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

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

Exploration of physical activity knowledge, preferences and support needs among pulmonary hypertension patients

Objective: Physical activity (PA) is an established adjunct therapy for pulmonary hypertension (PH) patients to mitigate PH symptoms and improve quality of life. However, PA engagement within this population remains low. This study investigated PH patients’ knowledge of PA, recalled advice, exercise preferences and PA support needs. Methods: Semi-structured interviews were conducted with 19 adults (mean age 50 years; SD ±12 years) diagnosed with PH, living in Ireland. Interview scripts were digitally recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Results: Four key themes were identified: Lack of PA knowledge; exercise setting preference; accountability and monitoring; and clinician delivered PA information and guidance. Conclusion: This study found that PH clinicians provide suboptimal PA advice, yet patients desired clinician-delivered PA guidance. Home-based exercise was preferred with monitoring and external accountability deemed as important to facilitate sustained engagement. Practice implications: PH clinicians are well positioned to play a critical role in assisting and empowering PH patients to engage in PA. Providing training and education to PH clinicians regarding exercise prescription may be beneficial. Further research is needed to evaluate the feasibility and efficacy of home-based exercise interventions to improve quality of life and physical activity in PH

Safety, Feasibility and Effectiveness of the remotely delivered Pulmonary Hypertension And Home-Based (PHAHB) Physical Activity intervention

Background Pulmonary hypertension (PH) is a heterogeneous condition, associated with a high symptom burden and a substantial loss of exercise capacity. Despite prior safety concerns regarding physical exertion, exercise training as a supportive therapy is now recommended for PH patients. Currently, most programs are hospital-based, which limits accessibility. There is a need to provide alternative approaches for physical activity engagement for PH patients. The aim of this research was to develop, implement and evaluate the safety, feasibility, and effectiveness of home-based physical activity intervention for PH. Methods An entirely remotely delivered home-based exercise intervention underpinned by behaviour change theory and informed by end-users, was assessed using a single-arm feasibility study design. Participants (n=19; 80% female) with a mean (±sd) age of 49.9±15.9 y with a diagnosis of PH undertook a 10-week, home-based exercise intervention with induction training, support materials, telecommunication support, health coaching, exercise training, and assessments, all remotely delivered. Training involved respiratory training along with a combination of aerobic and resistance exercises. Results The intervention was deemed safe as no adverse events were reported. A high level of feasibility was demonstrated as the protocol was implemented as intended, sustained a high level of engagement and adherence and was well accepted by participants in terms of enjoyment and utility. There was a significant improvement in functional capacity, physical activity, exercise self-efficacy and quality of life (QoL), between baseline and post-training. Conclusion The study demonstrates that an entirely remotely delivered home-based exercise program is safe, feasible and effective in improving functional capacity, physical activity, and QoL in PH patients

Phenotypic Responses to a Lifestyle Intervention Do Not Account for Inter-Individual Variability in Glucose Tolerance for Individuals at High Risk of Type 2 Diabetes

Background: Lifestyle interventions have been shown to delay or prevent the onset of type 2 diabetes among high risk adults. A better understanding of the variability in physiological responses would support the matching of individuals with the best type of intervention in future prevention programmes, in order to optimize risk reduction. The purpose of this study was to determine if phenotypic characteristics at baseline or following a 12 weeks lifestyle intervention could explain the inter-individual variability in change in glucose tolerance in individuals with high risk for type 2 diabetes.Methods: In total, 285 subjects with normal glucose tolerance (NGT, FINDRISC score &gt; 12), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were recruited for a 12 weeks lifestyle intervention. Glucose tolerance, insulin sensitivity, anthropometric characteristics and aerobic fitness were measured. Variability of responses was examined by grouping participants by baseline glycemic status, by cluster analysis based on the change in glucose tolerance and by Principal Component Analysis (PCA).Results: In agreement with other studies, the mean response to the 12 weeks intervention was positive for the majority of parameters. Overall, 89% improved BMI, 80% waist circumference, and 81% body fat while only 64% improved fasting plasma glucose and 60% 2 h glucose. The impact of the intervention by glycaemic group did not show any phenotypic differences in response between NGT, IFG, and IGT. A hierarchical cluster analysis of change in glucose tolerance identified four sub-groups of “responders” (high and moderate) and “non-responders” (no response or deteriorated) but there were few differences in baseline clincal and physiological parameters or in response to the intervention to explain the overall variance. A further PCA analysis of 19 clinical and physiological univariables could explain less than half (48%) of total variability.Conclusion: We found that phenotypic characteristics from standard clinical and physiological parameters were not sufficient to account for the inter-individual variability in glucose tolerance following a 12 weeks lifestyle intervention in inidivuals at high risk for type 2 diabetes. Further work is required to identify biomarkers that complement phenotypic traits and better predict the response to glucose tolerance

G-protein signaling: back to the future

Heterotrimeric G-proteins are intracellular partners of G-protein-coupled receptors (GPCRs). GPCRs act on inactive Gα·GDP/Gβγ heterotrimers to promote GDP release and GTP binding, resulting in liberation of Gα from Gβγ. Gα·GTP and Gβγ target effectors including adenylyl cyclases, phospholipases and ion channels. Signaling is terminated by intrinsic GTPase activity of Gα and heterotrimer reformation — a cycle accelerated by ‘regulators of G-protein signaling’ (RGS proteins). Recent studies have identified several unconventional G-protein signaling pathways that diverge from this standard model. Whereas phospholipase C (PLC) β is activated by Gαq and Gβγ, novel PLC isoforms are regulated by both heterotrimeric and Ras-superfamily G-proteins. An Arabidopsis protein has been discovered containing both GPCR and RGS domains within the same protein. Most surprisingly, a receptor-independent Gα nucleotide cycle that regulates cell division has been delineated in both Caenorhabditis elegans and Drosophila melanogaster. Here, we revisit classical heterotrimeric G-protein signaling and explore these new, non-canonical G-protein signaling pathways

Creatine use in elite team sports in Ireland: exploring prevalence, knowledge and attitudinal patterns.

Creatine is a nutritional supplement that is commonly, if controversially, used as an ergogenic aid in sport. The aim of the present study was to examine the prevalence, use and knowledge of this substance among a sample of elite Gaelic football, rugby, and soccer players in Ireland. 460 male athletes completed an anonymous self-report questionnaire that examined their use and knowledge of creatine. Overall, 18.9% of the sample (n = 87) had not heard of creatine, 56.7% (n = 261) reported that they had heard of it but had never used it, a further 16.3% (n = 75) had used creatine in the past but were no longer doing so and 5.2% (n = 24) were currently using it. Further analysis showed some differences in patterns of use among those who had heard of creatine. In general, although there were more users at adult level than at school level, there was no difference in percentage of users across sport types. However, when school and adult players were examined separately, there were significantly more users in rugby at the adult level. The data indicate a higher awareness of this substance among adult rugby players than among players of other sports tested in the sample