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History of video games/Platforms/C64 Direct-to-TV

Launch
The C64 Direct-to-TV was released in 2004.

Legacy
Unlike the earlier Commodore 64 Games System, the C64 Direct to TV is held in high regard.

Compute
Jeri Ellsworth designed a custom chip for the system, combining the Commodore 64 CPU, SID audio chip, VIC-II video chip, and other features.

Unlike a Commodore 64 RAM and ROM are expanded.

The expanded 2 megabytes of ROM made loading times much lower.

RAM was expanded to 128 kilobytes.

Hardware
Due to using only two composite cables, audio is only mono.

The system uses 4 AA batteries.

Games
The system included 30 games.


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Exercise as it relates to Disease/How physical activity affect mortality in patients with cardiovascular disease

This wikipage is an assignment for the University of Canberra (subject: Health, Disease and Exercise / 2021). It is a critical assessment of the article "Mortality reduction with physical activity in patients with and without cardiovascular disease" by Jeong SW et al. (2019)

What is the background to this research?
Cardiovascular Disease (CVD) has become the top cause of morbidity and mortality worldwide. Evidence suggests that patients with CVD are less prone to participate in physical activity and more likely to have a sedentary lifestyle. From this however it is not possible to conclude that patients with CVD could decrease their rate of mortality by engaging in physical activity. To date, no studies have analysed the benefit of physical activity in primary or secondary CVD.

This study aims to evaluate the incidence of physical activity in patients with CVD to identify the relationship between mortality, physical activity and CVD

Where is the research from?
This study used the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) which is a population-based cohort created in Korea in 2015 in order to provide researchers with useful data regarding non-communicable diseases and health risk factors.

All authors of this study were involved with the Department of Internal Medicine at the Cardiovascular Centre in Seoul, Korea.

This research was funded by the Basic Science Research Programme through the National Research Foundation of Korea. No conflict of interest was declared.

What kind of research was this?
The design of this study was a Retrospective Cohort Study (RCS). The participants who underwent a screening program and completed surveys on physical activity between 2009 and 2015 were extracted from the cohort.

RCS' are usually advantageous due to having the potential to access the complete individuals profile and their exposure to a specific condition, including a thorough follow up of the individual’s condition.

They also have the potential to establish a correlation between physical activity and CVD levels. However, in comparison with a Randomized Control Trial, it may be less effective in establishing a cause and effect due to the existence of different factors that may alter the participants’ condition.

What did the research involve?
This RCS consisted of 441,798 profiles of individuals with and without CVD. These profiles were taken into consideration to analyse the participants’ physical activity and CVD levels.

These profiles belonged to individuals made up part of the Cohort from at least 2002 and who completed surveys regarding their physical activity between 2009 to 2015. The selected individuals were split into two different groups: Primary prevention group (individuals without CVD) and secondary prevention group (individuals with) CVD.

By being part of the NHIS-HEALS the individuals had the duty of filling out a series of self-report standardized questionnaires (a 7-day recall method was used to collect data regarding physical activity), participating in anthropometric and blood pressure measurements and laboratory tests using blood and urine samples.

There were two different outcomes. The primary one measured all-cause mortality where vital status, date of death and causes of death were certified. The secondary outcomes were cardiovascular or non-cardiovascular death.

One of the major limitations of this research is the Recall Bias in the data collection. All physical activity data relies on the self-report questionnaires administered by the Cohort guidelines. Not only individuals may under or over-report physical activity, but also, only leisure time physical activity was contemplated in the study. Other physical activity such as home or occupational duties may influence the results.

Another important limitation of this study is that only aerobic physical activity was evaluated when calculating the levels of physical activity. Therefore, data regarding musculoskeletal physical activity (AKA Strength training) was not evaluated leaving no option to the researcher but to make assumptions regarding levels of physical activity.

What were the basic results?
Out of the 441,798 participants 131,558 (29.8%) were found to have CVD while 310,240 (70.2%) had no history of CVD.

In the matter of physical activity, it was found that those participants with CVD were less physically active than those without CVD (measured in MET-min/week. Range 0-2429 MET-min/week). Also, 27.2% of the Secondary prevention group was found to be totally sedentary while only 24.4% of the primary prevention group was. The difference between prevention groups in these two findings was statistically significant (P<0.001).

Regarding rate of mortality, and after a follow up of 10 years (5.9 median), it was found that those with CVD had a significantly increased risk of mortality (Hazard Ratio 2.57).

When analysing both physical activity and rate of mortality, it was possible to observe that they have an inverse relationship. An increase in 500 MET-min/week showed a 14% risk reduction in mortality for the secondary prevention group whilst it was only 7% for the primary prevention group.

What conclusions can we take from this research?
Based on the findings, it is possible to conclude that individuals with CVD may be greatly benefited by participating in physical activity (>500 MET-min/week) by decreasing the rate of mortality. As well, even though patients without history of CVD have a lower rate of mortality than those with CVD, they can also see a benefit from participating in physical activity. This opens up another discussion regarding prevention of CVD when participating in physical activity.

Practical advice
Even though it is clear in this research that physical activity may reduce the risk of mortality in patients with CVD and to an extent in patients without, it is important to note that different types of physical activity have different adaptations and physiological effects. These adaptations may also differ from individual to individual due to other factors linked to lifestyles, genetics and other conditions. Therefore, any individual, regardless of their cardiovascular status, must consult with a health professional before participating in any physical activity.

Further information/resources
World Health Organization / Cardiovascular Diseases

Subjects with cardiovascular disease or high disease risk are more sedentary and less active than their healthy peers

Physical Inactivity and Cardiovascular Disease

Cardiovascular Effects and Benefits of Exercise

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


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Skaneateles Conservation Area/Invasive species/Viburnum

The majority of the Viburnum species found in our vicinity area are native shrubs or small trees, but there are a half dozen Viburnum species that are listed as invasive in our region.


text:
User:Livi.clark/sandbox

About me:

 * Name - Olivia Clark
 * Nickname - Lib or Liv
 * Ethnicity - Aboriginal
 * Family - Have a younger sister
 * Hobbies - Playing netball and basketball, spending time with family and friends
 * Achievements:
 * Playing in the inaugural NSW Indigenous all-stars team 2021
 * Selected in the inaugural Capital Darters team for the Australian National League
 * Playing in the Netball NSW Premier Netball League for the Capital Spirit Opens team 2020-2021
 * Playing in the division 1 state league Queanbeyan team since I was 15 (currently the longest serving player in division 1 for Queanbeyan)
 * Awards
 * NSW public schools Nanga Mai awards, Outstanding Student Participation - 2014
 * NSW public schools leadership citizenship and community service achievement - 2013 public schools NSW Illawara and South East Aboriginal Education Achievement Awards

title: User:Livi.clark/sandbox


text:
Exercise as it relates to Disease/The effects of high-intensity resistance and impact training on women with Osteopenia and Osteoporosis

This Wikibook page is a critique on the research article “High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial” by Steven L Watson, Benjamin K Weeks, Lisa J Weis, Amy T Harding, Sean A Horan and Belinda R Beck. This was done as an assessment for the unit Health, Disease and Exercise, 2021, studied at the University of Canberra.

What is the background to this research?
Osteopenia and Osteoporosis are conditions which result in the thinning and weakening of bones. As the bones become more fragile there is a higher risk of injury such as fractures from falls. These conditions are highly prevalent in women affecting around 14% of women aged 55-64, around 23% aged 65-74, and around 29% of women aged 75 and over. As these conditions are highly prevalent it is important to find the most effective methods of treatment. The article being critiqued tests the effects of High Intensity Resistance and Impact Training (HIRIT) on physical performance and bone mineral density in women with these conditions. HIRIT is generally discouraged as a method of treatment for those with Osteopenia and Osteoporosis due to the said risks of injury or adverse events occurring and many exercise guidelines for these conditions state moderate intensity resistance training is recommended rather than high intensity resistance training. Although this is the case, the intervention in this article provides evidence on the effectiveness of participating in HIRIT for women with Osteopenia and Osteoporosis in reducing related decreases in bone mineral density and physical performance.

Where is the research from?
This research was published from the American Society for Bone and Mineral Research which is a large society with more than 4000 members including medical and health professionals. The Authors of the article (Steven L Watson, Benjamin K Weeks, Lisa J Weis, Amy T Harding, Sean A Horan, Belinda R Beck) all have multiple research articles published on the American Society for Bone and Mineral Research's website on bone health and conditions and have related accreditations. Belinda R Beck and Lisa J Weis are both directors of the Bone Clinic in Brisbane, QLD.

What kind of research was this?
This research consisted of a randomised control trial called LIFTMOR in which participants were women aged 58 and over with osteoporosis who had low bone mass recorded at the femoral neck and/or lumbar spine. There was a strict inclusion criterion for more valid and reliable results and out of 406 willing participants, 101 were chosen. Then participants were randomly selected to either the control or intervention group. By conducting a randomized control trial, the researchers were able to compare results of the control and intervention groups pre and post intervention.

What did the research involve?
The Intervention group participated in 8 months of twice weekly, 30 minute bouts of supervised HIRIT where as the control group participated in low intensity home based exercise over the same period. The main outcomes measured were bone mineral density of the femoral neck and lumbar spine, and functional performance. The femoral neck and lumbar spine are valid and reliable measurement sites as the most common fractures due to Osteoporosis are of the hip and the lumbar spine is the best site for monitoring treatment. Bone measures were taken using DXA which is the current most effective measure. Four tests were taken before and after the 8-month intervention to assess functional performance. These tests were timed up-and-go, five times sit-to-stand, functional reach test and vertical jump test. These are all valid tests of physical performance as they test the functional capabilities of the participants femoral neck and lumbar spine in combination with the surrounding muscles. An improvement in these tests would constitute greater physical performance caused by the intervention.

What were the basic results?
Table 1: Physical performance tests pre and post intervention Table 2: Bone Mineral Density DXA measures pre and post intervention (* BMD = bone mineral density, LS = lumbar spine, FN= femoral neck)

Results in table 1 show the HIRIT participants had a larger increase in leg extensor and back extensor strength compared to the control group from baseline to follow-up. The timed up-and-go test and the five times sit-to-stand test also saw greater performances in the HIRIT participants than the control group with a decrease in time taken to complete the tests. The functional reach and vertical jump test performances increased greater in the HIRIT participants than the control participants.

Results in table 2 show an increase in both lumbar spine and femoral neck bone mineral density in the HIRIT group from baseline to follow-up where as the bone mineral density in both areas in the control group decreased. This decrease in the control group's bone mineral density could be due to the low intensity exercise not being able to stimulate an osteogenic response from the the low levels of skeletal strain. It could also be due to the control group not being under supervision which could result in falsely reported completion of set training.

There were no injuries or adverse events during the intervention. The authors claim since this is the case women with Osteopenia or Osteoporosis should not be discouraged to participate in HIRIT. Although this is the case, the low level of injuries in the HIRIT participants may be due to the supervision of their training and should be considered before participating HIIT in an environment which isn't supervised.

What conclusions can we take from this research?
As shown by the results, there was a greater increase in both bone mineral density and physical performance in the HIRIT participants compared to the control participants. Therefore High Intensity Resistance and Interval Training is an effective way of reducing the adverse effects of Osteopenia and Osteoporosis in women. Although moderate exercise is recommended by many guidelines, HIRIT is a greatly effective way of improving bone mineral density and physical performance and should be a preferential treatment method.

The positive results of this intervention could be due to the effective methodology, testing parameters and the supervision of the HIRIT participants.

The control group being unsupervised could have led to unreliable results in the control group although this does not effect the outcome of the HIRIT group's improvements in bone mineral density and physical performance pre to post intervention.

Practical advice
For women with Osteopenia or Osteoporosis High Intensity Resistance and Impact training can be very beneficial. As shown from the LIFTMOR intervention, HIRIT is a more effective way to help prevent the adverse affects of these conditions than lower intensity training. When beginning resistance training as a treatment for these conditions start training at a low intensity and gradually progress to a higher intensity as the body becomes more capable. As supervision of HIRIT was undertaken we would recommend supervision to reduce the risk of injury or adverse events occurring.

Further information/ resources
Osteoporosis: Current Concepts - Akkawi I, Zmerly H. Osteoporosis: Current Concepts. Joints. 2018;6(2):122-127. Published 2018 Jun 14. doi:10.1055/s-0038-1660790

Effects of Resistance Exercise on Bone Health - Hong AR, Kim SW. Effects of Resistance Exercise on Bone Health. Endocrinol Metab (Seoul). 2018;33(4):435-444. doi:10.3803/EnM.2018.33.4.435

Maximal Strength Training in Postmenopausal Women with Osteoporosis or Osteopenia - Mosti MP, Kaehler N, Stunes AK, Hoff J, Syversen U. Maximal strength training in postmenopausal women with osteoporosis or osteopenia. J Strength Cond Res. 2013 Oct;27(10):2879-86. doi: 10.1519/JSC.0b013e318280d4e2. PMID: 23287836.


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Skaneateles Conservation Area/Invasive species/Phellodendron amurense

Phellodendron amurense (Amur corktree) is a member of the citrus family (Rutaceae) from northeastern Asia.

Invasiveness ranking for Phellodendron amurense (Amur corktree)
Phellodendron amurense (Amur corktree) was ranked in 2008 as highly invasive with a score of 75/100 = 75%.

The NYS invasive species tier is 4 (local control), and the Finger Lakes tier is 2 (eradication).

Prohibited by New York State law.

1. Ecological impact (/)
1.1. Impact on Natural Ecosystem Processes and System-Wide Parameters:

1.2. Impact on Natural Community Structure:

1.3. Impact on Natural Community Composition:

1.4. Impact on other species or species groups:

2. Biological characteristics and dispersal ability (/)
2.1. Mode and rate of reproduction

2.2 Innate potential for long-distance dispersal:

2.3. Potential to be spread by human activities:

2.4. Characteristics that increase competitive advantage:

2.5. Growth vigor:

2.6. Germination/Regeneration:

2.7. Other species in the genus invasive in New York or elsewhere:

3. Ecological amplitude and distribution (/)
3.1. Density of stands in natural areas in the northeastern USA and eastern Canada:

3.2. Number of habitats the species may invade:

3.3. Role of disturbance in establishment:

3.4. Climate in native range:

3.5. Current introduced distribution in the northeastern USA and eastern Canada:

3.6. Current introduced distribution of the species in natural areas in the 8 NY PRISMs:

4. Difficulty of control (/)
4.1. Seed banks:

4.2. Vegetative regeneration:

4.3. Level of effort required:


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Exercise as it relates to Disease/Do specifically targeted exercise programs improve the symptoms of asthma in children?

What is the background to this research?
Asthma is a disease characterised by chronic airway inflammation, airway hypersensitivity to various irritants and airway obstruction. It is more common in children than in adults. Airway obstruction may be due to smooth muscle spasms of the bronchi and bronchioles, airway mucosal oedema, increased mucus secretion and/or damage to the airway epithelium.

Allergens are substances that trigger an allergic response. Common allergens that can trigger or aggravate asthma attacks include grass, pollen, animal fur, dust and certain food and drugs. Anxiety, stress, strenuous exercise (exacerbated by cold weather) and respiratory infections are among the most common variables.

The diagnosis of asthma during childhood is approximately 10-15% in the Netherlands; similar figures can be found in other countries within Europe and North America.

Asthma affects about 50-74% to nearly 90% of children, due to physical limitations they tend to avoid physical activity because of symptoms such as shortness of breath, also called exercise induced bronchoconstriction (EIB).

Where is the research from?
This study was conducted in the Netherlands by professors from various universities who worked in education and social science faculties, university hospitals and the Heideheuvel Asthma Centre.

Given that the prevalence of asthma is higher in children, the chosen study group is very appropriate as it included ages from late childhood to pre-teen (8-13 years). This can influence other researchers to use this information as a foundation for future studies of children from a similar age group and socio economic background.

A few of these same authors worked on other clinical research such as a Home Training Programme for Children with Asthma (1999), Scenario for the Physical Exercise Program for Children with Asthma(1999), Psycho-social and Physiological Effect of Physical Activity with Asthma (1994).

What kind of research was this?
This research was conducted under a randomised control trial (RCT). Involving 47 children of both genders, who were divided into two groups. A control group (n=24) and experimental group (n=23).

RTC is the most frequently used method to determine the efficacy of new interventions or treatment within a specific demographic. This form of research reduces the risk of bias while providing a precise technique for examining the relationship between an intervention and the outcome.

What did the research involve?
The intervention trial included forty seven (34 boys and 13 girls) asthmatic children ranging from ages 8 to 13 (mean 10.6). Nine children were recruited from the Heideheuvel Asthma Centre in HIlversum, Netherlands, 19 via a local newspaper advertisement and 20 from a special school [3]l. Only children with a clinical asthma diagnosis were recruited, either suffering from EIB, as defined by a drop of 10% in FEV1 after exercise (as determined by a physician), and/or fear of exercise. The severity of asthma was determined using a questionnaire through the classification of the Dutch Central Advisory Committee for Peer Review (CBO) concerning detection and treatment of asthma in children.

The following physical and psycho-social tests were conducted to ensure a range of thorough and accurate results: maximum incremental exercise test, endurance test, self-perception for children (CBSK), asthma coping test (ACBT), lung function and exercise induced bronchoconstriction test.

To compare data, the children were split into two groups of experimental (n=23) and controlled  and control (n=24). The experimental group received physical intervention in groups of 6-10 individuals and the controlled group received no treatment. They were assessed both before and immediately after each intervention. Physical Exercise Testing

The physical exercise program lessons consisted of 1 hour of gymnasium based activities. Beginning with a 10 minute warm up, followed by 20 minutes of fitness training (a) and 15–20 minutes of other physical exercises (b). Before and after the exercises, the children were provided explanations and information about asthma and exercise in order to improve their asthma coping behaviour.

Furthermore, twice a week group workouts for one 20-minute activity at home were implemented during a three-month period. Premedication, typically an inhaled ß2-agonist, was administered before training as indicated by the children’s paediatrician, and less frequent wheezing episodes were revealed by inhaling salbutamol.

Lung Function and EIB

Lung function was measured using a pneumotachometer and the exercise induced bronchoconstriction (EIB) was measured on a treadmill. It was hypothesised that there would be no significant changes in the lung function variables and EIB. The results shown below : The mean FEV1 /FVC, indicating the degree of obstruction, was in the normal range for both experimental (mean 0.84) and control (mean 0.87) groups.

Psycho-social Indices

A self-perception profile for children was used to measure perceived competence (CBSK). The test consisted of 36 items, each answer was scored between 1 = most competent and 4 = least competent 3.

Asthma coping test (ACBT) for children  of 8-13 years was conducted. It consisted of two factors: coping with asthma and it’s consequences daily life (25 questions) and the subjective attitude towards the illness and the amount of anxiety caused by asthma (18 questions). Reliability of the test was acceptable (Cronbach’s alpha was 0.72 and 0.80 for the coping scale and anxiety scale respectively).

However reliable these tests were, they showed no significant  improvement on the athletic competence from CBSK test.

What were the basic results?
Overall, the severity of the asthma may possibly have altered the intervention's effects. The findings revealed that the children in the study had mild to moderate asthma on average. A mean percentage fall at the pretest of 9% in the experimental group and 6% in the control group suggested that these children behaved considerably differently during exercise.

In contrast to the hypothesis, no significant changes were found on perceived physical competence (athletic competence) and self-esteem (global self-worth). This may have been due to the relatively high pretest scores, making average improvement difficult to attain. However, there was a tendency among boys in the experimental group to show a greater increase in athletic competence. Although the metabolic adaptation or efficiency of the cardiopulmonary system did not tangibly improve, the hypothesis suggesting the intervention would have a positive effect on physical condition was substantiated to some degree.

The variation of ways children were recruited for this study exposes potential risk for systematic bias, for example children from a special school for sick children were already in a circumstance which could have influenced their psychosocial state and their peer interaction. There were also no distinguishing differences on the pretest between the experiment and control group.

Furthermore, children in the experiment group had better overall health, were more competent with daily life activities, and had less anxiety about asthma.

What conclusions can we take from this research?
This study provided a wide variety of evidence based testing for children with exercise induced bronchoconstriction, where a comparison was drawn between two groups to deduce whether an exercise programme would enhance physical performance and psycho-social well being. Gathering all four tests, it can be concluded that using specifically targeted exercise programs  improve the symptoms of asthma in children. In light of potential benefits, children with asthma should be encouraged to avoid a sedentary lifestyle and instead engage in ‘life-time’ sports and consistent physical activity. As demonstrated in this study, the enhancement of coping abilities is therefore important to ameliorate the life standard for an asthmatic child.

Practical Advice
Children with medically controlled asthma may encounter restriction during physical activities, however are encouraged to engage in sports and exercise to enhance their coping abilities. Additionally, seeking a health professional for an asthma action plan is highly recommended and ensuring access to a full inhaler at all times.

Further Information/Resources
For further information and to educate yourself more about asthmas and its treatments, refer the following links.

 * Asthma Treatment - National Asthma Organisation
 * Asthma Management
 * Sports Medicine Australia
 * Anxiety: 9- 18 years

The Helpline 1800ASTHMA, can be used for support, questions or concerns in regards to the chronic disease.


text: User talk:114.179.44.208

title: User talk:114.179.44.208


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User:TootsieRollsAddict

I edit on Wikipedia and Fandom, what'd you expect?? Huh.

Wikimedia Foundation copyright law is BS

title: User:TootsieRollsAddict


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Exercise as it relates to Disease/How swimming helps children with asthma and other illnesses

This page is the critique of the journal article Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma written by Matsumoto I et al.

What is the background to this research?
Asthma is quite a common condition due to chronic inflammation of the lower respiratory tract. Chronic lower airway inflammation is known to be more common in individuals that also have inflammatory disorders of the upper airway. Asthma is distinguished by chronic inflammation of the airways in which there is an accumulation of eosinophils, mast cells, and activated T helper lymphocytes. These inflammatory cells release facilitators that then trigger bronchoconstriction, mucus secretion, and remodelling. . Globally, over 300 million people suffer from asthma.

Despite the fact that exercise is a contributing factor to triggers one’s asthma/exercise induced asthma and exercise induced bronchospasm, there is an increase in evidence that regular exercise combined with aerobic and anaerobic conditioning, can reduce the frequency and severity of all. Swimming is a common pastime activity and competitive sport for those who suffer from respiratory issues such as asthma. Review of available studies and research show that swimming induces less bronchoconstriction compared to other sports.

Several studies have shown that people who suffer from asthma, and other respiratory issues,  can improve their quality of life by participating in physical conditioning programs. Swimming is widely accepted in the community and is the form of exercise that is most commonly prescribed to suffers of asthma and other respiratory issues as it does not trigger and aggravate the symptoms compared to land-based exercises.

This study is important as asthma effects many children in the world.

Where is the research from?
This research was published at the Fukuoka University in Japan. The Research undertaken was done by multiple people at two locations; I Matsumoto, H Araki, K Tsuda, H Odajima and S Nishima were apart of the Division of Paediatrics located at the National Minami Fukuoka Chest Hospital, and Y Higaki, M Tanaka, H Tanaka and M Shindo were apart of the Laboratory and Exercise Physiology, School of Physical Education.

I Matsumoto is the correspondent for this article. All researchers appear to be appropriate and have produced a factual article.

What kind of research was this?
This was a randomised test where the test subjects were randomly allocated to a training group or a control group. The test subjects did not differ with respect to age, height, pulmonary function, or frequency of acute asthma attacks. This present study was undertaken to determine whether swimming training improves aerobic capacity and whether this truly results in less asthmatic symptoms in the test subjects, and in less exercise induced bronchoconstriction or whether apparent protection from exercise induced bronchoconstriction is simply due to an increased exercise capacity.

What did the research involve?
16 children with asthma diagnosed according to the ATS criteria who had been admitted to hospital for treatment for asthma participated in the study. All had severe asthma when admitted to hospital and the asthma attacks were controlled by treatment as an impatient. None were prescribed oral steroids. . As mentioned previously, the 16 children were randomly allocated into a training group or control group with eight in each. Their asthma medication was not modified during the duration of this study. The study was performed during autumn when allergic stimuli were minimal and when the children were free from asthma or any respiratory issues.

The first tests conducted focused on determining the subject’s aerobic capacity. These included a cycling ergometer test and a swimming ergometer test which were conducted with a one-day interval between tests. The incremental cycle ergometer test started with 10-15W for four minutes. The workload was increased by 5-10W every four minutes until exhaustion. The incremental swimming ergometer test was performed in a heated indoor pool using a tethered swimming method. Subjects swam freestyle for two minutes, their position was kept constant, and a load was applied with a rope that was attached around their waist. The workload was initially 0.1-0.2kp and gradually increased  by 0.2kp every two minutes until exhaustion. . Heart rates were monitored, and blood lactate concentrations were measured to determine their lactate threshold. Their aerobic capacity was defined as the workload at their lactate threshold.

The evaluation of exercised induced bronchoconstriction (EIB) was performed using both the cycle and swimming ergometers using six-minute protocols. The workloads were set at 100%-175% of  their lactate thresholds. Forced expiratory volume in one second was measured immediately before exercise and again 5 and 15 minutes after. EIB was expressed as follows :

((pre-exercise – lowest post-exercise/pre-exercise) x 100)

What were the basic results?
The swimming training programs improved the aerobic capacity in all subjects significantly in the training group. In the training group, the workload increased by 0.26 (0.11)kp on average whereas in the control group, the increase was only 0.4 (0.11)kp. Similar results were shown in the cycle ergometer with an increase in aerobic capacity by 10.6 (4.5)W in the training group and by 3.8 (5.2)W in the control group.

What conclusions can we take from this research?
We can conclude that swimming can benefit children who suffer from asthma. By having an individualised program and setting the training intensity at 125% of the child’s aerobic capacity while increasing the intensity weekly, increase in aerobic capacity can be achieved with significant improvements. The increase in aerobic capacity resulted in a decrease in EIB when assessed before and after the training period. This and many other studies have provided evidence that swimming is very beneficial to children who suffer from asthma in many ways and can improve their overall quality of life.

Practical advice
For children suffering from asthma and other respiratory issues, the most appropriate actions to take would be:

 * Have an accredited swimming coach assess the child and make an individualised training program for them
 * Continue to take their medication
 * Train in a heated pool
 * Get advice from professionals in the industry
 * Train consistently
 * Be assessed weekly
 * Have a healthy and balanced diet

Further information/resources

 * The effects of a swimming intervention for children with asthmaresp_1
 * Swimming and Asthma Benefits and Deleterious Effects
 * Swimming attendance during childhood and development of asthma: Meta-analysis

 * Effects of swimming training on children with asthma
 * Is Swimming the Best Exercise for Children with Asthma?
 * Asthma and swimming


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User:JohnTengo

Wiki books on John Tengo page

title: User:JohnTengo


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Exercise as it relates to Disease/Effects of exercise on older military veterans With PTSD

This is a critical appraisal of the cited study below:

Hall K, Morey M, Beckham J, Bosworth H, Sloane R, Pieper C, Pebole M. Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD [Internet]. OXFORD Academic. 2019 [cited 14 September 2021]. Available from: https://academic.oup.com/biomedgerontology/article/75/11/2130/5606340?login=true [1]

What is the background to this research?
This study was an intervention for the group of veterans living with Post-Traumatic Stress Disorder (PTSD). [1] There is already some information about this, however further testing can increase accuracy and reliability. This is good to improve as the experiment is dealing with the physical and mental health of people.

This study is important because veterans live all over the world and it is respectful and shows appreciation to their sacrifices for society to understand the struggles they may be facing and how they can be helped to manage those problems. Knowing if something as simple as exercise could help them physically and perhaps mentally too then society would be able to implement services like active groups that are available.

Where is the research from?
The study was done by seven individuals with advanced qualifications. Katherine Hall, Miriam Morey, Jean Beckham, and Hayden Bosworth all have a PhD. Richard Sloane has an MPH, Carl Pieper has a D.Ph. and Michelle Pebole has an MA. [1] These individuals are all based in North Carolina, USA. [1] The large military in the United states could be something that encouraged the study to take place.

What kind of research was this?
This experiment was a randomized controlled trial. It randomly assigned participants to either a supervised exercise group or the usual wait-list care.

Other studies on similar topics have had similar findings in their results [2] [3] [4], strongly supporting that the results gained from the studies should be applied to help others.

What did the research involve?
After the participants met eligibility for the study they were split into either a supervised exercise group or the usual wait-list care with a 2:1 ratio. The exercise group were supervised through three weekly 90 minute sessions including aerobic, resistance, flexibility and balanced based training. The wait-list group continued to go to their usual medical professional appointments however did not receive exercise training throughout the 12 week duration of the study. At the start and end of the 12 weeks all participants took place in a series of tests to compare progress afterwards. The primary outcomes included the self reported physical activity level, aerobic endurance. The secondary tests included physical performance, health-related quality of life and cardiometabolic risk factors. [1]This was an effective way to conduct this experiment. A limitation of this experiment, which is very difficult or even impossible to accomplish, would be to study the reaction of each individual's mental health to the prescribed exercise and find a way to measure his overall mental health and PTSD state, not just an estimation. This would help to know for sure the overall health of each individual.

What were the basic results?
The study showed that the veterans in the exercise group exercised over 400% than they usually did, due to the supervised training sessions. They also had an increase of 15% on the aerobic test. [1] The wait-list group only increased in physical activity levels by only 90% during the study, and only had a 2% increase in their aerobic test results. Both of these are far less than the exercise groups results. [1] There were also significant changes cardiometabolic risk factors, physical performance and health-related quality of life all in the exercise groups favour. [1] The supervised exercise was showed to be highly beneficial and encouraged to all veterans suffering from PTSD not involved in a supervised training program. This was communicated clearly and concisely by the researchers. They showed they had a clear purpose, and set out to efficiently test what they wanted to prove, and they did that effectively.

What conclusions can we take from this research?
The study was well done, providing a clear experiment with clear results, and this was seen in the concise nature of the conclusion. It also provides a next step of how the finding can be applied when it mentions exercising in groups being a good option for the future due to it's low cost and is beneficial to PTSD suffering veterans.

As this study is one of the most recent pieces of research in this field, it is difficult to show what newer experiments are being found. Some insight can still be gained from other studies from the same time and comparing results. As previously mentioned, some other studies from around the same time all have similar results, therefore giving confidence to their findings, and thus their applications moving forward. [2] [3] [4]

Practical advice
The clear application of this study in the future is the implementation of active groups which either are welcome and adjusting for veterans or exclusive groups for veterans to exercise and have the benefit of being kept accountable. Due to most veterans in society today being older, exercise groups need to have different fitness levels, or be accountable to all. Aerobic exercises, balance exercises, controlled resistance exercises and flexibility exercises are encouraged to be included in these groups as they are less threatening of injury and still provide the benefits of exercising.

It is important that everyone completes a pre-exercise screening before engaging in physical activity.

Further information/resources
Some similar studies are listed below:

 * Ley C, Barrio M, Koch A. “In the Sport I Am Here”: Therapeutic Processes and Health Effects of Sport and Exercise on PTSD - Clemens Ley, María Rato Barrio, Andreas Koch, 2018 [Internet]. SAGE Journals. 2017 [cited 14 September 2021]. Available from: https://journals.sagepub.com/doi/full/10.1177/1049732317744533 [2]
 * Babson K, Heinz A, Ramirez G, Puckett M, Irons J, Bonn-Miller M et al. The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD [Internet]. ScienceDirect. 2021 [cited 14 September 2021]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1755296615000022casa_token=Hb5kYeBFStoAAAAA:yfya5VbQAg-hdFSWtZq6ORdvHXCV0jn8oyLhbDqkAH8qrJyqtONfmIcmsq6-SRn6lywWkRtIyQ0 [3]
 * Stubbs B, Vancampfort D, Rosenbaum S, Firth J, Cosco T, Veronese N et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis [Internet]. ScienceDirect. 2017 [cited 14 September 2021]. Available from: https://www.sciencedirect.com/science/article/pii/S016517811630909X [4]

Support services are also available for mental health. Below are some helplines in Australia:

 * Beyond Blue: https://www.beyondblue.org.au/ [5]
 * Better Help: https://www.betterhelp.com/ [6]
 * Trusted Clinical Services: https://trustedclinicalservices.org.au/ [7]


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Exercise as it relates to Disease/Exercise and its effects on cardiovascular disease

Ho SS, Dhaliwal SS, Hills AP, Pal S. The effect of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial. BMC public health. 2012 Dec;12(1):1-0.

What is the background of this research?
Cardiovascular disease (CVD) is one of the leading causes of illness and death in the world, accounting for 31% of mortality. As alarming as these numbers are, the World Health Organisation has estimated that over 75% of premature CVD can be stopped. Hypertension, diabetes, obesity, smoking are known factors to increase the risk of CVD. Studies in the past have shown links to exercise and a reduction in CVD risk factors. Finding ways to reduce the damage of this disease will have a real-world impact, helping to save lives and improve the quality of many lives too. This study aimed to compare health benefits associated with aerobic, resistance, or combination training as it related to CVD. The study conducted a 12-week training program in which participants would be placed into three groups (aerobic, resistance, combination of the two). The aim is to see how different exercise interventions would impact the health and weight of the participants.

Where is the research from?
This research was registered with the Australian New Zealand Clinical Trials Registry. Three of the four authors were from the Curtin University of Technology in Perth, Western Australia. The other author was from Griffith University in Brisbane, Queensland. Part of the research was funded by the Curtin DRG grant and ATN centre for Metabolic Fitness. Suleen Ho coordinated the trial and data collection, Andrew Hills assisted in writing the manuscript, Satvinder Dhaliwal focused on all statistics and analysing them and Sebely Pal designed and supervised the study.

What kind of research was this?
The research was a randomised parallel study, this means all subjects were placed in one of the four groups at random. It is a parallel design as there are more than two intervention groups, with there being three groups and a control group. This is also a form of primary research as the data collected for the study is from the authors themselves, although in their full report they reference several sources to support their research. It is quantitative research as the authors focus on statistical analysis from the data extracted rather than conducting surveys of their participants.

What did the research involve?
The research involved a 12-week training plan with 64 participants, the participants were randomly placed into one of the four groups. Group 1 was the control group (n = 16); Group 2 was the aerobic training group (n = 15); Group 3 was the resistance training group (n = 16); Group 4 was the combination group (n = 17). All participants were classified as overweight or obese individuals, the aim was to see how different forms of moderate-intensity exercise would impact their overall cardiovascular risk profile and weight.

What were the basic results?
There were large improvements in the combination group when compared to the control and resistance training groups. The aerobic training group also saw improvements but not to the extent of the combination group where the most significant change is seen in all areas. Cardio-respiratory fitness and fat loss were most prevalent in the combination group and to a lesser degree, the aerobic, minimal changes were seen in the resistance training group.

What conclusions can we take from this research?
A combination of resistance training and aerobic training provides the greatest health benefits in general, as well as provides greater cardio-respiratory fitness improvements. The authors took a deep dive to extract as much data as possible, this study can be taken seriously by the reader as the research is extensive. This was not just a basic look at weight change over 12 weeks, this was a deep dive into all physiological changes occurring in the body. Anthropometric measurements were taken in the form of DXA scans, BMI calculations, and several circumference measurements. Enzymatic colorimetric kits were used to measure serum triglyceride and total cholesterol. Plasma glucose and plasma insulin were also measured. A cardio-respiratory fitness test was conducted at baseline and again at 12-weeks to add another parameter to analyse. The authors took into account that the participants were mostly sedentary and unhealthy and conducted this fitness test on an Astrand-Rhyming Submaximal Cycle Ergometer. Would have been interesting to look at some surveys taken from baseline and at the end of the experiment, measuring overall mood change or some other form of qualitative data could provide a deeper insight.

Practical advice
The authors mentioned in the study design that all participants were asked to keep their food intake the same during the study, each participant had a food diary in which they were to write down exactly what they ate each day. One problem, the table of data showing the energy intake average of each group changed significantly from baseline, 8 weeks, and again at 12 weeks. Energy intake for the control group was initially much lower than the intervention groups, this could skew the data, if dietary intake were consistent across all participants the results may have varied. Studies have shown a link between particular food groups and an increased CVD risk. Highly refined carbohydrates and sugar-sweetened beverages have both been linked to increased CVD and type 2 diabetes risk. This would not be an easy study to organise however, relying on generally unhealthy individuals to adhere to a meal plan or prescribed macronutrients for months at a time would be difficult. The other variable would be ensuring everyone is at the right energy intake in regards to their size, people at the low end of the weight range should not be consuming as much as those on the high end, they would lose less weight and skew the data. By increasing the calories of each individual as their output rises, preventing weight loss, it would be possible to narrow down the true effect exercise has on CVD. If weight loss was the main factor in improving CVD risk factors then health professionals could focus more on the diet side rather than the exercise/overall output side.

Further information/resources
One further resource that provides an interesting study design is a randomised control trial that was addressing the effects of exercise during weight loss on bone health in older adults. Considerations could be made that even without exercise interventions, someone with cardiovascular disease (usually being overweight or obese) could improve their cardiovascular risk profile by being in a calorie deficit, leading to weight loss. This study had a stand-alone weight loss group which consisted of participants having their calories reduced to lose 0.3kg per week throughout the study, this group went along with the exercise intervention groups. Although this resource does not relate specifically to exercise and its effects on CVD, it aids as a tool to provide future studies with a research design to extract more valuable data on the topic.


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Exercise as it relates to Disease/Effects of swimming on children with asthma

This is a critique of Jeng-Shing Wang and Wen-Ping Hung's (2009) article The effects of a swimming intervention for children with asthma for the purpose of a 'Wiki Assessment' in Semester 2, 2021 at the University of Canberra for the unit; Health, Disease and Exercise.

Background Research
Asthma is a common paediatric respiratory disease that effects an individual’s airways making it difficult for them to breathe. As of 2007, approximately 300 million people globally had asthma with prevalence increasing 50% per decade. Within the same year 11% of children 6 to 7 years and 14% of children 13 to 14 years had reported the prevalence of asthma. Studies have shown that swimming is unlikely to provoke an asthma attack and can help increase lung volume, breathing technique, physical and psychological development, muscle tone and general fitness.

This study uses pulmonary function tests (PFT) to determine whether there is an association between pulmonary function and children with asthma. At the time of publishing there was minimal information on this topic but has since expanded.

This study looks to analyse the effects of a 6-week swimming intervention on PTF, peak expiratory flow (PEF) monitoring and severity of asthma in 30 children with asthma.

Where is the research from?
The study was conducted by Jeng-Shing Wang and Wen-Ping Hung.

Wang is a highly experienced researcher, who has published numerous articles since 1995. He currently is a part of the Department of Medicine in Taipei Medical University and specialises in chronic obstructive pulmonary disease. Many of his articles address rising respiratory diseases however are generally reproductions of previous literature with minimal new findings.

This study appeared to be Hung’s first published article. He is a part of the Department of Physical Education, Kaohsiung Medical University in Kaohsiung, Taiwan. From research it appears he has not published any further articles.

What kind of research was this?
This study is a randomised controlled study, investigating the effects of a 6-week swimming intervention on PFT, PEF monitoring and the severity of asthma in 30 children with asthma. Individuals within the experimental group (n=15) participated in three, 50-minute sessions per week. Individuals within the controlled group (n=15) received no specific intervention.

What did the research involve?
Children between the ages of 7 and 12 years, diagnosed with asthma according to the American Thoracic Society (ATS) criteria were invited to partake in the study. 30 children were enrolled and separated into an experiment and controlled group. The experimental group consisted of 10 males and 5 females with an average age, height and weight of 10 years, 141cm and 41kg respectively. The controlled group consisted of 10 males and 5 females with an average age, height and weight of 10 years, 136cm and 36kg respectively. Participants partook in three 50 minutes sessions consisting of a 10-minute warm up including breathing exercises, 30 minutes swimming training and a 10-minute cool down with breathing exercises. Swimming training for beginners started with kicking and experienced swimmers, freestyle and breaststroke.

There are several limitations within this study. Within no post intervention feedback, the researchers will have limited evidence that the intervention effected participants outside physical test results. This means they may not be able to conclude if the intervention has a positive effect on the participants social, emotional or cognitive development. The study uses complex terminology and can be difficult to understand if you are not educated within the field. A firm knowledge on research statistics and interpretation are needed. Understanding of chi-squared tests, two-tailed student t-tests, power, p values, confidence intervals, standard deviation and z-scores will aid in interpretation of data.

What were the basic results?
The following results were concluded,

-       Significant improvement (P < 0.05) in post-intervention FEV1, FEF50, FEF25-75 in the experimental group compared with pre-intervention test results.

-       There was no significant difference in post-intervention PFT results when comparing the experimental and controlled group

-       No significant difference (P < 0.05) between groups in PEF at baseline (224 L/min) however, there was significant improvement in the experimental group after 3 weeks (300 L/min, P < 0.05) and 6 weeks (330 L/min, P < 0.01)

-       In the experimental group there was a significant improvement (P < 0.05) in post-intervention PEF compared with baseline, which was not seen in the control group

-       Post-intervention there was a significant improvement (P < 0.05) in the severity of asthma in the experimental group compared to the controlled group. This could not be confirmed as data was not shown

The results concluded that there is a significant difference between respiratory parameters and severity of asthma in a 6-week swimming intervention. However, there was no significant difference between PFT parameters and a 6-week swimming intervention

Within the study, some conclusions seem over-emphasised. Wang and Hung concluded that there was significant improvement in emergency room visits, rate of hospitalisations, days absent from school, chest deformity, snoring and doctors’ visits following the program, yet no data was collected on these aspects. There may have been a positive association between these variables and children with asthma but with no reported data it’s only an assumption.

What conclusions can we take from this research?
From the study we can conclude that swimming has a positive association with decreased risk of respiratory factors that induce asthma. During swimming, the high humidity of inspired air induces less airway mucus build up as well as the high hydrostatic pressure to reduce expiratory effort and work. Through frequent contact with health professionals there was an improvement in asthma awareness and asthma control which saw an increase in compliance with asthmatic treatment. The results align with other literature.

PFT parameters at the conclusion of the intervention did not differ between the controlled and experimental group suggesting that there is no association with asthma. This may be due to the physical characteristics of the participants or the lack of respiratory efficiency. Generally, PEF results see a greater decrease in asthmatic effects on children than PFT results. The results align with other literature.

The severity analysis is subject to bias through the way it’s report. Those within the experimental group may rate severity lower as they expect to see improvement over the 6 weeks. Change could also be caused by external factors such as lifestyle change, time of year or medication compliance. The validity of these results should be questioned but is challenging as the data is not shown in the report.

The study suggests that swimming in a chlorinated pool may cause inflammation of the airways and increase the severity of asthma. This does align with other studies hypothesis however, the evidence in inconclusive. Similar studies conducted in chlorine pools have reported neutrophilic airway inflammation and noncellular inflammation are associated with airway dysfunction in swimmers. This suggests that the combined exposure to chlorine and exercise is presumably unrelated to eosinophilic ‘asthma-like’ inflammation. Further, specific study should be conducted to determine the association between chlorinated pools and asthma within children.

Practical Advice
-       Generally, a swimming program will improve variables associated with children with asthma greater than many other sports

-       Ask participants for direct verbal or non-verbal feedback to limit external factors and conclude if intervention impacted social, cognitive or emotional development

-       Further insight into impacts of chlorinated and non-chlorinate

-        Those with family history of asthma should look to get children into swimming as soon as comfortable

Further Information/Resources
General Information:

American Thoracic Society Guidelines

Exercise Associated with Asthma Control

Specific Information:

Effects of Swimming Training on Aerobic Capacity and Exercise induced Bronchoconstriction in Children with Bronchial Asthma

Effectiveness of Swimming on Lung Function and asthma Control in Children with Asthma

Pros and Cons of Chlorinated Pools and Risk of Asthma


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User:U3203075

What is the background to this research?
This specific article has focussed on the sport 'Football' or Soccer as some may call it within Europe. By looking deeper in the mental aspect of elite athletes and their sport, articles like this, show how important picking up these issues are and the benefits of performance after acting on these issues. This article studies the top footballers of Switzerland (male and female) in the first team league, as well as the under 21's team, and runs them through a depression, and anxiety test, looking for particular signs and symptoms of these two mental illnesses.

The vast amounts of pressure an elite footballer has to deal with must be hard to handle. Players are relied on to perform week in, week out in front of huge crowds which must be nerve racking. We know especially in the young ranks (under 21's & 23's) that various mental health issues arise in regards to performance, especially if playing for a major European club. Various factors could relate as to why players are suffering from mental illness, and this article may show why.

Where is the research from?
The organization this article was published by BMJ Journals, whom are a Sports & Exercise medicine based journal cite that cover a vide variety of the particular field but have a huge range of articles specific to physical activity for chronic disease prevention.

The authors have previous articles that have been focussed on injury prevention and psychology as well which is very similar to this particular article.

What kind of research was this?
This type of study was a 'questionnaire' based on the players characteristics with the questions falling under the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale.

Although there are a variety of tests to be completed for Anxiety and Depression, few articles have stated that these two questionnaires are good and basic, but true and proper results will come from the gold standard tests of that field.

What did the research involve?
Overlooking the method of this article, the questionnaires of both the CES-D and the GAD-7 scales were very characteristic specific. Both questionnaires asked the players questions relating to the playing position, number of matches and training sessions, number of injuries and frequency of intake of any medication (for pain, sleep, relaxation, depression, anxiety and others) within the last 12 months, as well as current injuries of the players. All players participated in both scaled tests. The CES-D was a self-reported questionnaire which looked at symptoms of Depression from the player over that past week. The GAD-7 however, measured the symptoms of Anxiety experienced in the past two weeks.

Both of these scales/tests have been deemed 'acceptable' for the general public, however ineffective with a isolated group in measuring Depression and Anxiety.

There have been many 'Gold Standard' tests for both Depression and Anxiety, which most have been compared in various studies. The Composite International Diagnostic Interview (CIDI), and the Patient Health Questionnaire-9 (PHQ-9) have both proven to gold standard for a Depression screening instrument. As for an Anxiety instrument, many tests have proven results, but as for the Zung scales, this instrument indicates and shows predictors more than the acceptable level.

Due to the study choosing Questionnaires to be the main instrument of diagnosis, there can be few limitations to the method. Questionnaires allow for the participant to answer in any form they feel, whether it being truthful of not, there can be times where participants will lie whilst answering the questions which leads to inconsistency of results. Another limitation to the study in general was the population, as this study looked at European teams (Switzerland League Teams), its a very country based population. Studies in various countries would help this study overall and boost results.

What were the basic results?
The main finding for the entire study was that the Swiss first team players were at the same risk of Depression and Anxiety as the general population. However, as for the male under 21's team, players had a higher prevalence of depression than the male general population. The study did show scores of the different positions play and their relationship to the scale. For the CES-D scale, results showed that players in an attacking position had a higher score than any other position on the team (male and female). For the GAD-7 scale, players of the Goalkeeper position scored higher than any other player (male and female).

Both scales had results for players playing in more than one position at different times, had a higher scale score than a player in one set position.

This was also the case of players being currently injured or not, stating that players are more likely to show characteristics of Depression and Anxiety whilst being injured.

What conclusions can we take from this research?
By how many elite footballers there were taking place in this study, there were bound to be results swaying towards high levels of depression and anxiety. The fact that the male U21's players scaled higher levels of depression was surprising. This could possibly be from pressure from managers, nervous in losing games, getting relegated or even just a lack of knowledge towards mental health and wellbeing. However, it is eye opening that specific positions show different levels of depression and anxiety.

Whilst similar authors of this study also completed the exact same trial in the Female German League, results show similarities in that depression and anxiety symptoms are influenced majorly by sport-specific variables such as player position, age and gender.

Practical advice
Someone's Mental Health and Wellbeing is a very serious thing and if not discovered, can be very serious. Especially for elite football players, playing a match every 4 or 5 days, coaches and staff of clubs would not like to see players in an unhealthy mental state.

The biggest thing clubs could do to help prevent these issues from arising is creating awareness on not just depression and anxiety but mental wellbeing as a whole. Clubs could consider:

 * Team talks with a psychologist (every week)
 * 24/7 professional assistance
 * Meditation sessions (daily)

By creating as much awareness as possible, the less likely for mental health symptoms to arise. To the athletes in need however, Adequate psychotherapeutic and/or pharmacological treatment should be provided ensuring that the athletes are going about these issues the correct way, which is seeking help or assistance professionally.

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Exercise as it relates to Disease/Physical activity and application of breathe technique during exercise effect on young children with cystic fibrosis

This article from 2012 articulates the study of a 6 week physical activity and physiotherapy observed program for young children children suffering from Cystic Fibrosis (also known as CF). This article aims to assess the physiological effects previously studied breathe techniques during exercise for children with CF.

What is the background to this research ?
Cystic Fibrosis is an incurable genetic disease which causes the body to produce excessive amounts of mucus in the lungs, due to this, individuals effected by CF find it more difficult to breathe due to the mucus blocking airways, as-well as a higher risk of infection due to the mucus in the lungs trapping bacteria without release.

This article assists in filling gaps in pre existing knowledge by bringing studied physiotherapist breathe techniques to assist individuals with CF to clear airways more efficiently and applying this during aerobic exercise when respiratory rate is increased. Thus, this study assists in providing evidence of effectiveness of breathe techniques to support existing studies.

More than 70,000 people are currently living with CF with the life expectancy of these individuals no greater than 38 years. With no current cure the staggering numbers show the severity of the pulmonary disease and the importance of more treatments assessed by studies to assist individuals with coping mechanisms.

Where is the research from?
The Study was conducted in Hacettepe University Medical Faculty of Child Pulmonary disease. This department in the University located in Turkey is one of the leading resources in pulmonary diseases in Turkey, following the Turkish Paediatric and Respiratory Diseases and Cystic Fibrosis Society.

Three of the four researchers conducting this study are a part of the department of Physiotherapy and Rehabilitation, with the final researcher being apart of the Child Pulmonary Disease Department at the university. Due to this article representing the students PHD research at the university, the standard of this article must be delivered at a high standard. All researchers have experience in the field demonstrated through multiple studies already published in the field go physiotherapy, exercise and respiratory functions in individuals with chronic diseases.

The article was published by the Italian Journal of Paediatrics, this is important to mention as this assists in increasing the validity of the study conducted. The Italian Journal of Paediatrics Provides high-grade research and up to date research in public health and paediatrics. known for its highly commended reputation over an extended period of time (since 1975).

What kind of research was this?
This study was quantitative research assessing several variables in the relationship to the study question conducted as an uncontrolled longitudinal study.

An uncontrolled longitudinal study is a case series study in which researchers observe the effects of an intervention on the whole cohort with no control group. The results from an intervention are analysed via identical pre and post intervention assessment where the results are compared to draw a conclusion.

This study design is beneficial for this type of intervention as it assists in deciphering the effectiveness of the intervention through the change in results between pre and post intervention assessment. This is valuable for researchers due to CF having a vast range of severities, which, would create more bias if the results of the intervention were compared to a control group.

What did the research involve?
For the study, 20 children with diagnosed cases of CF aged 8.25 ± 2.77 years contributed in a pre intervention requirement to ensure the individuals capability to exercise with low risk factors. The individuals conducted a max force expiratory volume test (FEV1) and were required to reach 35% or greater capacity to participate in the study. Of the 20 children 4 did not meet the requirement.

16 individuals remained in the study and were subject to a series of pre intervention testing which included; The individuals were then put through a six week training intervention in which participants were to train three times a week. Each session involved a series of breathing techniques administered by physiotherapists whilst assessed at 80% aerobic capacity for 30 minutes on a treadmill. All participants were monitored via regular blood pressure, ECG analysis and heart rate measurements.

At the end of the six week intervention all pre intervention tests were then repeated and data was used in comparison to pre intervention results.

In the instance of evaluating the effects of the six week intervention on the subjects, the use of pre and post testing methodology on all participants whom all have contributed to the intervention deemed a successful approach, however did bring limitations.

The type of research design used in this study may bring forward bias, this can be perceived with the limited range of subjects and no consideration of severity levels of CF between each individual.

What were the basic results?
The data from the results was analysed through a statistical analysis and data was represented by researchers as a mean ± standard deviation, using a significance level which stated if the p value was greater than 0.05 there was no significant difference between pre and post intervention results and if the p value was less than 0.05 it suggested there was a significant difference observed.

The basic results displayed that in regards to the parameters of physical fitness and chest circumference there was a significant difference observed.

On average, chest circumference increased via 2 cm in all fields, standing long jump showed a 9cm increase, 20 meter sprint time decreased by .81 seconds, 10-step ladder time decreased by 2 seconds and aerobic training capacity during the bruce protocol significantly improved in all parameters (blood pressure, ECG, heart rate).

What conclusions can we take from this research?
The researchers conclude that with the supervision and prescription of breathe techniques by health professionals during exercise, children with CF will have an increase in physical fitness. Although not mentioned in the conclusion of the article, a greater insight into increase in axilla, subcostal and epigastric chest circumference is essential in the benefit of individuals suffering with CF.

These findings are supported by other research found in the Italian Journal of Paediatrics and specifically by the authors of this article Ugar Ozcelik, due to similar research published via the author which include individuals with CF.

Practical advice
This type of research design could have been better with a reduced level of bias by implementing a control group to participate in the study. This would give the researchers another aspect to compare results to rather than just comparing pre and post results of the intervention to draw a conclusion.

Considerations such as correct breathing techniques and exercise delivery only from a registered physiotherapist or health professional should be taken into account for individuals with CF. this is due to the high health risk levels that individuals with CF pose when undertaking exercise.

Further information
For further readings that may interest and benefit individuals with CF and/or the further education and awareness of physical therapies for CF, it would be recommended that the article found at https://www.resmedjournal.com/article/S0954-6111(05)00519-6/fulltext may prove beneficial.

Articles by the Italian Journal of Paediatrics also assist in the further of evidence based information relating to Paediatrics, pulmonary disease and cystic fibrosis.


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Exercise as it relates to Disease/Investigating the effects of Resistance Training on Crohn's disease clients regarding the prevention of early mortality

1.What is the background to this research?
Crohn’s Disease (CD) is an inflammatory bowel disease (IBD) where nutrients are not effectively absorbed in the digestive system which could lead to pain, discomfort, diarrhoea, malnutrition and a stoma (perforation of the bowel). This article conveys that Resistance Training (RT) may be a solution, by enabling microtears in the muscle allowing the body to repair itself and attain muscle and bone strength to prevent falling, osteoarthritis, osteoporosis and sarcopenia. Calcium is lost from exercise (eg. sweat), and with minimal absorption, calcium is stripped from bones to maintain blood calcium levels. Therefore physical activity contributes to bone loss.

Benefits from RT involve an increase in: neuromuscular connection, potential gut microbiome, muscle mass, movement control, cardiovascular health, cognitive abilities and reduced body pain. Other studies depict aerobic exercise to decrease susceptibility and inflammation of the bowel. To contrast, high intensity and prolonged exercise increases the stomach lining’s surface area, allowing large particles through causing a stoma. CD clients undergo a social and emotion toll, through discomfort and fatigue problems arising from a cytokine inflammation response.

2.Where is the research from?
Researchers Jones, Baker, Speight, Thompson and Tew conducted research from Northumbria University United Kingdom, and PROcare ApS Denmark; delving into the study between CD and RT. Jones and Baker have articles together and independently in the fields of RT and CD released in the last few years. Dr. Speight specialises in Inflammatory Bowel Disease (IBD). Working in Newcastle, Thompson studies IBD, CD and has published literature in the area since 1995. Professor Dr. Tew is an exercise scientist, focusing on CD in the last few years. The article states that there are no associated funding biases.

3.What kind of research was this?
The experiment was a blinded Randomised, Control Trial (RCT), which is a validated method of experimentation. Being blinded meant the participants did not know whether they were in the control group, or the experimental group. Randomised meant the clients were chosen at random based on who accepted the offer to participate. The article was published recently in an ongoing field of supporting literature.

4.What did the research involve?
Applicants had to have a mildly active disease indicated on the Crohn's Disease Activity Index (CDAI). All participants (male and female) were Caucasian (mean age 49) and were given the same care. The experiment was well described using a simple chart consisting of participants who were eligible, withdrew, randomised and were checked after 3 and 6 months .Supervised exercise frequented at the start (2+ sessions/week), less frequently toward the end, but participants were checked upon via telehealth phone call for motivation and support. Participants were given equipment needed for the exercises. Outcomes assessed include upper and lower body muscle function, body mass, stature, resting blood pressure and heart rate, quality of life questionnaire, fatigue (IBD fatigue scale), physical activity questionnaire and enjoyment scales and medications. Bone Mass Density (BMD) was tested at base line and 6 months only at hip and lumbar spine using Dual Energy X ray absorptiometry (DEXA) machine. This methodology was well laid out in detail, except for the specific exercises which were completed by the participants. The study could not be completely replicated because of non-specific targeted exercises being done, which impacts the results. Participants had no knowledge of which group they were in, thus proving internally valid. The data supplied in results were accurate and well described. The p-value was set at 0.05 and the statistics were well presented in tables, regarding the specific test and the result.

5.What were the basic results?
Muscle function outcomes increased significantly, along with grip strength as portrayed in the table and table summary. Also, a significant increase in lumbar spine and greater trochanter for the BMD for the experimental group. Findings were explained in the discussion and supported with connected evidence. The experimental group experienced positive effects of physical activity, reported in increased enjoyment of life results, which surprised researchers. The resting heart rate was lower in this group(-6bpm) understandably, given the adaptation to the exercise volume. Fatigue was overall lowered at the 6-month period. Participants in the control group had a slight deterioration in health; found in a case of light headedness, disease flare up and disease relapse. Supervised exercise had more participation than non-supervised.

6.What conclusions can we take from this research?
The conclusion portrayed CD participants increased BMD and muscle function by RT. Therefore RT is suitable for preventing fractures from falling and age-related diseases such as sarcopenia and osteoporosis, osteoarthritis etc. Accuracy was measured using a DEXA scanner and multiple muscle strength and functionality tests. The basic level of prescription (PROTECT system) was sufficient to incur positive results. Fatigue was an influential setback, which affected personal and work-life balance. More exercise increased mobility and strength of muscles which lead to less fatigue and more daily activity. The written conclusion may have limitations and does not guarantee the prevention of diseases, due to genetic variation and differences in Basal Metabolic Rate. However, to disregard the findings altogether is untrue due to its supported evidence in the field. Greater understanding on CD with RT could come from other demographics and more control of food and lifestyle factors. DEXA did not consider bone quality (microarchitecture) ,or composition.

7.Practical advice
When RT CD clients, show caution to prescribing load and volume, due to abdominal inflammation during exercise. Supervision portrays accountability and allows clients to be motivated and inspired. When home exercising, limitations need to be known beforehand, so effort is made to minimise injury and further illness. Group exercise with the CD community is good for monitoring intensities of exercise with supervision and minimal risk involved. During COVID-19 online classes are a viable method of exercise. When prescribing a routine, progressively apply resistance and load when the client feels applicable, considering necessary fatigue and energy levels due to lifestyle, behaviour and motivation. Prescription should be individualised.

8.Further information/resources
Other materials suggest that even low grades of impact exercise can also stimulate the growth of BMD in CD clients. RT can help and promote overall good health in CD clients who suffer from bowel inflammation due to exercise. Some benefits of exercise can even promote better gut health and alleviate discomfort in CD. Further research is needed to consolidate findings among different demographics. Research could be done into a correlation between the mind – gut axis with CD and RT.

9.References
1.[https://onlinelibrary.wiley.com/doi/10.1111/apt.16002 Jones K, Baker K, Speight RA, Thompson NP, Tew GA. Randomised clinical trial: combined impact and resistance training in adults with stable Crohn's disease. Alimentary pharmacology & therapeutics. 2020;52(6):964-75].

2.[https://academic.oup.com/ecco-jcc/article/3/4/225/471064?login=true Perez Pérez CA. Prescription of physical exercise in Crohn's disease. Journal of Crohn's and Colitis. 2009;3(4):225-31.]

3.[https://journals.lww.com/acsm-csmr/Fulltext/2012/07000/Resistance_Training_is_Medicine__Effects_of.13.aspx Westcott WL. Resistance training is medicine: effects of strength training on health. Current sports medicine reports. 2012;11(4):209-16].

4.[https://www.sciencedirect.com/science/article/pii/S0016508598703622 Robinson RJ, Krzywicki T, Almond L, Al–Azzawi F, Abrams K, Iqbal SJ, et al. Effect of a low-impact exercise program on bone mineral density in Crohn's disease: a randomized controlled trial. Gastroenterology. 1998;115(1):36-41].

5.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322027/ Papadimitriou K. Effect of resistance exercise training on Crohn’s disease patients. Intestinal Research. 2021;19(3):275].

6.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319130/ Minderhoud IM, Samsom M, Oldenburg B. Crohn’s disease, fatigue, and infliximab: is there a role for cytokines in the pathogenesis of fatigue? World journal of gastroenterology: WJG. 2007;13(14):2089].

7.[https://www.sciencedirect.com/science/article/pii/S0140673604176708 Rothwell PM. External validity of randomised controlled trials:“to whom do the results of this trial apply?”. The Lancet. 2005;365(9453):82-93].

8.[https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01739-z Lamers CR, de Roos NM, Koppelman LJM, Hopman MTE, Witteman BJM. Patient experiences with the role of physical activity in inflammatory bowel disease: results from a survey and interviews. BMC Gastroenterology. 2021;21(1)].


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Exercise as it relates to Disease/Exercise and the mind: the psychological benefits of exercise

The critique of the research article: Edwards S. Physical Exercise and Psychological Well-being. This critique was undertaken as part of an assignment unit Health, Disease, and Exercise (8340) at the University of Canberra, during Semester 2 of 2021.

What is the background to this research?
The world health organisation (WHO) determines health to be in a state of complete physical, mental and social well-being. A mental illness can be defined as ‘a clinically diagnosable disorder that significantly interferes with a person’s cognitive, emotional or social abilities’ (COAG Health Council 2017). The term itself covers a range of illnesses including anxiety disorders, affective disorders, psychotic disorders and substance use disorders. In 2007, nearly 1 in 2 (46%) Australians aged 16–85 had experienced a mental disorder during their lifetime and 1 in 5 (20%) people who had experienced a mental disorder in their lifetime had symptoms in the 12 months before the survey interview. Physical exercise may be defined as a subset of physical activities that are planned and purposeful attempts to improve health and well-being.

In the past the relationship between exercise and physical well-being has been well researched and its only recently that more research has been done around relating exercise to mental well-being. This research paper compares the psychological well-being of health club members compared to university students.

Where is this research from?
This research was performed at the Zululand University, South Africa by Stephen Edwards. The exercise group were members of a local South African health club. Stephen Edwards was the head of the psychology department at the Zululand University from 1982-2007. He was involved in many research papers that have been presented at world conferences. Stephen now has a Professor Emeritus status, which is given to those retired who have made significant contributions in their specific field.

What kind of research was this?
This study was a longitudinal cohort study. Longitudinal studies are studies that are done with the same group of people for an extended period of time and cohort means that they are grouped based on a particular characteristic. The advantages of longitudinal studies are that they allow observers to see changes over time. The disadvantages of longitudinal studies are that they can be expensive and that participants are likely to drop-out.

What did this research involve?
This research involved comparing the psychological well-being of University students and 26 health club members. A well-being profile was developed for each of the participants using various well-being components including mood, lifestyle, satisfaction with life, sense of coherence, fortitude, stress management, coping and total well-being score. These components were defined as

 * Mood: Respondents were required to evaluate their current feelings on a five-point scale with regard to six positive and six negative mood states. Negative moods included feeling anxious, depressed, confused, angry, fatigued and stressed. Positive moods included feeling energetic, confident, happy, healthy, being in control and strong.
 * Lifestyle: Respondents were required to affirm or deny seven habits associated with health (Noakes & Granger 1995). These included regular exercise, regular eating, eating breakfast, sleeping, smoking, drinking and being over- or underweight.
 * Satisfaction with life: The scale required respondents to make cognitive judgements, rather than affective responses, as to their global satisfaction with their quality of life.
 * Fortitude: The Fortitude scale was developed and standardised in South Africa by Pretorius (1998) and consists of 20 items, reflecting three subscales labelled self-appraisals, family appraisals and support appraisals.
 * Stress/ Stress management: The Holmes and Rahe (1967) social readjustment scale requires respondents to indicate their current experience of stress in terms of commonly occurring life events.
 * Coping with stress: This component consisted of 15 items reflecting typical reactions to stress which respondents were required to confirm or deny.

Some limitations from this research are:

 * The sample size of 26 is a small group. This may not be a true reflection of the broader population.
 * The exercise was only performed in a health club setting. This means it hard to determine if exercise outside of that setting would be as effective or effective at all in improving mental well-being. Not everyone can afford a gym membership either limits the application of these results.
 * The participants from the health club were generally determined to have better psychological well-being prior to the research so the results indicate that regular exercise is great at preventing mental illness but cant determine that it will have the same effects in treating individuals that already have a mental illness or a psychological unwell.

What were the basic results?
The components of well-being were all positive and low to moderate, ranging between 0.09 and 0.5, indicating that the seven components, though related, were sufficiently independent. Analysis of variance of well-being components of health club members and university students indicated that health club members were significantly more psychologically well than students, especially due to their healthier lifestyle, decreased stress and improved coping.

The table below shows the pre vs post and t-test statistic.

A t-test is used to to determine if there is similarities between the means of two groups. A p-score >0.05 indicates there is a significant difference between the two. As seen in the table above mood, sense of coherence, fortitude, stress and coping with stress all saw massive differences. Stress saw the biggest drop which is great as this is a major determinant of psychological illness.

What conclusions can be made from this research?
We can conclude that health club members are have a higher psychological well-being then university students. However this result may have been influenced by the fact that the health club members regularly participated in physical activity prior to the test. The results from this research suggest that physical activity may be correlated with preventing mental illness but not necessarily as a treatment option.

Practical advice
Further research needs to be done to determine if regular physical activity can be used as a treatment option for individuals that are already suffering from a mental illness. Also determining if different forms of physical exercise are also as effective as health club memberships are not affordable for all, especially those with low SES which is also linked to higher levels of stress.

Further resources

 * 1) Further research
 * 2) Exercise for mental health
 * 3) Beyond Blue


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Exercise as it relates to Disease/Can physical activity and decreased sedentary behaviours reduce associated symptoms of ADHD?

This is a critique of the article titled 'Association of Symptoms of Attention-Deficit/Hyperactivity Disorder with Physical Activity, Media Time, and Food Intake in Children and Adolescents' by van Egmond-Fröhlich A, Weghuber D, de Zwaan M

What is the background to this research?
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder, often characterized by inattention, hyperactivity and impulsivity. ADHD is often diagnosed in childhood but symptoms can last well into adulthood, if left untreated can interfere with social and emotional as well as education and work. Children and adolescents with ADHD often show increased physical activity during the night and more evidently during work or school. Additionally children and adolescents are seen to be less likely to engage in vigorous physical activity and organized sports on a regular basis. Higher TV exposure is consequently met with higher rates of sedentary behavior, viewing of advertisements of high energy snacks as well as the consumption of said energy dense foods. Cross sectional studies have linked inattention and symptoms of ADHD to higher levels of media time successfully linking higher media times as a risk factor for subsequent inattention problems. Although there are many studies linking ADHD and obesity, there are few studies that draw associations between energy balance factors such as increased sedentary behaviors as well as decreased sedentary behavior, demonstrating the need for further studies in the area.

Where is the research from?
The study was published on November 14 2012 by:

1 Andreas W. A. van Egmond-Frohlich of the Department of Pediatrics, SMZ-Ost Donauspital, Vienna, Austria.

2  Daniel Weghuber from the Department of Pediatrics, Paracelsus Private Medical School, Salzburg, Austria.

3 Martina de Zwaan Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany.

The researchers declared there were no competing interests.

What kind of research was this?
The research conducted was a cross sectional population survey named KiGGS. The Robert Koch Institute of the Federal Ministry of Health has been running the ‘German Health Interview and Examination Survey for Children and Adolescents’ or KiGGS since 2003. The survey has collected comprehensive health data used to formulate health decisions federally as the cohort data is seen to represent the country as a whole.

What did the research involve?
The study involved 17641 adolescents and children aged 0-17 derived from 167 German communities. Data on screen time was collected via self reports and parental reports on average weekday screen time as well as average weekend screen time. Additionally, physical activity was also collected via self reports for medium to high intensity physical activity, this was measured in the questionnaire by the amount of time they really started to sweat or were out of breath.

Potential parental confounders were selected on their high Strengths and Difficulties Questionnaire as well as overweight status indicated by a previous study from the same database. In order to confirm these a general linear model was conducted with high Strengths and Difficulties Questionnaire candidates and the possible parental confounders as independent variables. Then an examination was undertaken in order to determine that possible parental confounders were independently linked to health behavioral outcomes. Health behavior outcomes were examined with the high Strengths and Difficulties Questionnaire scores with sex and age. All of the analysis and P values were found via SPSS statistics software.

What were the basic results?

 * The results of analysis found that of the children 5.2% were obese and 15.1% were overweight according to BMI scales.
 * conduct problems, emotional problems, peer problems, prosocial behavior were statistically notable with  high Strengths and Difficulties Questionnaire.

 * Higher prevalence of medium to high intensity physical activity and total energy consumption were negatively correlated with behavioral outcomes.

What conclusions can we take from this research?
The study showed significant correlation between ADHD symptoms with low diet quality as well as high total caloric intake. Additionally it found that food quality was more closely correlated with these behavioral symptoms more than food volume indicating that these symptoms are more to do with food selection. Moreover females demonstrated a significantly stronger correlation with dietary quality and volume with ADHD symptoms than males. The study also confirmed an independent association that  increased media time can consequently cause ADHD symptoms, another study finds a dosage of one hour or more had increased association with inattention and hyperactivity. In terms of physical activity the study found a weak but positive correlation with medium to high intensity exercise and the behavioral symptoms of ADHD.

Practical advice
In order to decrease ADHD symptoms among children and adolescents the children should eat a balanced diet including high in vitamins, minerals and other nutrients along with low amounts of unnecessary fats. Next limiting screen time to less than an hour on weekdays. Both these factors have been shown to decrease the behavioral symptoms of ADHD. Furthermore, extensive longitudinal research is needed to understand more comprehensively ways to decrease the symptoms of ADHD among children, adolescents and adults.

Further information/resources
The following links provide information and fact sheets about ADHD:

 * 1) Attention Deficit Hyperactivity Disorder (ADHD) in Children
 * 2) What is ADHD - ADHD Australia?
 * 3) Attention deficit hyperactivity disorder - ADHD/ADD symptoms, causes and diagnosis | health direct
 * 4) What Is ADHD? Where can I get help for ADHD in Australia? - ADHD Foundation


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