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World Cultures/Culture in Africa/Culture of Nigeria

Introduction
The culture of Nigeria is shaped by Nigeria's multiple ethnic groups. The country has 527 languages, seven of them are extinct. Nigeria also has over 1150 dialects and ethnic groups. The six largest ethnic groups are the Hausa and Fulani in the north, the Igbo in the southeast, and the Yoruba predominate in the southwest, the Tiv people of North Central Nigeria and the Efik - Ibibio.

The Edo people are most frequent in the region between Yorubaland and Igboland. Many of the Edo tend to be Christian. This group is followed

by the Ibibio/Annang/Efik people of the coastal south southern Nigeria and the Ijaw of the Niger Delta.

Nigeria's other ethnic groups, sometimes called 'minorities', are found throughout the country but especially in the north and the middle belt. The traditionally nomadic Fulani can be found all over West and Central Africa. The Fulani and the Hausa are predominantly Muslim while the Igbo are predominantly Christian and so are the Efik, Ibibio, and Annang people. The Yoruba are equally likely to be either Christian or Muslim. Indigenous religious practices remain important to all of Nigeria's ethnic groups, and frequently these beliefs are blended with Christian beliefs, a practice known as syncretism.

Efik-Ibibio Culture
The Efik-Ibibio culture of coastal southeastern Nigeria has made a significant contribution to the culture of Nigeria, especially the culture of the southern region. A brief summary is as follows:

 * Efik-Ibibio language: This language is spoken in Akwa Ibom State and Cross River State. It has various dialects such as the Annang dialect, Oron dialect, and many others. The Efik-Ibibio language has a significant influence on the languages and names of the people of southern Nigeria.
 * Protectors: The Efik-Ibibio culture was protected by a secret society, the Ekpe, that was indigenous to southeastern Nigeria. The "Ekpe", meaning 'Leopard', became a popular symbol in the Efik-Ibibio culture which later became popular in other Nigerian ethnic cultures.
 * Writing: Nsibidi is the popular ancient indigenous writing of the Efik people was invented by the Ekpe of the Efik-Ibibio people.
 * Food: Located in the coastal southeastern Nigeria by the Atlantic Ocean, the Efik-Ibibio people are blessed with various edible vegetables. Their food is popular throughout the entire Nigeria including the popular Afañg soup, Edikang Ikong soup, pepper soup, Ukwoho, Atama, Eritañ, jollof-rice, etc., etc.

Bini
Eghosa the queen of Bini

Yoruba Culture
The Yorubas are located on the western region of Nigeria and their leadership is monarchial in nature. They have kings who are allowed to take as many wives as they want and chiefs and titled individuals. They also practice traditional worship, paying homage to gods like Sango; the god of thunder, Oya, Ogun; the god of iron...etc. The Yoruba people are very friendly and welcoming to people of other tribes and nationalities.

Igbo Culture
The eastern part of Nigeria is the home of the Igbos, who are mostly Christians. Their traditional religion is known as Omenani. Socially they are led by monarchs known as Eze Igwes. These figures in turn are expected to confer subordinate titles upon men and woman that are highly accomplished. This is known as the Nze na Ozo title system. People of title are usually well-spoken, highly respected and well recognized in their communities.

Hausa-Fulani Culture
The Hausa-Fulani live in Northern Nigeria. Nigeria Consist of my Tribe and many Cultures, Hausa Fulani are the largest or is the most popular tribe in Nigeria, even though the Hausa and Fulani are different tribes but they are considered as one tribe due to the close relationship that exist between the two tribes. Hausa In Hausa land the their one culture that is always practice yearly by Hausa people known as Hawan Sallah.

Nigerian literature
Nigeria is famous for its English language literature. Things Fall Apart, by Chinua Achebe, is an important book in African literature. With over eight million copies sold worldwide, it has been translated into 50 languages, making Achebe the most translated African writer of all time.

Nigerian Nobel laureate Wole Soyinka described the work as "the first novel in English which spoke from the interior of the African character, rather than portraying the African as an exotic, as the white man would see him." Nigeria has other notable writers of English language literature. These include Femi Osofisan who first published a novel Kolera Kolej was in 1975; Ben Okri whose first work, The Famished Road was published in 1991 and Buchi Emecheta who wrote stories drawn from her personal experiences of gender inequity that promote viewing women through a single prism of the ability to marry and have children. Helon Habila, Sefi Atta, Flora Nwapa, Iquo DianaAbasi Eke, Zaynab Alkali and Chimamanda Ngozi Adichie among others are notable Nigerian authors whose works are read widely within and outside the country.

Apart from the speakers of standard English, a large portion of the population, roughly a third, speaks Nigerian pidgin, which has a primarily English lexicon. It has become a common lingua franca as a result. Pidgin English is a creolized form of the language. For instance, "How you dey" means "How are you". The Palm Wine Drinkard, a popular novel by Amos Tutuola, was written in it.

Nollywood
Since the 1990s the Nigerian movie industry, sometimes called "Nollywood", has emerged as a fast-growing cultural force all over Africa. Because of the movies, western influences such as music, casual dressing and methods of speaking are to be found all across Nigeria, even in the highly conservative north of the country.

Sports
Supporters of English football clubs like Manchester United, Arsenal, Manchester City, Liverpool and Chelsea often segregate beyond the traditional tribal and even religious divide to share their common cause in Premier League teams. The Nigerian national football team, nicknamed the "Super Eagles", is the national team of Nigeria, run by the Nigeria Football Federation (NFF). According to the FIFA World Rankings, Nigeria ranks 31st and holds the second-highest place among the African nations behind Senegal (20th). The highest position Nigeria ever reached on the ranking was 5th, in April 1994.

Food
Nigerian food offers a rich blend of traditionally African carbohydrates such as yam and cassava as well as the vegetable soups with which they are often served. Maize is another crop that is commonly grown in Nigeria. Praised by Nigerians for the strength it gives, garri is "the number one staple carbohydrate food item in Nigeria" a powdered cassava grain that can be readily eaten as a meal and is quite inexpensive. Yams are frequently fried either fried in oil or pounded to make a mashed potato-like yam pottage. Nigerian beans, quite different from green peas, are widely popular. Meat is also popular and Nigerian suya—a barbecue-like roasted meat—is a well-known delicacy. Bush meat, meat from wild game like antelope and giraffes, is also popular. Fermented palm products make a traditional liquor, palm wine, and also fermented cassava. Nigerian foods are spicy, mostly in the western and southern part of the country, even more so than in Indian cuisine. Some more examples of their traditional dishes are eba, pounded yam, iyan, fufu and soups like okra, ogbono and egusi. Fufu is so emblematic of Nigeria that it figures in Chinua Achebe's Things Fall Apart, for example. Achebe's magnum opus is the most widely read book in modern African literature.

Music
The music of Nigeria includes many kinds of folk and popular music, some of which are known worldwide. The singer and social activist Fela Kuti was instrumental in Nigeria's musical development.

Traditional musicians use a number of diverse instruments, such as Gongon drums. The kora and the kakaki are also important.

Other traditional cultural expressions are found in the various masquerades of Nigeria, such as the Eyo masquerades, the Ekpe and Ekpo Masquerades of the Efik/Ibibio/Annang/Igbo peoples of coastal southeastern Nigeria, and the Northern Edo Masquerades. The most popular Yoruba manifestations of this custom are the Gelede masquerades.

Resources
A very important source of information on modern Nigerian art is the Virtual Museum of Modern Nigerian Art operated by the Pan-Atlantic University in Lagos.

In addition, the Nigerian Investment Promotion Commission, and Naija Invest Gateway, provide real time information on the Nigerian business culture.

Clothing
Women wear long flowing robes and headscarves made from local markets who dye and weave the fabric locally. Southern Nigerian women choose to wear western-style clothing. People in urban regions of Nigeria dress in western style, the youth mainly wearing jeans and T-shirts. Other Nigerian men and women typically wear a traditional style called Buba. For men the loose fitting shirt goes down to halfway down the thigh. For women, the loose fitting blouse goes down a little below the waist. Other clothing gear includes a gele, which is the woman's headgear. For men their traditional cap is called fila.

Historically, Nigerian fashion incorporated many different types of fabrics. Cotton has been used for over 500 years for fabric-making in Nigeria. Silk (called tsamiya in Hausa, sanyan in Yoruba, akpa-obubu in Igbo, and sapar ubele in Edo) is also used. Perhaps the most popular fabric used in Nigerian fashion is Dutch wax print, produced in the Netherlands. The import market for this fabric is dominated by the Dutch company Vlisco, which has been selling its Dutch wax print fabric to Nigerians since the late 1800s, when the fabric was sold along the company's oceanic trading route to Indonesia. Since then, Nigerian and African patterns, color schemes, and motifs have been incorporated into Vlisco's designs to become a staple of the brand.

Nigeria has over 250 ethnic groups and as a result, a wide variety of traditional clothing styles. In the Yoruba tradition, women wear an iro (wrapper), buba (loose shirt) and gele (head-wrap). The men wear buba (long shirt), sokoto (baggy trousers), agbada (flowing robe with wide sleeves) and fila (a hat). In the Igbo tradition, the men's cultural attire is Isiagu (a patterned shirt), which is worn with trousers and the traditional Igbo men's hat called Okpu Agwu. The women wear a puffed sleeved blouse, two wrappers and a headwrap. Hausa men wear barbarigas or kaftans (long flowing gowns) with tall decorated hats. The women wear wrappers and shirts and cover their heads with hijabs (veils).


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User talk:Primefac

Good morning, I'm writing here in Wikibooks because my IP range was blocked in Wikipedia. You're a bureaucrat, so maybe you could help me. My situation is complicated but my request will be simple. Let me tell you what happened. Now I'm going to speak frankly. I don't think that Ohnoitsjamie's behavior has been correct since the beginning, he's been interfering even after the page had been protected even if he had no reason to do it, and to me it looks like he's more interested in frustrating me than in the sake of the project (why on earth unprotecting a page which continues being disrupted by new and new IPs?!), even if I may be wrong. But I know he isn't the owner of Wikipedia, he's one admin among hundreds. His way to deal with this issue is "his" way, not everybody else would have acted in the same way as him, maybe somebody but not everybody. This is what I'm asking: what can I do to have a fair judgement about this story, to have my name cleared (for him I'm still the vandal who did this and this and all the other similar vandalisms just because one of the vandal's IP ranges matches with mine), to have my IP range unblocked and, possibly, that page protected? I hate the vandal who caused all this to me, so you can imagine how being accused to be him and have to undergo the same punishment as him screws me up. I'm not the vandal, would I ever ask to protect that page from all anonymous if I were the vandal who keeps switching IPs? Ohnoitsjamie is as human as us, he isn't infallible, I'm sure he's a good person but in this case he got wrong and he's persisting in his error. I'd like to be freed from his error, do you have any advice to help me succeed or there's no way this error can be reviewed and remedied? You're a bureaucrat, if a bureaucrat can't help me out of this situation I don't know who I might ask, and what I'm undergoing because of a vandal living in my country and of an admin who was mistaken is now beyond forbearance... I'm sorry for writing so much, but please give me a reply and help me in the limits of what you're able to do, User:Primefac. 151.21.78.77 (discuss) 19:12, 14 September 2020 (UTC)
 * 1) There's a cross-wiki vandal, probably an LTA, has been disrupting for over almost 2 years the page "Dredg" and other similar pages, not only in the English wiki but also in others.
 * 2) The vandal has been using IP ranges starting with 151, included mine which starts with 151.21, which are Italian IP ranges, quite common in the northern regions.
 * 3) After the latest vandalism, in that case from my same IP range, the user who reverted him last week asked to protect the page.
 * 4) An admin, Ohnoitsjamie, declined the request and, instead, partially blocked that IP range used by the vandal, 151.21.0.0/16, which is mine too.
 * 5) When I noticed that there was a block on my IP range I asked for an unblock, because I'm not that vandal and because, if the goal is "preventing the vandal from disrupting that page", the better solution is "protecting the page" instead of blocking a single IP range and other single IPs, in fact the vandal has continued disrupting it from different IP ranges, but the request was rejected.
 * 6) I asked to semiprotect it in the RFPP page but this request was rejected too, so I asked for "pending changes protection" which was finally granted by an admin.
 * 7) Happy ending? No. Ohnoitsjamie unprotected the page (which was disrupted again, QED) and fully blocked my IP range (after increasing the partial block from 6 months to 2 years which had no meaning at all) so now I can neither request to protect the page nor ask for advice other admins. And nothing that justifies that has been done from this IP range!
 * For reference: Further discussion at User talk:Useight. 1234qwer1234qwer4 (discuss • contribs) 17:23, 17 September 2020 (UTC)

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

title: User talk:Primefac


text:
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English-Hanzi/Occupational therapy

Occupational therapy can help activities. Assistive technology is usually a tool that helps people with disabilities by improving the use of damaged parts of the limb after amputation. Assistive technology devices can be tailored to the patient, or they can be purchased commercially.

职业疗法可以帮助活动. 辅助技术通常是通过改善截肢后肢体受损部位的使用来帮助残疾人的工具. 辅助技术设备可以为患者量身定制，也可以商业购买.

title: English-Hanzi/Occupational therapy


text:
Exercise as it relates to Disease/Effects of physical training on land and in water on cardiorespiratory adaptation in COPD patients

This Wiki page is a critique of the research article: Cardiorespiratory Adaption of COPD Patients to physical training on land and in water (J. Perk, L. Perk, C. Bóden, 1995).

For the purpose of this wiki page, Chronic Obstructive Pulmonary Disease will be abbreviated as COPD.

This critique is purposed to be assessed under the Health, Disease & Exercise unit of The University of Canberra, written September 2020.

What is the background to this research?
The study was conducted to investigate the implementation of physical training in water in comparison to training on land and determine whether the activity would be 'feasible and safe' for patients diagnosed with Chronic Obstructive Pulmonary Disease. Contextually, the definition of COPD by the European Respiratory Journal in 1995 was "a disorder characterised by reduced maximum expiratory flow and slow forced emptying of the lungs due to varying combinations of diseases of the airways and emphysema". While previously COPD was alternatively termed as 'bronchitis' or 'emphysema', present studies determine these diseases as co-factors rather than aliases, as these conditions along with lifestyle choices (e.g; cigarette smoking) trigger an inflammatory response that causes the airways to constrict. Recent studies detail a more specific insight into the characteristics of the disease, defining the term 'phenotype' in the realm of COPD as a "a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes” . Thus, the individually progressive nature of COPD is now more explicitly outlined.

Considering COPD is characterised by multiple different respiratory diseases with varying levels of severity, the study was undertaken by 20 patients without pre-existing cardiac failure or hypoxaemia. Parameters such as these indicate the lack of predetermined knowledge obtained in regards to aquatic exercise by European health systems at the time, resulting in determining a small population of subjects that had no cardiovascular issues or other illnesses that were present as a consequential progression of COPD. Establishing grounds to conclude that COPD patients could safely train in water and benefit from doing so in ways that they may or may not from training on land was particularly important for the way present rehabilitation services produce exercise programs for patients.

Where is the research from?
Joep Perk, one of the three researchers involved in the execution of this study, has since followed on to specialize in cardiology and health sciences as a professor at the Linnaeus University in Kalmar, Sweden. The study's location was Oskarshamn District Hospital, Sweden, where Perk was in close correspondence to the Department on Internal Medicine. It was then published by the European Respiratory Journal in October 1995 after revision from the European Respiratory Society, an organisation whose membership now reaches across 140 countries. While the study had been published by the ERS, there was no previous contribution made towards the authors by a sponsor concerned with achieving a specific outcome or result, suggesting there was no bias driving the execution of the experiment.

What kind of research was this?
A quasi-experimental study design was implemented across a two-stage process over the experiment. The first stage saw subjects engaging in exercise on land, while the second stage saw them them train in water. Before each stage, quantitative data regarding specific cardiovascular and respiratory measurements was collected, whereas both quantitative and qualitative data was collected during the training regime. In both occasions, the groups had not been divided or randomised. This is the greatest limitation to the study as lack of randomisation tends to limit the "ability to conclude a causal association between an intervention and an outcome"

What did the research involve?
20 subjects aged 62-76 years diagnosed with COPD were assessed in the study, all of which had an FEV1 to FVC ratio of less than 70% prior to the consumption of terbutaline (used as a bronchodilator for asthma symptoms). During the first stage, participants engaged in physical training on land involving three submaximal upper body exercises. These would be performed for three minutes each, followed by two minutes rest after each round, totalling 15 minutes. If a patient was to experience developing an arrhythmia, having their oxygen saturation fall below 85% or any discomfort, the training would cease for that participant. Before proceeding to the second stage, the subjects were given 10-15 minutes rest time to recover. The second phase involved the same exercises and timing for participants to perform except the experiment would require them to be submerged in water up to their necks in a training pool while harnessed to a hydraulic chair. For both stages, the following measurements were taken:

Prior to Exercise
 * Oxygen Saturation                                                                                * Heart Rate
 * Breathing Frequency
 * Blood pressure

During Exercise
 * Oxygen Saturation
 * Heart Rate
 * Breathing Frequency
 * Blood pressure
 * Rated perceived Exertion using the Borg Scale

This methodology is appropriate to the study as it ascertains meaningful data that allows for suitable comparison of results for each stage due to consistency of procedural execution and measurement amongst subjects. Despite this, having only an elderly population limits the study's results to translate across different ages of people diagnosed with COPD. It allows for reliability within the study, though validity in relation to the broader COPD population is questionable.

What were the basic results?
At rest
 * Oxygen saturation, heart rate and breathing frequency were not notably affected in the instance of either stage.
 * Systolic blood pressure dropped by 9% in water, while diastolic pressure dropped by 7%, resulting in a decrease of 7% in rate pressure product.

During Exercise
 * Heart rates did not return to normal as quickly or efficiently on land as they did in water post-exercise.
 * Oxygen saturation saw a 2% fall in one of the three exercises in water, whilst others were unchanged.
 * RPE for effort during horizontal exercises in water was higher, as was dypsnoea.
 * Participants with poorer lung function experienced less loss in oxygen saturation in water. For these patients, systolic pressure on land was lower, as well as diastolic in water.

What conclusions can we take from this research?
The study's results conclude that all participants subject to submaximal aquatic exercise experienced no adverse events or experiences during engagement, deeming it feasible and safe. Comments in the discussion seem to describe aquatic exercise to be preferred over training on land, however we must take into consideration that this study was aimed to determine whether or not training in water is safe to COPD patients, rather than it being more beneficial. This is individually subjective, and it is important to note that COPD sufferers with more severe symptoms or associated diseases need to be assessed more critically before engaging in aquatic activities due to factors including swimming ability, exercise type and frequency.

Practical advice
People diagnosed with COPD should be assessed by a general practitioner before gaining advice or coaching from a health professional when engaging in physical training. Aquatic training can offer these people a way to exercise without significantly raising blood pressure or lowering oxygen saturation as long as they are guided by an experienced physiotherapist (or another health practitioner) and still reap the physical and psychological benefits of exercise. Trainers should have experience in or at least be aware of the hazards that may present themselves during training in water in regards to their patients experience in swimming, water depth, and procedures that must be followed in the event of someone potentially drowning.

Further information/resources

 * Asthma and Swimming
 * COPD Evidence and Implications
 * Pulmonary Rehabilitation for COPD Patients in Primary Care


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Exercise as it relates to Disease/Affecting cognition and quality of life via aerobic exercise in Alzheimer’s disease

/Affecting cognition and quality of life via aerobic exercise in Alzheimer’s disease/

This is a review of the article 'Affecting Cognition and Quality of Life via Aerobic Exercise in Alzheimer’s Disease' ; A pilot study conducted by Fang Yu, Nathaniel W. Nelson, Kay Savik, Jean F. Wyman, Maurice Dysken, Ulf G. Bronas

What is the Background to this research?
Alzheimer's disease (AD) is the world's leading cause of dementia and affects up to 25 million people world-wide. AD can be characterised by a progressive decline in cognitive function, which typically begins with deterioration in memory. Due to AD 's primary feature being an impairment of cognitive function, daily-living activities become quite limited also resulting in poor quality of life (QOL), psychological and behavioural symptoms and escalating health care costs. The global prevalence of AD continues to grow exponentially, hence, developing interventions that could potentially improve cognitive impairment is critical for altering AD trajectory and improving health care outcomes in this population. In the article; 'Affecting Cognition and Quality of Life via Aerobic Exercise in Alzheimer’s Disease' they examine the effect of 6-month aerobic exercise on the change in executive function, global cognition, QOL, and depression in older adults with mild to moderate AD.

Where is the Research From?
This study was conducted in a retirement community in Saint Paul, Minnesota, USA between July 2008 and December 2009 and published in the Western Journal of Nursing Research in 2013. The corresponding author is Fang Yu of The University of Minnesota School of Nursing, Minneapolis. Yu's main research revolves around how to prevent and treat AD non-pharmacological interventions. Yu is involved in 49 completed publications, with 29 of these focusing on AD.

What kind of research was this?
Researchers performed a cross-sectional pilot study with a small sample size of 11 participants, including females and males, with only 8 of those completing the study. The final 8 participants were made up of both males and females, aged 81.4±3.6, who all had probable AD diagnosis. Four recruitment strategies were used to enrol participants for the study. These strategies included advertisements at senior newspapers, referral by senior housing managers, flyer distributions at senior housing and community events, and seminars delivered by author F.Y. at AD support groups. This particular study differs to other studies surrounding aerobic exercise and AD as it investigates the impact of aerobic exercise on cognition in AD whereas many studies show the positive impact of aerobic exercise on behavioural therapy for AD.

Eligibility Criteria

 * Have a probable AD diagnosis
 * Live in the community such as home or residence where skilled nursing services are not provided
 * Understand and speak English
 * Age 60 years or above
 * Have medical clearance from the primary physician for aerobic exercise

Exclusion Criteria

 * Mini-mental State Examination (MMSE) score was <12 during screening
 * Has contraindications to exercise such as uncontrolled hypertension
 * Displayed signs and symptoms that need to be evaluated by a physician
 * Cannot cycle
 * Has a recent history of unstable medical conditions

Summary of the Research Design and Methods

 * Once the participants were deemed eligible, all study activities were conducted at a retirement community in Saint Paul, Minnesota.
 * Participants who lived outside the retirement community were transported to and from the retirement community by research staff.
 * Participants completed individualised, moderate intensity cycling on Precor™ recumbent stationary cycles 3 times a week for 6 months.
 * Cycling was conducted for 10 to 45 minutes per session under the supervision of a certified exercise therapist
 * At baseline and when participants completed 3 and 6 months of cycling, outcomes were collected using specific tests on following:
 * Executive function
 * The Executive Interview (EXIT-25)
 * The Stroop Colour-Word Test
 * The Trail Making Test (TMT)
 * The Controlled Oral Word Association (COWA-FAS) Test
 * Global cognition
 * The MMSE
 * The AD Assessment Scale–Cognitive Subscale (ADAS-cog)
 * QOL
 * The QOL in AD
 * Depression.
 * The Geriatric Depression Scale–Short Form (GDS-SF)

What were the basic results?
Results from the present research portray potential changes over time within the participants. Scores on three of the executive function measures show a trend towards improvement from baseline to 3 and 6 months. EXIT-25: Baseline - 13.3, month 3 - 11.6, month 6 11.6. Stroop Colour-Word Test: Baseline - 17.6, month 3 - 28.0, month 6 20.1. COWA-FAS: Baseline - 20.6, month 3 - 26.9, month 6 - 27.3. Although these results look promising, they are statically insignificant according to Friedman’s Test of Significance as they are all a level of significance >0.5. The only measure that showed a statistically significant improvement was significant linear decrease in depression scores over time (p = .026. At month 3 participants reported significantly less depressive symptoms compared to baseline and at month 6 compared with month 3. Baseline: 2.8 ± 4.3, month 3: 2.0 ± 1.9, month 6: 0.9 ± 1.7 . The authors emphasised on the suggestion that the executive function measures could be positively impacted by the intervention along with the significant decline of depressive symptoms in this time frame.

What conclusions can we take from this research?
As this is just a small pilot study, it is not powered to detect significant differences. The overall results were not statistically significant, although they do suggest that there is possibility that aerobic exercise can have positive impacts on executive function, QOL, and depression in older adults with AD. Aerobic exercise can be seen to be a positive intervention for AD.

A 26-week randomised control trial in 2017 came to a similar conclusion. It showed that participants with AD who performed regular aerobic exercise had benefits associated with functional ability.

Practical Advice
Emerging study suggest that older adults with AD were significantly less physically active than those without AD. This could lead to all the negative health consequences associated with physical inactivity. Individuals with AD are likely to achieve many of the same health benefits resulting from aerobic exercise participation irregardless of the factors correlating directly to AD.

The results of this pilot study can be beneficial for future studies to help plan randomised controlled studies with sufficient numbers or participants to test these hypotheses.

Further Information and Resources
For further information regarding Alzheimer’s Disease:
 * About Dementia - Alzheimer's Disease
 * Healthline - Alzheimer's Disease
 * Alz.org - What is Alzheimer’s Disease?

Further readings and studies on Alzheimers' Disease and Aerobic Exercise
 * Improving Cognition and Function Through Exercise Intervention in Alzheimer's Disease
 * Aerobic exercise for Alzheimer's disease


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Exercise as it relates to Disease/Can physical activity slow the development of sarcopenia as we age?

This page is a critique of the article 'Yearlong physical activity and sarcopenia in older adults: the Nakanojo Study' by H Park, S Park, R J Shephard and Y Aoyagi in 2010.

What is the background to this research?
Sarcopenia is described as the progressive decline and loss of skeletal muscle mass and strength as one ages . A number of potential variables have been associated with the development of sarcopenia such as physical activity level, hormone deficiencies and dietary protein intake. As muscle function is a determinant of physical ability, sarcopenia can affect quality of life and consequently ability to maintain independence  . Many studies have found a direct link between physical inactivity and the progression of sarcopenia.

The relationship between habitual exercise and sarcopenia is one that is of importance. By understanding this relationship, the development of sarcopenia in the elderly population can be further understood and factors associated with the onset of the disease recognised.

The authors, Park, Park, Shephard and Aoyagi, hypothesised that there would be a positive association between habitual physical activity and muscle mass. While there have been a range of studies investigating the relationship between physical activity and sarcopenia, many are somewhat biased as they are based on self-reports or are very short in duration. This study spanned one year and used a pedometer/accelerometer for data recording, making the study representative of everyday physical activity.

Where is the research from?
This research focuses on elderly people living in Nakanojo, Gunma, Japan. As the study focuses on a small Japanese population, the results collated may not be reflective of other socio ethnic groups. For example, it has been observed that typically, Japanese individuals tend to be thinner than individuals of European or American descent and this may impact the study.

This study ‘Yearlong physical activity and sarcopenia in older adults’, is part of the Nakanojo study. Published in the European Journal for Applied Physiology, the study was conducted by H Park, S Park and Y Aoyagi from the Tokyo Metropolitan Institute of Gerontology as well as R J Shephard from the University of Toronto. Focusing on the Japanese population, the Nakanojo studies investigate the relationship between physical activity and a number of health aspects including physical and mental health. Park, Park, Aoyagi and Shephard are associated with many of these studies, but not all of them.

In addition to the studies included in the Nakanojo study, these authors have also produced a number of different publications, focusing on a range of health issues. Knowing that these authors have reputations in the field of health research and investigation, a combination of their knowledge is beneficial for this study.

What kind of research was this?
The results in this original study were cross-sectional. Cross-sectional studies are especially useful when investigating two different variables. In this study they observed the relationship between physical activity and the development of sarcopenia. Exercise level and intensity was compared to appendicular muscle mass.

What did the research involve?
Taking place between July 2002 and June 2003, the study comprised of 78 male and 97 female Japanese citizens all between the ages of 65-84. Those that took part in the study were ambulatory as well as free of any orthopaedic problems, cognitive impairments, myopathies and any chronic or terminal illnesses.

Participants were asked to wear an accelerometer/pedometer constantly for 1 year, 24 hours per day. The study focused on the duration and intensity of physical activity as well as appendicular muscle mass. Intensity was assessed using metabolic equivalents (METs). It was decided that the intensity at which daily physical activity would be performed would be set at >3 METs, which is equal to a moderate intensity. The pedometer/accelerometer recorded daily step counts and the intensity at which the individual was working. Skeletal muscle mass was measured using a whole-body dual X-ray absorptiometer (DXA) following the intervention. This allowed for assessment of muscle mass associated with the physical activity being undertaken.

The study had multiple limitations in the methodology:

The pedometer/accelerometer:
 * Errors in distance walked could have been encountered when an individual was walking uphill or downhill.
 * The pedometers response to resisted movements varies and is somewhat limited.
 * These factors possibly limit the estimate of total energy expenditure as well as the association with muscle mass.
 * Despite this, it was seen that step count remained unchanged and accurate.

The DXA:
 * Participants were only scanned by a DXA at the end of the study.
 * This allows a direct correlation between muscle mass and sarcopenia, but does not allow comparison of changes in muscle mass with sarcopenia.
 * If a DXA was performed at the start of the study, the findings could potentially be strengthened.

What were the basic results?
Results presented a number of notable findings. Values for appendicular muscle mass, year-averaged step count and year-averaged duration of physical activity were noticeably different between individuals. Those that were considered sarcopenic tended to have values lower for all 3 categories compared to those that were non-sarcopenic. When compared to sarcopenic individuals, non-sarcopenic individuals demonstrated to be of younger age, reiterating the fact that the disease is age related. Furthermore, non-sarcopenic individuals demonstrated to also be heavier and taller. It was found that participants between the ages of 65-74 had a higher duration of exercise that was >3METS compared to those between 75-84. Non-sarcopenic individuals also exhibited a greater duration of exercise.

Overall, males and females that had step counts of 7000 to 8000 and/or spent 15 to 20 min/day engaging in physical activity at intensities greater than 3 METs were likely to have muscle masses exceeding the sarcopenic threshold. Muscle mass tended to increase with habitual activity that was performed at a moderate to vigorous intensity.

What conclusions can we take from this research?
From the results presented in this study, it can be concluded that habitual exercise is beneficial in slowing the development of sarcopenia. By engaging in a minimum of 15-20 minutes of physical activity (walking) at a moderate intensity, and maintaining between 7000 and 8000 steps a day, an individual can significantly slow progression of sarcopenia.

A meta-analysis published in 2017 came to the same conclusion. It found that overall, individuals that engaged in physical activity were at a lower risk of developing sarcopenia. This is consistent with the findings of Park, Park, Shephard and Aoyagi.

Practical Advice
Taking the conclusions from this study, together with others, it is easy to say that physical activity has a strong relationship with the onset and progression of sarcopenia. In the case of older individuals, ensuring daily physical activity is of importance as maintaining muscle mass is imperative to slowing development of sarcopenia.

When undertaking physical activity or wanting to increase the level being undertaken, it is important to ensure it is safe to do so. This is especially important for older individuals and those with underlying health conditions. Consulting a medical professional would be beneficial for individuals with significant levels of sarcopenia, so that an appropriate exercise plan can be developed.

Further Information/Resources
2018 AIMSS Fact Sheet: https://aimss.org.au/wp-content/uploads/2018/07/Sarcopenia-Day-factsheet-for-Patients.pdf

ANZSSFR Website: https://anzssfr.org

Exercise and Sarcopenia: https://www.racgp.org.au/afpbackissues/2006/200603/200603taaffe.pdf


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Exercise as it relates to Disease/Short-term high-intensity interval training on body composition in overweight and obese young women

This is a critique of the journal article titled "Short-term high-intensity interval training on body composition and blood glucose in overweight and obese young women" by Kong Z, Sun S, Liu M, Shi Q, published in September 2016 in the Journal of diabetes research.

What is the background of this research?
Obesity is one of the worlds leading health issues, with over 1.9 billion people overweight in 2016 and of those people, 650 million people classed as obese. Epidemiological data shows that regular physical activity helps prevent obesity, cardiovascular disease, diabetes and hypertension. “Lack of time” being the main barrier for adults performing exercise, a more time efficient mode of exercise training has been developed. Both high-intensity interval training (HIIT; involves “near maximal” effort at intensities between 80-100% maximal heart rate) and low-volume sprint interval training (SIT; involves “all-out” or “supramaximal effort at the intensity of 100% of maximal oxygen uptake) are time efficient training strategies that can have positive impacts on health. There is a growing body of evidence to suggest that HIIT/SIT could reduce body mass, total or regional fat mass,   and waist circumference  and increase in fat-free mass. The purpose of this study was to compare effects of five weeks of HIIT intervention or moderate-intensity continuous training (MICT) on body composition and blood glucose as well as the systemic hormones that might influence body composition and blood glucose in overweight and obese young women.

Where is the research from?
This intervention was published in the Journal of Diabetes Research and written by Zhaowei Kong in 2016. Kong is an Associate Professor from the University of Macau and has been working there since 1991. He has been a part of over 50 research articles both English and Chinese with many of these articles focusing on obesity in a number of ways. His main research interests are physiological response and adaptation to exercise, hypoxic exercise and training and health and fitness.

What kind of research was this?
This research was a prospective cohort study taken over 5 weeks. The advantages of having a prospective cohort study is that it clearly indicates the temporal sequence between exposure and outcome. The study only had 22 eligible participants so following up on results wasn’t difficult. In comparison to retrospective cohort studies, the prospective cohort study will have fewer bias results as no information could be lost due to the study being taken out over a number of weeks instead of being looked back onto.

What did the research involve
This study involved female volunteers aged between 18 and 30 who had a classification of inactivity (doing less than 90 minutes of exercise a week for the past 6 months), and being overweight or obese, having a BMI over 23 and a body fat percentage over 30%. After completing a medical history questionnaire and a full physical examination to gain clearance to undertake vigorous exercise from a doctor, there were 22 eligible participants recruited to participate in the study. 11 participants were put in each group, the HIIT group and the MICT group, three participants from the MICT group and one participant from the HIIT group quit before completing the training intervention due to personal reasons. For five weeks each subject completed either the HIIT or the MICT exercise intervention, with four sessions per week.

Study Limitations
- The study had a small sample size with only 18 people participating, which limits the ability to draw meaningful conclusions regarding the improvement of body composition in response to HIIT and MICT.

- The study did not have a group of participants who did not participate in any physical activity for the two groups to be compared against.

- The timing of the intervention was done at the end of the year from mid-October to early December when people are more likely to gain weight. With evidence showing an average of 0.5 kg weight gain reported in fall and winter.

Study Strengths
- Pretraining measures were conducted during the follicular stage of the menstrual cycle for each subject, helps keep a reliable result to compare subjects.

- Appropriate tests were conducted and to a good standard.

- Recording of diet and other daily physical activity, taking into account external influences.

- Uses relevant and recent articles for research.

What were the basic results?
The study found a few key results:

- No significant differences on HR between the two groups (HIIT 164 +/-8 bpm, MICT 160+/-12 bpm)

- Both HIIT and MICT had a significant improvement in VO2peak and Peak power output (PPO) HIIT increased VO2peak by 7.9% and PPO by 13.8%, MICT increased VO2peak by 11.7% and PPO by 21.9%.

- No significant changes in weight, BMI, total fat mass and total body fatness for both groups.

What conclusions can we take from this research?
This study came to the conclusion that there was no significant changes or improvement in body composition after completing HIIT and MICT but there were improvements in their VO2peak and aerobic capacity. A further study showed that for a longer duration, 12–15 weeks there was an even higher improvement in their results for VO2peak and aerobic capacity. They found that HIIT was perceived to be easier than MICT when looking at the average bpm of each. For people who have limited time and want to get some exercise the HIIT sessions were just as beneficial as the MICT group but for a shorter duration. Another study done shows that there was only an improvement in the body composition of obese women using the HIIT course when also having a strict diet such as the Mediterranean diet.

Practical Advice
If you are a young woman struggling to lose weight and find the time to exercise the HIIT sessions would be beneficial for you. You should also consider changing up your diet as it accounts for roughly 80% of weight loss verses just 20% due to exercise. Any exercise is better than none though, so even taking an hour out of your day to go on a walk around your neighbourhood or nature walk is beneficial, with other research showing that even 2.5 hours of moderate activity per week can lower the risk of heart disease by 14%.

Further information
If you would like to find out more information have a look at these sites:

- Australian Physical Activity Guidelines https://www1.health.gov.au/internet/main/publishing.nsf/Content/fs-18-64years

- Overweight and Obesity in Australia https://www.aihw.gov.au/reports-data/behaviours-risk-factors/overweight-obesity/overview


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Exercise as it relates to Disease/Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults

Article critiqued - Willis, L. H., Slentz, C. A., Bateman, L. A., Shields, A. T., Piner, L. W., Bales, C. W., Houmard, J. A. & Kraus, W. E. (2012). Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. Journal of applied physiology.

This article critique is an assignment for the unit; Health, Disease and Exercise at University of Canberra, Semester 2, 2020.

What is the background to this research?
The 2009–2010 National Health and Nutrition Examination Survey found that 75% of U.S adults aged 20 years and older are overweight, obese or extremely obese. This may indicate that exercise guidelines are not being met or appropriate modes of exercise are not being utilised. Obesity is a condition that can cause mortality due to the increased risk of chronic disease and cancers. It is widely supported that exercise can decrease body mass and fat mass in overweight and obese individuals, however, there are limited recommendations of exercise modes which are most effective in achieving this. Exercise guidelines have often focused on endurance or aerobic training to treat weight loss and maintenance, recent studies have shown that resistance training can also be effective in reducing fat mass.

Where is the research from?
Willis, Slentz, Bateman, Shields, Piner, Bales, Houmard, and Kraus conducted their research and testing at Duke University Medical Center and East Carolina University in North Carolina. The protocols for the study were reviewed by the institutional review boards at each university. There were no conflicts of interest, financial, or otherwise declared by the authors. Funds were provided by the National Heart, Lung, and Blood Institute, the third-largest Institute of the National Institutes of Health. The authors in this study are well established and have a variety of experience and published articles related to obesity, chronic diseases, and physical activity.

What kind of research was this?
This study was a randomised comparative effectiveness research trial of overweight and obese adults with cardiometabolic risk factors.

What did the research involve?
119 sedentary, nondiabetic, overweight or obese adults were selected from 3,145 that responded to newspaper, magazine, internet, and word of mouth advertisements at Duke University and East Carolina University. Participants were randomised into one of three 8-month exercise protocols:
 * 1) Resistance training 3 days a week, 3 sets a session, and 8-12 repetitions per set
 * 2) Aerobic training calorically equivalent to 12 miles a week at 65-80% peak VO2
 * 3) Resistance and aerobic training combined requiring double the time commitment

Nutrition, body composition, weight, height, and waist circumference were measure pre and post-exercise intervention. Greater investigation of factors such as missed sessions, calorie intake, and energy expenditure would have provided further insight into the results of individuals. Body composition was measured using either a BOD POD or DEXA allowing lean mass and fat mass to be measured accurately. Calorie intake was calculated pre and post-exercise intervention using a 24-hour recall interview and 3-day food record. Using a 24-hour recall was a limitation of the study as it requires subjects to rely on memory, honesty, and may not reflect their usual intake. Computed tomography was used to measure the change in thigh muscle area which adds validity to methods used to measure body composition. A cardiopulmonary exercise test with a 12 lead ECG was used to measure absolute peak VO2 and heart rate monitors were used at each session.

What were the basic results?
Key findings of this study
 * Group 2 and 3 reduced total body mass and fat mass more than group 1
 * Group 1 and 3 increased lean body mass more than group 2

The study implies that there is conflicting research in regard to whether or not resistance training reduces fat mass. The study has effectively discussed how resistance training has been perceived in other studies and acknowledges they have failed to show resistance training results in a significant total body and fat mass loss. Multiple studies within the discussion emphasize resistance training alone does not show a decrease in fat mass however it is equally effective as aerobic training in decreasing the risk of cardiovascular diseases. Nutrition results in this study were not significant or evident in the discussion, further research was needed. Results could have been different if subjects did not volunteer, were not supervised, and relied on their own self-efficacy. further to this outside of the study, it may be difficult for the general population to access heart rate monitors and know 65-80% of their peak VO2.

What conclusions can we make from this research?
It can be concluded that aerobic training alone is the best mode of exercise to reduce body mass and fat mass in nondiabetic, overweight, and obese adults. Resistance training and aerobic training combined did not show a significant decrease in fat mass and body mass compared to aerobic training alone. Resistance training showed an increase in lean muscle mass but did not decrease fat mass or total body mass. whilst the study did not place a great emphasis on this, it is evident that resistance training and aerobic training combined showed a greater decrease in waist circumference compared to aerobic or resistance training alone. This is supported by two studies that demonstrated visceral adipose tissue decreased after a resistance training intervention.

Practical advice
This advice relates to those who are over the age of 18 with no present cardiovascular diseases or those who are nondiabetic.
 * If the goal is to gain lean mass than resistance training at a total of 180 minutes a week is the optimal mode of exercise.
 * If the goal is to maintain weight and reduce the risk of cardiovascular risk a combined program of resistance and aerobic exercise is the most appropriate mode of exercise. Aerobic training at 65-80% peak VO2 for 133 minutes a week and resistance training for 133 minutes a week is optimal.
 * If the goal is to reduce fat mass and total body mass aerobic training alone is deemed to be the most effective mode of exercise. This should be completed at 65-80% peak VO2 for over 133 minutes a week.

Further information/resources
This study supports the widely accepted notion that aerobic training can decrease total body mass and fat mass, although further research is needed to investigate the effectiveness of resistance training in combination with aerobic training on obese and overweight individuals. This study demonstrates that resistance training does not directly decrease fat mass, there are however other benefits it can have on obese or overweight adults with cardiometabolic risk factors which warrant further investigation. In addition, energy expenditure and calorie intake could be examined further to determine if aerobic and resistance training combined with a low-calorie diet can enhance weight loss. A decrease in calorie intake is shown to be an important factor in long term weight loss.

These ideas can be explored further by the links below
 * https://europepmc.org/article/med/618431
 * https://www.hindawi.com/journals/jobe/2011/482564/


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User:Louisajoseph

Background and Interests:

I am currently a student attending the University of Canberra, studying exercise physiology and rehabilitation. I am interested about the physiology of the human body, more specifically, how we can use physical activity as a tool to improve the well being of different populations.

Wikibook Projects:

None

title: User:Louisajoseph


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User talk:2401:4900:3B01:6AB8:992A:E939:EF89:834F

--Synoman Barris (discuss • contribs) 08:16, 15 September 2020 (UTC)


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Exercise as it relates to Disease/Finding the motivation to exercise

This Wikibooks page is a critical appraisal of the research article “Understanding exercise adherence and dropout: an interpretative phenomenological analysis of men and women’s accounts of gym attendance and non-attendance” by Pridgeon, L. and Grogan, S. (2011).

What is the background to this research?
Low participation in physical activity (PA) has become one of the leading global health concerns. A primary contributing factor to low PA is a lack of motivation, which often leads to a cease in exercise. The decline in participation often begins in adolescence but is still far from a rarity in adult groups, especially with gym adherence.

Various reasons including time, motivation, financial problems, and boredom have been noted as common reason that lead to gym dropouts. Men and women are shown to have different motivations that lead to their interest in exercise. Women have shown a more positive understanding in the health benefits of PA, whereas men see exercise as less of a priority. Many adults find beginning PA easier when extrinsic motivation is a factor, but most participants cease exercise once the incentive has been obtained. These individuals have lower levels of intrinsic motivation meaning the continuation of PA is less prevalent.

The study undertaken in this article questions males and females in two groups, separated into whether they continued or discontinued adhering to a gym routine, with the goal of finding common themes between the groups.

Where is the research from?
This study was conducted by Lisa Pridgeon and supervised by Sarah Grogan through Staffordshire University. Their article was published as a part of the ‘Qualitative Research in Sport, Exercise and Health’ journal, Volume 4 – Issue 3. Pridgeon’s interests focus on qualitative research methods with this study being part of her MSc Health Psychology.

What kind of research was this?
This research is classified as Qualitative research, due to its literacy-based findings and descriptive explanations of the results. There was no numerical data collected, only responses that were expanded on to understand similar themes. The experiment was interest-based, as the researcher was motivated by the discrepancy between her own, and less inspired people’s lifestyles. This method proved effective for the chosen research.

What did the research involve?
14 participants aged 19-32 years old; seven men and two women who had maintained their current gym membership, and three women and two men did not.

The information was collected using an Interpretative phenomenological analysis. This methodology helps understand a person’s thoughts and feelings on a matter by listening to accounts of their personal experiences. Face-to-face interviews were conducted and recorded with a digital recorder. A questionnaire and consent forms were completed, then the interview proceeded by following a set of guiding questions which accurately obtained participant information.

What were the basic results?
Results were split into 5 themes; three shared between the two groups, one discussed by adheres only and one discussed by non-adheres only.

The three themes that were common to both groups were Upward Social Comparison, Culture and Habit. The adherer specific theme was Exercise Dependency, whilst the non-adherer theme was Social Support. Each theme was created into a subheading, followed by relevant quotes, interpretations and supporting literature. Different attitudes between each group are notable when describing motivation and lack-there-of.

Validation seemed to be the strongest motivator for adherence. Validation from others then self-validation in achieving “goals” and what they see as a healthy “addictive” lifestyle. The opposite view is evident in the non-adherers, as they seem to validate others above themselves, resulting in poor attendance and body dissatisfaction, especially in women.

What conclusions can we take from this research?
This study is a sound resource that provides great insight into the thought processes behind exercise adherence. As the trend of global inactivity increases, research involving motivation and drop-out numbers will become more valuable in educating relevant groups. The effectiveness of this study shows the benefit of a literature style alternative to data collection, increasing the reach to people non-responsive to numeric data. This article provides a great understanding of exercise adherence in both men and women.

Practical advice
A larger sample size would give a more accurate conclusion if the relevant themes were still commonly addressed with larger participation. Following up with additional participants could provide greater post-interview developments, due to one of the two follow up participants suffering an injury. The intrigue would be based on non-forced drop-out rates, so additional follow up’s with healthy participants would be advantageous.

Further information/resources
https://psycnet.apa.org/record/1996-01401-005

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0838.2009.01064.x

https://shapeamerica.tandfonline.com/doi/abs/10.1080/02701367.2008.10599501


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Exercise as it relates to Disease/Age-related effectiveness of endurance training as it relates to diastolic function in systolic heart failure patients

The following is a critical analysis of the paper: "Age-related effects of exercise training on diastolic function in heart failure with reduced ejection fraction: The Leipzig Exercise Intervention in Chronic Heart Failure and Aging (LEICA) Diastolic Dysfunction Study" (Marcus Sandri, Irina Kozarez, Volker Adams, Norman Mangner, Robert Hollriegel, Sandra Erbs, Axel Linke, Sven Mobius-Winkler, Joachim Thiery, Jurgen Kratzsch2, Daniel Teupser, Meinhard Mende, Rainer Hambrecht, Gerhard Schuler, and Stephan Gielen)

What is the background to this research?
Diastolic dysfunction has been identified as an important predictor of increased mortality for patients who have experienced heart failure and often is an indication of reduced exercise capacity. The heart has trouble relaxing between breaths which limits the amount of blood the ventricles can collect. The impact being that with less oxygen rich blood being pumped with each contraction (< 40%), the heart is required to work harder. Diastolic left ventricular dysfunction is also influenced by a number of clinical factors including age, hypertension, obesity, and diabetes. The research paper hypothesises that endurance exercise training can improve diastolic dysfunction among heart failure patients with reduced ejection fraction (HFREF) and seeks to determine if the training is attenuated in older patients.

Where is the research from?
This research paper was published in the European Heart Journal, a peer reviewed medical journal focussing on cardiology, and published by Oxford University Press on behalf of the European Society of Cardiology, a very reputable medical journal.

The papers primary author was Dr Stephan Gielen, a reputable researcher with over 238 papers to his name. This paper was co-authored by a number of researchers (15). Often the case where data collection and coordination is non-trivial as is the fact that collaboration among researchers is more the norm.

There were no conflicts of interest or bias declared. The study was supported by an unrestricted research grant of the Deutsche Forschungsgemeinschaft. A self-governing institution for the promotion of science and research.

The importance of this research lies in the age of the group tested as this enabled the researchers the ability to make an assessment on diastolic dysfunction in heart rate patients based on age and hence a predictor in quality of life based on a complimentary prescription of endurance exercise.

What kind of research was this?
This study was conducted in the form of a prospective Randomised Control Trial (RCT), in which the HREF patients participating in the trial were first recruited based on categories relating to age (≤55 and ≥65) and then within the age group, randomly divided into either the training group participating in the endurance exercise intervention, or as an inactive control group for later comparison.

An RCT method of research is considered one of the most plausible ways of establishing a cause and effect relationship and generally accepted approach consistent within clinical interventions. Randomly allocating alike participants into a treatment or control group, helps to limit bias within the intervention itself or from those studies such as case controlled or observational studies where the outcome may be known and the study conducted is usually retrospective.

What did the research involve?
The study involved the 120 participants, 60 were healthy and 60 with HFREF. Once divided into age groups, half assigned an endurance exercise training program whilst those not assigned the program remained the control group.

The exercise intervention consisted of four supervised training sessions per week each for 20 minutes followed by a 60-minute recreation session.

Primary outcome measures involved the measurement of improved functional exercise capacity (through cardiopulmonary exercise testing) and the subjects left ventricular diastolic function as assessed by tissue Doppler (E/E' ratio).

The same echocardiographer was used for all measurements and was blinded to the patient status to remove any bias.

There are some limitations to the research worth noting:
 * Patients with HFREF were recruited based on referral to a single center. Therefore, patients in the study may not be representative of the entire HFREF population.
 * The patients were taking normal medications throughout the process which may have altered the potential of results via beta-blockers, some medications can influence heart rate.
 * Given the disparate ages in the control group, common age related diseases such as hypertension and dyslipidemia were identified which can have an effect on exercise using max heart rate as a measure of effort.

What were the basic results?
Diastolic Functional Assessment
 * Endurance training is highly effective in improving left ventricular diastolic function in HFREF patients regardless of age.
 * Reduction of LV isovolumetric relaxation time by 29% in young and by 26% in old.
 * As assessed by tissue Doppler, septal E′ increased by 37% in young and by 39% among old
 * significant decrease in the E/E′ ratio from 13±1 to 10±1 in young and 14±1 to 11±1 in old.

Exercise Functional Assessment
 * Maximal exercise capacity in the control group increased by 30% in the younger and 31% in the older.
 * Maximal oxygen uptake increased by 14% in the younger and 19% in the older.
 * In HFREF subjects, maximal exercise capacity increased by 31% in the younger and 37% in the older.
 * Maximal oxygen uptake increased by 26% in the younger and by 27% in the older.

The researchers presented a very clinical approach to their analysis and did not over-emphasise the results. They proved the physiological benefits of the endurance exercise intervention on patients with and without the HFREF condition not just with before and after testing but with paired data testing. To complete the analysis of findings it would have been beneficial to better understand the recommendation on research next steps regarding the potential physiological benefits for the higher risk patients that were initially removed from the trial and to broaden the trial to a larger more representative population.

What conclusions can we take from this research?
There is no doubting the benefits of physical exercise as a compliment to modern medicine. The intervention quantitatively proves the success of endurance exercise for HFREF and control patients. The older age group that were used as the control group that showed symptoms of age-related disease also showed markable improvement. As these life diseases are common, it would be helpful to further the research to demonstrate the benefits more quantitatively. A wholistic approach to research would ensure that health span and its relationship to lifespan and age-related diseases is understood.

Practical advice
As evidenced in this review and recent studies, endurance-based training provides significant benefit to cardiovascular health, particularly diastolic heart function and should be considered, within a controlled setting, an integral part of any patient recovery or exercise program.

 * Aerobic programs that encourage lower intensity social activities would benefit all participants regardless of pre-existing conditions and could assist with intrinsic motivation to adopt more permanent change.
 * Examples include walking, jogging, dancing and biking.
 * Seeking advice from your doctor or allied health professional is critical to ensure you're following a safe and effective program.

Keep an eye out for warning signs of heart attack such as chest discomfort, shortness of breath or other signs such as cold sweat, nausea or light headedness. Refer to Heart foundation's recovery support and resources section for further information heart foundation my-heart-my-life

Further information/resources
For further information on the benefits of endurance training as it relates to your heart, below are some additional resources that would be considered useful.
 * 1) Heart foundation
 * 2) Exercise based rehabilitation
 * 3) Chronic Heart disease and exercise
 * 4) Australian Allied Health Professionals
 * 5) Exercise and Sports Science Australia
 * 6) Exercise right


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User:KierenWhyte/sandbox

This is a critique of the research article: Jan MH, Lin JJ, Liau JJ, Lin YF, Lin DH. Investigation of clinical effects of high-and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Physical therapy. 2008 Apr 1;88(4):427-36.

What is the background to this research?
Osteoarthritis (OA) is a common musculoskeletal disorder which commonly affects hands, knees, hips, the lower back and neck. According to a 2011-12 national survey, 8% of Australians had been reported with osteoarthritis with twice as many female cases as males (10.2% and 5.6% respectively). There are many factors that have been linked to causing OA: Osteoarthritis can also have a heavy impact on the lifestyle of the population. Common symptoms of osteoarthritis include pain, reduced mobility, stiffness and decreased muscle strength which may lead to decreased physical activity, and ultimately further health concerns. A decrease in physical activity has potential to lead to weight gain or obesity which then may bring upon health issues such as high cholesterol, diabetes, heart disease and high blood pressure. People living with OA are also at greater risk of falls and fall-related injuries. The National Council on Aging found that people with OA have a 30% greater chance of having a fall, and 20% greater chance of a fracture from a fall. Resistance training has been linked to reducing pain and promoting exercise in OA patients. The current literature suggests that resistance training (resulting in increased muscle strength) has been found to reduce pain and improve joint function. Another study on blood flow restriction training found a greater increase than just standard resistance training. The aim of the present study was to determine the effects of high- and low-intensity training on pain and functional scores related to knee OA. The hypothesis of the study was that the resistance training groups would present a greater functional improvement compared to the control group.
 * Age
 * Joint injury/overuse: common in both work and sporting environments
 * Obesity: extra weight and forces being placed on joints
 * Weak muscles: weak muscles causing instability
 * Genetics
 * Sex/gender

Where is the research from?
The authors of this study were The study was completed in Taiwan with participants recruited from the Department of Orthopaedics at the National Taiwan University Hospital.
 * MH Jan, PT, MS, is Associate Professor, Medical College, School and Graduate Institute of Physical Therapy, National Taiwan University, and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital
 * JJ Lin, PT, PhD, is Associate Professor, Medical College, School and Graduate Institute of Physical Therapy, National Taiwan University
 * JJ Liau, PhD, is Associate Professor, Medical College, School and Graduate Institute of Physical Therapy, National Taiwan University
 * YF Lin, MD, PhD, is Chairman, Department of Orthopaedics, West Garden Hospital
 * DH Lin, MD, is Attending Doctor, Department of Orthopaedic Surgery, En Chu Kong Hospital, Taipei Hsien, Taiwan, Republic of China

What kind of research was this?
This study was a single-blind randomised controlled trial. The evaluation of results was performed by the same examiner, who also remained blinded to the experiment. There were three groups in this study, two exercise groups and a control group – of which participants were assigned to via a randomisation number table.

What did the research involve?
There were 102 participants split into three groups – high-resistance (HR), low-resistance (LR) and a control group. These participants needed to meet the needs of the American College of Rheumatology criteria of knee OA (hyperlink a link of needs). Participants were also excluded if they had received physical therapy in the 3 months prior to the study or had other musculoskeletal issues with the knee joint. There were 34 participants in both the resistance (high and low) groups with 30 participants featuring in the control group. All participants were required to do some pre-testing for pain and physical function. The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain scale was used to compare pain levels of the participants whilst performing general housework tasks such as bathing, walking, sleeping and sitting. The physical function tests were Participants were required to complete these tasks as quick as they could, time was measured in seconds. Participants were seated in an upright position against a backrest inclined to 15 degrees. The test required participants to either extend or flex their knee as far as possible with starting angles of the knee being at 60 degrees, 120 degrees and 180 degrees. The practical part of the study was an 8-week resistance training program that was individually prescribed and monitored by an experienced therapist. The programs all had similar total volume (resistance x repetitions x sets) and was referred from a predicted 1RM. Every two weeks the participants’ 1RM was re-tested to adjust the resistance increased 5%. The sessions consisted of: For each session, there was a 10-minute stationary bike warm up and post exercise cold packs were applied to the participants knees for 10 minutes.
 * Walking time over 4 different terrains: hard/level surface, a figure-eight pattern, a staircase consisting of 13 stairs and along a spongey surface
 * Knee extensor and flexor muscular torque
 * High resistance: participants resistance was set to 60% 1RM for 3 sets of 8 repetitions. Sessions lasting 30 minutes
 * Low resistance: participants resistance was set to 10% 1RM for 10 sets of 15 repetitions. Sessions lasting 50 minutes.
 * Control group: the control groups were not permitted any exercise throughout the duration of the study

What were the basic results?
The results from the study was that resistance training does reduce pain and increase function of OA sufferers. Both resistance groups scored much better after the 8-week training program compared to the control group with similar results between the high-resistance and low-resistance groups. The WOMAC pain index scores decreased, the walking times for the figure-eight pattern and the spongey surface times decreased and the muscle torque for flexion and extension all improved. Some key results included the WOMAC pain subscale scores (8.5 to 4.8 and 7.8 to 4.8 in HR and LR), figure-eight pattern time (11.0 seconds to 6.1 seconds and 10.9 seconds to 6.8 seconds) and the spongey surface times (12.6 seconds to 6.3 seconds and 12.5 seconds to 7.3 seconds).

What conclusions can we take from this research?
The conclusion of the study found that both high- and low-resistance training groups are beneficial in reducing pain and increasing function in people with knee OA compared to the control group. Previous literature has stated that high-resistance training has greater results compared to low-resistance training but with the results of this current study we can see that low-resistance training can be just as effective. Between the high- and low-resistance training groups the differences in improvements for the WOMAC pain scores were quite little, but for knee function the high-resistance training proved to have a greater result.

Practical Advice
People who are experiencing pain or a loss of function in their knee(s) from OA should be doing some resistance training as part of their rehab and/or management. All through the literature there are lots of papers supporting the findings of this study. Although most OA studies have been looking at participants of the older population, the younger population can still benefit off the same style of training.

Further information/resources
Osteoarthritis Australia

Strength training with Arthritis

title: User:KierenWhyte/sandbox


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Exercise as it relates to Disease/Physical activity treatment in multiple sclerosis

This is a critical analysis on the article from the Multiple Sclerosis Journal, “Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis.”

What is the background to this research?

(MS) is a disease of the, in which the attacks , the protective sheath that covers nerve fibres. This means MS patients are not able to drive active motor units at high firing frequencies, resulting in impaired muscle activation and lower limb.

When it comes to using training as a form of  for people suffering with multiple sclerosis, there is already a wide range of studies that have found supervised training results in improved, , , mobility, and health-related quality of life in MS patients. Although these are positive findings, it has also been found that people with multiple sclerosis are not simply not participating in sufficient amounts of this style of exercise training, resulting in the recommended levels not being met by majority of the MS community.

This study addresses the promotion of moving away from structured exercise training and instead encouraging engagement in more lifestyle based physical activity, and applying it to the MS community. Lifestyle physical activity involves the daily accumulation of 30 or more minutes of moderate-to-vigorous intensity self-selected activities. This can include activities that make up every day life such as leisure, household chores, gardening etc.

Where is the research from?
This research was undertaken in the United States at the University of Illinois. The article was published in the Multiple Sclerosis Journal, a peer reviewed journal which is recognised by the Committee on Publication Ethics, making it a reputable source that focuses on all aspects of multiple sclerosis.

The research was supported by a grant from the National Multiple Sclerosis Society. There is no evidence of bias when considering that this is a national, multi-chapter, non-profit organisation. Furthermore, the lead author, Lara A. Pilutto was the recipient of a Postdoctoral Fellowship from the Multiple Sclerosis Society of Canada and a Du Pré Grant from the Multiple Sclerosis International Federation, the international body that links the National MS societies around the world. All of these reputable sponsorship links show no conflict of interest or bias.

Lead author, Professor Lara A Pilutti has 87 publications that focus on the role of exercise in the management and treatment of disability arising from neurological disorders, particularly multiple sclerosis.

What kind of research was this?

This study was a, the gold standard in research when it comes to determining whether a cause-effect relation exists between the trial groups ensuring bias does not impact the results of the treatment.

There have been many cross-sectional and cohort studies of daily physical activity and it’s outcomes for people with multiple sclerosis, with evidence showing improved quality of life, fatigue and depression as a result of physical activity. By examining these outcomes using a randomized control trial, these correlations found in previous studies can be supported by stronger evidence.

What did the research involve?
This study was a 6-month randomized controlled trial using an internet-delivered intervention based on symptomatic, health-related quality of life, and physical activity outcomes in 82 ambulatory persons with multiple sclerosis. The initial aim of this trial was to determine the efficacy of using an internet-based intervention for this particular community, which should be considered more important than ever with the current often placing sufferers of MS into isolation which is exactly where tools like this can be most useful. Once this had been established, the aim was to replicate previous results from other studies encouraging free-living physical activity instead of a structured structured exercise program.

The intervention included:
 * A website with information about becoming more physically active
 * Self-monitoring and goal setting using a and activity logs
 * One-on-one web-based video coaching sessions.

Intervention Strengths:
 * Gold standard randomized control trial
 * Duration of 6 months with regular interventions and one-on-one check ins
 * Thorough recruitment, baseline and post-trial testing
 * Excellent adherence

Intervention Limitations:
 * Relying on participants self-reporting which leaves the potential for personal bias when rating activity levels.

What were the basic results?
Most statistically significant differences between the two trial groups post-trial were seen in the measures of
 * Leisure Time Exercise
 * Fatigue severity
 * Depression and Anxiety

What conclusions can we take from this research?
The primary finding was the significant and positive effect of the intervention on fatigue severity and its physical impact, depression, and anxiety, and increase in self-reported physical activity.

One limitation to these findings is that all results that showed significant improvements were taken from data pulled from self-completed questionnaires and self-reported activity from participants which does present the risk of personal bias.

This suggests that interventions targeting lifestyle physical activity can provide the same benefits as an intervention based on a structured exercise program, promoting the engagement in lifestyle physical activity among the MS community.

Practical advice
People with multiple sclerosis should first consult an allied such as an exercise physiologist and complete and an adult pre-exercise screening before making any changes to their current physical activity regime as individual symptoms for persons with MS can vary substantially.

Some examples of lifestyle activities a person with MS could include in their day-to-day life to increase physical activity levels are: (depending on severity of symptoms and recommendations from an allied health professional)

 * Walking to local shops or walking a pet
 * Taking the stairs instead of an elevator
 * Gardening
 * Chores around the house
 * Occupational physical activity
 * Cooking

For general recommendations on physical activity and exercising with MS, please see the link below under the further information/resources heading for MS Australia’s guidelines.

Further information/resources
For further information regarding this topic, please see below resources for additional support:

 * Information on the disease of Multiple Sclerosis: https://www.msaustralia.org.au/what-ms
 * Online community for people affected by Multiple Sclerosis: https://shift.ms/
 * Physical activity recommendations for Multiple Sclerosis: https://www.msaustralia.org.au/living-with-ms/expert-blog/exercise-and-ms#:~:text=Choose%20exercise%20that%20you%20enjoy.&text=disabilities%20(4).-,Physical%20Activity%20Guidelines%20for%20adults%20with%20mild%20to%20moderate%20MS,days%20per%20week(5).
 * Useful Resources for exercising with Multiple Sclerosis: https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Exercise
 * Articles for the Multiple Sclerosis Community: https://www.gene.com/topics/multiple-sclerosis


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Exercise as it relates to Disease/Physical activity trends in an older population post-stroke

This page is a critique of the research article: Birgit Vahlberg Med Dr, PT, Annika Bring Med Dr, PT, Karin Hellström PT & Lena Zetterberg Med Dr, PT (2019) 'Level of physical activity in men and women with chronic stroke'. Physiotherapy Theory and Practice, 35:10, 947-955.

It was undertaken as an assignment for the Health, Disease and Exercise Unit (8340) at the University of Canberra in Semester 2, 2020.

What is the background to this research?
Low physical activity (PA) levels are a common trend amongst stroke survivors. In order to improve PA levels, a better understanding of the factors influencing participation must be enhanced. This study examined gender differences in PA, physical functioning and psychological factors and the association between these factors and PA in men and women 1–3 years post-stroke. The American Heart Association recommends at least 20–60 minutes of medium - high level intensity exercise (expressed as 40–70% of either peak oxygen uptake or heart rate reserve) 3 or more days per week for stroke survivors.

Stroke is a major global health issue. About 25.7 million people were living with a stroke in 2013, one-quarter of which are often recurrent. Physical, psychological, and psychosocial problems following stroke have been linked to a reduction in PA participation. The reason as to why PA participation is so low is not as well documented, therefore making this study quite valuable. It examines gender differences and whether they play a significant role in PA, something that has been given minimal attention in stroke research.

Where is the research from?
This study consisted of 187 community-dwelling individuals, aged between 65 and 85, with history of a stroke in the last 1–3 years. Males made up the majority of the cohort at 71%, with the remaining 29% being female. Any individual's with dementia or severe cognitive or language dysfunctions were excluded from the study.

The research was published in 'Physiotherapy Theory and Practice: An International Journal of Physical Therapy'. Vahlberg, Bring, Hellström and Zetterberg conducted their research at the Uppsala University, Uppsala, Sweden. Despite the study being conducted overseas, it is still very relevant for Australians. All four authors have a good reputation in the Department of Neuroscience field, with over one hundred publications between them. Hellström would have the most experience in the field, as shown with her 55 publications alone.

What kind of research was this?
This research was a secondary analysis based on previously obtained data from a cross-sectional study. The evidence surrounding lack of PA post-stroke is undeniable, however the reason as to why this is occurring is not so clear. Given the objective of the study was to analyse different factors between genders, psychological and physical functioning, the study design is fitting.

What did the research involve?
Data was collected from the 187 community-dwelling individuals in a range of index and scale type formats. These included:

 * 1) Charlson Comorbidity Index
 * 2) Physical Activity Scale for the Elderly (PASE)
 * 3) Short Physical Performance Battery (SPPB)
 * 4) Modified Motor Assessment Scale (M-MAS)
 * 5) Berg Balance Scale (BBS)
 * 6) 10-metre walking test (10mWT)
 * 7) Geriatric Depression Scale (GDS-20)
 * 8) Short Portable Mental Status Questionnaire (SPMSQ)
 * 9) Falls Efficacy Scale, Swedish version (FES(S))
 * 10) EQ-5D index.

All of these scales have been used in previous stroke research in elderly individuals, proving to be reliable and valid forms of measurement.

All performance based tests (i.e PASE, GDS-20, FES(S), EQ-5D) were conducted by the first author (Vahlberg) at the Uppsala hospital. The other tests were sent to each participants' homes to be completed and brought back with them. Once the data was collected, Statistical Package for Social Sciences (SPSS) Version 24 was used to analyse the statistics.

Small bias may exist in some aspects of the data in relation to the self-reporting. Some may under or over estimate their PA levels, leading to a skew in the results. Perhaps a more even spread of male and female participants would have been more desirable.

What were the basic results?
Of the 187 individuals within the cohort, the mean age was 74 years, with a median time of 13 months since their stroke for both men and women. No comorbidities were observed for 57% of males and 67% of females. There were no gender differences in the level of self-reported PA. In men, a significant correlation was found between PASE and: age (r = −0.19; p = 0.033); BBS (r = 0.55; p < 0.001); EQ-5D (r = 0.48; p < 0.001); SPPB (r = 0.59; p < 0.001); walking speed (r = 0.51; p < 0.001); FES(S) (r = 0.48; p < 0.001); GDS (r = −0.29; p < 0.001); M-MAS (r = 0.49; p < 0.001); and SPMSQ (r = 0.26; p = 0.003). No significant correlation was found between PASE and FOF (r = −0.12; p = 0.26) or falls (r = −0.1; p = 0.28).

In women, a significant correlation was found between PASE and: BBS (r = 0.42; p = 0.001); EQ-5D (r = 0.37; p = 0.006); SPPB (r = 0.48; p > 0.001); walking speed (r = 0.33; p = 0.015); FES(S) (r = 0.43; p = 0.001); GDS (r = −0.39; p = 0.003); and M-MAS (r = 0.54; p < 0.001). No significant correlation was found between PASE and age (r = −0.03; p = 0.83) or SPMSQ (r = 0.05; p = 0.69).

The researchers found that the self-reported PA, as measured by PASE, was associated with walking speed in men, and self-reported PA was associated with balance, as measured by the BBS, in women. The regression model explained 29% of the variance in the PASE outcome for males, and 23% of the variance in the PASE outcome for females.

What conclusions can we take away from this research?
This research is advantageous for anyone affected by a stroke in some way, whether it be personally or someone they know. First and foremost, having the knowledge of the benefits of PA is paramount. Following PA guidelines set out by the American Heart Association is a great starting point, and something to follow as closely as possible in order to maximise health post-stroke.

The study found that a gender-specific approach could be effective in optimising strategies to increase PA 1 – 3 years post-stroke. The information from other studies regarding gender differences in PA is scarce, therefore this is an area of study that should be looked into further to help increase the rate of PA in stroke survivors.

Practical advice
Based on the evidence available, it is recommended that stroke survivors should undertake different forms of PA each week to assist them in their day-to-day life. This includes strength, flexibility, balance and coordination training (2-3 times per week for each modality) to enhance independence, increase range of movement and prevent deformities. Aerobic exercise should also be carried out a few times per week at a moderate intensity for at least 20 – 60 minutes at a time, which will help improve physical capabilities and decrease the risk of other issues, such as cardiovascular disease.

It would be in the best interest of an individual to see a doctor or some other healthcare professional in order to safely prescribe a rehabilitation program for them. This will minimise any risk factors that may come with PA after suffering a stroke.

Further information/resources

 * https://www.stroke.org
 * https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/stroke-rehabilitation/art-20045172
 * https://www.ahajournals.org/doi/epub/10.1161/STR.0000000000000211
 * https://www.webmd.com/stroke/home-after-stroke