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Exercise as it relates to Disease/The effect of high-intensity intermittent exercise on body composition of overweight young males

This Wikibook page presents a critical appraisal of the research article: The Effect of High-Intensity Intermittent Exercise on Body Composition of Overweight Young Males

What is the background of this research?
Obesity and overweight are medical conditions in which excess body fat accumulates to the extent that affects health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. Since obesity is associated with many health issues, effective fat loss strategies are needed. Aerobic exercise programs have been shown to improve cardiorespiratory fitness and maintain lean body mass. Most aerobic exercise interventions consist of stationary, moderate-intensity exercise lasting about 30 to 40 minutes, 3 to 4 days a week, for 4 to 6 months. Disappointingly, these types of training programs result in minimal fat loss.

Therefore, high-intensity intermittent exercise (HIIE) or other forms, such as High-intensity interval training (HIIT) has been shown to improve fat loss in all age groups. According to the research, there are two groups that have done exercises, one following a 20-minute HIIE program, which consisted of an 8 seconds sprint followed by 12 seconds of low-intensity cycling, and the other group carrying out an aerobic cycling protocol for 40 min each session. Results have shown a 0.5 kg increase in fat-free mass (FFM) after HIIE exercise. However, the results of the aerobic cycling protocol were changeless. Hence, this study focus on HIIE intervention on the total body, abdominal, trunk, and fat-free mass of overweight young males.

Where is the research from?
This research is organized in 2012 at the University of New South Wales in Sydney Australia. Specifically, all the authors have track-record in health and medicine. Mohammad Heydari was worked for School of Medical Sciences in University of New South Wales, and Dr. Judith Freund was worked in St Vincent's Hospital, Darlinghurs, Sydney , who major in bone densitometry.

What kind of research was this?
The study method was a randomized controlled parallel-group study (n=25), and the control group (n=21). Both groups were similar in terms of age (24.7 ± 4.8 and 25.1 ± 3.9 years) and body mass index (BMI: 28.4 ± 0.5 and 29 ± 0.9 kg m−2). Specifically, all participants were recruited from the UNSW university population and randomly allocated to either exercise.

The research hypothesis was '''"that HIIE would result in significant reductions in the total abdominal, trunk, and visceral fat and a significant increase in fat-free mass and aerobic power." '''

Strength

Randomization helps to minimize bias in studies by providing a fair and accurate way to investigate relationships between interventions and outcomes. Additionally, the Procedures of this research. Subjects were advised to avoid strenuous activity and caffeine consumption for 24 hours prior to testing and to enter the laboratory after a 10-hour fast. Testing for all subjects in the control and exercise groups was done at the same time of day. Moreover, subjects were asked to fill out The Physical Activity Readiness Questionnaire, the questionnaire is to identify whether the subjects have a higher risk for a disease. Specifically, subjects used TrueMax 2400 Metabolic Cart and Monark 869, an electronically braked cycle ergometer to assess aerobic power and V˙O2max.

What did the research involve?
This research aimed to examine the effects of 20 minutes of HIIE, repeated three times a week for 12 weeks, on the body composition of overweight males. To make the research results valid, procedures are required, it delivers a systematic and scientific, and orderly work plan to complete the research. All procedures included resting metabolic rate (RMR), diet, body composition, work output, and assays. Subjects in the exercise group performed continuously monitored exercises (8-second sprint, 12-second recovery) during each 20-minute session. The HIIE workload was set at 80-90% of each subject's maximum heart rate (HR), with a cadence between 120 and 130 rpm, and recovery was set at the same resistance, but with a cadence of 40 rpm. Instruct subjects to maintain exercise intensity at the level required to achieve between 80% and 90% of peak HR.

It is important to know that the research statistical analysis was considered significant while the probability level less than 0.05.

What were the basic results?
Furthermore, the research pointed out that HIIE have taken place within the first month as reduction in waist circumference was significantly correlated.

What conclusions can we take from this research?
In conclusion, 20 minutes of HIIE, exercised three times per week for 3 months, resulted in increased in fat-free mass of overweight adolescent. The main findings of this study was that HIIE significantly increased V˙O2peak and significantly decreased total fat, abdominal fat, trunk fat, and visceral fat in young obese men. Additionally, lean torso and leg mass increased significantly after HIIE. Moreover, HIIE resulting in enhanced aerobic fitness and developing in cardiorespiratory fitness is an important factor to counter obesity or other heart disease.

Practical advice
HIIE exercise is more suitable than normal seated exercise, such as jogging and cycling to lower trunk fat and overall bodyweight. Because this HIIE program requires the least amount of time, it affects population's adherence to the exercise intervention. Therefore, a physical activity regimen that requires minimal effort while providing adequate reduction of subcutaneous and visceral fat may be optimal. HIIE exercise appeared to fail into this category, as the total exercise commitment was 60 minutes per week. Therefore, patient are needed and no shortcut

Further information/resources
https://doi.org/10.3389/fpsyg.2020.01291

https://doi.org/10.1016/j.physbeh.2018.07.018


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Exercise as it relates to Disease/Effects of a supervised exercise intervention on recovery for breast cancer survivors

This Wikibook page presents a critical appraisal on a research article “Effects of a Supervised Exercise Intervention on Recovery From Treatment Regimens in Breast Cancer Survivors” published by Hsieh, Sprod, Hydock, Carter, Hayward, and Schneider in 2008. This is written as an assignment for the unit Health Disease and Exercise, at the University of Canberra in 2022.

1.What is the background to this research?
Breast cancer has become the most prevalent type of cancer in the world; according to WHO (2021), in the year 2020, the number of female diagnosed with breast cancer can reaches 2.3 million, and the number of breast cancer survivors in the past five years can be 7.8 million. In Australia, breast cancer posted the second most prevalent cancer in 2018, and will be very likely to remain its position in 2022. The most commonly treatments for breast cancer patients include surgery, radiation therapy, chemotherapy, along with anti-cancer medicines.

Noticeable that a number of negative symptoms are reported by patients receiving these treatments: fatigue, pain, weaken exercise tolerance, affected cardiovascular and muscular systems, , hence their physical activity level would decrease accordingly. On the other hand, a number of studies, support that the patients’ physical activity levels are related to their quality of life: breast cancer patients with higher physical activity level are more likely to have better health-related quality of life (HRQOL), and relatively lesser fatigue and pain.

An interesting interaction is observed here: the negative impacts of breast cancer treatments make patients suffer or even lower their function of body, but still they have to engage in certain level of physical activity to mitigate these comfortableness.

Hence, this study looks in efforts of exercise interventions on breast cancer survivors’ cardiopulmonary function and fatigue under different types of treatment.

2.Where is the research from?
The study took place in Rocky Mountain Cancer Rehabilitation Institute (RMCRI) in Colorado, America. Participants were chosen from the breast cancer survivors referred to RMCRI for rehabilitative exercise straightway after their cancer treatments. The informed consent was obtained prior to participating.

The authors were the specialists from Rocky Mountain Cancer Rehabilitation Institute (RMCRI) and the School of Sport and Exercise Science at the University of Northern Colorado, American, along with a scholar from the Department of Physical Education at the National HsinChu University of Education, Taiwan.

This research article was published on the journal Oncology Nursing Forum in 2008.

3.What kind of research was this?
The researchers assessed these participants’ functions thoroughly both before and after the six-month exercise intervention.

This research design is “pretest and post-test quasi-experimental”.

4.What did the research involve?
A total of 96 participants aged 57.9 ± 10.4 years were involved, of which were all female. Based on the type of clinical treatments received, they were divided into 4 groups: surgery alone (n = 22), surgery and chemotherapy (n = 30), surgery and radiation (n = 17), and surgery, chemotherapy, and radiation (n = 27). Noticeable that all of them received surgery.

A group of certified cancer exercise specialists collected the data with a focus on patients’ cardiovascular endurance, pulmonary function, and fatigue were evaluated. Namely, their following data were collected:

 * systolic and diastolic blood pressure
 * resting heart rate
 * forced vital capacity (FVC)
 * forced expiratory volume (FEV1)
 * predicted oxygen consumption (predicted VO2max)
 * time on treadmill
 * fatigue scale (Piper Fatigue Scale)

Exercise prescription and intervention were designed individually by certified cancer exercise specialists. There were individually y supervised exercise sessions for participants 2-3 times per week and for 6 months. Each session’s length was 60 minutes, composed of:

 * 1) a 10-minute warm-up
 * 2) 40-minute aerobic exercise, resistance training and stretching
 * 3) ended with a 10- minute cool down

The intensity was 40-75% of each one’s heart rate. Before every following sessions, participants’ feedbacks and feelings of last exercise session were obtained by the cancer exercise specialists, in order to meet each individual’s circumstance.

5.What were the basic results?
After the 6-month exercise intervention, participants’ significant improvements in cardiopulmonary function were observed in all groups (p < 0.05), without significant differences among the 4 groups. More specificity, their predicted VO2max and time on treadmill had been improved. Moreover, group 4 (the surgery, chemotherapy, and radiation group) showed reductions in resting heart rate along with concurrent increases on FVC %pred. In terms of fatigue scale, the scores reduced significantly in all groups.

6.What conclusions can we take from this research?
This study showed that exercise interventions can improve breast cancer survivors’ cardiopulmonary function, and reduce fatigue score. And this finding is in line with previous studies. Most importantly, this study is the first to compare exercise intervention’s effort on patients who had different cancer treatment type.

The most positive part of this study is, the participants' adherence to follow the exercise prescriptions was pretty high- around 90%. The authors supposed that’s because every participant received a personalized exercise prescriptions, individual supervised exercise sessions, and most importantly, their feedbacks and feelings were obtained before next exercise start by cancer exercise specialists.

Of no doubt, the results were outstanding. The critical appraisal part of the article is, how many ordinary cancer patients in the world are luckily enough to reach these kind of luxury services: personalized exercise prescriptions, individual supervised exercise sessions services, and by cancer exercise specialists?

7.Practical advice
The main take home messages are:

 * Cancer’s treatments can affect a person’s normal body functions negatively while working on tumors.
 * A great number of studies    have shown that certain physical activity level can help cancer patients reduce these negative symptoms effectively. The authors of this study suggested moderate intensity, personalized, prescriptive exercise sessions.
 * The health workers should raise awareness of the efforts of exercise on cancer patients, and so on other chronic disease suffers. Recommendations, referrals should be given. According to this study, the excellent works of exercise specialists have been seen.

8.Further information/resources
For further information concerning the breast cancer and exercise, see the links below.
 * Exercise During Cancer Treatment. https://www.cancer.net/survivorship/healthy-living/exercise-during-cancer-treatment
 * World Health Organization.(2021). Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer
 * Cancer Australia. (2022). Breast cancer in Australia statistics. https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics
 * Rocky Mountain Cancer Rehabilitation Institute (RMCRI), Colorado, America. https://www.rockymountaincancercenters.com/

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


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Exercise as it relates to Disease/Association of physical activity levels and the prevalence of COVID-19 associated hospitalization

The following critique article is from the research article “ Association of physical activity levels and the prevalence of COVID-19 – associated hospitalisation” by Francis Ribeiro de Souza, Daisy Motta-Santos, Douglas dos Santos Soares, Juliana Beust de Lima, Gustavo Goncalves Cardozo, Luciano Santos Pinto Guimaraes, Carlos Eduardo Negrao, Marcelo Rodrigues dos Santos.

What is the Background to this research?
Recently, the world is facing an unprecedented pandemic, the new serve acute respiratory syndrome coronavirus (SARS-CoV-2). As the virus spread around the world quickly, it strongly impacted the general population’s daily activities, the prevalence of hospitalization and the burden on public health in Brazil. Till April 2021, there are over 378000 deaths caused by COVID-19 in Brazil. The WHO & government have already promoted and published distinct rules to minimize the spread of the virus, such as self-isolation, social distancing, wearing masks, etc. They are all potential strategies for preventing the disease. Nevertheless, to improve and strengthen the immune system response, exercise training could be an auxiliary tool and strategy against infection. Specifically, it is significant to reduce the number of hospitalizations and advocate faster recovery for the infected patients. This study aimed to assess the link between physical activity and the prevalence of COVID-19 related to hospitalization.

Where is the research from?
This original research being critiques was published in the journal of Science and Medicine in Sport (JSAMS). The journal is an official journal of Sports Medication Australia (SMA) where covers worldwide aspects of sports science and medicine. Also, it encompassed the publication original research and review papers in relation to the sports science field and public health. With a total of eight authors contributed to this research article whom from Brazil and all of them have their particular professionals in the sports and medicine field. The author’s team declared that there is no conflict of interest.

What kind of research was this?
This study was a cross-sectional and observational study followed by the STROBE statement checklist. The cross-sectional often used to measure the prevalence of disease, comprehend the determinants of health and attributes of a population. In particular, it was registered on ClincialTrails.gov and acknowledged by the local Human Subject Protection Committee in the Hospital das Clinicas da Faculadade de Medicina da Universida de de Sao Paulo in Brazil. To ensure participants are willing to engage and valid studies, online written informed consent is provided. Therefore, it allows the team to assess and compare different variables from the population of COVID-19 survivors in Brazil.

What did the research involved?
In this research article, it invited the patient who survived and fully recovered from the SARS-CoV-2 between March and August 2020 in Brazil. During this time period, they designed and conducted online questionnaire for their target population via social media, newscasts, hospitals, medical care providers and disease control centres across the country.

Prior to commencing the first analysis, written consent was obtained and collected with a total of 1597 completed questionnaires. Upon on that, it included the short version of the International Physical Activity Questionnaire. The study separated into two different parts of analysis: After collecting all the qualitative data, there are some sample calculations and tools included for the final analysis.

 * G*Power software
 * SPSSv.25 software
 * Chi-square test
 * Winpepi v.11.65 software
 * Poisson regression model (prevalence ratio)

The methodology was an accessible that well utilising the internet service and collect data from a big population (research target). Also, it reduced the face to face interview time which is quite valid, faster and cheaper approach to accomplish the analysis. Hence, it facilitated the team to interpret the relationship between PA levels and hospitalisation prevalence.

What were the basic result?
In the result, 938 participants were selected for the final analysis, but there are only 91 were admitted to the hospital due to COVID-19. To identify the higher prevalence of hospitalization, they mainly relied on four main variables including gender, age, BMI, pre-existing disease and medication.The following tables demonstrated the result of sufficient PA having a  LOWER  prevalence ratio (PR):

What conclusions can we take from this research?
In conclusion, the authors found sufficient physical activity (PA) is significant that it could demonstrate a lower prevalence of COVID-19-related hospitalization. In general, WHO recommended individuals should be doing more exercise, as PA has crucial benefits to our hearts, minds and bodies. Also, it improves our overall health and well-being. Individuals who do little or no PA are easy to suffer or diagnose with severe COVID-19, compare with those who are physically active. Within the same year, similar findings can also be found in a study, increasing the PA levels and maintaining a healthy lifestyle could reduce the severity of COVID-19 disease. Although it is not directly related to the hospitalization prevalence, it demonstrated adequate PA benefits to the individuals’ health and well-being, especially to the global disease COVID-19. Overall, governments should encourage and promote more physical exercise to the population, so that it could prevent complications from COVID-19 and burden on the public health system.

Practical Advice
The study did not provide a complete exercise plan for people to follow, but it mentioned at least 150 min per week of moderate-intensity or 75 min a week of vigorous-intensity as a recommendation. For people who are physically inactive/ sedentary, it is quite challenging and struggling with moderate intensity of exercise. Hence, they have to foster an interest in exercise. Home-based exercise intervention will be the best option, such as yoga workouts which could easily find on the internet, individuals could follow the instructions at home. It benefits for them to stretch their body and avoids injuries after being inactive for a long time. Resistance training and HIIT are also encouraged for the populations to engage, as they could facilitate with better immune system and strength the cardiorespiratory fitness level. However, it is strongly recommended individuals to select an accredited gym coach as the instructor. Apart from the exercise practical advice, it is significant to adhere the COVID-19 rules and restrictions, maintain good respiratory hygiene, so that it could minimize the risk of having COVID-19.

Further Information
Readings:
 * 1) Relationship between physical activity, healthy lifestyle and COVID-19 disease severity; a cross-sectional study
 * 2) Influence of Baseline Physical Activity as a Modifying Factor on COVID-19 Mortality: A Single-Center, Retrospective Study
 * 3) Fidelity, tolerability and safety of acute high-intensity interval training after hospitalisation for COVID-19: a randomised cross-over trial

 * https://www.who.int/health-topics/coronavirus#tab=tab_1 (Details of COVID -19 from WHO)


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Pokémon/Pokédex/Quaxly

Description
A ducklike Pokémon.

How to Evolve
Quaxly evolves into Quaxwell.

Name
The name of Quaxly references the word "Quack", an English Onomatopoeia that represents a sound that ducks make.

title: Pokémon/Pokédex/Quaxly


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21 Expected Difficult Questions With Simple Answers/Sexuality

Some of the questions might be really disturbing, But that's the purpose of this book to collect and answer those difficult and tricky questions. Currently, this page contains questions related to the LGBTIQ+ community only but we intend to add more questions to cover the maximum of the sexual behaviors and identities.

Why do members of Hijda community prefer begging over paid work?
--> The Hijda community from the Asian continent is a culturally recognized community of the local population. Culturally, they participate in Hindu and Muslim rituals like the birth of a child and marriage. Members of the community come to bless and also identify the sex of the newborn. Similarly, they also bless the newlywed couple and sing songs to praise the local deity and celebrate the auspicious moment. The Hijda community was also assumed to be in possession of supernatural powers to bless and curse, an ability achieved through their sacrifice of manhood and worship of various goddesses. In return for their services, hijda community members were paid hefty amounts. But such big events don't really come every day. So, to fulfill their everyday needs, they beg. As only who were forbidden from possessing any assets including land were earning their livelihood by begging. So sages, priests, and hijdas who were worshippers too made living by begging. And in ancient India begging was a holy way of earning a living. With changing times and newly accepted victorian morality in the last couple of centuries we lost the prestige. But with the increased taboo on hijda community, they were forced to do only and only begging. Now there are many hijdas who are well educated and well trained in many trades and are struggling to fetch jobs in their respected fields.

Do lesbian, gay, bisexual and transgender people spread diseases like HIV (Aids)?
--> Sexually transmitted diseases (STDs) and HIV (an infection, which can progress to the desease Aids if untreared) spread through unsafe sexual practices (e.g. "unprotected" sex). While rates of HIV are disproportionately higher among members of the LGBTQ+ community, HIV is by no means confined to LGBTQ+ people. Anyone, regardless of sexual orientation, gender identity, gender expression or other factors - can acquire HIV. The "super spreader" in the case of HIV are factors like the use of unsafe sexual practices, unequal access to healthcare (further due to geographic location or economic status) and discrimination. Dealing with the potential consequences of bias and discrimination in life – job loss, homelessness, lack of healthcare insurance – often results in LGBTQ+ people engaging in behaviors that facilitate the spread of HIV.

The good news is that due to the burden of advocacy and other awareness works done around these issues, many people, especially LGBTQ+ are more and more into safe sexual practices. The yearly number of new infections and deaths world wide, due to HIV has fallen non-stop since the late 1990s.

No matter what you say about it, talking about all this is obscene and not so good
-> Talking about sexuality, sexual acts, sexual orientation, sexual desires, and sexual health is necessary to live a healthy and peaceful life. Talking about sexuality also makes us aware of issues of sexual health, and reproductive health.

As IPC377 was repealed in India, so can gays get married to each other?
-> IPC377 was about the criminalization of gay sex. Before two men could not engage in anal/oral sex. But now they can do it, given the condition that they are consenting adults and they are doing it in private.

Gay lesbians can not produce children so they are unnatural
->

Gays and Lesbians achieve sexual pleasure through unnatural ways
--> Anal/oral sex are the ways in which they satisfy themselves if they want to do penetrative sex at all. Otherwise, most and even many heterosexuals seek pleasure through non-penetrative sexual acts. Our view of penetrative that too peno-vaginal sex is a normal and natural way to seek sexual pleasure is wrong. Not all of them heterosexuals prefer it. So if some homosexual couples choose to go for anal/oral sex, there is absolutely nothing wrong with it.

Gay, lesbian and Queer its all western influences, We Indians do not have such weird things
--> Yes these words are definitely English and came from the west, but such identities always existed in all the non-western parts of the world. In India, we have a long history of all sorts of queer individuals playing important roles in all walks of life. Shikhandi, Arjuni, Ayyappa are a few examples of this.

What is gay? Why all of them are so feminine/girlish?
-> Not all but many homosexual men identify themselves as gay and in old English lesbian women were called gay women. Most of them are not feminine/girlish in fact very few are. Sexual orientation has very little to do with their gender expression.

What is hijda? why they are so loud
--> Most of the transgenders and especially from the non-western world, transgender communities existed for ages. And currently, they are forced to be in closets in their own worlds so that they won't pollute

Are 'gay', 'Hijda' and 'transgender' the same thing?
-> Usually, homosexual men who have access to modern English vocabulary and western culture tend to identify themselves as gay. While homosexual woman used to be refered to as gay woman, the term lesbian is more common today. Those who identify with the opposite gender than they were assigned at birth are transgender (or short trans). Lastly, hijdas are intersex, eunuch, but mostly transgender people and have access to the local hijda culture and identify themselves as hijda.

Why are all gays feminine and all lesbians manly?
--> It's a myth that gays are feminine and all lesbians manly. Sexual orientation has nothing to do with the kind of gender expression one might have. feminine males may or may not be gay, similarly, lesbians may or may not be masculine in their gender expression. We need to understand that being overtly manly or feminine has nothing to do with their sexual orientations. But which gender they prefer for their intimate desires decides what is their sexual orientation.

What genitals do Hijdas have?
-> Hijda/Male-to-female transgenders may have anything in between their legs. that doesn't define them as transgenders but identifying themselves as transgender does. So gender identity is something self define. No other person has any right to define or force any gender identity on any person. So even in the case of intersex persons, it is advocated that the person born with ambiguous genitals should not be operated on until they are adults and they give consent to the surgeries.

Why all the transgender/Hijdas are so loud in their behavior and expressions?
-> Not many hijdas are loud by themselves. There are many hijdas who are working as professionals and being business owners, receptionists, and security guards they have already reached dignified positions so their voice is heard and they can keep social civility in their behavior. But many are not that fortunate Hijda community, and transgenders, in general, are kept unheard for long. until they start loud, there is less chance that they will be noticed at all. So to be able to start the communication they need to be loud.

What is rape? Can men be raped?
--> As per definition, rape is sexual act forced upon someone against their will. Historically, rape was defined as, a crime committed solely against females. Still, primarily committed by males against females, rape of males is now commonly criminalized and has been subject to more discussion than in the past.


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Statistics/Preliminaries

This chapter discusses some preliminary knowledge (related to statistics) for the following chapters in the advanced part.

Empirical distribution
Since all these $$n$$ random variables follow the same cdf as $$X$$, we may expect their distribution should be somewhat similar to the distribution of $$X$$, and indeed, this is true. Before showing how this is true, we need to define "the distribution of these $$n$$ random variables" more precisely, as follows:

We have mentioned how we can approximate the cdf, and now we would like to estimate the /. Let us first discuss how to estimate the pmf.

For the discrete random variable $$X$$, from the empirical cdf, we know that each $$X_1,\dotsc,X_n$$ is "assigned" with the probability $$1/n$$. Also, considering the previous example, the empirical pmf is $$f_n(x)=\frac{\sum_{k=1}^{n}\mathbf 1\{X_k=x\}}{n}$$.

To discuss the estimation of pdf of continuous random variable, we need to define first.

For the continuous random variable $$X$$, construct class intervals for $$X$$ which are a non-overlapped partition of the interval $$[X_{\text{min}},X_{\text{max}}]$$, in which $$X_{\text{min}}$$ and $$X_{\text{max}}$$ are the minimum and maximum values in the sample. Then, the pdf $$f(x)\approx\frac{F(c_j)-F(c_{j-1})}{c_j-c_{j-1}},\quad x\in(c_{j-1},c_j]\text{ and }j=1,2,\dotsc,i,$$ when $$c_{j-1}$$ and $$c_j$$ are close, i.e. the length of each class interval is small. (Although the union of the above class intervals is $$(c_0,c_i]$$ and thus the value $$c_0$$ is not included in the interval, it does not matter since the value of the pdf at $$c_0$$ does not affect the calculation of probability.) Here, $$c_0$$ is $$X_\text{min}$$ and $$c_i$$ is $$X_\text{max}$$.

Since $$F(c_j)-F(c_{j-1})=\mathbb P(X\in(c_{j-1},c_j])\approx{\color{darkgreen}\frac{\sum_{k=1}^{n}\mathbf 1\{X_k\in(c_{j-1},c_j]\}}{n}}$$ is the relative frequency of occurrences of the event $$\{X_k\in (c_{j-1},c_j]\}$$, we can rewrite the above expression as $$f(x)\approx h_n(x)=\frac{{\color{darkgreen}n}(c_j-c_{j-1})},\quad x\in(c_{j-1},c_j]\text{ and }j=1,2,\dotsc,i$$ in which $$h_n(x)$$ is called the.

Since there are many possible ways to construct the class intervals, the value of $$h_n(x)$$ can differ even with the same $$n$$ and $$x$$. When $$n$$ is and the length of each class interval is, we will expect $$h_n(x)$$ to be a good estimate of $$f(x)$$ (the theoretical pdf).

There are some properties related to the relative frequency histogram, as follows:

Expectation
In this section, we will discuss some results about expectation, which involve some sort of inequalities. Let $$a$$ and $$b$$ be constants. Also, let $$\Omega$$ be the sample space of $$X$$.

Convergence
Before discussing convergence, we will define some terms that will be used later.

In a, say $$x_1,\dotsc,x_n$$, we observe values of their sample mean, $$\overline x=\frac{\sum_{i=1}^{n}x_i}{n}$$, and sample variance, $$s^2=\frac{\sum_{i=1}^{n}(x_i-\overline x)^2}{n}$$. , each of the values is only realization of the respective random variables $$\overline X$$ and $$S^2$$. We should notice the difference between these definite values (not random variables) and the statistics (random variables).

To explain the definitions of the sample mean $$\overline X$$ and sample variance $$S^2$$ more intuitively, consider the following.

Recall that the empirical cdf $$F_n(x)$$ assigns probability $$\frac{1}{n}$$ to each of the random sample $$X_1,\dotsc,X_n$$. Thus, by the definition of mean and variance, the of a random variable, say $$Y$$, with this cdf $$F_n(x)$$ (and hence with the corresponding pmf $$f_n(x)$$) is $$\sum_{i=1}^{n}\left(X_i\cdot\frac{1}{n}\right)=\overline X$$. Similarly, the of $$Y$$ is $$\sum_{i=1}^{n}\left((X_i-\overline X)^2\cdot\frac{1}{n}\right)=S^2$$. In other words, the and  of the empirical distribution, which corresponds to the, is the  $$\overline X$$ and the  $$S^2$$ respectively, which is quite natural, right?

Also, recall that the empirical cdf $$F_n(x)$$ can well approximate the cdf of $$X$$, $$F(x)$$ when $$n$$ is large. Since $$\overline X$$ and $$S^2$$ are the mean and variance of a random variable with cdf $$F_n(x)$$ it is natural to expect that $$\overline X$$ and $$S^2$$ can well approximate the mean and variance of $$X$$.

Convergence in probability
The following theorem, namely, is an important theorem which is related to convergence in probability.

There are also some properties of convergence in probability that help us to determine a complex expression converges to what thing.

Convergence in distribution
A very important theorem in statistics which is related to convergence in distribution is.

There are some properties of convergence in distribution, but they are a bit different from the properties of convergence in probability. These properties are given by, and also continuous mapping theorem.

Resampling
By, we mean creating new samples based on an existing sample. Now, let us consider the following for a general overview of the procedure of resampling.

Suppose $$X_1,\dotsc,X_n$$ is a from a distribution of a random variable $$X$$ with cdf, $$F(x)$$. Let $$x_1,\dotsc,x_n$$ be a corresponding of the random sample $$X_1,\dotsc,X_n$$. Based on this realization, we have also a of the empirical cdf: $$\frac{1}{n}\sum_{k=1}^{n}\mathbf 1\{x_k\le x\}$$ . Since this is a realization of the empirical cdf, by Glivenko-Cantelli theorem, it is a good estimate of the cdf $$F(x)$$ when $$n$$ is large. In other words, if we denote the random variable with the same pdf as that of the empirical cdf by $$X^*$$, $$X^*$$ and $$X$$ have similar distributions when $$n$$ is large.

Notice that a realization of empirical cdf is a cdf (since the support $$x_1,\dotsc,x_n$$ is countable). We now draw a (called the bootstrap (or resampling) random sample) with sample size $$B$$ (called the ) $$X_1^*,\dotsc,X_B^*$$ from the distribution of a random variable $$X^*$$ ($$X^*$$ comes from from $$X$$, so the behaviour of sampling from $$X^*$$ is called ).

Then, the relative frequency historgram of $$X_1^*,\dotsc,X_B^*$$ should be close to that of the corresponding of the empirical pmf of $$X^*$$ (found from the realization of the empirical cdf of $$X^*$$), which is close to pdf $$f(x)$$ of $$X$$. This means the relative frequency historgram of $$X_1^*,\dotsc,X_B^*$$ is close to the pdf $$f(x)$$ of $$X$$.

In particular, since the cdf of $$X^*$$, $$F_n(x)$$, assigns probability $$1/n$$ to each of $$X^*_1,\dotsc,X^*_B$$ , the pmf of $$X^*$$ is $$\mathbb P(X^*=x_i)=\frac{1}{n},\quad i=1,2,\dotsc,n$$. Notice that this pmf is quite simple, and therefore it can make the related calculation about it simpler. For example, in the following, we want to know the distribution of $$T^*=g(X_1^*,\dotsc,X_n^*)$$, and this simple pmf can make the resulting distribution also quite simple.

In the following, we will discuss an application of the bootstrap method (or ) mentioned above, namely using bootstrap method to the distribution of a statistic $$T=g(X_1,X_2,\dotsc,X_n)$$ (the inputs of the functions are random variables and $$g$$ is a function). The reason for approximating, rather than finding the distribution exactly, is that the latter is usually infeasible (or may be too complicated).

To do this, consider the "bootstrapped statistic" $$T^*=g(X_1^*,X_2^*,\dotsc,X_n^*)$$ and the statistic $$T=g(X_1,X_2,\dotsc,X_n)$$. $$X_1^*,X_2^*,\dotsc,X_n^*$$ is the bootstrap random sample (with bootstrap sample size $$n$$) from the distribution of $$X^*$$ and $$X_1,X_2,\dotsc,X_n$$ is the random sample from the distribution of $$X^*$$. When $$n$$ is large, since the distribution of $$X^*$$ is similar to that of $$X$$, the bootstrap random sample $$X_1^*,X_2^*,\dotsc,X_B^*$$ and the random sample $$X_1,X_2,\dotsc,X_n$$ are also similar. It follows that $$T^*$$ and $$T$$ are similar as well, or to be more precise, the of $$T^*$$ and $$T$$ are close. As a result, we can utilize the distribution of $$T^*$$ (which is easier to find and simpler, since the pmf of $$X^*$$ is simple as in above) to approximate the distribution of $$T$$. A procedure to do this is as follows: This histogram of the $$j$$ realizations (which are a realization of a random sample from $$T^*$$ with sample size $$j$$) is close to the pmf of $$T^*$$, and thus close to the pmf of $$T$$.
 * 1) Generate a  $$x_1^*,x_2^*,\dotsc,x_n^*$$ from the  $$X_1^*,X_2^*,\dotsc,X_n^*$$, which is from the distribution of $$X^*$$.
 * 2) Calculate a realization of the bootstrapped statistic $$T^*$$, $$t^*=g(x_1^*,x_2^*,\dotsc,x_n^*)$$.
 * 3) Repeat 1. to 2. $$j$$ times to get a sequence of $$j$$ realizations of $$T^*$$: $$t_1^*,t_2^*,\dotsc,t_j^*$$.
 * 4) Plot the relative frequency historgram of the $$j$$ realizations $$t^*_1,t^*_2,\dotsc,t^*_j$$.

title: Statistics/Preliminaries


text:
21 Expected Difficult Questions With Simple Answers/Caste

What is caste anyways?
-> A endogamous social group engaged in a single occupation that also follows untouchability, sexual purity-chastity rules, and many other regional variations of cultural practices, which mark the distinction of this group from other groups. Generally, characteristics include, inter-marriage, untouchability, ban on widow re-marriage, parda/veil, housebound wives, etc.

Caste based reservations are right or wrong?
-> In Maharashtra We have following reservations in Place

He

Inter-caste marriages are right or wrong?
->

Why can't we destroy caste? or education is enough to end caste system?
->

Nowadays we don't follow caste, so as per my opinion there is no caste discrimination now?
->

I don't believe in caste, but if "those people" keep pushing their caste, will it end?
-> I want to ask you a few questions and you will have to answer them for yourself, at the end, you will find out whether Do you actually follow caste or not?

 * Your spouse/lover/intimate partner is of the same caste as yours? or similar to your caste?
 * Maximum of your friends/peers with whom you usually hang out are from the same caste as yours?
 * Your food habits/language identifiable to your caste/community?
 * You believe and follow all the codes around holy-unholy, purity, chastity, virginity, etc
 * You are following and feel that everyone should carry their caste occupations

What is the Atrocity act? Is the atrocity act getting misused?
-> The Scheduled Castes and the Scheduled Tribes (Prevention of Atrocities) Act, 1989 is an act of India. Which was enacted to safeguard the rights of STs and SCs. There are hardly any instances where it was proven in court that this act was used wrongly. In fact, the chart sheet rate and execution rate for such cases are ridiculously low, and even use of this act is in question let alone misuse.


text:
Hobo tourism/Transport

Transport and the costs associated with it — one of the components of the budget of travel, carried out in the format of "hobo tour".

General information
To begin with, it is necessary to divide the transport issue into two categories: "method of getting to the planned point of the planet" and "options of moving on arrival".

On the first point:
 * Watch for seasonal airline fares, planning to take advantage of which, it is important to remember that the direction should be chosen from the available low-budget options, among which the country you need may not be.
 * There are loukosters, where the meaning of the savings boils down to the following: the earlier purchased ticket — the cheaper it is.

On the second point: For the first of the listed options — read below.
 * In the territory of the countries selected for the route can be moved by hitchhiking, or use a low-cost public transport.

Hitchhiking: pros and cons
One of the main methods of movement of the supporters of hobo tourism (as well as backpacking) is hitchhiking. However, here there are "pitfalls".

First, you need experience and some skill, otherwise drivers will ignore your efforts as they pass by.

Second, this method is not always economical: in poor countries (namely, they are a priority for a hobo tourist) the cost of public transport is often low, and finding passing cars will take some time. So initially you should decide what is more important for you: hours spent and even days, or a modest amount of money.

One of the regularities in force in any country of the world: in the places, where there is no public transport, the driver can enter the position of a foreigner, sometimes voluntarily offer a ride, but, where plying public transport — will be different.

Experienced hitchhikers know how to use the method, not only traditionally — stopping cars on the track (or at petrol stations, as is customary in South Africa), but also practice ways of free transportation by air transport, water transport and even on freight trains.

Examples from practice
While travelling through the Sudan in December 2010 (prior to political events), I have repeatedly asked for help from the traffic police on duty on the highway. The logic is as follows: it is easier to express once on a broken Arabic the essence of the question to a representative of the law enforcement (he will summarize in native language and quickly pass the request to passing); than every time long and tedious to explain drivers. Policeman in any country of the world — a respected man, A driver of truck is more likely to respond to his request than to the words of some stranger with a backpack.

I received similar assistance from the police in Semonkong (Lesotho): the policemen agreed with the driver of one of the passing cars and he drove me to the next point.

In 2011, changing vehicles repeatedly, I reached the ticket office of Fish River Canyon, (from where to the natural attraction a few kilometers of the way), and sought help from the responsible person. He volunteered to help and, only on the second day, was able to find a car, the passengers and driver of which agreed to drive a money-less tourist.

On the island of ʻEua (Tonga), which is 19 kilometres long and 7.5 kilometres wide, there is no public transport, so drivers are sympathetic to the request of foreigners who are not frequent in these parts, and sometimes they offer help: I was given a free lift by the owner of a car who was not going to drive anywhere.

Moving along the highway in the wilderness of Paraguay, hoping to find the waterfalls marked on the map, I was invited in a passing car whose driver volunteered to help the foreigner; after visiting natural attractions, the well-wisher placed the guest on his territory in the village, and in the morning — brought it to the place from where had to continue way.

Russian traveller Anton Krotov hitchhiked through Indonesia using a variety of transport, including locomotives of freight trains. .

For the information
It is difficult, if not impossible, to hitchhike to objects that are far away from population centres. For example, a three-day excursion to the Salar de Uyuni in Bolivia, including a visit to several scenic sites (such as Italia Perdida, Ciudad del Encanto and many others) passes through the desert.

Another example. El Nido in Philippines known to the world for number of picturesque islets located at some distance from the shore. Public transport does not go to uninhabited islands. You will have to pay for the tour at the local agency, or... remove this item from your route.

Summarising the above
It is better to get to another country or another continent (and even more so, the territory of the island state) to make budget flights, and on arrival — to move by hitchhiking.

In general, the methods of moving international bums are not different from those used by backpackers.

authors: Виктор Пинчук

title: Hobo tourism/Transport


text:
Metroid franchise strategy guide/Dark Samus

Dark Samus is a character in the Metroid series. It first appears in Metroid Prime 2: Echoes after being teased in Metroid Prime and serves as the primary antagonist of the Metroid Prime trilogy. Dark Samus is a concentration of Phazon energy that takes on the form of Samus Aran after her Phazon Suit and DNA mix with the remains of Metroid Prime in a pool of Phazon.

Appearances
At the conclusion of Metroid Prime Samus defeats the titular Metroid Prime, which absorbs her Phazon Suit and explodes. In a post-credits scene, the hand of Samus's Phazon suit reaches out from inside the creature's remains.

Dark Samus makes its first proper appearance in Metroid Prime 2: Echoes, revealed as Metroid Prime having used Phazon energy and the Phazon suit to reconstruct itself into a dark doppelgänger of Samus. Seeking to absorb Phazon and make itself stronger, Dark Samus travels to the planet Aether, where it repeatedly clashes with Samus. Ultimately, Dark Samus is defeated by Samus and destroyed, but is revealed to have reformed itself in a post-credits scene.

Dark Samus appears again in Metroid Prime 3: Corruption, having forcibly taken control of the Space Pirate forces. With the pirates' help, Dark Samus locates the source of all Phazon, the planet Phaaze, and plans to spread Phazon and use it to control the universe. Dark Samus then infects Samus, her allies, and a stolen supercomputer with Phazon, and begins invading planets and using Phazon to corrupt them. Overcoming her corruption, Samus travels to Phaaze and engages in a final battle with Dark Samus from which she emerges victorious, with Dark Samus exploding into Phazon dust as the planet is destroyed.

In other media
Outside of the Metroid series, Dark Samus also appears in the Super Smash Bros. series. The character initially appeared as an assist trophy item in Super Smash Bros. for Nintendo 3DS and Wii U before being announced as a playable character in Super Smash Bros. Ultimate as an "echo fighter" that uses moves similar to Samus's.  Dark Samus is also scheduled to receive its own amiibo figure.

Reception
The character of Dark Samus has received positive reception. According to Super Smash Bros. series director Masahiro Sakurai, Dark Samus was included with Chrom in Super Smash Bros. Ultimate due to the character's popularity with western players. IGN listed Dark Samus as their 88th best video game villain.


text:
Exercise as it relates to Disease/Use of targeted interventions to reduce recreational screen time in adolescents

A critical appraisal of the research paper  'Intervention to reduce recreational screen-time in adolescents: Outcomes and mediators from the ‘Switch-Off 4 Healthy Minds’ (S4HM) cluster randomized controlled trial' by Mark J. Babic, et al (2016)

What is the background to this research?
Sedentary behaviour is becoming an increasing issue in young Australian adolescents. Only 1 in 5 (20%) Australian adolescents aged 13-17 met the Australian physical activity guideline. Recreational screen time is the use of devices such as computers, phones and gaming devices that does not promote activity or education. Recreational screen time is a cause of sedentary behaviour as it is normally an activity that is performed below the 1.5 metabolic equivalents (METs) that equates to a person being sedentary.

The research paper being appraised is a study on the effectiveness of the switch off 4 healthy minds (S4HM) intervention and its impact on the recreational screen time of adolescents. The researchers hypothesised that adolescents in the S4HM intervention will report significantly lower levels of recreational screen-time at 6-month post-intervention, compared to those in a wait-list control group.

Where is this research from?
This research was collected from 8 catholic secondary school in the Hunter region of New South Wales, Australia. The research conducted was published in the Preventive Medicine Journal in 2016.

The authors of the article come from multiple different universities located in New South Wales, within the authors, there fields of practice relate heavily to the topic being discussed, though many of the authors participating in the research have had little peer reviewed research published in the past.

What kind of research was this?
The study performed was a parallel group cluster randomised controlled trial. A cluster randomised trial is effective as it able to effectively able to evaluate whether a guideline recommendation is affecting the outcome for the participants. A cluster randomised trial also is also preferred as there is potential for contamination of the study by members of the control group.

The methodology of this research is similar to other studies performed on similar topics using a cluster randomised controlled trial such as a study by Pedersen J et al. (2022)

What did the research involve?
The study consisted of 322 students, of which 308 responded to follow up assessments. The control group contained 155 students who did not participate in the intervention and continued their normal school curriculum and usual behaviours. The intervention group contained 167 students who were assessed over a six month period where they were participating in the Switch off 4 Healthy Minds program. The program involved participants attending an interactive seminar at the beginning of the 6 months, receiving Ehealth messages online twice weekly and signing behavioural screen time contracts. Parents of the participants were also sent newsletters once monthly.

The methodology of the study is deemed appropriate. The primary outcome of the study, which was the recreational screen time amount, was measured using the adolescent sedentary activity questionnaire (ASAQ). A study by Hardy et al. (2007) deemed that the ASAQ can gather comprehensive amounts of gathering information and the information is of a good to excellent reliability. Secondary outcomes measured included multiple assessments of health (BMI, Weight) which were all measured using equipment and methods adequate to scientific and research standards.

There is one major limitation that is present in the research. That is the completion of the ASAQ by participants as it is completely subjective. This introduces the possibility of recall and social desirability biases amongst the participants which may affect the results of the study.

What were the basic results?
There was no significant difference found in the recreational screen time of the intervention group compared to the control group at the end of the 6 month period. Both groups observed had significant reductions in screen time from baseline to post-test, S4HM (intervention) = − 50.5 min/day, p < 0.001; Control = − 29.2 min/day, p = 0.030. Though when observing the adjusted between group difference, mean = − 21.3 min/day; p = 0.255, the results are not statistically significant. Of the secondary outcomes the researchers also interpreted that there were no statistically significant group-by-time effects for any of the mental health outcomes, BMI or physical activity.

The results of the study are interpreted positively even though most outcomes are not statistically significant. The researchers identify that the students have found the S4HM intervention to be helpful and an educational tool. The study does not over emphasis the implications of its finding as it simply states the results and indicates the need for future research to be conducted on the recreational screen time of adolescents for more impactful data to be obtained.

What conclusions can we take from this research?
Recreational screen time in the adolescent population of today is an ever growing issue. Multiple interventions have been trialled but it seems that none are having the needed effect in reducing screen time. This study has not produced statistically significant data so it is somewhat clear that further measures need to be taken in the future to provide interventions that produce statistically significant data. Though the data does show that the intervention had somewhat of an effect on the participants as they themselves deemed that the intervention was appropriate and educational in providing methods to reduce screen time.

The results of this research have similar outcomes to other screen time intervention studies. One recent study from Da Silva Bandeira, et. al in 2019 had similar findings stating that there was no significant differences between the intervention and the control group for reduction of screen time.

Practical advice
Recommendations for screen time in Australian adolescents aged 13-17:

 * No more than two hours of sedentary recreational screen time per day for children and young people aged 5–17 years (not including schoolwork).

Recommendations for physical activity in Australian adolescents aged 13-17:

 * Children and young people do  at least 60 minutes each day  of  moderate to vigorous physical activity

Further information/resources
[https://aifs.gov.au/resources/short-articles/too-much-time-screens-screen-time-effects-and-guidelines-children-and#:~:text=no%20more%20than%20two%20hours,years%20(not%20including%20schoolwork). Australian National Guidelines for Screen Time]

Australian National Guidelines for Physical Activity for Young People

Tips to help reduce screen time in children


text: Category:Places and ways for staying overnight of hobo tourists

authors: Виктор Пинчук


text:
Exercise as it relates to Disease/Mental health in Australian elite athletes

What is the background to this research?
Mental health is defined as psychiatric disorders and symptoms of psychological distress which has a significant impact on quality of life, resulting in functional impairment in work, social activities, and other important aspects of life. Athletes, in particular elite athletes face a variety of day to day challenges such as overtraining, burnout, body weight focus, injury, deselection and pressure to perform/expectation to name a few which can have a significant impact on an individuals mental health.

The prevalence of mental disorders is greatest among younger people with one-quater of 16-34 year olds meeting the clinical criteria for one or more mental health disorder. These disorders include depression, generalised anxiety, social anxiety, panic disorder and eating disorder. Due to the very little knowledge regarding prevalence of Mental health disorders in athletes, this study was aimed at investigating Australian Elite Athletes symptoms of general psychological distress and common mental disorders.

Where is the research from?
Gulliver, Griffiths, Mackinnon, Batterham, and Stanimirovic conducted their research by administrating a self-report internet-based survey comprising measures of demographic status and mental health symptoms. Dr Gulliver is an early career research fellow at the Centre for Mental Health Research, National Centre for Epidemiology and Population Health, ANU College of Health & Medicine. Gullivan completed a Bachelor of Psychology (honours) as well as a PHD in research where she focuses on finding practical solutions to improve mental health in key at-risk population groups.

What kind of research was this?
This research classifies as an observational study due to all subjects participating in the same methods, in the same order. It contains quasi-experimental elements as there were no random assessments or tasks undertaken outside of the experiment given. The main research undertaken was a cross-sectional survey design which was employed to assess self-reported symptom prevalence of mental health in elite athletes in Australia.

What did the research involve?
224 elite athletes (118 Female, 106 male) from the Australian Institute of Sport (AIS) and Australian sporting organisations were administered a self-report internet-based survey comprising measures of demographic status and mental health symptoms. The survey took approximately 20-30 mins to complete and all online data was conducted using Lime Survey (www.limsurvey.com). Inclusion criteria were being aged 18 years or older and being an elite athlete, as defined by participants’ level of competition (Olympic or Paralympic, professional, or state, national, or international-level athletes). Ethics approval for the study was granted by both the Australian Institute of Sport (AIS) and The Australian National University Human Research Ethics Committee

There are a few limitations within this study. First being the response rate among AIS Athletes was low and the findings may not represent all Australian Elite Athletes. Second, athletes with past experience of mental health problems or injury may have been more likely to participate in the survey which could lead to a biased sample. Finally, the symptoms recorded where self reported which could represent indications of likely or probable mental disorder.

What were the basic results?
Out of 224 elite athletes, just under half of respondents met criteria for at least one mental health problem, and over half had sought help from a mental health professional for personal or emotional problems.

General psychological distress (K-10) scores for the present study were significantly higher than other measures with a mean score of (males = 14.63, females= 16.67) (table 2) with 20.3% of females reaching the caseness cut-off score (table 3). Linear regression models demonstrated that injured athletes had significantly higher symptoms of depression (t = 3.23, p = .001) and generalised anxiety (t = 2.26, p = .025) than non-injured athletes. However Injury and relocation were not significantly associated with meeting criteria for any other disorder.

Specifically, 46.4% of athletes (males = 38.7%, females = 53.4%) were likely cases for at least one of the mental health problems measured (general psychological distress, depression, generalised anxiety, social anxiety, panic disorder, or eating disorder). One-quarter (males = 23.6%, female = 30.5%) of the athletes scored above the caseness cutoff score (table 3) for depression and 7.1% (males = 3.8%, females = 10.2%) was recorded for generalised anxiety disorder.

Table 1: Respondents Demographic Data

Table 2: Symptoms of mental health disorders and reported help-seeking behaviour. {| class="wikitable"

Construct

 * Symptom measure (potential range)
 * Male (n=106)
 * Female (n=118)
 * Total (n=224)
 * General physiological distress
 * K-10 (10–50), M (SD)*
 * 14.63 (6.11)
 * 16.67 (5.70)
 * 15.71 (5.97)
 * Depressive symptoms
 * CES-D (0–60), M (SD)
 * 10.33 (9.47)
 * 12.64 (9.06)
 * 11.55 (9.31)
 * Anxiety symptoms
 * GAD-7 (0–21), M (SD)*
 * 3.32 (3.86)
 * 4.78 (3.84)
 * 4.09 (3.91)
 * Social anxiety symptoms
 * SPIN (0–68), M (SD)
 * 9.46 (8.40)
 * 9.97 (8.61)
 * 9.72 (8.49)
 * Panic disorder symptoms
 * PDSS-SR (0–28), M (SD)
 * 0.67 (2.92)
 * 1.02 (2.60)
 * 0.86 (2.75)
 * Eating disorder symptoms
 * SCOFF (0–5), M (SD)**
 * 0.43 (0.88)
 * 1.07 (1.25)
 * 0.77 (1.14)
 * }
 * Eating disorder symptoms
 * SCOFF (0–5), M (SD)**
 * 0.43 (0.88)
 * 1.07 (1.25)
 * 0.77 (1.14)
 * }

Table 3: Percentages meeting cut-off score

What conclusions can we take from this research?
This study is useful as it identifies the specific mental health disorders in elite athletes. In the study undertaken, it was demonstrated that more than half of the athletes surveyed met caseness for at least one mental health problem. It was reported that at least One-quarter (males = 23.6%, female = 30.5%) of the athletes scored above the caseness cutoff score for depression and 7.1% (males = 3.8%, females = 10.2%) was recorded for generalised anxiety disorder (Table 3). Within the study it was evident that one-quater of the athletes experienced an injury (table 1). Injury is considered to have a significant impact on depression in athletes and predicted depression symptoms. In this study sample injured athletes had higher depression scores than non-injured athletes. This indicates that anxiety and in particularly depression seem to be the most common mental health disorder found among elite athletes. Despite current data, the responses to depression and anxiety were ultimately self diagnosed and the questionnaire does not provide a mental health evaluation.

Practical advice
Mental Health is something that can often be forgotten about. There should be a significant amount of importance placed on mental health, in particularly to elite athletes ensuring they are well supported and have access to mental health professionals. As seen in the results, injured athletes have a significantly high score for mental health problems and therefore should be a priority. Although there was an encouraging amount of help seeking behaviours for psychological problems, help seeking from professional sources should be facilitated. It is fundamental that Elite Athletes have access to qualified psychologists as this will allow for the athletes to better understand the way in which their brain ticks both away from training and during performance. Not only will this benefit an individual off field however it will allow athletes to be able to cope with added stresses when performing which can have a positive effect on overall performance.

Further information/resources
Research Supports the need of continued focus on Mental Health

Focus on Mental health for Elite Athletes a must

IOC Mental Health In Elite Athletes Toolkit


text: Category:Hobo tourism

authors: Виктор Пинчук

title: Category:Hobo tourism


text: Category:The routes, passed by modern travelers

authors: Виктор Пинчук


text:
Exercise as it relates to Disease/Cardiovascular disease exercise interventions in the elderly population

This WikiBook is an analysis and critique of the article: Amidi CB, Trevisan C, Dotto M, Ferroni E, Noale M, Maggi S, Corti MC, Baggio G, Fedeli U, Sergi G. Association of Physical activity trajectories with major cardiovascular diseases in elderly people. Heart. (18.11.2022) https://heart.bmj.com/content/108/5/360#ref-18

What is the background to this research?

 * The research is about the physical exercise levels of the elderly population (65 years and above) in Italy. Baseline assessments were taken from participants between 1995-1997, with follow-up assessments being taken every 4-7 years (until 2018). Participants with prevalent coronary heart disease, heart failure or stroke at the baseline assessment were excluded from the study.

 * At each follow-up assessment, thorough medical history and physical examinations were performed, as well as biohumoral and radiological tests.

 * Questionnaires were also given out to the participants at each follow-up to measure their physical activity levels

 * Morbidity and mortality surveillance was also conducted up until December 2018

This research is produced from over decades of research, taking note of all participants physical variables at every follow-up, while also showing what exactly physical activity may affect and how at certain points of elderly life.

This research is important not just for the most elderly population, but for all to learn from, to understand how exercise can prolong our lives and even how late is too late to prevent heart disease and heart related issues.

Where is the research from?

 * The research was conducted in Italy with 3099 participants, all aged 65 and above

 * The research was conducted from 1995 until 2018

Most of the authors of the research have multiple research papers published, with all authors being heavily involved in the health field.

There are many contributors to the study, with most being either universities, health care companies or philanthropic organisations. The one possibility of conflict of interest is the local council (Veneto regional authority) which could try to skew the finding to be more in favour of healthy and more well looked after elderly population. However, the article states that no sponsor had a roll in the design, methods, subject recruitment, data collections, or analysis and preparation of the paper. As well as the article also taking note of the participants economical and educational status.

What kind of research was this?
The research was done as a cohort study, with questionnaires given to the participants to record their physical activity at each ‘follow-up’ appointment.

The level of evidence from this sort of study can differ from others that are a lot more ‘hands-on’ as participants are only asked to recall their physical activity at the follow-up assessments, rather than recording every day, using an accelerometer or more regular follow-ups. Due to this, evidence may have been collected better.

What did the research involve?

 * The participants would come back for follow-up assessments every 4-7 years as stated in ‘background to the research’.

 * They would be given questionnaires about how many hours were spent each week on activities (while also stating what activities they participated in), which was categorised as either moderate or vigorous.

 * Hours of moderate and vigorous activity were then turned into minutes/day and calculated as moderate + 2x vigorous physical activity.

 * After this, participants were then defined as active (above 20 minutes per day) or inactive (below 20 minutes per day).

 * Physical activity trajectories were then identified in 4 trajectories:

 * 1) Stable-low (inactive-inactive)
 * 2) High-decreasing (active-inactive)
 * 3) Low-increasing (inactive-active)
 * 4) Stable-high (active-active)

 * Participants were then put into these categories based on their questionnaires

The methodology may not have been the best for 2 main reasons. People can often skew the truth about their physical activity habits and have poor recall of their physical activity over the past weeks let alone years (especially in the older population).

Which leads us to the next reason, which is time between follow-up assessments and questionnaires. With questionnaires being conducted roughly every 3 years, recall of events can be poor and actual physical activity levels can be very hard to measure accurately, especially when it is exercise minutes per day.

What were the basic results?
The results were that physical activity did decrease the rates of incident of both coronary heart disease and heart failure in men and women. With a lower risk of cardiovascular disease by about 26%, lower risk of coronary heart disease by about 34% and heart failure by about 28%.

Physical activity was also associated with a reduced risk of mortality in both men in women, with a lowered risk of about 28% in men and 19% in women.

They also found that the optimal minutes per day for exercise was between 20-40 minutes, with risk reduction of any cardiovascular event being was most prevalent at 70 years, moderately in 75 years but no significant correlation seen at 80 or 85 years.

Incidents of cardiovascular events were also always lower in the low-increasing and stable-high levels of activity compared to high-decreasing and stable-low.

The researchers assumed that there may be a need for longer exposure to an active lifestyle as significant associations of physical activity with cardiovascular outcomes were only seen in the early in late life (around 70-75) participants.

It appears the researchers don’t over-emphasise their findings as they do not make any outlandish recommendations without the evidence to support it.

What conclusions can we take from this research?
The conclusions that we can take from this research is that physical is very important in our lives. This can be seen with all the decreases in cardiovascular events in the more physically active groups in the research. It is also important to be regularly active as early as possible, as seen with physical activity not having much change in the late elderly population’s cardiovascular events.

This research also aligns with the Australian governments department of health and aged care, recommending 30 minutes of moderate activity per day (within the 20-40 minutes found). Centre for disease control and prevention of the U.S also recommends this amount of time per day.

Practical advice
There are no specific exercise recommendations in this article, however as stated before, between 20-40 minutes of physical activity per day is recommended. However, the exercises undertaken by the participants was recorded in the questionnaires and are as follows.

Moderate exercises conducted in this study were:

 * Walking, bowls, fishing, and other games that require moderate physical activity

Vigorous exercises conducted by the participants were:

 * Gardening, gym, biking, dancing, and swimming

This could be seen as a rough guide or reference of what you can do for exercise.

The main considerations for encouraging physical activity in the elderly population is that it prevents cardiovascular diseases significantly.

Further information/resources
The world health organisation, department of health and aged care, centre of diseases control and prevention are just some examples of organisations that can provide support and helpful guidance for the elderly population. With recommendations for exercise, what exercises are most useful, how often to exercise and useful information for more physically impaired people.


text: Category:Survival practice in extreme conditions

authors: Виктор Пинчук


text:
Exercise as it relates to Disease/The associated effects of swimming with spinal deformities

This is a critique of the research article: Swimming and Spinal Deformities: A Cross-Sectional Study by Fabio Zaina, Sabrina Donzelli, Monia Lusini, Salvatore Minnella, Stefano Negrini,

Volume 166, Issue 1,2015,Pages 163-167

The critique was written as an assignment for the unit: Health Disease and Exercise in 2022

What is the background to this research?
Spinal curvature deformities are significant medical problems within the skeletally system caused by a variety of genetic or lifestyle reasons.

Scoliosis, kyphosis, and lordosis are the three main forms of deformities associated with spinal curvature.

 * 1) Scoliosis, which is characterised by a side-to-side curvature of the spine the curve is often S-shaped or C-shaped and are frequently adolescents. Adults can also develop scoliosis.
 * 2) Kyphosis, which causes the spine to curve forwards creating an abnormally rounded upper back (more than 50 degrees of curvature). most frequently affects elderly persons.
 * 3) Lordosis denotes an inward curve of the spine at the lower back. Although lordosis is less frequent than other disorders linked to curvature, it is nonetheless a dangerous condition in and of itself.

 * It progresses slowly and affects both the appearance and function of the body, for example, worsening the degree of pain on spine, radicular pain. Once asymmetric load and degeneration of spine starts, it probably results a chronic degeneration and deformity. In extreme cases, it may affect the shape of the rib cage, hence, respiratory system.
 * Finding and diagnosing the cause of the spine curvature is the first step in treating a suspected spinal deformity. Surgery is widely regarded as the only intervention that can stop curve progression. However, most research indicates that scoliosis-specific exercise combined with therapy treatment can prevent or delay curve progression of spinal curvature deformities.

Where is the research from?
Swimming and Spinal Deformities: A Cross-Sectional Study by Fabio Zaina, MD1, Sabrina Donzelli, MD1, Monia Lusini, MD1, Salvatore Minnella, MD1, and Stefano Negrini, Prof, MD2

The study was carried out at Italian Spine Institute (ISICO), which was formed in 2003 in Italy. ISICO promotes and develops an innovative approach to the rehabilitation of non-surgical spine illnesses in people of all ages, from children to the elderly. Physical and Rehabilitation Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy were also involved.

Portions of the study were presented at the International Society for the Study of the Lumbar Spine meeting, May

13-17, 2013, Scottsdale, AZ

What kind of research was this?
Cross-sectional study with questionnaire used to gather data on LBP, and a Bunnell scoliometer was used these were to measure the angle of trunk rotation and screen for scoliosis. Kyphosis and lordosis plumbline distances were also measured.

What did the research involve?
This cross-sectional study used competitive swimming organisations from both public and private schools. They utilised a convenience sample in northern Italy's densely populated area between Milan and Varese, which is thought to be representative of an urban population. Controls were attracted from nearby schools, the ACS group was attracted from a number of swimming societies. To compare competitive swimmers with the general population in the latter group, there were no restrictions on participating in sports activities.

The 329 participants who accepted the invitation were split into the control and ACS groups. ACS participants exercised at least four (up to six) times per week for an approx of 2-2.5 hours per session.

 * A clinical evaluation of both groups to look for spinal deformities based on the angle of trunk rotation (ATR), which was measured with a Bunnell scoliometer at the thoracic, thoracolumbar, and lumbar levels, as well as the distances between the plumblines at C7 and L3 to look for kyphosis and lordosis.15,16 The resulting data were then analysed for mean values and the use of clinical cutoff.
 * Established cutoffs at 5 and 7 for Bunnell degrees. five  is a significant cutoff for subjects who might benefit from a particular exercise programme, and seven is a significant cutoff for patients who need a brace.17-20 For the plumbline distances, various clinical cutoffs, including 50 mm for C7 and 60 mm for C8.
 * To determine the amount of LBP, we administered a specific questionnaire that asked about current and previous LBP and sciatica, use of drugs, need for medical visits, and potential diagnostic exams that had previously been validated.

What were the basic results?
Male average ATR did not differ between the 2 groups however, female average ATR was significantly different. The highest risk of trunk asymmetries was found to be among swimmers(OR, 1.86; 95% CI, 1.08-3.20). Swimming also increased the risk of hyperkyphosis and hyperlordosis (OR, 2.26; 95% CI, 1.35-3.77) and increased LBP in females by 2.1-fold (95% CI, 1.08-4.06).

What conclusions can we take from this research?
The results of the current study support the literature showing that competitive swimming, is linked to spinal injuries and back pain, losing the protective benefits that the same activity can offer when practised in a less-intense way. key points include;

 * The growing spine may be significantly negatively affected by swimming.

 * Kyphosis, which is easily detectable clinically, as well as trunk asymmetries that are important for scoliosis detection.

 * Females a higher risk of LBP. There was a gender difference in this regard, with swimming appearing to have a greater effect on adolescent girls. Remember that scoliosis and back pain are more common in women overall and even for young children.
 * spinal deformities cannot be treated solely through swimming; the conservative treatments for these pathologies continue to be targeted exercises and braces.
 * swimming has long been regarded as a risk-free and beneficial sport for the spine, and some medical professionals have even suggested it as a spinal decompression therapy.

Practical advice
When working with individuals who have a spinal deformation condition, it is critical to slow the development of the deformity, restore the patient's quality of life, and enhance their overall health outlook.

 * The study is informing physicians and families about the risks associated with high performance swimming and the link between how much swimming is practised and spinal deformities.

 * Swimming is going to cause asymmetries and can impact performance through a number of techniques, muscular function, and postural alignment are some of the mechanisms. though with care and consideration it can be managed with a specialised exercise strength and conditioning program to help balance out the negative affects.

Further information/resources
Scoliosis information

Asymmetries in Swimming


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Exercise as it relates to Disease/The effect of resistance training on muscular strength in patients with Anorexia Nervosa

This Wikibooks page is a detailed critique of the research article: “Muscular Strength Changes in Hospitalized Anorexic Patients After an Eight Week Resistance Training Program" [internet]. International Journal of Sports Medicine, Vol 27 660-665, 2006.

What is the background to this research?
Anorexia Nervosa (AN) is characterised by a consistent reduction and restriction of caloric energy intake, disturbances in body weight, fear of weight gain and distorted body image. Recovering from the disorder is difficult and multifaceted. The importance of physical activity has been highlighted in previous literature among eating disorder patients. Beumont and colleagues suggested supplementing an exercise program as early as 1994, alongside existing treatment as a beneficial intervention for patients with eating disorders.

Where is this research from?
This study was performed in partnership with the University of Witwatersrand Medical School, Johannesburg, South Africa, in which the head author was a leading professor within the University’s School of Physiology and co-author was Head of Department in Psychiatry, with previous research history in mental health and illness. Wits Technikon Biokinetics Centre within the University was used for equipment and procedure. No personal bias or conflict of interest appeared to be present.

What kind of research was this?
As a randomised controlled trial, participants were randomly selected to reduce selection bias, and form a basis for statistical tests. This kind of research is prospective and highly regarding when considering the effectiveness of a new or introduced intervention. Randomisation allows for cause-effect relationships between interventions and patient outcomes by balancing characteristics of participants between groups (attribution). .

What did this research involve?
The focus of the study was to investigate the effects of an eight-week resistance training on muscular strength of the elbow and knee flexors and extensors in patients with Anorexia Nervosa. Subjects were categorised into three groups of females aged 15-36. The first group performing the exercise program consisted of seven in-patient Anorexic Exercisers (AE). The second acting-control group consisted of seven Anorexia Controls (AC) not be participating in exercise. The third group consisted of seven Non-anorexic Exercisers (NAE) volunteers acting as controls, who participated in the program to the same extent as the AE.

Table 1. Inclusion Criteria for Subject Groups
The program included a warm-up and cool-down and an alternation of two full-body low-weight resistance program designs for variation. Statistical analysis was measured using a one-way ANOVA test and a Tukey-Kramer post-hoc test for peak torque differences prior to the study, and a t-test post-study (p ≤ 0.05). All isokinetic strength tests were measured using the "Cybex Norm Tm" before and after the program.

What were the basic results?
There was a significant increase in groups AE and AC body mass, BMI, percentage body fat, fat mass and lean body mass after the resistance program. The Beck Depression Inventory score suggested improved positive mental well-being following completion of the program in the AE subjects only.

The isokinetic strength tests showed significant differences only in the right knee and elbow in peak torque for all groups. All measures were increased for the AE group.

Knee Extensors

 * Peak torque in AE and AC pre-intervention was significantly less than NAE
 * Suggests loss of strength as a result of weight loss

 * Peak torque in AE post-intervention was significantly increased (32%) showing adaptive response to overload principle. Whereas AC experienced very little to no change in values. Peak torque was decreased in NAE suggesting lack of overload principle.

Knee Flexors

 * Peak torque in all groups had little change: Suggests the strength of the hamstring group may be preserved in patients with Anorexia Nervosa regardless of the energy and caloric deficiency.

Elbow Extensors

 * Peak torque in all groups before and after the program were statistically similar: Suggests energy and caloric deficiency had no effect on strength of elbow extensors.

 * Peak torque was not increased significantly enough to elicit a response for any and should be revisited in future.

Elbow Flexors

 * Peak torque was initially lower in AC and AE than NAE: Suggests energy and caloric deficiency in Anorexia Nervosa could affect the strength of the elbow flexors.

 * Peak torque following the eight weeks was significantly increased by 40% in the AE group suggesting retraining ability. Decreased slightly in AC and NAE groups.

Evaluation of research and future implications
Given increases in all areas of muscular strength for AE, it can be suggested that the intervention was not interfered by caloric negative energy balance or conflicting behaviours and weightloss.

 * Important to note: Metabolic myopathy can cause a defect in anaerobic glycolysis . This was found to be reversed by implementing re-feeding and increased caloric intake in patients with AN, resulting increased strength . This was neglected in the study, in which its role played an unknown effect in body composition and strength increases.
 * Regarding compulsive behaviours: Although a Beck Depression Inventory score was taken pre- and post-intervention, psychological consideration to thoughts and attitudes could have additionally monitored using journals, entries or logs after each week of the program. This could account for patients attitudes and thought processes during the intervention.

Additionally, the study neglected physiological functionality such as bone mineral density and strength while minimising calorie expenditure. A study by Bratland-Sanda (2018) and authors considered this and found that a further follow-up (6 months after post-intervention) was needed to produced a large increase in bone mineral density.

Implications of neuromuscular factors from muscular strength, such as synergist coordination, increased antagonist inhibition and excitation of motor neurons were not measured. Conducting an EMG, seen in other studies measure deeper associations between torque and neuromuscular factors contributing to strength increase. However this becomes an expensive process.

Focussing on methodology of the tests, measures were taken by the same person to reduce inter-observer variability. However, only female participants were tested on, with no male conclusions or generalisability for in-patient population.

Practical advice
Thorough critique defines this study as appropriate and successful. It carried out a functioning and in-depth resistance program which produced positive results and statistical significance towards the overall health in patients with Anorexia nervosa. Additional tests and improvements in generalisability could be revisited, as well as measuring different duration programs and follow-up procedures.

Given the increased measures in body composition and peak torque of muscles, practical advice should suggest prescribing a structured low resistance training program to in-patients to increase muscular strength. Implementing this into hospital environments, alongside weight-restorative 're-feeding' can ultimately improve their health and well-being.

Further information/resources
If you know someone who may be suffering from an eating disorder visit Lifeline or Butterfly Foundation.

The original journal article can be found here.

The following resources can provide additional information discussed:

 * https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia
 * https://www.ccjm.org/content/87/6/361
 * https://www.healthyplace.com/blogs/survivinged/2020/11/strength-training-in-eating-disorder-recovery


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History of video games/Platforms/PocketStar

Compute
The system makes use of an ESP32-C3 processor clocked at 160 megahertz. The system includes 400 kilobytes of SRAM.

Connectivity
The system supported Bluetooth 5.0 LE.

Hardware
The system supported force feedback via a vibration motor.


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History of video games/Platforms/Wikipad

History
Noted comic book artist Stan Lee recommended the console.

Launch
The system has an odd legacy, notably in the decedent technology GameVice.

Hardware
The tablet portion of the console sported an IPS LCD with a resolution of 1280 pixels by 800 pixels measuring at 7 in.

Software
The system ran Android 4.1 for it's operating system.


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Exercise as it relates to Disease/Improving knee osteoarthritis in elderly women with the use of hydrotherapy

This Wikibooks page is a critical appraisal of the journal article " Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized

controlled trial" (Dias et al, 2017)

What is the background to this research?
Only cardiovascular disorders cause more severe chronic disabilities than osteoarthritis, which is a consequence of aging and affects close to 10% of those over the age of 60. The rising interest in understanding the basic mechanisms by which this disease affects human joints can be attributed to both its prevalence and the associated expenditures, which in total,can cost billions of dollars in terms of medicines, surgeries, and lost workdays over the span of someones life. Axial, or spinal, as well as peripheral joints, including weight-bearing joints (such as the hips and knees), can be affected by osteoarthritis and are the most common areas that are effected in people. The impact of motion is minimised by the moveable joints' proper alignment and the resilience of the subchondral bone beneath the articular cartilage.

The practice of hydrotherapy in physiotherapy has grown out of the scientific theory of hydrodynamics. It has been easier for physiotherapists to use hydrotherapy as a method for promoting movement and regaining function because they have a better grasp of the physiology of human immersion, as well as the ability to analyze human movement within water. The aim of hydrotherapy is to help individuals rehabilitate injuries or soreness, exercise or simply relaxation. Because of buoyancy, it can be substantially more comfortable and easier for an individual who has trouble weight bearing due to osteoarthritis to complete functional movements and exercises in water because of the reduced amount of stress and friction on the joints.

Where is the research from?
This study that is getting critically appraised took the form of a randomised controlled trial designed to see whether it is beneficial for people to use hydrotherapy for people (in particular women) with knee osteoarthritis. The blueprints of the study were approved by the ethics committee of Universidade Federal de Minas Gerais, Brazil. Joao Marcos Dias who is the main author of this article as well as his fellow editors have written other articles and completed other studies on health and disease related issues. Despite this research being conducted in Brazil, it will still have some degree of relevance to the same specific population type in other countries.

What kind of research was this?
In this particular study the research undertaken was done in a randomised control trial (RCT) style. Participants in an RCT are randomly selected into either one of two groups. One group would be receiving a more conventional style of treatment in regards to osteoarthritis (phone calls, lectures, verbal advice) and the other group will be known as the ‘experimental group’ receiving the intervention treatment (hydrotherapy) the researchers want to test.

What did the research involve?
This study involved a total of 73 elderly community dwelling females with knee osteoarthritis in small city called Belo Horizante, Brazil. In this study, 36 participants were put into what was called the 'educational group' (controlled). This consisted of face to face lectures on the diagnosis, symptoms and how to take basic care of knee osteoarthritis. Telephone calls were also given to this group providing them with strategies and preventative measures of reducing pain associated with weight-bearing whilst performing basic daily activities. The remaining 37 participants were in the intervention group which consisted of progressive hydrotherapy exercises, twice a week for six weeks.

The layout of the hydrotherapy program contained warm-up exercises, strengthening exercises and a cool down, all together the session ran for approximately 40 minutes. The primary outcomes that were measured included function and pain of the patients knee, this was measured with the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), which is a very reliable and renowned knee osteoarthritis index test. A secondary measure was also assessed testing the muscular strength of the individual pre and post-intervention. The results for this were gathered through the use of an isokinetic device testing the individual's knee extension. Data from these measures were conducted pre and post-intervention for all participants.

What were the basic results?
The results indicated that there was a significant improvement in the experimental group over the control group. In both Primary and secondary measures, data shows that the hydrotherapy intervention group proved to make enough difference to improve significantly over the 6-week duration of the study in areas such as pain levels, functional ability, strength, power and resistance.

The tables below includes the data from " Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomised controlled trial" (Dias et al, 2017)

Table 1: Data showing primary measures

Experimental                                     Control

Table 2. Data showing secondary measure outcomes

Experimental                           Control

What conclusions can we take from this research?
The data demonstrates that participating in an activity such as hydrotherapy can be well worth someone's time and effort if they have knee osteoarthritis. This study is  a promising indicator that demonstrates improvement with increased function, less pain and improved strength for anyone who has knee osteoarthritis.

Practical advice
Further research needs to be done on this topic as there is not much evidence to say this helps all the time. Additionally, more studies should take into account men and women with knee osteoarthritis and it would be beneficial to have all of the participants engage in the intervention as they could all potentially feel the benefits of hydrotherapy. The study design itself was good in the fact that it kept the programs the same for both groups throughout the duration of the study and did not change any of the variables.

Further reading/studies
Journal article: "Evidence for Effective Hydrotherapy"

Journal article: "Exercise therapy for older adults with lower-back pain"

Journal article: "An update on the pathophysiology of osteoarthritis"