Maintaining physical activity in cardiac rehabilitation

This chapter describes an intervention that has been used to encourage individuals to remain regularly physically active in exercise-based CR in phases III and IV.The principles of this intervention are also appropriate for allphases of CR.This intervention, called the exercise consultation (EC), is based on the Transtheoretical Model of behaviour change and Relapse Prevention Model (pp.197-205), and uses cognitive and behavioural strategies to increaseand maintain physical activity (Loughlan and Mutrie,1995,1997). The strategies used in this EC include: assessing stage of change, decisional balance, overcoming barriers to activity, social support, goal setting, self-monitoring and relapse prevention. It involves a client-centred, one-to-one counselling approach and encourages individuals to develop an activity plan, tailored to their needs, readiness to change and lifestyle. The EC aims to encourage accumulated physical activity accumulating at least 30 minutes ofmoderate intensity activity on five days per week (Pate, et al., 1995, stage one, as discussed in Chapter 4). In addition, this level of physical activity may be easier for cardiac patients to incorporate into their daily routine and to sustainin the long term. Thus, the exercise consultation encourages individuals to integrate moderate intensity activity into their daily lives. In addition, EC can help maintain involvement in structured exercise in phases III and IV (SIGN, 2002)

Girls on the move impact statement

Since 2005, Youth Scotland’s Girls on the Move programme has been increasing young women’s physical activity levels in Scotland, by addressing the barriers that prevent their participation. The programme has been evaluated by a team from the School of Sport at Stirling University, led by John Taylor, Research Fellow. This team, in partnership with Youth Scotland, has recently published an Impact Statement to summarise the findings of the evaluation. The Impact Statement contains facts, figures and case studies which the influence Girls on the Move has had on young women across Scotland

Effect of an exercise consultation on maintenance of physical activity after completion of phase III exercise-based cardiac rehabilitation

Aims: The primary aim of this randomised-controlled trial was to evaluate the effect of an exercise consultation (experimental condition) compared with standard exercise information (control condition) on maintenance of physical activity six and 12 months following completion of a phase III hospital-based exercise programme. Secondary aims included assessing the effect of an exercise consultation compared with exercise information on physiological and psychological variables at six and 12 months. Conclusions: This study demonstrated that the exercise consultation was more effective than exercise information in maintaining self-reported physical activity for 12 months after completion of a phase III exercise programme. However, the change in CSA accelerometer readings over the 12-month study period did not parallel the significant decrease in self-reported physical activity observed in the control group. The exercise consultation was not effective in maintaining exercise capacity for 12 months after completion of phase III. Significant decreases in peak VO2 from baseline to 12 months were observed in both groups. In contrast, an improvement in the VO2 at the lactate threshold, which is an index of submaximal endurance capacity, was recorded in the experimental group compared to the control group from baseline to follow-up. Finally, the exercise consultation had no significant effect on processes of exercise behaviour change, lipid profile and psychological function. These variables were normal at baseline and were maintained over the study period in both groups. The results of this study demonstrate that the exercise consultation may be an effective intervention for maintaining physical activity after completion of phase III hospital-based exercise programmes. The exercise consultation is a minimal intervention that could be delivered by physiotherapists to patients at the end of phase III or by British Association of Cardiac Rehabilitation (BACR) trained exercise instructors to patients in phase IV

Introduction: Increasing and maintaining physical activity in special populations

Exercise Physiology in Special Populations covers the prevalent health conditions that are either linked to an inactive lifestyle or whose effects can be ameliorated by increasing physical activity and physical fitness. The book explores physiological aspects of obesity and diabetes before moving on to cardiac disease, lung disease, arthritis and back pain, ageing and older people, bone health, the female participant, neurological and neuromuscular disorders, and spinal chord injury. The author team includes many of the UK?s leading researchers and exercise science and rehabilitation practitioners that specialise in each of the topic areas

The impact of pneumolysin on the macrophage response to Streptococcus pneumoniae is strain-dependent

Streptococcus pneumoniae is the world's leading cause of pneumonia, bacteremia, meningitis and otitis media. A major pneumococcal virulence factor is the cholesterol-dependent cytolysin, which has the defining property of forming pores in cholesterol-containing membranes. In recent times a clinically significant and internationally successful serotype 1 ST306 clone has been found to express a non-cytolytic variant of Ply (Ply306). However, while the pneumococcus is a naturally transformable organism, strains of the ST306 clonal group have to date been virtually impossible to transform, severely restricting efforts to understand the role of non-cytolytic Ply in the success of this clone. In this study isogenic Ply mutants were constructed in the D39 background and for the first time in the ST306 background (A0229467) to enable direct comparisons between Ply variants for their impact on the immune response in a macrophage-like cell line. Strains that expressed cytolytic Ply were found to induce a significant increase in IL-1β release from macrophage-like cells compared to the non-cytolytic and Ply-deficient strains in a background-independent manner, confirming the requirement for pore formation in the Ply-dependent activation of the NLRP3 inflammasome. However, cytolytic activity in the D39 background was found to induce increased expression of the genes encoding GM-CSF (CSF2), p19 subunit of IL-23 (IL23A) and IFNβ (IFNB1) compared to non-cytolytic and Ply-deficient D39 mutants, but had no effect in the A0229467 background. The impact of Ply on the immune response to the pneumococcus is highly dependent on the strain background, thus emphasising the importance of the interaction between specific virulence factors and other components of the genetic background of this organism

Isolation site influences virulence phenotype of serotype 14 Streptococcus pneumoniae strains belonging to multilocus sequence type 15

Streptococcus pneumoniae is a diverse species causing invasive as well as localized infections that result in massive global morbidity and mortality. Strains vary markedly in pathogenic potential, but the molecular basis is obscured by the diversity and plasticity of the pneumococcal genome. We have previously reported that S. pneumoniae serotype 3 isolates belonging to the same multilocus sequence type (MLST) differed markedly in in vitro and in vivo phenotypes, in accordance with the clinical site of isolation, suggesting stable niche adaptation within a clonal lineage. In the present study, we have extended our analysis to serotype 14 clinical isolates from cases of sepsis or otitis media that belong to the same MLST (ST15). In a murine intranasal challenge model, five ST15 isolates (three from blood and two from ears) colonized the nasopharynx to similar extents. However, blood and ear isolates exhibited significant differences in bacterial loads in other host niches (lungs, ear, and brain) at both 24 and 72 h postchallenge. In spite of these differences, blood and ear isolates were present in the lungs at similar levels at 6 h postchallenge, suggesting that early immune responses may underpin the distinct virulence phenotypes. Transcriptional analysis of lung tissue from mice infected for 6 h with blood isolates versus ear isolates revealed 8 differentially expressed genes. Two of these were exclusively expressed in response to infection with the ear isolate. These results suggest a link between the differential capacities to elicit early innate immune responses and the distinct virulence phenotypes of clonally related S. pneumoniae strains

Pragmatic evaluation of the Go2Play Active Play intervention on physical activity and fundamental movement skills in children

Active play is a novel approach to addressing low physical activity levels and fundamental movement skills (FMS) in children. This study aimed to determine if a new school-based, ‘Go2Play Active Play’ intervention improved school day physical activity and FMS. This was a pragmatic evaluation conducted in Scotland during 2015–16. Participants (n = 172; mean age = 7 years) were recruited from seven primary schools taking part in the 5-month intervention, plus 24 participants not receiving the intervention were recruited to act as a comparison group.189 participants had physical activity measured using an Actigraph GT3X accelerometer at baseline and again at follow-up 5 months later. A sub-sample of participants from the intervention (n = 102) and comparison (n = 21) groups had their FMS assessed using the Test of Gross Motor Development (TGMD-2) at baseline and follow-up. Changes in school day physical activity and FMS variables were examined using repeated measures ANOVA. The main effect was ‘group’ on ‘time’ from baseline to follow-up. Results indicated there was a significant interaction for mean counts per minute and percent time in sedentary behavior, light intensity physical activity and moderate to vigorous physical activity (MVPA) (all p < 0.01) for school day physical activity. There was a significant interaction for gross motor quotient (GMQ) score (p = 0.02) and percentile (p = 0.04), locomotor skills score and percentile (both p = 0.02), but no significant interaction for object control skills score (p = 0.1) and percentile (p = 0.3). The Go2Play Active Play intervention may be a promising way of improving physical activity and FMS but this needs to be confirmed in an RCT

Parents’ journey through treatment for their child’s obesity: a qualitative study

Background: Treatment for childhood obesity is characterised by patient non-attendance and drop-out, and widespread failure to achieve weight maintenance. Qualitative methods may improve our understanding of patient perceptions and so improve treatment for childhood obesity. Aim: To provide insight into the perceptions of parents of obese children as they &lsquo;journey&rsquo; from pre-treatment to end of treatment. Methods: We used purposive sampling and studied 17 parents of children attending 6-month outpatient treatments for obesity (BMI&gt;98th percentile). Parent&rsquo;s perceptions were explored by in-depth interviews, analysed using Framework methods. Results: Parents were characterised as being unaware of their child&rsquo;s weight, in denial, or actively seeking treatment. Parents were consistently motivated to enter treatment due to perceived benefits to their child&rsquo;s self esteem or quality of life, and weight outcomes appeared typically less important. During treatment parents expressed a lack of support for lifestyle changes outside the clinic, and noted that members of the extended family often undermined or failed to support lifestyle changes. Parents generally felt that treatment should have continued beyond six months, and it had provided benefits to their child&rsquo;s well-being, self esteem, and quality of life, and this is what motivated many to remain engaged with treatment. Discussion: This study may help inform future treatments for childhood obesity by providing insights into the aspects of treatment of greatest importance to parents. Future treatments may need to consider providing greater support to lifestyle changes within the extended family, and may need to focus more on psycho-social outcomes

Systematic review and evidence appraisal of objectively assessed longitudinal changes in moderate-to-vigorous physical activity among children and adolescents (2-18 years old)

The aim of this study was to systematically review accelerometer based longitudinal studies which have quantified year to year changes in moderate-to-vigorous physical activity (MVPA) among the general paediatric population in the absence of any intervention