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Exercise as it relates to Disease/Promoting exercise with cognitive behavioural strategies in people with Type 2 diabetes

This article is an analysis critiquing of the paper: "Increasing Physical Activity in People With Type 2 Diabetes"

Background to Research
The benefits of exercise on the body are widely known, and there are many guidelines recommending types and amounts of exercise in order to maintain optimal health. Exercise that does not improve fitness components, still has the capacity to improve overall health. Type 2 diabetes makes it challenging to meet these exercise requirements. Previous interventions have been conducted using subjects that are motivated and in good health, although adherence rates are low. There is a lack of promotion for physical activity with those living with the condition and increases in motivation have high potential to improve adherence rates, and in turn, overall health.

Where is the research from?
The primary authors of this article are Alison Kirk (BSCI), Nanette Mutrie (PHD1) Paul Macintyre (MD1) and Miles Fisher (MD2). The article was published to the American Diabetes Association, an organisation that funds research aiming to inform and alleviate diabetes. Alison Kirk has completed a BSC in Physiology and Sports Science at the university of Glasgow, before partaking in her PHD study. Nanette Mutrie is a psychologist with the British Psychological Society specialising with interventions aimed at increasing physical exercise. Paul Mcintyre has been involved in the production of multiple papers involving cardiopulmonary health, myocardial infarction and more. Miles Fisher has written on hyperglycaemia, ketoacidosis papers and more.

What kind of research is this?
This research was an intervention study. Intervention research is the systematic study process where a change in strategy or conditions is implemented. Under this type of research falls randomized controlled trials. This study is a randomised control trial as 50% of the participants were randomly assigned to either receive an intervention, or not (see the following section for more information).

What did the research involve?
The research involved a subject pool of 70 individuals with type 2 diabetes consisting of 50% males and 50% females. The following characteristics were observed within the gorup:

- mean BMI was 34.6 +- 6.8kg/m2

- mean age was 57.6 +-7.9 years

- mean diabetes duration was 6.0 +- 4.5 years.

16 subjects were overweight (BMI 25-30 kg/m2), 50 subjects were obese (BMI 30 kg/m2 +) and 4 subjects were of normal weight with a BMI equal to or- under 25 kg/m2. Participants with medical conditions preventing them from exercising were not included in the study. Half the sample was cut out as the study was a randomized control trial, where only 35 subjects received an intervention. Diabetes was controlled by insulin, oral hypoglycaemic agents or diet. Participants were categorised into either a contemplation of exercise group or a preparation to exercise group. Participants were encouraged to increase exercise levels via an individualised approach, utilising the trans theoretical model to identify which stage of change the participant was at and was then capitalised on for greater chance of success. Individuals were required to self report on the exercise they completed. Primary outcome measures including physical activity levels, behaviour change and cardiopulmonary fitness were established. These were measured by accelerometers, short surveys and individualised exercise protocols. Secondary outcome measures were blood pressure, BMI, glycaemic control, lipid profile and fibrinogen. Participants then completed maximum of five visits, where the first two visits saw health questionnaires, demographic details and other information was collected. Participants with underlying medical issues were removed and then one-on-one discussions were conducted where the transtheoretical model was used to induce change in participant behaviours and motivate them to exercise. Follow-up meetings saw the duration and exercise demands (low, moderate low vigorous) which was self reported by participants discussed in further detail. Follow up phone calls and information was provided to participants, discussing positives and negatives of the intervention.

Results
Within the results, no between-group differences were observed, signalling randomisation was successful. There was an increase in minutes of activity along with activity counts. Furthermore, there was an increase in exercise duration in the case group, and no differences in the control group. The following were recorded physiological changes:

- decrease in oxygen uptake within the control group

- increase in exercise duration in the experimental group

- decreases in systolic blood pressure (BP), but not diastolic BP

- increase in fibrinogen in the control group

Conclusions
The study concluded that consultation for exercise led to an increased physical activity level, improved glycemic control and cardiovascular risk factors in people with type two diabetes, more so than a standard leaflet would. The study acknowledges there is minimal research available on the effects off long term exercise interventions in people with type 2 diabetes. Results observed were an increase in exercise duration within the experimental group, a decrease in oxygen uptake in the control group and more. The intervention, a family minimal one, was successful in promoting physical activity and resulted in positive health effects.

Practical Advice
Upon review and critiquing of the article, it has come to light that the competency of the authors is an issue and it is clear that not all authors are sufficiently skilled for such an experiment. Kirt is qualified in exercise physiology, but as the paper focuses on psychological methods to increase motivation to exercise, this does not fall within her skillset. Mutrie, a qualified psychologist who has previously worked on and specialises in interventions for increasing physical activity, is far more qualified for such an intervention and excellently suited for the study. Little information was available on the qualifications of Macintyre and Fisher, only previous papers they had co-edited, none aligning with the nature of this study.

While the author(s) have stated in the conclusion of the article that there was 'increased physical activity and improved glycemic control and cardiovascular risk factors in people with type 2 diabetes' and this has been supported by the results of the study, there is a great chance that the results have been skewed due to inaccurate and biased reporting. This is due to the exercise records being self-reported records. It is widely known that self-reported methods of tracking exercise have a high chance of being biased as individuals participating in group studies (despite confidentiality of results) do not wish to be record lower amounts of exercise, or more importantly, less improvements and adaptations. While it is clear patient physiological abilities have increased due to response to the increase in exercise, the degree to which the self reported exercise was actually conducted, remains unknown. It is acknowledged patient ability has improved, however multiple factors on testing day (pressure, placebo affect of being watched, sleep, diet) may have enhanced the subjects ability. As the method of recording exercise is unreliable, the claim of the exercise being the sole purpose of the improvements is weakened and the chance the results are due to other variables increases.

Further Readings/Insights
Exercise for mental health - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/

When Adults Don’t Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults - https://academic.oup.com/innovateage/article/2/1/igy007/4962182

Strategies to Increase Physical Activity - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4626000/

Behavior therapy for nonalcoholic fatty liver disease: The need for a multidisciplinary approach - https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.22009


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User talk:Kpsparent

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

title: User talk:Kpsparent


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Exercise as it relates to Disease/The effects of physical activity on young adults mental health

What Is The Background To This Research?
Previous studies have indicated that physical activity can be a management tool for those suffering with mild-to-moderate mental health disease, such as depression and anxiety. Exercise is used commonly to relieve the emotions associated with these disorders and is considered a form of coping mechanism for many young people. This is because anxiety and depression are the most prevalent mental health challenges faced by young adults within modern society, with one study suggesting that at least 60% of undergraduate university students were suffering with some form of this disease. According to these studies, young adults with increased stress may be the ones most at risk of developing mental health complications, which can have an detrimental relationship with their physical activity levels due to a variety of factors. Factors such as loss of motivation can lead to increased sedentary time, negatively impacting mental health.

Where Is The Research From?
Physical activity and mental health in a student population is a study conducted in Gloucestershire, South West England. The cohort partaking in this study were (males = 20; Females = 80) recruited via opportunity sampling from the facility of education, humanities and sciences at the University of Gloucestershire. 90% were traditional age students and the mean age was 20.4. The entire sample spoke English as a first language and none were injured. All participants consented and agreed to partake in physical activity.

What Kind Of Research Was This?
The research involved with this study were two questionnaires, one being the Hospital Anxiety and Depression Scale (HADS) and the other being the Physical Activity Questionnaire. Both these questionnaires identify depression and anxiety levels and types. 'HADS', is a 14 item self-report questionnaire with seven questions identifying anxiety and the other seven questions relating to depression. The scoring system will rate the participants answers, the maximum score for each sub-scale is twenty-one and the scoring system goes as follows: 0-7 is indicative of clinical symptoms of anxiety and depression, 8-10 indicate mild symptoms, 11-14 are moderate symptoms and scoring higher is equal to severe symptoms. The questionnaire is relevant to a student population because it was established to uncover symptoms of mental illness in non psychiatric hospital patients.

The Physical Activity Questionnaire assesses the correlation between PA and cardiovascular fitness on mental health and mood. The questionnaire is applied assuming increased physical activity, decreases mental illness. It works via a self-report system where participants exercise for a month recording data such as volume, frequency and type of exercise, it is then calculated to the nearest minute. The exercise is then categorised with a numerical value reflecting oxygen uptake per minute. The more strenuous the exercise, the greater the value when compared to more sedentary exercise. The total physical activity score is then calculated by multiplying the activity type by the total amount of minutes.

What Does The Research Involve?
Participants answered the criteria best reflecting their mental health. The research has been published in the Mental Health Journal, within the domain Taylor and Francis Online. The Authors are Philip Tyson, Kelly Wilson, Diane Crone and Richard Brailsford. The lead author Phillip Tyson has published 30 papers and 3 books all in mental health The reputation of the lead author is well known in Wales psychology institutes and the majority of his papers have been very well received.

The methodology of using self-report questionnaires usually does not completely cover the individualism and complexities of each person's mental health struggles, however, the 'HADS' questionnaire is well-received for its original purpose of diagnosis. Further follow up for each individual taking the questionnaire, for instance an interview process would help legitimise the results further.

The level of research two questionnaires provides is not sufficient at obtaining legitimate results. Further layering an interview process with the original questionnaires would help, but also sampling from a larger size using snowball and opportunity sampling would be a more accurate way to create legitimate results.

The appropriateness of the title should also be considered when understanding this study. The study claims to look at the mental health of university students, however only elaborates on depression and anxiety scales. There are many other mental health struggles that plague young adults in society that deserve more attention when placed under the banner of 'mental health'

What Were The Basic Results?
Anxiety and Depression Cohort Scores:

 * The basic scores for anxiety within the student cohort were 8.5 (SD = 3.9; Range = 1 - 19.) This anxiety score reflects a mild-to-moderate anxiety level according to the 'HADS' questionnaire. The depression mean score was 3.6 (SD = 2.7; Range = 0 - 14), which is significantly lower than the mean anxiety score, demonstrating that more students are likely to suffer from acute anxiety rather than depression. 6% of students within this study fall within the severe anxiety category, with no students suffering from severe depression.

Physical Activity Scores:

 * The students were split into 3 non overlapping groups with accordance to their PA levels, the groups were high, medium and low. All students were the same age. (F=1.6) (P=20) After the students physical activity scores were recorded, they were correlated with the previous 'HADS' scores.

Association Between Mental Health And Physical Activity:

 * The data presented associates lower physical activity with higher depression and anxiety levels. The cohort displayed a negative correlation with mental health and exercise that is; as physical activity goes up, anxiety and depression levels go down. The findings are consistent with other studies in this field of interest. The research was then further confirmed through a correlation analysis.

What Conclusion Can We Take From This Research?
The conclusions drawn from this study are that physical activity can have a significant positive impact on depression and anxiety levels in university students. However, results demonstrate that a cause and effect relationship is not entirely present with PA and mental health. Furthermore, management of anxiety levels in this small university population may be hindered by worry or judgement from friends and peers. Finally, to reiterate there is still a lack of acknowledgement of other mental health disorders and struggles apart from anxiety and depression.

Practical Advice
While anxiety and depression can be manageable for some people by using PA, that does not mean other methods of management cannot be considered. Taking good care of yourself through your diet and lifestyle choices can have a very positive impact on mental health. It is exceptionally important to meet the physical activity guidelines of 150 - 300 minutes per week to help improve symptoms. Finally based on the results of this study and many others, students should look towards finding exercise that suits them, making it enjoyable rather than a task.

Further Information/Resources
Beyond Blue Australia

Treatment For Anxiety Disorder

Mindfulness In Australia

Lifeline

Headspace

Depression and Anxiety in Young Adults Further Study/Reading


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Learning anatomy/Nephron

Anatomy
The parts of the nephron are the bowman’s capsule, proximal tubule, a loop of Henle, distal tubule, and collecting tube.

Function
The urine starts in the bowman's capsule and then into the proximal tubule and then into the loop of Henle and then into the distal tubule and then into the collecting tubes which takes the urine to the ureters.

title: Learning anatomy/Nephron


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Learning anatomy/Ureter

Anatomy
The parts of the ureter are the abdominal ureter, pelvic ureter, and intravesical or intramural ureter.

Function
The ureters carry urine from the kidneys to the bladder.

title: Learning anatomy/Ureter


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Exercise as it relates to Disease/Can resistance training improve muscle strength, mobility and balance in older people with hip fracture?

This is a critique of the article: Effects of Resistance Training on Lower-Extremity Impairments in Older People With Hip Fracture, A randomized controlled trial. Erja Portegijs, Mauri Kallinen, Taina Rantanen, Ari Heinonen, Sanna Sihvonen, Markku Alen, Ilkka Kiviranta, Sarianna Sipilä.

Contents

 * 1What is the background to this research?
 * 2Where is the research from?
 * 3What kind of research was this?
 * 4What did the research involve?
 * 5What were the basic results?
 * 6What conclusions can we take from this research?
 * 7Practical advice
 * 8Further information/resources
 * 9References

What is the background to this research?[edit | edit source]
Quality of life for older people is highly affected by their ability to walk and the ability to do essential work, and hip fractures in old age are a major cause morbidity and morality, hip fractures in old age result in death of 20% of the people. Hip fractures have shown to increase sedentary behavior in older people, which has been linked with all cause mortality, morbidity, and increase in fall risk.

The aim of this study is to find out the effects of progressive resistance training in relation to muscle strength, balance, and mobility in older adults with previous hip fractures. There have been similar previous studies but some of these studies didn't show the its effect on mobility, whereas some studies did not take into account the asymmetry in muscle strength of the previously fractured leg. This particular study has taken the changes in mobility into account, and has also worked on minimizing the strength difference between the two asymmetric legs.

Where is the research from?[edit | edit source]
This research was conducted in Finland and was supported by Finnish Ministry of Education. It was presented to the International Conference on Strength Training on October 20, 2006 in Odense, Denmark, to the Congress of the European College of Sport Sciences on July 12, 2007 in Jyväskylä, Finland, and was published by Archives of Physical Medicine and Rehabilitation in 2008. Some authors from this research paper have previously published many more research articles and have a good reputation in this field. There was no commercial organization that had direct financial interest in the results of this research.

What kind of research was this?[edit | edit source]
This was a randomized trial controlled trail, it has participants aged between 60 to 85 years who had hip fracture in previous 6months to 7 years. The participants were divided into two groups, training and control, the training group underwent 12 weeks of progressive strength training, whereas the control group was told to continue with their regular routine for next 12 weeks. Other similar studies support the findings of this research, they have shown decrease in mortality, improvement in strength, and ease in doing daily activities.

What did the research involve?[edit | edit source]
The participants were divided into two groups, training and control. The control group continued their daily routine for 12 weeks and the training group was given 12 week intensive progressive strength training program, which begin with a clinical examination to check their health status. Max voluntary isometric knee extension of both legs, hand grip strength of dominant hand, LEP, and dynamic balance was also tested. The weaker leg was trained more intensively to reduce asymmetry. The participants trained twice a week for around 1-1.5 hours. The 1RM of the participants was tested after first 2 session of familiarization with the equipment, same 1RM test was repeated in week 6 to 8. For power, 3-4 sets of 12 reps for weaker leg at 40%-50% of 1 RM, and 2-3 sets of 12 reps for stronger leg using same percentage of 1RM were performed. For strength, 2-3 sets of 8 reps for weaker leg and 1-2 sets of 8 for stronger legs with resistance of 60%-80% of 1RM for weaker leg and 50%-70% of 1RM was used.

The methodology used was better approach than previous studies as this research focused more on the weaker leg thus improving the asymmetry between legs, there was progressive increase in training intensity with progression of the weeks. This research also aimed at finding the improvement in mobility and balance, the parameters that were ignored by previous studies.

On major limitation of this study was the small sample size, the program could have been longer than 12 weeks for more clear results. The maximal strength and power were also underestimated due pain and fear of pain in the participant.

What were the basic results?[edit | edit source]
Difference in variable between baseline and post trial for training and control group.

Findings:

 * Significantly greater mean improvement in KET of both legs for the training group as compared to control group.
 * Significantly greater mean improvement in LEP in weaker leg for the training group as compared to the control group.
 * Mean reduction in asymmetric LEP deficit significantly greater in training group as compared to the control group.

This showed increase in power and strength of participant who underwent the training program, and decrease in asymmetry between the weaker and stronger leg. There was no use of balance specific exercise, therefore there was not a significant improvement in balance and mobility, the not significant improvement in balance and mobility could be due to participants already being in well functioning condition, whereas if there were mobility-limited participant, there could have been a significant improvement in mobility using resistance training.

What conclusions can we take from this research?[edit | edit source]
Resistance training can be vital in improving power and strength, this improvement in power and strength can play a very important role in decreasing mortality and morbidity. Progressive resistance training can also improve asymmetry between legs, but a longer program than 12 weeks could possible have improved the asymmetry to the point where there is a very small difference between KET and LEP of both the legs. Including balance training in the program could have also helped participants with significantly improving their balance.

Other researches have found similar results as this one, one study has shown that resistance training after hip fracture can increase overall strength and can also increase strength of the weaker leg such that it is almost as same as the stronger leg. Another study also found that progressive resistance training after hip fracture can increase strength and can improve mobility.

Practical advice[edit | edit source]
Individual must first go through a clinical examination. Training session should begin with with a proper warm up, and maximal range of motion that can be achieved without any pain should be used for exercises. There should be slight increment in loads as the training progresses and the body adapts to training. For power training the concentric phase of the exercise should be performed as fast as possible, and for strength training the concentric phase should be performed a little slower. To improve participation, there should be an increase in education and awareness regarding the benefits of resistance training in improving not only the strength but also the quality of life, there should also be encouragement from close friends and family of the individual.

Further information/resources[edit | edit source]
]https://www.safetyandquality.gov.au/sites/default/files/migrated/Hip-Fracture-Care-Case-for-Improvement.pdf

https://anzhfr.org/wp-content/uploads/2016/07/ANZ-Guideline-for-Hip-Fracture-Care.pdf

https://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf


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Skaneateles Conservation Area/Invasive species/Pyrus calleryana

Pyrus calleryana (Callery pear)
The Callery pear (Pyrus calleryana), including its 'Bradford' cultivar, is now listed as highly invasive in New York State. There is a single known Callery pear present at the SCA near the fishing pond. It appears to have been planted sometime around 2003, shortly after the pond was expanded. This tree has not been removed (as of Sep. 12, 2021). It does not appear to be spreading at this time but there is evidence that the species is rapidly becoming invasive in much of its horticultural range in at least the eastern United States.

Invasiveness ranking for Pyrus calleryana (Callery pear)
The 2008 assessment gave Pyrus calleryana a score of 54/83 = 65.06%, which gave it a New York invasiveness rank of Moderate.

As of 2021, the New York Natural Heritage Program gives Pyrus calleryana a New York invasiveness rank of High and places it in State Tier 4 and Finger Lakes Tier 4.

Pyrus calleryana is not yet regulated by New York State law.

Callery pear is present and listed as a Tier 4 invasive plant in the Finger Lakes PRISM.

1. Ecological impact (13/20)
1.1. Impact on Natural Ecosystem Processes and System-Wide Parameters: Unknown (U)

 * As of 2008, analysis of herbarium specimens indicated a recent shift from the lag-phase to the spreading phase of this species, so the ecosystem-level effects have yet to be examined.

1.2. Impact on Natural Community Structure: Significant impact in at least one layer (7/10)

 * Recent field observation have shown this species to be rapidly invading fields, thus creating a canopy layer where one was absent.

 * Once established Callery pear forms dense thickets that push out other plants including native species that can’t tolerate the deep shade or compete with pear for water, soil and space.

1.3. Impact on Natural Community Composition: Influences community composition (3/10)

 * Definitely out-competes with native spp. in areas where it invades.

1.4. Impact on other species or species groups: Minor impact (3/10)

2. Biological characteristics and dispersal ability (19/22)
2.1. Mode and rate of reproduction

2.2 Innate potential for long-distance dispersal:

2.3. Potential to be spread by human activities:

2.4. Characteristics that increase competitive advantage:

2.5. Growth vigor:

2.6. Germination/Regeneration:

2.7. Other species in the genus invasive in New York or elsewhere:

3. Ecological amplitude and distribution (15/21)
3.1. Density of stands in natural areas in the northeastern USA and eastern Canada:

3.2. Number of habitats the species may invade:

3.3. Role of disturbance in establishment:

3.4. Climate in native range:

3.5. Current introduced distribution in the northeastern USA and eastern Canada:

3.6. Current introduced distribution of the species in natural areas in the 8 NY PRISMs:

4. Difficulty of control (7/10)
4.1. Seed banks:

4.2. Vegetative regeneration:

4.3. Level of effort required:


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Learning anatomy/Urinary bladder

Anatomy
The bladder or urinary bladder is made up of the dome or apex, neck, body, and fundus. The bladder is between the ureter and urethra.

Function
The detrusor muscle expands when filled with urine. Then the nerve signals tell the brain that you need to run to the bathroom. When emptying, the detrusor muscle squeezes the urine to the urethra. Check out the urethra page to learn more. Make sure to read the kidney, nephron, and ureter pages too.

title: Learning anatomy/Urinary bladder


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Learning anatomy/Urethra

Anatomy
Male and female urethras are different.

Male
The first thing at the bottom of the urethra is called the penis. Then there is the spongy urethra and then there is the membranous urethra. The prostatic urethra is last.

Female
The parts of the female urethra are the muscular, erectile, and mucous parts but no penis.

Function
The internal urethral sphincter opens itself. The external sphincter is what we control to open and when that sphincter is open it goes into the toilet. It passes through the penis in men.

title: Learning anatomy/Urethra


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A Traveler's Guide to the World of Pokémon/Johto/Ilex Forest

The Ilex Forest is a forest located in the Johto Region of the Pokémon world, only accessible in Pokémon Gold, Silver and Crystal.

Getting through Ilex Forest
One has to pass through Ilex Forest in order to reach Goldenrod City. The player will find that the cutter's apprentice has lost his master's Farfetch'd, as it will not obey him because he does not have a badge. The player then finds the missing Pokémon, and has to take it on a chase through the forest, pressing 'A' on the correct side of it (the side closest to the player, mostly) until it returns to the apprentice, who has been joined by his master. His master gives the player HM 01, Cut as his thanks. The player will need to have beaten Bugsy, The Gym leader of Azalea Town before he/she can use it outside battle, though.

The player will need to use it immediately, as the route through the forest is blocked by a small tree. There are also two other things of importance; A man next to one of the small trees seen lining roads who will give the player TM 02, Headbutt, and the Ilex Forest Shrine. The Shrine is dedicated to Celebi, the forest's protector, but Gold and Silver players will not need to bother with it as it is only in Crystal that it plays a role. In the Japanese version of Crystal, there was a Nintendo event that required the use of the Mobile Adapter to get the GS Ball, and gave it to Kurt to investigate. If the player spoke to him the next day, he would tell you something strange was happening in Ilex forest, and give the player the GS Ball back, so they could place it in the Shrine and a level 30 Celebi would appear.

The Mobile Adapter
The Mobile Adapter feature was taken out in the US and UK versions of the game, even though this part was translated. However, there are two Gameshark codes to achieve it: one will make the GS Ball appear in the player's bag to give to Kurt, and the other will make Kurt give the player the GS Ball, regardless of whether they gave it to him or not.


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Learning anatomy/Test

Quiz
You have random organs. You have to type the name. You also have to describe if the the the organ is needed to live. Your score will be on Wednesday. Answers will be cleared 10 days after being scored so other people can answer. Please edit visually. Please put your user name so that I know who did it. First, I will read your user page and then give you a score. I will remind you that you need to put your user name if you didn't. I will also put it on your talk page in case you forget.

title: Learning anatomy/Test


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Skaneateles Conservation Area/Invasive species/Cirsium

Cirsium (plume thistles)
Three Eurasian plume thistles (Cirsium) are considered to be invasive in New York State and are of concern at the Skaneateles Conservation Area (SCA):
 * Cirsium vulgare (bull thistle) is known to be present and fairly common at the SCA and is listed as moderately invasive in NY, NYS & FL Tier 4.
 * Cirsium arvense (creeping thistle) is probably present at the SCA and is listed an highly invasive in NY, NYS tier 4 and FL Tier 3.
 * Cirsium palustre (marsh thistle) is known to be present in Madison, Herkimer and Otsego counties, is listed as moderately invasive in NY, and should be watched for at the SCA.

It should be noted that there are several native Cirsium species that may be present in the area:
 * Cirsium muticum (swamp or fen thistle)
 * Cirsium discolor (field thistle)
 * Cirsium pumilum (pasture thistle)
 * Cirsium horridulum (yellow thistle)

Invasiveness ranking for Cirsium arvense (creeping thistle)
Cirsium arvense (creeping thistle or "Canada" thistle) was ranked in 2009 with an invasiveness of High, based on a score of 71/100 = 71%. The Ecological Invasiveness listed in 2021 remains High and placed in NYS Tier 4. The Finger Lakes PRISM places it in Tier 3 for this region.

Prohibited by New York State law.

1. Ecological impact (20/40)
1.1. Impact on Natural Ecosystem Processes and System-Wide Parameters: Significant alteration of ecosystem processes (7/10)

 * 2009: no targeted studies on the impact on natural ecosystem processes or system-wide parameters located.

 * The species can grow in dense stands much taller than the rest of the herb layer and significantly limit light availability to the lower herb layer.

 * Allelopathy has been suggested

 * A study from Tazmania showed that extracts from the plant inhibited germination and growth of its own as well as other plant species

 * No evidence of irreversible impacts to ecosystem processes.

1.2. Impact on Natural Community Structure:

1.3. Impact on Natural Community Composition:

1.4. Impact on other species or species groups:

2. Biological characteristics and dispersal ability (/)
2.1. Mode and rate of reproduction

2.2 Innate potential for long-distance dispersal:

2.3. Potential to be spread by human activities:

2.4. Characteristics that increase competitive advantage:

2.5. Growth vigor:

2.6. Germination/Regeneration:

2.7. Other species in the genus invasive in New York or elsewhere:

3. Ecological amplitude and distribution (/)
3.1. Density of stands in natural areas in the northeastern USA and eastern Canada:

3.2. Number of habitats the species may invade:

3.3. Role of disturbance in establishment:

3.4. Climate in native range:

3.5. Current introduced distribution in the northeastern USA and eastern Canada:

3.6. Current introduced distribution of the species in natural areas in the 8 NY PRISMs:

4. Difficulty of control (/)
4.1. Seed banks:

4.2. Vegetative regeneration:

4.3. Level of effort required:


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Learning anatomy/Muscle

Anatomy
There are 650 muscles in the body made by myocytes.

Function
Skeletal muscles control movement so we can walk, run, and jump and even breathing and chewing needs muscles. Smooth muscle is what we can’t control. Cardiac muscle is found only in the heart.

title: Learning anatomy/Muscle


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Stardew Valley/Influences

Harvest Moon
Stardew Valley takes inspiration from the Harvest Moon series, though it possesses significant differences and innovations in it's own right.

title: Stardew Valley/Influences


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Exercise as it relates to Disease/The efficacy of cross-sectional lumbar strengthening in spinal stabilization for pain reduction and disability in patients with degenerative disc disease

This is a critical assessment of the original article "Effects of Spinal Stabilization Exercise on the Cross-sectional Areas of the Lumbar Multifidus and Psoas Major Muscles, Pain Intensity, and Lumbar Muscle Strength of Patients with Degenerative Disc Disease" Seongho Kim, PhD, PT, Hyungguen Kim, MSC, PT, Jaeyeop Chung, MSc, OT, J. Phys. Ther. Sci. 26: 579–582, 2014

What is the background to this research?
Degenerative disc disease is characterised by acute, subacute, and chronic lower back pain, which can often cause radiating pain in the surrounding areas and down the leg/s. Progression of disc degeneration drastically accelerates the eradication of surrounding cartilage, compresses disc height/s, atrophies deep intrinsic muscles and inaugurates spinal instability.

Lower back pain can arise from soft tissue damage and muscle weakening, resulting in restricted spinal movement due to decreased flexibility, contraction speed and muscular endurance.

Lower back pain (LBP) is one of the most common diseases within modern society, occurring in ~80% of the population. Quick fixes often include anti-inflammatories, pain suppressant medications, steroidal injections and surgery. These options are expensive, intrusive and present with dangerous side effects.

The following research paper addresses spinal stabilisation for patients suffering with 'degenerative disc disease' for the promotion of safe, non-invasive, cost-effective and easily-administered management of symptoms, due to the high prevalence of reoccurring 'flare-ups'.

Where is the research from?
This study was carried-out in the Republic of Korea and published in the Journal of Physical Therapy Science. Its execution was orchestrated by Dr. Seongho Kim, (Department of Physical Therapy). His experience is recognised internationally, having contributed to publications across a diverse field of studies. Other authors involved include Hyungguen Kim (Rusk Hospital, Department of Physical Therapy) and Jaeyeop Chung (Inje University, Department of Rehabilitation Science). The study has no conflicts of interest from organisations and/or sponsors.

What kind of research was this?
The research was conducted utilising a Cross-Sectional, Interventional design; consisting of a pre-test and post-test.

The use of questionnaires was administered to determine subjective results of pain levels via the visual analogue scale (VAS) and lumbar function via the Oswestry Disability Index (ODI). CENTAUR 3D Spatial Rotation Device (BFMC, Germany) was used to capture Paraspinal Muscular Strength at four angles (0°, 90°, 180°, -90°)

The ODI is deemed highly reliable with no differentiation amongst studies. Data proposes VAS to have sufficiently high reliability. The CTT Centaur equally shows good test-retest reliability.

What did the research involve?
Thirty-three people were enrolled; 14 males and 19 females, aged 25 - 68. Participants were outpatients of W Hospital, Seoul from November 2011 to October 2012, diagnosed with Degenerative Disc Disease at the L4 and L5. Inclusion criteria required participants to have presented with symptoms for over a twenty-week period, with the absence of radiating leg pain.

Under the direction of a supervisor, participants undertook the following activities twice a week;

 * Warm-Up: (10 minute) Fixed bicycle ride
 * Main: (25-30 minute) Exercises including a mat and/or ball within CENTAUR 3D SRD.
 * Cool-Down: (10 minutes) Stretching; quadriceps, psoas major, quadratus lumborm and calf
 * Loading progression (% of Max Intensity): Weeks 1-4: 30–40% & Weeks 5-8: 40–50%

Limitations included a small sample size and absent control group of alternative therapeutic approaches. The study was confined to the strict inclusion/exclusion criteria mentioned above.

What were the basic results?
The main findings are presented in the tables below. Data obtained from this research included those of associated pain levels via VAS, levels of disability via ODI and paraspinal muscular strength measured via the C3D SRD at 4 angles. Results were obtained pre and post the commencement of the 8-week spinal stabilisation program for comparison.

Data was interpreted positively, where an increase in muscular size and width correlates positively to a reduction in muscular atrophy, increased spinal stability and an improvement in both perceived pain and disability. Researchers placed a large emphasis on the significance of improvement, this is justified.

What conclusions can we take from this research?
Muscle strengthening positively influences spinal stabilisation by providing support and protection of the spinal structures. The correlation between stabilisation, improved function and pain reduction is evident and promotes quality of life.

Stretching is an imperative part in the maintenance of spinal mobility, in conjunction with pain reduction and promotion of function.

It is established that LBP is multi dimensional and impacted by a variety of variables. Therefore, it is evident that more research needs to be conducted into the potential benefits of alternative therapies and/or a combination of therapies on a control group.

Practical advice
A few considerations need to be taken around some of the potential implications including, but not limited to, time constraints, motivation, consistency, patience, education, confidence, nature of disease and lifestyle factors.

This disease is sensitive in nature and easy to aggravate. Caution should be exercised when prescribing and programming, including specificity of exercises, loading, volume and rate of progression. Level of education is crucial in the proper execution of movement patterns and understanding of pain responses, including what is an acceptable pain threshold.

The risk/reward pay-off should not be overlooked, with spinal stabilisation presenting as a healthier, more cost-effective alternative to current methods and procedures. This includes the prescription of anti-inflammatories, pain relief medications, steroidal injections and surgeries. This method promotes self reliance and the management of realistic expectations.

Further information/resources
For those wishing to further their understanding Degenerative Disc Disease the following readings may be of interest.

Physical Therapy Guide to Degenerative Disk Disease

Controlling Degenerative Disc Disease Pain: Three Things You Can Do

Exercise and Physical Therapy for Disc Disease Treatment and Pain Management

Pain Management Techniques for Degenerative Disc Disease

The evidence for an alternative to spinal fusion surgery

For a more in depth understanding providing a deeper insight include:

Pathophysiology of Degenerative Disc Disease.

Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain


text: User:Guy Nesbitt-Titheradge/sandbox

title: User:Guy Nesbitt-Titheradge/sandbox


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Exercise as it relates to Disease/Physical activities role in mental health among twins

What is the background to this research?
The paper being referenced in this analysis researches the role that the recent pandemic 'stay at home' protocols has had on exercise and its effect on mental health among twins. The study utilised surveys to conduct research on how stay at home orders have impacted participants levels of physical activity, stress and anxiety.

This paper is vital to research conducted in the field of the pandemic as it was conducted almost immediately after the initial 'stay at home' orders occurred across the world. Due to the fast role out of the survey the data collected is an insight into how individuals levels of physical activity were first impacted by the orders, and the impact this had on mental health.

Where is the research from?
The research was conducted by researchers from both Washington State University and University of Washington with the use of the Washington State Twin Registry. The organisation is in Washington State although the participants were enlisted from multiple states in America. The location of the participants is meaningful as each State and in some cases, jurisdictions had differing 'stay at home' orders which decided the amount of exercise which was permitted and the extent of closure of gymnasiums and other places for exercise.

The primary author of the research Glen E Duncan and his team are all accredited in differing fields of health. Glen has been a part of many other research articles focusing on similar fields of exercise science in assessing exercise performance

There are no conflicting interests between the researching group or the topic of research. The Washington State Twin Registry is an organisation for which participants who are twins opt in conduct research for which there is significant link which would indicate any conflict of interest or biased issues.

What kind of research was this?
The research article was designed to utilise observational study method. The study observed and recorded the effects that the ‘stay at home’ orders had on factors rather than interfere or any manipulation by the researchers. To stay in accordance with the non-experimental study design the researchers utilised a mixed method survey to accurately represent the changes levels of physical activity, stress and anxiety. Other studies which utilised the same method of data collection and interpretation found similar evidence supporting the research conducted in the study.

What did the research involve?
The surveys asked the participants to scale the amount of change which had occurred in multiple areas since the beginning of ‘stay at home’ protocols. The level of stress was recorded with the use of the Perceived Stress Scale (PSS). The PSS included a 5-point Likert scale, the survey addressed multiple questions referring to the participants level of stress and a total was obtained from all concurring answers.

Brief Symptom Inventory (BSI) was implemented to record feedback on the participants level of anxiety. The study implemented the same method used for the PSS as participants once again completed a self-assessment and a score was obtained post testing.

The method used to identify the amount of physical activity being undertaken compared to pre ‘stay at home’ orders utilised the method of qualitative analysis, participants were asked to select an answer which best represented their amount of physical activity. The participants were given options are asked to select the answer which best reflected their changes in physical activity.

The use of surveys for data collection was ideal due to the conditions of the research and the purpose being to utilise the observational study type to not interfere with the research but record the effects of the lockdown measures on physical activity and mental wellbeing in twin.

The primary limitation of any survey research is the issue of selection bias. Self-selection bias may be present in the results due to the relatively low average stress and anxiety levels reported. These results indicate that the lower scores could be due to individuals with lower stress levels being willing to participate and less participation for those who were likely more stressed or anxious. Although without the results from the non-participants only speculations can be made on the limitations that selection bias had on the study.

What were the basic results?
The study found high associations between a decrease in physical activity (PA) and a lower score in the anxiety levels when compared to those who recorded no change in PA. The research also an increase in perceived stress in twins who both recorded less or no change in physical activity. Although there was an association made between decreased PA and increased anxiety and stress levels there was no association found between an increase in PA and a decrease in both perceived stress and anxiety which counters the second hypothesis of the study.

The researchers made separate comparisons on the independent variables which concluded with a total of 4 comparisons made, the classical twin model was used to help with analysis of the independent components. Anxiety and perceived stress were separately regressed to assess the change in PA without reflecting shared environmental or genetic confounds.

What conclusions can we take from this research?
The study shows that a decrease in perceived PA is associated with an increase in stress and anxiety due to the ‘stay at home’ pandemic mitigation methods. The elongation of measures and further restrictions being put in place which limit PA could see a further increase in mental health worries.

The results in a study assessing the link between mental health and physical activity during pandemic conditions found that participants who reported a decrease in their mental health had a greater reduction in PA compared to participants who reported a no change or an increase in mental health.

Practical advice
This study is quite applicable as it shows a direct correlation between decreased PA and a decrease in mental health factors, although the research only shows the link with general PA and doesn’t give the consumers any further knowledge on duration and type of exercise and how it impacts mental health. Due to the study not having any recommendations on the exercise being conducted there is no considerations relevant for the consumers. The research also shows the importance accessibility to exercise and resources associated and the adverse effects of sedentary behaviour causes.

Further information/resources
For the consumers that have an interest on furthering their knowledge on adverse health effects caused by pandemic related protocols and looking to improve mental wellbeing the following readings have been recommended.

The study by Mattioli and co investigates the effects that quarantine and sedentary behaviour has on increasing cardiovascular risk factors, a greater understanding how to increase cardiovascular well-being will help consumers be able to implement better habits during ‘stay at home’ protocols.

This research article examines the benefits and differences that both aerobic and resistance training has on an improved quality of life, his article will helpful for informing the consumer of the individual benefits of both training types.


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Exercise as it relates to Disease/Effect of a low-impact exercise program on bone mineral density in Crohn’s Disease

What is the background to this research?
Crohn’s Disease is a chronic autoimmune disease that falls under the Inflammatory Bowel Disease category. The cause is unknown but genetics, environmental factors, and immunobiological elements are suggested triggers. Among those with Inflammatory Bowel Disease, osteoporosis is a common resultant due to steroidal treatment that causes malabsorption. Individuals living with Crohn’s Disease can be significantly restricted physically, socially, educationally, professionally, and emotionally. With the possible addition of osteoporosis, quality of life can deteriorate. This study conducted on people with Crohn’s Disease aimed to determine the effects of a 12-month low-impact exercise program on bone mineral density. This research is crucial as malabsorption of calcium and vitamin D in these individuals would contribute to osteoporosis more than people without malabsorption issues. This research is important because Crohn’s is a debilitating disease that requires lifelong maintenance as it has no cure. Crohn’s and Colitis affects 1 in 250 Australian’s aged 5-40 with almost 75,000 Australian’s currently living with these forms of Inflammatory Bowel Disease. This number is set to surpass 100,000 by 2022. With these people already experiencing a lower quality of life due to their limitations and constant management requirements, finding a way to increase bone mineral density in a low-impact and achievable way would largely improve quality of life.

Where is the research from?
This study was based in Leicester, England and was published in 1998. Seven researchers conducted the study;

 * 1) Richard Robinson and John Mayberry from the Gastrointestinal Research Unit in Leicester General Hospital.
 * 2) *Richard’s main research focus is on bone formation and bone mineral density in Crohn’s and Colitis sufferers and he has 7 publications.
 * 3) *John’s main research focus is Inflammatory Bowel Disease, Coeliac Disease and Achalasia research and he has 469 publications.
 * 4) Tara Krzywicki and Len Almond from the Department of Physical Education and Sports Science at Loughborough University.
 * 5) *Tara’s main research focus is Crohn’s Disease and she has two publications.
 * 6) *Len’s main research focus is physical education and exercise science and he has 43 publications.
 * 7) Keith Abrams from the Department of Epidemiology and Public health at the University of Leicester.
 * 8) *Keith’s main research focus is on meta-analyses and systemic reviews of disease and medicinal treatments and he has 146 publications.
 * 9) Farook Al-Azzawi from the Menopause Research Unit of the Department of Obstetrics and Gynaecology at the Leicester Royal Infirmary.
 * 10) *Farook’s main research focus is on gynaecology and endocrinology and he has 156 publications.
 * 11) S J Iqbal from the Department of Biochemistry at the Leicester Royal Infirmary.
 * 12) *Iqbal’s main research focus is on Crohn’s Disease and he has eight publications.

What kind of research was this?
This study was a 12-month randomised control trial (RCT). An RCT design is the only study design that can assess cause-effect relationships between the intervention and the outcome. It also reduces bias as participants are randomised to balance individual characteristics. This allows for outcomes of the study to be ascribed to the intervention rather than individual participant differences. Participants in this study were randomised by stratified block randomisation into an exercise or control group. This is effective as a block randomisation balances the number of participants therefore increases comparability between groups, and a stratified approach balances prognostic factors of participants. The study was approved by the Leicestershire Ethical Committee once all participants had given written consent.

What did the research involve?
400 mailed study invitations were sent to Crohn’s sufferers in the Leicester area. This is a more expensive measure but produces a higher response rate than an email invitation. Some participants were excluded and the researchers were left with 117 eligible participants. Exemplary intra-tester reliability was shown through all data being collected by the same researcher. Intra-tester produces less data variability than inter-tester therefore produces more externally valid results. Bone mineral density was measured using a DEXA scan which is the gold standard for measuring this variable. Exercise sessions consisted of a 5-minute warm up, 12 all-body floor-based low-impact exercises and a 5-minute cool down. The exercise group had to complete a minimum of 120 sessions over the 12-months for full adherence. This was feasible as low-intensity exercise does not amplify gastrointestinal symptoms or lead to flare-ups in this population. Compliance was monitored by a self-reported exercise diary which was only assessed by researchers twice. Motivation and support were only provided to the exercise group three times over the 12 months. The control group was advised to maintain current physical activity and dietary habits.

What were the basic results?
Bone mineral density increased at all measured sites (femoral neck, lumbar spine, greater trochanter and Ward’s triangle) in the exercise group compared to the control group but the difference was not significant. Those in the exercise group who were fully compliant (completed more than the minimum 120 sessions over the 12 months) had an increase in bone mineral density at all measured sites but there was a significant increase in greater trochanter bone mineral density compared to the control group. It was also found that an increase in bone mineral density at the hip and spine was positively correlated to the number of exercise sessions and repetitions of individual exercises that were completed. These findings support the claim that low-impact exercise can improve bone mineral density in those with Crohn’s Disease but do not over-emphasize the relationship.

What conclusions can we take from this research?
This research shows that bone mineral density can be improved in individuals with Crohn’s Disease through a low-impact exercise program only when adhered to and progressive overload is applied. A positive correlation exists between amount of exercise and amount of bone mineral density gained. These findings are consistent with a study by Leonard et al. that found low-magnitude mechanical stimuli is associated with increased bone mineral density in Crohn’s sufferers.

Practical advice
A limitation of this study was finding significant results given the small sample size. A larger sample gives a smaller confidence interval meaning more precise results. This could be an issue in a clinical population as Crohn’s sufferers experience indiscriminate symptoms and therefore have a higher chance of dropping out or adhering less due to periodic discomfort. Some practical advice for similar studies would be to monitor participants more closely to improve adherence. Gauging adherence via a self-reported journal twice in a 12-month study is unsatisfactory especially given a clinical population that requires extra caution to be taken. Although low impact exercise is effective if adhered to, there is evidence that suggests resistance and plyometric training increase bone formation. However greater caution is required in a clinical population when completing high risk exercise.

Further information/resources
This article – Effect of Low-Impact Exercise Program on Bone Mineral Density in Crohn’s Disease: A Randomized Controlled Trial (1998)

https://www.gastrojournal.org/article/S0016-5085(98)70362-2/pdf

Research paper - Bone Loss in Crohn’s Disease: Exercise as a Potential Countermeasure (2005)

https://academic.oup.com/ibdjournal/article/11/12/1108/4685985?login=true

Advice for patients and caregivers, resources, news, events and research - Crohn’s and Colitis Foundation

https://www.crohnscolitisfoundation.org/

Inflammatory Bowel Disease support Australia

https://www.ibdsupport.org.au/

Research paper – Low-Intensity Exercise Improves Quality of Life in Patients with Crohn’s Disease (2007)

https://crohnsandcolitishub.com.au/wp-content/uploads/2018/02/Low-intensity-exercise-research.pdf


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Exercise as it relates to Disease/How effective is collective exercise on the mental health of elderly hypertensive patients?

This is a critique of the journal article titled "Intervention of Collective Exercise on the Mental Health of Elderly Hypertensive Patients".

What is the background to this research?
Hypertension is a highly common, non-communicable disease that afflicts large portions of the population worldwide. 1.28 billion cases of hypertension in adults between the ages 30-79 are estimated to be active as of 2021. Hypertension is a chronic increase of blood pressure, both systolic and diastolic, to exponentially high levels. It is classified into three grades with grade 1 being the most mild and grade 3 the most severe. It is also major risk factor in many diseases and cardiovascular events, such as Alzheimer's and heart failure.

Hypertension has also been linked to poor mental health and the development of mental health disorder such as depression and anxiety. Unfortunately, many people who have hypertension are unaware of the condition and are therefore unable to seek medical assistance, be it pharmacological or otherwise. Thankfully there are a range of treatments for the condition, such as lifestyle changes (exercise and diet), pharmacological treatments (blood thinners and cardiovascular muscle relaxants) and psychological (strategies to reduce stress and anxiety).

Where is the research from?

 * This paper was published in the Iranian Journal of Public Health in March of 2016. This journal has a rigorous publication process in which papers are subject to multiple 'in-house' evaluations, which are followed by a double-blind peer review system.
 * Authors Wenxin Xu, Menglong Li, and Jiwei Yao are from Fujiun Normal University, Hunan First Normal university and Hunan University of Science and Technology respectively, in China. The research was conducted in the Fuzhou city of China and used residents of the Iou, Jinan, Taijiang, Cangshan and Mawei Districts.
 * A specialist/physician of cardiovascular medicine and a psychological consultant assisted with the trial, with both being from First Affiliated Hospital of the Fujian Medical University in Fuzhou City in China.
 * Participants were selected between May 2012 and January 2015 and data for this study was collected over a period of 12 week period during this time.

What type of research article was this?
This was a randomized intervention study, due to participants being randomly placed into control and experiment groups.

The aim of this study was to ascertain the effectiveness of collective or group exercise in altering the mental health of elderly hypertensive patients. A further objective was to observe whether there were any changes in coping behavioral patterns.

What did the research involve?

 * 115 elderly hypertensive patients, aged between 60 and 70 years old were randomly selected to participate. The course of hypertension was highly variable, ranging from 1 year to 15 years, with an average of 6.2 years.
 * These 115 participants were then randomly divided into two groups.
 * One control group consisting of 57 patients, 25 females and 32 males with an average age of 66.5 ± 11.1 years. These patients did not engage in any regular exercise and accepted regular hypertension treatment according to assisting cardiovascular specialist's advice.
 * One trial group consisting of 58 patients, 30 females and 28 males with an average age of 68.2 ± 12.1 years. This group exercised four times per week and alternated between Baduanjin (a form of Qi Gong focusing on gentle utilization of the entire body) and elderly ballroom dancing (ballroom dancing with movements and tempo adjusted for elderly participants). There was a rest period of 1-2 days between each exercise session.
 * Participants mental health and coping mechanisms were examined through the SCL-90 scale and the simple coping style questionnaire

What were the basic results?
There were significant differences between the control and trial groups. Positive coping styles were reported being significantly higher in the trial group compared to the control group whilst negative coping style score was significantly lower than that of the control group. SCL-90 total score and individual measure scores were significantly different between the groups as well. All individual measures except the terror and mental disease scores were significantly lower in the trial group than the control.

There were also significant differences between scores taken before and after the study within the trial group. SCL-90 total score and individual measure scores were significantly lower post-intervention than those reported beforehand. Terror and mental disease scores were not significantly affected. Positive coping score was significantly higher post-intervention.

In the control group there was no significant difference between data recorded before or after the study.

What conclusions can we take from this research?
It was concluded by the authors of this study that collective exercise can effective improve the mental health of elderly hypertensive patients. Collective exercise granted patients access to not just exercise but regular social contact and opportunities to form and improve interpersonal relations, both of which have been found to strongly influence the mind-body problems (anxiety, depression, etc.) that elderly hypertensive patients suffer from.

This conclusion I drew from the study coincides with the author's conclusions. Collective exercise is an inexpensive and accessible method of mental health treatment for elderly patients of hypertension.

Further research is needed to identify whether Baduanjin and elderly ballroom dancing are the best forms of collective exercise, as the paper states that they were selected due to the limited conditions of the study.

Practical advice

 * Collective exercise may become difficult during times of social hardship, such as in the recent (2020-?) Covid 19 pandemic, which has necessitated the isolation of many people around the world. This can be worked around through the use of technology such as Zoom to conduct classes.
 * Weaknesses
 * This study was conducted on a very small population and may not truly represent the effects of collective exercise on a larger scale or from differing cultural backgrounds.
 * Limited number of collective exercise treatments.
 * Strengths
 * This study utilized multiple methods to ascertain the mental health of participants and sourced professional opinions from trained mental health professionals.
 * Use of established psychological measures.
 * Roughly equal ratio of male/female participants.
 * Attendance was stable throughout study.
 * Gender, age, education level, marital status and family economic situation did not significantly vary between the two groups.
 * It should be noted that the building of an equal, mutually encouraging and positive emotional atmosphere is an important aspect of this intervention. This was found to allow elderly patients to further improve their interpersonal relationships as well as reduce their fear of disease to improve their mental health.

Further information

 * Hypertension info: https://www.who.int/news-room/fact-sheets/detail/hypertension
 * Exercise and mental health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/
 * Contact your GP for assessment if you suspect you might have hypertension.
 * Contact your GP for assessment if you suspect you might have hypertension.


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Exercise as it relates to Disease/The effect of the GLA:D program on individuals with hip or knee osteoarthritis

The following critical appraisal analyses: 'Good Life with Osteoarthritis in Denmark (GLA:D)' by Skou and Roos (2017).

What is the background to this research?
Osteoarthritis is the most common degenerative joint disorder,  affecting the articular cartilage and underlying bone in joints. The high prevalence of osteoarthritis is correlated to older age, 65 years and above. However, predisposition to osteoarthritis can also occur from lifestyle factors, genetics and comorbidities. Pain in the affected joint is commonly present in patients with osteoarthritis. Due to this, patients are less likely to exercise and more likely to develop comorbidities such as obesity. This ultimately increases the risk of undergoing surgical interventions such as menisectomys. Patients may also experience impaired quality of life due to joint pain and restrictions in daily activities. Due to these outcomes, Good Life with osteoArthritis: Demark (GLA:D) aims to educate and provide neuromuscular exercise programs for osteoarthritic populations. The GLA:D program strongly serves as a first-line intervention strategy to prehabilitate patients, and reduce the likelihood of undergoing surgical interventions through exercise.

GLA:D was introduced in 2013 in Denmark. Since the program is relatively new it currently requires data analysis from participants, to examine the validity and reliability of the program. This research article consists of randomised control trials for osteoarthritic patients in GLA:D programs. As a meta-analysis, the research article can systematically evaluate data over a larger cohort to assess the effectiveness of the GLA:D program in clinical practice. This is essential to reducing unnecessary surgical interventions and promoting prehabilitation through the GLA:D program.

Where is the research from?
The research was published through BMC Musculoskeletal Disorders. BMC uses submission guidelines for all proposed articles and has developed into a reputable platform over the last 20 years. The authors Skou and Roos both have strong research connections in the physiotherapy industry, and have collaborated and aided in the publications of many previous articles in the field. Both authors are based in Denmark, placing them at the frontier for the GLA:D program. No conflict of interests is present. However, it is relevant to acknowledge that both authors of the research article have extensive track records in the field. Due to this, the authors have been involved in the majority of the supporting evidence. This may impact the reliability of the evidence due to possible bias from the authors.

What kind of research was this?
The following research article is a meta-analysis of GLA:D programs. This study attains greater evidence through systematically reviewing randomised control trials.

The meta-analysis consists of:

 * 50 randomised control trials for knee osteoarthritis.

 * 10 randomised control trials for hip osteoarthritis.

What did the research involve?
Certified physiotherapists for the GLA:D program must follow strict clinical guidelines and practices when implementing the intervention. Due to this, the randomised control trials used in the study were uniform in their methodology. Participants were required to complete educational (3 sessions over two weeks) and neuromuscular components (2 sessions per week for 6 weeks) as part of the GLA:D program for a minimum of 8 weeks. Participants completed physical function tests taken at baseline, 3 and 12 months (30-second chair stand test and 40m fast-paced walk test) as objective measures for the program. The meta-analysis compiles this data to assess the aims of the GLA:D program. These aims include reduced pain, number of patients taking pain killers, and patients on sick leave. Along with improved physical activity, physical function and quality of life. The study also investigates access to health care, since participation requires a qualified physiotherapist who has completed the GLA:D education course.

The research article uses the visual analogue scale (VAS), along with quality of life questionnaires; Knee Injury and Osteoarthritis Outcome Score (KOOS) and Hip Disability and Osteoarthritis Outcome Score (HOOS). VAS was used to assess pain intensity at baseline, 3 and 12 months. This tool has been supported as effective in clinical practice for patients with osteoarthritis. KOOS and HOOS tests assess quality of life, pain intensity, and functional tests capacity (30-second chair stand test, 40m fast-paced walk test). Assessing maintained physical activity and medication usage during and post GLA:D is also supported in literature. Using the 30-second chair stand test and 40m fast-paced walk test as physical function tests proposed by the Osteoarthritis Research Society International (OARSI), is also supported in literature. Limitations to the methodology include having the majority of the meta-analysis based on knee osteoarthritis compared to hip osteoarthritis. This affects the interpretation of the results due to the skewed data. 74% of participants were female, therefore, data may not be accurate when interpreting for male populations. Participant numbers reduced for the 12 month compared to the 3 month follow up at 68% and 84% respectively. Therefore, final results are affected due to the limited data.

What were the basic results?
The study found that:

 * Pain intensity decreased after 3 months for both hip and knee osteoarthritic patients.
 * The use of pain medication significantly decreased for both hip and knee osteoarthritic patients . Risk of taking pain medication also decreased.
 * Patients improved on the 30-second chair stand test and 40m fast-paced walk test after 3 months.
 * Patients improved on maintaining physical activity (at least 30 minutes of light to moderate daily exercise) after 3 months.
 * Patients improved on KOOS and HOOS questionnaire ratings after 3 months.
 * Reductions in sick leave were statistically significant from baseline to 12 months.

The data was interpreted using crude and adjusted means, standard deviations, 95% confidence intervals and p values. Result interpretation occurred with both exercise and surgical intervention patients. Further interpretation occurred with only exercise intervention patients. Positive publication bias is evident in the research article. Data on 12 month follow up, though started as not statistically significant was not included in the final results. If included it could hinder overall results and reliability of the program.

What conclusions can we take from this research?
The GLA:D program supports reductions in pain, patients taking pain killers and sick leave. Along with improvements in physical function, physical activity and quality of life. The program also serves to reduce comorbidities through exercise. Further research into the impact of the GLA:D program on surgical prevention, would have strengthened the research articles expected outcomes of the program as a preventative intervention. Additional implications include that improvements in pain, physical function and physical activity were only significant in the short term of the program. Therefore, further study into the program and follow up measures needs to occur to ensure patients experience long term benefits of the GLA:D program.

Practical advice
Although this is developing research, it has potential as a prehabilitation intervention in hip and knee osteoarthritic populations. Patients may be referred by an orthopaedic surgeon or consult physiotherapists independently to participate in the GLA:D program. Only after approval from a physiotherapist can a patient participate in the GLA:D program. During the program, patients are encouraged to engage in at least 30 minutes of daily exercise, for instance going for a walk. For further information talk to your general practitioner or physiotherapist regarding the GLA:D program.

Further information/resources
Further information on the GLA:D program, support groups and facilitators can be found below:

 * 'GLA:D Australia'
 * 'GLA:D Australia Locations'
 * 'GLA:D'
 * 'GLA:D PROGRAM FOR HIP AND KNEE OA'


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Exercise as it relates to Disease/Sports participation and health-related behaviours among US youth

This Wiki Page is a University assignment in which the article Pate et al. (2000) Sports Participation and Health-Related Behaviors Among US Youth is critically appraised.

What is the background to this research?
"Adolescence is a critical developmental period marked by rapid physical, psychological, and social growth" and whilst there are many factors that lead to delinquency, participating in team sports has always thought to increase pro-social behaviour in adolescents by providing a safe environment away from negative influences. Pate et al. explores how sports participation in ethnic adolescents affects pro- and anti-social behaviours. It is assumed that exercise alone provides many health benefits both physical and mental, however, adhering to sporting guidelines and a lack of spare time due to trainings are also contributing factors to pro-social behaviour. This nationally (United States) representative study has not been observed previously and provides valuable information on the affects of participating in team sports.

Where is the research from?
Pate et al. analyses data from the 1997 Centres of Disease Control and Prevention Youth Risk Behaviour Survey by using a 3-stage cluster sampling procedure to produce a nationally represented sample of 9th to 12th grade student from public and private schools. Of the four authors, three are from the Department of Exercise Science and Prevention Research Centre and Dr Levin is from the Department of Epidemiology and Biostatistics. The University of South Carolina and the School of Public Health Columbia were also involved in the analysis of the study, all of whom are individual from any bias to the findings.

What kind of research was this?
Pate el al. is a quantitative cross-sectional study that utilises one-time self-reported survey data. Students were required to recall information about their participation in activities ranging from the past three to 12 months (1997). The concluding findings aline with those of other studies including Hastad et al. and Ponsoda et al. which indicate a negative association between sports participation and delinquency.

What did the research involve?
The 88-item Youth Risk Behaviour Survey was administered in school classrooms by trained administrators to over 16000 students. Of these, 87.4% were included in the analysis of those approximately 39% were American students, 31% were African-American students and 30% were Hispanic students. Those who described themselves as Asian or Pacific Islander, Native American or Alaskan Native, or other were excluded due to small numbers. All analyses were performed using an SAS version of SUDAAN where males and females were analysed separately.

The survey included questions about participation in sports teams, vigorous physical activity, dietary habits, substance abuse, sexual activity, violence and weight loss. Sports participation was defined as "playing on one or more sports teams run by the school or by organisations outside of the school during the past 12 months".

The methodology of this research has low reliability and validity as data has been interpreted from self-reported surveys which asks students to recall information about their activities from as early as 12 months prior. There are also limitations to the assumptions that can be deduced from this research as a proportion of student's data - those stated above and surveys that had missing information including: age, sex, ethnicity, participation in school sports, participation in sports teams run by organisations outside of school, and participation in vigorous activity - were not included.

What were the basic results?
In Pate el at. it was observed that 62.5% of high-school students reported participating in one or more school and/or non-school sports teams, with male students (69.9%) being more likely to participate in sports than female students (53.4%). Participation between the three main ethnicities studied (American, African-American and Hispanic students) was approximately 57.7% each.

As per the table below, female and male sports participants were reported more likely to consume fruit and vegetables than those who did not participate in sports, and engaged in more vigorous physical activity (at least 20 minutes per day) in the last seven days than their counterparts.

It was also less likely for both male and female sports participants to report cigarette smoking and use of marijuana or cocaine. For females participating in sport; having sexual intercourse during their lifetime, having sexual intercourse during the past three months and contemplating or attempting suicide was less likely than females who did not partake in sport. Males participating in sport were also less likely to report taking illegal drugs, sniffing glue, contemplating suicide, carrying a weapon or trying to lose weight than males who did not participate in sport.

In regards to ethnicities; "African-American sports participants were more likely than non-participants to report illegal drug use", and "Hispanic female sports participants were more likely than nonparticipants to carry a weapon and/or use steroids". American male sports participants were also more likely than nonparticipants to report having sexual intercourse during their lifetime, having sexual intercourse with multiple partners, and/or contemplating suicide.

What conclusions can we take from this research?
Overall, Pate et al. interpreted that "sports participation is highly prevalent among US high school students, and is associated with numerous positive health behaviours and few negative health behaviours". Clark et al. reviewed whether participation in sport would contribute to increased prosocial behaviours and decreased drug and alcohol consumption and observed that sports participation in adolescents is related to self-esteem, self-regulation, life skills and pro-social behaviour, with very little studies stating any negative impacts of participation in sport.

While adolescent participation in sport encourages positive health-related behaviours, there are many factors that contribute to anti-social behaviour including smoking during pregnancy, divorce, teenage parenthood and social disadvantage that participation in sport cannot reduce.

Practical advice
It is recommend that exercise and participation in sport occurs across the whole of one's life from childhood to adulthood as there are many known benefits such as decreased risk of cardiovascular disease, decreased association with anti-social behaviours , and a reduction in depressive and anxious symptoms. Participating in team sports also provides a social aspect to people's lives which is yet another mental health benefit.

If you wish to begin exercising or participating in sport, it is advised that you visit your General Practitioner to complete a Pre-Exercise Screening before commencing any activity.

Further information/resources
Exercising for our mental health during to Covid-19

How to look after yourself

Peer pressure and fitting in

The importance of physical activity

Kids help line


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Exercise as it relates to Disease/Barriers that prevent people with epilepsy from exercising

This is a critique of a journal article titled "How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy" by the authors Sarah S. Collard and Caroline Ellis-Hill. The article was published in 2017 in a transformative journal titled “Epilepsy and Behaviour”.

What is the background to this research?
People with epilepsy suffer from unprovoked seizures, making it more difficult to engage in physical activity when compared to non-epileptic people. There are many studies discussing barriers to exercise and how beneficial exercise is for the health of people with epilepsy. However, previous studies lack information about adaptations to exercise and methods to overcome these barriers.

The research by Caroline Ellis-Hill provides detailed, current methods used by people with epilepsy to aid in overcoming barriers to exercise. The new findings can guide further advancements in exercise techniques and explore medical professionals’ knowledge and ideas around exercising with epilepsy. epilepsy is a difficult condition to live with and there are differing opinions about the importance of exercise for this population and the overall effect on their health.

Where is the research from?
The research was conducted at Bournemouth University in England and online using video conferencing platforms. The study was published in 2017 in “Epilepsy and Behaviour”, an international journal involving the most current information about behavioural aspects of seizures and epilepsy.

Both the author and the corresponding author are from the Faculty of Health and Social Sciences at Bournemouth University. The Main author, Caroline Ellis-Hill has contributed to a total of 57 research articles about Caregiving, Dementia, Aphasia, Strokes and Men’s Health. The corresponding author, Sarah Collard has 11 published articles associated with Chronic Fatigue Syndrome, Physics and Chemistry Experiment in Space, Cognitive Behavioural Therapy and Knee Osteoarthritis. Their reputations continue to expand each year. The authors claim there has been no conflict of interest within the research, though, medical professionals have had contrasting opinions regarding physical activity recommendations.

What kind of research was this?
The research was an exploratory study, using qualitative methods to explore different coping strategies to improve exercise for people with epilepsy. To do this, current perceived barriers and adaptation techniques needed to be recognised. The research was conducted using three focus groups and three semi-structured interviews with 2-3 participants in each group. A focus group is a small group of participants engaging in an open discussion guided by the main researcher. Focus groups are most appropriate for situations that involve discussing detailed information and sensitive topics as it provides an accepting environment allowing participants to add meaning to discussion. Examining barriers to exercise provided qualitative data regarding ways to enhance physical activity for people with epilepsy and overcome barriers preventing exercise.

What did the research involve?
11 epileptic participants from England, aged 18-60 years engaged in the research. Most of these participants were White-British (n=10) and female (n=7).

The participants were prompted through a discussion about barriers preventing them from exercise and methods they use to overcome barriers. ‘Active people management’ was incorporated to avoid the conversation being dominated by a single participant. The focus groups were conducted for 1 ½ to 2 hours. The semi-structured were conducted using a videoconferencing platform for those who could not travel and ran for 1 to 1 ½ hours.

This research method was the most appropriate as the participants were able to freely discuss their situations without feeling uncomfortable or pressured by researchers. The participants were able to reveal more detail about their epilepsy that may be absent from current research by sharing common situations. Constructionist grounded theory was used to analyse the data collected and identified the effects of the researcher on the study and aims to give a voice to the subjects.

Study Limitations

 * Only 11 participants, so data cannot be generalised for the entire epileptic population.
 * All participants are from England so findings cannot reflect possible findings from other countries.
 * Lack of diversity (female to male ratio).
 * No information regarding socioeconomic status (demographics need to be considered).
 * We cannot assume the findings of this study apply to children under 18.

What were the basic results?
The study found the following key barriers to exercise: The study also explored methods to prevent seizures during exercise:
 * Fear of injury by triggering seizures with strenuous activity, overheating or high heart rate
 * Lack of social support and a feeling of being unsafe alone.
 * Conflicting advice from medical professionals, family, and friends.
 * Side effects of seizure medication
 * Modifying intensity level and type by identifying pre-seizure symptoms and understanding their boundaries.
 * Use of technology to track seizure activity and gain a sense of control
 * Exercising with others

The findings were analysed using Constructive grounded theory to introduce new understanding of the motivating factors, perceived barriers, and adaptations to exercise. There was no over-emphasis placed on the limitations of the study. The restraints to the study were all based upon the individuals rather than the research methods.

What conclusions can we take from this research?
From the study we can see that not all people with epilepsy are the same when exercising, a range of factors such as the type or severity of epilepsy that has been diagnosed, current PA status and triggers affect how they exercise. The biggest finding is that people with epilepsy need to find what works for them in terms of intensity, heart rate, temperature, and duration of exercise to avoid triggering a seizure. They must identify their boundaries and know when exercise needs to be ceased.

There have not been more recent studies as this research was conducted in 2017. However, there are many studies from different countries that present similar findings. In 2009, A study in Wichita, USA surveyed 193 people with epilepsy and found that the main barriers were: lack of motivation (41%), concern for personal safety (27%), fear of epileptic seizures (19%) and the conception of epilepsy itself as a barrier (29%). Another study was conducted in Seoul in 2011, the main barriers explored were fatigue after physical activity (73%), fear of seizures during exercise (65%) and advice from family or friends to not exercise (55%). When patients were asked about exercise restriction by a physician, the frequency was 0%. In 2015, The States Centre for Disease Control and Prevention found no differences in exercise recommendations between people with and without epilepsy (34% vs. 35%).

Practical advice
The participants discussed types of exercise that suits them and their seizure frequency, these involved walking, running, and swimming. Avoiding the midday sun when exercising is also most appropriate to prevent overheating and triggering seizures. This information varies for each person with epilepsy and exercises that work for one person may not work for another.

Any individuals with epilepsy should consult an Epilepsy Specialist to discuss their specific type of epilepsy and barriers/limitations specific to them. But epilepsy should not be a barrier to exercise, and physical activity is recommended daily, they just need to understand boundaries and how to monitor their triggers. There was also no information about the effects of age, gender, seizure medication on their ability to exercise.

Further Information and Resources
The Epilepsy Foundation aims to ensure that all individuals with epilepsy have access to information relevant to their age and condition by delivering support programs, education/training and community awareness programs.

Epilepsy Action Australia is an organisation that helps people self-manage and better understand their epilepsy. They also provide information to parents, teachers, and medical professionals to support people and their specific needs. Further information:
 * https://www.epsyhealth.com/seizure-epilepsy-blog/can-you-exercise-with-epilepsy
 * https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy-and-exercise
 * https://www.issaonline.com/blog/index.cfm/2017/people-with-seizures-can-train-heres-how-to-do-it-safely


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Exercise as it relates to Disease/The effect of high-intensity resistance exercise on patients with rheumatoid arthritis

This critique is on the article "The effects of high-intensity resistance training in patients with rheumatoid arthritis: A randomised controlled trial". The journal piece has been produced by the authors Andrew B. Lemmey, Samuele M. Marcora, Kathryn Chester, Sally Wilson, Francesco Casanova and Peter J. Maddison.

What is the Background this Research?
Rheumatoid arthritis (RA) is a chronic inflammatory disorder that attacks an individual's own joint tissue causing damage to a wide variety of different body systems. This disorder is characterised as an autoimmune condition which attacks the body's own tissue causing bone erosion and joint deformity. Even though this disease is caused through an autoimmune condition, it is unknown the trigger that causes this. The use of exercise can be significant for individuals possessing RA and can be used to increase muscle mass and restore physical function. Resistance exercise can be particularly beneficial for individuals with RA and is highly recommended.

This condition is lifelong affecting many if not all joints in the body causing deformity as well as painful bone erosion. In Australia this condition is rare with approximately 456,000 individual's possessing the condition. This research allows us to understand that with constant maintenance of this condition, individuals can fight the effects of RA and sustain a healthy lifestyle.

Where is this Research from?
This study was conducted at the Bangor University located in Wales, United Kingdom. The study was ethically approved by the Northwest Wales National Health Service Trust Research Ethics Committee. This study was published in 2009 by The Wiley Online Library. This is a highly ranked, dependable journal recognised all over the world covering a wide variety of journals in many different areas of research.

Andrew B. Lemmey was the lead author in this study. Lemmey is a clinical exercise physiologist in the School of Sport, Health and Exercise Sciences at Bangor University. This is one of his 50 peer journals therefore showing his background and work has good credibility. Lemmey's research and work for the past 14 years is focused on restoring physical function and attenuating disabilities in patients with RA. All other authors are exercise physiologists at Bangor University with ranging expertise in a variety of different fields.

The authors have no apparent conflicts of interest.

What Kind of Research was this?
The research conducted was a randomised controlled trial (RCT) taken over two and half years. A RCT consists of participants being randomly assigned into one of two groups. The first group are receiving the intervention and the second is a control group receiving an alternate procedure. RCTs are used frequently as they determine whether there is a cause and effect relationship between the intervention and outcome. Other research in this field uses this same trial structure as it provides reliable and valid data and is the most ideal trial type.

What did the Research Involve?
During this intervention, 36 volunteers were chosen from the Gwynedd Rheumatology Department as participants in the study. Although at baseline assessment only 28 persons fit the requirements for the study. 13 individuals were assigned to the progressive high intensity resistance training (PRT) group with 15 individuals assigned to the control group. All participants were randomised into each group and then given a 24 week training program to follow. Individuals in the PRT group trained twice a week at a community gym under the supervision of exercise physiologists while the control group were asked to perform range of motion (ROM) exercises twice weekly at home.

The PRT group's program consisted of 3 sets of 8 repetitions with a load corresponding to 80% of the 1-repetition maximum with between 1-2 minutes of rest between each set. Although these guidelines were subject to change to cater for adaptation and muscle soreness. The main resistance exercises were completed on multi stack machines which included leg press, chest press, and leg extension. PRT sessions were also preceded by a warmup and ended by a cool down, each comprising 10 minutes of low-intensity ROM exercises.

To test the differences between the groups, 3 main areas were analysed.

 * Body composition
 * Physical function
 * IGF system

Limitations

There are some limitations in this trial such as chance error and experimenter bias. Unfortunately, it cannot be known whether experimenter bias has occurred. Due to the small sample size chance error can still occur. Another limitation that could have hindered the results is that the trial was conducted in Wales. The population is from that specific part of the world and therefore could have been biased to a particular population. A larger sample size would have also allowed for greater credibility and a wider range of results within the study. Overall, the methodology of this study is correctly used as most biases were minimised.

What were the Basic Results?
Body Composition (BC) - The PRT group showed significant improvement in the tests assessing BC. The control group showed a slight decline in the tests assessing BC.

Physical Function (PF) - The PRT group showed a significant improvement in the test assessing PF. The control group showed a slight decline in the tests assessing PF.

IGF System - The PRT group showed a significant improvement in the IGF system tests. The control group showed a significant decline in the IGF system tests.

Through these areas, investigators were able to measure the overall effect high-intensity resistance training on the body. The participants stated they enjoyed contributing to the study. No injuries were sustained by both groups and individuals were satisfied that the intensity of the exercise was catered to their abilities. During this study many tests for each area were used. These tests were completed by every participant in both groups before and after the 24 week program. Tests included muscle mass, total fat mass, total protein, 50 foot walk test and many others. Overall, these tests allowed for the primary objectives and areas of the study to be tested.

What Conclusions can be Taken from this Research?
Overall, the results showed that through high intensity resistance training, individuals with RA had found an effective way of restoring muscle mass and functional capacity. The PRT group also showed an improvement in the 3 main areas compared to the control group allowing for better maintenance of RA. Different ROM exercises completed were shown to complement the high intensity resistance training rather just completing ROM exercises respectively as shown in the control group where the results were ineffective.

In other studies, focused on high intensity resistance exercise and RA, similar results were displayed, and that high intensity resistance exercise can be used as a treatment against the effects of RA.

Practical Advice
As the research above shows that high intensity resistance exercise does have a benefit against the effects of RA. It is vital individuals possessing it both maintain and prevent the long-lasting effects of the disease.

Exercises recommended:

 * Standing calf raises
 * Goblet squats
 * Romanian deadlifts

Other exercises to compliment:

 * Aerobic Exercises
 * ROM exercises

Further Resources
RA in Australia:

https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/rheumatoid-arthritis/contents/what-is-rheumatoid-arthritis

Exercise and RA:

 * https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/physical-activity-and-exercise/exercise-and-ra/
 * https://www.arthritis.org/health-wellness/healthy-living/physical-activity/other-activities/best-exercises-for-rheumatoid-arthritis


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Grand Theft Auto: Vice City/Introduction

Grand Theft Auto: Vice City is a non-linear driving and shooting computer and video game released by Rockstar Games on October 27, 2002 for the PlayStation 2 and May 12, 2003 for the personal computer, as well as in November 2003 for the Xbox, along with Grand Theft Auto III in the Grand Theft Auto: Double Pack re-release. As the title implies, the game involves an amount of crime and plenty of carjacking. Vice City is also a loose sequel to Grand Theft Auto III (2001).

The game takes place in 1986, when player character and protagonist Tommy Vercetti is released from prison and dispatched by Sonny Forelli, head of the Forelli Mafia family in Liberty City, to Vice City for the establishment of a narcotics deal. Unfortunately, as the deal was almost complete, gunmen attack the meeting and kill several other men, while Tommy flees, leaving the drugs and the Forelli-supplied money behind. Together with lawyer Ken Rosemberg and with no money, Tommy is forced to find the party responsible for the attack, and eventually seize power of the city. You, the player, will take the role of Tommy Vercetti after he arrives in Vice City.

This Wikibook will guide you on how to play Vice City, and the features and item available to you in game.


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Grand Theft Auto: Vice City/How to contribute

Anyone who wishes to improve on this book is highly encouraged to do so. Before you do, make sure you've read the MediaWiki editing help page and the project metadata page (particularly the project standards page).

If you can't be bothered to create a new page or find the appropriate page to add your content to, try adding it to an appropriate place on the Frequently Asked Questions (FAQ) list. This way, someone else can move it to the appropriate place at a later date.


text: User talk:110.175.202.130

title: User talk:110.175.202.130