RA) is an autoimmune disease where the body's immune system attacks the tissue around joints and other parts of the body, mainly affecting small joints such as the hands and feet but can also be seen to affect the hip and knee joints. About 458,000 Australians (1.9% of the total population) are affected, while 41 out of every 100,000 people in the US are diagnosed with RA every year.

Obesity is thought to be an under recognised risk factor of RA. Obesity and RA prevalence have both been on the rise, therefore it is thought that there may be a relationship between the two diseases. These diseases exhibit similar characteristics as both involve high inflammation in the body, obesity involves inflammation of adipose tissue while RA involves chronic systemic inflammation. Further research and a growing understanding of Adipokines have explained their important role as negotiators of inflammation and immune response, which are also involved in the pathophysiology of rheumatic diseases, in which RA is one.

The aim of this study was to assess the influence of obesity on the risk of developing RA, and to determine whether obesity could explain the increasing incidence of RA.

Where is the research from?
This study was conducted and completed by four authors; Cynthia S. Crowson, Eric L. Matteson, John M. Davis III and Sherine E. Gabriel. All of which were involved in the writing of the article or revising intellectual content. All authors have previously and since been involved in multiple research and scholar articles. The authors own claims correspond with the results and were all appropriate to this research topic. Therefore, we can assume that they are reliable sources.

The research was completed by the American College of Rheumatology in 2012, a professional organisation based on improving the care/understanding of rheumatic disease and improving the rheumatology subspecialty.

What kind of research was this/ What did the research involve?
This was an inception cohort, retrospective, population-based study. The study was conducted using resources of the Rochester Epidemiology Project.

Conditional logistic regression was used to assess the influence of Obesity on developing RA. Population attributable risk was used to estimate the incidence of RA in the absence of obesity.

Participants included:

 * 813 residents of Olmsted County, Minnesota.
 * Aged ≥18 years.
 * Who fulfilled the 1987 American College of Rheumatology criteria for RA in 1980-2007.
 * They were compared to population-based controls (Matched on age, sex and calendar year).
 * The mean age of both groups was 55.9 years.
 * 68% were women.
 * Obesity was defined as a BMI ≥30 kg/m².

The method for this study was appropriately chosen. The Rochester Epidemiology Project (REP) is a collaboration of medical facilities in Minnesota and Wisconsin, and allows for shared medical records for research. REP has been a reliable information source for hundreds of research articles, not just the article in this critique. However the size of the Olmsted County population creates a limitation as REP only accounts for 502,820 individuals (As of 2012), the small population that would then meet the needs of this particular study may affect the reliability of the results, a bigger study would be more accurate. A cohort study is also an appropriate choice as it allows the researchers to look at groups of people, possible risks and disease in relation to them.

This study has been supported by a number of reliable references, the study results can also be supported by a number of other scholar articles/research studies in the same field. A report conducted by Jennifer M. Hootman et al. found "Arthritis is common among U.S. adults with obesity (35.6%)". Another study conducted by Lynda F. Voigt et al. found "Women in the highest quartile of body mass index had a risk of 1.4 (95% CI = 1.0-2.0) relative to women with lowest body mass index" in terms of being diagnosed with RA. Bing Lu et al. also found "Risks of seropositive and seronegative RA were elevated among overweight and obese women, particularly among women diagnosed with RA at earlier ages".

Results:
A history of obesity was somewhat more common in cases than in controls (40% verses 36%, P=0.052), whereas obesity at the incidence/index date was similar in cases and controls (30% versus 28%, P=0.41).

The cases had a higher BMI at the incidence/index date on average (mean 28.2 versus 27.2 kg/m², P=0.004), with 95% of cases and 85% of controls categorised as over-weight at the incidence/index date.

Conditional logistic regression models revealed that history of obesity was a significant risk factor for the development of RA (OR 1.24, 95% confidence interval (CI), P=0.046), whereas obesity at the incidence/index date did not reach statistical significance (OR 1.10, 95% CI).

Association between obesity and developing RA was similar for both sexes. *Values are the percentage of patients with obesity at the index date/percentage of patients with history of obesity prior to the index date.Association between history of obesity and development of RA was somewhat stronger among patients aged <60 years at the incidence/index date (OR 1.32, 95% CI versus OR 1.15, CI 95%).

However, results also show that obesity could explain 52% of the increase in the incidence of RA among women from1995-2007. Sensitivity analyses were performed, the estimated OR being 1.24 (95% CI 1.01-1.53). If the relative risk (RR) for obesity on the development of RA was only 1.01, then only 18% of the increase in RA incidence could be explained, while if the RR was as large as 1.50, 82% could be explained among women.

Conclusions
The conclusions that can be drawn from this article is that a moderate risk for developing RA is associated with obesity, especially among women.These findings suggest that unless the obesity epidemic is controlled, prevalence of RA will continue to rise. With this rise also comes the demands for increased funding and rheumatologic care.

More research would need to be completed to further confirm these findings. This study was published in 2012, since then there has been an even greater rise in the prevalence of obesity and RA. This studies results may now be out of date/irrelevant, a similar updated study with a greater population would be suggested. Although the study was conducted with appropriate methods, and results did show a relationship between obesity and RA, the percentages were low in areas and the relationship between the two diseases was not confirmed for men. In conclusion this study was very well organised, with great sources of information and qualified authors. The results confirmed the hypothesis for certain population groups, however the age of the study and the small amount of participants affects the reliability of the results.

Practical advice
To avoid the risk of Obesity and Rheumatoid Arthritis:

 * Maintain physical activity guidelines: 150–300 minutes of moderate intensity, or 75–150 minutes of vigorous activity.
 * Eat a healthy balanced diet.
 * Avoid/Quit smoking.
 * Be consistent in your healthy lifestyle, create a healthy routine and GET HELP EARLY!!
 * More on RA.
 * More on obesity.

Further readings/insights
For further information/interesting readings, follow the links below:

 * Evolving concepts of Rheumatoid Arthritis.
 * Obesity in rheumatoid arthritis
 * Association of obesity with worse disease severity in rheumatoid arthritis as well as comorbidities.
 * Obesity and inflammation.

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


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Exercise as it relates to Disease/Can 'finding our center' help to reduce the size of our center?

This Wikibook page presents a critical appraisal of the research article: “Ashtanga yoga for children and adolescents for weight management and psychological well being: An uncontrolled open pilot study” (Benavides, S. & Caballera, J. 2009)

What is the background to this research?

 * In 2016 the | World Health Organisation recorded that more than 340 million children and adolescents aged 5-19 were overweight or obese . This ever increasing prevalence has driven considerable research devoted to identifying non-invasive and non-pharmaceutical treatment methods for childhood obesity and the psychosocial impacts of such interventions.
 * Obesity, and the limitations it imposes (i.e. restricted mobility, joint pain and inflammation, social acceptance etc.) yield an unwillingness to participate in conventional physical activity . Therefore, activities which encourage movement and demonstrate positive physiological and psychological outcomes for obese populations are at the forefront of health related research.
 * The increasing rate of obesity in minority ethnic groups (Mexican/African Americans, Hispanics etc.) is a relatively unexplored field and is touched upon briefly in this article.
 * Yoga, an Indian form of meditative exercise has recently gained international popularity as a recreational activity . Specifically, Ashtanga Yoga uses regulated breathing to reach a meditative state . Numerous studies have investigated the benefits of Yoga on cardiac health, cardiopulmonary function and psychological well-being however little is known about the positive weight management effects of yoga for obese youth.
 * The present study aimed to investigate the feasibility of Ashtanga Yoga for weight loss in youth at risk of developing Type 2 Diabetes. Additionally, psychiatric symptoms were observed and measured in response to the intervention.

Where is the research from?

 * Both authors of this study are leading experts in the areas of pharmacy, paediatric obesity, diabetes and obesity related depression.
 * The senior author, Dr Sandra Benavides, is an Associate Professor of Paediatrics at Nova Southeastern University Department of Pharmacy Practice . Dr Benavides has published over 70 articles with much of her research devoted to paediatric obesity in Hispanic/Mexican-American populations.
 * The supporting author, Dr Joshua Caballero, is a board-certified psychiatric pharmacist with a Doctor of Pharmacy. Dr Caballero's interests and research surround paediatrics, depression and diabetes.
 * The research project was funded by the University of Texas, Pan American Faculty Research Grant however the sponsors were not involved in any facet of the study and therefore the results have not been influenced by bias.
 * The researched was published in the Complimentary Therapies in Clinical Practice Journal by Elsevier Publishing Company. Complimentary Therapies in Clinical Practice is a longstanding journal which presents high quality peer reviewed research on complementary therapies in an effort to promote safe and effective clinical practice.

What kind of research was this?

 * The research was an uncontrolled prospective pilot study . Uncontrolled studies are conducted in the absence of a designated control group meaning the effectiveness of the intervention cannot be directly compared . Whilst this places limitations on the research, it is not uncommon of pilot studies.
 * A Pilot study typically aims to assess the feasibility of future research and obtain guidelines for future full-scale study rather than focusing on the statistical significance of the results.

What did the research involve?
Fourteen participants aged 8-15 years (11.7 SD 1.5) participated in the study. Eligibility of participants was based on criteria outlined in Table One. Inclusion criteria was type 2 Diabetes risk factors as defined by The American Diabetes Association.

 * By opening the eligibility to ‘at least one’ of the inclusion criteria the researchers have somewhat invalidated their conclusion that "Ashtanga yoga may be beneficial as a weight loss strategy in a predominately Hispanic population" . Two thirds of the inclusion criteria does not require a subject to be Hispanic nor are the participants required to be overweight or obese, evidenced by baseline Body Mass Index (BMI) data ranging from 16.6-36.2kg/m2. Therefore, a portion of the population were categorised in the underweight (BMI <18.5) and normal weight category (18.5-24.9) . In order to develop more reliable results for subsequent studies participants should be screened against a more robust inclusion criteria with a mandated BMI window.
 * Additionally, the small same size of 14 participants potentiates skewed results due to the imbalance of age, gender and BMI. Increased recruitment of participants will reduce the standard deviation of results thereby indicating clearer feasibility of subsequent studies in this area.

 * The protocol involved three, 1.5-hour yoga sessions per week over 12 weeks. A discretionary attendance saw participants average a total of 33 hours across the whole study (72.9%).
 * A number of fasting laboratory analysis tests were conducted at baseline for all participants however these results were not presented in the article and therefore, comment cannot be made with regard to their influence on the intervention outcomes.
 * To measure baseline self-concept, symptoms of depression and/or anxiety, participants completed three Beck Youth inventories as shown in Table Two. These were conducted in the absence of parents.

What were the basic results?
Overall results for both weight loss and psychiatric symptoms were diverse and are summarised in Table Three:

 * These varied results complicate the findings of the study and limit the ability of the authors to make conclusive statements. However again, this is not uncommon of pilot studies and simply stands to direct future research in this area.

What conclusions can we take from this research?

 * These findings are consistent with similar projects evaluating the efficacy of physical activity interventions on overweight youth however other studies have presented more promising results pertaining to self-concept and depression. Therefore, this article does not place yoga favourably ahead of alternative childhood obesity interventions but rather poses an interesting premise for future studies.

 * Further research, employing more robust parameters of inclusion and methodology is recommended in order to accurately assess the effect of yogic practices on childhood psychiatric symptoms (i.e self-esteem, depression and anxiety).

Practical advice
This article provides both clinical and research guidance and advice.
 * This research postulates that a relationship exists between yogic exercise and lowered anxiety scores. However, due to limitations typical of pilot studies (i.e. small sample size, voluntary participation, restricted budget and duration) the results do not convincingly tie yoga with the other assessed parameters of weight loss, self-concept and depression. The study also attempts to link the alleged weight loss benefits of yoga with Hispanic ethnicity, however, without a control group for comparison there is insufficient evidence to support this.
 * This pilot study has laid the foundation for further inquisition and future research. However, the absence of robust methodologies, consistent population demographics and adherence to the intervention highlights the impact these factors can have on forming strong conclusive research. Therefore, a larger controlled study prescribing yoga to participants categorised as either overweight or obese, for a longer duration, measuring fat mass and additional metabolic responses would be a more appropriate design.
 * Locally, this study presents a space for future research on whether indigenous Australians have a varied physiological and psychological response to exercise when compared to non-indigenous Australians.

Further information/resources

 * | Early Childhood Measurement and Evaluation Tool Review
 * | Facts and figures on childhood obesity
 * | Fact Sheet 1 - Yoga for Children
 * | Beyond Blue - Depression in Children
 * | Beyond Blue - Anxiety in Children
 * | Kids Help Line


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User:U3187557

hey guys, my name is u3187557, i have to do an assignment on MY ASSIGNMENT!

title: User:U3187557


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English Grammar Worksheet/Reported and unreported speech

CHANGE THE FOLLOWING INTO DIRECT SPEECH

Ramu said that they had had no rain since January.

James said that he had had a bad week.

He requested me to wait there till we returned.

The students wished the teachers good morning.

She suggested to him that he should find a job.

The officer ordered to open the door.

The teacher advised the students not to waste time.

Doctor suggested me to exercise daily.

I advised the child not to look down.

He claimed to have won $10000.

He threatened to send me to to my room if I wasn't quiet.

He warned me not to touch the wires.

He reminded me to feed the dog.

He forbade me to park there.

He begged me not to hurt him.

He advised me to study mathematics.


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User:U3176318/sandbox

This is a critique of research article: Effects of a Physical Training Programme on Cognitive Function and Walking Efficiency in Elderly Persons with Dementia. by Kemoun G, Thibaud M, Roumagne N, Carette P, Albinet C, Toussaint L, Paccalin M, Dugué B. 2010 Apr 1;29(2):109.

What Is The Background To This Research?
Cognitive function commonly refers to the ability to be able to perform a variety of skills including memory, thinking, orientation, comprehension reasoning, attention, learning capacity, imagination, language, calculation, visuospatial abilities and judgement. An impairment in cognitive function can result in a declined ability to perform these skills as well as a deterioration in emotional control, social behaviour or motivation may be present. A decline or deterioration in ones’ cognitive function may be indicative of a diagnosis of chronic or progressive Dementia. Dementia can be associated with a variety of diseases and / or injuries that primarily or secondarily affect the brain, example the onset of Alzheimers’s Disease or Stroke

The progression of Dementia can lead to motor impairments such as balance issues and gait abnormalities and a decline in physical activity may arise. There is an underlying risk of fear of falling in elderly patients. Therefore, participation in physical activity is important in managing and supressing the progression of dementia.

Where Is The Research From?
This study was completed at University of Poitiers, France and University Hospital of Poitiers, France, by lead Author Prof. Gilles Kemoun. Kemoun works as head of Department of Physical Medicine and Rehabilitation within the University Hospital of Poitiers. Kemoun has published many studies and reviews looking at various cognitive impairments in the elderly population as well as a variety of exercise and performance based studies.

Although this study was conducted in France and examined the cognitive decline in elderly people living in a nursing home, there is a wide variety of international studies that obtained similar results. A systematic review conducted by Blankevoort CG, Van Heuvelen MJ, Boersma F, Luning H, De Jong J and Scherder EJ stated that there is a strong association between higher levels of physical activity reducing the risk of cognitive decline and dementia.

What Kind Of Research Was This?
This study was a randomised controlled trail that looked at the effects of physical stimulation based on walking exercises, equilibrium and endurance on cognitive function and walking efficiency in patients with dementia A randomised control trail is a type of study in which participants are randomly assigned to one of two clinical interventions. Randomised controlled trials are the most scientifically rigorous method of hypothesis testing available and therefore there is a minimal risk of confounding factors influencing the results. This trail method is considered to provide the most reliable evidence on the effectiveness of the tested intervention and because of this it is regarded as the gold standard trial.

What Did The Research Involve?
This trail compared 16 subjects who suffer from dementia to a control group of 15 participants who had not been diagnosed with dementia or any other cognitive impairment. All 31 subjects (aged 81 +/-5.3 years) were recruited from the same nursing home and were evaluated with the Rapid Evaluation of Cognitive Functions test (ERFC French version) as well as undertook a walking analysis before and after the rehabilitation process. The intervention group (n = 16) undertook a 15-week physical activity programme involving three 1-hour supervised sessions per week. The control group (n = 15) did not practice any physical activities. Each session focused on a specific walking parameter to aid in gait efficiency. One session was dedicated to motor route exercises (e.g. walking by striding over boards, going up a step, zigzagging). The second weekly session was devoted to stamina-based exercises, particularly on an ergocycle. The final weekly session involved activities that combined stamina, equilibrium and walking e.g. dance and stepping activities.

The inclusion of the participants was based on two criteria: one looked at cognition, a diagnosis of Alzheimer-type dementia by a neurologist according to DSM IV criteria with a score on the Mini Mental State Examination lower than 23; the other assessed motor-based skill, the ability to walk 10 metres without technical assistance. Each participant walked the 10 metres while the longitudinal movement of each foot and spatiotemporal walking cycle data was collected. The analysis of their walking efficiency data was measured with a Bessou locometer and SATEL software. The movement of each foot was transmitted, by means of a thread attached from each of the participants foot, to an optical sensor. Although this study found that physical activity programme can slow the cognitive decline and improve the quality of walking efficiency in elderly persons suffering from dementia, further research in this area is necessary.

Whilst the methodology and recruitment of participants in this study was effective in obtaining results, a reasonably low number of participants (a total of 31) were used. The study did not include intensity, frequency, duration or type of activity as a parameter. It was also deemed difficult to standardise the amount of activity each participant partook pre-study intervention. Medications and co-morbidities of the participants were unknown, this may have affected their locomotion abilities.

What Were The Basic Results?

 * The study found a strong correlation (p < 0.001) between changes in cognitive score and walking efficiency in dementia patients.

 * A significant correlation between higher cognitive scores and walking speed ( p = 0.76, p < 0.01), stride length ( p  = 0.61, p <  0.01) and double limb support time (p = 0.74, p <  0.01) was also found.

What Conclusions Can We Take From This Research?
The authors of this article conclude that partaking in a regular exercise programme can supress the effects and slow the progression of cognitive impairments such as Dementia and Alzheimer's Disease. The results obtained within this study follow trends reflected in other literature. Authors state that stamina-based physical activity programmes have proven beneficial in slowing cognitive decline and improving locomotion and walking efficiency in patients suffering cognitive impairment

The conclusion I draw from this study and other literature in this field, is that, like the authors, regular physical activity and participation in training programmes slows the onset and decreases the effects of cognitive impairments in the elderly.

Practical Advice
This article provides practical advice for the general public, health practitioners and future researchers interested in this area of health.

 * For those who suffer from cognitive impairments, exercising has been shown to improve cognition whilst slowing the onset of Dementia and Alzheimer's Disease. As cognitive decline is most prevalent in the elderly population, adopting exercise programmes within nursing homes may encourage more motivation and interest with being active at an older age. Public activities such aqua aerobics and Pilates has been seen to improve walking efficiency and decreases the risk of falling within this population.

 * For researchers interested in further developing this area, in-depth research could be undertaken to look at participation frequency, activity intensity and the minimum duration needed to design an optimum intervention.

Further Information / Resources
For interest in more readings regarding exercise and its effect on cognition in the elderly population, the following reviews and websites provide a sufficient overview of the topic:

 * 'Does Physical Activity Prevent Cognitive Decline and Dementia?: A Systematic Review and Meta-Analysis of Longitudinal Studies' (Research article)
 * 'The Effect of Exercise Interventions on Cognitive Outcome in Alzheimer's Disease: A Systematic Review' (Research article)
 * 'Recommended Measures for the Assessment of Cognitive and Physical Performance in Older Patients with Dementia: A Systematic Review' (Research article)
 * Health Direct - Dementia Prevention (website)
 * Integrated Living - Dementia Care (website)

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Exercise as it relates to Disease/Implications of physical activity for women with Ehlers Danlos syndrome hypermobility type

This is a critique of the research article 'Muscle Mass, Muscle Strength, Functional Performance, and Physical Impairment in Women With the Hypermobility Type of Ehlers-Danlos Syndrome' by.

This critique was written as an assignment in Health, Disease and Exercise at the University of Canberra - September 2019.

Background to the Research
The article defined a distinct gap of knowledge between the understandings of Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) and the implications of health and physical activity. As the condition is becoming easier to diagnose, greater understanding of the associated symptoms need to be addressed. This article aims to provide that, though suggests further research may be required.

Ehlers-Danlos Syndrome may vary in many ways, as each type of EDS is not yet fully understood. Treatment and lifestyle are very difficult for those with EDS, which is defined by; Diagnosis of EDS-HT is very complicated, it is known it is an inherited autosomal dominant pattern and will consist of one, two or all of the features;
 * Joint hypermobility
 * Skin hyperextensibility
 * Tissue fragility
 * Systemic manifestations of a more generalised connective tissue disorder
 * Positive family history, with one or more first degree relatives independatly meeting the current diagnostic criteria for EDS-HT
 * Musculoskeletal complications

Research
Research was conducted by Rombaut et al, she is a leading physiotherapist in Belgium that has conducted multiple research programs to develop the understanding of Ehlers Danlos Syndrome. Her postdoctoral work has been done at the Department of Rehabilitation Sciences and Physiotherapy at Ghent University and Centre for Medical Genetics of the Ghent University Hospital.

The article was published by the American College of Rheumatology in 2012, under Care & Research. The focus of this article was muscle strength and pain implicating physical activity levels for women with Ehlers-Danlos Syndrome, sponsorship from the American College of Rheumatology may have influenced bias and therefor findings.

This case-control study compared 43 women with to 43 women without EDS-HT with significant differential findings. The research strongly recommended more research needed to be conducted for treatments. This belief was also supported by other studies.

Methods of Study
Participants of the study were measured by their characteristics such as height, body mass, age, body mass index, Beighton score and physical activity levels using the Baecke questionnaire. Followed by these general assessments were several physical tests to assess the following; Aspects and reliability of methodology were strong and concise. Given there were so many tests performed in this article, clear explanation was beneficial to understand what was asked of the patients. Accountability of mistakes and mishaps were noted during the method and discussion.
 * Muscle Strength. Was assessed by a Biodex Medical System used to calibrate force. Participants were asked to sit upright in a chair with the lever arm of a Biodex Medical System attached at the ankle. Followed by repeated maximal voluntary concentric knee flexion and extension. Repeated 5 times at 60 degrees per second and 5 times at 180 degrees per second.
 * Muscle Strength Endurance. Used the same set up to evaluate isokinetic muscle strength endurance performed at 240 degrees per second over 30 second period of maximal concentric contractions at the knee.
 * Pain and Fatigue Associated with Muscle Strength and Endurance Tests. Assessed associated pain with the above tests. This was measured using a visual analog scale (VAS) immediately before and after the test occurred. Simultaneously using the Borg Scale fatigue was measured.
 * Muscle Mass. Was measured using a Dual X-Ray Absorptiometry (DXA).
 * Functional Performance. Was assessed by participants performing 5 chair rises as fast as possible whilst being timed. Women who exceeded 2.5 seconds during the test were categorized as having a higher falls risks.
 * Physical Impairment. Using the Arthritis Impact Measurement Scale (AIMS) questionnaire, functional impairment was evaluated. This questionnaire has been adapted and validated and is now used widely amongst the field of rheumatology.

Results
Different statistical analyses were used to analyse the various tests. Pain and muscle fatigue scores were calculated using PASW statistics shown in clustered box plots. Physical characteristics used independent t-tests which provided evidence of considerable variation of physical activity levels and muscle function (P<0.001). Univariate analysis of covariance was used to determine differences between groups for muscle strength, muscle strength endurance, and functional performance. For Subjects characteristics, findings proved that the subject group had higher Beighton scores (1.5-9.7 <0.001) and considerably lower physical activity levels (6.1-11.5 <0.001). As expected women with EDS-HT had muscle strength weakness, -33.3% to -42.9% lower than the control group. Though it is noted that the ratio between quadriceps and hamstring strength was not significantly different between the two groups. The Muscle strength endurance test proved women with EDS-HT have considerably weaker isokinetic and static endurance and therefor expressed a lower total work. For Pain and Fatigue assessments women with EDS-HT said they felt mild lower extremity pain at rest before the test, after the test their pain increased to moderate (between 40-60 of 100 - using VAS). Some of the subject patients had fatigue even before the test was performed, the subject group were completely exhausted after the endurance test and remained exhausted one-minute post. Many of the subject group were over the 2.5 second marker time for chair raises, increasing the risk of falls for this population.

Conclusion
Conclusively participants of the study with EDS-HT are significantly limited by pain, fatigue and muscular weakness. Greatly impacting their in-ability to participate in physical activity and a functional life. As this is the first extensive study in lower extremities of EDS-HT there was limited comparison of correlated research. Given the 13 different types of Ehlers Danlos Syndrome, relevancy of results in various articles is divided by focuses, which is a limitation.

Various hypothesis questions the reason for muscle weakness in EDS, whether it is due to muscle weakness as a lack of exercise, collagen abnormalities or mitochondrial dysfunction. It is yet to be determined, and the limited knowledge implicates treatment management and lifestyle.

Practical Advice
The article provides strong evidence that women with EDS-HT have chronic moderate-severe pain worsened by physical activity. Understanding of pain is limited, with various suggestions listed above. Several studies on patients with rheumatoid arthritis and fibromyalgia determined light aerobic and resistance training both on land and aquatically are beneficial for improving muscular strength and endurance. Suggested treatment includes pain prescription medication and sometimes blood pressure medication. Physical therapy is also recommended to strength joint stability and potentially braces, frames or crutches. This can be prescribed by Physiotherapists and/or Exercise Physiologists. In severe cases, surgery can be considered to repair damage. Though due to collagen dysfunction this is not strongly recommended because of the associated healing issues.

With this evidence, recommendation of a repetitious light intensity exercise program prescribed by a Physiotherapist or Exercise Physiologist will be beneficial.


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Exercise as it relates to Disease/The effects of high vs moderate-intensity exercise on coronary artery disease

This is a critique of the research article, Rognmo et al (2003). ‘High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease’. European Journal of Cardiovascular Prevention and Rehabilitation. 2004, Volume 11, page: 216 – 222.

This critique was written as an assignment in the unit; Health, Disease and Exercise at University of Canberra, August – September 2019

Background to this Research
The purpose of the study was to find the effects of high – intensity aerobic interval training and moderate intensity aerobic interval training and which one was most effective on decreasing mortality in Coronary Artery Disease (CAD) patients.

Coronary Artery Disease is when the arteries that supply bloody to the heart muscles become harder and narrow, this is from a build up of plaque on the inner walls of the arteries.

The issue they are highlighting is that most patients with CAD only work at low to moderate intensity. Within the study they discuss the correlation between a high intensity workout and how it reduces the risk of cardiovascular disease (CVD) and reduces the progression of CAD.

This article highlights that if you have CAD how the level of exercise intensity helps to reduce the affect it has on your life. It is important that patients with CAD are maintaining physical activity in order to help maintain their disease and prevent mortality.

Research
The study involved 21 participants who must have at least CAD in one major epicardial vessel and lived within 40 km of the hospital. Epicardial vessels are the vessels that remain on the surface of the heart. In addition, the medications that the participants were on were not different. A randomisation code was used to divide the participants into two groups to determine if they were in the high intensity (11 participants) or moderate intensity group (10 participants). This means the study was a randomised controlled trial, which means they are trying to reduce the amount of bias when testing effectiveness of a new treatment. As the participants had to live within 40 km of a hospital, there is a potential that the participants may have been manipulated to meet this specific requirement.

The study was conducted in Norway at Trondheim University Hospital in the Department of Circulation and Medical Imaging. All participants had undergone a medical investigation for CAD at the hospital the year prior to the study being conducted. This study was supported by grants from the Department of Cardiology at St Olavs Hospital, which could cause a bias in the results and findings as the research paper is being funded by a cardiology department. There could also be a conflict of interest because the study was conducted at St Olavs Hospital, which may have also influenced the interpretation of the results to highlight what they wanted to see. Additionally, as this study was conducted in Norway it may not be relevant to the Australian population as they have a different diet and exercise guidelines compared to Australia.

Methods of Study
A 12 point Electrocardiogram (ECG) was set up for every test. Patients were measured at rest before the exercise and at the end of each work level. Patients were stopped if an indication by the patients for terminations was presented. The researchers familiarised the patients with the treadmill by getting them to walk on the treadmill without holding the handles. Once the patients were comfortable with this and could walk without holding the rails, the speed started to increase and incline was adjusted, this was followed for 10 minutes as a warmup. After the warmup was completed they placed a face-mask on the patients to measure metabolic measurements. They used a protocol called ramp which is when the speed is a constant with a 2% increase in the incline every 2 minutes until VO2 peak max was reached.

The data was collected over 10 weeks during 2004. The patients were informed they were not allowed to perform exercise out of these protocols. This was a necessary part of the control to make sure no one was exercising out of the protocols and ensure accurate interpretation of the results.

Both groups were assigned to an Exercise Physiologist who ran the sessions for each group. Each group met 3 times a week for 10 weeks, each session went for 33 minutes. There was no changes in the groups exercise besides intensity levels. It is good they kept the exercises the same however, this could have been boring for the participants as it may have become repetitive and this may have influenced a desire to exercise outside of the training program.

Results
The main findings indicate that both groups significantly increased their VO2 peak before and after the training. The difference in each groups results were calculated using the U-Test. A two tailed P< 0.05 was accepted as statistically significant for all tests. The difference in P - value for moderate intensity was P<0.02 and for high intensity was P<0.05. Which resulted in a 17.9% improvement in the high intensity group compared to a 7.9% improvement in the moderate intensity group.

The researchers stated that the improvement was significantly higher in the higher intensity group. As all patients wore heart rate monitors they were able to adjust the workload based on their heart rate which caused them to find higher adaptations to the training and resulting in higher VO2 peak.

The results are consistent with the method as the high intensity group had better adaptations to the training and their VO2 peak increased higher, which makes sense as they are working at a high – intensity then the moderate – intensity group.

As there were a low number of participants this may not be a very reliable source of the interpreting the results. It would be desirable repeat the study to ensure that the conclusions drawn are more accurate. Further, as outlined in a study conducted by Lee MI whilst there is a correlation between exercise intensity, there needs to be considerations in the patients fitness levels before commencing moderate intensity exercise.

Conclusion
To conclude, the research demonstrated that high to moderate intensity exercise will increase VO2 peak max within patients with Coronary Artery Disease. This study has shown that people with Coronary Artery Disease should exercise aerobically at least 3 times per week at a moderate to high intensity which my in turn reduce their risk of mortality. Overall, the study has a good experimental design, however they had a small population of participants, so it would be desirable to repeat the research to ensure that the results achieved are repeatable. Additionally, as the cardiology department funded this research thee is a perceived conflict of interest which may question the validity of the study. The results from this study would be very helpful for Exercise Physiologists to create an exercise program for CAD patients. There is limited information and other studies to support this research on the effects of exercise intensity in CAD patients. However in one particular study it was found that understanding a patients existing fitness level may be a consideration rather than the level of exercise intensity they perform.

= Practical Advice =

For patients with CAD or people who are at risk to this disease it is best that they work with an Exercise Physiologist. This is important as they are able to see if any issues appear and so they are able to terminate the exercises. It is also important as an Exercise Physiologist is able to write up an exercise program for patients. Another option is for patients to go to their General Practitioner and ask to join a Cardiac Rehabilitation Program which if you have had surgery for CAD you should already be doing. The exercises you want to complete are aerobic and Strength training, as these are the best exercises to increase your heart rate via aerobic and strength training. You should aim to exercise at least 3 times a week for adaptations to occur. You are wanting to target large muscle groups, the exercises you can do are walking, running, cycling and swimming just to name a few.


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The following is a critique of the research paper Correlates of Physical Activity Among Individuals with Multiple Sclerosis: A cross sectional trial, published in 2006

What is the background to this research?
Across the United States of America, there are approximately 400,000 known cases of Multiple Sclerosis (MS), leaving it as the leading neurological disease in younger and middle aged adults. MS is a disease that affects the central nervous system, which is made up of the brain, the spinal cord and the optic nerve. Research has found that females are two times more likely to have MS then males. MS is an unpredictable disease, as everyone's case is different. Although everyone will have functional limitations, only 50% of people will require a walking aid at a stage in their lives and only 10% of that population will need to be placed in a wheelchair Although there is no found cue for MS, there are ways in which the symptoms can be reduced. Physical activity is defined as "bodily movement produced by contraction of skeletal muscles resulting in an increase in energy expenditure and is accumulated in leisure time physical activity, exercise, household chores, and occupational work". Research has found that physical activity has unique advantages for those who suffer from MS, as it helps to reduce fatigue symptoms, mobility, spasticity, pain and without the participation of regular physical activity, there are increased chances of relapse and worsen symptoms

The hypothesis behind this study is that self-efficiency will have a direct link to physical activity. Enjoyment, social support, disability will all be link to physical activity through self- efficiency. It’s important to understand the relationship between variables and psychical activity as physical activity is becoming a treatment for those who have been diagnosed with MS.

Where is the research from?
The Authors of this study, Robert Molt, Erin Snook, Edward McaAuley, Jennifer Scott and Martha Douglass, were from Department of Kinesiology and Community Health University of Illinois at Urbana-Champaign. All authors are co-authors on other published articles in the area of sport science.

What kind of research was this?
This trial was a cross sectional research. Cross sectional trials give the authors an understanding of how MS can affect a population at any specific point in time.

What did the research involve?
Subjects were recruited though the Greater Illinois, Indiana, and Gateway chapters of the National Multiple Sclerosis Society (NMSS), which has approximately 12,000 people diagnosed with MS. The targeted population were contacted though a support group and advertising. The researches asked for those who were interested to make contact. Those who were interested were then re-contacted and were given an explanation on how the study was going to work. During these phone calls a verbal consent and a brief screening was conducted. Those who passed met the criteria of the following: a.	Definite diagnosis of MS b.	No relapse in the past 30 days c.	Need minimal assistance (walking with or without just a cane) After the criteria was and screening were finished, 196 subjects were moved on to participate in the research. 173 women and 23 males took part in the research. They were all sent a package that included a written consent form, a number of questionnaires and an accelerometer. The participants were asked to fill out all forms on the Sunday before commencing on the Monday. The accelerometer was to be worn from the time they woke up until they go to bed. Water based activities were excused. The time spent wearing the accelerometer was recorded in a logbook. The testing finished after 7 days and the participants were asked to send all of the documents back to postal address. The researchers looked into how different factors changed the amount someone participated in physical activity. A social cognitive perspective was embraced and the physical activity influences of social support, enjoyment, disability and self-efficacy were all studied. They were looking to understand which were closely related to physical activity and which would have an influence on individuals with MS.

What were the basic results?
Those who participated in this study were found to be less active compared to those in a separate similar study. Comparing the QLTEQ in table one between current study and compared study, it is clear that the participates in current study could recognise they started off less active. During the seven days the accelerometer again proved that those whom took part in this study were less active compared to those in compared study.

 * SD = Standard Deviation
 * GlTEQ = Godin Leisure Time Exercise Questionnaire

The data was analysed by covariance modelling and maximum likelihood estimation. The models were broken down into two steps. Step one involved testing the fit of measurements and the second step two involved testing if the models worked.

The models were assessed by using chi- square, root mean squared error approximation (RMSEA), standardised root mean squared residual (SRMSR) and comparative fit index (CFI). Each of these have a specific way of understanding how close the measure of fit is. These statistical measures were then used to help design the models and how the variables influenced physical activity

The hypothesised model of how the variables related to physical activity was that Enjoyment, Social support and Disability all related directly to Slef-efficany. Self-Efficacy was then the direct link to Physical activity. After completely several different tests with the statistical measurements, it was found that the original model wouldn’t fit the given results. The researches completed an additional testing that would state that statistically self-efficiency and enjoyment both have significant impacts on physical activity. There was direct relationships between Social Support and disability which then related them to Physical activity through either Enjoyment and or Self efficiency.

What conclusions can we take from this research?
Based on the evidence provided, self-efficacy and enjoyment are both scientifically related to physical activity for those whom suffer from MS. The finding in this study aligns with the findings in a study which was investigating how physical activity creates a better quality of life for those with MS. Benito-León J, in their review they state that those who were more self-efficient, participated in more physical activity and as did other results in other studies

Practical advice
While the optimal amount of physical activity is unknown for those who suffer from MS, maintaining a continuous schedule but ensuring the activity is self-efficient and enjoyable. Exercise treats the symptoms that arise with MS and slows the deformities happening with in the central nervous system. Before commencing any physical activity, participants should always consult with their general practitioner.

Further information/resources
Understanding MS – an introduction for people living with MS
 * https://www.msaustralia.org.au/sites/default/files/Understanding-MS-Aug2012(1).pdf

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Exercise as it relates to Disease/Can Exercise Really Help Multiple Sclerosis?

The following is a critique of the research paper Correlates of Physical Activity Among Individuals with Multiple Sclerosis: A cross sectional trial, published in 2006

What is the background to this research?
Across the United States of America, there are approximately 400,000 known cases of Multiple Sclerosis (MS), leaving it as the leading neurological disease in younger and middle aged adults. MS is a disease that affects the central nervous system, which is made up of the brain, the spinal cord and the optic nerve. Research has found that females are two times more likely to have MS then males. MS is an unpredictable disease, as everyone's case is different. Although everyone will have functional limitations, only 50% of people will require a walking aid at a stage in their lives and only 10% of that population will need to be placed in a wheelchair Although there is no found cue for MS, there are ways in which the symptoms can be reduced. Physical activity is defined as "bodily movement produced by contraction of skeletal muscles resulting in an increase in energy expenditure and is accumulated in leisure time physical activity, exercise, household chores, and occupational work". Research has found that physical activity has unique advantages for those who suffer from MS, as it helps to reduce fatigue symptoms, mobility, spasticity, pain and without the participation of regular physical activity, there are increased chances of relapse and worsen symptoms

The hypothesis behind this study is that self-efficiency will have a direct link to physical activity. Enjoyment, social support, disability will all be link to physical activity through self- efficiency. It’s important to understand the relationship between variables and psychical activity as physical activity is becoming a treatment for those who have been diagnosed with MS.

Where is the research from?
The Authors of this study, Robert Molt, Erin Snook, Edward McaAuley, Jennifer Scott and Martha Douglass, were from Department of Kinesiology and Community Health University of Illinois at Urbana-Champaign. All authors are co-authors on other published articles in the area of sport science.

What kind of research was this?
This trial was a cross sectional research. Cross sectional trials give the authors an understanding of how MS can affect a population at any specific point in time.

What did the research involve?
Subjects were recruited though the Greater Illinois, Indiana, and Gateway chapters of the National Multiple Sclerosis Society (NMSS), which has approximately 12,000 people diagnosed with MS. The targeted population were contacted though a support group and advertising. The researches asked for those who were interested to make contact. Those who were interested were then re-contacted and were given an explanation on how the study was going to work. During these phone calls a verbal consent and a brief screening was conducted. Those who passed met the criteria of the following: a.	Definite diagnosis of MS b.	No relapse in the past 30 days c.	Need minimal assistance (walking with or without just a cane) After the criteria was and screening were finished, 196 subjects were moved on to participate in the research. 173 women and 23 males took part in the research. They were all sent a package that included a written consent form, a number of questionnaires and an accelerometer. The participants were asked to fill out all forms on the Sunday before commencing on the Monday. The accelerometer was to be worn from the time they woke up until they go to bed. Water based activities were excused. The time spent wearing the accelerometer was recorded in a logbook. The testing finished after 7 days and the participants were asked to send all of the documents back to postal address. The researchers looked into how different factors changed the amount someone participated in physical activity. A social cognitive perspective was embraced and the physical activity influences of social support, enjoyment, disability and self-efficacy were all studied. They were looking to understand which were closely related to physical activity and which would have an influence on individuals with MS.

What were the basic results?
Those who participated in this study were found to be less active compared to those in a separate similar study. Comparing the QLTEQ in table one between current study and compared study, it is clear that the participates in current study could recognise they started off less active. During the seven days the accelerometer again proved that those whom took part in this study were less active compared to those in compared study.

 * SD = Standard Deviation
 * GlTEQ = Godin Leisure Time Exercise Questionnaire

The data was analysed by covariance modelling and maximum likelihood estimation. The models were broken down into two steps. Step one involved testing the fit of measurements and the second step two involved testing if the models worked.

The models were assessed by using chi- square, root mean squared error approximation (RMSEA), standardised root mean squared residual (SRMSR) and comparative fit index (CFI). Each of these have a specific way of understanding how close the measure of fit is. These statistical measures were then used to help design the models and how the variables influenced physical activity

The hypothesised model of how the variables related to physical activity was that Enjoyment, Social support and Disability all related directly to Slef-efficany. Self-Efficacy was then the direct link to Physical activity. After completely several different tests with the statistical measurements, it was found that the original model wouldn’t fit the given results. The researches completed an additional testing that would state that statistically self-efficiency and enjoyment both have significant impacts on physical activity. There was direct relationships between Social Support and disability which then related them to Physical activity through either Enjoyment and or Self efficiency.

What conclusions can we take from this research?
Based on the evidence provided, self-efficacy and enjoyment are both scientifically related to physical activity for those whom suffer from MS. The finding in this study aligns with the findings in a study which was investigating how physical activity creates a better quality of life for those with MS. Benito-León J, in their review they state that those who were more self-efficient, participated in more physical activity and as did other results in other studies

Practical advice
While the optimal amount of physical activity is unknown for those who suffer from MS, maintaining a continuous schedule but ensuring the activity is self-efficient and enjoyable. Exercise treats the symptoms that arise with MS and slows the deformities happening with in the central nervous system. Before commencing any physical activity, participants should always consult with their general practitioner.

Further information/resources
Understanding MS – an introduction for people living with MS
 * https://www.msaustralia.org.au/sites/default/files/Understanding-MS-Aug2012(1).pdf


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Exercise as it relates to Disease/Does playing active video games increase energy expenditure in children?

This page reviews and critiques the article: Does playing active video games increase energy expenditure in children.

What is the background to this research?
With a population that is becoming increasingly sedentary and obese, many would say that technological advances have a big role to play in this issue. Exercise is an important part of life and is one of the best, healthiest solutions (alongside a healthy diet) for keeping healthy. Video games have become a massive part of children's lives in the last couple of decades and is often seen as an unhealthy habit. This is believed to be an unhealthy habit due to the long hours children tend to sit and play for. To combat the issue of sedentary behaviour while video gaming, companies like Nintendo have introduced 'active video gaming' where the game requires the player to physically move around while playing the game. Although this might sound like a good solution, do these active video games really have a lasting impact? There are a many articles and studies that have been produced exploring this issue, many of which come to the conclusion that active video gaming is a solution to combat sedentary behaviour. The article chosen for this particular review explores the extent and effect that active video gaming has on children's daily energy expenditure. Studies like these are important as it helps prove whether active video games are truly good alternatives compared to normal video games. This kind of information would be useful and informative for the parenting population, who have concerns for their child's wellbeing and health.

Where is the research from?
This article was added to the Official Journal of the American Academy of Pediatrics in 2009. This journal has be published continuously since 1948. The article and research was conducted at the University of Oklahoma and published on July 13, 2009. Although it was conducted in the United States of America, the research is still relevant in Australia.

All co-authors from this study have had contributions to other peer-reviewed articles and studies. All co-authors bar Diana L. Graf, have contributions to other studies either relating to this article or in the field of pediatrics. Since all co-authors are experienced and have contributed to other research, this improves the reliability of this article.

Bias and conflict of interest is unlikely from all of these co-authors as they do not benefit from the study in any way other than the experience gained by conducting and publishing the study.

What kind of research was this?
This researchers used a randomised crossover trial (RCT) for this study. For this type of experiment, an RCT is suitable as it is a controlled study and provides the researchers with the ability to incorporate a repeated measures design. This works well for this particular study as the researchers need to compare numbers of different variables produced by the same subject. An observational study would not be appropriate for this kind of study as the researchers need to control some variables in order to gather and find differences in the results. A meta-analysis study could benefit the level of evidence for this type of research. By comparing multiple studies that address the same question, it could add a high level of evidence supporting the research that it is intending to show. However if there is conflicting evidence in the articles used, this could decrease the level of evidence for the intended result.

Method
14 boys and 9 girls aged 11–13 years old, with a BMI at 3-98th percentile for age and gender were used for this study. Energy expenditure, heart rate, step rate, and perceived exertion were all measured while performing different activities. The activities were watching television at rest, playing Dance Dance Revolution (DDR) at 2 skill levels, playing Wii bowling and boxing, and walking at 2.6, 4.2, and 5.7 km/hr on a treadmill. Arterial elasticity was also measured before and after each activity.

Approach and limitations
The research approach was appropriate for the study and all variables measured were suitable to determine the energy expenditure for each activity. The study may lack validity as the sample size used was small. Only using a total of 23 children could affect the validity of the study as it may not reflect the general population.

Important findings

 * Energy expenditure while participating in active video gaming or walking increased 2-to-3 times, compared with watching television at rest.
 * The highest rates of energy expenditure, heart rate, and perceived exertion were found during Wii boxing, DDR level 2, and at highest walking rate of 5.7 km/hr on the treadmill.
 * Wii bowling and beginner level DDR had a 2x increase in energy expenditure compared to television watching at rest.

Researcher's interpretation of results
The researchers came to the conclusion that energy expenditure during active video gaming is comparable to light-moderate intensity walking. This was then extended to say that children who spend long periods of time playing video games, would benefit from playing physically active games as they are a safe, fun, and valuable means of promoting energy expenditure.

What conclusions can we take from this research?
The conclusion that active video games increase energy expenditure compared to watching television at rest is a fair statement. However the article only compares active video games to treadmill walking, which considering exercise standards, isn't a very good example of the level of exercise that children should be getting everyday. This article could be misleading in the way that people reading could think they are promoting active video gaming as a complete alternative to genuine exercise.

Comparison to other research in this area
Other articles and research in this area found similar results to the article being critiqued. In the years 2008 and 2013 studies using the similar research methods to the study being critiqued, found very similar results. Furthermore, in 2011 Wei Peng and others produced a meta-analysis of the energy expenditure during active video games. The meta-analysis put together multiple studies adding up to a total of 354 participants. The researchers found that energy expenditure during active gaming can be the same as during light-moderate intensity exercise.

Implications of this research study

 * Small sample size means that the study may not be relevant to the wider population.
 * Exercise on a treadmill is not an everyday exercise which most children undertake on a day to day basis.
 * Researchers conclude that playing physically active games are a safe, fun and valuable means of promoting energy expenditure. However they failed to provide that active video games must not be used as a genuine substitute for exercise. An article by Susan E. Klepper about the benefits of exercise and physical activity for children highlights the reason that genuine physical activity is so important for the development and wellbeing of children.

Conclusion
Active video games are a better option for energy expenditure than video gaming or watching television at rest. However, active video gaming should not completely replace genuine exercise.

Further information/resources
For further reading on the effects of active video gaming on energy expenditure in children, please click the links below:

 * Is Playing Exergames Really Exercising? A Meta-Analysis of Energy Expenditure in Active Video Games.
 * Energy Expenditure and Cardiovascular Responses to Seated and Active Gaming in Children.
 * Activity promoting games and increased energy expenditure.
 * Couch potatoes to jumping beans: A pilot study of the effect of active video games on physical activity in children


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Exercise as it relates to Disease/The effects of progressive resistance training on individuals with Down Syndrome

This is a critique of the article by Patrick M. Cowley, Lori L. Ploutz-Snyder, Tracy Baynard, Kevin S. Heffernan, Sae Young Jae, Sharon Hsu, Miyoung Lee, Kenneth H. Pitetti, Michael P. Reiman & Bo Fernhall (2011) The effect of progressive resistance training on leg strength, aerobic capacity and functional tasks of daily living in persons with Down syndrome, Disability and Rehabilitation, vol. 33:22-23, pp. 2229-2236

What is the background to this research?
Down syndrome (DS) is a developmental disability resulting from an extra copy of a chromosome. Individuals with DS also present hypotonia, muscle weakness and low aerobic capacity which can lead to impairments in physical function and limit functional ability resulting in loss of independence, increased need for services and support and decreased quality of life.

In this article, it mentions that the cause of muscle weakness in individuals with DS is still unknown. Although, it does address the research question by testing the hypothesis that progressive training would increase isometric and isokinetic knee extensor and flexor strength, peak aerobic capacity and increase walking speed.

Individuals with DS are more likely to perform labour jobs such as filling boxes, carrying, standing and their ability to perform these jobs could become impaired if any further losses in strength occur with ageing. Therefore, it is important to address these issues related to these individuals.

Where is the research from?
Thirty individuals with DS participated in this study and all individuals had been diagnosed with DS and mild intellectual disability by a medical professional and this was confirmed by the parent and/or guardian.

The author of this article, Patrick M. Cowley, is a PhD at Syracuse University in San Francisco. Patrick has over 30 research items dating from 2005 to 2019. After this article, a study offered new insights on the cause of muscle weakness in DS individuals where Patrick Cowley was the lead researcher.

What kind of research was this?
This research is a non-randomised controlled trial to test the hypothesis with an intervention and control group.

Many studies show similar evidence of progressive resistance training improving lower limb strength. Such as data from, shows that progressive training was effective in improving the strength of the major antigravity muscles of the lower limb (quadriceps and hip extensors) in adolescents with DS. The average percentage increase in muscle strength was 42% which suggests that it is clinically worthwhile.

What did the research involve?
There were four tests that the thirty participants completed; progressive resistance training program, knee extensor and flexor isometric and isokinetic strength, functional tasks of daily living and peak aerobic capacity. Progressive resistance: This included three sets of 8-10 repetitions of leg extensions and flexion, leg press, shoulder press, chest press, bicep curl and tricep pushdowns that was performed using machines 2 days per week for 10 weeks. At the start of the program, the participants were familiarised with the exercises and how to properly use the machines. Each participant worked one-on-one with an exercise professional who supervised all training sessions. The weight was lifted recorded and was progressively increased to consistently load the muscle. Knee extensor and flexor isometric and isokinetic strength: Participants were positioned in the dynamometer where maximal isometric peak torque was obtained by having the participant perform three sets of maximal contractions with the knee extensors and flexors at a joint angle of 45, 60 and 75 degrees. Maximal isokinetic peak torque was obtained by having the participant perform three sets of five maximal contractions with knee extensors and flexors at 60 degrees/sec with 3 minutes between sets. Functional tasks of daily living: Each participant was timed on their ability to perform functional tasks of daily living as fast as comfortable as possible, which included the time to rise from a chair with varying heights. For stair ascent, participants were asked to ascend 10 stairs as quickly as possible without using the hand railing for support. They were asked to walk one step at a time and one leg after the other. Walk speed was determined by having the participant walk 7.62m as fast as possible without running. Walk speed was calculated by dividing the distance travelled by time. Peak aerobic capacity: Each participant performed a test of peak aerobic capacity on a treadmill using an individualised protocol. The speed was first adjusted to a fast walk and every 2 minutes the grade was increased by 2.5% until a maximum grade of 12.5% was reached. At this point, the speed of the treadmill was increased every minute by 1.61km/h until participants could no longer keep up or showed volitional exhaustion.

Three sites in the USA were chosen as an intervention and control group and this was based on the capability to provide supervised intervention. This method is selection bias which strays away from being random. Although, pre and post-testing method were performed by the same investigators.

The biggest limitation of this study was selection bias due to the non-randomised controlled trial. Participants were assigned to a control or intervention group and were not randomised. Another limitation is the uneven size of the intervention and control group. There was also a small number of female participants in the study which could have prevented an examination of sex differences in the training response.

What were the basic results?
The results for isokinetic measures showed that the intervention group exhibited a greater increase in knee extensor and flexor peak torque compared to the control group. For the isometric measure of strength showed that the intervention group exhibited a greater increase in knee extensor peak torque but not knee flexor compared to the control group. For the chair rise time, the intervention group exhibited a decrease in the absolute change in stair ascent and descent. For aerobic capacity, the intervention group exhibited an increase in the absolute change in the respiratory exchange ratio.

Results interpreted that isometric knee flexor strength did not change with training due to it being highly angle specific and participants did not perform isometric contractions with knee flexors at the angles tested during training. However, the increase in isokinetic strength is likely due to the resistance training mirroring the type of testing. Results suggest that improving leg strength can positively impact functional tasks such as ascending and descending stairs. However, improving leg strength does not affect aerobic capacity. This might be due to the program not having a sufficient number of training days and low training stimulus.

Implications of the research findings were mentioned and their reasons why were also mentioned which suggests that they are aware of the improvements they need to make in later studies.

What conclusions can we take from this research?
The conclusion states that further investigations should examine the effect of progressive resistance training in adults with DS where functional becomes very limited and becomes an indicator of mortality, in which I do agree due to the increased level of evidence the data will have. The participants' age in this study ranged from 20-30 years old where functional abilities could still be increasing. Data from this article suggest that individuals with DS have 80% reaching the third decade and 60% living beyond fifty. Furthermore, I do believe that progressive resistance training and other healthy lifestyles should be implemented into individuals with DS at an early age so they can be healthy going into old age.

A recent article (2017) conducted a randomised controlled trial with 31 children with DS to investigate the effects of isokinetic training on muscle strength and postural balance. Results suggest that the children who participated in the isokinetic training program displayed greater improvements in muscle strength and postural balance.

A more recent article (2018) conducted a 4-week high amplitude standard exercise program on 8 adults with DS that were recruited from a residential facility. Results displayed that there was an increase in self-selected gait speed but it did not have a significant effect on their balance or functional strength. This result suggests that there is a minimum amount of time where improvements in functional strength will be visible in individuals with DS.

Practical advice
This research did have exclusion criteria which included:
 * 1) Any contraindications to exercise
 * 2) Severe or profound intellectual disability
 * 3) Documented atherosclerotic heart disease
 * 4) Documented atlantoaxial instability
 * 5) Uncorrected congenital heart disease
 * 6) Implanted prosthetic device
 * 7) Implanted pacemaker
 * 8) Musculoskeletal disorders preventing participants from successfully completing any of the tests
 * 9) Less than 16 years of age

Other types of real-world implications were not mentioned.

Further information/resources
After this article was published, an article was shortly published providing new insights on the cause of muscle weakness in individuals with DS which was conducted using mice as a control group.

This website article is very informative and can offer a lot of support to families of individuals with DS and medical professionals.

This website can offer support and reliable information to parents who have or expecting a child with DS. Information is constantly being updated and reviewed which can ensure that the information is latest.


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User:MrFidaAliEngr

Assalam-u-alaikum and good night! I created an account titled as MrFidaAliEngr some eight years back in Wikiversity with the intention to keep a good liaison with Wikiversitans. I also contributed some data regarding myself, my family, my country, my area, etc. in good faith. But when I searched for the same today, to my astonishment, I could not find them. Would Wikibooks kindly guide me in this regard, please?

title: User:MrFidaAliEngr


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User:LGreg/sandbox

Testing sandbox.

Approaches to Knowledge (LG seminar 2019/20)

/Approaches to Knowledge (LG seminar 2020/21)/

title: User:LGreg/sandbox


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User:LGreg/sandbox/Approaches to Knowledge (LG seminar)

This is the sandbox page for Lara's seminar groups. Please click through to your relevant group.

 * Group 1 (Fridays 10-11am)
 * Group 2 (Fridays 11-12pm)


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Template talk:SUBJECTNAME

Safesubst
Add in the text. 64.114.239.29 (discuss) 19:25, 11 September 2019 (UTC)
 * As I remarked at BOOKNAME talk, wouldn't this require repetitions at ever level of the nested template calls? --Pi zero (discuss • contribs) 23:39, 11 September 2019 (UTC)

title: Template talk:SUBJECTNAME


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History of wireless telegraphy and broadcasting in Australia/Topical/Biographies/Cecil Ralph Newman Morris

Cecil Ralph Newman Morris was a prominent amateur operator, amateur broadcaster, amateur club administrator in the late 1920s and early 1930s, and ultimately senior state public servant. His station callsign was initially 4CN (4=Queensland, C=Cecil, N=??) then 4LW (4=Queensland, L=Long, W=Wave) and he operated from Brisbane (Rosalie), Queensland. A summary biography has not yet been prepared however the following resources have been assembled in preparation:
 * Transcriptions and Notes - Cecil Ralph Newman Morris - More than 20 transcriptions and notes from 150+ identified
 * Photos, QSL cards and other graphics - Cecil Ralph Newman Morris - Nothing uploaded as yet