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Exercise as it relates to Disease/High volume‐low intensity exercise camp and glycemic control in diabetic children

This Paper is a review of the article 'High volume‐low intensity exercise camp and glycemic control in diabetic children' (Ruzic et. al, 2007).

Background research
This paper looked at the effects of high volumes of low intensity programmed exercise on the improvement of glycemic control in children diagnosed with diabetes mellitus (type 1). Glycemic control is characterised as maintaining euglycemic (normal) blood glucose levels, which in a diabetic child ranges from 4-9 mol/L depending on exercise and time of day.

While it is well understood that exercise is an extremely effective tool to help control blood glucose and other glycemic characteristics, there are still significant numbers of diabetic children who do not engage in sufficient amounts of physical activity. With much literature suggesting that exercise in diabetic patients comes with increased risks of hypoglycemia and hyperglycemia; particularly the former, it is understandable that children and their carers may be hesitant to engage in exercise and organised physical activities.

Summer camps have become an increasing popular exercise intervention with this particular population. With their increasing popularity there have been several studies based out of these camps investigating exercise and its effect on diabetes. Most of these studies do not achieve exercise volumes as large as this study investigates.

Where is this research from?
This study was published in the journal of paediatrics and Child health, coming from the Faculty of Kinesiology at the University of Zagreb, Zagreb Croatia. It was completed in partnership with the Croatia Association for Diabetic Societies and the Paediatric branch of the University of Zagreb Hospital (also known as Sisters of Charity). It's Authors Dr Lana Ruzic, Professor Goran Sporis and Branka Matkovic have an immense amount of experience in the sport and exercise science industry, as well as significant publishing experience.

What kind of research was this?
This study was an intervention based observational study. This means, the same group of participants were monitored before and after the particular intervention, and their initial and final results compared. In this study 185 participants were invited the camp based upon selection criteria. 28 participants were then selected, only 20 were used for the data analysis. Participants were already members of the Croatian Association for Diabetic Societies and had been treated at the Vuk Vrhovac clinic.

What did the research involve?
Summary of study procedures:

For this particular study 28 participants aged 9 –16, participated in a summer camp on an island in Croatia for 15 days. On each day of the camp the participants completed approximately 4 hours of exercise, based on a strict schedule. The exercises varied in intensity and type, all exercise was prescribed by an exercise physiologist in conjunction with a kinesiologist. Exercise and the intensity are as follows:

Throughout the camp the children participated in a range of activities. These activities were set on a five-day cycle and repeated three times.

Throughout the exercise, heart rate blood glucose were Monitored. Blood glucose was also recorded at varying times of the day. Calorie intake was also predetermined and set for each individual and adjusted if needed. At the conclusion of the camp each participant received a recommended exercise program, to continue on with.

The study took measurements of the participants HbA1c, on the first day of before the camp, 10 days after the camp and two months after the camp.

Methodology review: Strengths:

The summer camp setting allowed for a lot of biases and variables to either be eliminated or controlled, for example insulin dosage and calorie intake. The structure of the program was also designed off heart-rate models making physical exertion, and energy expenditure slightly more normalised. The exercises in the program were also very consistent, however contained enough variability to ensure proper adherence.

Potential improvements:

The final hour of exercise completed at the end of each day, was potentially completed too late at night. It has been well researched that exercise increases incidence of hypoglycemia and nocturnal hypoglycemia, exercising right before bed and without blood glucose checks throughout the night, there was the potential for participants to experience a severe nocturnal hypoglycaemic event.

The measurement of HbA1c, was an effective measurement, and given it is a historical measurement was measured at appropriate times. However for this particular study results were taken at 10 days after the camp, where they HbA1c reduction was very evident and then at 2 months when results had to basal levels. This gives us a general trend, however had more data been collected we may have a more accurate idea of how long the adaptions caused by the intervention lasted.

What were the basic results?
Note: significant p-value <0.05

Overall this type of intervention achieved the desired results. The number of children achieving a predetermined satisfactory HbA1c result (<7.5%) doubled (to 8) when measured 10 days after the camp, the average values for HbA1c also dropped significantly. The researchers also found a drop in blood glucose (when measured after meals) in many of the participants in the final days of the camp.

The researches of this paper deemed this intervention a short-term success. They found that the exercise prescription achieved the desired results, however these adaptions where not as long lasting as they hoped, with results reverting to baseline measures at around two months after the termination of exercise.

Conclusions
With low incidence of hypoglycemia (only two recorded cases) and significant improvements in glycemic control this study illustrates the effectiveness of high volume and low intensity exercise. With the final results measured after two months showing regression back to initial data this study also highlights the importance of continued and habitual exercise and exercise behaviours in the ongoing management of diabetes mellitus.

Recent research would suggest that whilst continual aerboic based low-moderate intensity exercise is an effective tool to improve glycemic control, introducing high-intensity bouts of exercise can help reduce the risk of hypoglycemia and particularly nocturnal hypoglycemia.

Practical implications

 * This type of exercise was very effective in a controlled environment, however once the camp ended not one participant reported adherence to exercise recommendations for the end of the study.
 * Organised participation will receive the best adherence (particularly in children) and help build habitual exercise behaviours.
 * Ongoing organised programs e.g. built into school curriculums or through clubs with the support of parents will be the best chance of using this type of intervention in the long term.

Further readings
Below are some addition resources:

 * American Diabetes Association
 * Diabetes Australia
 * Pediatric Diabetes
 * World Health Organisation (WHO)


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Exercise as it relates to Disease/Does incorporating more physical activity into everyday lifestyle improve body composition, thyroid function, and structure in obese children?

What is the background to this research?
The Thyroid is a gland that sits in the front of the throat and is responsible for the secretion of several hormones responsible for influencing metabolism, growth and development and body temperature which is important in early life for normal growth and development in children. Weight excess correlates with several obesity-related conditions and thyroid structure and function is now considered among them. A study conducted on obese children between 2004 and 2008 displayed alterations in thyroid structure and function were present in obese individuals particularly in children. Function reverses to normal after weight loss, but not a lot is known about alterations to the thyroid structure. the study aimed to assess any improvements to thyroid structure as well as function following weight loss due to implementation of physical activity and structured diet into everyday lifestyle.

Where is the research from?
The study was conducted over the course of 4 years from 2004 to 2008 by G. Radetti, S. Longhi, M. Baiocchi, W. Cassar, and F. Buzi, who are all affiliated with pediatrics studies. Giorgio Radetti, the main author of this work has done previous studies on the structure and function of the thyroid and how it is affected by obesity and weight loss. The Study was conducted at two Pediatric Endocrinology Centers, the Department of Pediatrics, Regional Hospital of Bolzano and the Department of Pediatrics, University of Brescia, Italy. This research was first published online on the 27th of May 2011 as part of the Journal of Endocrinological Investigation Issue 3, pp 281–285.

What kind of research was this?
This study is classified as a longitudinal follow-up study. Subjects are followed over time with continuous or repeated monitoring of risk factors or health outcomes, or both. The study is designed to verify the effectiveness of a dieting program together with participation in regular physical activity on reverting changes observed in thyroid structure of obese children. This study design is appropriate for desired research conclusions, and other studies done by Giorgio Radetti and others support the findings of the study with little differentiation in results of similar studies conducted. hormones before and after weight loss in obesity ,Function and Structure Are Affected in Childhood Obesity, Influences of obesity and weight loss on thyroid hormones

What did the research involve?
Between March 2004 and September 2008, 72 overweight and obese children [body mass index (BMI) >85 percentile) (41 males, 31 females) were evaluated. Measurement of free T3 (fT3), free T4 (fT4), TSH, anti-thyroid-antibodies and a thyroid ultrasound was performed at the beginning (phase 1) and after a period of 1.8±1.0 years of lifestyle intervention (phase 2). Clinical characteristics assessed include, chronological age, bone age, height (SDS), BMI (SDS), fitness (hr/week), Fat mass(kg), fat mass percentage and fat free mass(kg).

The children assessed were part of a cohort of 186 obese children evaluated in a previous study Function and Structure Are Affected in Childhood Obesity, who agreed to follow a weight-management program at two Pediatric Endocrinology Centers.

The methodology was sound, as it accurately collected the clinical data showing a correlation between weight loss and thyroid structure over time with no major errors in data collection. The design of the study could improve as there is no detail about a set exercise or dietary plan, making it completely reliant on individual participation at a given exercise intensity and healthy diet choices. There are few ways to ensure participants follow the program strictly, short of constant monitoring of all 72 patients.

Limitations of this study:

 * The children were all diagnosed with simple obesity, other syndrome, organic, and hormonal causes have been excluded from the study. None of the children showed signs of thyroid autoimmunity, nor were any of the subjects affected by diabetes. This means this study intervention cannot be applied to any chronic disease condition outside of simple obesity as a valid intervention.
 * Studies are all done on children, so its unknown if this outcome of revered thyroid structure would occur in other population groups.
 * the studies success is heavily reliant on the compliance of the children to the program and the results may be altered by how strictly the plan was followed over the 4 years the study was conducted for.
 * The study does not mention a set diet and exercise plan and appears to be dependent on the individual patients motivation and lifestyles choices.

What were the basic results?
The aim of this study was to verify whether changes in lifestyle might improve the alterations in thyroid function and structure that we previously showed in a group of obese children, without signs of thyroid autoimmunity. The weight-management program offered to the children was based mainly on modifications of their eating habits together with increased physical activity, with tests done at two stages. The children were examined for the first time at a mean age of 10.4±2.9 yr (phase 1) and subsequently at a mean age of 12.2±3.4 (phase 2)

Height SD score (SDS), body mass index SDS, total fat mass did not change from phase 1 to phase 2 however Percentage of fat mass decreased

significantly.

Changes in thyroid function can be observed as levels of FT3 & FT4 decrease back to normal range compared to changes in thyroid structure which were thought to be fairly insignificant however they were still present, along with other positive correlations to lifestyle intervention such as insulin sensitivity and body composition improvements due to decrease in fat mass and a significant decrease in waist/height measurements and waist/hip despite there being little change in total weight.

What conclusions can we take from this research?

 * Overall changes in thyroid structure were thought to be insignificant however they still occurred.
 * regardless of changes in weight status children with lifestyle intervention reported changes in homeostasis model assessment for insulin resistance and in adiponectin that were associated with loss of fat mass.
 * This establishes that thyroid structure and function can be added to the list of health benefits correlated in the results with early obesity intervention and weight loss in children.
 * This research supports studies focused around increased sedentary behavior in children with increasing levels of screen time now taking place and its negative effects, further highlighting the importance for kids to remain active during this crucial growth and development stage.

Practical advice

 * The study is not very specific in how the intervention took place, what exercise was involved or dietary requirements throughout the study. In future a more specific intervention with a set out diet plan and exercise criteria ( IE.20 mins vigorous PA a day), may make results more consistent.
 * The children were all diagnosed with simple obesity, other syndrome, organic, and hormonal causes having been excluded from the study and non showed signs of having diabetes or thyroid autoimmunity, so this intervention cannot reliably be applied to those thought to suffer from more than simple obesity.
 * Future research might benefit from looking at the effect of lifestyle intervention on those who are already suffering from chronic disease or other population groups such as the elderly population, and whether the same effects on thyroid structure and function can be observed during weight loss.

Further information/resources

 * the Journal of Endocrinological Investigation Issue 3, pp 281–285.
 * Function and Structure Are Affected in Childhood Obesity
 * changes in thyroid structure and function
 * hormones before and after weight loss in obesity
 * Function and Structure Are Affected in Childhood Obesity
 * Influences of obesity and weight loss on thyroid hormones

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


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Exercise as it relates to Disease/The hidden benefits of team sport in youth self-esteem

The following is a critique of the research paper "The link between children's sport participation and self-esteem: Exploring the mediating role of sport self-concept", from the journal "Psychology of Sport and Exercise".

What is the background to this research?

 * “The link between children's sport participation and self-esteem: Exploring the mediating role of sport self-concept”. The main purpose behind this article was to determine if a child’s participation in team sports had a positive effect on their feelings of self-concept and self-esteem. The article also delved into the question of whether a child is benefited further playing a team sport compared to that of an individual sport.

 * It is widely known that sport and exercise is beneficial both physically and mentally in the development of adolescents, particularly in areas of self-concept and self-esteem. Less is known about whether this participation also benefits younger children and therefore leads onto higher and healthier levels of self-concept and self-esteem as they go through adolescence and then into adulthood.

 * Allowing children to participate in sport activities gives them the opportunity to not only construct sport capabilities but also allows them the chance to develop self-concept of their abilities. Theories also suggest that a child’s time in sport has associations with not just a child's sport self-concept but also their overall self-esteem through childhood and later on in adolescence. (1) The key aim of this investigative article was to assess the associations between the time children spent in organized sport activities and their reported sport self-concept, and self-esteem during elementary school.

Where is the research from?

 * This study was conducted in the mid-west of North America based on elementary aged public-school children of the European-American middle-class. There was minimal diversity seen across races, ethnics and classes. The article states the study was conducted nearly two decades ago, with this particular study being written in 2008. Many factors that influence a child’s opportunity to play sport have changed in the last two decades, many leading to the increase of sport participation in children. Therefore, is this data still relatable to our children now?

 * Both authors Carly B. Slutzky and Sandra D. Simpkins are university professors based in the school of social and family dynamics at Arizona State University. Making them reasonably established specialists in the area, although this article being one of the first for Slutzky and fourth for Simpkins. Simpkins has a history of previously written articles based on similar factors, one being organized activities and their effect on obesity and social marginalisation.

What kind of research was this?

 * This particular study was a longitudinal school-based study. Due to the nature of the study, especially being based on children of a young age the use of parental feedback was necessary but perhaps not 100 percent reliable. Other studies completed of similar nature seem to have the same issue of being based off self-report and therefore the issue of bias, exaggeration or understating of the results comes into play.

 * Similar studies conducted on adolescents sees results being reported by the child themselves, which is perhaps a slightly more reliable outcome than that of parents but also has the possibility of being even less reliable depending on how honest the child feels they need to be with their results. An example of this method is seen in the research article “Team Sports Achievement and Self-Esteem Development Among Urban Adolescent Girls” located in Sage Journals.

What did the research involve?

 * The study included three year groups of children and their families. Data was collected in 4 waves. In wave 1 the respective children were in kindergarten, year 1 and year 3. Wave 2 they were in years 1,2 and 4, wave 3 they were in years 2,3 and 5 and wave 4 they were in years 3, 4 and 6. Data was collected each spring within the classroom under the supervision of school staff and project researchers. Only parent-reported organized sport activities were included in this particular study.

 * There were several limitations of this study. The first being this study was piloted nearly two decades before the article was written. Many factors may have changed over these two decades, including the fact that children’s participation in sport has been continually on the rise. The continues growth of women’s sport has also become an undeniable factor when compared to figures two decades ago.

 * Other limitations included the fact that parents were the key source of result feedback, which perhaps could allow an element of bias to be brought into the study. The question is would parents really have accurately reported their children’s time in physical activity? This dependence on parent feedback may have increased error variance in the time children spent in sports.

 * The final limitation that can be noted is the key fact that the study’s findings were based around European-American, middle-class children. Although it can be seen that physical activity participation does not change noticeably across racial and ethnic groups, the way in which sport has an influence on self-esteem may change depending on the child’s race and cultural beliefs.

What were the basic results?
Key findings included:

 * Children on average weekly spent more time in team sports than individual sports (1.2hr compared to .96hr)
 * Boys made up 66% of team sports participants but only 48% of individual sport participants
 * Children participating in team/individual sports were on average 9.8 years of age
 * Participants results reported high levels od sort self-concept and sport importance
 * Participant results showed on average they were well adjusted children (i.e. above average self-esteem and peer acceptance ratings were seen in results)
 * Overall proposed time spent in team sports was positively correlated with sport self-concept. Although no correlation was seen in time spent in individual sports and sports self-concept.
 * Overall researchers interpreted results as these findings showed that children who spent a higher amount of time in team sports felt they were more capable at sport, furthermore children who felt they were more capable in sport reported to have higher self-esteem than their peers who were found to have less involvement in team sports.

What conclusions can we take from this research?

 * The study provides compelling evidence that a child’s participation in team sports correlates with their feelings of sport self-concept and furthermore overall self-esteem. A child who participates in team sports for a higher amount of time is reported to have higher levels of self-esteem than children who don’t participate to that level.
 * The key take away message from this study is in this current day and age of life being prioritised around technology and social media children’s battle with self-concept and self-esteem is evermore increasing. The aim needs to be getting children out and involved in as much physical activity as possible but in particular a higher amount of time spent in team sports. By doing this parents, carers and teachers should hopefully see the positive benefits in the growth of their child's feelings of self-concept and self-esteem and the associated benefits that comes with these imperative factors of mental health.

Practical advice

 * As shown above getting your child involved in team sports has the greatest benefit over their self-esteem, especially when compared to other forms of physical activity such as individual sports.
 * Playing a team sport particularly for the first time can be quite daunting for a child of any age. Therefore, some suggestions that may help influence getting them involved in a team sport are noted below:

 * 1) Allowing them to join a team with a few friends they may already know
 * 2) Letting them be involved in the choice of which sport they are interested in trying and want to play
 * 3) As a parent or carer setting an example by playing a team sport yourself or getting involved in their team (coaching/managing)
 * 4) Being positive and supportive in the child's abilities and enthusiastic in the fact that they are giving it a go

Further information/resources

 * For further information on children involved in sport specifically within Australia: https://www.clearinghouseforsport.gov.au
 * For ideas and resources on getting your child involved in a team sport: https://www.getactivesports.com.au


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User talk:Nicola.georgiou

Wikibooks is not a webhost and the pages you have created are inappropriate. Student discussion should be held on the Talk pages of the book and not in separate pages. As they are out of scope, the pages you have added have been deleted. Please do not create them again. QuiteUnusual (discuss • contribs) 18:20, 18 September 2019 (UTC)
 * I've asked you before not to create standalone pages - we've just had to delete another set of them. Please take more time to consider what you are doing and not create work for the administrators. QuiteUnusual (discuss • contribs) 11:08, 4 October 2019 (UTC)

title: User talk:Nicola.georgiou


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Exercise as it relates to Disease/The effect of exercise intensity on women with depression

What is the background to this research?
Depression is a serious mental disorder present throughout the world, and women are twice as likely to suffer from it. Despite the availability of pharmaceutical and psychotherapeutic treatments for depression, only 51.6% of adults suffering from Major Depressive Disorder (MDD) seek treatment, with only a further 21.7% being effectively treated. Due to the social stigma surrounding traditional treatments for MDD (anti-depressants, therapy etc.), exercise is deemed ‘socially acceptable’ due to its fewer side effects and other health benefits. Therefore exercise can be a more satisfactory treatment for some (not all) individuals with depression. Further studies indicate that exercise training (structured or not) is as effective as antidepressant medication and psychotherapy.

Where is the research from?
All four authors have been published within well-known journals (The Journal of Sport and Exercise Psychology, international Journal of Mental Health and Addiction) therefore aiding us in trusting this is a reliable source.

 * Hua Chu, Department of Family and Preventative Medicine, University of California
 * Janet Buckworth, Health and Exercise Science, The Ohio State University
 * Timothy E. Kirby, Health and Exercise Science, The Ohio State University
 * Charles F. Emery, Department of Psychology, The Ohio State University

What kind of research was this?
This design of study had one between subject factor (group assignment- 3 levels) and one within-subject factor (time - 3 levels). This design of study could also be categorised as a randomised control study of sedentary* female volunteers (aged 18-43) with depressive symptoms (a score of 14-28 on Beck Depression Inventory –II). However written consent from a physician or other health care professional to participate was required for any female scoring above 28 on BDI-II.

These volunteers were randomly assigned to one of two aerobic exercise groups (high intensity or low intensity), or to an exercise control group consisting of flexibility and stretching exercises. This randomisation was accomplished by drawing the names of participants from a bag. This form of study helps reduce bias, aids in statistical consistency and is considered the most reliable intervention due to the processes used which help minimise the risk of different factors influencing the results.

 * exercising less than three times a week for less than twenty minutes a session

What did the research involve?
After completing all baseline assessments (BDI-II, maximal oxygen intake, exercise self-efficacy* and depression coping self-efficacy), participants were informed of their group assignment and all participants began their training program within a two-week window of their baseline evaluation.

Over the course of the selected 10-week training program, each group met with the investigator once a week for a supervised exercise session. Aerobic group participants (both high intensity and low intensity) exercised on a treadmill for 30-40 minutes and those in the stretching control group performed 30 minutes of supervised stretching and flexibility exercises. The aerobic participants were also asked to complete three to four unsupervised aerobic exercise sessions each week.

 * Participants rated confidence from 0% (cannot do it at all) to 100% (certain I can do it) in their ability to exercise under a number of different conditions (mood, weather) over the course of the 10 weeks.

What were the basic results?
Of the initial 54 participants, 16 (30%) did not finish the 10-week training program (three from high intensity, seven from low intensity, and six from the stretching control). The major reasons for drop out were lack of time for exercise, and a low compliance with the assigned intensity of exercise. There were no significant differences between the participants who completed the study and those who didn’t, except for antidepressant use. A significant amount of participants who dropped out were taking antidepressants at study entry.

The remaining participants who completed the full 10-week program revealed significant improvements over time in their BDI-II scores. Overall the average BDI-II score decreased significantly from 22.5 at study entry, to 13.9 at 5 weeks and continued to decrease to 11.3 at 10 weeks.

What conclusions can we take from this research?
According to the results of this 10-week program, it suggests that high intensity and low intensity aerobic exercise as well as stretching exercise contribute to a reduction in depressive symptoms. However, when comparing the BDI-II scores between each group, participants in high intensity presented significantly fewer depressive symptoms at both weeks 5 and 10, where low intensity and stretching did not differ greatly at either time point.

If we were to go off these results then we can assume a high intensity aerobic exercise may be more effective at reducing symptoms of depression in the long term. However, since there were no significant reductions in depression between each of the groups, there would need to be further investigation into whether high intensity exercise really is necessary for improving symptoms of depression.

Despite the results, there is also the possibility of a placebo effect since the stretching control group also showed significant improvements in their depressive symptoms. There’s the possibility that participants expectations, the social aspect and personal attention given by the investigator and study could also have contributed to an improvement in depressive symptoms. Therefore, despite stretching being used as a placebo control, may also be an effective treatment for depressive symptoms.

There were also a number of limitations to this study. Unsupervised exercise sessions relied on self-analysis to measure participant’s behaviours and so therefore possible that participants would either overestimate the intensity and duration, underestimate it, record extra sessions or not exercise at all.

The study claims that both high and low intensity aerobic exercises as well as stretching exercise were associated with depressive symptoms reductions over the 10-week training period. Therefore we can assume that although high intensity exercise may affect depressive symptoms more effectively, it can be said that low intensity exercise and stretching have an effect also and so the extent of exercise intensity doesn’t really have a massive effect on the reduction of depressive symptoms.

Practical advice
Regular exercise for patients suffering from depressive symptoms can be an effective treatment by itself or alongside other treatments like therapy, medication etc. and can then increase a sense of control, social support and self esteem in the individual.

Due to the low cost and simplicity, exercise and physical activity can be a beneficial intervention for those suffering from depression (mild to severe). However due to lack of motivation, self esteem and other mind blocks in some patients it can be beneficial to seek professional help or advice.

Even if exercise causes little to no improvements initially; exercise is low risk and is advantageous to a patient’s health and fitness regardless and eventually may improve their self-esteem or self love once they see a change. Exercise alongside other treatments like therapy and a solid support system, can help improve an individuals well being, mental stability, improved motivation and a better outlook in the general sense.

Further information/resources

 * If you are interested in taking up an exercise program, please contact your GP for health advice, and see a personal trainer for an exercise program to help you reach your goals.

 * If you or someone you know is may be experiencing depression, please contact Beyond Blue on 1300 22 4636 or reach them at https://www.beyondblue.org.au/

 * If you or someone you know is suicidal call lifeline on 13 11 14 or https://www.lifeline.org.au/


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Talk:International Postage Meter Stamp Catalog/Sweden

Group PO
PO2 can be purchased the following ways:

1). Online. Printed by a printer at your disposal, either directly to the cover − or to a label, which is then affixed to the cover, and finally posted from a postal franchise. 2). Postal franchise. The sales person performs the same as described in the first line. At the postal franchise payment can be made by:
 * Cash.
 * Credit or debit card.
 * Postage stamps affixed to the cover.

In case the postage stamps pays for the shipment in full, PO2 has no indication of price. 94.191.140.208 (discuss) 22:00, 18 September 2019 (UTC)


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User talk:Ekenyos

Cardiovascular and metabolic adaptations through different training intensities within middle aged men and the considerations associated with cardiovascular disease.

This is a critique of the research article: Left ventricular vascular and metabolic adaptations to high-intensity interval and moderate intensity continuous training: a randomized trial in healthy middle-aged men.

What is the background to this research?
Cardiovascular disease (CVD) is a collective term that refers to various diseases that have an adverse effect over the heart and blood vessels. These forms of disease are the most prevalent cause of mortality within countries of higher economic standards, while it continuous to grow through developing countries parallel to their economic growth. Due to the diverse number of contributing factors towards diseases of this form it often goes undiagnosed, thus highlighting the importance of providing individuals with sufficient knowledge to conduct safe practices regarding their health. It is hypothesised that individuals with CVD may be at increased risk with higher intensity adaptations to training, emphasising the importance in understanding potential negative reactions surrounding the epidemic.

The current trend associated with high intensity interval training (HIIT) has generated a large pool of studies providing significant amounts of evidence surrounding the various health benefits associated with the style of training however, the resources linked to potential risks for certain individuals is limited. This study examined the myocardial perfusion, metabolism and cardiac functions of healthy, sedentary, middle aged men when conducting either HIIT or moderate intensity continuous training (MICT). Thus, providing a resourceful base for reference when determining probable risk factors or benefits associated with training at high intensities for individuals suffering from CVD.

Where is the research from?
The entirety of the study was conducted regarding the Declaration of Helsinki and was approved by the ethical committee of the Hospital District of South Western Finland. It was directed within the Centre of Excellence in Cardiovascular and Metabolic research and no obvious biases were evident throughout the article, as majority of the authors had past research in exercise related adaptations through the body as well as cardiovascular research. The authors background may have been advantageous for the study as their knowledge may have provided them with an increased understanding of both benefits and risks alike. Interpretation of results may also have been conducted efficiently considering the knowledge depth present.

What kind of research was this?
The interventional study was one of pre-post design. There were two parallel groups that conducted separate training regimes with no crossover. Neither participants nor investigators were blinded regarding group allocation as the action would've been ineffective and had no influence over the final results. Studies of this design have the ability to create ideal opportunities to examine specific changes implemented through the intervention purpose. However, factors such as incidence or prevalence need to be considered as they often reduce the reliability of the studies results.

What did the research involve?
Twenty-eight untrained, non-smoking, middle aged, healthy men conducted a total of six sessions over a two-week study time frame. They were equally divided into two groups and conducted either a HIIT regime consisting of 4-6 repeated Wingate tests with approximately four minutes of rest in between each run or the MICT program where 40-60 minutes cycling was completed at 60% max workload. Developments were made through the number of repeated efforts, starting from 4 and working through to 6 respectively, while the MICT group increased in time from 40 to 50 minutes to additionally 60 minutes after every other session.

The methodology managed was sufficient for the examination at hand. Equal group participants along with the thorough physical pre-screenings ensured that participants were standardised, reducing outside confounding factors, thus emphasising the intervention as the only variable, increasing validity through statistical tests based on probability theory. However, conducting the intervention over a longer timeframe would have benefitted those investigating the adaptations as it would've allowed for more relevant considerations to be observed such as changes through left ventricular mass, which has been shown through other studies as a noteworthy adaptation. Additionally, an inadequate amount of background information was available regarding the relationship between exercise and reduced vascular function and insulin action within the heart.

What were the basic results?
The study found that the adenosine stimulated myocardial perfusion had the most significant difference between intervention groups with the HIIT group having a reduction of 19%, while the MICT had an increase of 9%. This finding was found to be connected to the myocardial glucose uptake, particularly within the HIIT group. Despite this connection to myocardial glucose uptake there was little understanding regarding the reasoning for the reduction in adenosine stimulated myocardial perfusion through the HIIT group, highlighting the requirement of additional future studies examining this component. It was also found that the myocardial vascular hyperaemic reactivity was impaired post HIIT. All other metabolic and functional adaptations of the heart were similar throughout both groups. Additionally, the insulin stimulated myocardial glucose uptake was decreased by training, with no significant differences evident throughout the groups, as well as no changes through free fatty acids.

What conclusions can we take from this research?
The authors conclusion stated that, HIIT training in healthy, previously sedentary men may lead to compromised myocardial vasodilation. The evidence suggested that the reduction in adenosine-stimulated myocardial perfusion was decidedly linked to high intensity training as well as clear impairments through the myocardial vascular hyperaemic reactivity, therefore individuals who were untrained shouldn't par take in exercise of the strenuous form. Thus, supporting the hypothesise regarding cautious exercise prescription for individuals suffering from CVD as the already prevalent conditions within their heart could increase risk or mortality and create dangerous situations for participants. However, a large majority of studies have been published that provide evidence supporting HIIT as a positive form regarding improvements through cardio-metabolic factors. Various studies have found that both HIIT and MICT interventions have had significant reductions in resting blood pressure with participants suffering from hypertension, with HIIT having larger improvements. Arguments may be made concerning what aspects were examined through the studies at hand and whether the lack of focus surrounding the in-depth adaptations to the heart on a muscular level as its this analysis that highlights the high risk associated with training at high intensities with CVD. Nevertheless, it's clear that there are advantageous aspects to HIIT within participants suffering from CVD, and even without minimal evidence for comparison of varying HIIT prescriptive variables for optimal treatments, the overarching rule for the training regime has proven effective.

Considering the large variety of evidence across numerous spectrums its hypothesised that there is not concrete answer regarding whether or not HIIT with individuals suffering from CVD is worthwhile. Rather than establishing a clear decision regarding the prescription of the training intensity, personalised considerations regarding whether or not the benefits outweigh the risks for specific individuals would be most effective. Individual assessments regarding previous aerobic fitness and current health standpoints will provide professionals with an efficient amount of information to conduct the most educated prescription of either HIIT or trainings at lower intensities levels for those suffering from CVD.

Practical advice
The conclusions state that previously sedentary males should not participate in strenuous HIIT. There is a brief mention that perhaps a slow integration of the training style would be beneficial, however the recommendations are no HIIT sessions throughout the early stages of a program. Additional resources suggest that conducting a baseline stress test, from which personalised training sessions may be calculated regarding intensities based off the heart rate maximum calculations, reduce the risks associated. It is advised that individuals suffering from CVD of any severity seek medical clearance prior to executing any training at high intensities. Once cleared, a slow progressive introduction to the training regime will allow the body to adapt efficiently, while experiencing all the health benefits associated with HIIT.

Further information/resources
For further information regarding exercise and cardiovascular health, please click the links below:

Heart Disease in Australia

Physical Activity for People With Cardiovascular Disease: Recommendations of the National Heart Foundation of Australia

High-Intensity Interval Training for Patients With Cardiovascular Disease - Is It Safe?

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Exercise as it relates to Disease/Cardiovascular and metabolic adaptations through different training intensities within middle-aged men and the considerations associated with cardiovascular disease

Cardiovascular and metabolic adaptations through different training intensities within middle aged men and the considerations associated with cardiovascular disease.

This is a critique of the research article: Left ventricular vascular and metabolic adaptations to high-intensity interval and moderate intensity continuous training: a randomized trial in healthy middle-aged men.

What is the background to this research?
Cardiovascular disease (CVD) is a collective term that refers to various diseases that have an adverse effect over the heart and blood vessels. These forms of disease are the most prevalent cause of mortality within countries of higher economic standards, while it continuous to grow through developing countries parallel to their economic growth. Due to the diverse number of contributing factors towards diseases of this form it often goes undiagnosed, thus highlighting the importance of providing individuals with sufficient knowledge to conduct safe practices regarding their health. It is hypothesised that individuals with CVD may be at increased risk with higher intensity adaptations to training, emphasising the importance in understanding potential negative reactions surrounding the epidemic.

The current trend associated with high intensity interval training (HIIT) has generated a large pool of studies providing significant amounts of evidence surrounding the various health benefits associated with the style of training however, the resources linked to potential risks for certain individuals is limited. This study examined the myocardial perfusion, metabolism and cardiac functions of healthy, sedentary, middle aged men when conducting either HIIT or moderate intensity continuous training (MICT). Thus, providing a resourceful base for reference when determining probable risk factors or benefits associated with training at high intensities for individuals suffering from CVD.

Where is the research from?
The entirety of the study was conducted regarding the Declaration of Helsinki and was approved by the ethical committee of the Hospital District of South Western Finland. It was directed within the Centre of Excellence in Cardiovascular and Metabolic research and no obvious biases were evident throughout the article, as majority of the authors had past research in exercise related adaptations through the body as well as cardiovascular research. The authors background may have been advantageous for the study as their knowledge may have provided them with an increased understanding of both benefits and risks alike. Interpretation of results may also have been conducted efficiently considering the knowledge depth present.

What kind of research was this?
The interventional study was one of pre-post design. There were two parallel groups that conducted separate training regimes with no crossover. Neither participants nor investigators were blinded regarding group allocation as the action would've been ineffective and had no influence over the final results. Studies of this design have the ability to create ideal opportunities to examine specific changes implemented through the intervention purpose. However, factors such as incidence or prevalence need to be considered as they often reduce the reliability of the studies results.

What did the research involve?
Twenty-eight untrained, non-smoking, middle aged, healthy men conducted a total of six sessions over a two-week study time frame. They were equally divided into two groups and conducted either a HIIT regime consisting of 4-6 repeated Wingate tests with approximately four minutes of rest in between each run or the MICT program where 40–60 minutes cycling was completed at 60% max workload. Developments were made through the number of repeated efforts, starting from 4 and working through to 6 respectively, while the MICT group increased in time from 40 to 50 minutes to additionally 60 minutes after every other session.

The methodology managed was sufficient for the examination at hand. Equal group participants along with the thorough physical pre-screenings ensured that participants were standardised, reducing outside confounding factors, thus emphasising the intervention as the only variable, increasing validity through statistical tests based on probability theory. However, conducting the intervention over a longer timeframe would have benefitted those investigating the adaptations as it would've allowed for more relevant considerations to be observed such as changes through left ventricular mass, which has been shown through other studies as a noteworthy adaptation. Additionally, an inadequate amount of background information was available regarding the relationship between exercise and reduced vascular function and insulin action within the heart.

What were the basic results?
The study found that the adenosine stimulated myocardial perfusion had the most significant difference between intervention groups with the HIIT group having a reduction of 19%, while the MICT had an increase of 9%. This finding was found to be connected to the myocardial glucose uptake, particularly within the HIIT group. Despite this connection to myocardial glucose uptake there was little understanding regarding the reasoning for the reduction in adenosine stimulated myocardial perfusion through the HIIT group, highlighting the requirement of additional future studies examining this component. It was also found that the myocardial vascular hyperaemic reactivity was impaired post HIIT. All other metabolic and functional adaptations of the heart were similar throughout both groups. Additionally, the insulin stimulated myocardial glucose uptake was decreased by training, with no significant differences evident throughout the groups, as well as no changes through free fatty acids.

What conclusions can we take from this research?
The authors conclusion stated that, HIIT training in healthy, previously sedentary men may lead to compromised myocardial vasodilation. The evidence suggested that the reduction in adenosine-stimulated myocardial perfusion was decidedly linked to high intensity training as well as clear impairments through the myocardial vascular hyperaemic reactivity, therefore individuals who were untrained shouldn't par take in exercise of the strenuous form. Thus, supporting the hypothesise regarding cautious exercise prescription for individuals suffering from CVD as the already prevalent conditions within their heart could increase risk or mortality and create dangerous situations for participants. However, a large majority of studies have been published that provide evidence supporting HIIT as a positive form regarding improvements through cardio-metabolic factors. Various studies have found that both HIIT and MICT interventions have had significant reductions in resting blood pressure with participants suffering from hypertension, with HIIT having larger improvements. Arguments may be made concerning what aspects were examined through the studies at hand and whether the lack of focus surrounding the in-depth adaptations to the heart on a muscular level as its this analysis that highlights the high risk associated with training at high intensities with CVD. Nevertheless, it's clear that there are advantageous aspects to HIIT within participants suffering from CVD, and even without minimal evidence for comparison of varying HIIT prescriptive variables for optimal treatments, the overarching rule for the training regime has proven effective.

Considering the large variety of evidence across numerous spectrums its hypothesised that there is not concrete answer regarding whether or not HIIT with individuals suffering from CVD is worthwhile. Rather than establishing a clear decision regarding the prescription of the training intensity, personalised considerations regarding whether or not the benefits outweigh the risks for specific individuals would be most effective. Individual assessments regarding previous aerobic fitness and current health standpoints will provide professionals with an efficient amount of information to conduct the most educated prescription of either HIIT or trainings at lower intensities levels for those suffering from CVD.

Practical advice
The conclusions state that previously sedentary males should not participate in strenuous HIIT. There is a brief mention that perhaps a slow integration of the training style would be beneficial, however the recommendations are no HIIT sessions throughout the early stages of a program. Additional resources suggest that conducting a baseline stress test, from which personalised training sessions may be calculated regarding intensities based off the heart rate maximum calculations, reduce the risks associated. It is advised that individuals suffering from CVD of any severity seek medical clearance prior to executing any training at high intensities. Once cleared, a slow progressive introduction to the training regime will allow the body to adapt efficiently, while experiencing all the health benefits associated with HIIT.

Further information/resources
For further information regarding exercise and cardiovascular health, please click the links below:

Heart Disease in Australia

Physical Activity for People With Cardiovascular Disease: Recommendations of the National Heart Foundation of Australia

High-Intensity Interval Training for Patients With Cardiovascular Disease - Is It Safe?


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Exercise as it relates to Disease/Body dissatisfactions effect on exercise avoidance

The below is a critique of the journal article ‘Evaluating the potential roles of body dissatisfaction in exercise avoidance’ by Kimberly R.Morea, L. AlisonPhillipsa and Miriam H.Eisenberg Colman.

Background
A person that suffers from body dissatisfaction has a negative perception of their body image, as well as, having negative thoughts and feelings that develop from that perception.

There are three reasons believed to influence a dissatisfied person in avoiding exercise, namely, emphasis on physique, fatigue and lack of competency towards exercising.

Emphasis of physique

 * This usually develops if they have experienced a stigma towards their body image in the past through exercise. This causes a negative feeling of embarrassment towards physical activity and thus the avoidance of it is created.

Fatigue

 * A dissatisfied person has a perception towards their body as it is unsuitable for exercise. They believe that fatigue is a barrier they are unable to overcome and therefore they should not take part in the exercise in the first place.

Lack of competency

 * Dissatisfied people often have little experience in exercise training, causing them to feel like they are not competent enough to part take in exercise. This leads to the avoidance of exercise because of a low perceived behavioral control.

Due to the above reasons, dissatisfied people may try avoiding cardio vascular exercise.

Where is the research from?
Two of the authors, Kimberly R. More and L. Alison Philips, both work in the Department of Psychology, at Iowa State University and have been involved in other research papers that look at different demographics and their relationship towards participating in physical activity. The final author, Miriam H. Eisenberg Colman, has experience in examining people with body and health issues. All three authors bring a range of experience within the field and are well suited in conducting a study of this nature.

What kind of research?
This research article was based on a self-reported perspective study design. A perspective study monitors a group of individuals to see if a pattern of behavior emerges that may be caused by a common factor within the group. Additionally, given that dissatisfaction is a psychological factor, self-reported data is the best way to gauge the effects it may have on someone’s motivation to exercise over a set time period.

What did the research involve?
The study used 334 undergraduate students between 18–41 years of age. They first recorded their base-line information to create a profile of each person. The questions covered were:

 * 1) Demographic
 * 2) Their level of body dissatisfaction
 * 3) The perceived barriers they may feel
 * 4) Their perceived behavioral control
 * 5) And finally, their level of exercise avoidance

Two weeks later, participants were followed up on to record their exercise, each under the same conditions, to limit the margin for error. Each criteria was measured using a survey/questionnaire compiled for this study. Additionally, due to be a new study, several of the individual questions were developed specifically for this study. Therefore, the survey/questionnaire may be improved in the future, to draw greater direct links for exercise avoidance.

What were the basic results?
First hypothesis: one predictor being body dissatisfaction and one mediator being exercise avoidance

 * The first hypothesis was proven, with results showing body dissatisfaction was mediated by exercise avoidance β = −0.02, SE = 0.01, 95% CI [−0.05, −0.002]
 * They also found that body dissatisfaction did not have a direct link to exercise avoidance meaning that fewer minutes of exercise due to them wanting to avoid exercise to begin with

Second hypothesis: one predictor being body dissatisfaction and three mediators being embarrassment, fatigue, and perceived behavioral control

 * The second hypothesis, found that there was a relationship between body dissatisfaction and exercise avoidance and was mediated by embarrassment (3) β =0 .22, SE = 0.04, 95% CI [0.15, 0.29], 0.30] and fatigue β = 0.02, SE = 0.01, 95% CI [0.002, 0.04]
 * The relationship between body dissatisfaction and exercise avoidance was found to not be mediated by perceived behavioral control B = 0.02, SE = 0.01, 95% CI [0.003, 0.06]
 * The relationship between the three variables are dependent on perceived barriers to exercise. This is due to a non-significant direct relationship between body dissatisfaction and exercise avoidance

The study also found that for both Hypotheses, that there was no indirect evidence to say that the persons sex had an effect.

Through the survey style of testing, the study was able to find links illustrating that many exercise avoidance can be influenced by a person’s negativity towards their body image. Additionally, findings in the second hypothesis also include factors of fatigue and embarrassment, stemming from negative body image, giving a stronger tie to exercise avoidance.

What conclusions can we take from this research?
This study is an important step towards understanding other factors that affect people’s perceptions of exercise. The paper allows us to understand that people whom feel dissatisfied by their body, participate in less exercise, along with determining several factors that cause this avoidance. Due to being one of the first studies within its area, further research should be done to confirm its findings. Further studies should investigate the development of solutions to the problem that has been outlined through this paper, and what types of body dissatisfaction; fat or muscle dissatisfaction, cause this avoidance. This additional research will allow for the targeting of groups and possible solutions.

Practical advice
The research found a correlation between people that have a greater dissatisfaction with their body and exercise avoidance. This means that these people are part of a high-risk group that should be targeted for exercise programs. Such targeting could include:

 * Advertising - can then be developed to help targeted groups through the perceived barriers, such as fatigue and embarrassment, and get them into a fitness center.
 * Educational Programs - The use of educational programs could make targeted groups better aware of their situation, and provide methods of overcoming their perceived barriers.

This could suppress feelings of fatigue and lack of competence when exercising, increase their activity and make them happier on a psychological level in regards to their body image.


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Exercise as it relates to Disease/The effect of Body dissatisfaction on exercise avoidance

The below is a critique of the journal article ‘Evaluating the potential roles of body dissatisfaction in exercise avoidance’ by Kimberly R.Morea, L. AlisonPhillipsa and Miriam H.Eisenberg Colman.

Background
A person that suffers from body dissatisfaction has a negative perception of their body image, as well as, having negative thoughts and feelings that develop from that perception.

There are three reasons believed to influence a dissatisfied person in avoiding exercise, namely, emphasis on physique, fatigue and lack of competency towards exercising.

Emphasis of physique

 * This usually develops if they have experienced a stigma towards their body image in the past through exercise. This causes a negative feeling of embarrassment towards physical activity and thus the avoidance of it is created.

Fatigue

 * A dissatisfied person has a perception towards their body as it is unsuitable for exercise. They believe that fatigue is a barrier they are unable to overcome and therefore they should not take part in the exercise in the first place.

Lack of competency

 * Dissatisfied people often have little experience in exercise training, causing them to feel like they are not competent enough to part take in exercise. This leads to the avoidance of exercise because of a low perceived behavioral control.

Due to the above reasons, dissatisfied people may try avoiding cardio vascular exercise.

Where is the research from?
Two of the authors, Kimberly R. More and L. Alison Philips, both work in the Department of Psychology, at Iowa State University and have been involved in other research papers that look at different demographics and their relationship towards participating in physical activity. The final author, Miriam H. Eisenberg Colman, has experience in examining people with body and health issues. All three authors bring a range of experience within the field and are well suited in conducting a study of this nature.

What kind of research?
This research article was based on a self-reported perspective study design. A perspective study monitors a group of individuals to see if a pattern of behavior emerges that may be caused by a common factor within the group. Additionally, given that dissatisfaction is a psychological factor, self-reported data is the best way to gauge the effects it may have on someone’s motivation to exercise over a set time period.

What did the research involve?
The study used 334 undergraduate students between 18–41 years of age. They first recorded their base-line information to create a profile of each person. The questions covered were:

 * 1) Demographic
 * 2) Their level of body dissatisfaction
 * 3) The perceived barriers they may feel
 * 4) Their perceived behavioral control
 * 5) And finally, their level of exercise avoidance

Two weeks later, participants were followed up on to record their exercise, each under the same conditions, to limit the margin for error. Each criteria was measured using a survey/questionnaire compiled for this study. Additionally, due to be a new study, several of the individual questions were developed specifically for this study. Therefore, the survey/questionnaire may be improved in the future, to draw greater direct links for exercise avoidance.

What were the basic results?
First hypothesis: one predictor being body dissatisfaction and one mediator being exercise avoidance

 * The first hypothesis was proven, with results showing body dissatisfaction was mediated by exercise avoidance β = −0.02, SE = 0.01, 95% CI [−0.05, −0.002]
 * They also found that body dissatisfaction did not have a direct link to exercise avoidance meaning that fewer minutes of exercise due to them wanting to avoid exercise to begin with

Second hypothesis: one predictor being body dissatisfaction and three mediators being embarrassment, fatigue, and perceived behavioral control

 * The second hypothesis, found that there was a relationship between body dissatisfaction and exercise avoidance and was mediated by embarrassment (3) β =0 .22, SE = 0.04, 95% CI [0.15, 0.29], 0.30] and fatigue β = 0.02, SE = 0.01, 95% CI [0.002, 0.04]
 * The relationship between body dissatisfaction and exercise avoidance was found to not be mediated by perceived behavioral control B = 0.02, SE = 0.01, 95% CI [0.003, 0.06]
 * The relationship between the three variables are dependent on perceived barriers to exercise. This is due to a non-significant direct relationship between body dissatisfaction and exercise avoidance

The study also found that for both Hypotheses, that there was no indirect evidence to say that the persons sex had an effect.

Through the survey style of testing, the study was able to find links illustrating that many exercise avoidance can be influenced by a person’s negativity towards their body image. Additionally, findings in the second hypothesis also include factors of fatigue and embarrassment, stemming from negative body image, giving a stronger tie to exercise avoidance.

What conclusions can we take from this research?
This study is an important step towards understanding other factors that affect people’s perceptions of exercise. The paper allows us to understand that people whom feel dissatisfied by their body, participate in less exercise, along with determining several factors that cause this avoidance. Due to being one of the first studies within its area, further research should be done to confirm its findings. Further studies should investigate the development of solutions to the problem that has been outlined through this paper, and what types of body dissatisfaction; fat or muscle dissatisfaction, cause this avoidance. This additional research will allow for the targeting of groups and possible solutions.

Practical advice
The research found a correlation between people that have a greater dissatisfaction with their body and exercise avoidance. This means that these people are part of a high-risk group that should be targeted for exercise programs. Such targeting could include:

 * Advertising - can then be developed to help targeted groups through the perceived barriers, such as fatigue and embarrassment, and get them into a fitness center.
 * Educational Programs - The use of educational programs could make targeted groups better aware of their situation, and provide methods of overcoming their perceived barriers.

This could suppress feelings of fatigue and lack of competence when exercising, increase their activity and make them happier on a psychological level in regards to their body image.


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Exercise as it relates to Disease/A comparison of efficient treatments regarding workplace sitting time and its impact

This is a critique of the article American Journal of the Cancer prevention research centre: Workplace sitting and height-adjustable workstations: A randomised controlled trial.

What is the background to this research?
Desk-based office employees are spending most of their days sitting at a desk. Not only is this unhealthy but, prolonged bouts of inactivity can cause increases in BMI, increased risk of mortality, and increased risk of multiple types of cancer as-well as other health complications. Sitting times should be interrupted regularly to prevent these issues. This trial aims to address the issue of excessive sitting using a multi-component approach. The issue being that this approach is resource intensive and knowledge about the relative impact is inadequate. The authors of the study specifically considered the impact in the context of cancer risk on the employees. Additional risks of living a sedentary life involve obesity, diabetes and cardiovascular disease. Understanding the issues associated with sedentary behaviour can decrease its impact on the work force. Not only is the research beneficial to a working environment, it is also beneficial to similar contexts such as excessive bouts of video gaming and class timing structures in schools. Whilst the research may not fill any gaps in existing knowledge, it allows for a more practical analysis of the working environment and the results of certain interventions.

Where is the research from?
Research was conducted at the University of Queensland in Heston by the cancer prevention research centre. The data was collected in January to June 2012 and was analysed in the same year. The environment in which the research was conducted is representative of the entire Australian population. All authors have been a part of a multitude of studies. These include studies regarding: Despite being involved in separate studies, the majority of work completed by the authors is based around sedentary behaviours and its effect. This means that the authors have both credibility and experience on this subject. The conclusion from the authors correlates with the results of the study. There is no evidence to support the idea that there was any bias in a certain result.
 * Outcomes of living with diabetes and its correlation with weight loss, physical activity and glycemic control
 * Beneficial associations of physical activity with 2-h fasting glucose
 * Television viewing time and mortality

What kind of research was this?
The study involved a three-arm quasi-randomised control trial ran by three separate administrative units of the University of Queensland. This type of trial allocates different arms of the trial to receive either: the multi-component intervention, height-adjustable work stations and a comparison group in usual practice. Participants and research staff were not blinded to group allocation. The participants were recruited by the university’s wellness program manager, supplying groups from three separate campuses. The issue with using quasi-randomised trials is that there is a greater risk that the investigators will be aware of which participants are in which group, increasing the chance of selection bias. However, since the participants have been chosen from pre-set groups from an outside source, there is a decreased chance of selection bias.

What did the research involve?
The interventions were based on the social cognitive theory, which focussed on elements of self-efficacy, outcome expectancies and sociostructural factors. There were three groups supplied by the university of Queensland. The first was the multi-component intervention group, the second was the height-adjustable work station group, and third was the comparison group (usual practice; assessment-only). Since one of the units was located 90 km away from the university, that two local units were randomized to the intervention arms, while the remote unit was located to be the comparison group. Strategies that referenced normative feedback in comparison to average sitting time among Australian office workers was used. the key messages of the intervention were to: The main prompt was ‘stand up’ to break up long bouts of sitting (≥30 minutes). ‘sit less’ stressed the importance of reducing the overall sitting time. Participants were encouraged to implement periods of standing or walking by primary use of the height-adjustable desks. While the intervention worked to prevent periods of inactivity, it did little in terms of increasing levels of exercise to counteract sedentary behaviour. Despite using ‘move more’ as a que to walk up the stairs, one of the biggest issues with sedentary behaviour is that adults aren’t getting enough exercise at a correct intensity. Perhaps implementing under desk mini bikes (or other exercise instruments of a similar function) could’ve had a more beneficial acute and long-term impact.
 * Stand up
 * Sit less
 * Move more

An activPAL3 monitor was used for 7 consecutive days to record results. The monitor was replaced once a week till the 3-month period finished. 3-months was an appropriate amount of time to use the monitors. The monitors were waterproofed and attached on the midline of the right thigh so it wouldn’t distract the participants. Participants were required to record monitor removal times and their wake, sleep and work hours in a diary. This allowed for accurate data collection which adds to the validity of the overall results. Issues could have occurred from human error in terms of recording data.

What were the basic results?
The researchers interpreted a positive outcome experienced for the multi-component group compared to the component group, with an average reduction in workplace sitting of 89 minutes. When the multi-component group was compared to the workstations-only group there was a difference of only 56 minutes. The authors gave a simplified solution for what was the best approach for reducing workplace sedentary behaviours. There was a substantial decrease in inactivity when compared to the average 8 hour working periods.

What conclusions can we take from this research?
The results show that the multi-component model is the most appropriate in the context of reducing workplace sedentary behaviour. It shows that consistent stimulus of prompts to move, sit or stand up will substantially reduce the chance of being sedentary for extensive periods of time. Further research has concluded that physical movement implementation during working hours is both beneficial and will result in a more economic working environment.

Practical advice
While the use of a multi-component approach should be used, individuals should also participate in high intensity exercise outside of work. Ideally, healthier behaviours would increase the motivation for further life changes whether it be diet, exercise, time management etc., An under desk mini bike an example of exercise equipment that can and should be used when working.

Further information/resources
For any readers interested in the benefits of decreasing sedentary time, improving diet, and increasing time spent exercising, the following links will give necessary information.

https://www.medicalnewstoday.com/articles/322910.php

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743603/

https://www.tandfonline.com/doi/full/10.1080/17437199.2015.1082146

https://www.helpguide.org/articles/healthy-living/how-to-start-exercising-and-stick-to-it.htm

https://www.nerdfitness.com/blog/healthy-eating/

https://www.helpguide.org/articles/healthy-eating/healthy-eating.htm


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Test page

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Exercise as it relates to Disease/Effect of strength training in clients with multiple sclerosis

This is a criqtue of Enhanced neural drive after maximal strength training in multiple sclerosis patients

What is the background to this research?
Multiple sclerosis (MS) is a condition of the central nervous system, interfering with nerve impulses within the brain, spinal cord and optic nerves. It is a disease that effects the central nervous system, leading to destruction of myelin, oligodendrocytes and axons. MS affects over 25,600 in Australia and more than two million diagnosed worldwide. With females making up every 3 out of 4 people diagnosed with multiple sclerosis in Australia. Currently there is no known cure for MS, but are multiple treatments to alleviate the symptoms associated with MS through medication and other practical measures. There are certain risk factors that go into diagnosing Multiple Sclerosis such as genetics, sex, age, infections, and certain autoimmune diseases.

The published research article called " Enhanced neural drive after maximal strength training in multiple sclerosis patients" hypothesis stated that "maximal strength training (MST) using high loads and few repetitions would improve central neural drive and thus strength capacity of MS patients".

Where is the research from?
The article was published in the European journal of applied physiology. Specifically, article volume 110 pages 435-443. The authors of the article are Marius S. Fimland, Jan Helgerud, Markus Gruber, Gunnar Leivseth and Jan Hoff. With the authors representing departments of Circulation and Medical Imaging, Physical Medicine and Rehabilitation, Training and Movement Science along with having connections to rehabilitation centres in Norway

What kind of research was this?
The research conducted in the article questioning if strength training has any effect on clients with multiple sclerosis is a randomized controlled trail (RCT). With that being said a RCT is a study where participants are assigned into a controlled or experimental group. With only the outcome data being uncontrolled throughout the study. The RCT is considered a gold standard testing method.

What did the research involve?
The research consisted of two groups, a MST group (maximal strength training) or an CG (controlled group) with seven subject in each group.The participants coming from the Multiple Sclerosis Center in Hakadal, Norway. Participants in both groups submitted informed consent along with were subject to the disability status scale (EDSS) to assess the severity of neurological impairment among the subjects before and after training. The MST group underwent a trained 4 x 4 repetitions of unilateral dynamic leg press and plantar flexion 5 days a week for 3 weeks.

Since it was such a small subject group the methodology was enough although the size is a limitation. Due to a small subject population the range of collected data does not allow for large scale application of the acquired data. Although drawing from a specific MS center provides with an instant source of participants with the downside of the population of MS patients in that center limiting the subject population.

What were the basic results?
Results of the testing showed no differences between the MST group and the CG group in the pretest measurements. With no changes observed in the EDSS scores which remained unchanged in all subjects from pre- to post-test. The authors interpreted the results in a manner that stated that training increased the magnitude of efferent motor outflow from spinal motor neurons to the lower limb muscles in MS patients. Along with the increased soleus EMG activity and isometric strength gains of the plantar flexors

 * Data are presented as mean ± SE
 * MVC maximum voluntary isometric plantar flexor contraction, TA tibialis anterior, VL vastus lateralis
 * p < 0.05, from pre- to post-test

What conclusions can we take from this research?
Taking in the data and limitations of the randomized controlled trial study that was undertaken, a conclusion can be argued that the hypothesis was not incorrect nor was it correct. As in belief of that a larger scale subject group would have proved more beneficial and yielded more data to support the suggest hypothesis. The key limitation of this study is the subject population size, which was 14 people, which limits the size of possible collected data. Although the authors stated that the evidence shows that with strength training or normal repetitive rehabilitation seasons can be effective in helping alleviate some of the neuromuscular symptoms in patients.

Studies in other areas of MS yielded results. Such as a fifty-four participant study on how aerobic fitness can influence their quality of life while living with MS. The study concluded that exercise helped improve fitness, plus upper and lower extremity strength, along with improvements to quality of life. Another study published in 2009 stated that through "Moderate resistance training programs can improve muscle function and can be a promising therapy to delay the functional deterioration in multiple sclerosis patients.

Practical advice
Recomendations on what type of intervention into helping repair or prevent the damage done by the immune system on the nervous system vary from patient to patient.Although it is to be stated that MS is a very variable disease, with each patient reacting differently to medication and having varied side effects thus contacting know organisations and practictionars to better help discuss and decide the best treatment is highly advised.

Practical advice can be given in taking to treatments by using certain medications that can help target specific symptoms of MS such as fatigue, neurological symptoms, continence along with the muscle problems such as spasm and paralysis requirign the recommended assistance of a physiotherapist.

Futher information/resources
For more information regarding multiple sclerosis you can look up
 * https://www.msaustralia.org.au/what-ms
 * https://brainfoundation.org.au/disorders/multiple-sclerosis/
 * https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
 * https://msra.org.au/news/unravelling-causes-ms/


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Exercise as it relates to Disease/The impact of resistance training on young people with cerebral palsy

Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial
This is a review of research presented in the Journal of Developmental Medicine & Child Neurology in 2013.

Background
Cerebral palsy (CP) is the most common cause of physical disability in children in developed countries, with 2-2.5 affected per 1000 live births.

CP is a collection of syndromes notably characterised by abnormal movement patterns and postures. Cerebral palsy is often caused by a lesion on the brain but may also be caused by genetic factors, infections in-utero, and premature or complicated births. Brain lesions are irreparable but do not usually change across a lifetime, however resultant clinical musculoskeletal syndromes may change in nature and severity as the child ages. Physical abnormalities are not usually evident at birth but develop during periods of rapid growth in childhood

There are several types of CP, collectively known as the cerebral palsies; identified by their topographical brain location. Approximately 80-85% of diagnoses constitute spastic and mixed motor disorders. with dyskinetic and ataxic cerebral palsies much less common. Spastic hemiplegia, spastic diplegia, and spastic quadriplegia are most common, with the nomenclature coinciding with the severity of the condition, and capacity for independent or assisted walking, or no functioning gait

During early childhood, the primary focus of treatment is on improving the function of affected limbs**. The focus shifts to avoidance of pain in adolescence and adulthood. A key feature of the conditions is the insufficient growth of longitudinal skeletal muscles, leading to contracture, poor balance, weakness, muscle spasticity, and consequent inactivity. Spasticity commonly leads to contracture in the gastrocnemius (calf muscle) and deformities of the foot and ankle. In many cases persons with cerebral palsy will experience torsion on long bones, joint instability, and joint dislocation, resulting in premature joint degradation and pain.

The primary treatment for the cerebral palsies is orthopedic surgery to incrementally lengthen affected tendons however, Botox injections, used to reduce muscle activation in spastic skeletal muscle, thereby facilitating new muscle and neural pathway development, have proven successful in numerous trials; with many children receiving the treatment soon after birth. Commonly, Botox is used to treat dynamic equinus (toe walking), adductor spasticity (scissor gait), and hamstring spasticity (crouching gait). Spasticity in upper limbs and management of pain following surgery has also been successful.

It is generally accepted that physiotherapy is required to regain strength and function following surgery, but little research has been done into the effectiveness of resistance training programs outside of surgical rehabilitation.

Research
This study was a single-blind randomised controlled trial comprising two groups: progressive resistance training and a control group receiving their usual level of care and recreational activity. Participants, aged between 14 and 22 years, were recruited through a major metropolitan children's hospital. All 48 participants (26 male; 22 female; mean age 18 years, one month) were required to be classified as level II or III on the Gross Motor Function Classification System (GMFCS) and had not participated in strength training programs for the preceding six months, nor had surgery in the preceding two years.

Participants were randomly assigned to control (usual activity) or experimental (progressive resistance training twice a week) groups for a period of 12 weeks

Method
Separate randomisation steps were implemented for both GMFCS II and III, with participants in the experimental group undertaking physiotherapist-supervised resistance training twice a week for 12 weeks. Three sets of 10-12 repetitions of exercises, with a two minute break between sets. Participants were instructed to 'work hard', or a minimum of 5 on the 0-10 Borg Perceived Exertion Scale, which was evaluated at the end of each session. Exercises were individualised to address issues identified during gait analysis. Following 12 weeks of resistance training, participants were instructed to take a rest from resistance training until the final testing at 24 weeks. Control group participants were required to continue with their usual recreational activities, provided they did not include resistance training.

Results
Outcome measures were evaluated at baseline, at 12 weeks (immediately following the intervention), and 12 weeks from the end of the trial. Participants' subjective reports, measured against a Functional Assessment Questionnaire and the Functional Mobility Scale indicated that resistance-trained individuals noticed an improvement in mobility, whereas fewer control group participants reported notable change (10 out of 23, and 4 out of 25 participants respectively). Importantly, whilst targeted muscle strength increased by 27%, it did not result in improvement in gait or walking speed, nor objective measures of mobility.

Discussion
The results of this study suggest that individualised progressive resistance training does not directly affect mobility or gait in young people with CP. There are some notable limitations of this particular study, including its small sample size; that the recreational activity undertaken by the control group was not documented; and that the program delivery timeframe was short. This may account for the negligible impact on gait and mobility measures, despite the increase in targeted muscle strength. The training protocol was delivered in a local gym, so whilst not performed under laboratory conditions, was representative of the ways training is undertaken in practice. Walking is a complex combination of movement patterns, with skill components as well as musculature requirements. The current study assumed that muscular strength and gait share a linear relationship, however, future research should consider the possibility that strength training combined with specific gait skill-based training may yield more significant results. Future research should also consider evaluation of participants of resistance training programs in longitudinal format in order to note the long term ramifications. The authors of this study took care to note that the benefits of resistance training may go beyond improved mobility, as participants experienced the physical and mental health benefits of undertaking exercise and increased strength. The combination of surgery and strength training; Botox and strength training; or a combination of all three was beyond the scope of this study but should also be considered before dismissing the potential for improved gait through individualised resistance training programs.


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Exercise as it relates to Disease/The effects of resistance exercise training on anxiety

This is a critique of the article "The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials".

What Is The Background To This Research?
Basically defined, anxiety is an emotion characterised by an unpleasant state of inner turmoil or impending doom, often accompanied by nervous behaviour such as pacing back and forth, somatic complaints (e.g. stomach butterflies etc.), and rumination. Anxiety is the most common mental health condition in Australia. Anxiety affects approximately one quarter of Australians, at some point in their lifetime (1 in 3 women, and 1 in 5 men). According to the ABS National Survey of Mental Health and Wellbeing, 2007, 26.3% of Australians aged 16–85 have experienced an anxiety disorder. Using the 2007 statistic, that percentage equates to 4.96 million people today.

The statutory effects of resistance exercise training (RET) are well established, however, there is far less known regarding the effects of RET on mental health outcomes. While there is a large amount of consensus about the positive effects of aerobic exercise training (AET) on anxiety, a quantitative synthesis of RET effects on anxiety is needed.

About the article
This paper looks to collectively examine and consolidate data from 16 existing studies that were completed prior to 2017. The purpose of the meta-regression analyses reported in this article was to examine participant characteristics and features of the RET stimulus that may moderate, or influence, and ideally could be manipulated to enhance, the effect of RET on anxiety symptoms. The purpose of these analyses was not to test whether those variables help to explain the effects of RET.

Where Is The Research From?
The Analysis, published in Sports Medicine, compiles studies and results from 16 articles published prior to 2017. For an article to be included in the analysis, it had to fulfil the following criteria; English language peer reviewed publications, randomised allocation to either a RET intervention group or a non-active control group, and anxiety outcome measures at baseline (pre), and at mid- and/or post-intervention.

The articles that were included in this study are as follows:

 * 1) The influence of resistance exercise training on the levels of anxiety in ischemic stroke
 * 2) Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial
 * 3) The effects of strength training on strength and health-related quality of life in older adult women
 * 4) Effects of aerobic training, resistance training, or both on psychological health in adolescents with obesity: the HEARTY randomized controlled trial
 * 5) Effects of short-term exercise training on signs and symptoms of generalized anxiety disorder
 * 6) The efficacy of 12 weeks supervised exercise in obesity management
 * 7) The physiological and psychological effects of resistance training on Chinese obese adolescents
 * 8) Effects of strength and aerobic-based training on functional fitness, mood and the relationship between fatness and mood in older adults
 * 9) Psychological and physical benefits of circuit weight training in law enforcement personnel
 * 10) Low-load/ high-repetition elastic band resistance training in patients with COPD: a randomized, controlled, multicenter trial
 * 11) Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial
 * 12) Effects of an 8-week circuit strength training program on the body images and anxiety in untrained college students
 * 13) Comparison of high and moderate intensity of strength training on mood and anxiety in older adults
 * 14) The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial
 * 15) Efficacy of a weight training program as a treatment for chemically dependent adults
 * 16) The effect of a strength training program on affect, mood, anxiety, and strength performance in older individuals

What Kind Of Research Was This?
The study is a meta-analysis. As opposed to a systematic review, which answers a particular, specific research question, a meta-analysis is a quantitative, formal, epidemiological study design used to summarise the results of a group of these studies, and derive conclusions about that body of research. Outcomes from a meta-analysis may provide a more accurate estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study included, if it where in it’s own.

What Did The Research Involve?
The authors derived 31 'effects' from the 16 studies. These effects were the independent variables in each intervention. Anxiety was found to be the primary outcome in 10 of the studies (23 of the effects pertained directly to anxiety).

'Hedges’ d' effect sizes were calculated for each effect. Put simply, effect size tells you how much one group differs from another (in this case RET vs. Control). Effect sizes were adjusted for small sample size bias and calculated so that a larger reduction of anxiety symptoms among those in the RET group resulted in a positive effect size. Meta-regression was used as the overall analysis tool for the effects.

What Were The Basic Results?
In regard to the 16 studies included, the average participant age was 43 ± 21 years, and 68% of participants randomised were female. The average intervention length was 11 weeks; and intervention frequency ranged from 2 to 5 days per week.

To give a brief summary of the cumulative results gathered by the authors, RET has a small-to-moderate statistically significant, positive effect on anxiety symptoms. The overall mean effect score (Δ=0.31) provides quantitative, measurable support for the anxiolytic effects of RET previously reported by O'conner et al.

Lowered anxiety symptoms found among RET participants in the reviewed studies, expressed as a function of absolute risk reduction, resulted in a number-needed-to-treat of approximately 7. This mean that reductions of anxiety symptoms could be expected to occur for 1 in every 7 participants of comparable RET.

What Conclusions Can We Take From This Research?
It can be clearly included that RET can help to reduce the symptoms of anxiety. The results found are in line with the more commonly accepted benefits of AET on anxiety and other mental health symptoms and conditions.

The effects of the prescribed AET programs did not vary significantly based on differing participant characteristics, specifics of the exercises given. This provides support for real-world use of various RET programs to serve as a treatment and management method for anxiety symptoms among otherwise healthy adults and chronically ill adults.

Practical Advice
From the findings of the analysis, it seems that while effective, RET may be hard to facilitate due to specific equipment needed for such exercises. This can be avoided however with the prescription of body weight exercises such as squats, lunges, push-ups, and abdominal crunches etc.

Also, with the level of effect prevalence being approximately, 1 in 7, RET may serve best as a compliment to other means of treatment for anxiety, whether that be more traditional pharmaceutical treatment, among other methods.

Further Information/Resources

 * Beyond Blue national help lines and websites
 * Anxiety self-checklist
 * Full Article (see reference 1.)