Epidemiology of injury in male Irish secondary school adolescents in one academic year.

BACKGROUND:Establishing the incidence of injury is the first step in initiating injury prevention strategies. There is a lack of research on injury in Irish adolescents and this study paves the way for further injury prevention research, by implementing a prospective cohort study. PURPOSE:To establish the epidemiology of injury in male adolescents in Irish secondary schools in one academic year. METHODS:452 male 4th and 5th year adolescents (aged 15.62±0.70 years) took part in a prospective epidemiology study for one academic year. Any injury sustained during training or competition resulting in restricted performance or time lost from play was assessed weekly by an athletic rehabilitation therapist. An injury report form was completed to ensure standardisation of the injury description. RESULTS:5.16 injuries per 1,000 hours were noted, with 35.6% at risk of injury and 27.9% of injured participants at risk of sustaining another injury that school year. Competition injuries (16.91 injuries per 1,000 hours) were more common than training injuries (2.63 injuries per 1,000 hours). Lower limb injuries predominated (73.1%) with knee (17.9%), ankle (13.5%) and hamstring (11.7%) injuries most common. Strains (29.4%), sprains (20.8%), fatigue-induced muscle disorder (14.5%) and contusions (13.1%) were frequent. Injuries were primarily minor (0–7 days) (41.6%), followed by severe (>22 days) (39.7%) and moderate (8–21 days) (18.7%). CONCLUSION:Injuries are common in adolescents in Irish secondary schools and the development and implementation of injury prevention strategies are required

Uptake to a community based chronic illness rehabilitation programme (CBCIR): Is there a gender disparity?

Background: Multi-morbidity and chronic conditions pose a threat to population health. Despite known benefits of rehabilitation using structured exercise, uptake to such programmes remain sub-optimal. The aim of this study is to identify the psychosocial and health related fitness correlates of uptake to a CBCIR in men and women, with the secondary aim of identifying the rate of uptake. Methods: Participants referred to a CBCIR via GPs and hospitals completed an induction process. This introduced them to the CBCIR programme and got them to complete a multi-section questionnaire (including instruments on physical activity, exercise self-efficacy, intentions for exercise, and perceived family/friend social support) and complete a battery of physical health measures (including the Incremental shuttle walk test (ISWT), a lower body strength test and body mass index (BMI)). Post induction participants who attended an exercise class were classified as ‘Uptakers’, whilst those who never came back were classified as ‘Non-Uptakers’. Class attendance was objectively monitored by the researchers. Data were analysed using SPSS, and are presented using means, standard deviations and proportions, group differences are examined via t-tests and logistic regression was used to predict uptake. Results: A total of 441 participants (56% male; average age 64.3 ±12 years completed induction measures. Overall, 77% were identified as Uptakers (81% female, 74% male, p=0.068, 2-sided). Among men, Uptakers reported more days of 30mins moderate to vigorous physical activity (t(111) = -2.499,

Technology use among patients with cardiovascular disease: an assessment of patient need for a technology enabled behavioural change intervention.

Effective Cardiac Rehabilitation (CR) can significantly improve mortality and morbidity rates in relation to cardiovascular disease; however, uptake of traditional community-based long-term is very low. PATHway (Physical Activity Towards Health) will provide individualized rehabilitation programs, through an internet-enabled sensor-based home exercise platform that allows remote participation. The purpose of this study was to assess the level of interest and use of technology by individuals living with CVD in order to inform the design of a technology-enabled CR programme. Method: A technology usage questionnaire based on a previous study investigating the role of technology and mHealth in a CVD population was used (Dale et al., 2014) to ascertain the current level of technology use. All patients attending the Phase Four community cardiac rehabilitation HeartSmart programme (MedEx) were recruited (N=67; 66.2 years, SD= 8.55, Males =76.1%, Females=20.9%). Results: Technology usage was high with 60% of participants owning a smartphone and 85% accessing the internet (54% of whom access it everyday). Participants endorsed the idea of technology enabled cardiac rehabilitation, indicating that they found the idea ‘ appealing’. 79% were interested in receiving ongoing CR support via their smartphones, 79% were interested in receiving CR via the internet. It was found that 52% of patients found the idea of a virtual rehabilitation class appealing. Conclusion: This study provides support for the patient need for a technology enabled behavioural change intervention, specifically through the provision of an internet-enabled sensor-based home exercise platform that allows remote participation in CR exercise programs

A between sex analysis of self and proxy efficacy and its relationship with attendance at a community based chronic illness rehabilitation programme.

Background: Physical activity is a principal intervention in primary and secondary prevention of chronic illness. While the benefits of community based rehabilitation is acknowledged,the rate of attendance and adherence remains sub optimal. Self-efficacy is acknowledged to be a key factor relating to adherence in rehabilitation but the construct of proxy efficacy, defined as one’s confidence in the skills and abilities of a third party to function effectively on another’s behalf, is less often studied. This paper examines the relationship between gender and ‘self’ and ‘proxy-efficacy’ and their potential role in attendance to a community based chronic illness rehabiliation (CBCIR) programme. Methods: Participants attending induction at the programme completed a questionnaire assessing demographics and both self (9 items) and proxy efficacy for exercise (9 items) which was assessed on a Likert scale from 0 (not confident at all) to 10 (very confident), with a higher score indicating greater efficacy. Subsequently, attendance was objectively monitored by researchers at exercise sessions for 24 weeks. Results: 69 participants (M age=65.5 +9.8 years, 56% Male) completed all measures. Mean proxy-efficacy and mean self-efficacy is significantly greater in women compared to men (p<0.05). Mean proxy-efficacy was found to be higher than mean self-efficacy in both males (proxy-efficacy=8.7+1.2, self efficacy=8.3+1.8) and females (proxyefficacy= 7.7+2.2, self-efficacy=6.5+2.0) with no correlation between the variables. Correlational analyses found a moderate significant positive correlation between proxy efficacy and number of weeks attended in the 24 weeks (r=.440,p<.05) in women with no correlation observed between self-efficacy and weeks attended. No correlations are observed between either form of efficacy and attendance in men. Discussion: Participants report greater confidence in the proxy agent than themselves as the agent. This was furthered in women with an association identified between proxy efficacy and 24-week attendance. These results suggest the importance of the proxy for women in a CBCIR setting but further longitudinal research should be carried out in the area of proxy efficacy and attendance at community based chronic illness rehabilitation programmes. Implications: An understanding of these variables help CBCIR programme facilitators intervene to ensure greater attendance

Physiological and perceptual responses during self-regulated exercise in men with coronary artery disease

Purpose: Physiologically based exercise prescriptions normally involve identifying an intensity range that elicits a predetermined VO2 or heart rate. In many instances prescribed exercise that exceeds an individual’s preferred level of intensity may establish a negative attitude toward physical activity. Longitudinal studies report that participants tend to deviate from physiologically based prescribed levels of intensity in favour of their apparently preferred levels. Self regulated exercise intensity may increase enjoyment and promote adherence by allowing individuals successfully complete an activity within their perceptual preference range and without undue physiological strain. This study examined the physiological and perceptual responses during self-regulated exercise in men with CAD. \ud Methods: Eight men with CAD (65.7 ± 4.5 yr, VO2max 18.6 ± 4.1 ml/kg/min, BMI 29.7±3.3 kg/m-2) exercised on a treadmill for 20 min at a self regulated intensity. They were allowed to change the velocity and grade every 5 min. Respiratory metabolic and gas exchange variables were measured continuously using open circuit spirometry. Heart rate was continuously recorded using telemetry, and undifferentiated RPE (RPE-O) was recorded every 5 min using the Borg 15-category scale. \ud Results: Perceptual and physiological responses remained stable after the first 5 min of exercise. Subjects exercised at 65.7 ± 14.2 % VO2max and 94 ± 5.0 % HRpeak during the final 15 min of self regulated exercise. This equates to a treadmill velocity of 5.3 ± 0.9 km/h, and a grade of 0.7 ± 1.1. The RPE-O was 12.0 ± 2.0, and falls between the verbal descriptors of fairly light and somewhat hard. \ud Conclusion: When allowed to self-regulate their exercise intensity, men with CAD select an intensity that is perceived to be fairly light to somewhat hard, and elicits a physiological response likely to improve cardiovascular health

Perceptions of wellbeing and quality of life following participation in a community-based pre-operative exercise programme in men with newly diagnosed prostate cancer: a qualitative pilot study

Background Men with a newly diagnosed prostate cancer are often treated by surgery. The time window between cancer diagnosis and surgery causes high levels of uncertainty and stress, which negatively impact quality of life (QoL). We previously reported a larger intervention pilot study which demonstrated that participation in a community-based pre-operative exercise programme significantly improved physical fitness and health-related quality of life in men with prostate cancer prior to surgery. The aim of the current pilot study was to get an insight into men’s perceptions of wellbeing and QoL following completion of the pre-operative exercise programme. Methods From November 2017 to June 2018, men scheduled for prostate cancer surgery were recruited and took part in a prescribed community-based pre-operative exercise programme in the time available between referral and surgery. Following completion of the pre-operative exercise programme (within 1 week before surgery), participants took part in one semistructured interview which explored four broad QoL domains: physical, psychological, social, and spiritual wellbeing. Data were analysed using thematic analysis (a bottom up/ inductive analysis). Results Eleven men were recruited: mean standard deviation (SD) age was 60 ± 7 years. Data supported four main themes. Participation in the community-based pre-operative exercise training programme (over a mean (SD) of 4 ± 2 weeks) provided participants with: 1) a teachable moment; 2) a journey of preparation; 3) a sense of optimism; and 4) social connectedness prior to surgery. Conclusion This study provides an insight into how the exercise programme impacted wellbeing and QoL in men preparing for prostate cancer surgery. These findings highlight the important role that exercise prehabilitation plays for men preparing for prostate cancer surgery. Such exercise programmes can be easily implemented into standard cancer pathways by establishing relationships between hospital teams and community exercise programmes.ye

The development of the MedEx IMPACT Intervention: a patient-centred, evidenced-based and theoretically-informed physical activity behavior change intervention for individuals living with and beyond cancer.

Regular physical activity (PA) can address many of the negative side effects experienced by individuals following cancer treatment and support the optimization of physical and psychosocial well-being. However, many survivors of cancer are not sufficiently active to achieve these health benefits. The purpose of this study was to describe the development of a physical activity behavior change (PABC) intervention, MedEx IMPACT (IMprove Physical Activity after Cancer Treatment), which aims to increase cancer survivors’ PA levels. A review of the literature and focus groups with survivors of cancer were conducted in order to generate recommendations to inform the intervention development process. This process was guided and informed by: (1) the Medical Research Council’s (MRC) framework for the development, evaluation, and implementation of complex interventions, (2) the Behaviour Change Wheel (BCW), and (3) the Theoretical Domains Framework (TDF). Recommendations for strategies to support habitual PA and adherence to community-based exercise programs, generated by survivors of cancer who participated in 7 focus groups (n ¼ 41), were synthesized with 13 statements of findings that were generated from 10 studies included within the review of the literature. Detailed mapping exercises are presented which outline the link between these sources, the MRC framework, the BCW and TDF, and the intervention content. MedEx IMPACT is the first PABC intervention for survivors of cancer to be developed through the application of the MRC framework, BCW, and TDF. The next phase in this research is to test the acceptability and effectiveness of MedEx IMPACT.ye

Impact of a physician-led exercise programme on quality of life, muscle mass and clinical response in inflammatory bowel disease patients during induction with disease-modifying therapy: a study protocol

Introduction Biologic and small-molecule therapies have revolutionised the treatment of moderate-to-severe inflammatory bowel disease (IBD). A significant proportion of patients experience early or delayed treatment failure. Patients with IBD with greater visceral obesity are less likely to respond to biologics. Sarcopenia has been identified as a predictor of disease severity and need for rescue therapy in acute severe ulcerative colitis. The aim of this study is to assess the feasibility of a physician-derived exercise programme in patients with IBD commencing biologic or small-molecule therapy in addition to the effect on physical fitness, body composition and objective measures of quality of life, fatigue scores and disease activity. Methods and analysis This is a randomised controlled feasibility study comparing the effects of a physician-derived exercise programme and standard medical care (biologic/small-molecule therapy) with standard care alone in patients with moderate to severe IBD. Patients with IBD in the intervention group will undergo a structured exercise programme for 20 weeks. Both IBD groups will carry out body composition, disease activity and quality-of-life assessments at baseline, week 12 and week 26. The primary objective is to assess the feasibility of the physician-derived exercise programme in patients with IBD commencing disease-modifying therapies. Secondary endpoints include a change in cardiorespiratory fitness, disease activity/inflammation, fatigue, health-related quality of life outcomes and body composition between the two IBD groups. Exploratory endpoints include validation of anterior thigh ultrasound for sarcopenia screening, assessment of proinflammatory cytokines and markers of immunometabolism. Ethics and dissemination This study has received ethical approval from the Beaumont Hospital Ethics committee on 22 October 2021 (reference number 21/21). Data generated or analysed during this study will be published as an article and supplementary appendix in relevant medical journals. The data will also be presented at national and international conferences.ye

Study protocol for the investigation of the clinical effectiveness of a physical activity behaviour change intervention for individuals living with and beyond cancer

Most individuals living with and beyond cancer are not sufficiently active to achieve the health benefits associated with regular physical activity (PA). The purpose of this study was to describe the study protocol for a two-arm non-randomised comparison trial conducted within a community-based setting, which aimed to investigate the clinical effectiveness of a cancer-specific PA behaviour change (BC) intervention, namely MedEx IMPACT (IMprove Physical Activity after Cancer Treatment), compared to a general exercise rehabilitation programme, among survivors of cancer. Individuals who had completed active-cancer treatment who were referred to a community-based exercise rehabilitation programme were invited to participate in the trial. Participants in the control group (CG) attended twice-weekly supervised exercise classes for 12 weeks. Classes were delivered as part of a chronic illness exercise rehabilitation programme. Participants in the MedEx IMPACT intervention group (IG) also attended the twice-weekly supervised exercise classes for 12 weeks and received cancer-specific materials, namely an independent PA programme, 4 PA information sessions and a 1:1 exercise consultation. The primary outcome was PA levels measured by 6-day accelerometry and self-report PA. Secondary outcomes included cardiorespiratory fitness (CRF), quality of life (QoL) and sedentary behaviour. Outcomes were measured at baseline and months 3, 6 and 12. Few effective PA BC interventions for individuals living with and beyond cancer have been identified. The results of this study will have implications for the planning and provision of community-based exercise oncology rehabilitation programmes for individuals living with and beyond cancer.ye

The National Exercise Referral Framework

A 2013 Review of the HSE funded GP Exercise Referral Programme (GPERP) highlighted the need for a new National Exercise Referral Framework (NERF). The evidence suggests that exercise referral is an effective targeted health intervention for specific patients and with the increasing prevalence of chronic disease it is imperative that we examine, design and progress the implementation of scalable, sustainable evidence-based, interventions, integrated across the health system to improve the health and wellbeing of the population. The development of this proposed National Exercise Referral Framework, commissioned by Health Promotion and Improvement, was led by DCU involving a multi-disciplinary Working Group and supported by a HSE Cross-Divisional Group. We are grateful to the Working Group and in particular to Dr Catherine Woods and the team in DCU for their extensive work and commitment to this project. There are a number of practical steps now required to determine the feasibility of the proposed framework as a national model namely, identification of a sustainable funding model; design and development of chronic disease care pathways and a phased implementation plan that would build on the existing programmes. The Health & Wellbeing Division of the HSE will lead the next phase of this project