High intensity interval training for people with Multiple Sclerosis: a systematic review

Background: Aerobic High Intensity Interval Training (HIIT) is safe in the general population and more efficient in improving fitness than continuous moderate intensity training. The body of literature examining HIIT in Multiple Sclerosis (MS) is expanding but to date a systematic review has not been conducted. The aim of this review was to investigate the efficacy and safety of HIIT in people with MS. Methods: A systematic search was carried out in September 2017 in EMBASE, MEDline, PEDro, CENTRAL and Web of Science Core collections using appropriate keywords and MeSH descriptors. Reference lists of relevant articles were also searched. Articles were eligible for inclusion if they were published in English, used HIIT, and included participants with MS. Quality was assessed using the PEDro scale. The following data were extracted using a standardised form: study design and characteristics, outcome measures, significant results, drop-outs, and adverse events. Results: Seven studies (described by 11 articles) were identified: four randomised controlled trials, one randomised cross-over trial and two cohort studies. PEDro scores ranged from 3-8. Included participants (n=249) were predominantly mildly disabled; one study included only people with progressive MS. Six studies used cycle ergometry and one used arm ergometry to deliver HIIT. One study reported six adverse events, four which could be attributed to the intervention. The other six reported that there were no adverse events. Six studies reported improvements in at least one outcome measure, however there were 60 different outcome measures in the seven studies. The most commonly measured domain was fitness, which improved in five of the six studies measuring aspects of fitness. The only trial not to report positive results included people with progressive and a more severe level of disability (Extended Disability Status Scale 6.0-8.0). Conclusion: HIIT appears to be safe and effective in increasing fitness in people with MS and low levels of disability. Further research is required to explore the effectiveness of HIIT in people with progressive MS and in those with higher levels of disability

The effectiveness of interventions targeting physical activity and/or sedentary behaviour in people with Multiple Sclerosis: a systematic review

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Web-based physiotherapy for people affected by multiple sclerosis: a single blind, randomized controlled feasibility study

Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with multiple sclerosis. Design: Multi-centre, randomized controlled, feasibility study. Setting: Three multiple sclerosis out-patient centres. Participants: A total of 90 people with multiple sclerosis (Expanded Disability Status Scale 4–6.5). Interventions: Participants were randomized to a six-month individualized, home exercise programme delivered via web-based physiotherapy (n = 45; intervention) or a sheet of exercises (n = 45; active comparator). Outcome measures: Outcome measures (0, three, six and nine months) included adherence, two-minute walk test, 25 foot walk, Berg Balance Scale, physical activity and healthcare resource use. Interviews were undertaken with 24 participants and 3 physiotherapists. Results: Almost 25% of people approached agreed to take part. No intervention-related adverse events were recorded. Adherence was 40%–63% and 53%–71% in the intervention and comparator groups. There was no difference in the two-minute walk test between groups at baseline (Intervention-80.4(33.91)m, Comparator-70.6(31.20)m) and no change over time (at six-month Intervention-81.6(32.75)m, Comparator-74.8(36.16)m. There were no significant changes over time in other outcome measures except the EuroQol-5 Dimension at six months which decreased in the active comparator group. For a difference of 8(17.4)m in two-minute walk test between groups, 76 participants/group would be required (80% power, P > 0.05) for a future randomized controlled trial. Conclusion: No changes were found in the majority of outcome measures over time. This study was acceptable and feasible by participants and physiotherapists. An adequately powered study needs 160 participants

Web-based physiotherapy for people with axial spondyloarthritis (WEBPASS) - a study protocol

Background: Evidence suggests people with axial spondyloarthritis (axial SpA) should exercise up to five times per week but lack of time, symptoms, cost and distance are barriers to regular exercise in axial SpA. Personalised exercise programmes delivered via the internet might support people with axial SpA to reach these exercise targets. The aim of this study is to investigate the effect of, and adherence to, a 12 month personalised web-based physiotherapy programme for people with axial SpA. Methods: Fifty people with axial SpA will be recruited to this prospective, interventional cohort study. Each participant will be assessed by a physiotherapist and an individualised exercise programme set up on www.webbasedphysio.com. Participants will be asked to complete their programme five times per week for 12 months. With the exception of adherence, data will be collected at baseline, 6 and 12 months. Discussion: The primary outcome measure is adherence to the exercise programme over each four week cycle (20 sessions maximum per cycle) and over the 12 months. Secondary measures include function (BASFI), disease activity (BASDAI), work impairment (WPAI:SpA), quality of life (ASQoL, EQ5D), attitude to exercise (EMI-2, EAQ), spinal mobility (BASMI), physical activity and the six minute walk test. Participants will also be interviewed to explore their adherence, or otherwise, to the intervention. This study will determine the adherence and key clinical outcomes of a targeted web-based physiotherapy programme for axial SpA. This data will inform clinical practice and the development and implementation of similar programmes.sch_phy1. Rudwaleit M, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770-6. 2. Dougados M, et al. The DESIR cohort: a 10-year follow-up of early inflammatory back pain in France: study design and baseline characteristics of the 708 recruited patients. Joint Bone Spine. 2011;78(6):598-603. 3. Rudwaleit M, et al. The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum. 2009;60(3):717-27. 4. Karapolat H, et al. Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression. Clin Rheumatol. 2008;27(6):695-700. 5. van den Berg R, et al. First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Rheumatology. 2012;51(8):1388-96. 6. Millner JR, et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. in Seminars in arthritis and rheumatism. 2016;45(4): 411-27. 7. O'Dwyer T, O'Shea F, Wilson F. Exercise therapy for spondyloarthritis: a systematic review. Rheumatol Int. 2014;34(7):887-902. 8. Uhrin Z, Kuzis S, Ward MM. Exercise and changes in health status in patients with ankylosing spondylitis. Arch Intern Med. 2000;160(19):2969-75. 9. Aytekin E, et al. Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions. Clin Rheumatol. 2012;31(1):91-7. 10. Sundstrom B, Ekergard H, Sundelin G. Exercise habits among patients with ankylosing spondylitis. A questionnaire based survey in the County of Vasterbotten, Sweden. Scand J Rheumatol. 2002;31(3):163-7. 11. Dagfinrud H, Kvien T, Hagen K. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev. 2008;23(1):CD002822. doi:10.1002/ 14651858.CD002822.pub3. 12. Liang H, et al. Effects of home-based exercise intervention on health-related quality of life for patients with ankylosing spondylitis: a meta-analysis. Clin Rheumatol. 2015;34(10):1737-44. 13. Yigit S, et al. Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors. Rheumatol Int. 2013;33(1):71-7. 14. Internet users in the UK: 2016, in Statistical Bulletin. 2016, Office of National Statistics. http://www.ons.gov.uk/businessindustryandtrade/itandinternet industry/bulletins/internetusers/2016. 15. Bossen D, et al. Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial. J Med Internet Res. 2013;15(11):e257. 16. Van den Berg M, et al. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. Arthritis Care Res. 2006;55(6):935-45. 17. Paul L, et al., Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study. Clin Rehabil. 2014;28(9):924-35. 18. Coulter, E., et al., Web-based Physiotherapy: The effectiveness and satisfaction in people with Spinal Cord Injury Spinal Cord. (in press). 19. Kelders SM, et al. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res. 2012;14(6):e152. 20. Michie S, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81-95. 21. Hall AM, et al. Measurement tools for adherence to non-pharmacologic self-management treatment for chronic musculoskeletal conditions: A systematic review. Arch Phys Med Rehabil. 2015;96(3):552-62. 22. Jenkinson TR, et al. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol. 1994;21(9):1694-8. 23. Balke, B., A Simple Field Test for the assessment of Physical Fitness. Rep 63-6. Rep Civ Aeromed Res Inst US, 1963: p. 1-8 24. Focht BC, et al. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Arthritis Care Res. 2005;53(5):659-65. 25. Grant PM, et al. The validation of a novel activity monitor in the measurement of posture and motion during everyday activities. Br J Sports Med. 2006;40(12):992-7. 26. Aronson JK. Compliance, concordance, adherence. Br J Clin Pharmacol. 2007;63(4):383-4. 27. Calin A, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281-5. 28. Garrett S, et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286-91. 29. Doward L, et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis. 2003;62(1):20-6. 30. Reilly MC, et al. Validity, reliability and responsiveness of the Work Productivity and Activity Impairment Questionnaire in ankylosing spondylitis. Rheumatology. 2010;49(4):812-9. 31. Brazier J. Measuring and valuing health benefits for economic evaluation. Oxford: Oxford University Press; 2007 32. Manigandan C, et al. Construction of exercise attitude questionnaire-18 to evaluate patients' attitudes toward exercises. Int J Rehabil Res. 2004;27(3):229-31. 33. Arturi P, et al. Adherence to treatment in patients with ankylosing spondylitis. Clin Rheumatol. 2013;32(7):1007-15. 34. Markland D, Hardy L. The Exercise Motivations Inventory: Preliminary development and validity of a measure of individuals' reasons for participation in regular physical exercise. Personal Individ Differ. 1993;15(3):289-96.17pub4548pub

Factors influencing quality of life following lower limb amputation for peripheral arterial occlusive disease: a systematic review of the literature

Background: The majority of lower limb amputations are undertaken in people with peripheral arterial occlusive disease,\ud and approximately 50% have diabetes. Quality of life is an important outcome in lower limb amputations; little is known\ud about what influences it, and therefore how to improve it.\ud Objectives: The aim of this systematic review was to identify the factors that influence quality of life after lower limb\ud amputation for peripheral arterial occlusive disease.\ud Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science and Cochrane databases were searched to identify\ud articles that quantitatively measured quality of life in those with a lower limb amputation for peripheral arterial occlusive\ud disease. Articles were quality assessed by two assessors, evidence tables summarised each article and a narrative\ud synthesis was performed.\ud Study design: Systematic review.\ud Results: Twelve articles were included. Study designs and outcome measures used varied. Quality assessment scores\ud ranged from 36% to 92%. The ability to walk successfully with a prosthesis had the greatest positive impact on quality\ud of life. A trans-femoral amputation was negatively associated with quality of life due to increased difficulty in walking\ud with a prosthesis. Other factors such as older age, being male, longer time since amputation, level of social support and\ud presence of diabetes also negatively affected quality of life.\ud Conclusion: Being able to walk with a prosthesis is of primary importance to improve quality of life for people with lower\ud limb amputation due to peripheral arterial occlusive disease. To further understand and improve the quality of life of this\ud population, there is a need for more prospective longitudinal studies, with a standardised outcome measure

Whole-Exome Sequencing and Homozygosity Analysis Implicate Depolarization-Regulated Neuronal Genes in Autism

Although autism has a clear genetic component, the high genetic heterogeneity of the disorder has been a challenge for the identification of causative genes. We used homozygosity analysis to identify probands from nonconsanguineous families that showed evidence of distant shared ancestry, suggesting potentially recessive mutations. Whole-exome sequencing of 16 probands revealed validated homozygous, potentially pathogenic recessive mutations that segregated perfectly with disease in 4/16 families. The candidate genes (UBE3B, CLTCL1, NCKAP5L, ZNF18) encode proteins involved in proteolysis, GTPase-mediated signaling, cytoskeletal organization, and other pathways. Furthermore, neuronal depolarization regulated the transcription of these genes, suggesting potential activity-dependent roles in neurons. We present a multidimensional strategy for filtering whole-exome sequence data to find candidate recessive mutations in autism, which may have broader applicability to other complex, heterogeneous disorders

A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation

Background: The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial. Methods/Design: The randomised controlled trial, with nested economic and process evaluations, recruited 2,104 inactive men and women aged 16+ with coronary heart disease (CHD) risk factors and/or mild to moderate depression, anxiety or stress. Participants were recruited from 12 local health boards in Wales and referred directly by health professionals working in a range of health care settings. Consenting participants were randomised to either a 16 week tailored exercise programme run by qualified exercise professionals at community sports centres (intervention), or received an information booklet on physical activity (control). A range of validated measures assessing physical activity, mental health, psycho-social processes and health economics were administered at 6 and 12 months, with the primary 12 month outcome measure being 7 day Physical Activity Recall. The process evaluation explored factors determining the effectiveness or otherwise of the scheme, whilst the economic evaluation determined the relative cost-effectiveness of the scheme in terms of public spending. Discussion: Evaluation of such a large scale national public health intervention presents methodological challenges in terms of trial design and implementation. This study was facilitated by early collaboration with social research and policy colleagues to develop a rigorous design which included an innovative approach to patient referral and trial recruitment, a comprehensive process evaluation examining intervention delivery and an integrated economic evaluation. This will allow a unique insight into the feasibility, effectiveness and cost effectiveness of a national exercise referral scheme for participants with CHD risk factors or mild to moderate anxiety, depression, or stress and provides a potential model for future policy evaluations. Trial registration: Current Controlled Trials ISRCTN4768044

Wheelchair and walking physical activity in the spinal cord injured population

Physical Activity (PA) is widely accepted as a deterrent against all cause disease and is especially important for people with Spinal Cord Injury (SCI). People with SCI mobilise by using a wheelchair, walking or a combination of both. Current methods of objectively measuring wheelchair P A are positioned on the wrists or on the rear wheel of the wheelchair and rely on detecting bilateral repetitive wrist movements or are not capable of detecting all wheelchair movement. The main aim of this thesis was to investigate both walking and wheelchair Pain the spinal cord injured population in both the rehabilitation setting and capturing the key transition period of discharge into the community: A secondary aim was to explore the associations between objectively measured P A and clinically used outcomes in the spinal cord injured population. In order to achieve these aims a wheelchair monitoring system that was capable of accurately measuring wheel revolutions and distinguishing the direction of movement was required. A wheelchair monitoring system, consisting of a tri-axial accelerometer positioned on the rear wheel of a wheelchair and an analysis. algorithm as developed and validated. Wheelchair and walking PA levels of participants with acute SCI were measured in the rehabilitation setting and at six weeks and six months post discharge in a cross-sectional and longitudinal study and associations with clinically used outcome measures were assessed. The wheelchair monitoring system was a valid measurement tool capable of accurately measuring wheelchair P A. P A levels of people with SCI were found to vary greatly between participants. There was no statistically significant difference between PA accrued in the rehabilitation and community settings although there was a trend for PA to increase in the community. Associations were also found between wheelchair P A and age and outcome measures such as muscle strength, sensation, functional ability and physical performance. The studies within this thesis are the first to quantify and detail the wheelchair, walking and the combination of walking and wheelchair use of participants with a SCI in the rehabilitation and community settings, and to assess the associations between P A and clinically used outcome measures in the spinal cord injured population.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Sitting and health: The emerging evidence and potential solutions

Here we discuss the emerging research evidence and suggest potential opportunities to intervene and help older people get active.sch_phyCampbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing. 1999; 28(6): 513-8. Chang AK, Fritschi C, Kim MJ.Sedentary behavior, physical activity, and psychological health of Korean older adults with hypertension: effect of an empowerment intervention. Res Gerontol Nurs. 2013; 6(2): 81-8. Chastin SFM, Schwarz U, Skelton DA. Development of a Consensus Taxonomy of sedentary Behaviours (SIT): Report of Delphi Round 1. PLoS ONE 2013; 8(12): e82313. Chastin SF, Mandrichenko O, Helbostadt JL, Skelton DA. Associations between objectively-measured sedentary behaviour and physical activity with bone mineral density in adults and older adults, the NHANES study. Bone 2014; 64C:254-62. de Brito LB, Ricardo DR, de Arajo DS, Ramos PS, Myers J, de Arajo CG. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2012;21(7):892-8. de Rezende LFM, Rey-L_pez JP, Matsudo VKR, Luiz OdC. Sedentary behavior and health outcomes among older adults: a systematic review. BMC Public Health 2014, 14:333 doi:10.1186/1471-2458-14-333. Department of Health. Start Active, Stay Active: A report on physical activity for health from the four home countries' Chief Medical Officers. Department of Health, Physical Activity, Health Improvement and Protection, London, 2011. English C, Manns PJ, Tucak C, Bernhardt J. Physical activity and sedentary behaviors in people with stroke living in the community: a systematic review. Phys Ther. 2014 Feb;94(2):185-96. Fitzsimons CF, Kirk A, Baker G, Michie F, Kane C, Mutrie N. Using an individualised consultation and activPAL feedback to reduce sedentary time in older Scottish adults: results of a feasibility and pilot study. Prev Med. 2013;57(5):718-20. Gao X, Nelson ME, Tucker KL. Television viewing is associated with prevalence of metabolic syndrome in Hispanic elders. Diabetes Care. 2007; 30(3): 694-700. Gardiner PA, Eakin EG, Healy GN, Owen N. Feasibility of reducing older adults' sedentary time. Am J Prev Med. 2011; 41(2): 174-7. Gennuso KP1, Gangnon RE, Matthews CE, Thraen-Borowski KM, Colbert LH. Sedentary behavior, physical activity, and markers of health in older adults. Med Sci Sports Exerc. 2013; 45(8): 1493-500. Grant M, Granat, M, Thow, M Maclaren WM. Analyzing freeliving physical activity of older adults in different environments using body-worn activity monitors. Journal of Aging and Physical Activity 2010; 18 (2): 171 - 184. Harvey JA, Chastin SFM, Skelton DA. Global Prevalence of Sedentary Behavior in Older Adults: A Systematic Review. International Journal of Environmental Research and Public Health 2013; 10: 6645-61. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009; 41(5): 998-1005. King AC, Hekler EB, Grieco LA, Winter SJ, Sheats JL, Buman MP, Banerjee B, Robinson TN, Cirimele J. Harnessing different motivational frames via mobile phones to promote daily physical activity and reduce sedentary behavior in aging adults. PLoS One. 2013 Apr 25;8(4):e62613. Kunkel D, Fitton C, Burnett M, Ashburn A. Physical inactivity poststroke: a 3-year longitudinal study. Disabil Rehabil. 2014 May 14:1-7. [EPub ahead of print]. Leask C, Harvey JA, Skelton DA, Braid H, MacDonald J, Shergill K, Starrat A, Chastin SFM. Determining the context of sedentary behaviour in older adults using lifelogging body worn sensors (timelapse camera, activPAL). In press. Journal of Aging and Physical Activity, Oct 2014. Lindemann U, Oksa J, Skelton DA, Beyer N, Klenk J, Zscheile J, Becker C. Effect of indoor cold environment on physical and cognitive performance of older women living in the community. Age Ageing. 2014; 43(4): 571-5. Mart_nez-G_mez D, Guallar-Castill_n P, Le_n-Muoz LM, L_pez- Garc_a E, Rodr_guez-Artalejo F. BMC Med. 2013 Feb 22;11:47. Owen N, Bauman A, Brown W (2009). Too much sitting: a novel and important predictor of chronic disease risk? Br J Sports Med 2009;43:81-83. doi:10.1136/bjsm.2008.055269 Schmid D, Leitzmann MF. Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst. 2014 Jun 16;106(7). Sedentary Behaviour Research Network. Letter to the editor: standardized use of the terms sedentary- and sedentary behaviours-. Appl Physiol Nutr Metab 2012; 37: 540-2. Skelton DA, Young A, Greig CA. Muscle function of women aged 65-89 years meeting two sets of health criteria. Aging Clinical Experimental Research (Aging Milano) 1997; 9:106-11. Skelton DA. Effects of physical activity on postural stability. Age and Ageing 2001; 30-S4; 33-9. Stotz A, Rapp K, Oksa J, Skelton DA, Beyer N, Klenk J, Becker C, Lindemann U. The effect of heat on blood pressure and physical performance of older women living in the community - A pilotstudy. Submitted to Int. J. Environ. Res. Public Health, 2014. Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, Khunti K, Yates T, Biddle SJ. Diabetologia. 2012 Nov;55(11):2895-905Winterpub4547pu

The effectiveness of structured exercise in the south Asian population with type 2 diabetes: a systematic review

Objectives: The impact of exercise interventions on south Asians with type 2 diabetes (T2DM), who have a higher T2DM incidence rate compared to other ethnic groups, is inconclusive. This study aimed to systematically review the effect of exercise interventions in south Asians with T2DM. Method: Five electronic databases were searched up to April 2017 for controlled trials investigating the impact of exercise interventions on south Asian adults with T2DM. The Pedro scale was used to assess the quality of the included studies. Results: Eighteen trials examining the effect of aerobic, resistance, balance or combined exercise programs met the eligibility criteria. All types of exercise were associated with improvements in glycemic control, blood pressure, waist circumference, blood lipids, muscle strength, functional mobility, quality of life or neuropathy progression. The majority of included studies were of poor methodological quality. Few studies compared different types or dose of exercise. Conclusion: This review supports the benefits of exercise for south Asians with T2DM, although it was not possible to identify the most effective exercise prescription. Further studies of good methodological quality are required to determine the most effective dosage and type of exercise to manage T2DM in this population.sch_phy45pub4932pub