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Exercise as it relates to Disease/Improving behavior and cognitive functions in children with ADHD with a physical activity program

The article being critiqued is. This is for an university assignment

What is the background to this research?

 * ADHD children have been known to struggle with academics and socializing in schooling environments so a paper by Claudia Verret etal, called "A physical activity program improves behavioral and cognitive functions in children with ADHD: an exploratory study" in 2012 was done to see if exercise could help. The small intervention looked at the kids behaviours, social interactions, how they felt, their physical performance and intellectual performance to see if the exercise had any effect.
 * While other studies had been done to look at the relationship between ADHD and cognitive ability this study was one of the first ones to look into a wider range of effects exercise can have on ADHD children.
 * While this was only a small study it allowed other researchers to use its information to give reason to look more deeply into this topic and the paper can be found being used by other papers years after its release.

Where is the research from?

 * The group of researchers were from Québec Montréal Canada with 4 of the 5 of them holding a PHD most relating in different ways to the research and the other had a masters in science, most taking an interest in how physical activity can help ADHD children . The journal the paper is in is called "The Journal Of Attention Disorders " which has an impact factor of 2.826 according to web of science group and 3.044 from scopus, when 3 is considered a good impact factor this puts it just on the line of being a good reliable journal . The paper would have been an exciting one to have in their Journal with it being one of the first of its kind , especially with positive outcomes making it more desirable to have, as positive reliable results in this area were uncommon at the time.

What kind of research was this?

 * The study was a randomized control trial with the two groups, one doing the experiment while the other group is there for control, the children were selected by finding children in the local area of Québec Montréal to met a criteria set by the local hospital 'Rivière-des Prairies Hospital'. When split into two groups the experiment group was all from the same school and the control group was all on medication compared to the 30% in the experiment group, so there were some things that could have been better tested if more randomized.
 * With lots more research coming out there is stronger support to agree with the evidence of physical activity supporting, ADHD symptoms and some help with social and behavioural problems compared to this paper where there wasn't as much strong effects to support the findings.

What did the research involve?

 * In the study both groups ( Refer to the previous paragraph for the selection process) started off by going through different types of testing, fitness and motor skills tests like the test of gross motor development 2 and the Bruce treadmill protocol along with other body measurements. There was a child behaviour check list done by parents and teachers for behaviour. Attention and response inhibition was measured using the test of everyday attention for children. These tests were done 10 days before the experimental group started the exercise program. Then 3 times each week for 10 weeks the children would spend 45 minutes doing an exercise program that was made to work them from moderate to vigorous intensity using team sports tag games and exercise circuits to keep the sessions entertaining to the children. After the 10 weeks both the experimental group and the control group were tested again through the same tests to see if there were any differences.
 * Because of the way this test was run there could have been places of bias. For example putting all the children from one school together and the children with medication together doesn't give much randomization making the source less reliable. If there was a chance to prevent teachers, parents and information gatherers from knowing which child was in which group for testing and surveys then we could reduce that chance of bias even further . But besides these few things the method of the randomized control trial was successful with its use of defining ADHD and way of programing and testing, including their use of t tests and one tailed testing was all used effectively.
 * Their one biggest let down is the limited participants in the study which makes it hard to be a reliable source with such low numbers. With data collection from teachers and parents it can be heavily biased especially with qualitative data.

What were the basic results?

 * The important findings in this research were that there was improved motor skills and locomotion scores, as well as improved social, depression scores, impulse and inattentive component scores. However the scores for most behavioural changes tended to not reach a significant difference standard besides rule breaking tendencies . For intellectual there were findings with improved information processing and visual research.
 * The way the researches interpret these results seem to make it sound much more significant, while they do say their research can't hold much power they still infer that all these finding are a very positive step forward for physical programing with ADHD children.

What conclusions can we take from this research?

 * My personal take on the research is that it provides some evidence that exercise can have a positive effect on ADHD children but with the lack of power this research can provide with its limitations it can only be used to encourage more research to be done in the area which in its own way is useful to the research community.
 * As found in later research papers there are many that agree with the findings of this paper with stronger correlations with cognitive function and behaviour.

Practical advice

 * From this paper while the results weren't majorly significant it can still show that ADHD children can benefit from physical activity, but more specifically doing it with other children.
 * As the study found there was social benefits along with behavioural ones its likely team sports or games with other people involved is effective to improve lots of symptoms of ADHD while also improving their interaction skills with other people.
 * Important things readers should know is that exercise is far from a cure for ADHD but it can help a lot with some of the symptoms and social anxieties that usually come with it.

Further information/resources

 * Here's a list of a few difference resources depending on how would like to learn more about ADHD children exercising
 * For those who are interested in looking at more resent research in a similar area there's a study done by Narkeesh Arumugam just this year looking at exercise programs but with more modern research knowledge and equipment.
 * For those more interested in getting their own children involved in exercise here's a website by Rae Jacobson about how to help kids get into exercise and how and also a page from the NDIS on how you can get your child into sport programs with them.


text:
History of video games/Platforms/Elecrow Crowbits

Development
Elecrow Industries is a company based in Shenzhen, China. The Crowbits were designed by Richard Lee.

The Elecrow Crowbits are a series of educational learning kits for learning electronics. One such kit, the master kit, included instructions for a game console. Marketing for the console showed gameplay of a game very similar to the NES version of Super Mario Bros..

On June 1st, 2021 an Indigogo crowdfunding campaign for the product was successfully completed. A Kickstarter campaign was also held.

The Crowbits won a 2021 Red Dot design award.

Launch
The cost of the Master Kit was between $149.90 and $139.90.

Technology
The master kit game console makes use of a Crowbit module containing an ESP32 and a TFT display.

The Crowbits were also unofficially compatible with Lego bricks.

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


text:
Talk:Exercise as it relates to Disease/Does high-intensity exercise reduce the risk of cardiovascular disease?

What is the background to this research?
It is well established that obesity is a major risk factor for cardiovascular and metabolic diseases. Moreover, poor aerobic fitness, poor diet, physical inactivity and hypertension contribute significantly to the development of cardiovascular disease (CVD). However, it is also established that engagement in a physically active lifestyle is key in the prevention of cardiovascular and various metabolic diseases, and while children and adolescents generally have little risk of CVD, issues may ensue in later life if an unhealthy lifestyle develops. It is known that regular physical activity protects against CVD risk; however, recent estimates suggest that current activity levels in youth in Scotland, which involve only 45 minutes for a physical education (PE) class and may also be irregular, are not sufficient to prevent CVD risk in the future. Moreover, evidence suggests that youth spend less than 50% of PE time in moderate intensity activity 3. Therefore, there is a need to consider the non-traditional exercise interventions as a method of improving the health and well-being of Scottish youth. 5 In adults, studies have shown positive effects high intensity exercise (HIT) and aerobic interval training interventions, which lead to improved health and well-being. 6-9 In one study such interventions were found to be superior to a multidisciplinary approach that involved exercise, nutritional and psychological advice with greater improvements in cardiorespiratory fitness, endothelial function, measures of adiposity and blood pressure, and in measures of fasting glucose and high-density lipoprotein cholesterol than those involved in the multidisciplinary approach. Children and adolescents in the school setting have less time for such interventions and it is unclear whether HIT of a short duration would still be effective on the immediate and long-term health and well-being of youth. The aim of this study was simply to determine if HIT interventions improved CVD outcomes by measuring cardiorespiratory performance, muscular power and speed/agility. A second aim was to investigate the effects of the intervention on traditional markers of CVD i.e. blood pressure, percentage body fat and body mass index (BMI).

Where is the research from?
The research is published as a brief report in the Journal of Public Health Research (2012, 1:e24), which is an open access peer reviewed journal, and was conducted by researchers from Scotland and Wales - from the University of West Scotland, Swansea University, UWIC Wales. The senior author, Duncan Buchan, has over 70 publications and is a senior lecturer in exercise science and Julien S Baker is a professor (physiology) with several fellowships and now currently a professor in Hong Kong. The research team can be considered as experienced, widely published and reliable.

What kind of research was this?
This research is an interventional study, which is a prospective study specifically tailored to evaluate direct impacts of the preventative measures (interventions) on each parameter.

What did the research involve?
After obtaining appropriate ethics approval, forty-one subjects aged 15-17 years, 35 boys and 6 girls, participated in the study and were randomly assigned to a non-exercising control group or to a HIT group. Anthropometric measures, blood pressure, cardiorespiratory fitness, muscular power, jumping height, running speed 10 metres, and agility were all measured pre-and post- intervention following standardised warm-up procedures.11 Post-intervention testing was within five days of the exercise session and all participants completed a validated physical activity questionnaire, which required them to detail their physical activity over the previous seven days.

13 Participants in the HIT group (15 boys, 2 girls) were required to complete a 30 s maximal effort sprint within a 20 m distance separated by cones equating to 1 repetition. This increased weekly by 1 repetition for six weeks and on the 7th week repetitions were interspersed by just 20 s recovery. This was performed 3 times weekly at the start of every PE class. The control group (20 boys, 4 girls) maintained normal activity.

Means and standard deviations were calculated for each observation point and The Anderson-Darling test was applied to confirm normality, and homogeneity of variance was assessed using Levene’s test. The results were analysed using a two way repeated measure analysis of variance. Where a Group × Time interaction was significant (P<0.05) the simple effects of Time were investigated for both the Control and HIT groups.

What were the basic results?
The intervention measures revealed that there were significant improvements in the HIT group for aerobic fitness, counter movement jump (CMJ) and agility performance compared to the control group. This is shown in the table below from the paper itself REF Participants in the control group also experienced a significant decrease in CMJ performance post-intervention. There was no significant difference in activity levels within or between groups either pre- or post- intervention. Moreover, no significant difference was found for other parameters including stature, body mass, BMI, WHR, body fat, blood pressure and mean heart rate.

What conculsions can we take from this research?
This study supports the claim that brief intense exercise interventions may be useful for improving some components of physical fitness; i.e. cardiorespiratory fitness and agility. Also, that these improvements can be gained in a short time (3 sessions per week for 7 weeks).

However, there are a number of limitations to this study:
 * The sample size of only 41 with very few females makes it impossible to determine if girls in this age group might need different interventions.
 * The sample size is not large enough to give statistical power to form any firm conclusions about parameters that did not show any significant difference (i.e. body mass, BMI, WHR, body fat, blood pressure and mean heart rate).
 * The study was done in a narrow age band (15-17 years) and the results cannot be extrapolated to other younger age groups (there are differences in physical development).
 * The study was done in only one school and the study would benefit from data which included students from other schools.
 * Genetic, socioeconomic and general health status has not been taken into account.
 * The study did not follow subjects’ long term to determine if the interventions made during adolescence had any improvements on subjects over time; and finally,
 * These findings may not be applicable to other country settings.

Practical advice
This study has shown that brief intense exercise interventions may be useful for improving cardiorespiratory fitness and agility, which may also have long term benefits; so, it is important to encourage young people to exercise regularly.

There are many reasons to encourage children and adolescents to exercise -
 * Psychologically it can help those who have mild depression and low self-esteem as endorphins are elevated.
 * Regular exercise can also help people sleep more deeply.
 * Physically, exercise helps people to control their weight and lower the risk of some diseases such as CVD, high blood pressure and metabolic diseases including type 2 diabetes.
 * Finally, regular exercise, especially when young, can protect against osteoporosis; simple weight-bearing exercises like jumping, running, or brisk walking assists with bone health during the aging process.

Further information/resources

 * https://www.who.int/news-room/fact-sheets/detail/physical-activity
 * https://www.health.gov.au/health-topics/physical-activity-and-exercise/about-physical-activity-and-exercise
 * https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-172
 * https://www.heartfoundation.org.au/heart-health-education/physical-activity-and-exercise
 * https://www.nature.com/articles/s41390-020-01194-8
 * https://www.sciencedaily.com/releases/2018/10/181015100459.htm
 * https://www.aihw.gov.au/reports/risk-factors/insufficient-physical-activity/contents/insufficient-physical-activity


text:
Learning anatomy/Venule

Anatomy
The venules are made up of the intima, media, and adventitia.

Function
The venules move blood from the capillaries to the veins.

title: Learning anatomy/Venule


text:
History of video games/Platforms/Kasey the Kinderbot

Launch
Software cartridges for Kasey the Kinderbot were being released by 2002.

The system was nominated for, but did not win, Educational Toy of the Year 2002 by the Toy Association.

A version of the system was launched in 2004.

Legacy
Software for some Kasey the Kinderbot was discontinued by 2005. Support for the system itself was discontinued by 2006.

Technology
While rarely described as a console, the system accepted cartridges, allowing it to load a number of educational games.


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Exercise as it relates to Disease/Benefits of nasal breathing compared to oral breathing in regards to exercise-induced Asthma

This wiki page is a critical appraisal of a published research article relating to exercise-induced asthma and nasal breathing versus oral breathing. This appraisal is part of an assignment with the University of Canberra, Unit; Health Disease & Exercise.

Mangala PK, Menon MPS. (1981) Effect of nasal and oral breathing on exercise-induced asthma. Clinical Allergy. Vol 2 pp 433-439

What is the background to this research?
Asthma is a chronic inflammation of the airways involving bronchoconstriction (a tightening of the smooth muscle around the bronchiole and narrowing of the airway), mucous secretion and airway remodelling. Exercise-induced asthma (EIA) is characterised as the above symptoms when brought on by exercise as the increased volume of air irritates the airway. Nasal breathing throughout exercise is one suggested method of alleviating exercise induced asthma and the basis of this study. Research in to whether nasal breathing can in fact reduce EIA is critical as it is a deterrent to many people undertaking physical activity through fear of triggering their EIA symptoms. This study compares nasal breathing to mouth breathing during vigorous exercise to record how each style of respiration affects the airways. EIA in this study is defined as a 20% or greater decrease in Forced Expiratory Volume (FEV) from baseline measures. Despite the associated benefits, nasal breathing is not commonly practiced throughout vigorous physical activity due to a lack of awareness of the benefits coupled with a reduced capacity to dump carbon dioxide. This results in a phenomenon described as air hunger and causes a switch to oral breathing.

Where is the research from?
This research by P.K. Mangala and M.P.S. Menon comes form the University of Delhi, India. This is important information to consider due to the air temperature and humidity at the time of the study of between 32-35°C and 50-70% humidity. This air temperature is ideal for people with EIA in reducing bronchoconstriction whilst lower or higher temperatures can negatively effect EIA. Similarly the humidity of 50-70% at the time of the study has been shown to be ideal for EIA as opposed to dry air. Mangala has done limited research relating to exercise induced asthma with just one other study on EIA and Aspirin. Menon has been involved in several published studies relating to asthma. It is worth mentioning that one of the referenced articles in this study was Mangalas’ own thesis and is not available online for review.

What kind of research was this?
This research was a case control experimental study. Designed to replicate two breathing phenomenon in a controlled environment to discover the effects of each on both asthma sufferers with and without EIA and non asthma sufferers. The variable, method of respiration was manipulated to determine its effect on other variables like FEV post exercise in all groups.

What did the research involve?

 * An initial study was undertaken to detect the prevalence of EIA that enabled participants to be selected and placed in one of three groups
 * Non asthmatics, asthmatics with EIA, asthmatics with no EIA

 * FEV, heart rate (HR) and blood pressure baseline readings were recorded
 * A 6 minute maximum intensity run was completed by each individual. Once with a clipped nose and once with a taped mouth in a randomised sequence.
 * FEV was tested at the end of the run and 5, 10, 15, 20 and 30 minutes post run.
 * A greater than 20% decrease in FEV post exercise was recorded as EIA
 * The results of FEV, HR and blood pressure post oral breathing and nasal breathing exercise were compared

What were the basic results?
The important findings of this study were the improvement of EIA symptoms in asthmatics with EIA when they performed nasal breathing instead of mouth breathing during exercise. This was also the case for the non-asthmatic group. The researchers optimistically interpreted that in all three groups, mouth breathing caused a greater decrease in FEV however then went on to say that in asthmatics with no EIA there was not significant changes in FEV. The second statement is supported by Table 2 and Fig 2.

What conclusions can we take from this research?
The observation of wheezing that was present after mouth breathing and not present after nasal breathing in the asthmatic EIA group is a subjective observation that can also be altered. The wheeze also wasn’t recorded for any of the other groups and therefor has little relevance to the results of the study. The researchers could have been more transparent about the insignificant changes for the asthmatics with no EIA and perhaps mentioned that more study could be done on this group in cooler or dryer conditions to observe if nasal breathing becomes more relevant in less ideal conditions.

The findings in HR and blood pressure differ to some more recent research that also measures HR, blood pressure and FEV during both nasal and oral breathing exercise. The more recent research found that HR did in-fact differ during maximum effort exercise bouts of nasal breathing and oral breathing. It’s worth noting that HR and respiration rate both stayed lower when nasal breathing whilst performance was the same. This may be advantageous information to those affected by EIA.

The study by Mangala and Menon doesn’t mention how HR was recorded. It also refers to HR recordings in table 2 however table 2 only reports on FEV. The observation about HR not differing between nasal breathing and mouth breathing may be unreliable.

Practical advice

 * Complexity and unpredictability of real world implications include, pollen or pollution affecting air quality, emotional state of the individual, fitness level, temperature and humidity; other factors that contribute as EIA triggers.
 * Asthma sufferers at risk of EIA should always seek medical advice before attempting any form of vigorous activity that could trigger EIA and if medication has been prescribed by a medical professional it should be administered as instructed.
 * The research considered, suggests that nasal breathing throughout exercise should be investigated as an aid to those who experience EIA. A good base of aerobic fitness is also beneficial in reducing EIA symptoms. Exercise should be monitored, intensity should be gradually increased over time and always undertaken with supervision for asthma sufferers with EIA.
 * Nasal breathing as a means to improve performance should be considered by athletes who experience EIA.

Further information
The National Asthma Council of Australia have a very informative and up to date handbook available online for anyone wanting more information on asthma and EIA as well as links to medical support, action plans and support groups.


text:
Exercise as it relates to Disease/Does high-intensity exercise reduce the risk of cardiovascular disease?

This is a critique of the article: The effects of a novel high intensity exercise intervention on established markers of cardiovascular disease and health in Scottish adolescent youth

Duncan S. Buchan University of the West of Scotland, United Kingdom. John D. Young Alan D. Simpson University of the West of Scotland, United Kingdom. Non E. Thomas Swansea University, United Kingdom. Stephen-Mark Cooper Cardiff School of Sport, United Kingdom. Julien S. Baker University of the West of Scotland, United Kingdom.

What is the background to this research?
It is well established that obesity is a major risk factor for cardiovascular and metabolic diseases. Moreover, poor aerobic fitness, poor diet, physical inactivity and hypertension contribute significantly to the development of cardiovascular disease (CVD) However, it is also established that engagement in a physically active lifestyle is key in the prevention of cardiovascular and various metabolic diseases, and while children and adolescents generally have little risk of CVD, issues may ensue in later life if an unhealthy lifestyle develops. It is known that regular physical activity protects against CVD risk; however, recent estimates suggest that current activity levels in youth in Scotland, which involve only 45 mins for a physical education (PE) class and may also be irregular, are not sufficient to prevent CVD risk in the future. Moreover, evidence suggests that youth spend less than 50% of PE time in moderate intensity activity. Therefore, there is a need to consider the non-traditional exercise interventions as a method of improving the health and well-being of Scottish youth. In adults, studies have shown positive effects high intensity exercise (HIT) and aerobic interval training interventions, which lead to improved health and well-being. In one study such interventions were found to be superior to a multidisciplinary approach that involved exercise, nutritional and psychological advice with greater improvements in cardiorespiratory fitness, endothelial function, measures of adiposity and blood pressure, and in measures of fasting glucose and high-density lipoprotein cholesterol than those involved in the multidisciplinary approach. Children and adolescents in the school setting have less time for such interventions and it is unclear whether HIT of a short duration would still be effective on the immediate and long-term health and well-being of youth. The aim of this study was simply to determine if HIT interventions improved CVD outcomes by measuring cardiorespiratory performance, muscular power and speed/agility. A second aim was to investigate the effects of the intervention on traditional markers of CVD i.e. blood pressure, percentage body fat and body mass index (BMI).

Where is the research from?
The research is published as a brief report in the Journal of Public Health Research (2012, 1:e24), which is an open access peer reviewed journal, and was conducted by researchers from Scotland and Wales - from the University of West Scotland, Swansea University, UWIC Wales. The senior author, Duncan Buchan, has over 70 publications and is a senior lecturer in exercise science and Julien S Baker is a professor (physiology) with several fellowships and now currently a professor in Hong Kong. The research team can be considered as experienced, widely published and reliable.

What kind of research was this?
This research is an interventional study, which is a prospective study specifically tailored to evaluate direct impacts of the preventative measures (interventions) on each parameter

What did the research involve?
After obtaining appropriate ethics approval, forty-one subjects aged 15-17 years, 35 boys and 6 girls, participated in the study and were randomly assigned to a non-exercising control group or to a HIT group. Anthropometric measures, blood pressure, cardiorespiratory fitness, muscular power, jumping height, running speed 10 metres, and agility were all measured pre-and post- intervention following standardised warm-up procedures.11 Post-intervention testing was within five days of the exercise session and all participants completed a validated physical activity questionnaire, which required them to detail their physical activity over the previous seven days.

13 Participants in the HIT group (15 boys, 2 girls) were required to complete a 30 s maximal effort sprint within a 20 m distance separated by cones equating to 1 repetition. This increased weekly by 1 repetition for six weeks and on the 7th week repetitions were interspersed by just 20 s recovery. This was performed 3 times weekly at the start of every PE class. The control group (20 boys, 4 girls) maintained normal activity.

Means and standard deviations were calculated for each observation point and The Anderson-Darling test was applied to confirm normality, and homogeneity of variance was assessed using Levene’s test. The results were analysed using a two way repeated measure analysis of variance. Where a Group × Time interaction was significant (P<0.05) the simple effects of Time were investigated for both the Control and HIT groups.

What were the basic results?
The intervention measures revealed that there were significant improvements in the HIT group for aerobic fitness, counter movement jump (CMJ) and agility performance compared to the control group. This is shown in the table below from the paper itself. Participants in the control group also experienced a significant decrease in CMJ performance post-intervention. There was no significant difference in activity levels within or between groups either pre- or post- intervention. Moreover, no significant difference was found for other parameters including stature, body mass, BMI, WHR, body fat, blood pressure and mean heart rate.

What conclusions can we take from this research?
This study supports the claim that brief intense exercise interventions may be useful for improving some components of physical fitness; i.e. cardiorespiratory fitness and agility. Also, that these improvements can be gained in a short time (3 sessions per week for 7 weeks).

However, there are a number of limitations to this study:
 * The sample size of only 41 with very few females makes it impossible to determine if girls in this age group might need different interventions.
 * The sample size is not large enough to give statistical power to form any firm conclusions about parameters that did not show any significant difference (i.e. body mass, BMI, WHR, body fat, blood pressure and mean heart rate).
 * The study was done in a narrow age band (15-17 years) and the results cannot be extrapolated to other younger age groups (there are differences in physical development).
 * The study was done in only one school and the study would benefit from data which included students from other schools.
 * Genetic, socioeconomic and general health status has not been taken into account.
 * The study did not follow subjects’ long term to determine if the interventions made during adolescence had any improvements on subjects over time; and finally,
 * These findings may not be applicable to other country settings.

Practical advice
This study has shown that brief intense exercise interventions may be useful for improving cardiorespiratory fitness and agility, which may also have long term benefits; so, it is important to encourage young people to exercise regularly.

There are many reasons to encourage children and adolescents to exercise: Regular exercise can also help people sleep more deeply.
 * Psychologically it can help those who have mild depression and low self-esteem as endorphins are elevated.
 * Physically, exercise helps people to control their weight and lower the risk of some diseases such as CVD, high blood pressure and metabolic diseases including type 2 diabetes.
 * Finally, regular exercise, especially when young, can protect against osteoporosis; simple weight-bearing exercises like jumping, running, or brisk walking assists with bone health during the ageing process.

Further information

 * https://www.who.int/news-room/fact-sheets/detail/physical-activity
 * https://www.health.gov.au/health-topics/physical-activity-and-exercise/about-physical-activity-and-exercise
 * https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-172
 * https://www.heartfoundation.org.au/heart-health-education/physical-activity-and-exercise
 * https://www.nature.com/articles/s41390-020-01194-8
 * https://www.sciencedaily.com/releases/2018/10/181015100459.htm
 * https://www.aihw.gov.au/reports/risk-factors/insufficient-physical-activity/contents/insufficient-physical-activity


text:
Learning anatomy/Kidney

Anatomy
The kidneys are not just in kids. They are also in adults too. So why are they called -ney? The answer is that the word kidney is probably a compound of the Old English cwið ”womb,” and ey, “egg,” describing the shape of the organ.

Function
The kidneys filter your blood and removes waste.

title: Learning anatomy/Kidney


text:
Exercise as it relates to Disease/Does hand-based resistance training improve handwriting ability in patients with Parkinson's disease?

This is a critique of the article 'Bryant MS, Workman CD, Jamal F, Meng H, Jackson GR. Feasibility study: Effect of hand resistance exercise on handwriting in Parkinson’s disease and essential tremor. ''Journal of hand therapy. 2017 April 4;''31(1):29–34.'

What is the background of this research?
Parkinson’s disease (PD) is a neurodegenerative disease in which nerve cells (neurons) in the brain become damaged, weaken, or begin to die. The disease is characterized by a decline in motor control and noticeable shaking caused by a loss of dopaminergic neurons. As the disease progresses, symptoms worsen and begin to interfere with the sufferer’s ability to complete daily tasks. Primary symptoms of PD include tremor (shaking), rigidity (muscle stiffness), bradykinesia (the slowing down of automatic movement) and postural instability (impaired balance). Essential tremor (ET) is one of the most common types of tremors experienced in those with PD; with a difficulty in writing found to be a common complaint amongst those possessing the upper limb tremor. Decreased strength and reductions in writing size (a condition known as micrographia) and increased writing size (macrographia) have been reported in patients with PD and ET and are thought to contribute to the increased writing difficulty of PD sufferers. There is evidence to suggest that resistance training improves digit force steadiness as well as both intra- and inter-muscular coordination in neurologically impaired person’s. Hence, this research was conducted to examine the relationship between hand resistance training and hand movement control during handwriting. In particular, the research aimed to determine whether training would increase handwriting letter size in PD and decrease letter size in ET.

Where is the research from?
The study was conducted in the United States of America; with participants in the research, recruited from Parkinson’s Disease Research Education and Clinical Centre, Houston, Texas. The corresponding author of the study was Mon S Bryant, from the Michael E. DeBakey VA Medical Centre, Houston. The VA Medical Centre provides health care services across 12 locations in Texas and conducts research projects, with major research areas in gene therapy and traumatic brain injury. The Medical Centre is a teaching hospital with state-of-the-art technology, multiple awards and accreditation from multiple associations such as The Joint Commission, Rehabilitation Accreditation Commission and American Psychological Association.

Signed participant consent forms were approved by the institutional review boards of the Baylor College of Medicine and the Michael E. DeBakey VA Medical Centre, Houston, United States; whilst the study involved a home-based, resistance program that was carried out by participants in their homes in Houston.

What kind of research was this?
The research was conducted using an experimental, single group, repeated measures design. All participants completed resistance training and the results were measured after participants’ exposure to the ‘treatment.’ A comparison of subjects pre- and post- intervention test results was then conducted. An advantage of this research design is that fewer participants are required overall for the study which allowed the experiment to be conducted with greater ease and in a quicker manner. This research design, however, can also be disadvantageous due to the ‘order effect’. Factors such as fatigue can affect the performance of participants involved in the study and the level of reliability of results.

What did the research involve?
The study involved nine participants with PD and nine with ET. Participants were an average age of 65.3 years, and underwent a home-based, hand and arm resistance exercise program three times a week for six weeks. All participants had an average disease duration of 7.8 years, and an experienced tremor with difficulty writing. The aim of the study was to explore the influence of 6 weeks of home-based hand resistance exercise on handwriting letter size in individuals with PD and ET. Participants completed pre-intervention tests to assess grip strength and handwriting size. Two writing samples (a sentence and a set of three words) and a hand dynamometer were implemented for the conduction of these tests.

Following baseline testing, participants underwent a 6-week, home-based resistance exercise intervention which involved various upper limb exercises. Bicep curls, tricep extensions, wrist flexion and extension, hand and finger exercises were completed bilaterally for three sets of approximately 10-12 repetitions for the full six weeks. Throughout the study, a research staff member had weekly phone contact with participants to enhance adherence and to provide assistance if required. The study selected training duration based off previous studies to ensure that exercise volume demands were high enough for strength improvements to occur. Post training, participants underwent the same testing procedures as those conducted at baseline. A comparison between area of handwriting and maximal grip strength was then conducted between measurements pre- and post- six weeks of resistance exercise training.

The small number of participants involved in the study is a major limitation of the research. Small participant numbers provide a lack of normal distribution and an inability to confidently associate the results to the wider, neurologically impaired population. The study did attempt to overcome this limitation through the implementation of the Wilcoxon signed rank test, however, this does not completely resolve the existing limitation. The study also only consisted of male participants, which would further affect the ability to generalise results. Regarding the protocol that was followed throughout the exercise intervention, the study lacked the inclusion of important warm up and cool down procedures which increases the potential risk of injury for the participants involved within the study.

What were the basic results?
The results obtained from the research included participants’ maximum grip strength and handwriting size. 17 participants completed the study, with one participant dropping out due to unrelated injury. No significant differences were found in handwriting size between pre-post-test measures (for either words or the sentence) in participants with PD (p = 0.238 and p = 0.557, respectively) or ET (p = 0.282 and p = 0.160, respectively). Similarly, no significant increase in grip strength was found in participants with ET (p = 0.093). However, a significant increase in grip strength post-intervention was reported in those with PD (p = 0.031). The study hypothesized that the 6-week, home-based hand resistance exercise program would improve the size of handwriting in patients with a hand tremor related to PD or ET however the results confirm that the exercise program did not significantly change handwriting size for those with PD or ET. Although phone calls with participants for compliance checks were carried out weekly, a lack of participant adherence throughout the study could have negatively affected results due to the absence of supervision and motivation throughout training sessions.

What conclusion can we take from this research?
From the results of this research, it can be concluded that hand resistance training in patients with PD and ET had no positive effect on handwriting ability. Small improvements to strength and handwriting size were reported, however most data reported was insignificant. The variables explored (grip strength and letter size) may have lacked a strong correlation to handwriting ability, with other factors such as writing pressure, potentially more important.

Practical advice
Many factors need to be considered when aiming to improve one’s handwriting ability. Further research should be conducted to draw conclusions more confidently around the factors associated with handwriting ability in those with PD and ET, and how they are best to be managed. Additionally, a longer intervention duration would be useful to increase the magnitude and likelihood of achieving the desired result and or outcome.

Further information and resources
Understanding Parkinson's Disease

Strategies for those living with Parkinson's Disease

Managing Parkinson's Disease


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Old English/Roadmap to learning Old English

Okay, so, you are interested in learning Old English. But, it's a dead language, so how do you even do that?

It won't be very easy!

People who learn Old English usually either:
 * 1) only care about reading Old English (this is true of most academics) - it is not necessary to develop the skills to be good at writing and speaking Old English, only reading and understanding it
 * 2) are interested also in speaking Old English (this is mostly true of enthusiasts) - this is a harder goal to achieve, but this Old English Wikibook should (eventually) be in a condition to help you achieve this

This Old English Wikibook overall should eventually be sufficient to get a person a significant way down the path of speaking Old English, and therefore also reading it. It is currently under work, and therefore you may find as your learning advances, that there have been some mistakes in this Wikibook. If you spot any clear mistakes yourself, feel free to correct them, or notify someone who is active in writing this Wikibook.

However, your own approach also matters. Because Old English is a dead language, and almost all of the resources for Old English are technically focussed, with no focus on developing speaking skills, you yourself will have to make special, well-considered efforts, to achieve even an intermediate level of speaking ability in Old English. This page offers advice on how to achieve an intermediate level of speaking. If you make it that far, you will be as well qualified as anyone else to figure out how to achieve an advanced level of speaking.

Fulk's Grammar
Robert Fulk has kindly made his modern, reputable, basic scholarly introduction to Old English freely available under the public domain. It can be used to follow this learning road map for Old English, and can be found here:
 * |An Introductory Grammar of Old English with an Anthology of Readings

This book is a high-quality resource. If you are unclear on grammar jargon, you may wish to look at the grammar page, which explains some fundamental grammar concepts.

Old English Discord Server
As of 2021, there is a very active Old English Discord server, with several advanced learners of Old English present, and a number of intermediate learners. This is one of the few places you will be able to practice Old English with other people, and can expect some degree of reliable corrective feedback. You can also practice speaking Old English, and you can also ask specific questions, which can greatly accelerate your learning.

General advice

 * Be careful not to assume that cognate ("cousin words", like "Eis" in German, "ice" in Modern English, and "īs" in Old English) words in Old English had the same meaning as in Modern English. The primary meaning of "mann" in Old English is "person" or "human", not "male adult human".
 * Don't assume that because you can put words together in a particular way in Modern English, or any modern language, you can also do that in Old English - Old English was its own language with its own standards. Modern German has many similarities, but they are not identical.
 * It may be helpful to learn Modern German or Modern Icelandic before you learn Old English. They are grammatically similar, and benefit from being living languages - you can find people who can correct your errors.
 * As you become more advanced, after you have mastered the basics, put increasing effort into avoiding making errors. Over time, with care and attention, you should make fewer and fewer errors, as you become aware of more and more facets of Old English.
 * There are 3 aspects of "correctness" when you speak a language: correct sense of meaning of words, correct grammar, and suitable style/phrasing. The first two points are what you should focus on when you are first getting started in Old English, but after you have mastered the basics, you should start paying attention to how things are written in authentic, historical Old English texts - take notes, and remember those phrases.
 * Don't sweat learning something perfectly before you move on to the next topic; so long as you have learned most of the topic, you can move on. You can always revisit old lessons if you need a reminder.
 * Most modern Old English content which you find on the internet is poor quality, even much of that written by academics (note: with regards to academics, this is only applicable to their modern Old English content, which is barely ever viewed as an important part of academic Old English studies, not their content about Old English). Modern Old English should never be considered as a primary learning source. You should always prioritize authentic, historical texts as the authoritative examples of Old English. Academics, generally speaking, despite often not being able themselves to use advanced Old English with reliable correctness and proficiency, nevertheless provide the most in-depth, reliable analyses and descriptions of historical Old English, and are the main providers of reliable resources which can be used to learn Old English. Pouring over a text to analyse a technical point, or even reading such a text to understand its contents, are very different activities to speaking a language in a social context, or writing a text in that language.
 * To learn how to write and speak Old English, you have to practice. You cannot learn how to write and speak Old English well only by reading. You should, however, also be exposing yourself to historical Old English texts, and comparing it with your own writings, and correcting yourself by comparing what you write to authentic texts.
 * Learning is a mentally creative and proactive process. You need to take active notice of things. Although repetition is necessary to first memorize something, that alone will not help you master Old English. Repetition of noun, adjective, verb paradigms only helps you remember their forms - you also have to try to use those forms, to get good at it.
 * At the start, your Old English will be very bad. Don't be discouraged - this is normal. You will get better over time as you keep at it.
 * Because it is a dead language and there are few people who can reliably correct you, or who you can practice speaking with, your progress in Old English will likely be slower than for living languages.

Detailed roadmap
Here is a specific roadmap to how to learn spoken Old English. For a very driven learner, they might perhaps be able to cover this entire roadmap in just a few months, but for most people, going at a reasonable pace, it might take 1-2 years.

 * 1) learn at a pace that is effective for you. In general, to make progress in a new language, you need to put at least several hours in a week. However, if you become frustrated trying to understanding something, you should give it a break, move on to something else, and come back to it later. Revisiting topics which you learned imperfectly is a key to effective learning. If you get mentally fatigued, you've done enough for that day - leave it and come back another day.
 * 2) first learn the pronunciation. At first, don't worry if your pronunciation isn't perfect - you can improve it as you learn. Every so often, as you continue improving in your Old English journey, revisit Old English pronunciation - you will gradually improve over time, as you get a better understanding of what you were doing wrong as a beginner. However, if you let "perfect" pronunciation hold you up too much as a beginner, that is as needless slowdown.
 * 3) next, ensure you are familiar with some basic grammatical concepts. The Grammar page gives an introduction to some important grammar concepts. If you don't understand it all the first time, don't worry - revisit the page as often as you need, whenever you come across a grammatical concept you don't understand.
 * 4) next, memorize the declension paradigm of the definitive article ("sē" - "the"). It may seem boring, but the definitive article is a very common word in Old English, and it has similarities to some noun and adjective declensions which make them easy to learn afterwards.
 * 5) as soon as you have memorized the definite article, you can start memorizing Old English nouns that you want to - make sure you memorize them with their grammatically correct definitive article form, to remember their grammatical gender (e.g. memorize "sē mann" not just "mann", so that you can remember the gender; "þæt ƿīf" not just "ƿīf", and so forth). You can search for nouns at |the Bosworth-Toller website. You can specify nouns using the relevant advance search fields.
 * 6) next, memorize the strong masculine noun declension and the strong masculine adjective declension and weak adjectival declension for all genders (this is because the weak declension for all genders is almost identical, so you might as well just learn them all at once). You should notice that the strong declension has some similarities with the declension of the definitive article. Make sure you also read the Strong or Weak? section, so you can understand when to use the strong adjectival declension, and when to use the weak adjective declension. You can now also start finding and memorizing adjectives.
 * 7) next, memorize the weak class 2 verb conjugation. Don't worry if you haven't mastered it the first time - revisit it several times. The weak 2 conjugation is the easiest verb conjugation in Old English. Note that even though nouns, adjectives, and verbs are all called "weak", it doesn't mean the same thing in all of the cases. In general, it just refers to the fact that the weak declensions, and the weak conjugations, are easier to learn than the strong declensions and conjugations.
 * 8) Now that you have memorized the article, the strong masculine noun declension, some adjective declensions, first make sure you understand the meaning, purpose of usage of cases, but, now you can start making Old English sentences! Practice making a variety of different simply Old English sentences. Here are some simple ones you could try: "the dog goes"; "the man sings a song"; "the rooster bites the waggon". This is your first big milestone! From hereon, keep trying to make new, simple sentences. You can start trying to read Old English prose if you would like - Ælfric is known for his simple writing style. Don't worry if you don't understand it - just give it quick shot, see how much of it you can work it, and come back to it later when you have a better understanding.
 * 9) Next, memorize the neuter strong noun and adjective declensions (which has some similarities with the strong masculine declensions), as well as the weak noun declensions (they have the exact same pattern as the weak adjective declension, so you don't really need to learn anything - you just have to apply them to the correct nouns). This expands the range of nouns you can use considerably!
 * 10) Next, memorize the weak 1 verb conjugation (the second easiest verb conjugation) and the strong 1 verb conjugation. The strong verb conjugation may seem intimidating at first, but remember that they have 2 main components: the vowel changes and the suffixes. The strong suffixes are identical across the different strong verb conjugations. Once you have mastered the suffixes for one strong verb paradigm, you have mastered the suffixes for all strong verb paradigms, and you only need to learn the new vowel changes to learn the new strong verb paradigms.
 * 11) Next, memorize the strong feminine noun and adjective declensions. You are now able to correctly handle the vast majority of Old English nouns and adjectives! (However, there are a few common nouns that you still haven't specially learned).
 * Now, learn the conjugation of the irregular verb "ƿesan/bēon" - to be. You will need this verb to say many things, like "I am happy" - "Iċ eom glæd (man)/gladu (woman)". Also learn the conjugation of the common class 3 verb, "habban" - have. It is obviously fairly similar to the other weak verb conjugations. You may also want to familiarize yourself with the other class 3 verbs, including "libban" - "to live, be alive", and "hyċgan" - "to think, intend"; however, you don't have to memorize them aright now. There are very few class 3 verbs.
 * 1) Learn the i-mutated strong noun declensions. They are somewhat modified versions of the normal strong declensions; not many nouns are i-mutated in declension; but some important common ones are, like "mann" - "person, human" ("menn" - "people", compare Modern English "men"), "fōt" - "foot" ("fēt" - "feet"). Also learn the somewhat irregular declensions of the common family terms "brōðor" (brother), "sƿeostor" (sister), "fæder" (father), "mōdor" (mother), "dohtor" (daughter). Finally, familiarize yourself with the strong-declension nouns which end in -h and those which end in -u/-o (which gets turned to -ƿ before suffixes that start with a vowel) - these should be very easy, because they are almost identical to the normal strong declensions you have already learned, just with a slight modification.
 * 2) Okay! Let's get stuck into more complicated sentences now. You should familiarize yourself with a number of common conjunctions and prepositions. You can now start making more complicated sentences like "my mother had a cat, but the cat fled". This is your second big milestone. From now on, you can practice making more complicated sentences.
 * 3) Since you learned the strong 1 verb conjugation earlier, you don't need to re-learn the correct suffixes for all other strong verb conjugations. Instead, you only need to learn the vowel shifts. You should familiarize yourself with the vowel shifts, but it doesn't matter if you memorize them all, just so long as whenever you learn a strong verb going forward, you learn it with the correct vowel shift (you can do this by memorizing e.g. the present tense, the past simple indicative third person, the past plural, and the past participle, whenever you learn a strong verb. So if I was learning "ƿrītan" - "to write", I would memorize it as "ƿrītan, ƿrāt, ƿriton, ƿriten"). Dictionaries often either tell you which conjugation a verb belongs to, and you can check the correct vowel shifts by looking at the verbs page.
 * 4) Now learn about the preterite-present verbs. They use vowel shifts normal of strong vowel past tense, in the present tense; and usually use suffixes, like weak verbs, in the past tense. These include a number of common auxiliary verbs, such as "cunnan" - "to know how to", "magan" - "to be able to, can", "sċulan" - "must, should, have to", "ƿillan" - "to want to, will", "mōtan" - "be allowed to". Now you can express much more subtlety in your Old English. This is your third big milestone!
 * 5) There aren't that many basic grammar points left to cover! You can choose what order you learn them in: The u-declension for nouns, indeclinable nouns and adjectives, partitive genitive, how to use the subjunctive mood for verbs.
 * 6) After this, what waits for you is advanced topics: Mastering word order in main clauses and dependant clauses, learning different sentence structures with subtle meanings, and natural ways of saying things in Old English as well as idioms (set phrases that have a particular meaning which is not the same as their surface meaning, like "She gave it everything she had to master Old English." She didn't literally give everything in her possession - she just made a big effort. In Old English, there are lots of normal ways of saying things, that are different to Modern English.
 * 7) You should now, with a dictionary, be able to read quite a bit of Old English prose. As you are reading the Old English prose, make sure you take notes of anything interesting that you notice, and particular phrases that seems interesting or hard to understand. Put time aside to try and figure out what they mean. Often, scholars will have already figured it out before you, so you can search on the internet for what this or that particular phrase means. You should learn these phrases, so that your own Old English is more authentic.
 * 8) When you find you are able to understand a lot of prose, you should start reading Old English poetry. Old English poetry uses many artistic conventions and clause structures which are not normal to Old English prose, making Old English poetry generally more difficult to understand. However, this is a good opportunity for you to practice speaking Old English: Why not memorize some short Old English poems, and verbally recite them? This makes the language feel alive, and gives you good pronunciation practice. Don't worry if you don't understand the poem - you can try and figure it out later. After all, if you memorized it, you can think about it in any free moment.


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Exercise as it relates to Disease/Does resistance training improve muscle strength and pain intensity in Fibromyalgia?

This page is a critical analysis of the research article "Resistance Exercise Improves Muscle Strength, Health Status and Pain Intensity in Fibromyalgia - a Randomised Controlled Trial" by Larsson A, Palstam A, Löfgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I et al.

What is the background to this research?
Fibromyalgia (FM) is a rheumatic, chronic, widespread pain condition, causing stiffness and tenderness of the muscles, tendons and joints. Fibromyalgia affects approximately 1-3% of the general population, and is more commonly identified in older women.

An association between physical activity - in particular resistance training - and the improvement of muscular strength and pain intensity in patients with fibromyalgia has been explored and analysed by a number of studies. Although the precise aetiology of FM is unknown, physical deconditioning is believed to contribute to the development of fibromyalgia. Current guidelines for patients with FM recommend standard aerobic exercise such as brisk walking and cycling. However, a few studies have documented promising effects of the embodiment of resistance training to increase muscle strength in patients with FM, as well as avoid an increase in the susceptibility of mechanical strain. A prompt diagnosis and treatment of fibromyalgia patients may produce substantial improvement in quality of life.

Where is the research from?
The research was conducted and completed in Sweden and was primarily supported by the Swedish Rheumatism Association. This article was published in the Arthritis Research & Therapy journal which is an international, open access, peer-reviewed journal. The lead author, Anette Larsson is a reputable expert within the Department of Rheumatology and Inflammation Research. She is respected for her research on fibromyalgia and the impact of physical activity on muscle conditioning and inflammatory cell control studies. The authors declare that they have no competing interests.

What kind of research was this?
This research was an assessor blinded randomised controlled multi-center trial (RCT). RCTs are the most stringent way of determining whether a cause-effect relation exists between the intervention and the outcome. The subjects within this study were placed in either a progressive resistance group exercise or an active control group. Additionally, a person-centred model of exercise was used to support the participants’ self-confidence for management of exercise. According to a report on the “levels of evidence” conducted by the Canadian Task Force on the Periodic Health Examination in 1979, RCTs were given the highest level because they are designed to be unbiased and have less risk of systematic errors.

What did the research involve?
A number of inclusion/exclusion criteria were determined and exhibited below in Table 1.

A total of 130 women were recruited for this and informed written consent was obtained from all participants before the baseline examination. The resistance exercise program was performed twice a week for 15 weeks and conducted on physiotherapy premises and at a local gym. An introductory discussion about the participants’ earlier experiences and instructions/modifications of specific exercises according to individual conditions and self-efficacy principles took place. An exercise protocol was created for each participant based on this information provided. Exercise focusing primarily on the lower extremity, core stability, and power were included in the program, and loads were increased only when the participant was ready to do so. The active control group was delivered similarly and performed as a series of mental exercises known as autogenic training. Participants spent 25 minutes focusing on relaxation and body awareness, followed by discussion and stretching.

The limitations of this study explored the biases of a small sample size of participants that possibly were already motivated to exercise, hence why they chose to participate. This was limited by blinding the participants in advance to which intervention was the control intervention or the active intervention. Additionally, a longer period of guidance and support was recommended to increase the possibilities of maintaining regular exercise habits.

What were the basic results?
Outcomes were assessed at baseline and at post-treatment examination after 15 weeks.

Primary outcomes:
 * Isometric knee-extension force: significantly greater improvement (p = 0.010). The effect size of change in isometric knee-extension force for the intervention group compared with the active control group was 0.55

Secondary outcomes:
 * The fibromyalgia impact questionnaire (FIQ): resistance exercise group improved significantly, demonstrating a lower score indicating a higher health status
 * 6 minute walk test (6MWT): significant improvement (p = 0.003) in the resistance exercise group compared to the active control group
 * Isometric elbow-flexion force: significantly greater improvement (p = 0.020) in the resistance group
 * Current pain intensity (VAS): Significantly greater improvement in current pain intensity (p = 0.033)
 * Health related quality of life (SF-36 PCS and MCS): Significant improvements within the resistance exercise group (p = 0.007). This was stated to be reflecting what is considered to be a clinically important difference.

What conclusions can we take from this research?
The positive results of the study showed that a supervised resistance exercise program based on person-centred principles with individually adjusted loads according to each participant’s resources, is feasible and successful. It was concluded that muscle-strengthening activity, such as resistance exercise, at least twice a week is recommended for preventing age-related loss of muscle mass and impaired physical function. These results prove positive outcomes of resistance training on patients with fibromyalgia; however, it can be difficult to obtain long-lasting effects following an intervention, as was stated by previous studies.

Practical advice / further resources
A possible reason for the paucity of studies evaluating the effects of resistance exercise in FM, is the risk of increased pain during isometric muscle contraction. If there is a possibility of pain during exercise, this may inhibit the participant to engage in physical activity, especially without the motivation and supervision of a health practitioner. Within the study, some of the reasons given by participants for not continuing to exercise were expensive gym memberships, need for continued supervision and guidance, and difficulties in prioritising exercise in daily life. Resistance exercising can be challenging and sometimes dangerous, therefore it is crucial that an individual exerts these exercises with the correct form and has a thorough understanding of loads, intensity, and repetitions. Furthermore, an unawareness of the psychological determinants that have an influence on motivation and maintenance of physical activity can be recognised in this study and may conflict with real-world implications.

Websites for FM exercising tips/advice
 * 1) https://fmaware.net/strength-training-for-the-person-with-fibromyalgia/
 * 2) https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/physical-activity-and-exercise/exercise-and-fibromyalgia/

Support group information
 * 1) https://www.everydayhealth.com/fibromyalgia/resources/


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Exercise as it relates to Disease/Is regular aerobic exercise alone effective for weight loss in sedentary adults?

This page is a analysis and critique of the journal article "A 6-Month Exercise Intervention Among Inactive and Overweight Favela-Residing Women in Brazil : The Caranguejo Exercise Trial" by Alves JG et al.

This was written as an assessment item for the unit Health, Disease and Exercise at the University of Canberra, 2021.

What is the background to this research?
Obesity and inactivity are major issues in the world right now. In 2005 Obesity cost Australia $21 billion. Obesity is a major contributing factor to other lifestyle diseases such as cardiovascular disease, type 2 diabetes, and obesity related cancers and increases the chance of death. The challenges that obesity places on society have meant that it has been a well-researched topic. Within the literature general exercise has a positive relationship with improvements in obesity and obesity related effects. This research wanted to examine the viability and efficacy of a known quantity of exercise in facilitating weight loss among previously sedentary or irregularly active overweight and obese adult women residing in poor living conditions.

Where is the research from?
The research conducted in Favela-residing Women in Caranguejo, Brazil. This part of Brazil has an extremely low socioeconomic status with an average daily income of $1 US dollar per day with a population of 3733. The research was published within the American public health associations journal and available in 2011.

What kind of research was this?
The research involved was a randomized control trial. Participants within the trial were assigned to either a control or intervention group.

What did the research involve?
The research involved the participants being split into either a control or intervention group. The intervention group completed an exercise protocol while the control group did nothing. The exercise protocol used was three, 50-minute exercises sessions a week for 6 months. These exercise sessions were aerobic in nature consisting of a 5-minute warmup followed by 40 minutes of moderate intensity exercise such as walking and rhymical movement to fast tempo music. This was followed by a 5-minute cooldown. During the most demanding portions of the exercise 40—60% of heart rate reserve was recorded using the Borg scale. All exercise was supervised by a trained physical education instructor. No dietary or other lifestyle modifications were made for the intervention group.

What were the basic results?
At the end of the 6-month intervention 96% of the participants successfully completed it. There was a statistically significant reduction in weight (Kg) with a mean of 1.69kg for the group. Body mass index score decreased from a mean of 29.8 to 29.2. With a final overall bodyweight change of 2%.

What conclusions can we take from this research?
This research helps quantify a specific amount of exercise that allows for weight loss in sedentary or irregularly active and weight/obese women in a poor area of developing countries. It also gives us insight into a hypothetical minimum effective dose and timeline for exercise without dietary modifications is necessary to facilitate weight loss reduction. It also helps us specify the type of exercise that can be effective in modality. The exercise used within this was not only aerobic in energy pathway nature but walking, dancing, or stepping in modality. This intervention unintentionally targeted women with a body mass index (BMI) of a score between 25 and 35 on average (29.7 +/- 3.313 which is categorised as class 1 obesity and the end of the overweight . This specific range of BMI targeted becomes a confounder when the potential efficacy of this intervention is considered to be used on other populations including other populations with BMI ranges that may be higher or lower in score then the range used. Weight loss is predominantly an energy expenditure vs energy intake equation . While this may be true in theory the practical application can be very challenging due to several different biopsychosocial factors. This study had a successful adherence and completion rate (96%) which may show the benefits on keeping intensity at a moderate level and keeping the modality simple to encourage individuals to be consistent with exercise and sustain it for a longer period of time. An important aspect to mention is that these results (amount of weight lost) while objectively low but statistically significant happened over the course of a 6-month period. This timeline may help practitioners appropriately educate the public, clients, and patients of realistic goals regarding the outcomes on weight loss and exercise without a change in diet or other lifestyle factors.

Practical advice:
This research helps use provide the following advice:

 * 1) ·        Regular exercise of at least 150 minutes a week at moderate intensity can promote weight loss.
 * 2) ·        Exercise choice can be as simple as walking, stepping, or dancing, require no equipment and does not need to be complex.
 * 3) ·        Moderate intensity may encourage better adherence for a longer period than high intensity exercise programs.
 * 4) ·        Dietary intervention alongside an  exercise regime like this would encourage further weight loss.
 * 5) ·        Exercising with supervision from a qualified professional and/or in a group setting may promote adherence to an exercise regime.
 * 6) ·        Expectations of the timeline that exercise effects weight loss could be re considered and become more conservative when realistically goal setting.

·

Further information/resources:
While this study predominantly focused on the effects that a specific quantifiable amount of exercise had on weight loss, there are other benefits of exercise on overweight/obese individuals besides just adipose tissue reduction. Other research completed has shown that a similar amount of exercise to this intervention (3x a week 30 minutes per session) with similar average % of weight loss (2.1%) improved both HDL cholesterol and insulin levels. Participants that completed exercise 3x a week for 30 minutes per session also had 8% increase in aerobic capacity. This intervention is similar to the one we reviewed and thus shows the other important outcomes that exercise has on people who are overweight/obese. It is still advised generally that weight loss between 5% and 10% is necessary to achieve a reduction of coronary heart disease risk factors.


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Exercise as it relates to Disease/The effect of resistance training on breast cancer patients

This Wikibooks page critiques "Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life" by Steindorf et al. (2014)

What is the background to this research?
Breast cancer is the most prevalent cancer in females, with an estimated 2.3 million diagnoses in 2020. Of these, many require ongoing treatment such as adjuvant radiotherapy. The disease itself and these treatments are often associated with a range of side effects, most commonly fatigue, that are detrimental to the patient's quality of life (QoL).

This paper explores the effect of resistance training on the fatigue and QoL of breast cancer patients undergoing adjuvant radiotherapy.

Minimal research has been conducted within this field so this paper fills an essential gap in existing knowledge. There has only been one small study on breast cancer patients undergoing radiotherapy. Previous research has only investigated the effects of aerobic training or a combination of aerobic and resistance training. Psychological rather than physiological effects have been studied.

It is vital to discover the most effective methods in reducing fatigue and improving the QoL of such a significant percentage of the worldwide population.

Where is the research from?
This research was conducted at the Institute of Sports and Sport Science of the University of Heidelberg in Germany. It is one of the leading research institutions in Europe with a university ranking of 42 for 2022. Each of the authors have numerous other papers published within the cancer field. For example, Professor Steindorf has 204 publications and has conducted prior research at the German Cancer Research Centre and the National Centre for Tumour Diseases, investigating physical activity, fatigue, QoL and different cancers.

This research appears in an Elsevier medical journal, Annals of Oncology, which is considered to be one of the leading journals with a high impact factor of 32.976.

It has also been presented at multiple conferences in Germany and the United States of America.

This research was funded by the Interdisciplinary Research Funding Program of the National Centre for Tumour Diseases and partially supported by the cancer foundations ‘Stiftung Leben mit Krebs’ and ‘Manfred-Lautenschlaeger-Stiftung’. It does not appear that there would be any personal gain by these findings.

The authors have declared no conflicts of interest.

What kind of research was this?
This study was a prospective randomised control trial (RCT). 80 breast cancer patients were assigned to the resistance training intervention and 80 were assigned to the control group muscle relaxation program. Both groups were designed to have potential psychosocial benefits, so if exercise had an effect it was in addition to this. These allocations were conducted by someone not involved in the study who used predetermined lists (not accessible by study personnel) with a random block size, arranged by age and baseline fatigue level. There was no blinding in this study as the patients and the researchers knew which treatment was being received.

RCTs are desirable as they allow the researcher to make causal inferences. Since the participants were randomly allocated, selection bias and confounding factors were minimised and the groups were comparable. Because it is a prospective study, recall error is eliminated. This means the findings are more likely to be valid and generalisable, and the researcher is able to successfully determine the effect of resistance training.

Many other studies within this field used a similar framework since alternative designs are unable to produce the same level of evidence for a causal relationship.

What did the research involve?
The participants in both the experimental and control group had 2 60-minute professionally administered sessions each week for 12 weeks, beginning on the day of the first radiotherapy session. The experimental group participated in resistance training using 8 machines. They completed 3 sets of 8-12 repetitions at 60-80% of 1 repetition maximum. The control group participated in muscle relaxation with no aerobic or strength components.

These outcomes were measured pre-radiotherapy (baseline), post-radiotherapy (week 7) and post-intervention (week 13):

 * fatigue- self-assessment Fatigue Assessment questionnaire
 * QoL- self-assessment QoL questionnaire and breast cancer specific questionnaire
 * depressive symptoms- self-assessment depression scale for cancer patients
 * cognitive function- trail-making test assessing visual attention and task switching
 * muscle strength- isometric and isokinetic tests for upper and lower extremity
 * endurance performance- VO2peak measured on a bicycle ergometer

The baseline scores were compared to the post-intervention scores to see if resistance training had an effect on any variables measured.

Limitations
The main limitation is that most outcomes were measured using self-assessments, which introduces bias and threatens the validity and reliability. However, the nature of this study makes this unavoidable because it is difficult to measure these outcomes without using self-assessment questionnaires. The methodology was designed in a way that maximises validity and reliability, making it a suitable approach.

What were the basic results?

 * Fatigue- significant reduction in total (P=0.044) and physical fatigue (P=0.013) for resistance training when compared to control, but not for affective (P=0.91) or cognitive (P=0.65)
 * QoL- no significant difference in global QoL (P=0.37) but resistance training improves QoL aspects: role function (P=0.035), pain (P=0.040), future perspective (P=0.047)

 * Muscle strength- significant improvements with resistance training (P<0.0001)
 * Endurance performance- no significant difference between groups

What conclusions can we take from this research?
This study found that resistance training reduces fatigue and improves some aspects of QoL, beyond the psychosocial aspects, for breast cancer patients receiving adjuvant radiotherapy. Additionally, but unsurprisingly, it also improves muscle strength which counters a side effect of treatment. Steindorf et al. inferred that for optimal patient outcomes, resistance training should be implemented alongside treatment.

These findings align with previous studies. Resistance exercise has been found to reduce treatment side effects in prostate cancer patients. Many studies have investigated the benefits of aerobic training for breast cancer patients. This study confirmed that resistance training alone does not provide those cardiorespiratory benefits. Therefore, it can be deduced that the optimal program should incorporate both resistance and aerobic training.

Practical advice
Every person has different needs and risk factors to consider, particularly within this population group, so it is vital to follow the specific recommendations given by health professionals. Whilst executing the resistance and aerobic program the patient should be supervised by a professional and have their critical measures (blood pressure, heart rate and oxygen saturation) monitored throughout the session. They should progress to 150 minutes of moderate intensity activity and 2 sessions of resistance training per week. Activities could include running on the treadmill and whole body machine-based exercises.

Further information/resources
Breast cancer:

https://www.who.int/news-room/fact-sheets/detail/breast-cancer

Exercise guidelines for cancer patients:

https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/physical-activity-and-the-cancer-patient.html

Resistance training:

https://www.betterhealth.vic.gov.au/health/healthyliving/resistance-training-health-benefits


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Exercise as it relates to Disease/How physical activity affects the symptoms of depression in young adults

This is a critique of the research paper Physical Activity and Depression Symptom Profiles in Young Men and Women with Major Depression, published by Psychosomatic Medicine, 2013.

What is the background to this research?
Lowered mood, loss of interest, rapid weight loss/gain, disturbances in sleep, sense of worthlessness, difficulty in concentration, or thoughts of suicide are all major symptoms of major depression. In Australia, 15% of people over the age of 16 have experienced depression in their lifetime. Major depression affects one in six females and one in eight males, and depression is expected to become the single largest healthcare burden by 2030.

There are many ways to treat major depression via pharmacological, psychological, and lifestyle changes. There is no perfect cure for depression, as a mix of pharmacological and psychological interventions was found to be only effective for 30% of patients. Lifestyle changes such as physical activity used in conjunction with these other treatments, can be used as symptom management for depression.

This study explores how young adults with major depression and who are also physically active differ from those who are not physically active. Physical activity has been shown to help with sleep problems, concentration difficulties, negative self-worth, and improve overall mood. The research found that withdrawing or decreasing physical activity levels has been found to worsen sleep patterns, increase fatigue and overall depressed mood.

Where is the research from?
The authors of this research paper are Charlotte Mckercher University of Tasmania, George Patton University of Melbourne, and Michael Schmidt University of Georgia. All three authors have published several research articles covering mental health, adolescents and young adults, and physical activity.

The authors state that they were funded by the National Health and Medical Research Council, the National Heart Foundation, the Tasmanian Community Fund, and Veolia Environmental Services, and report no conflict of interest.

What kind of research was this?
The research was an observational cohort study completed in 1985, with a follow up 20 years later. A cohort study follows a group over a large period of time and are useful when investigating risk factors yet are time consuming and can have large dropout rates. To reduce any potential bias in cohort studies due to dropout rates, ensure that the dropout rate does not exceed 20% of the original sample. In this study, 61% of the original sample re-enrolled and provided follow up data.

What did the research involve?
This study was conducted in Australia in 2012. The research is a follow up of participants who participated in the 1985 Australian Schools Health and Fitness Survey.

As this was a follow up study, 81% of the original participants were traced and 61% enrolled to provide follow up data. Of these participants, 2410 attended a study clinic, and 2070 self-reported their physical activity and major depression levels. A further 75 were excluded due to pregnancy, leaving 1995 participants eligible for analysis. Of the clinic attendees, 84.3% completed a seven-day pedometer diary.

All participants completed the Internal Physical Activity Questionnaire (IPAQ) as well as the Composite International Diagnostic Interview (CIDI). Between those who did and did not provide a pedometer diary, there were no significant differences at their baseline of the depressed mood and physical activity levels.

As questionnaires were used to determine physical activity and depressive symptoms, the results gained might not be entirely accurate. However, the IPAQ and CIDI have been shown to improve standardisation and have acceptable measurement reliability.

Numerous studies have investigated how physical activity affects major depression and other mental health disorders. A study by Legrand et Al. found that among hospitalised patients with major depression, that 10 days of endurance training and antidepressant medication can be a helpful adjunct treatment while in the initial stages of pharmacotherapy.

What were the basic results?
Overall, this study found that adults with major depression that are physically active differ in their symptom profile from those who are physically inactive. Those who were physically active were shown to have an improvement in depressed mood, vacillating thoughts, appetite changes, and thoughts of suicide.

Among the participants, 5.5% of men and 11.6% of women had major depression. Physically active men with major depression were significantly less likely to experience insomnia and fatigue, and physically active women with major depression were significantly less likely to experience hypersomnia and suicidal thoughts. According to the authors, young adults with major depression who are physically active appear to have differing depressive symptoms from those who are not physically active.

The authors thought their analysis of physical activity and major depression characteristics did not fully account for other documented associations in other literature, yet they found a strong correlation between physical activity and the decreased suicidal thoughts in both men and women. The authors also found a strong correlation that increased physical activity was inversely related to young women having a suicide plan, in contrast to previous research which found that there was a positive association with moderate levels of physical activity and suicide plans in young women.

What conclusions can we take from this research?
Based on the evidence presented in this article, physical activity does have an impact on depressive symptoms in young adults. The evidence from this study also shows how physical activity can have a particular benefit in reducing sleep disturbances and thoughts of suicide.

These results match with other studies that also show how physical activity can aid in the treatment of major depression. Legrand et Al. shows how physical activity helps with major depression in conjunction with antidepressants. Even though multiple studies have proven the benefit of physical activity, many studies are unable to provide information on the most efficient type and the optimal amount of physical activity. Further research is required to find the ideal amount and type of physical activity to aid with major depression.

Practical advice.
Physical activity is inexpensive, improves general health and well being, and can decrease depressive symptoms. Even though the ideal type or amount of physical activity is still unknown, this research article and others have proven the effects of physical activity on depressive symptoms. A general practitioner should be consulted prior to the beginning of a program, to ensure that there are no underlying health conditions that could affect physical activity.

If you or someone you know is living with major depression, there are multiple different ways to get help. A GP is a great part as they can begin a treatment plan or point you in the right direction. The websites below have plenty of helpful information to help you get started, but for more urgent help you can call Lifeline on 13 11 14.

Further information/resources:
https://www.blackdoginstitute.org.au/

https://www.beyondblue.org.au/

https://www.lifeline.org.au/

Lifeline number: 13 11 14


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User:HJ1506

Student at University of Canberra, studying a Bachelor of Exercise Physiology and Rehabilitation.

Wikibooks Projects
Exercise as it relates to Disease/The effects of community-based exercise interventions in people with Alzheimer’s Disease

title: User:HJ1506


text:
Exercise as it relates to Disease/The effects of community-based exercise interventions in people with Alzheimer’s Disease

This page is a university assignment critiquing the article 'A community-based exercise program to improve functional ability in people with Alzheimer’s disease: a randomised controlled trial' conducted by Anthea Vreugdenhil, John Cannell, Andrew Davies and George Razay, for the Health, Disease and Exercise unit at the University of Canberra.

What is the background to this research?
Dementia is a degenerative neurological disorder that affects 35 million people across the world and it causes cognitive impairment, behavioural disturbances and physical decline. The study looks at how a community-based exercise program improves functional ability and increases the independence of patients in activities of daily living (ADL). Other similar studies have been conducted and found that exercise can improve the areas of life that decline with the progression of dementia, such as cognition, behaviour and functional ability, but they are few exercise programs that have been specifically designed for the needs of dementia patients. The increasing rates of people with dementia and the limited benefit of pharmacological treatments in reducing decline, show that it is important to explore other treatment variations for Alzheimer's disease (AD).

Where is the research from?
The patients in the study are community-dwelling AD patients from Tasmania, Australia. They were included in the study from a hospital outpatient memory disorders clinic and they live in a community dwelling and have a carer who visits on a daily basis or that lives with them. The authors of the study have completed previous studies on AD, showing their knowledge of the disease. The study was funded by the Tasmanian Community Fund and the Clifford Craig Medical Research Trust.

What kind of research was this?
The study was a randomised controlled trial. This type of study when exploring effectiveness of interventions, is considered to be the gold standard in terms of reliable evidence, because of the reduced risk of confounding factors which could affect the results.

What did the research involve?
64 patients were invited to take part in the study and 40 patients agreed to participate. The reasons for not participating ranged from being too busy or not interested in exercising. The patients were then randomly allocated to the control group, that conducted their usual treatment, or the treatment group, that participated in the exercise intervention. Patients in the control group participated in a 4 month at home exercise program as well as receiving their usual treatment. The exercise program was adapted from an earlier study and was trialled in a feasibility and safety study of 12 people with AD. The program involved 10 simple exercises, with 3 levels that got progressively more challenging, focusing on strength in the upper and lower body, and balance training, as well as at least 30 minutes of brisk walking. The patients were asked to complete the exercise daily and they were trained in the exercise program and provided with a manual that contained information and illustrations on how to complete the exercises. Patients of the control group continued their usual treatment. Patients in the study had two calls at 2 weeks and 2 months, to ask about well-being and how they were progressing with the exercises. Patients were assessed at baseline and at 4 months on various anthropometric measurements as well as outcome measures which are listed along with the assessment names :

 * Cognitive function - The Alzheimer's Disease Assessment Scale - Cognitive Sub-Scale (ADAS-Cog) and the Mini-Mental State Examination
 * Physical function - The Functional Reach Test (balance), the Timed Up and Go Test (mobility) and the Sit-to-Stand Test (lower body strength)
 * ADL (Activities of Daily Living) - The Barthel Index of Activities of Daily Living and the Instrumental Activities of Daily Living assessments
 * Depression - The Geriatric Depression Scale - Short Form
 * Global change in function - The Clinician's Interview-Based Impression of Change plus Caregiver Input (CIBIC-plus)
 * Carer burden - The Zarit Burden Interview

The format that the study was completed in is an effective approach because it allows the participant to fit the exercise into their daily routine and does not force them to complete the exercise with an external trainer or in an external location. Although it is important to note that in other studies of older populations, it has been found that group-based exercise is just as effective as home-based exercise in community-dwelling older adults. The limitations of this study are that participation and compliance is placed on the patient and their carer, the study relies on self-reporting and it was not double blinded because patients knew what group they were in.

What were the basic results?
16 men and 24 women participated in the study with a mean age of 74.1 years. The key baseline measures indicated that there was no difference between the control and treatment groups. At the 4 month follow-up, patients in the treatment group had increased positively in each of the functional domains, while the control group decreased in areas and had much less positive change. The researchers interpretation of the results was that they were significant in showing the benefit of community-based exercise programs. The researchers made a point that this is the first study to their knowledge, to show improvements in all functional domains and emphasised that the most important finding was the improvement in ADL as it is the strongest predictor of care hours for patients with AD. The implications of this research are not over-emphasised, as this is an increasingly important area of research due to the increasing amount of people affected by AD.

What conclusions can we take from this research?
The main conclusion to take from the study is the benefit that a specific exercise program for AD patients can provide for daily quality of life. A 2018 study on exercise interventions for cognitive improvement in individual's with AD, found that exercise can slow down the process of cognitive impairment and is an effective alternative to pharmacological therapy. Similar findings can also be found in a study of people over 50 from 2019, which concluded that physical exercise improved cognitive function, through aerobic and resistance exercise in line with exercise guidelines. While this study is not specific to AD patients, it provides more evidence that exercise will assist the daily function of patients.

Practical advice
The study, while not specifically describing exercises involved in their program, highlighted key areas of focus for exercise in upper and lower body strength and balance, as well as walking. The study also describes how the carer acts as a personal trainer and how the manual of exercises assisted patients in completing the program. These two points are highly important in providing recommendations for exercise for AD patients. The study also shows the effectiveness of community-based exercise. Another consideration could be how would the exercise need to be changed for patients with other pre-existing conditions.

Further information/resources
Further sources of information are listed below, for patients and allied health professionals:

 * What is Alzheimer's Disease? https://www.dementia.org.au/information/about-dementia
 * Exercise and Alzheimer's Disease Fact Sheet https://www.dementia.org.au/sites/default/files/helpsheets/Helpsheet-DementiaQandA08-PhysicalExercise_english.pdf
 * Australian Physical Activity Guidelines for Older Adults https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-older-australians-65-years-and-over
 * Cognitive Improvement with Exercise in AD paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866875/
 * Exercise Intervention for Cognitive Function in Older Adults paper https://bjsm.bmj.com/content/52/3/154.citation-tools


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User:Jack.weeden

My name is Jack, I'm interested in boxing and rugby.

Exercise as it relates to Disease

title: User:Jack.weeden