Effects of dual-task functional power training on cognitive function, well-being and inflammatory and neurological markers in older adults

This thesis found that a 26 week dual-task functional power training program improved several aspects of cognition, lower limb muscle power and function, and mobility in independently living older adults. However the intervention had no effect on circulating levels of inflammatory or neurological markers, with minimal benefits for well-being

A qualitative and quantitative exploration of sedentary behaviour, physical activity and exercise in people with multiple sclerosis

Multiple sclerosis (MS) is a chronic neurological disease affecting motor and sensory nerve function and leading to a range of symptoms. Physically, gait, balance and vision can be impaired, with fatigue and depression being common mental health symptoms. People with MS have high levels of sedentary behaviour and low levels of physical activity. Despite the well-researched benefits of exercise for the symptoms of MS, uptake and participation in exercise programmes is low, particularly in those with higher disability. This thesis investigated a number of research questions relating to activity behaviours in people with MS using both qualitative and quantitative methodologies. Qualitative studies explored the measurement of sedentary behaviour, and perspectives of people with MS and health professionals around barriers and facilitators to exercise. This provided recommendations for exercise programmes. Communication was a key aspect, which included communication to the person with MS tailored to their individual circumstances and acceptance of MS, as well as communication within the multidisciplinary team. Appropriate knowledge of health professionals about exercise for people with MS was essential as well as suitable behavioural support for exercise. This support should be individualised to the patient, depending on their stage of acceptance of the disease. Cross-sectional analyses of associations between subjective and objective assessments of behaviour, physical function, and wellbeing revealed differences, such as objective but not subjective sedentary behaviour being associated with depression. Greater self-reported but not objective physical activity was associated with higher fitness. This highlighted the need to assess activity and function both subjectively and objectively. Subsequently, the effects of a twelve-week home exercise programme which included balance, strengthening and aerobic exercise, on physical activity, sedentary behaviour, functional ability, and wellbeing were explored. The outcomes of those with higher and lower disability from their MS were compared, as well as an internet group with access to web-based resources to support their programme, and a control group without these online resources. The exercise programme achieved good self-reported adherence. However, there were no significant changes in physical activity, function, wellbeing or behavioural measures, which suggests that more intensive behavioural support might be needed to ensure that participants exercise at the right intensity. Future research could investigate the effectiveness of different ways to provide additional support to encourage exercise in people with MS

Evidence Synthesis of Shoulder Pain Among Canadian Firefighters

Injury or degeneration of rotator cuff tendon leads to rotator cuff disease (subacromial impingement syndrome and rotator cuff tears). Shoulder pain – pain in the upper arm close to the deltoid muscle insertion has been reported as the most common symptom for subacromial impingement syndrome and rotator cuff tears. However, the current state of evidence on treatment effectiveness of rotator cuff disease is indeterminate. The shoulder function is essential for many of the physically demanding tasks that firefighters perform on the fire ground. For fire services and firefighters, the preservation of active duty is critical for their continued service to their communities. However, the prevalence of shoulder pain among Canadian firefighters has not been synthesized. Further, high quality randomized clinical trials (RCTs) provide the highest level of evidence and assist in clinical decision making. The International Committee of Medical Journal Editors (ICMJE) recommendation of RCT trial registration in public trials registry has been made to improve the reporting, transparency, rigor and reproducibility in RCTs. However, there is a paucity of evidence on the proportion of RCTs with proper trial registrations in the field of rehabilitation therapy. Therefore, the purposes of this thesis were 1) to assess the effects of arthroscopic versus mini-open rotator cuff repair surgery on function, pain and range of motion at in patients with rotator cuff tears; 2) to quantify the effects of surgical vs conservative interventions on clinical outcomes of pain and function in patients with subacromial impingement syndrome; 3) to assess the prevalence of musculoskeletal disorders (MSDs) among Canadian firefighters, 4) to examine the proportion of RCTs that were reported to have been prospectively, retrospectively registered or not registered in the field of rehabilitation therapy, and 5) to use the synthesized evidence to inform the design of a single center (fire-station), investigator-blinded, randomized, 12-month, parallel-group, superiority trial for the evaluation of the efficacy of a shoulder exercises on clinical outcomes in firefighters with shoulder pain. From the existing literature, we found evidence that both arthroscopic and mini-open techniques to rotator cuff repairs with post-operative rehabilitation exercises were effective in improving clinical outcomes of function, pain and shoulder range of motion in patients with rotator cuff tears. However, the between-group differences in outcomes were too small to be clinically important. The effects of surgery plus physiotherapy (exercises) vs physiotherapy (exercises) alone on pain and function were too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up. This further highlighted that rehabilitation exercises be considered as the first treatment approach in patients with shoulder pain. We also identified high point-prevalence estimates (1 in 4 firefighters) of shoulder-, back-, and knee-related MSDs among Canadian firefighters (shoulder pain was 23%). Our review study indicated that fifteen years after the introduction of standards for RCT registration by ICMJE, only one-third of the RCTs in the field of rehabilitation therapy were prospectively registered. Subsequently, the emergence of further evidence (observational studies in firefighters and RCTs in active-duty military personnel) indicating the clinical effectiveness of occupation-specific rehabilitation exercises along with our evidence syntheses provided the rationale for the design and conduct of an RCT to assess the effectiveness of firefighter-specific rehabilitation exercises among Canadian firefighter with shoulder pain

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require