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Exercise as it relates to Disease/Physical activity involvement in lower limb amputee populations

What is the background to this research?
There are many forms of disabilities, a key contributor to permanent disability are those who live with amputations (1). Individuals living with amputations often further into having struggles with anxiety, isolation and depression (1). Many know the benefits of physical activity (PA) such as increasing longevity of life and promotes psychological wellbeing; equivalent to those with amputations can benefit similarly to those without an amputation (1).

In Scotland, 82.9% of those who live an amputee is due to peripheral vascular disease, 38.6% undergo an amputation due to diabetes (1). Average age of amputation in Scotland with an Average of 80% over the age of 60 and 20% over the age of 80 (1). Those who attended Sub-regional English Limb Center, 50.5% were trans-tibial amputation, 49.5% of amputations where due to vascular diabetic cases (1). The demographics presented represent a perspective how PA may be projected. Pell et al. stated that physical mobility inability was the significant factor that affected quality of life measured by the Nottingham Health Profile, compared to non-amputee individuals (1). According to the demographics presented, creating personalised activity programs could reduce metabolic diseases such as diabetes, diminishing the cause of diabetes (1).

The aim of the study is to determine a relationship between quality of life and the restriction of PA activity in lower-limb amputation individuals (1).

Where is the Research from?
Sarah A. Deans, Angus K. McFadyen, & Philip J. Rowe from the University of Strathclyde, Glasgow, UK, and Glasgow Caledonian University, Glasgow, UK. This article was first published online on January 1, 2008, than later published on June 1, 2008.

The corresponding author for the article was Sarah A. Deans, who is based in: The National Centre for Prosthetics & Orthotics, University of Strathclyde.

Participants for the study were gathered from West of Scotland Mobility and Rehabilitation Centre, Southern General Hospital Trust, Glasgow, UK, for prosthetic care (1).

What Kind of Research was This?
The research is a [crosshttps://en.wikipedia.org/wiki/Cross-sectional_data|cross-sectional], mixed-methodology study of a group of lower-limb amputees (1). A cross-sectional design was selected to compare prevalence and scores between amputee and non-amputee individuals (1). A mixed-methodology design was chosen to compare both qualitative and quantitative data (prevalence and scores) (1).

What Did the Research Involve?
75 participants were selected who were both adult men and women who trans-tibial or trans-femoral lower-limb amputation and who were fitted and ambulatory with a prosthesis (1). There was no upper age limit however there was a lower age limit of 18 years. Participants for the study were gathered from West of Scotland Mobility and Rehabilitation Centre, Southern General Hospital Trust, Glasgow, UK, for prosthetic care (1). The selected sample consisted of individuals who lost their limb due to peripheral vascular disease (with/without accompanying diabetes), in order to create a similar physical-stamina levels (1).

In order to measure PA a section from the Trinity Amputation and Prosthesis Experience Scales (TAPES); Activity Restriction section, where the limitation of PA became prominent (1). This allowed for the range of activities to be covered whilst excluding those that weren’t relevant (1).

Three subcategories that were selected from the Activity Restriction were i. Athletic, ii. Functional and iii. Social (1).

i.	Activities that involve more dynamic physical effort; ie. sport and recreation.

ii. Simple functional activities such as climbing up stairs.

iii. Social activities such as visiting friends and/or working on hobbies.

In order to measure Quality of Life (QOL), the World Health Organization (WHO) Quality-of-Life Scale (WHOQOL-Bref) self-administration questionnaire was used (1). The goal of the questionnaire, is to identify the individual’s perception on their QOL (1). Four categories were analysed in the WHOQOL-Bref; physical health, psychological health, social relationships and environment (1).

Results from both the Activity Restriction TAPES and the WHOQOL-Bref were collected and analysed using descriptive statistics (1). Summary statics were also gathered (mean, standard deviation), subscales and domains were analysed using Spearman’s Rank correlation.

What Were the Basic Results?
A return rate of 33% occurred with the questionnaires (25 of the 75 participants), Table 1 outlies the samples profiles (1).

Table 2 presents the summary statistics, for the TAPES subscales, the highest mean score was achieved on the Athletic subscale (7.24, SD = 0.88) and the lowest on the Social subscale (3.44, SD = 2.50). For the WHOQOL-Bref, the lowest mean score was achieved in the Physical domain of (56.32, SD = 18.70), and highest in the Environmental domain (72.20, SD = 15.19) (1).

Table 3 represents the relationship between both the TAPES subscales and WHOQOL-Bref domains. The negative sign on all correlations reflects that a higher score on a TAPES subscale indicates more restriction, hence less PA, whilst a higher score in a WHOQOL-Bref domain indicates a better perception on quality of life (1). A large negative correlation between PA and perceived QOL, therefore it demonstrates a strong positive relationship (1).

What Conclusions Can We Take from This Research?
Core data suggests that older individuals who are less active seek to comfort, gain confidence and priorities social situations such as relationships rather than level of physical functioning (1). Findings highlight a weaker-than-expected relationship between PA and QOL, potentially due to rehabilitation post-operative (1). Post-operative physiotherapy, individuals may only receive one-on-one gait training or prosthetic therapy (1). Without positive one-on-one reinforcement, important PA information is missed. However, group/social rehabilitation may counteract, as amputee individuals, seeking guidance through others experiences (1). The study confidently states that amputee individuals rely on social support, PA increases so long as social relationships do not compromise (1).

Practical Advice
Through the physiotherapy component, during rehabilitation, implementation of PA programs, promotes patient adherence, especially in early stages (1). Promotion in early stages allows the amputee individual to identify an activity which they enjoy, at an intensity which is appropriate to induce psychological effects (1). Creating positive situations for amputee individuals, such as positive reinforcing teams can escalate amputee individual’s comfort and confidence (1). Constructing such scenarios for these individuals can be valuable to recovery, and adjustment to social life, profound social situation, allows for better PA execution. Further Information/Resources

Further information/resources
https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

https://apps.who.int/iris/handle/10665/40268


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Exercise as it relates to Disease/Adolescents at risk of endometriosis - Does physical activity reduce the risk?

This is a critic of physical activity levels and how it relates to risks of Endometriosis article. This critic has been written as a university assignment for the University of Canberra for the unit: Health, Disease and Exercise.

The article: Vitonis, A., Maruti, S., Hankinson, S., Hornstein, M. and Missmer, S., 2009. Adolescent Physical Activity and Endometriosis Risk. Journal of Endometriosis, 1(3-4), p.157-163.

Endometriosis
Endometriosis is a chronic menstrual health disorder. Endometriosis occurs when the existing tissue that is similar to the lining of the uterus occurs outside this layer and causes pain and/or infertility. When the menstrual cycle begins in the menses cycle, the menstrual fluid flows outside of the body and usually lasts for three to five days. When Endometriosis is present the menstrual fluid travels backwards through the fallopian tubes and into the pelvis. An individual who has been diagnosed with Endometriosis can experience but are not limited to:
 * heavy periods or irregular bleeding and bleeding between periodsor going to the toilet
 * abdominal or pelvic pain before and during a period, when having sex or going to the toilet
 * bleeding from the bladder or bowel

Further on, additional problems that Endometriosis causes includes increase pain and increase chances of infertility. The researchers of the current study designed the research to determine if physical activity levels of adolescents to reduce the risk of Endometriosis.

Physical Activity

 * Studies show that lifestyle changes including exercises levels can improve quality of life among Endometriosis Cancer survivors.
 * Studies support evidence relating to the positive properties that physical exercise have associated to it, and directly links it to Endometriosis.
 * Risk factors for the disease have been identified including obesity, in which physical activity can reduce the obesity state of an individual.

What is the background to this research?
The current study background highlighted that one study that investigated the relationship between adolescents and physical activity. The relationship highlighted that physical activity wasn’t associated with risk of Endometriosis. Although multiple case-control studies have illustrated a 40-80% reduction in risk of Endometriosis for adults who participated in physical activity.

Where is the research from?
The current study was conducted using data from Nurses’ Health Study II, and was performed at the Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts. The researchers were from various departments including, Department of Obstetrics, Gynaecology, and Reproductive Biology, Department of Medicine and the Department of Epidemiology. The article was published in the Journal of Endometriosis Vol. 1, which is a peer-reviewed medical journal.

What kind of research was this?
The current study was a prospective cohort study that investigated the effects of the average amount of time per week spent in a moderate and strenuous physical activity. The current study analysed the amount of exercise spent during three age periods. As a base line, each activity had assigned a metabolic equivalent score (MET).

What did the research involve?
The research involved data collected from the Nurses’ Health Study II. The researchers reviewed the data every two years from 1989 through to 2001. The researchers condensed the data recorded into three age periods: ages 12-13, ages 14-17, and ages 18-22. Additionally, a MET score was assigned to each activity and were summed to estimate a total activity level for the participants.

What were the basic results?
The results indicated that, in analyses of the individual activity types within each time period, only strenuous activity during ages 12-13 was associated with Endometriosis. Interestingly, the greatest amount of the greatest amount of activity (≥80 MET-h/wk) with the least (<20 MET-h/wk).

Multiple adjustment was made to simplify the data, the adjustments included age, calendar time, birth wright, age at menarche, parity, oral contraceptive use and body mass index. The results then acknowledged a 16% increase in the risk for Endometriosis when comparing the largest amount of exercise to the smallest during the age period of 12-12 and there were no associations for ages 14-17 or ages 18-22.

What conclusions can we take from this research?
This research was conducted early in teams of understanding the full extent of Endometriosis. What was significate was the continuous data updates over the 12 years the data was collected.

There was observed only one statistically significant association.Although the association may be due to chance, it may be that the early adolescent period is a critical time frame for endometriosis risk.

Although there is a lack of evidence to directly link to increasing physical activity that can then reduce the risk of developing Endometriosis. There were some limitations with the study, the most noticeable one included the lack unmeasured variables. Theses variable nowadays can be measure however when the original data was collected these variables can be compromised by the problem of missing data.

Practical advice
The current study explores the lack of evidence given to relate physical activity directly to reducing the risk of Endometriosis. Although physical activity has multiple positive outcomes that adolescents will benefit from, including but not limited to:
 * Reduced body weight
 * Reduce fatigue
 * Increase endorphins
 * Increased mental capacity/awareness

Physical activity may not have a direct link with reducing the risk of Endometriosis, although it can help with symptoms and improve pain. Additional resources below are supplied in regards to more information/ advice for Endometriosis.

Further resources
For further information on Endometriosis and the benefits of exercise read the following:
 * Endometriosis: https://www.endometriosisaustralia.org/about-endo
 * Signs and Symptoms of Endometriosis: https://www.health.qld.gov.au/news-events/news/signs-symptoms-endometriosis
 * Endometriosis Cancer: https://www.thewomens.org.au/health-information/womens-cancers-pre-cancers/endometrial-cancer
 * Endometriosis and the benefits of physical activity: https://endometriosisnews.com/endometriosis-and-exercise/
 * Support Groups in Australia: https://www.endometriosisaustralia.org/support-groups

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


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Exercise as it relates to Disease/The effects of exercise programing on adolescents and children with visual impairments

This is a critique of the research article by Pineio Christodoulou exploring the effects of exercise programming on adolescents and children with visual impairments, from the Open Science Journal of Education. This was written as an assignment for the unit Health, Disease and Exercise at the University of Canberra.

What is the background to this research?
Whilst it is evident there are many health benefits associated with physical activity, boundaries exist for those who are visually impaired or blind in regards to how they participate in exercise. Additionally, those who are visually impaired are less likely to participate in exercise in comparison to those who have clear vision. The importance of implementing physical activity at a young age reinforces better behavioural attitudes towards exercise into adulthood. Through the implementation of programming, adolescents and children with visual impairments or blindness demonstrated an improvement in their motor skills, physical attributes and well being. These skills can be utilised into adulthood to prevent the occurrence of falls and poor lifestyle decisions which are more prevalent in the blind and visually impaired population.

The study examined the effects of an adaptive physical activity program on motor development of children and adolescents with visual impairment. Children with visual impairment show deficits in their motor development, resulting in lower levels of resistance, cardiovascular fitness, and physical performance in comparison to one with clear vision. Additionally, parental knowledge about physical activity for the visually impaired is limited, establishing a barrier for how visually impaired children can participate in physical activity and exercise. The necessity for implementing exercise programs for children and adolescents with visual impairment are heightened to further their quality of life and improve multiple health outcomes.

The purpose of this research was to improve the balance and motor skill ability of the participating children. The Bruininks Oseretsky Test of Motor Proficiency (BOTMP) psychometric assessment was utilised to evaluate the outcomes. Assessing a field that is currently poorly documented, this study deems to be valuable as it deepens our understanding on the importance of physical activity for the above outcomes.

Where is the research from?
This study consisted of 24 children and adolescents with visual impairment aged between 6–14 years of age. 12 of the participants were allocated in an exercise group, with the remaining 12 being part of the control group that did not participate in any form of exercise. This sample size was selected from a school in Greece. There is little information known about the lead author, Pineio Christodoulou, however the same group of authors have participated in studies together, directed towards autism and visual impairment, assessing both adaptive behaviours and the effects of exercise. The study was published in the Open Science Journal of Education vol.5 (2017).

What kind of research was this?
This study implements a matched subject design, comparing a group of 12 who have been involved in an exercise program for 12 executive weeks, with two sessions a week, with a group of 12 that did not participate in exercise. To improve the equivalence between the groups, the individuals were distributed as homogeneously as possible with similar characteristics in relation to some variables (age, sex, time of visual disability, degree of visual disability and somatometric characteristics). Those with additional disabilities were excluded from the study.

What did the research involve?
Data was collected from the 24 visually impaired or blind children and adolescents using the Bruininks Oseretsky Test of Motor Proficiency (BOTMP) psychometric instrument. Notably, the assessment was modified to address the specific demands of visually impaired individuals. Implementing the BOTMP psychometric instrument, the program was orientated to address the following motor components:

1.Fine motor precision 2.Fine motor integration 3.Dexterity of hands 4.Bilateral motor coordination 5.Balance 6.Flexibility 7.Coordinate of the upper limbs 8.Development of power

Evidently, the two groups were not randomly assigned, rather distributed based on physical characteristics. Consequently, matched subject designs are limited, as they don't address all the variables and barriers of the visually impaired population. Despite this, they still maintain a good degree of validity and can be considered appropriate for the small sample size of 24 participants.

The BOTMP psychometric instrument is a tool utilised to provide an objective measure on the participants motor skill ability. This assessment uses a motor-scale which objectively scores their movement based on completion and/or range of motion. This measure increases the validity of the assessment, minimising subjective input from scorers.

What were the basic results?
The participants were examined pre- and post-intervention, providing an insight into the changes in their motor skill ability. Illustrated through the BOTMP scoring, the intervention group highlighted improvements in their motor development. Contrastingly, the control group who did not participate in exercise demonstrated no statistically significant change following the intervention.

Notably, the population that participated in exercise were categorised ‘well below average’ - in regards to their motor skill ability, prior to the intervention and were categorised ‘below average’ following the intervention. Therefore whilst there are still improvements in their motor ability, it remains below standard.

What conclusions can we take from this research?
Exercise programs that are tailored to the specific needs of blind and visually impaired children and adolescents highlight an improvement in their general motor ability. With greater levels of motor control, the population possesses higher levels of balance which is useful in injury prevention and physical well-being.

Further studies should investigate similar interventions, perhaps in different age groups, and dividing the results into different levels of visual impairment severity. Additional factors such as psychological readiness and behavioural attitudes should also be examined to better understand the population’s approach to physical activity, and its role in how confidently this group performs different motor skills.

Practical advice
Specialised exercise programs to improve motor control and balance in visually impaired or blind populations deem to be effective. Represented through this study, two exercise sessions a week that are participated in a leisurely manner highlight potential to improve motor control long term. Depending on the assessment used, it must be modified to address the demands of the visually impaired, and other health related needs must be met.

Further information/resources

 * Relationship of mptpr development to adaptive behaviour of children and adolescents with visual impairment
 * Motor activity in children who are blind or partially sighted


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Exercise as it relates to Disease/Exercise and its effects on preventing Alzheimer's disease

This is a critique of the research article 'Effects of Aerobic Exercise on Mild Cognitive Impairment' by Laura D. Baker, PhD, et al. (2010) from the JAMA Neurology Journal.

This critique was written as an assignment in Health, Disease and Exercise at the University of Canberra.

Background to Research
There is a great deal of research on the topic of Alzheimer’s Disease (AD) and the effects of exercise as an intervention to slow down cognitive degeneration in Elderly populations. With no distinct cause known for the disease, the need for research on the topic proves paramount. One leading theory to prevent the effects of the disease is the intervention of regular moderate to high intensity exercise.

AD is a progressive neurodegenerative disease that impairs memory and cognitive judgement, most commonly in the elderly. Due to its impacts on cognitive function, it is the leading cause of Dementia and is associated with increased morbidity and mortality.

The causes of AD are yet to be proven however, it is thought to be due to a number of different factors. AD is characterised by inexorable loss of neurons, particularly in the hippocampus and cerebral cortex as well as the formation of senile plaques and neurofibrillary tangles on brain cells. Theories of the cause of AD are mostly associated with; acceleration of aging, degeneration of anatomical pathways, environmental factors…, genetic factors including mutations… a metabolic disorder resulting in mitochondrial dysfunction, vascular factors and infecting agents.

Senile Plaques, a common biomarker of AD, are formed from extracellular deposition of beta-amyloid peptides in the brain. From various studies on mice, exercise has shown to reduce amyloid deposition in the cerebral cortex thus slowing down the effects of AD on an individual. Other benefits of exercise contributing to neuroprotection include alleviating memory loss in elderly, reducing inflammation and apoptosis markers. With these benefits proved on mice in controlled trials, it then would be feasible to think they could be replicated in humans.

This study also sparks as an area of interest as the intervention of exercise is an inexpensive and unintrusive method of slowing down the effects of AD. With the total spending on Health in 2019-20 for Australia coming to $81.8 billion, 16.3 per cent of total Australian Government expenditure, this intervention could save money as well as individual’s lives.

Where is the research from?
This research is from the JAMA Neurology Journal Vol. 67, No. 1 (2010). JAMA is an internationally peer-reviewed general medical journal with the key objective of promoting the science and art of medicine and the betterment of public health.

This particular article was concerned with the effects of aerobic exercise on cognition and other biomarkers associated with AD for older adults and sex as a predictor of response.

What kind of research was this?
This research was a six month, randomised and controlled clinical trial on 33 adults. 17 being female and 13 males that had amnestic mild cognitive impairment.

What did this research involve?
The research involved randomly dividing the participants into high-intensity aerobic exercise or a stretching control group. The aerobic group were prescribed exercise for 4 days/week at 75-85% Heart Rate Reserve (HRR) for 40-60 min/day, for 6 months. The controlled group carried out stretching activities to the same schedule but were required to keep their heart rate(HR) at or below 50% of HRR. Before and after the study, glucometabolic and treadmill tests were performed, and fat distribution was assessed using DXA scans. Blood was also collected at baseline, 3 months and 6 months. Cognitive tests were also administered. The Performance measures collected include:

 * β-amyloids 40 and 42.
 * Symbol-Digit Modalities
 * Verbal Fluency
 * Stroop
 * Trails B
 * Task Switching
 * Story Recall
 * List Learning
 * Fasting plasma levels of insulin
 * Cortisol
 * Brain-derived neurotrophic factor
 * Insulin like growth factor-I

Results
The basic results saw that high-intensity aerobic exercise had sex-specific effects on cognition, glucose metabolism and hypothalamic-pituitary-adrenal axis and trophic activity.

For Females, aerobic exercise improved performance on multiple tests of executive function, increased glucose disposal during metabolic clamp and reduced fasting plasma levels of insulin, cortisol and brain derived neurotrophic factor.

In Males, Aerobic exercise increased plasma levels of insulinlike growth factor 1 and had a increased performance only on trials B performance. These results also saw an increase in cardiorespiratory fitness and a loss of body fat in both sexes.

Beta Amyloid levels were recorded to decrease in Aerobic exercisers and increase in the stretching group however, the differences recorded failed to reach statistical difference.

These results have been replicated in other similar trials proving validity in that a specific improvement on executive function and brain activation changes can be attributable to exercise.

Conclusions
Conclusions we can take from this research is that Aerobic Exercise can be used as a potentially inexpensive non-pharmaceutical intervention to slow the effects of AD and lower biomarkers associated with the disease. More research will be needed to replicate and fill gaps in the research such as the impact of exercise on Beta Amyloid peptides.

The results also suggest that a sex bias in cognitive response may relate to sex-based differences in glucometabolic and hypothalamic-pituitary-adrenal axis responses to aerobic exercise; as was present in the female results.

Practical advice
From the results of this study, coupled with the growing thought that exercise may help to prevent and/or help to slow the effects of AD, it can be thought that regular Aerobic Exercise can prove somewhat effective.

Regular Aerobic Exercise proved to considerably drop particular biomarkers of AD in the participants of the trial, particularly females. Therefore, proving exercise should be undertaken by the elderly, especially females, to mitigate against AD.

Weekly exercise of 30 minutes of moderate intensity physical activity on most, if not all days of the week are encouraged by the Australian Government. Examples of exercise that could be prescribed to meet these guidelines and replicate the study’s findings include; Water aerobics, Power walking and Hiking. Not only will these exercises mitigate against AD but increase cardiorespiratory fitness and reduce body fat.

However, if an individual is not able to meet these levels of exercise they should start with 10 minutes once or twice a day. After two weeks, make it 15 minutes twice a day then they will have reached the goal of 30 minutes per day.

Further information/resources
Further sources for information on exercise guidelines for the Elderly and exercise’s effects on AD can be found below:

 * Physical Activity Recommendations for Older Australians – AUS Gov.: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/phd-physical-choose-health-l~phd-physical-choose-health-l-recommendations
 * Alzheimer’s Disease – Dementia Australia: https://www.dementia.org.au/about-dementia/types-of-dementia/alzheimers-disease
 * Preventing Alzheimer’s Disease – Helpguide.org: https://www.helpguide.org/articles/alzheimers-dementia-aging/preventing-alzheimers-disease.htm#:~:text=According%20to%20the%20Alzheimer's%20Research,started%20to%20develop%20cognitive%20problems.


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Exercise as it relates to Disease/The effect of disability on physical activity

What is the background?
It is well known that participating in regular physical activity improves health however disabled people don’t get the same opportunities as non-disabled people. In the U.S. around 20% of the population has some type of disability and those that don’t meet the recommendations stated in the physical activity guidelines have a 20-30% increased risk of all-cause mortality [4]. This paper identifies some barriers faced by disabled people that prevents them from participating in regular physical activity and solutions to these problems.

Where is the research from? [6]
The research conducted by the University of Illinois took place in the U.S. between 2001-2002 and was published in the American Journal of Preventative Medicine in 2004. Collection of results were supported by a few organizations such as the National Centre on Birth Defects and Developmental Disabilities and the National Institute on Disability and Rehabilitation Research The authors have high credibility as each has published many papers relating to disability and physical activity while having thousands of citations between them while lead researcher James Rimmer has received multiple awards for his work.

What kind of research is this?
This was an observational study where researchers travelled to 10 cities across the U.S. to collect data from different groups of people that have occupations related to physical activity [7].

What did the research involve? [6]
The first method of gathering information was to separate participants into four focus groups. People with disabilities, Architects, Fitness professionals and City planners. They were asked to comment on the accessibility of fitness centres, swimming pools, parks, trails and give ideas on what could be done to solve the issues. The information was gathered during recorded meeting sessions to be analysed. The second method was the researches going to the different cities to have a look at the facilities, brochures and signage provided, and advertisements of the facilities.

Strength of Study:
 * Addressed issues faced by disabled people regarding physical activity participation and provided some ideas on how they can be reduced
 * Taken opinions from professionals who work in the fitness industry and people than plan towns/cities

Weakness of Study:
 * Only takes into account people who have physical disabilities and not those with intellectual disabilities
 * Only 42 disabled people were interviewed

What were the basic results?
The results show that there are many barriers that prevent disabled people from participating in physical activity. The main barriers and solutions to increase physical activity are presented in the table below [6] :

What conclusions can we take from this research?
Many barriers prevent disabled people from participating in physical activity. Most of these barriers are created by non-disabled people overlooking the needs of disabled people that give off a negative attitude towards them as they are seen as unimportant [1]. Also, there are not many studies exploring factors that affect disabled people. This shows that there is a lack of understanding towards disabled people.

Practical advice

 * Suggestions were made to develop a reliable way of measuring physical activity levels in disabled people
 * It was suggested that researches should find more specific issues within the barriers that affect participation and that an ecological model is made to gain a better understanding
 * Deeper research into factors that affect participation in physical activity can help to reshape the way people think about disabled people and increase participation

Further information/resources
Overview of Physical Activity in Australia: [https://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/Physical%20activity/Participation_in_physical_activity_Research_summary.ashx#:~:text=Other%20factors%20impacting%20on%20physical,%2D%20conscious%20(Chau%202007). Participation in physical activity ]

Barriers:

Factors affecting Children with Disabilities

Environmental factors

Organization:

Increasing physical activity among adults with disabilities


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Exercise as it relates to Disease/Which is more effective in reducing type 2 diabetes in women; walking or vigorous-intensity activity?

This is a critique of the journal article "Walking compared with vigorous-intensity Physical Activity and Risk of Type 2 Diabetes in Women" by Frank B. Hu, MD, PhD; Ronald J. Sigal, MD; Janet W. Rich-Edwards, ScD; et al. Published in 1999 in the JAMA Medical Journal.

What is the background to this research?
Type 2 diabetes makes up over 85% of all diabetes cases and is the fastest growing chronic condition in Australia, for this reason, it is an important disease to prevent. Type 2 diabetes is a progressive condition due to a genetic disposition where the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in the pancreas. Physical activity in the absence of weight loss improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting the quality of life. The prevalence of diabetes is increasing year on year and in 2014 the World Health Organisation (WHO) recorded an increase from 108 million in 1980 to 422 million.

Strong evidence has emerged which identifies the association between physical activity and reduced risk of diabetes. Moderate-intensity physical activity such as walking is the most prevalent physical activity among older adults and is feasible, accessible, and readily adopted method for reducing type 2 diabetes. Observational studies have focused on the association of vigorous exercise and its effect on reducing the risk of type 2 diabetes. However, there is little research showing the comparison between the difference in the level of intensity of exercise has on reducing type 2 diabetes.

Where is the research from?
The research was published in JAMA which is an international peer-reviewed general medical journal that has been widely circulated around the world since 1883. The subjects for the research were registered female nurses from the Nurses’ Health Study Cohort. The Nurses’ Health Study is one of the largest prospective investigations into women’s health and factors leading to chronic diseases. Established in 1976 when 121 700 US female registered nurses aged 30–55 responded to a mailed questionnaire. The questionnaire investigated their medical history, health practices, dietary intakes and the results from the studies play an instrumental role in shaping public health recommendations.

Dr Frank B. Hu is the main author of the article and a professor of Medicine at the Harvard Medical School. His research focuses on diet, lifestyle, metabolic, and genetic determinants of obesity, type 2 diabetes, and cardiovascular disease (CVD). Dr Ron Sigal is an Associate Professor of Medicine, Kinesiology, Cardiac Sciences and Community Health Sciences at the University of Calgary. His current research focuses on physical activity, obesity, diabetes and CVD. All authors have a history with the topics being researched and therefore the knowledge presented is highly respected.

What kind of research was this?
The research was a prospective cohort study with data around the physical activity of 70,102 women as part of Nurses’ Health Study. Participants were observed at baseline (1986) and then followed up in 1988 and 1992 through a mailed questionnaire, inquiring about whether they had been diagnosed with diabetes.

Prospective studies are the gold standard in epidemiological studies. It involves assessing a cohort of participants with similar conditions from baseline to a future date whilst identifying and outcomes of interest (type 2 diabetes). The chosen research design requires a long-term follow-up, this study identified a 98% follow-up rate which provides high-quality data and validity of results.

A prospective cohort study seemed more appropriate than a retrospective cohort study, due to the benefit of being able to target for a specific outcome. The alternate method of observational studies would not have been suitable for the desired method as it involves the direct observation of individuals without forced intervention.

What did the research involve?
Over an 8-year period from 1986 70,102 female nurses who were free from diabetes were identified through a mailed questionnaire to participate in the study. The participants completed a physical activity questionnaire involving questions such as average time spent doing physical activity and the intensity of the activity. The data was analysed, and their baseline physical activity levels and weekly energy expenditure was calculated. Their energy expenditure was measured in metabolic equivalent task-hours (MET-hours) in relation to the different intensities of physical activity or walking. The above-mentioned questionnaire was first obtained in 1986 and then repeated two years later and in 1992. To control for confounding variables, the study also collected information on personal characteristics and lifestyle habits (e.g. smoking).

Strengths;

 * Large cohort and follow-up time
 * Comparable results with similar studies
 * Gold Standard Study Design

Limitations;

 * Questionnaires - leads to misclassification and over-reporting of physical activity. Self-reporting bias can appear due to different perceptions of exercise intensities, making it not as effective as electronic devices.
 * Standard classification for energy expenditure based on the activities not the individual, therefore results used are an estimate. Waviered due to the cohort size
 * All participants are Nurses with similar socioeconomic status and therefore may reduce external validity of the study and mean the results may not be generalisable to the general population.
 * ‘National Diabetes Data Group’ criteria were used to diagnose subjects and therefore exclude them. If the new criteria had been used, then some women would have become ‘excluded’ and vice versa.

What were the basic results?
The research showed that there is a positive relationship between physical activity and reduced risk of type 2 diabetes in women. Within the 8 year follow up 1419 cases of type 2 diabetes were recorded corresponding to an incidence rate of 265 per 100 000 person-years. In summary, the below points outline the key results;

 * Women who increased their activity level from 2.1-10.4 MET-hours in 1986 to >10.4 MET-hours in 1988 had a lower risk (RR = 0.71; 95% CI, 0.55-0.93) compared with those who were consistently sedentary.
 * Walking and vigorous activity was associated with comparable risk reductions when the energy expenditures were similar. Identifying substantial reductions of approximately 0.43 for individuals in the highest energy expenditure quintiles
 * The relative risk associated with a 5 MET-hours per week increase in energy expenditures were 0.95 (0.92-0.98) for vigorous activity and 0.92 (0.88-0.95) for walking.
 * Walking pace was an independent predictor for risk of type 2 diabetes. Multivariate RR for ‘normal pace’ was 0.72 compared to ‘brisk’ pace which was 0.41.

What conclusions can we take from this research?
If nothing else this study identifies that any exercise is better than none. Evidence shows that a 30-minute walk each day will reduce your risk of diabetes meaning it doesn’t have to be high intensity to see results. However, both intensities are associated with reduced risk of type 2 diabetes, therefore, it is a personal preference.

The findings show that the amount of physical activity required to reduce the relative risk is reliant on total energy expenditure rather than what type of exercise is undertaken or for how long. When the energy expenditure of moderate and vigorous was equivalent within the study the benefits were comparable. Whilst there are many other inflammatory markers that can increase risk of type 2 diabetes, regular physical activity alone is shown to reduce this risk regardless of changes in weight loss, lifestyle habits (e.g. smoking) or other metabolic factors. There are many misconceptions regarding the need to exercise vigorously to see any benefit however these results dismiss them.

The findings support the current guidelines from 'Centers for Disease Control and Prevention' and the 'National Institutes of Health' that individuals should participate in at least 30 minutes of moderate physical activity at least five days a week.

Practical Advice
Implementing some form of physical activity into your daily routine will not only decrease your risk of type 2 diabetes it will also improve your daily life and overall health.
 * Start somewhere; often getting started is the hardest part! Use the Physical Activity Guidelines as recommendations.
 * Make it enjoyable; find a form of physical activity that you enjoy (e.g. swimming, tennis, aerobics, walking) which will make it 'easier'.
 * Avoid long periods of sedentary behaviour (i.e. watching TV, sitting at your desk) by breaking it up with physical activity.
 * Choose activities that suit your lifestyle
 * If any form of physical activity causes severe pain or you have concerns, seek expert advice

Further Information
If you are interested in further information please see the links below;
 * Find out if you’re at risk of diabetes? https://www.diabetesaustralia.com.au/risk-calculator
 * Physical Activity Fact Sheet. Get Active. https://www.heartfoundation.org.au/active-living/get-active
 * Need help getting started? Find an exercise Professional nearby; https://www.essa.org.au/find-aep


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Exercise as it relates to Disease/Exercise and its essential role in long-term health – How 30 minutes of walking every day is the perfect ‘first step’ to improve health outcomes of individuals with type II diabetes

This is an analysis and evaluation of the research paper by Catrine Tudor-Locke et al; Tudor-Locke C, Bell RC, Myers AM, Harris SB, Ecclestone NA, Lauzon N, Rodger NW. Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes. International journal of obesity. 2004 Jan 1:113-9

Research background
Type II diabetes mellitus is a disorder characterised by high blood glucose levels, primarily developed due to a sedentary lifestyle with little or no physical activity (PA). The onset of type II diabetes can increase the chances of further health complications. These may include but not restricted to coronary heart disease, stroke, atherosclerosis, and diabetic neuropathy. The purpose of this study was to assess if the implementation of a First Step Program (FSP) is effective in improving walking behaviour with individuals suffering from type II diabetes.

While there is no cure for type II diabetes, regular PA has been a widely acknowledged solution for the management and prevention of the disease. Despite this however, a significant percentage of this population are still physically inactive. A national survey found that 66% of individuals with diabetes reported non-regular leisure-time PA. Additionally, another study found almost 55% of those with type II diabetes reported no weekly PA via walking. As a result, low cardiovascular fitness and physical inactivity are the largest individual causes for mortality for men with type II diabetes.

Research origin
The leading author of the study, Catrine Tudor-Locke, is a recognised world leader in objective PA assessment and promotion, and walking behaviour researcher. At the time of the study being published, she was working at Arizona State University East in the Department of Exercise and Wellness. She was also employed at the Canadian Centre for Activity and Aging. The research article was published by the International Journal of Obesity in October 2003. The intervention for this study was a behaviour modification program utilising goal setting, self-monitoring, and feedback, with the primary measurement of PA was steps/day using a pedometer. Given her specialty in pedometer and accelerometer-determined ambulatory activity captured as steps/day across the lifespan, Tudor-Locke was the correct person to lead the study. The findings of the article are very likely to remain accurate today, however the results presented may not be as significant if a larger population sample was used.

Research type
The study was conducted in the form of a randomised controlled trial. This is a form of scientific experiment used in many studies to try and eliminate any sources of bias towards the effectiveness of an intervention, by randomly assigning a population sample to two or more groups. These groups are treated differently but are compared to the same measurements of the study. In this case, a randomised trial was appropriate as it determined whether a First Step Program improved walking behaviour amongst patients with type II diabetes. However, given the strict criteria used for the study, this intervention may not be effective for all diabetes patients. For example, patients under the age of 40 or those who were already part of an exercise program may not benefit from this intervention. Additionally, a longitudinal study including more groups of diabetic patients that match a less strict criteria would be more suitable to assess the validity of the intervention and how it affects patients complying to higher volume and intensity programs later on in their treatment.

Research methodology
Patients from a diabetes education centre in Ontario, Canada were invited to take part in the part if they followed the following criteria: aged 40–60 y; minimum 3 months postdiagnosis of type II diabetes; treated by diet alone or by oral hypoglycaemic medications (not insulin); no PA limitations or documented heart conditions; not currently in an exercise program; and walked less than 8800 steps/day. At the conclusion of the experiment, 47 participants (male n= 26, female n= 21; mean age=52.9yrs) were assessed at both baseline and at the end of the intervention at 16 weeks. Five assessments were conducted on every patient, including PA using a pedometer, anthropometric measurements, resting heart rate and blood pressure, an oral glucose tolerance test, and blood samples for determination of insulin, haemoglobin A1c (HbA1c) and plasma lipid profiles. Smoking and educational status was also noted in the study. A limitation to this study was that due to the strict criteria for the population sample, the intervention is not likely to be an effective strategy for the entire type II diabetic population. In a real-world context, the findings of the article may not be as significant as initially suggested.

Basic results
The study hypothesised that a First Step Program would be effective in increasing levels of PA and improving blood pressure and waist girth. The results partially matched the presented hypothesis, as there was no evidence that the intervention significantly improved blood pressure. However, the program was successful in improving walking behaviour, consequently adding approximately 31 minutes of walking every day, and decreasing waist girth. As mentioned earlier, this intervention may only be effective for this sample selection, considering that type II diabetes is such a prominent disease. Furthermore, as stated in the paper, increasing PA volume and/or intensity would be necessary to improve long-term health outcomes in these patients. Future programs following these benchmarks may likely drastically lower the compliance to them amongst patients.

The findings published in this research matches with similar studies. The utilisation of a pedometer-based intervention has previously worked in a population known to have little interest and high drop out rates in exercise programs. Regardless, PA is essential in the treatment and prevention of type II diabetes.

Research conclusions
The study determined that a First Step Program was successful in increasing PA levels and lowering waist girth by improving the walking behaviour of patients. In accordance to the results, this type of change is very important to improve long-term health outcomes, making the intervention a perfect tool to start adopting a more physically active lifestyle and increase exercise volume and intensity later in treatment. Further research is important to determine realistic and responsive health outcomes for this population. Adjustments to the methodology may be necessary to validate these findings.

Practical advice
A physically active lifestyle is one of the key factors in managing type II diabetes and minimising the risk of other health complications. Diabetic patients should try to engage in physical activity, even if it is only 30 minutes of extra walking. A First Step Program has shown to improve walking behaviour amongst a sample of the type II diabetic population, consequently increasing PA. Improvements to body composition, blood lipid profiles, hypertension and glycaemia control are all benefits to engaging in regular PA. However, exercise should be cautiously proceeded with professional assistance to ensure it can be performed safely.

Background information on type II diabetes
https://www.healthdirect.gov.au/type-2-diabetes

https://www.diabetesaustralia.com.au/type-2-diabetes

In depth article discussing pedometers and physical activity
https://files.eric.ed.gov/fulltext/ED470689.pdf


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Exercise as it relates to Disease/Effects of upper body strength training, dynamic training and advice to train at home on peripheral arterial disease

This is a critique of the original research article Parr, B. M., Noakes, T. D., & Derman, E. W. (2009). Peripheral arterial disease and intermittent claudication: efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home. South African Medical Journal, 99(11).

What is the background to this research?
Peripheral arterial disease is quite a common circulatory issue. It involves the narrowing of arteries which in turn reduces blood flow to muscle groups around the body. Peripheral arterial disease is usually associated with intermittent claudication. Intermittent claudication is another consequence of artherosclerosis. Intermittent claudication results in individuals experiencing muscle pain and aches after mild use of the affected muscle group. The research that is being reviewed is a study of how different kinds of exercise can affect or improve cases of peripheral arterial disease and intermittent claudication. This research is important as it can assist our understanding of how to properly treat patients that are experiencing the effects of PAD and IC.

Where is the research from?
The research being reviewed comes from an original research article titled, 'Peripheral arterial disease and intermittent claudication: Efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home', and was authored by B M Parr, T D Noakes and E W Derman. T D Noakes is an author that has been involved with many articles within the field of exercise, nutrition, sport medicine and other health related topics. B M Parr has also been involved with multiple research articles involving Peripheral arterial disease. E W Derman, the director of the institute of sport and exercise medicine at the Stellenbosch university has also been involved in many research articles within the sport and exercise medicine field.

What kind of research was this?
The research conducted was a randomized controlled test. The control group for the experiment was the group advised to walk as much as they could from home without being placed in an actual program.

What did this research involve?
The research involved the participation of 30 patients that all had experience or history with PAD and IC. The participants of the trial were randomly assigned to either a strength based training program, a conventional exercise rehabilitation program or were advised to walk as much as possible from home. Over 6 weeks results were recorded on any physiological improvements in the patients. Before the patients began their specified trial they were all put through a standard graded treadmill test and a 6 minute walk test in order to determine certain physiological parameters such as, peak oxygen uptake, maximal walking distance, pain free walking distance and perceived pain.

What were the basic results?
The results from the study found that the maximum walking distance on the graded treadmill test increased for patients that participated in the conventional exercise rehabilitation program, compared to those in the strength training program and the home advice program. Similarly the vo2 peak increased for the conventional exercise group over the strength training and home advice groups. Patients involved in the strength training program and conventional exercise program saw an increase in pain free walking distance when undertaking the 6 minute walking test after the 6 weeks. There was also a decrease in the perceived pain of the participants that were involved in the conventional exercise rehabilitation program over those participants in the other 2 programs.

What conclusions can we take from this research?
The conclusions that can be taken from the research being reviewed is that dynamic training/ conventional exercise rehabilitation programs, are much more effective in the treatment and improvement of peripheral arterial disease and intermittent claudication. The authors of the original article have provided clear evidence that this type of exercise is much more physiologically rewarding than strength training or home training advice. However in saying this, the study was undertaken over a relatively short period of time (6 weeks) and may show differing results if testing for a longer period of time such as 4-6 months. Although this could possible be the case, through the study that has been provided, adequate evidence has been shown for the efficacy of dynamic training to significantly improve physiological barriers created by PAD and IC.

Practical advice
The results from this study can easily be implicated into real world scenarios. It can provide health professionals with the information and resources on how to best treat patients that are showing signs of peripheral arterial disease and intermittent claudication. The clear evidence shown from the study in relation to strengthening physiological barriers through dynamic exercise training can give insight to individuals and allied health professionals on what to avoid and how to achieve the greatest results for themselves or their patients. I think that study warrants individuals to seek medical assistance if they are perceiving symptoms of PAD or IC so that it can be treated properly and with the highest level of safety precautions.

Further information/resources
Some other articles that may interest anyone trying to learn more on this topic include:

1. https://www.sciencedirect.com/science/article/pii/S0741521405800400

2. https://www.ahajournals.org/doi/abs/10.1161/01.CIR.81.2.602


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Exercise as it relates to Disease/Effects of physical activity and nutrition program on retirement villages

This is a critique of the research article: Jancey, J. Holt, A. Lee, A.Kerr,D. Robinson, S. Tang,L. Anderson, A.S. Hills, A.P. Howat,P. 2017. Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial. Int J Behav Nutr Phys Act 14, 92. https://doi.org/10.1186/s12966-017-0543-6.

The critique was written as an assignment in the unit; Health, Disease and Exercise at University of Canberra, August-September 2020.

What is the background to this research?
The ageing population in Australia is rising considerably. With an increasing life expectancy, it is expected there will be approximately four million people aged between 65-84 years by the year 2022 ,and by 2025 approximately 25% of the population will be 65 years and over. Retirement is a period of major adjustment; it comes with multiple opportunities for the older population to re-evaluate their lifestyles and adopt healthier behaviours. With approximately 50% of the aged Australian population not meeting the physical activity guidelines, it is a huge burden on the health sector in Australia. The lack of mobility and independence within a retirement village can increase the possibility of illness and joint pain. The purpose of this study was to interpret if a home-based intervention would improve the physical activity and nutritious behaviours of adults aged 60-80yrs in retirement villages across metropolitan Perth.

Where is the research from?
This study was undertaken in retirement villages within a 75-km radius of metropolitan Perth in Western Australia. The authors have an extensive history of working in the Health Department of the Curtin University in Western Australia. This study was conducted by Jonine Jancey and supervised by Andy Lee. Their research was approved by the Australia and New Zealand clinical trial register and funded by the Western Australia Health Promotion Foundation.

What did the research involve?
This study was a six-month individual physical activity and nutrition intervention, participants were chosen from 38 different retirement villages. The retirement villages were selected if they met the specific requirements of having over 30 independent living units and at least 50 residents aged between 60 and 80 years. These residents needed to be completing less then 150 minuets of moderate intensity physical activity per week. The residents were educated about the project via an onsite informative session, encouraged by the managers. The residents were also able to reply via a post card placed in their letterboxes which explained the program and provided the detail of researchers. Overall 363 participants registered for the study (intervention n= 197)(controlled n= 166).

Participants were then given the Physical Activity Readiness Questionnaire (PARQ) in which they completed at both baseline and post intervention. Participants also undertook anthropometric measurements (height, weight, BMI and body circumference) and a measurement of their blood pressure was taken. To assess the dietary intake of each participant they used the Fat Fibre Barometer questionnaire, this assessed the 20 food behaviours in relation to fat food and fibrous foods intakes.

During the 6 months the participants were to be supported through personal goal setting, monitoring and feedback on progress, and skill building via good participation. Program ambassadors were in charge of completing two face to face meetings, the residents were provided with information about the program and distributed program resources. This continued with follow up session via telephone calls personalised for each participant. The way the researches went about collecting information was quite well, they took into account the participants needs and made it as easy as possible for the participant to undergo the study. the researches made personal visits to each retirement village, enabling them to get maximum participation which increased the results. The authors could have provided more information on the specific exercises and dietary plans they set in place for the residents and not just said moderate physical intensity exercise. Due to the lack of funding and resources, the study was only a 6-month period trial, limiting the perspective of the accurate change that would occur in longer periods. They did take into account that over long periods there was a high chance that the participants would slip into old habits. The authors suggested that the self-selection bias of the participants choosing to take part was unable to be avoided, they also stated that it was maintained through the use of random controlled trial. As this study was self-reported, it raises questions as to whether biasness was a factor in results and increases under or over reported data. It is possible that the authors adjusted the results to suit the outcome they were hoping for or planned for.

What were the basic results?
Of the 363 residents that were involved in the study, only 280 remained for the post-test intervention (n=139) (controlled n=141), with some residents dropping out due to poor health, injury and family commitments. The results showed the intervention group had a significant increase in physical activity with an average of 80 minutes per week compared to the controlled group which had an 8-minute increase. The intervention group displayed a reduction in weight of 0.5kg from baseline to post program. Engagement in strength exercise increased from baseline of 23.7% (p=<0.001) to post intervention of 48.2% (p=0.693). The controlled group had approximately 2% increase in strength exercise engagement and had no weight change. There was an increased intake of fruit (p=0.007), fibre (p=0.006) and a decrease in fat scores (p=<0.001) for the intervention group. The controlled group displayed very little change within their fruit, fibre and fat intakes. From these results the authors of the study outlined that this intervention had been effective in improving body weight, engagement in strength exercises, increasing the level of moderate intensity physical activity and consumption of fruit. The authors believe if the residents maintained the exercise and dietary patterns over a longer period of time, the intervention could potentially contribute to the delayed onset of chronic disease, support an increased range of motion and independent living.

What conclusions can we take from this research?
Retirement village residents are prone to an inactive lifestyle, with limited to 50% of the aged population not meeting the suggested physical activity guidelines. Physical activity and correct dietary intake contribute to building muscle mass and increased weight loss through better metabolic rate. This intervention incorporated both these factors and saw to improve the weight and strength of the residents, enhancing overall wellbeing and increasing enjoyment in their later life. This study also aligns with several other research articles that have found physical activity to be the main contributor to a better retirement and longer living. With a fair number of residents dropping out of the study and the authors concerns about keeping up this lifestyle long term, a question is raised around the details and contents of the intervention plan given to the residents. Was it a plan that would show good results in the short term but was too intense for the residents to continue and incorporate it as a part of their life, even as they continue to age.

Practical advice
Increasing the resident’s individual knowledge and available access to appropriate services and facilities may increase their enjoyment in retirement. Recommendation for managers and retirement villages:

 * 1) Provide information sessions for residents on exercises and dietary information.
 * 2) Provide day trips for residents to have access to facilities such as pools, gyms and parks where they can participate in moderate physical exercise.
 * 3) Walking Challenge – create an incentive for the residents to get some exercise – Who can get the most steps up in a month- have prizes for all levels of fitness and participation.

Further Information

 * 1) World Health Organization
 * 2) Exercise for Seniors
 * 3) Live Life Get Active


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User:Ekc2000

My name is Emily and I am currently in my second year of Exercise Physiology and Rehabilitation

title: User:Ekc2000


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Talk:Exercise as it relates to Disease/Does balance training and high intensity resistance training benefit people with idiopathic Parkinson's disease?

What is the background to this research?
-	Idiopathic Parkinson’s Disease (IDP) is a common neurodegenerative illness which negatively affects the human brain, muscles and movement. The illness weakens the muscles and gradually immobilises functions of the body. This occurs due to the loss of dopamine neurons in the substantia nigra, which is involved in the regulation of movement. Although the cause of this disease is unknown, certain factors can increase risk of IDP. Symptoms and signs include having slow bodily movements, tremor, rigidity and postural instability. Due to these symptoms, people with IDP have a higher rate of falling and risk of injury.

-	The resistance training component of this intervention focuses on increasing strength of the knee extensors, knee flexors, and ankle plantar flexors, as these are the main muscles required in the maintenance of optimal stability.

-	The balance training component was measuring the individual’s stability under somatosensory sensory conditions and altering their vision.

-	This issue is still important for people with IDP as it continues to arise, and many people still do not understand the impact of IDP has on patients. Physical inactivity is common among elderly individuals, which can be quite detrimental as balance and strength can deteriorate in people with IDP. This is why incorporation any type of physical activity (PA) is beneficial in slowing down the process of this disease.

Where is the research from?
-	This study was completed by the Department of Physical Medicine and Rehabilitation at John Hopkins University Medical Centre in Baltimore, US.

-	The study was approved by the Human Subjects Committee of Florida State University in order for them to continue.

-	All the participant’s and their primary care physicians gave written and informed consent.

-	The study was conducted by four authors with varying expertise and accreditations, Mark A Hirsch, Tonya Poole, Charles G Maitland and Robert A Rider.

-	These four authors have previously worked on a study together related to parkinsonism.

What kind of research was this?
-	The study was a randomized control trial which took a period of 10 weeks in order to test the effects of balance training by itself or combined with high resistance training in improving balance and muscular strength in patients with IPD.

-	The 15 participants chosen for the study were all recruited from the Big Bend Parkinson’s Disease Support Group in Tallahassee.

-	These participants were only eligible if they had been diagnosed with IPD by their neurologist, and if they had not partaken in any other balance or resistance training activities prior to this study.

What did the research involve?
-	The study involved 15 patients, seven people performing balance training by itself and six people performing both balance and high resistance training.

- All participants begun by going through baseline testing, pre-test for balance on one day, and then another pre-test for muscular strength on another day.

- Balance was measured through a computerised dynamic posturography test, which analyses an individual’s balance control and determines the patient’s response to the different balance exercises given (Sensory Orientation Test [SOT]).

- Strength was measured by the amount of weight the patient could lift during a 4-repetition max test of knee extension, flexion and ankle plantarflexion. Participants continued to take their required medication throughout the study and begun their training two hours after they have consumed their morning dose.

What were the basic results?
-	Balance analysis included the summary balance score from the SOT, latency to fall and proportion of trials resulting in falls.

-	Strength analysis included the muscular strength of the knee extensors, knee flexors and ankle plantar flexors.

-	These were all measured at baseline, after the intervention was finished and four weeks after the study was finished. At baseline testing, characteristics between both groups did not differ significantly.

Important Findings:
 * 1) Balance training improved performance on the summary balance measure from the SOT. The combined group had a significantly higher mean compared to balance group. Effect was greater by the addition of resistance training.
 * 2) The intervention increased latency to falling and reduced the amount of trials resulting in falls, this effect continued for at least 4 weeks. Latency to fall was increased by 15% and percentage of trials resulting in falls had decreased by 20%, this result remained the same for 4 weeks post-treatment.
 * 3) Although the balance group’s main focus was not to increase strength, both groups had an increase in muscular strength post treatment, but the combined group had a significantly higher score. The combined group increased strength in those three components by 52% with the balance group having an increase by 9%. Overall, muscular strength was increased, and this effect also continued for at least 4 weeks post-treatment.
 * 4) The benefits of the intervention post-treatment had also continued for 4 weeks, even if the participants did not continue with their training.

What conclusions can we take from this research?
-	Currently, there is no cure in preventing this disease, but this study had proven that utilising both resistance and balance training is beneficial and can improve muscular strength and balance within an individual’s with IDP. As IDP impairs these features, incorporating the regular use of balance training by itself or with strength training can help to slow down the process.

-	All the points the intervention was targeting at had all resulted in positive outcomes with an increase in strength or an improvement in balance. Although, the intervention had been proven to be beneficial for people with IDP, the intervention could have been simplified for the target audience: elderly people.

-	Comparing this study to other research papers relating to Parkinson’s and PA, majority of the studies have shown that incorporating PA into one’s daily routine is extremely beneficial.

Practical advice
- Patients should seek medical advice from their doctor and take the recommended medication needed to treat IPD.

-	Any type of PA is useful for the patients as long as they are moving their body and using their motor skills. The main goal is to make sure they implement exercises that improve on balance or strength which can be done through keeping the exercises simple and entertaining. This can be done with partners or in a group, where if help is needed, it can be given.

-	To improve upon balance within people with IDP, balance exercise such as standing on one leg for a certain time limit is extremely beneficial.

-	To improve on muscular strength for adults with IDP, performing exercises focused on lower extremity is beneficial in increasing strength and maintaining optimal balance. Examples of body weight lower body exercises include squats, lunges or holding a wall sit.

-	Training sessions should last at least 15 - 30 mins.

-	Training should be performed on three non-consecutive days to decrease risk of injury.

Further information/resources
Further Readings:

- About Parkinson's Disease

- Postural Control in Elderly subjects with Balance training

- Strength Training in Parkinson's Disease

- Physical Activity for people with IPD

Support Groups for patients with PD:

- https://www.parkinson.org/

- https://www.parkinsonsnsw.org.au/services/support-groups/


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Exercise as it relates to Disease/The effect of acute physical activity on executive functions in children with ADHD

The following is a critique of the scientific report Acute physical activity enhances executive functions in children with ADHD, published in the Journal of Scientific Reports, 2018.

What is the background to this research?
|Attention Attention Deficit Hyperactivity Disorder(ADHD) is the most prevalent neurobehavioral disorder globally, with 7.2% children under 18 diagnosed. ADHD is characterised by symptoms of inattention, hyperactivity and impulsiveness. ADHD’s symptomology is also associated with executive function (higher-order cognitive function) deficiencies, which are responsible for self-regulation and behaviour.

ADHD can lead to serious individual problems including academic performance, poor social relationships, and lower occupational status. It also causes family stress and has serious economic implications.

Studies have found exercise interventions to have a positive effect on executive functions in healthy children, however, the research is limited and contradictory for children with ADHD.

The aim of this particular study was to investigate whether acute physical activity selectively affects three core executive functions (EF) – inhibition, switching and working memory – in children with ADHD.

Where is the research from?
The research was authored by Valentin Benzing, Mirko Schimidt and Dr. Yu-Kai Chang, who have published 11, 44 and 137 articles respectively, in relation to exercise psychology.

Benzing, a PhD fellow, is a researcher at the Institute of Sport Science (ISPW), University of Bern, Switzerland, where Schimidt is an assistant professor. Chang is a professor in the Department of Physical Education at National Taiwan Normal University, and VP of the Society for Sport and Exercise Psychology of Taiwan.

The research was funded by the Suzanne and Hans Biäsch Foundation for the Promotion of Applied Psychology.

The study was conducted in the canton of Bern, Switzerland, and the study protocol was approved by the cantonal ethics committee. All authors declared they had no competing interests.

What kind of research was this?
This research was conducted using a randomised controlled trail (RCT). RCT’s randomly assign participants into either an experimental group which receives the intervention being tested, or a control group which receives a placebo, standard or no intervention. RCT’s are therefore able to determine whether a cause-effect relationship exists between the intervention and outcome.

RCT’s are considered the gold standard of research designs. They have the highest quality of evidence. The randomisation of patients’ group selection eliminates selection bias and balances confounding factors between both groups.

In this study, information about patient assignment was concealed from participants and researchers (blinding) to further reduce bias. Participants were also blinded with regard to the study aims and conditions.

What did the research involve?
46 participants (ages 8-12), diagnosed with ADHD under the International Classification of Disease, were randomly split into two groups – 24 into the group (EG) and 22 into the control group (CG).

Each participant was assessed twice. The sessions followed the routines below:

Despite using an RCT, there were limitations with the design.

 * 1) Sample Size – The small sample size did not allow analysis of sub-groups – ADHD symptoms, social economic status, pubertal development status, etc.
 * 2) Sample Diversity – 82.6% of the sample population were boys, therefore there was insufficient statistical power to confirm the results are true for girls.
 * 3) Heart Rate Estimations – The study used the formula 208-(0.7 x age) which only provides a rough estimate of participants maximal heart rate and used that estimation to set heart rate cut-offs for exercise intensity.
 * 4) Medication – 79.2% of the EG and 77.3% of the CG were on medication so the effects of the acute exercise alone is inconclusive.
 * 5) Physical Activity Modality – The exergaming condition required non-automated movements making it cognitively challenging, therefore the EF results could be due to the physical activity or the cognitive activity or a combination.
 * 6) EF Assessment – The aim was to separately assess all three core EF’s however the modified flanker test was used to assess both inhibition and switching.

What were the basic results?
The results showed that the Exergaming Group displayed significantly shorter reaction times than the Control Group in post-tests for inhibition and switching, but no significant difference in accuracy scores or working memory.

Results Summary:

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The authors suggest that acute cognitively engaging exercise at moderate to vigorous intensity for 14-15 minutes enhances inhibition and switching reaction times. The authors proposed that the mechanism responsible for these improvements is neuroelectric adjustments.

The authors also believe the reason there was no improved accuracy was due to the increased catecholamine concentrations in the brain which might have different sensitivities for speed of processing and accuracy.

What conclusions can we take from this research?
This study provides evidence supporting that following cognitively challenging acute physical activity at moderate to vigorous intensity for 14 minutes, ADHD diagnosed children can see significant beneficial improvements in inhibition and switching reaction times, but not in accuracy or working memory performance.

The results for this study were consistent with findings from similar studies that found that acute moderate intensity exercise bouts led to increased inhibition reaction time and processes and no significant effect on working memory in ADHD children.

One contradictory study conducted by Piepmeier et al. found similar exercise to have no significant effect on switching. This suggests that the effect of exercise on inhibition is stronger than on switching, which is supported by this present study.

Therefore, although the authors claim that the evidence suggests that physical activity may have specific beneficial effects on ADHD children, further research investigating acute exercise and cognitive challenging games (without exercise) in isolation is required to determine which is the cause for these EF benefits.

Practical advice
Current literature and reports from parents, teachers and scholars suggests that single bouts of exercise at moderate to vigorous intensity produces the most optimal results.

Although the duration-exercise relationship is unknown, Chang et al. found short bouts of 20-minute exercise conditions to exhibit the greatest EF performance.

Exercise has also been shown to improve social, emotional, and motor development and behaviour as well as EF and cognitive performance in ADHD children.

In terms of frequency, the National Association for Sport and Physical Education states that short bouts of exercise should be incorporated during the school day (recess, lunch, P.E class).

Most ADHD diagnosed children consider conventional physical activity programs tiring and boring, so it is important to use complex activities that challenge their cognition as well as body. Exercise modalities such as exergaming, rock climbing, gymnastics, martial arts, mountain biking have all shown greater positive impacts and higher arousal ratings than autonomous exercises.

ADHD children should be pre-screened to ensure they are fit for acute bouts of exercise.

Further information/resources

 * https://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-in-children.htm
 * https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889#:~:text=The%20primary%20features%20of%20ADHD,they%20may%20continue%20into%20adulthood.
 * https://childmind.org/article/adhd-and-exercise/#:~:text=The%20notion%20that%20physical%20activity,as%20a%20treatment%20for%20ADHD.
 * https://adhd-institute.com/disease-management/non-pharmacological-therapy/exercise-and-diet/
 * https://www.cdc.gov/ncbddd/adhd/treatment.html#:~:text=For%20children%206%20years%20of,of%20the%20treatment%20as%20well.


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Exercise as it relates to Disease/Menstrual cycle disruptions in response to strenuous exercise training

This is a critique of the article titled "Evidence for a Causal Role of Low Energy Availability in the Induction of Menstrual Cycle Disturbances during Strenuous Exercise Training" by NANCY I. WILLIAMS*, DANA L. HELMREICH†, DAVID B. PARFITT†, ANNE CASTON-BALDERRAMA‡, AND JUDY L. CAMERON

What is the background to this research?
Throughout recent decades, women have become increasingly physically active. Despite the extensive health benefits of exercise and physical activity, intensive, strenuous exercise can subject female athletes to an entirely unique set of risks. Reproductive disfunction includes: and can be developed as a result of the participation of female athletes in strenuous exercise training. The mechanisms behind exercise induced reproductive dysfunction have been studied over previous decades. These studies have examined physical and psychological stress of exercise, as well as low body weight or fat, as potential causal factors.
 * oligomenorrhea (infrequent menstrual periods fewer than 6-8 per year)
 * amenorrhea (the cessation of menstrual periods)
 * and luteal phase defects (reduced secretion of progesterone/no response from endometrium to normal stimulation of progesterone)

Despite these factors contributing to exercise induced reproductive dysfunction, an accumulation of evidence from a variety of studies conducted on both humans and animals, suggests that negative energy balance is the leading cause. Negative energy expenditure refers to energy expenditure exceeding energy intake, which can result in the secretion reproductive hormones being suppressed and infertility after extended lengths of undernutrition.

The article under review takes into consideration previous studies that simply suggests a correlation between negative energy balance and reproductive dysfunction as opposed to firm evidence about the causal relationship. Considering this, the article analyses exercise-induced amenorrhea in non-human primates while having complete control over dietary intake and exercise. Testing to confirm if reproductive dysfunction was developed as a result of increased energy expenditure from daily vigorous exercise or from a different factor of exercise by determining exercise induced amenorrhea was reversed by increasing energy intake while completing the same exercise schedule.

Where is the research from?
Williams, Helmreich, Parfitt, Caston-Balderrama and Cameron conducted their research at the University of Pittsburgh, Pennsylvania and had their research published in The Journal of Clinical Endocrinology & Metabolism (JCEM).

The 8 cynomolgus monkeys used for the study were housed at the University of Pittsburgh Primate Research Laboratory.

Credibility here is maintained as editors at JCEM may not take part in the editorial management of any reports of their own research or or close relation to their own research

What kind of research was this?
Nancy I Williams, Dana L. Hemlreich, David B. Parfitt, Anne Caston-Balderrama and Judy L. Cameron conducted a longitudinal study over a 7-24month time period to examine the development and reversal of exercise induced amenorrhea, focussing on the role of low energy availability.

Longitudinal studies generally follow a particular population or individual over an extended period of time, generating data that has no external influence. They are useful for determining relationships between risk factors and disease development and treatment outcomes over time.

What did the research involve?
The research involved observing 8 non-human primates and their changes in reproductive hormones throughout the development of exercise induced amenorrhea. This was done by conducting two experiments. First, they tested energy utilisation during vigorous exercise resulted in reproductive hormone suppression by determining whether exercise induced amenorrhea was reversed by increasing energy intake. The second text examined the link between changes in the hormone T3 and reproductive function during the development and reversal of exercise induced amenorrhea.

Animals

 * Eight 2.10 kg - 3.45 kg adult female cynomolgus monkeys were used (housed at university of Pittsburgh Primate research Laboratory)
 * Temperature in lab remained at 24 degrees +/- 2 degrees.
 * All monkeys received the same daily meal of approximately 300kcal at 1600h each day.
 * " All experiments were performed in compliance with the regulations of the animal care and use committee of the University of Pittsburgh "

Blood Sampling Procedures

 * Blood samples for LH, FSH, E2 and progesterone measurements were collected from the animals every other day, before exercise and feeding.
 * Hematocrit was measured every 6wks and remained within normal range in all monkeys for the duration of the study.

Monitoring Reproductive Function

 * Prior to commencement of study, the monkeys were familiarised with daily checks for menses which consisted of swabbing the vaginal area.
 * Before the study commenced, several normal menstrual cycles were documented.
 * A monkey was determined to be amenorrheic if at least 3 menstrual cycles were missed with low levels of E2 and progesterone.

Exercise Training

 * Monkeys were trained on standard treadmills.
 * When fully trained, they ran for 2hr/day, 7days/week with a 3 min break every 30 minutes.

Experimental Designs

 * Overfeeding face to reverse exercise induced amenorrhea
 * test hypothesis that exercise induced amenorrhea was caused by increased energy utilisation
 * an extra ~400kcal was provided to 4 monkeys that had experienced exercise induced amenorrhea for at least 3 menstrual cycles while implementing the same exercise schedule.
 * Measurement of T3
 * blood samples were taken to measure whether changes in reproductive function was linked to energy availability

It is unclear whether or not this methodology was the best approach as study was conducted in a small scale using non-human test subjects. They did, however, use an approach that measured variables in both the development and reversal of exercise induced amenorrhea to test their hypothesis and determine the primary cause.

What were the basic results?
The study found the following key results:
 * overfeeding led to a significant increase in energy intake (58%)
 * Mean body weight increased during overfeeding period (6%)
 * LH, FSH and E2 levels increase from late amenorrhea to surge
 * significant negative correlation (r = -0.98; P < 0.024) between the calories consumed during the overfeeding period and the number of days until the LH surge
 * no significant changes in body weight over development of amenorrhea
 * LH and FSH decreased over development of amenorrhea
 * During period of amenorrhea T3 levels decreased by ~20%
 * During reversal period all 4 overfed monkeys had increased T3 levels

What conclusions can we take from this research?
This study provides strong evidence that exercise induced amenorrhea is caused by a negative energy balance created by the increased energy expenditure of a regular, vigorous exercise schedule and low energy availability.

Spontaneous resumption of menstrual cycles in animals with exercise induced amenorrhea has not been witnessed in previous studies. It can be concluded that the primary cause of exercise induced reproductive dysfunction is energy cost in relation to exercise rather than physical or psychological stresses. This is because if any other factors had a significant role in the development of amenorrhea, caloric increase alone would not be enough to reverse the state of amenorrhea.

T3 levels decreased during the amenorrheic stage and dramatically increased during the overfeeding phase of the experiment and the reinstating of normal menstrual cycles.

The researchers have expanded on the findings of previous studies by including the extra experimental approach relating to the reversal of amenorrhea and how it can be achieved by increasing caloric intake.

More research into the involvement of T3 in changes in energy expenditure and the impact of metabolic efficiency on exercise induced reproductive dysfunction is needed for a greater understanding of the role that each has in mediating thefunction of the reproductive axis.

Practical advice
With the increasing number of women participating in exercise and physical activity, if is becoming continually more important that women are aware of the potential risks associated with constant, vigorous exercise and a negative energy balance.

Exercise induced reproductive dysfunction can have long term effects if left untreated, so it is important that the athlete, coach and nutritionist are working together for prevention/treatment. This will include monitoring susceptible athletes and encouraging them to keep a diary so they are aware of any irregular cycles and providing information about energy balance.

Further information/resources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435916/
 * The Female Athlete Triad

https://www.researchgate.net/publication/257814328_Effects_of_physical_exercise_on_the_female_reproductive_system
 * The Effects of Physical Exercise on the Female Reproductive System

file:///Users/emilycameron/Downloads/[14796805%20-%20Journal%20of%20Endocrinology]%20The%20effects%20of%20intense%20exercise%20on%20the%20female%20reproductive%20system.pdf
 * The Effects of Intense Exercise on the Female Reproductive System


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Exercise as it relates to Disease/Interventions to improve cardiovascular health in primary school children

This is the critique of the journal article: Harrell, J. S. et al., 1999. A Public Health vs a Risk-Based Intervention to Improve Cardiovascular Health in Elementary School Children: The Cardiovascular Health in Children Study. American Journal of Public Health, 89(10), pp. 1529-1535.