Physical fitness training for people with stroke

INTRODUCTION: Impaired physical fitness may contribute to functional limitations and disability after stroke. Physical fitness (including cardiorespiratory fitness and muscle strength/power) can be improved by appropriate fitness training; this is of benefit to healthy people and patient groups but whether it is of benefit for people after stroke is unclear. The aim of this thesis was to determine whether physical fitness training is beneficial after stroke. OBJECTIVES: (1) Develop a rationale for fitness training by determining whether physical fitness after stroke is a) impaired, and b) associated with functional limitations and disability. (2) Develop and evaluate randomized controlled trial (RCT) evidence by a) determining the feasibility of a definitive RCT, and b) evaluating the benefits of fitness training after stroke. METHODS: (1) Systematic review of observational data and multiple linear regression of exploratory RCT baseline data determined the nature of fitness impairments and any associations with functional limitation and disability. (2) Systematic review and meta-analysis of RCTs established the effects of fitness training on disability, death and dependence. An exploratory RCT (‘STARTER’) compared the effects of a fitness training programme (cardiorespiratory plus strength training 3 days/week for 12 weeks) with an attention control (relaxation) on fitness, function, disability, mood and quality of life in 66 ambulatory people with stroke. RESULTS: (1) Systematic review of observational data showed cardiorespiratory fitness (peak oxygen uptake and economy of walking) and muscle strength were low after stroke; the impairments predicted functional limitation but links to disability were unclear. STARTER baseline data showed little impairment in economy of walking but lower limb extensor power was impaired (42-54% of values expected in healthy age and gender matched people) and this predicted functional limitation and disability. (2) The systematic review identified 12 RCTs (n=289) in 2003, and 24 RCTs (n=1147) when updated in 2007. The systematic reviews showed death was uncommon, and effects on dependence and disability were unclear. However training did improve fitness and cardiorespiratory training during rehabilitation improved ambulation. Most benefits resulted from task-related training. The STARTER fitness training intervention was feasible, with good attendance (>90%) and good compliance with intervention content (94-99%). At the end of the fitness training intervention there were small improvements in some cardiorespiratory fitness, physical function and quality of life outcomes compared with the control group, but these differences had diminished four months later. CONCLUSIONS: (1) Cardiorespiratory fitness, muscle strength and power are impaired after stroke, so there is scope to increase fitness, and there are plausible benefits. (2) Physical fitness training after stroke is feasible, it improves fitness and has some functional benefits, in particular for walking ability. Effects on disability, death and dependence are not known. Further research is required to determine the timing, mode, duration, frequency and intensity of fitness training for optimum benefits, and investigate how benefits can be retained in the long-term

The views of doctors in their first year of medical practice on the lasting impact of a preparation for house officer course they undertook as final year medical students

<p>Abstract</p> <p>Background</p> <p>The UK General Medical Council recommends that medical students have the opportunity of shadowing the outgoing new doctor whose post they will soon undertake. At the University of Nottingham the two-week shadowing period was preceded by two weeks of lectures/seminars wherein students followed sessions on topics such as common medical/surgical emergencies, contracts, time management, surviving the first two years of clinical practice, careers advice and so on.</p> <p>The present study aimed to gain a better knowledge and understanding of the lasting impact of a four-week preparation course for new Foundation Year 1 doctors [F1 s - interns]. The objectives chosen to achieve this aim were:</p> <p>1/ to determine the extent to which the lecture/seminar course and shadowing period achieved their stated aim of smoothing the transition from life as a medical student to work as a new doctor;</p> <p>2/ to evaluate perceptions of the importance of various forms of knowledge in easing the transition between medical student and new doctor</p> <p>Method</p> <p>In the spring of 2007, 90 graduates from Nottingham were randomly selected and then emailed a link to a short, online survey of quantitative and qualitative questions. Of these 76 responded. Analysis of quantitative data was carried out using SPSS 16.0 and employed McNemar's test. Analysis of the qualitative data was carried out using the constant comparative method.</p> <p>Results</p> <p>Only 31% of respondents strongly agreed or agreed that the lecture/seminar part of the course prepared them well for their first FY1 post; 14% agreed that during their first job they drew on the knowledge gained during the lecture/seminar course; 94% strongly agreed or agreed that the shadowing part of the course was more useful than the lecture/seminar part.</p> <p>Experiential knowledge gained in the shadowing was the most highly valued, followed by procedural knowledge with propositional knowledge coming far behind.</p> <p>Conclusions</p> <p>Our study shows that new doctors retrospectively value most the knowledge they are able to transfer to the workplace and value least material which seems to repeat what they had learned for their final exams.</p

Application of OCT to examination of easel paintings

We present results of applying low coherence interferometry to gallery paintings. Infrared low coherence interferometry is capable of non-destructive examination of paintings in 3D, which shows not only the structure of the varnish layer but also the paint layers

What works to reduce sedentary behavior in the office, and could these intervention components transfer to the home working environment?:A rapid review and transferability appraisal

BackgroundWorking patterns have changed dramatically due to COVID-19, with many workers now spending at least a portion of their working week at home. The office environment was already associated with high levels of sedentary behavior, and there is emerging evidence that working at home further elevates these levels. The aim of this rapid review (PROSPERO CRD42021278539) was to build on existing evidence to identify what works to reduce sedentary behavior in an office environment, and consider whether these could be transferable to support those working at home.MethodsThe results of a systematic search of databases CENTRAL, MEDLINE, Embase, PsycInfo, CINHAL, and SportDiscus from 10 August 2017 to 6 September 2021 were added to the references included in a 2018 Cochrane review of office based sedentary interventions. These references were screened and controlled peer-reviewed English language studies demonstrating a beneficial direction of effect for office-based interventions on sedentary behavior outcomes in healthy adults were included. For each study, two of five authors screened the title and abstract, the full-texts, undertook data extraction, and assessed risk of bias on the included studies. Informed by the Behavior Change Wheel, the most commonly used intervention functions and behavior change techniques were identified from the extracted data. Finally, a sample of common intervention strategies were evaluated by the researchers and stakeholders for potential transferability to the working at home environment.ResultsTwenty-two studies including 29 interventions showing a beneficial direction of effect on sedentary outcomes were included. The most commonly used intervention functions were training (n = 21), environmental restructuring (n = 21), education (n = 15), and enablement (n = 15). Within these the commonly used behavior change techniques were instructions on how to perform the behavior (n = 21), adding objects to the environment (n = 20), and restructuring the physical environment (n = 19). Those strategies with the most promise for transferring to the home environment included education materials, use of role models, incentives, and prompts.ConclusionsThis review has characterized interventions that show a beneficial direction of effect to reduce office sedentary behavior, and identified promising strategies to support workers in the home environment as the world adapts to a new working landscape.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278539, identifier CRD42021278539

Circadian preference and physical and cognitive performance in adolescence:A scoping review

Adolescence is a crucial period of development which coincides with changes in circadian rhythmicity. This may augment the impact of circadian preference on performance in this group. We aimed to scope the literature available on chronotypes and their effect on physical and mental aspects of performance in adolescents. Methods: Studies were identified by systematically searching bibliographical databases and grey literature. Results: The Morningness-Eveningness Questionnaire was the most frequently reported tool for circadian preference assessment. Academic achievement was the most prevailing outcome, with evidence suggesting that morning type adolescents tend to outperform evening types, yet the results vary depending on multiple factors. Performance in tests of intelligence and executive functions was generally better at optimal times of the day (synchrony effect). Physical performance was examined in 8 studies, with very heterogeneous outcomes. Conclusions: Although the associations between circadian preference and performance in adolescents are evident in some areas, there are many factors that may be involved in the relationship and require further investigation. This review highlights the assessment of physical performance in relation to chronotypes, the multidimensional assessment of circadian preference, and the need for longitudinal studies as priorities for further research

Epidemiology of American Football Injuries at Universities in the United Kingdom

Background:College-level American football injury data are routinely collected; however, data relating to American football injuries at universities in the United Kingdom have never been reported.Purpose:To describe the epidemiology of UK university American football injuries.Study Design:Descriptive epidemiology study.Methods:An online survey tool was used to collect the injury data of 410 players from 56 UK university teams who participated in the 2014-2015 British Universities and College Sports American football season. Survey data were collected from January to February 2016 and were analyzed to determine the incidence and patterns of injury.Results:Overall, 710 injuries and 204 concussions were self-reported among the 410 participants, of which 334 (81.5%) were injured and 131 (32.0%) experienced concussion symptoms. The rate of injury per 100 athlete-seasons was greater in defensive players (195.3) than offensive players (155.1). The most common injuries were knee and ankle ligament injuries. Most injuries were classified as severe (time loss of >4 weeks).Conclusion:UK university American football injuries differ markedly from those reported for US colleges. UK university players appear to have less playing experience, greater concussion risks, more severe injuries, and a greater proportion of injuries in defensive players versus offensive players

Options in Pregnancy to Increase ActiveLy Sitting (OPALS) Feasibility Study

Background. A negative association between obesity and pregnancy outcomes has been described, as well as between time sedentary and pregnancy outcomes. Most interventions based on physical activity involving obese pregnant women have failed in improving pregnancy outcomes. Exchanging time spent in sedentary activities with time spent in light-intensity activities, performed in a home-based setting, might help morbidly obese pregnant women. We aimed to assess the feasibility of an exercise intervention. Methods. An exercise intervention for morbidly obese pregnant women was designed involving morbidly obese pregnant women. Pregnant women with BMI ≥ 40 kg/m² with 20 or less weeks of gestation were invited to take part in the OPALS Feasibility Study. A home-based approach was employed. Participants were asked to perform the intervention for at least 12 weeks, and to register their performance in an activity diary. After the intervention, participants were asked to return the activity diary and answer a feasibility questionnaire. Results. In the intervention, 28 participants took part. Six women completed the intervention for 12 weeks or more. All declared they intended to keep on doing the intervention. All women reported that the exercises made them feel better. Conclusion. Empowering, and involving morbidly obese pregnant women in taking care of themselves and giving them realistic tasks to do on their own and around their environment helps to increase commitment, as does avoiding the effect of their own weight whilst exercising. A 20% of compliance was observed in this study, which might be explained by the difficulties that pregnancy and excess weight mean. Thus, for future studies, we suggest adding a supervision plan to increase that number

Mood, Dimensional Personality, and Suicidality in a Longitudinal Sample of Patients with Bipolar Disorder and Controls

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151828/1/sltb12529_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151828/2/sltb12529.pd

Interventions for reducing sedentary behaviour in people with stroke

BACKGROUND: Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES: To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS: In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA: Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting‐list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random‐effects meta‐analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS: We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) ‐0.02 to 0.03; 10 studies, 753 participants; low‐certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD ‐0.01, 95% CI ‐0.04 to 0.01; 10 studies, 753 participants; low‐certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI ‐0.02 to 0.02; 10 studies, 753 participants; low‐certainty evidence), or incidence of other adverse events (moderate‐certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI ‐0.42 to 0.68; 7 studies, 300 participants; very low‐certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta‐analysis. AUTHORS' CONCLUSIONS: Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high‐quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer‐term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long‐term follow‐up