Leg-focused high-weight resistance training improves ventricular stroke volume, exercise capacity and strength in young patients with a Fontan circulation

INTRODUCTION: Effective therapy to improve exercise capacity in Fontan patients is lacking. Leg-focused high-weight resistance training might augment the peripheral muscle pump and thereby improve exercise capacity.METHODS: This randomized semi-cross-over controlled trial investigated effects of a 12-week leg-focused high-weight resistance training plus high-protein diet, on (sub)maximal exercise capacity, cardiac function (assessed with cardiovascular magnetic resonance), muscle strength and quality of life in pediatric Fontan patients.RESULTS: Twenty-eight pediatric Fontan patients were included, 27 patients, (median age 12.9 [10.5-15.7]), successfully completed the program. Peak oxygen uptake (PeakVO2) at baseline was reduced (33.3 ml/kg/min [27.1-37.4],73% [62-79] of predicted). After training PeakVO2/kg and Peak workload improved significantly with +6.2 ml/kg/min [95%CI: 3.4-9.0](+18%) p&lt;0.001 and +22 Watts [95%CI: 12-32](+18%) p&lt;0.001 respectively, compared to the control period. Indexed single ventricle stroke volume increased significantly (43 ml/beat/m2 [40-49] versus 46 [41-53], p=0.014), as did inferior vena cava flow (21 ml/beat/m2 [18-24] versus 23 [20-28], p=0.015), while superior vena cava flow remained unchanged. Strength of all measured leg muscles increased significantly compared to the control period. Self-reported quality of life improved on the physical functioning and change in health domains of the child health questionnaire, parent-reported quality of life improved on the bodily pain, general health perception, and change in health domains compared to the control period.CONCLUSION:In a relatively large group of 27 older Fontan children, 12-weeks of leg-focused high-weight resistance training improved exercise capacity, stroke volume, (sub)maximal exercise capacity, muscle strength, and domains of quality of life.</p

A 12-week lifestyle intervention: effects on fatigue, fear, and nutritional status in children with a Fontan circulation

IntroductionChildren and adolescents with a Fontan circulation are less physically active compared to healthy peers. In the current study, effects of a 12-week lifestyle intervention on fatigue, fears regarding exercise, caloric intake, rest energy expenditure (REE), and body composition were measured in children with a Fontan circulation.MethodsThis study was a semi-cross-over randomized controlled trial. The lifestyle intervention consisted of a 12-week high-weight resistance training (three supervised training sessions a week) supported by high-protein diet (&gt;2 g/kg) and tailored recommended caloric intake. Fatigue (measured by the validated PedsQol Multidimensional Fatigue Scale), fears regarding exercise (measured on a fear thermometer), REE (measured using indirect calorimetry), caloric intake and body composition using air displacement plethysmography, and four-skinfold method were measured before and after the intervention and control period.ResultsTwenty-seven pediatric Fontan patients, median age 12.9 years (IQR: 10.5–16.2), of the included 28 patients successfully completed the program. Before training, both child- and parent-reported levels of fatigue were significantly worse on all domains (general, sleep/rest, and cognitive fatigue) compared to healthy peers. After training, parent-reported fatigue significantly improved on the general and cognitive fatigue domains [effect size +16 points (7–25), p &lt; 0.001, and +10 points (2–17), p = 0.015, compared to the control period]. Before training, fear regarding exercise scored on the fear thermometer was low for both children and parents (median score 1 and 2, respectively, on a scale of 0–8). After training, child-reported fear decreased further compared to the control period [effect size −1.4 points (−2.3 to −0.6), p = 0.001]. At baseline, children had increased REE +12% compared to reference values, which did not change after exercise. Children ate an average of 637 calories below recommended intake based on REE, caloric deficit became smaller after the intervention, and protein intake increased compared to the control period [−388 calories (−674 to −102), p = 0.008, and +15 g (0.4–30), p = 0.044]. Body fat percentage did not change significantly.ConclusionA 12-week lifestyle intervention improved parent-reported fatigue symptoms in the children, further decreased child-reported fears, and increased caloric and protein intake

Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities:A systematic review

Background: Poor anger regulation is considered a risk factor of aggression in individuals with mild or borderline intellectual disabilities. Psychomotor therapy (PMT) targets anger regulation through body- and movement-oriented interventions. This study aims to inform practitioners on efficacy and research-base of PMT in this population. Method: This systematic review evaluated nine studies which met inclusion criteria in terms of participants, intervention procedures, outcomes and certainty of evidence. Results: Seven studies revealed a substantial reduction of aggressive behaviour or anger. Certainty of evidence was rated inconclusive in most cases due to absence of experimental control. Conclusions: We can conclude that body-oriented PMT, involving progressive relaxation and meditation procedure "Soles of the Feet", is a promising approach. However, the paucity of studies and methodological limitations preclude classifying it as an evidence-based practice. This suggests stronger methodological research and research aimed at PMT's mechanisms of action (e.g., improved interoceptive awareness) is warranted.</p

Psychometric properties of the Dresden Body Image Questionnaire:A multiple-group confirmatory factor analysis across sex and age in a Dutch non-clinical sample

Body image has implications for psychosocial functioning and quality of life and its disturbance is reported in a broad range of psychiatric disorders. In view of the lack of instruments in Dutch measuring body image as a broad concept, we set out to make an instrument available that reflects the multidimensional character of this construct by including more dimensions than physical appearance. The Dresden Körperbildfragebogen (DBIQ, Dresden Body Image Questionnaire) particularly served this purpose. The DBIQ consists of 35 items and five subscales: body acceptance, sexual fulfillment, physical contact, vitality, and self-aggrandizement. The main objective of the present study was to evaluate the psychometric properties of the Dutch translation of the Dresden Body Image Questionnaire (DBIQ-NL) in a non-clinical sample.The psychometric properties of the DBIQ-NL were examined in a non-clinical sample of 988 respondents aged between 18 and 65. We investigated the subscales' internal consistency and test-retest reliability. In order to establish construct validity we evaluated the association with a related construct, body cathexis, and with indices of self-esteem and psychological wellbeing. The factor structure of the DBIQ-NL was examined via confirmatory factor analysis (CFA). The equivalence of the measurement model across sex and age was evaluated by multiplegroup confirmatory factor analyses.Confirmatory factor analyses showed a structure in accordance with the original scale, where model fit was improved significantly by moving one item to another subscale. Multiple group confirmatory factor analysis across sex and age demonstrated partial strong invariance. Internal consistency was good with little overlap between the subscales. Temporal reliability and construct validity were satisfactory.Results indicate that the DBIQ-NL is a reliable and valid instrument for non-clinical subjects. This provides a sound basis for further investigation of the DBIQ-NL in a clinical sample

Quantum-classical transition in Scale Relativity

The theory of scale relativity provides a new insight into the origin of fundamental laws in physics. Its application to microphysics allows us to recover quantum mechanics as mechanics on a non-differentiable (fractal) spacetime. The Schrodinger and Klein-Gordon equations are demonstrated as geodesic equations in this framework. A development of the intrinsic properties of this theory, using the mathematical tool of Hamilton's bi-quaternions, leads us to a derivation of the Dirac equation within the scale-relativity paradigm. The complex form of the wavefunction in the Schrodinger and Klein-Gordon equations follows from the non-differentiability of the geometry, since it involves a breaking of the invariance under the reflection symmetry on the (proper) time differential element (ds - ds). This mechanism is generalized for obtaining the bi-quaternionic nature of the Dirac spinor by adding a further symmetry breaking due to non-differentiability, namely the differential coordinate reflection symmetry (dx^mu - dx^mu) and by requiring invariance under parity and time inversion. The Pauli equation is recovered as a non-relativistic-motion approximation of the Dirac equation.Comment: 28 pages, no figur

Conservation planning in an uncertain climate: Identifying projects that remain valuable and feasible across future scenarios

Conservation actors face the challenge of allocating limited resources despite uncertainty about future climate conditions. In many cases, the potential value and feasibility of proposed projects vary across climate scenarios. A key goal is to identify areas where conservation outcomes can balance both environmental and human needs. We developed a conservation prioritization framework that jointly considers the value and feasibility of candidate projects across future climate scenarios. We then applied this framework to the challenge of meeting environmental flow targets across the Red River basin of the south‐central United States. To estimate the conservation feasibility of meeting environmental flow goals in a river reach in each climate scenario, we used a basin‐wide hydrologic planning tool to quantify the reduction in societal water usage needed to meet environmental flow targets. To estimate the biodiversity value of each river reach in each climate scenario, we used climate‐driven species distribution models and species’ conservation status. We found that river reaches in the east‐central portion of the basin may be good candidates for conservation investments, because they had high biodiversity value and high sociopolitical feasibility in all future climate scenarios. In contrast, sites in the arid western reaches of the basin had high biodiversity value, but low feasibility of achieving environmental flow goals. Our framework should have broad applicability given that the value and feasibility of conservation projects vary across climate scenarios in ecosystems around the world. It may serve as a coarse filter to identify sites for more detailed analyses and could be integrated with complementarity‐based approaches to conservation planning to balance species’ representation across projects.This research was supported by S.M.W.'s Science to Action Fellowship through the National Climate Adaptation Science Center at the US Geological Survey. U.S. Geological Survey. Grant Number: G17AP00120 Open Access fees paid for in whole or in part by the University of Oklahoma Libraries.Ye