text:
Transportation Geography and Network Science/Scale-free network

Introduction
The scale-free network has heterogeneity, and the connection status (degrees) between its nodes has severe uneven distribution: a few nodes in the network called Hub points have extremely many connections, and most nodes only have a few connections. A few hub points play a leading role in the operation of scale-free networks. Broadly speaking, the scale-free nature of scale-free networks is an intrinsic property that describes the large uneven distribution of a large number of complex systems as a whole.

It has been shown that applying statistical dynamics to networks is applicable to a broad spectrum of social, biological and technical networks. Unlike many physics fields that concentrate on micro or local interactions, network research utilizes methods that are inherently inductive. Although statistical analysis refuted the claims of the scale-free network and seriously suspected others, many networks have been reported to be scale-free network. To explain power-law degree distribution in real networks, the mechanism of preferential attachment and the growth of network theory has been proposed.

Discovery of the property of scale-free
The World Wide Web is known as the largest humanitarian network. The size of the informatic system is more than a trillion $$ (10^7) $$, larger than the human brain, $$10^{11}$$. Because of the diversity of interest in organizations and individuals, it was considered an arbitrary network so that documents could be linked to randomly selected documents. Then, Hawoong Jeong of the University of Notre Dame created one of the Web domains. Unexpectedly, the results were different. In a random network, hubs with highly connected nodes are generally prohibited. However, in the topology of the World Wide Web, some degree nodes and nodes with large links coexist. This led to the discovery of the property of "scale-free".

This sample from the WWW is mapped in Albert's 1999 research. And the distribution of the degree is displayed on the double logarithmic axis (log-log plot), where a power law follows a straight line. The gamma in is 2.1 and 2.45 is the gamma out. Since the gamma-in is lower than gamma out, the gamma-in is straighter than the gamma-out line. As shown in the graphs, in comparison to the expectation of getting a Poisson distribution that characterizes random networks, the networks demonstrate power-law distribution. This can be simplified as the "scale-free network" is the network whose degree of distribution is power-law distribution.

Power law distribution
$$ P_k $$ ~ $$ k^{-r} $$ This is power law distribution equation and the exponent gamma is its degree exponent. K represents the degree of the node; the number of links. P is the probability; fraction.

Mathematical way of defining scale-free property
Mathematically, scale-free network means statiscal moments of degree distribution are not defined(Zhao, Park and Lai, 2004). The property of scale-free can be mathematically defined either with a discrete formalism or continuum formalism.

Discrete formalism
The discrete formalism provides the probability P_k at an exact number of k links as the number of links is always positive and discrete as k = 0, 1, 2, etc. According to the “normalization condition” and “Riemann zeta function”, the equation can be obtained with the following:

$$ P_k = k^{-r}/\zeta(r)$$

Continuum Formalism
$$ P(k) = (r-1)k^{r-1}_{min}k^{r-1}$$

In contrast to discrete formalism, the fact that this formalism is continuous means that the degree can have any positive real number within the interval of interest. Probability densities can be taken into account more than the value of the probability itself. P(k) is no longer a probability but a probability per x unit. According to continuum formalism, the probability P(k) can be obtained within some range of values.

Hubs
Hub is the most important difference between a random network and a scale-free network. It represents the distribution of altitude nodes, most of which do not exist in random networks, and naturally exist in scale-free networks. By calculating the maximum degree k_max, it can be seen that how the size of the hub is affected by the network size. It is called "natural cut-off," the expected size of the largest hub in the network.

According to the formula for random networks and scale-free networks, one can recognize how the size of a network affects the size of a hub.

Random network
$$ K_{max} = K_{min} + lnN/{\lambda} $$

$$lnN/{\lambda} $$ is a "slow function" of system size[1]. And this indicates the degree of nodes will not change noticeably from the minimum number of links.

Scale free network
$$ K_{max} = K_{min}N^\dfrac{1} $$

As the network size of scale-free networks increases, it can be seen that the degree of nodes will increase significantly. This, again, emphasizes that hubs are prohibited in random networks, but they exist logically in scale-free networks.

The difference between a random and a scale-free network

 * Scale-free network is like an air-network. Airports are nodes and the flights are links between them. As nodes have a few hubs with a large number of links, airports in big cities have a large number of flights to other cities, which act as hubs.
 * Random network is like a highway. All cities are connected from the highway system and there are no cities have a large number of highways. For instance, when travelling to Melbourne from Sydney by car, the vehicles should drive through many cities while one direct flight can reach the destination by using an aeroplane.
 * In random networks, the degree of nodes is comparable as hubs are forbidden. This results in having a bell-shape curve, following the Poisson distribution.

The growth of networks
The number of nodes continuously increase in the real network, in contrast, the number of nodes N is fixed in a random network.

Preferential attachment
In preferential attachment, nodes tend to link to the nodes have many other links and nodes in the scale-free network. In contrast, nodes randomly choose other nodes regardless of the degree of the nodes in a random network. Above the example, in the first figure, each link node has an equal chance of being linked to by another node. However, in the second figure, a node with two links has a 50% chance of being picked, whereas each of other nodes ahs one link, which makes the nodes with one link only have a 25% chance of being picked. Finally, in the last figure, the node with a 50% link is chosen. Hence, the more links that existing node has, the more likely it is to be chosen.

In a scale-free network
The main difference between a random network and a scale-free network is the existence of a hub. A hub in a scale-free network has supposedly unlimited links, and a node is not typical of others. A scale-free network is vulnerable to coordinated attack but is robust to accidental failure.

In a random network
Cascade failures are often caused by interconnectivity. One of the examples was North American blackouts in 2003. For electricity, there is less redundancy than for other networks. Electricity is one of the transportation systems. And because it cannot be stored, it must be used once it has been produced. And, if one node fails, it will affect other nodes due to interconnectivity. This is called "cascading failure." The figure shows 20 hours before and after the North American blackouts in 2003. Because of the interconnectivity between cities, other cities have failed to provide electricity.

Reference
BARABÁSI, A.-L., & PÓSFAI, M. (2016). Network science.

Albert, R., Jeong, H. & Barabási, A. L. The diameter of the World-Wide Web. Nature 401, 130–131 (1999).

Zhao, L., Park, K. and Lai, Y. (2004). Attack vulnerability of scale-free networks due to cascading breakdown. Physical Review E, 70(3).


text:
User:Grace.D'Amico/sandbox

This article is a critical analysis of the paper: "Effects of Physical Exercise Intervention on Motor Skills and Executive Functions in Children With ADHD: A Pilot Study” (Pan et al, 2015).

What is the background to this research?

 * Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that causes attention issues, impulsive behaviour and hyperactivity. ADHD can interrupt a person’s ability to demonstrate age appropriate behavioural, cognitive function and can cause life-long educational, social and emotional issues. United States ADHD rates have increased in children between ages 12-17 according to data collected over 20 years by the National Health Interview Survey (NHIS). In 2016, the rate was 13.5% compared to 7.2% in 1997.
 * A 2011 study found children with ADHD had a higher risk of becoming obese due to high anxiety levels and poor social interactions contributing to poor cardiovascular function and physical inactivity. Medication and behavioural interventions can be effective treatments in treating ADHD, however, not all individuals will respond to pharmacological and behavioural treatments.
 * The study aimed to establish if physical activity such as table tennis which combines both cognitive and physical functions has a role in helping cognitive and executive functions in ADHD children. Earlier studies have shown physical activity can improve motor/neuropsychological performances, muscular capabilities, and social and behavioural problems. However, those studies mainly focused on aerobic exercise and the FITT principals (frequency, time and intensity) and not exercise based complex motor skills typical of an activity like table tennis.

Where is the research from?

 * The study was published in 2015 in Taiwan. It focussed on male children with and without ADHD between 7 to 12 years of age, recruited through media announcements, from local primary schools and paediatric facilities. No details about when the data collection was taken have been mentioned in the study.
 * Chien – Yu Pan is one of the authors. He is a professor at the National Kaohsiung Normal University within the Department of Physical Education in Taiwan. Pan along with his co-authors have been involved in many studies specialising in physical activity in people with autistic and neurodevelopmental disorders.
 * According to its authors, there was no conflicts of interest associated with the study to benefit on their behalf.

What kind of research was this?

 * The research was conducted as a pilot study. Pilot studies are small-scale studies conducted before a main study is executed. It is used to refine research methods, and to identify errors or issues within the project, and whether it is even feasible.

What did the research involve?

 * The study involved 3 groups of all male participants: a training group with ADHD, ADHD non-training group and non-ADHD non-training group. The study involved a 12-week table tennis program, twice a week for 70 mins with each session focusing on motor skills and executive functions.
 * The study used the TGMD-2 Test to exam motor skills of 3 to 10-year old which were broken down into locomotor (e.g. run, hop, jump) and object control skills (e.g. catch, throw, bat).
 * The Stroop colour and word test: was used to assess executive function. The aim of the task: is to name the colour but to ignore what is written. The amount of correct answers was calculated in 45 seconds.
 * To measure executive functions, a computerised version of the Wisconsin Card Sorting Test (WCST):

Limitations of the Study

 * The study only included a small sample size of all male participants aged 7 to 12 years which limits the generalisability of the results.
 * The medication dose and type were not controlled and could have varied between the participants. Controlling the medication could have provided a more accurate representation of the benefits of exercise on ADHD children.
 * The tests used in this study only explored limited assessments of motor skills and executive functions which meant a participant’s full abilities were not assessed.
 * In a future main study, these limitations could be addressed in order to provide a more useful and accurate representation of the benefits of exercise based complex motor skills on ADHD children.

What were the basic results?
*Pre and post-test = out of 48 marks

 * The ADHD training group significantly improved their locomotor and object-control baseline marks compared to the other groups, indicating exercise program had a positive effect on this population. The ADHD training group were able to increase their correct answers by 8.74 in 45 seconds in the Stroop test compared to marginal improvement in the non-training ADHD group. The ADHD training group improved significantly in total correct answers by 10.94 in the WCST test compared to 0.9 improvement achieved by other groups. In addition, it is possible at least some of the improvement in other groups may have been due to familiarity of test conditions.

What conclusions can we take from this research?

 * The study conclusions suggest sport specific physical exercise can be used as a beneficial intervention that provides a safe and positive change on motor skills and some functions in ADHD children. However, further research would be required to address the limitations of the study including the absence of females because it has been shown males and females have different strengths and weaknesses in cognitive functions.
 * A future area of study might identify if ADHD males and females react differently and if the benefits of exercise interventions are similar across genders. It also is not clear to what extent medication interfered with the results.

Practical advice
For people with ADHD:
 * Undertaking moderate intensity aerobic exercise for 40 minutes three times a week has shown to improve behavioural and cognitive responses in patients with ADHD.
 * Adopting exercise into a daily routine should help those with ADHD, however, if this amount cannot be achieved, starting with some exercise is always better than no exercise. A good starting point would be to follow the Australian Physical Activity Guidelines.

For future researchers interested in the benefits of exercise among those with ADHD there are several areas that could be explored:
 * For instance, determining if sport specific, aerobic or resistance training is more beneficial for ADHD children or whether such interventions could address other related issues such as obesity or high social anxiety. Understanding whether various ages and genders benefit from certain exercise interventions could also be explored.

Further information/resources
The following resources provide fact-sheets, further support, and research studies regarding the effects of exercise on ADHD:

 * ADHD Factsheets and infographics:

 * Exercise Improves Behavioural, Neurocognitive, and Scholastic Performance in Children with Attention-Deficit/Hyperactivity Disorder:

 * Australia's Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines:

 * Neuroelectric and Behavioural Effects of Acute Exercise on Task Switching in Children with Attention-Deficit/Hyperactivity Disorder:

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

title: User:Grace.D'Amico/sandbox


text:
Exercise as it relates to Disease/Cystic Fibrosis: Physical exercise versus chest physiotherapy

This is a critique of the original research article “Cystic fibrosis: physical exercise versus chest physiotherapy” M. Zach et al (1982)

What is the background to this research?
Primarily affecting the lungs, airways and digestive system, Cystic fibrosis is a hereditary disease in which individuals produce an abnormal amount of excessively thick and sticky mucus. The result of thick sticky mucus is due to the mutation in a gene which changes a protein that regulates the movement of salt in and out of the cell.

Aerosol inhalation followed by chest physiotherapy is an essential part of the life-long therapeutic routine in CF patients.

Chest Physiotherapy is the traditional airway clearance technique and involves the removal of thick sticky secretions to prevent infections and help ease breathing through postural drainage and percussion and vibration.

Often with poor patient compliance, the efficacy of procedures to mobilise and remove secretions seems to decrease with age. Hence, a more effective alternate is needed. The study conducted by M. Zach et al, observed whether exercise was more beneficial for a group of twelve young individuals with Cystic fibrosis in comparison with their normal chest physiotherapy routine.

Where is the research from?
This study was conducted at University Children’s Hospital, Graz, and Paediatric Department, Stolzalpe, Austria 1982. We can rely on this journal as a valid source as it is led by Dr Nick Brown whom is a clinician, epidemiologist and international child health expert.

This scientific journal is jointly owned by Royal College of Paediatrics and Child Health and BMJ who have a very broad international reach in terms of readership and editorially.

What kind of research was this?
This published original research article is a cohort study in which a group of individuals sharing defining characteristics, in this case children with Cystic Fibrosis, had the effects of physical activity analysed in comparison to their normal chest physiotherapy routine. This particular type of research allowed M. Zach et al to perform a cross section at intervals over time observing the influence exercise had on a sample population all with the same diagnosis after seventeen days of exercise and the reversible outcome eight weeks post intervention.

What did the research involve?
Six boys and six girls with a median age of ten and a half years were sent to a paediatric rehabilitation hospital in a mountainous area in upper Styria (altitude 1180m above sea level). On the basis of a willingness to participate, positive sweat tests and a stable clinical condition the children were chosen from the Cystic fibrosis clinic at the University children’s Hospital, Graz.

During the seventeen day stay, the normal and strict routine of chest physiotherapy and aerosol inhalation were stopped. Instead, the children participated in an intense program of physical exercise and sport led by a chest physiotherapist. The activities involved; one hour of swimming and diving twice a day, a two-and-a-half-kilometre jog to and from the pool four times a day, hiking, gymnastics, swimming, minigolf, soccer and table tennis.

Ventilatory status of the children was assessed one day before admission, one day after the end of the hospital stay and eight weeks later. Data was collected by a qualified chest physiotherapist making results valid and reliable in comparison to other sources of data collection such as self-reporting.

To increase the accuracy of this study, a larger population of children could have been analysed as a larger sample group may have exhibited differing results. Measurement was only based off ten children; the two youngest patients did not cooperate sufficiently to obtain reproducible results making data collection from an even smaller group. Due to the study being undertaken in the Styrian mountains, this meant a higher altitude. A higher altitude means less oxygen to breathe which could potentially be advantageous as individuals are making greater adaptations in comparison to if the study were conducted in lower altitude such as Australia. A positive was the study conducted in the summer holidays in order to reduce any seasonal or occupational influences on clinical condition or pulmonary function.

What were the basic results?
M. Zach et al concluded that with all the activity a gradual increase in performance was evident in the children. As observed by the physiotherapist, frequency of coughing and volume of expectorated sputum decreased gradually to become only slight towards the end of the course.

Demonstrated in the table below, it is evident from pre-exercise to post exercise that some of the more significant results such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR) all saw an improvement. We can also notice that eight weeks after, without exercise the results almost returned to pretraining levels bar the PEFR in which only decreased slightly, potentially due to ventilatory muscle training.

Clearly, enhancement of airway function depends highly on the upkeep of exercise. A limitation to these findings is that the training program was adjusted to the physical capabilities of the majority. Thus, it did not always adequately meet each child’s individual exercising capability. The ones who may have been able to cope with a more strenuous workload may have potentially had more effective results with a harder program. Ultimately, altering the methodology and individualising programs to suit individual needs could prove beneficial.

What conclusions can we take from this research?
It is apparent that physical activity in children could replace the regular inhalation-physiotherapy routine in some children with Cystic Fibrosis.

Similar to healthy populations, exercise training programs such as those aimed at improving aerobic fitness or muscular strength and endurance, are effective in children with Cystic Fibrosis.

Evidence suggests that exercise tolerance is severely limited by pulmonary mechanics in some Cystic Fibrosis patients. Whilst these advanced stages of the disease may prove more risky than beneficial with major exertion, it is important that these physical activity interventions are modified to suit the individual needs of the patient depending on the severity of their diagnosis.

Although the value of each activity to improvement remains undefined, other sources suggest a similar pattern of improved pulmonary function was evident after a course of swimming lessons which may also be a cause of positive response in the experiment due to the participation in swimming and diving.

Consequently, a combination of physical activity and chest physiotherapy would be deemed most beneficial for individuals with Cystic fibrosis. However, the dependence on chest physiotherapy may decrease once adaptations and improvements are made through exercise.

Practical advice
Physical activity and sports provide abundant health benefits for individuals, hence Cystic fibrosis sufferers should not refrain from exercising nor be constrained from participation. Individuals who suffer from Cystic fibrosis should seek advice from health professionals on whether physical activity may be undertaken in regards to the severity of their condition.

A guide in which helps sufferers to exercise safely at home or in the community developed by Cystic Fibrosis WA can be found here- Cystic Fibrosis Exercise Guide. Another fantastic source the Cystic Fibrosis Foundation is great for diagnostic advice, care, and guidance for day to day living with Cystic Fibrosis.

Further information/resources
For further information regarding Cystic Fibrosis as well as its link to exercise please use the following:

Cystic Fibrosis

Cystic Fibrosis Centre

Cystic Fibrosis and Execrise

Day-to-day Exercise and Cystic Fibrosis

Exercise is medicine in Cystic Fibrosis


text:
Exercise as it relates to Disease/The effect of implementing a resistance training program to improve strength and mobility in children with Cerebral Palsy

This Wiki Page is an article critique of; Scholtes VA; Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy; a randomised controlled trial. Developmental Medicine and Child Neurology. 2010;52(6):e107-e13

The critique forms part of The University of Canberra unit; Health Disease and Exercise Unit assessment item. Written September 2019.

For the purpose of this page, Cerebral Palsy will be abbreviated to CP.

What is the background to this research?
Recent studies suggest the true definition of Cerebral palsy is still unknown. In 2006, Peter Rosenbaum et al, defined as a “permanent disorder of the development of movement and posture, causing activity limitations, that are attributed to non-progressive disturbances that occur in developing foetal or infant brain”. In 2010, Scholtes VA et al, suggested CP as a “group of disorders in the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occur in the developing brain”.

Scholtes et al furthered their definition in 2010, stating that CP is the most common cause of movement disability in children. For both clinical and research purposes, CP is generally classified based on the degree of neural impairment it causes as well as the anatomical distribution of motor abnormalities. Either categorised as spasticity, ataxia, dystonia and athetosis. The main issue that children with CP face is Spasticity. Which can be defined as the sequelae of neuromuscular disability and causes constant muscular contraction. Until recently, many researchers were hesitant behind introducing strength-based training programs for children with CP due to the belief that doing such would increase spasticity. This paper reports conflicting results from recent uncontrolled studies and suggests such results can be attributed to their low methodological quality and high variability in training methods.

Along with interruptions to what can be classified as normal muscular functioning there are a range of associative conditions attached to CP. As CP is a neuromuscular condition it affects the muscle tone, gross and fine motor skills as well as balance and coordination. In developing children this poses an increased injury risk as loss of balance and coordination leads to an increased falls incidence rate. Although still inconclusive in regard to CP, previous strength and conditioning programs have been seen to improve mobility via the development of strength to improve balance skills. Hence reducing the risk of falls and injury.

So not only will implementing a strength and conditioning based program in this population have beneficial effect on way of life its results will fill the gap and lack of valid and reliable evidence in this field.

Where is the research from?
Vanessa A Scholtes is a well renowned author in this field, who has written and published over 70 journal articles. She achieved her PHD at the Amsterdam University Medical Centre between the years of 2000-07 where she then worked Post Doctrine position from 2008-11. She currently works as a Senior Researcher in the Department of Orthopaedics at OLVG.

Associated authors on this paper are all are well respected, highly acknowledged authors that have both individually and collectively contributed to the rehabilitation and orthopaedic field in their respected institutions.

This paper has included a large collaboration from academics from a range of different areas within one collective field. Due to the diverse background of each author and the education and field they have personally excelled in; this article’s reliability is therefore enhanced. With the results it achieved therefore becoming more valid and hopefully contributing to the ever-advancing subject area.

What kind of research was this?
This research is a randomised control trial, meaning the selection of participants from a range of schools was conducted randomly via sealed envelopes It was undertaken to evaluate the successfulness of intervening a Progressive Resistance Training Program to improve muscle strength and mobility in Children with CP.

This study was approved by the medical ethics committee of the UV University Medical Centre in Amsterdam, and full written consent from parents and each child was obtained before enrolment. Two independent research assistants performed all assessments and data entry and during the treatment allocation process they were blindfolded.

A control group was used for comparison of results.

In comparison to other study designs the method of a Randomised Control Trial is considered to be the most reliable evidence on the effectiveness of interventions because the processes used minimise the risk of cofounding factors influencing the results.

What did the research involve?
Children with Spastic unilateral or bilateral CP, were selected with the extensive inclusion criteria. Children were excluded if they had unstable seizures or were taking any medication for spasticity within 3–6 months before the study.

The training group followed a 12-week progressive strength training program for lower limbs, which replaced their conventional physical therapy sessions. Each session involved one child adapted leg press exercise and three functional exercises with a weighted vest.

The primary measure was mobility, measured via the 66- item version of the Gross Motor Function Measure (GMFM- 66), the Sit-To-Stand (STS) test, and the Lateral Step-Up (LSU) test. The GMFM- 66 test is an internationally validated test that evaluate the changes in gross motor capabilities in children with CP. The STS assess the amount of repetitions a child can sit to stand in a time period and the LTU gauges the amount of times a child can step up 11 cm in 30 seconds.

The secondary measure muscle strength was assessed via a 6RM leg press test and isometric strength tests of the hip flexor/ abductor, knee flexor/extensor, ankle dorsi/plantar flexion and using a handheld dynamometer, hand strength.

The control measure was spasticity. Evaluated on a scale of 0-5. Calculated as the sum of catch in response to a fast muscle stretch in 5 leg muscles. Muscle soreness was also assessed on a weekly basis via a Likert scale.

For the population group, this methodology was likely the most applicable and achievable in the time frame. However, limitations do exist. Of a total of 36 sessions, 3 were cancelled due school related activities, compliance measures sat around 93%. Although, compliance and attendance were quite high, the study itself only had 49 participants. In the larger picture this is a small study. Also, the intervention group performed better at baseline on all outcome measures and therefore outcome measures were controlled for baseline differences.

What were the basic results?
This 12-week program resulted in 8% improvements in handheld isometric strength in the training group compared to the control. 11% improvements in hip-abductors and 12% in knee extensors were also seen. Scholtes suggested these results supported the idea of specified strength training as the circuit training specifically targeted these areas.

However unexpectedly improvements in mobility did not align with strength increases. The suggested reason for this was that the increase in strength was not in individual muscles making gains in mobility difficult.

There was no change in spasticity, during, directly after or 6 weeks post-training. Supporting the belief that strength training is not a contraindicator of spasticity.

The results of this study show that training with a sufficient intensity, e.g. with a training load at which no more than 8 to 12 repetitions can be completed before muscular fatigue, results in increases in muscle strength.

What conclusions can we take from this research?
In conclusion, 12 weeks of functional PRE strength training is effective in increasing isometric muscle strength of the knee extensors and hip abductor by 11 to 12% and increasing six- repetition maximum leg-press strength by 14%. However, this does not result in an increase in mobility and has no effect on the ankle dorsi/plantar flexors or the hip flexors.

Practical advice
Consequently meaning, to achieve increased leg strength in children with CP, this paper suggests implementing a more extensive treatment regime, addressing several elements of fitness including muscle strength. Or alternatively use as a target treatment specifically when anticipating temporary muscle weakness. Perhaps before or after a surgical treatment.

Therefore, the significance of implementing a training program is still yet to be determined and further research specific to this population is still in debt.

Further information and resources
Cerebral Palsy Alliance- https://cerebralpalsy.org.au/about-conditions/cerebral-palsy/

Understanding Spasticity- Dietz V, Sinkjaer T. Spastic movement disorder: impaired reflex function and altered muscle mechanics. The Lancet Neurology. 2007;6(8):725-33.


text: Japanese/Vocabulary/Pronoun

title: Japanese/Vocabulary/Pronoun


text: Japanese/Vocabulary/Adverbs

title: Japanese/Vocabulary/Adverbs


text:
User:Iramali20/sandbox

ENGINEERING STUDIES...?? Most of the points here are the result of my experience with engineering

title: User:Iramali20/sandbox


text:
User:Guy.Jones.ACT

Hello, and welcome to my Wikibooks user page.

I hope you enjoy my content.

Background
This user page is here to give you some information about me, the creator of the page.

Interests
I have a keen interest in lots of different things.

Wikibooks projects
This user page constitutes one of my vastly few Wikibooks projects.

title: User:Guy.Jones.ACT


text:
User:Guy.Jones.ACT/sandbox

This is my sandbox.

title: User:Guy.Jones.ACT/sandbox


text:
Exercise as it relates to Disease/Can playing physically-engaging video games be beneficial for metabolic health?

This Wiki document critiques the article: Worley J, Rogers S, Kraemer R. Metabolic Responses to Wii Fit™ Video Games at Different Game Levels. Journal of Strength and Conditioning Research. 2011;25(3):689-693.

What is the background to this research?
Video gaming has become an increasingly popular phenomenon since the early 2000's. It has quickly become one of the most popular recreational pastimes of many people. Digital Australia has reported that over 67% of Australians play video games, of that 46% are females and 77% of players are over 18 years old. This demographic averages 89 minutes of game time daily. An adverse effect of the increasing popularity and technological advancements of video gaming is time spent sedentary. Video gaming and other screen-based activities have replaced many active behaviours and have been independently associated with metabolic syndrome. For example, in New Zealand one third of children are over weight or obese, and 3 in 10 children take part in little to no physical activity, both mimicking world-wide trends.

Interventions aimed at decreasing screen time have continuously failed due to the high value placed on these games. Interventions based on making physically engaging video games became popular as all other interventions failed. Games like Wii Fit, Wii Sports, and Dance Dance Revolution became increasingly popular. With the rise of these games people started to wonder if they proved effective in increasing physical activity and overall metabolic health. This study was the first to determine the %VO 2 max and caloric expenditure elicited by the different Wii Fit games at different game levels in adults Using data from this study we can determine whether or not these new physically engaging video games have an actual effect on metabolic health.

Where is this research from?
Writers Worley, Rogers, and Kraemer from the department of Kinesiology and Health Studies, at Southeastern Louisiana University published this article in the Journal of Strength Research and Conditioning under the National Strength and Conditioning Association. The independent status of this journal removes the risk of potential bias from other organisations that could benefit from the results. There is no disclosure of funding.

What Kind of research is this?
This study is a clinical trial that examined 8 healthy females from the University of Southeastern Louisiana and tried to determine their physiological responses while playing Wii Fit during 2 separate counterbalanced trials. Clinical trial studies can be used when looking at how a group of people respond to a new intervention, to then determine if the intervention is beneficial to use.

What did the research involve?
This study consisted of 8 apparently healthy female university students. All participants had to fill out a medical history questionnaire and give informed consent. None of the students were collegiate athletes, meaning they didn't have a strenuous exercise regiment, none of them had any history with cardio vascular disease, diabetes, or any other metabolic health concerns.

The subjects participated in 3 separate sessions all completed on separate days. The first session was a graded exercise test to determine participants VO 2 max on a treadmill, as well as getting basic measurements such as height and weight. The next 2 sessions consisted of the subjects playing Wii Fit. Subjects played the "Hula game" during session 2 then played the "Intermediate Step game" in session 3. In both session the participants played the game for 10 minutes with a 1 minute warm up. They completed a total of 3, 10-minute sessions, with a 5-minute break in between where HR (heart rate), BP (blood pressure), and RPE (rate of perceived exertion) using a 6-20 Borg Scale was measured. During the first 2, 10-minute sessions they played at the beginning level, and the last session was played on the intermediate setting. The subjects VO 2, % VO 2 max, RER, RPE, and caloric expenditure were all recorded and compared between the 2 trials.

The methodology of this study was beneficial in establishing the validity of the Wii Fit Hula and Step games in young, healthy adult women. However, limitations exist that compromise the reliability of the study. The subjects were all females of similar ages' that attended the same university. These participants were also all healthy with no history of any metabolic issues. Due to the limited population studied the results can not accurately represent or benefit the general population.

What were the basic results?
Upon analysis the intermediate game levels produced the most metabolic stress and energy expenditure in each of the subjects. For both games the physiological responses significantly increased from the beginning level to the intermediate level. The intermediate Hula game resulted in the highest levels for all physiological responses.
 * The table represents the mean data for % VO 2 max, RER, caloric expenditure, and RPE.

Using the results, the researchers compared the VO 2 and energy expenditure rates for both beginning and intermediate games to grade walking. By using a standard equation to predict VO 2 from walking speed they took the lowest VO 2 and found that it was equivalent to 4.02 km/hr, then took the highest VO 2 and found it to be equivalent to 5.79 km/hr.

What conclusions can we take from this research?
Results from this study reveal that playing Wii Fit games can be used as a form of physical activity for adult females. It is recommended that games are played on the intermediate level to induce the highest metabolic stress and energy expenditure for the participant. At the time this was the first study to determine the exact VO 2, % VO 2 max , and caloric expenditure in response to Wii Fit at different gaming levels. Unfortunately, the study examined a limited population meaning that the results do not accurately reflect the same benefits on the general population. Other studies have since been conducted looking at other populations playing active video games. For example, a study looking at children playing Dance Dance revolution found that it increases heart rate and caloric expenditure. Though this study was conducted in 2006 the problem surrounding increasing sedentary behaviours due to gaming and screen time have only increased. Recent studies have looked at games like Pokémon Go, a very popular smart phone game and its effects on physical activity. The study found that playing this game can be an effective way to increase daily walking. However, there is a lack of evidence of long-term effectiveness surrounding these games.

Practical advice
The results of this study show that playing physically engaging games can beneficial to increasing physical activity levels, and young adult females should be encouraged to engage with these games. It is important to note however, that while these games can be beneficial to metabolic health, at their highest level they only contribute to a caloric expenditure similar to walking at 5.79 km/hr. This expenditure is lower than other recommended forms of physical activity, therefore, is not as effective as a daily means of exercise.

Further information/resources
For further information regarding recommended daily energy expenditures, and sedentary behaviours; click on the links below
 * Australian movement guidelines
 * Determinants of sedentary behaviour in youth
 * Help for gaming addicts


text:
User:Lukhanyo Seku

THE WORDS OF WISDOM

IN LIFE WE CHOOSE DARKNESS INSTEAD OF LIGHT

PEOPLE CHOOSE TO LOOK COOL IN ORDER TO BE LOVED OR TO IMPRESS OTHERS

IN THIS WORLD WE WERE NOT SENT TO ENTERTAIN OTHERS OR PLEASE THEM

title: User:Lukhanyo Seku


text:
Exercise as it relates to Disease/The warrior way: weekend exercise helps you live longer

This is a critical appraisal of the journal article "Association of "Weekend Warrior" and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality by O’Donovan et al. (2017)

What is the background to this research?
It is well established that exercise is good for health, and reduces the risk of mortality. While the international consensus is that we need at least 150 mins/week of moderate intensity exercise, 75 mins/week of vigorous intensity exercise, or some combination of the two, in order to protect ourselves against diseases such as cardiovascular disease (CVD) and cancer, modern lifestyles and work culture often makes it difficult for people to find the time to exercise during the working week. So what about 'weekend warriors', who can only exercise on the weekend - are they protected against the risk of mortality as much as those who spread their exercise more evenly throughout the week? That's the question that O'Donovan and colleagues sought to explore in this study.

Where is the research from?
The study was published in the JAMA Internal Medicine journal. Lead author Dr Gary O'Donovan was a Senior Research Associate in the School of Sport, Exercise and Health Sciences at Loughborough University. Dr O'Donovan has co-authored 54 original research articles on exercise and population health since 2004, with over 2000 citations. The study received funding and support from the UK National Institute for Health Research, with additional support from the Australian National Health and Medical Research Council. No conflicts of interest were disclosed, and funding sources had no involvement in the design or execution of the study.

What kind of research was this?
This retrospective cohort study involved combining and analysing the results from 11 National health surveys from the UK. Cohort studies involve selection of a group of people who do not have a certain condition of interest, and assessing variables which may be related to the that condition. The cohort is observed for a period of time, to see how many develop the condition and examine associations with the variables. Retrospective studies analyse data which has already been collected. This is faster and easier than a prospective study, and inherently free of bias as the original studies weren't intended to address the current purpose; however any study design issues can't be corrected.

What did the research involve?
The Health Survey for England (HSE) and the Scottish Health Survey (SHS) are annual household population health surveys, undertaken by trained interviewers, which collect data on various health, socioeconomic and lifestyle parameters to inform public health policy. Respondents are selected to reflect a representative sample of the population. Data from 63,591 (29,181 male, 34,410 female) respondents to 11 HSE and SHS surveys conducted between 1994 and 2012 were included in this study. Respondents under 40, and/or with CVD or cancer at baseline were excluded. Self-reported physical activity data was examined, with responses filtered into four categories:

 * Inactive (no physical activity reported)
 * Insufficiently Active (reporting less than the recommended weekly physical activity )
 * Weekend Warrior (reporting at least the recommended weekly physical activity in 1-2 sessions per week)
 * Regularly Active (reporting at least the recommended weekly physical activity in >3 sessions per week)

National Health Service data was used to identify survey respondents who have died since the survey and the cause of death. All-cause, CVD and cancer mortality among study participants were recorded in 2016. Those who died within 24 months of the survey were excluded.

A statistical model was used to generate mortality hazard ratios (HR), which compare the risk of dying for people in each Active category against the risk of dying for those in the Inactive category. A HR <1 represents a reduced risk, while a HR >1 represents an increased risk. HRs were calculated for all-cause, CVD and cancer mortality. Data was adjusted for age, sex, illness, smoking status and occupation, to control for factors which might influence the results.

What were the basic results?
A total of 8,802 respondents died from all causes, including 2,780 from CVD and 2,526 from cancer. Respondents in all three Active categories had HRs <1 for mortality from all causes, CVD and cancer.

HRs were similar between women and men. The ratio of vigorous to total exercise time was higher in the Weekend Warriors than in the other Active categories, in both relative and absolute terms.

What conclusions can we take from this research?
Weekend Warriors saw a significant reduction in their risk of death from all causes, including CVD and cancer, similar in magnitude to the other Active groups.

Weekend Warriors performed more exercise at vigorous intensity than the other categories. While vigorous intensity exercise is known to have different benefits to moderate intensity exercise, it is unclear what role exercise intensity played in the magnitude of risk reductions seen in the Weekend Warriors, nor whether Weekend Warrior 'types' are inherently more likely to 'go hard' to make the most of their limited exercise window. This highlights a potential area for more research on optimal exercise prescriptions.

The study does have some limitations which limit the applicability of the results. The study is observational, and thus can't prove causation or 'explain' its findings. Participants were sourced entirely from within the UK, and over 90% of participants were white. The study also relied on self-reported data, which can be susceptible to error. Occupational activity was also not taken into account, and indeed a greater proportion of Inactive participants reported having a manual job. Any influence of this is unclear.

Despite these limitations, a key advantage of this study over previous studies on this topic is the larger cohort size and the inclusion of male and female participants, providing greater statistical power to detect real effects. The study results thus present a strong - albeit correlative - case for engaging in weekend exercise, if that's all you have time for.

Practical advice

 * Meeting the physical activity recommendations is protective against all cause mortality, CVD and cancer.
 * If you don't have time for exercise during the week, completing the recommended amount of exercise in 1-2 sessions on the weekend is still effective.
 * If you can't meet the recommendations, even small amounts of exercise are better than nothing!

Further information/resources
For further information on physical activity for health, visit these websites:

 * WHO physical activity recommendations
 * Find you 30
 * Heart Foundation
 * Cancer Council Australia


text:
Exercise as it relates to Disease/The effects of coordination training on cerebellar disease

This article is a critical analysis of the paper: "Intensive coordinative training improves motor performance in degenerative cerebellar disease”1

What is the background to this research?
The cerebellum plays a strong functional role in motor control as well as motor learning2. Degenerative cerebellar diseases, including cerebellar ataxia and multiple system atrophy, share several distinctive features post onset including ocular degeneration, dysarthria, as well as progressive gait and limb ataxia 3.

Exercise is noted as the primary intervention for individuals with degenerative cerebellar disease. Exercise programs are proven to effect gait in relation to walking accuracy, speed, and dynamic balance. Improvement in these areas is particularly important in individuals with cerebellar disease as they act to improve mobility, and as a result, reduce falls risk which is highly prevalent in sufferers4.

Where is this research from?
The article was drawn from “Neurology,” a journal by the American Academy of Neurology. Neurology is recognised as the most widely used and highly cited peer-reviewed neurology journal.

The primary author of this article, Dr. Winfried Ilg, has been involved in 78 research items including 1 project, 44 articles and 25 full texts all pertaining to ataxia and other degenerative diseases1.

The article is recognised as unbiased, providing Class III evidence. This is determined by the evidence pertaining to the opinions respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. Ilg’s co-authors are also involved in research aligning with his studies of degenerative diseases, providing a wealth of knowledge and experience to the article1.

What kind of research was this?
The study undertaken was a case report, in which the target population is monitored in relation to a specific outcome.

As empirical inquiries, case reports provide natural, real world insight into certain populations and analysis of the events, conditions and outcomes pertaining to the study. Case reports are often avenues into further research, with evidence becoming stronger the more the outcomes are tested. They are becoming increasingly popular due to the ease in which they can be conducted, as well as their cost-effective nature5.

Whilst this is the case, there is debate as to their validity, particularly in relation to the teaching of evidence based medicine. Evidence based medicine aims to optimise decision making by utilising evidence from reliable and well-conducted research5. Therefore, data collated from case reports is not recognised as valid within these constructs.

What did the research involve?
The study included 16 patients with progressive ataxia due to cerebellar degeneration (n = 10) or degeneration of afferent pathways (n = 6). Each patient underwent an intensive four-week coordinative training program to assess improvements in motor performance and reduction in ataxia symptoms. To ensure a holistic approach, parameters were measured on four occasions; 8 weeks prior to the program, immediately before the program, immediately after the program, and 8 weeks after the program1.

What were the results?
The four-week intensive program elicited significant improvement in motor performance and reduction of ataxia symptoms. Greater improvements were seen in patients with predominant cerebellar ataxia than patients with afferent ataxia in aspects of gait such as velocity, lateral sway and intra-limb coordination. These measures were all recorded in relation to the Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS)1.

Critique/analysis
The study design utilised creates a holistic analysis of each individuals baseline results and subsequent improvement post intervention. A comparison of results was conducted (E1 to E2, E2 to E3, E2 to E4 and E3 to E4) as a means of analysing each measure. This allowed for acknowledgement of individual disease progression and recognition of intervention based improvement. Individuals were also measured in comparison to internationally recognised ataxia rating scales. Through a thorough analysis of both pre and post-intervention results, in association with internationally recognised standards, the results within the article present with little bias and strong validity. Reliability and validity are furthered by the nature of the evidence presented (Class III), which utilises leading authorities in the subject area.

Whilst this is the case, the sample population within the study is small, utilising only 16 participants. A small sample population poses questions as to how applicable the concepts are to the greater population. Thus, it can be inferred that further research must be conducted as a means of consolidating the current results. Effects over a longer period should also be measured, taking into account the likelihood of individuals maintaining coordinative training post intervention.

Practical Advice
As is supported by varying research articles and authors, coordinative and exercise training elicit positive results in relation to improving gait, balance and mobility in individuals with degenerative cerebellar diseases. Therefore, in association with an exercise physiologist, individuals suffering from cerebellar disease should regularly engage in exercise and coordination based programs, thus increasing functional movement ability.

Coordination Exercises - Physiotherapy

Further research/relevant information
For further information surrounding Cerebellar Disease and the role of coordinative training/exercise please utilise the links below:

Cerebellar Disease

Exercise and Cerebellar Ataxia

Physical Medicine and Rehabilitation


text:
Exercise as it relates to Disease/Quantifying occupational physical activity manual labour vs office workers

This is a critique of the research article: Occupational Physical Activity in Brewrey and Office workers

What is the background to this research?
Physical inactivity has been classified as the 4th most common risk factor for global mortality. With known health risks associated physical inactivity it is still estimated that only around 5% of American adults meet physical activity guidelines. However, with increasing growth and use of technology to aid in professional life has manufactured an a prevalent physically inactive life style.

Self-reporting measures of physical activity have previously been the primary source of obtaining physical activity or occupational physical activity measures. Though many suggestions of validity and reliability, some literature has suggested a limitation in assessing absolute measures as well as intensity of physical activity using self-reporting questionaries for physical activity. Developing accelerometry technology has been proposed to be a valid and reliable as well as practical method of quantifying the amount and intensity of physical activity as well as sedentary behaviour.

The purpose of this study was to assess the occupational physical activity levels between a generally physically active and relatively sedentary work environments. Additionally, this study assessed the level of agreement between two types of accelerometer-based activity trackers.

Where is the research from?
Thompson, Severson and Rosecrance’s article was published in the Journal of Occupational and Environmental Hygiene (JOEH). JOEH is a joint publication of the American Industrial Hygiene Association and The American Conference of Governmental Industrial Hygienists, dedicated to enhancing knowledge and practice of occupational and environmental hygiene and safety.

This was Janalee’s first publication while at the Centre for Health, Work & Environment at the Colorado School of Public Health. She than followed with her second publication relating to Total Worker Health relating to a small business leader perspective. Janalee has since becoming a Safety and Industrial Hygiene Professional II at City and County of Denver, Denvor Public. This suggests a great eagerness and depth of experience within the field of occupational health. Severson and Rosecrance have both also published several journals within this field.

This research was conducted in the United States of America however, is still relevant within Australia.

What kind of research was this?
This research was conducted classified as an observational study due to the purpose in which to quantify the physical activity within two working populations. It could be suggested that it consists of possible quasi-experimental components as there was no control group within the design. The study may also be considered to be cross-sectional designed as there is a comparison element with physical activity between two different occupation groups as well as between accelerometry devices. As the purpose of this study was to observe the physical activity levels related to occupational groups as well as assess the variability between devices, this study design is appropriate.

What did the research involve?
This research originally consisted of 101 participants. Of which 50 volunteers from which were within the physically activity occupation group (brewery) and 51 volunteers from the office-based occupation group (call centre an engineering department). However, the final data analysis was conducted on 47 participants from the brewery and 47 office workers due to removal policies relating to device connection, consumption of medication relating affecting heart rate and abnormal physical activity due to knowledge of physical activity recording. The physical activity of each participant was recorded for one working shift. Physical activity for these participants were measured using both a Fitbit Charge HR and a Hexoskin to obtain two separate interpretations. Each participant was allocated both a Fitbit Charge HR and a Hexoskin and asked to wear them for an entire singular work day. from this the following was recorded:

 * Steps (Steps per hour)
 * Heart rate (bpm)
 * Percent maximal HR Range (%)
 * Calories (kcal)
 * METS (only determined from the Fitbit)

Percentage maximal HE range was determined using the following formula:

100 x (Average HR on job-Resting HR)/(Predicted HRmax-Resting HR)

Predicted HRmax was found using the age dependent formula for maximal HR (220-age in bpm). Whereas, the resting HR was defined as the lowest mean HR for a 60sec time period while sitting during the shift.

Limitations related to this study need to be considered whilst interpreting the relating results. Whilst the Fitbit Charge HR is popular device, it has the ability to falsely record additional data when misinterpreting additional arm-based movements as steps. This device also has the ability to present possible bias relating to abnormal extra physical activity due to its obvious presence on the wrist. Additionally, the percentage maximal HR range’s validity could be questioned as a true resting HR was unable to be found, instead using the lowest mean HR at work for 60 seconds. The participant recruitment method of occupation management asking employees for expressions of interest, resulting in a possible ‘healthy worker effect’, including those with an already increased physical activity or healthy lifestyle participating. Finally, the duration of data collection was only the duration of one shift with shifts ranging from 5-12 hours. This may not give a true representation of the occupation populations physical activity levels.

What were the basic results?
Statistical analysis investigating the difference between groups measures of steps, HR average percent maximal HR range and energy expenditure, using a two-sample t-test. A two-factor ANOVA was also used to assess the difference in mean hourly steps, mean HR, between devices and between occupational groups. Finally, a Bland-Altman plot was used to analyse and quantify agreement and bias between mean differences. All statistical significance was determined to the level of 0.05 for all tests.

Reliability was found to be of moderate for hourly steps and good for mean HR within both devices. Significant differences were found between devices for both measures of hourly steps and HR. Fitbit Charge HR consistently measures higher mean hourly steps whereas the Hexoskin consistently measured greater mean HR. Brewery workers took more steps, had greater mean HR and maximal percent HR range, and higher energy expenditure than office workers. The following table 1. Summarizers means for, SD, difference between means and p-values for all measured factors.

What conclusions can we take from this research?
Significant differences were found in the physiological cost related to office workers compared to brewery workers. Differences in mean hourly steps and heart rate between occupations suggests it is important to understand the physical activity demands related to each occupation. The Hexoskin was reported to have invasive properties and therefore would not be recommended to record occupational physical activity levels. The Fitbit charge HR appears to be a practical tool to observe occupational physical activity, however, it too does possess some limitations and therefore may need to undergo resting to assess reliability and validity.

Practical advice
This study aids in adding depth into understanding physical activity levels within an different occupational environments. This research along with the previous research indicating the possible negative effects related to sedentary and physical inactivity lifestyles, may help business owners or employers implement initiatives to help increase OPA levels. On the other hand, it may also aid in predicting or evaluating levels of fatigue within more physically active occupations. Wearable devices are continuing to be developed and advanced and their validation should be continuously be assessed against proven methods. If work place duties are designed with OPA in mind and physical activity guidelines, then a healthier workplace could be obtained.

Further information/resources
World Health Organisation

The Australian Department of Health: For Australian Physical Activity and Sedentary Behaviour Guidelines An office-place stepping device to promote workplace physical activity


text:
Exercise as it relates to Disease/Does resistance training impact bone mineral density in postmenopausal women?

This Wikibooks Page is a critical appraisal of the article ‘Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial’ by Watson et al.

What is the background to this research?
Osteoporosis is a disease involving the loss of bone mineral density (BMD), instigating a lack of structural integrity in the body’s framework, increasing the risk of fractures. Common fracture sites of osteoporotic individuals are the hip and lumbar spine (main weight bearing areas). It affects nearly 10% of the world’s population and 30% of women after menopause.

During menopause, the ovaries cease functioning and 17beta-estradiol levels decrease causing accelerated bone loss (~ 2 - 6.5%). Therefore contributing to high incidence rates of osteoporotic postmenopausal women. A risk factor associated with these women is re-fracturing previously affected areas. After experiencing damage, a bone never returns to its original strength - making it more susceptible to re-injury.

To counteract the osteoporotic effects associated with menopause, women are prescribed hormone replacement therapy (HRT) and/or calcium supplementation by their GP’s or specialised doctors. HRT maintains BMD through artificially restoring oestrogen levels, whereas calcium supplementation replenishes calcium stores lost during menopause. However, research is beginning to associate bone strength with regular resistance training in this population.

Where is the research from?
This research was published in the journal ‘Osteoporosis International’ with Watson, Weeks, Weis, Horan, and Beck conducting research from Griffith University, Menzies Health Institute and the Bone Clinic in Queensland, Australia.

The study was led by Beck, B. who is a highly reputable Associate Professor at 'Griffith Health Institute's Centre for Musculoskeletal Research' and Watson who attained his PhD for 'Physiotherapy' following this research.

What kind of research was this?
The research by Watson et al. is a single-blind randomised controlled exercise intervention trial. RCT’s are commonly considered the gold standard for comprehending the dose-response outcomes of exercise and is therefore an appropriate study design for this intervention. It is through these highly specific studies that meta-analyses can be comprised on the overview of a treatment’s effectiveness in a target population.

What did the research involve?
Seventy-two postmenopausal women (>60 years old) with a low BMD at the hip and/or spine sites were randomised into 2 groups with there being a High intensity Progressive Resistance Training (HiPRT) group and a Control group (CON). HiPRT individuals performed 30 minute, supervised workouts twice weekly over 8 months involving high intensity resistance exercises (deadlift, squat, overhead press etc.) with progressions being added after 2 months. Control participants exercised at the same frequency however were un-supervised and home-based performing stretches and low resistance exercises (lunges, calf raises, shrugs etc.) with intensity mildly increasing over time. Only 28 individuals completed the full trial period with participants quitting due to reasons such as medical contraindications (n = 36), being unable to attend sessions (n = 28), currently conducting resistance or impact training (n = 23), and not having Osteopenia or Osteoporosis (n =10).

Post-trial, BMD was recorded at the Femoral Neck (FN) and Lumbar Spine (LS) using a Dual-energy X-ray Absorptiometry (DEXA), which is considered the gold standard for measuring body composition. A hand-held dynamometer and other performance-based tests were performed to analyse changes in strength also.

What were the basic results?
In the HiPRT group significant increases in BMD were present at both the LS (HiPRT = 1.6 ± 0.9 %, CON = -1.7 ± 0.6 %) and FN (HiPRT = 0.3 ± 0.5 %, CON = −2.5 ± 0.8 %) locations in comparison to the CON group. Presenting great evidence for resistance training as a treatment of osteoporosis in postmenopausal women.

However, it continues on to deliver the message ‘HiPRT is safe’ and do not further extrapolate. This is true, although many factors must first be considered for this to be accurate. For example, if a novice began this exercise regime un-supervised, this could potentially be extremely dangerous – increasing the incidence of injury not only in the present but in the future. Therefore, for HiPRT to be deemed as ‘safe’ it must be supervised by an exercise professional (e.g. exercise physiologist) especially in the cognitive stage of the task with progressive overload being utilised correctly throughout.

Another limitation of this research is that they claimed to have 72 participants when only 28 were mentioned in the data. Either they have severely over-exaggerated their group size or data was not collected for each participant and is therefore insignificant.

What conclusions can we take from this research?
Although this research had a small final group size, it shows strong evidence that high intensity resistance training does improve the BMD of post-menopausal women and could be implemented as a form of treatment for Osteoporosis. However, success of the intervention relies heavily on it being instructed by an exercise professional with increases in intensity being introduced periodically in regard to their stage of skill acquisition and physical ability. Further research should also be conducted to understand the specific exercises and load that provide the most significant results regarding Bone Mineral Density (BMD) / Bone strength at the Lumbar Spine and Femoral Neck respectively to reduce the prevalence of Osteoporotic fractures in this high risk target population.

Practical advice
Before postmenopausal women consider performing any high intensity exercise, a local GP or specialist should be approached to reduce the risk of serious injury. As mentioned above, if being introduced into an individual’s routine, correct technique and slow progressions must be utilised. This is safest when supervised by an exercise physiologist (or similar) as they are highly knowledgeable of the potential risk factors associated with exercise and can accurately prescribe protective measures to prevent injury. The combination of resistance and aerobic training should be considered also with research suggesting that both exercise modes can be extremely beneficial for BMD, aerobic capacity as well as anxiety and depression.

Further information/resources
Aerobic Exercise and Osteoporosis

Exercise - Osteoporosis Australia

Aquatic Resistance Training and Osteoporosis

Aerobic Exercise and the Treatment of Anxiety

Resistance Training - Preventing Injury


text:
FreedomBox for Communities/Monitoring Server

The monitoring client on the FreedomBox server of each of the communities will need to send the collected metrics to a central location. This central location, the monitoring server, needs to store the data sent, visualize the data for administrator and alert them when something is off. This section describes the setup on the server. It is assumed that the server is also running a FreedomBox. However, with minor changes to the instructions any server running Debian GNU/Linux Buster or above can be used as a server.

Setup Graphite Carbon
Graphite Carbon server is responsible collecting the data from the various FreedomBox servers and storing them in a time-series database called Whisper. Run the following commands to setup Graphite Carbon.

Install Graphite Carbon.

Open up ports in the firewall for receiving data from FreedomBox Servers.

After this, graphite-carbon server will be running and listening on port 2003. This can be checked using the following commands:

Setup Graphite Web
Graphite Web service is responsible for serving the data stored by Graphite Carbon to consumers that can visualize the data such as Grafana. Run the following commands to setup Graphite Web.

Install Graphite Web

Generate a secret key for Django framework used by Graphite Web.

Note the key generated from previous command and set it as secret key in the file /etc/graphite/local_settings.py.

Create a database for Graphite Web to store its own data.

Create Apache configuration for graphite-web and start serving.

Setup Grafana
Grafana consumes data from Graphite Web and produces beautiful visualizations. It can also be configured for alerting when certain event occurs in the data. Run the following commands to setup Grafana.

Install Grafana from it's project's Debian repositories.

Configure Grafana to be served from the a existing domain under a sub-path. Edit the file /etc/grafana/grafana.ini and ensure the following two directives are configured as shown.

Configure Grafana to start every time the machine is booted and start Grafana.

Create Apache configuration to proxy Grafana from a sub-path and start serving.

Setup credentials for Grafana access. Visit https://<domain_name>/monitor/ and login with the following credentials. You will be prompted to change the password. Set a strong password.

 * Username: admin
 * Password: admin

Create user accounts for each for users who will using the monitoring setup. In the left menu, go to Server Admin, Users. Click on the New User button and provide details such as name, email, username and password to create a new user account.

Connect Grafana to the Graphite Carbon database via Graphite Web we have configured in the previous sections. Go to Configuration, Data Sources and select Carbon data source. In the configuration dialog that shows up, provide the following details: The press Save & Test. You should see a message confirming the data source is accessible.

 * Name: Carbon (or anything you choose)
 * URL: http://localhost:8080
 * Access: Server
 * Version: 1.1

Creating a Dashboard for Each Community
In Grafana interface, you need to create a dashboard for monitoring each of the communities you are the administering. The following instructions provide an overview of how this can be done:

 * 1) Login to Grafana interface.
 * 2) In the menu, select Create, Dashboard. A dashboard is created and a prompt is shown to add a new panel. Select a Graph.
 * 3) A new dashboard is created with a simple graph.
 * 4) Save dashboard by clicking the save icon. In the save dialog, provide a name for the dashboard based on the community for which the dashboard is being created. Click Save.
 * 5) To start showing proper data in the panel, click on Panel Title and select Edit. In the Metric tab, click on select metric drop down. You should see the name of the domain you assigned to your community as configured in collectd. Then select a metric such as cpu-0 and then cpu-user. You should start seeing the plot of the metric in the graph. Save the dashboard.

Parameters to Monitor
It is recommended that you create a dashboard to your taste but monitor the following parameters at least for each community:

 * CPUs
 * Series: • * • cpu-user
 * Functions: averageSeries • alias(User)
 * Series: • * • cpu-nice
 * Functions: averageSeries • alias(Nice)
 * Series: • * • cpu-system
 * Functions: averageSeries • alias(System)
 * Series: • * • cpu-wait
 * Functions: averageSeries • alias(Wait)
 * Memory
 * Series: • memory • percent-used
 * Functions: alias(% Used)
 * Load
 * Series: • load • load • shorterm
 * Functions: alias(5min)
 * Series: • load • load • midterm
 * Functions: alias(10min)
 * Series: • load • load • longterm
 * Functions: alias(15min)
 * Disk
 * Series: • • disk_ops • read
 * Functions: alias(Read ops)
 * Series: • • disk_ops • write
 * Functions: alias(Write ops)
 * Series: • • disk_octets • read
 * Functions: alias(Read Bytes)
 * Series: • • disk_octets • write
 * Functions: alias(Write Bytes)
 * Disk I/O Time
 * Series: • • pending_operations
 * Functions: alias(Pending Operations)
 * Series: • • disk_io_time • io_time
 * Functions: alias(I/O Time)
 * Series: • • disk_io_time • weighted_io_time
 * Functions: alias(Weighted I/O Time)
 *  Partition (for each partition)
 * Series: • df- • percent_bytes-used
 * Functions: alias(Used)
 * Series: • df- • percent_bytes-reserved
 * Functions: alias(Reserved)
 * <LAN/WAN> Network Bandwidth (for each interface)
 * Series: • interface- • if_octets • rx
 * Functions: alias(Received)
 * Series: • interface- • if_octets • tx
 * Functions: alias(Transmitted)
 * Connections Tracked
 * Series: • conntrack • conntrack
 * Functions: alias(Connections Tracked)
 * Wi-Fi Access Points
 * alias(sumSeries(isNonNull( .ping.ping-10_42_0_[1-9][0-9])), 'Wi-Fi Access Points')
 * Internet Uplink
 * alias(isNonNull( .ping.ping-10_42_0_4), 'Internet Router')
 * alias(isNonNull( .ping.ping-10_42_0_5), 'PTP Link - Router A')
 * alias(isNonNull( .ping.ping-10_42_0_6), 'PTP Link - Router B')
 * Internet Ping
 * Series: • ping • ping-1_1_1_1
 * Functions: alias(Internet Ping)
 * Processes
 * Series: • processes • ps_state-running
 * Functions: alias(Running)
 * Series: • processes • ps_state-sleeping
 * Functions: alias(Sleeping)
 * Series: • processes • ps_state-paging
 * Functions: alias(Paging)
 * Series: • processes • ps_state-blocked
 * Functions: alias(Blocked)
 * Series: • processes • ps_state-zombies
 * Functions: alias(Zombies)
 * Series: • processes • ps_state-stopped
 * Functions: alias(Stopped)
 * Uptime
 * Series: • uptime • uptime
 * Functions: alias(Time Since Reboot)
 * Users
 * Series: • users • users
 * Functions: alias(Logged-In Users)
 * collectd Queue
 * Series: • collectd-cache • cache_size
 * Functions: alias(Cache Size)
 * Series: • collectd-write_queue • derive-dropped
 * Functions: alias(Dropped Metrics)
 * Series: • collectd-write_queue • queue_length
 * Functions: alias(Queue Length)


text:
Exercise as it relates to Disease/School-based Physical Education: The key to improving cognitive and academic performance among adolescents

Reviewed article: Ardoy DN, Fernandez-Rodriguez JM, Jimenez-Pavon D, Castillo R, Ruiz JR and Ortega FB. A Physical Education Trial Improves Adolescents' Cognitive Performance and Academic Achievement: The EDUFIT Study. Scandinavian Journal of Medicine & Science in Sports. 2014; 24:52-61. This critique was written as a submission for an assignment in the unit: Health, Disease and Exercise at the University of Canberra, August–September 2019.

=What is the Background to this Research?= The benefits of physical activity on the development and health of adolescents is well established, however physical activity rates statistically decline during high school years. Through mandatory school-based physical education classes, students of all ages are encouraged to participate in semi-regular exercise in order to achieve nationally set guidelines.

In recent years, literature has shown a positive association between physical activity and academic performance, reporting adolescents who participate in regular school activities and co-curricular sport are more likely to achieve higher grades when compared to their sedentary peers. Nevertheless, the role of physical education on academic achievement and cognitive performance remains relatively disputed.

This study by Ardoy et al. sought to examine the effect of volume and intensity of physical education on adolescents’ cognitive performance and academic achievement and contribute to the existing literature with its preliminary findings.

=Where is the Research From?= The research for this article was undertaken in Spain and supported by research grants from the Spanish Ministry of Science and Innovation and Center Teachers and Resources Murica of Education, Training and Employment Murica Ministry. Resources for the study were also provided through two EU-funded studies: the HELENA Study and the ALPHA study. The article was published in the Scandinavian Journal of Medicine & Science in Sports in 2014.

The authors of this study are from a number of tertiary institutions in both Spain and Sweden. They have backgrounds in the diverse areas of physical education and sport, biosciences and nutrition, education and psychology.

Several of the authors had published numerous articles in their respective areas of expertise.

=What Kind of Research Was This?= This study was a group-randomised controlled trial which is considered to be the gold-standard of scientific research due to its limitation of bias and validity of determining a cause-effect relationship between an intervention group and a desired outcome. Randomised controlled trials (RCTs) involve randomly assigned participants to a control and intervention group. These groups are followed up after a set period of time and the results are compared to the hypothesis as defined in the outset of the study. Nevertheless, RCTs do have their limitations:
 * Trials are often conducted on too few subjects or undertaken for too short a time period
 * Most trials are funded by large research institutions
 * They may produce “hidden bias” through imperfect randomisation

=What Did the Research Involve?= 67 adolescents between the age of 12 and 14 years were investigated over a four-month period to evaluate the effect of volume and intensity of physical education on cognitive performance and academic achievement. Three experimental groups were randomly allocated into a control group (CG), experimental group 1 (EG1) and experimental group 2 (EG2). CG group participated in regular PE sessions (two 55-minute sessions/week), EG1 received four sessions per week and EG2 undertook four high-intensity PE sessions/week (defined as achieving an average heart rate above 120bpm). As this study is group-randomised, the groups were randomised rather than the individual participant. Randomisation was also blinded for the assessors of the results. Academic achievement was assessed using student grades, however, teachers from each subject gave an additional average score on top of these grades based on student behaviour, attitude, homework, skills and knowledge as required by the Spanish curriculum. The baseline results were compared against the same testing criteria during the follow-up phase.

Study Limitations

 * Mixed gender and age cohort: The maturity and developmental differences between the categories may have had a significant impact on the cohesiveness of the intervention. These age and gender differences within the respective cohorts were not well controlled.
 * The assessors conducted irrelevant pre-intervention testing which did not justify how sexual maturation equated to mental maturation. Arguably, mental maturation has a greater influence on results.
 * Short study duration: a 4-month period is arguably inadequate to assess academic progress, particularly among a heterogeneous group of adolescents.
 * Sample size of 67 students reflects a small statistical power

Study Strengths

 * The experimental method was presented logically and results are displayed appropriately
 * Results were mathematically balanced for possible baseline differences
 * Data was collected for both cognitive performance and academic achievement

These limitations resulted in a lack of control and execution within the study leaving it open to bias and compromising the interpretation of meaningful results.

=What were the Basic Results?= The study found the following key results:
 * 1) Physical education classes do not compromise academic performance
 * 2) Increasing the volume and intensity of PE sessions per week has a positive effect on academic achievement and cognitive performance
 * 3) High intensity physical education is associated with the most improvement in cognitive performance and academic achievement

These test results are prone to over-emphasis and interpretation highlighted by Ardoy et al. in his reference to separate literature suggesting other plausible underlying methods that may have yielded the intended results.

=What Conclusions Can We Take From this Research?= Overall, this study had numerous limitations that effected the meaningfulness and power of its results. However, Ardoy et al.’s research does present some preliminary findings, adding to the literature and allowing future avenues of more extensive research.

Future studies should endeavour to increase the duration of the trial as well as aim to create precise cohorts in order to procure more accurate and reliable findings. Furthermore, more research should be conducted into the underlying mechanisms that support Ardoy et al.’s study, perhaps conclusively determining the effect of physical activity alone on academic achievement and cognitive performance.

=Practical Advice= As the link between physical education and academics remains disputed, it is notable to highlight the importance of physical activity on the development and health of adolescents. Although there may be no definitive correlation between physical education and academic results, high-school students should be encouraged to participate in regular physical activity by virtue of its positive health and developmental connotations.

=Further Information/Resources= For further resources regarding physical education and adolescents please access the links below:
 * The Australian Council for Health, Physical Education and Recreation
 * Top 5 Reasons Why Physical Education is As Important As Schoolwork
 * Why Is Exercise Important to Teenagers?
 * Australia's 24-Hour Movement Guidelines for Children and Young People

=References=


text:
Exercise as it relates to Disease/Aerobic exercise helps patients with panic disorder

This Wikibooks page is a critical appraisal of the journal article “Aerobic Exercise Reduces Anxiety Symptoms and Improves Fitness in Patients with Panic Disorder” by Lamego et al. 2016.

What is the background to this research?
In Australia 2.3 million people aged 16–85 years have an Anxiety Disorder (AD). Panic Disorder (PD) is an AD that affects 1-2 % of the Australian and New Zealand population every year. PD consists of recurrent unanticipated panic attacks to an individual. Individuals with PD experience panic attacks which are brief episodes of intense anxiety causing psychical sensations of fear. Panic attacks usually last around half an hour in duration and occur several times a day or may happen only once every few years.

Treatments options for PD patients are using pharmaceutical drugs or Cognitive Behavioural Therapy (CBT). Pharmaceutical drugs such as benzodiazepines or antidepressants are commonly prescribed to patients but have side effects such as cognitive dysfunction, cardiovascular implications and becoming medication dependent. Researchers in the field of anxiety disorders are shifting toward other treatment options for patients such as Aerobic Exercise (AE). AE is increasingly becoming a more accepted therapeutic treatment option for individuals suffering from anxiety disorders due to positive health benefits exercise has on physical and mental health. However, researchers are still debating to whether AE is an effective treatment option for AD. The aim of this study was to examine the effects of continuous AE on PD patients.

Where is the research from?
This journal article was undertaken in Rio de Janeiro, Brazil. The article was published by Medical Express in 2016 which is a non-profit organisation that is free from unilateral influence of professional society or research institution. The lead author Murilo Lamego is a respected researcher from Veiga de Almeida University (UVA). Despite the research being conducted in South America, the research findings are still valid for Australians.

What kind of research was this?
This research was an intervention study, as researchers implemented an AE program to see the effects it had on the participants. To be eligible for the study, participants had to meet the following criteria: patients had to be diagnosed with PD, display negative responses to a physical activity readiness questionnaire and finally, patients did not partake in AE in the last 6 months.

Limitations

It is important to identify the limitations of this research study when interpreting results:
 * The research study had one sample group with no controlled group
 * This was not a randomised control trial (RCT)or double blind study due to one sample group
 * The sample of participants was not enough to draw any convincing conclusions
 * The sample had only female participants and no male representation
 * The researchers in this study failed to perform a follow-up assessment and failed to retest body weight and body fat percentage after the 12-week AE intervention

Despite the limitation in this research study, the findings can be a reference for future research.

What did the research involve?
The research study consisted of a sample size of ten inactive female subjects. Individuals in this study were invited to participate and agreed to join the study on a voluntary basis. This research study was 12-weeks in duration with individuals performing AE on a treadmill 3 times per week, accumulating 36 sessions in total. Researchers composed the study into three phases: (1) baseline assessment, (2) experimental procedure and (3) reassessment.

AE was performed at 70-75% of participants VO2 max, which was established before exercise commenced. Participants VO2 max was then reassessed at the end of week 12 to see any change in aerobic fitness levels. Before AE started, participants had their anxiety symptoms examined during baseline. The tests used to assess anxiety symptoms were: Trait Anxiety Inventory (STAI-T) and State Anxiety Inventory (STAI-S), and the Subjective Units of Distress Scale. Anxiety symptoms were them reassessed during weeks 6 and 12, to identify any changes.

What were the basic results?
The study found the following key findings:

 * Significant reductions were found across all three anxiety symptom tests
 * STAI-T displayed significant reductions across all three testing protocols throughout the study
 * STAI-S and SUDS displayed significant reductions but only across baseline testing and week 12
 * Participants VO2 max improve over the 12-week intervention (Baseline: 22.5 ± 8.8 ml.kg-1.min-1 vs. Post-training: 24.2 ± 9.2 ml.kg-1.min-1)

What conclusions can we take from this research?
In summary, the 12-week AE protocol found positive benefits in cardiorespiratory fitness and anxiety levels in PD patients. AE may be a suitable non-pharmacological treatment option to reduce anxiety symptoms in PD patients. AE should be continued to be researched in this population as AE has many positive health benefits, which may aid recovery in patients. However, further studies are required to determine if AE is a valid treatment option for PD and other anxiety disorders. Research recommendations include:

 * Larger sample sizes with both male and female participants, which will allow for a RCT study
 * Different exercise protocols to determine the most suitable aerobic exercise program for PD patients.
 * Perform a follow-up assessment to investigate the biological and lifestyle changes that occur from following a regular exercise program

Overall, this research study found PD patients improved their anxiety levels and cardiorespiratory fitness levels by following a 12-week AE training program.

Practical advice?
If you are currently diagnosed with an AD such as PD, AE may be a suitable non-pharmacological treatment option to reduce anxiety symptoms. Performing AE at 70-75% of VO2 max on a treadmill can reduce anxiety symptoms and improve cardiovascular fitness levels and overall health in individuals. Make sure you speak with your doctor, psychologist and health professionals before commencing any exercise program protocol.

Further information/resources
If you are interested in further information, please see the links below:

 * Beyond Blue
 * Better Health Channel
 * The Department of Health
 * Beyond Blue National Help lines and Websites


text:
Exercise as it relates to Disease/The effects of interval training on cardiovascular health in adults with coronary heart disease

This is a critical analysis of the journal article "Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: A randomised study of cardiovascular effects and quality of life" (Trine T. Moholdt, et al. 2009)

What is the background to this research?
Coronary artery disease (CAD) can be defined as the narrowing of coronary arteries due to the build-up of fatty material called plaque. This plaque clogs up the arteries and reduces blood flow to the heart. In some cases surgical procedures are required to help blood flow correctly to the heart. Coronary artery bypass surgery, also known as coronary artery bypass grafting (CABG) is a procedure that uses blood vessels from another part of the body and connects them to blood vessels above and below the narrowed or blocked artery, bypassing the narrowed or blocked coronary arteries, allowing for blood to flow to the heart more efficiently.

The goal of CABG and exercise interventions is to reduce mortality rates. Patients enrolled in rehabilitation programs after CABG surgery have total and cardiac mortality reduced by 20%-26% compared to standard medical care patients. Exercise capacity is however, the best predictor of survival in both healthy individuals and those who suffer from cardiovascular disease. The best intensity, frequency, duration and type of exercise is still unknown. Aerobic interval training (AIT) however, has been shown to be more effective in improving cardiovascular function than moderate continuous training (MCT).

Where is the research from?
The research was completed by a large team from the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology, in conjunction with multiple different hospitals and medical centres from across the country.

The article was published in the American Heart Journal, which is a highly regarded medical journal consisting of peer-reviewed articles primarily focussed on cardiovascular disease. The journal aims to provide primary investigation, scholarly reviews and opinion based pieces about the practise of cardiovascular medicine.

What kind of research was this?
The study was a randomised controlled study, in which one group participated in Aerobic interval training, and the other completed moderate continuous training. The study aimed to investigate the effects of AIT and MCT on peak oxygen uptake (VO2peak) and quality of life after CABG surgery.

What did the research involve?
The study involved 59 CABG patients; 48 male, 11 female, who were randomly assigned to either AIT or MCT, stratified by gender. The randomisation code was completed using a computer number generation by a different unit at the University. Patients who suffered from heart failure, inability to exercise or drug abuse were excluded from the study.

The aerobic training program (AIT) consisted treadmill walking, 5 days a week for 4 weeks duration. It involved an 8-minute warm-up, followed by 4 sets of 4-minute intervals with the patient at 90% maximum HR and active pauses of 3-minute walking at 70% maximum HR. The session was completed with a 5-minute cool-down.

The moderate training group (MCT) walked continuously at 70% maximum HR for 46-minutes, to meet isoenergetic training protocols.

The intensity was controlled by heart rate monitors, and patients reported their rate of perceived exertion using the Borg CR10 scale. In addition to the MCT or AIT, participants also participated in training sessions held by the rehabilitation centre. These consisted of a variety of exercise modes and intensities, lasting between 45-60minutes duration. Both groups completed the same rehabilitation centre training, and all sessions had intensities measured by HR monitors.

If patients were discharged from rehabilitation centre, they received written exercise plans, which consisted of a 3-4 week training program with exercise at the same intensity and duration as their AIT or MCT group.

What were the basic results?
The study aimed to primarily measure VO2peak, as well as measuring left ventricular function, HR recovery, resting HR, work economy, quality of life and blood markers of cardiovascular disease as secondary outcome measures. These were measured a 3 time points; at baseline, after 4-weeks of rehabilitation and 6-months after being discharged from centre. Secondary measures were only taken at baseline and after 4 weeks.

Baseline characteristics from the two groups were well balanced, with no major complications and only one patient being excluded due to technical error.

The most significant changes from both groups were in VO2peak, HR recovery and quality of life. The AIT increased VO2peak from week 4-6 months and was also superior in increasing HR throughout the duration of the program and through to the 6-month follow up. This is ideal as low HR recovery is an independent predictor of mortality in cardiovascular disease patients. Quality of life also improved significantly in both groups in all three domains and therefore, was deemed to have improved patient's overall perceived quality of life. This can be seen in the table above.

During the 6-month follow up only the AIT group increased their VO2peak through their own at home exercise program, while MCT maintained the same capacity and did not improve. The improvement in the AIT group solely is believed to be caused by the higher intensity the exercise was, and how this transferred into patients at-home exercise routine. This aerobic capacity maintained for 2 years after the initial program was finished and could be due to the fact that patients in the AIT group had their activity pattern change, and were able to make a routine out of it.

What conclusions can we take from this research?
This study was a small, specific study, focussing on coronary artery bypass grafting patients from a small number of institutions in Norway. With only 58 participants including 11 female patients. The study size is too small for the results, evidence and conclusions made to be applicable to the population as a whole, which would require longer duration and more participants.

Interval training has been found to improve cardiovascular fitness more than moderate continuous training does. This research does however, come fundamentally from healthy individuals, and can be difficult to compare to CABG patients due to multiple confounding variables such as body composition, resting heart rate and blood pressure responses, selected risk factors, and cardiac performance. Due to the lack of control, improvements can only be made form baseline measurements.

Overall, the results from the study showed that aerobic interval training increased patients' VO2peak more than moderate continuous training did, although the low change from baseline could be due to the short duration of the exercise program, and results could change if duration was longer. The addition of rehabilitation centre training sessions in conjunction with the AIT/MCT sessions could have also influenced the VO2peak due to the training sessions difference in intensity and duration.

Practical advice
Aerobic interval training has been found to increase both HR recovery and VO2peak and may be the way to help improve cardiovascular function in CABG patient. Both aerobic training and moderate continuous training has been found to increase quality of life.

It may be as simple as just implementing regular exercise into patients routine for positive changes to result.

As cardiovascular diseases are becoming more common, more research and studies need to be completed for conclusions to be made in regard to the ideal duration and intensity of exercise to yield the best results.

Further information/resources
Below are extra studies and resources which provide extra information and may be of interest:

 * Benefits and Risks of High-Intensity Interval Training in Patients With Coronary Artery Disease
 * Effectiveness of High-Intensity Interval Training for the Rehabilitation of Patients With Coronary Artery Disease
 * High-intensity interval training in patients with coronary heart disease: Prescription models and perspectives