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Introduction. People with Parkinson’s disease (PwPD) present motor alterations which can impact daily life tasks that require speed and/or accuracy of movement. Objective. A sub analysis of NCT01439022, aiming to estimate the extent to which two different exercise training protocols (global and handwriting upper limb exercise training) impact reaction time, travel speed, and accuracy in PwPD. Methods. Seventy PwPD, right-side dominant were randomised 1:1 into two six-month training protocol groups; 35 PwPD performed global exercise training and 35 performed specific training (handwriting upper limb exercise movements). Assessments of speed-accuracy and trade-off were carried out at baseline, after 3 and 6 months of training, and at a 12-month follow-up. The current study used data from a previous publication of a randomised controlled trial that included a 6-month self-managed community exercise programme for PwPD. For the present study we included only the participants who completed the Fitts’ task during the baseline assessment. Results. In the upper limb assessments, no main effects were found for the number of touches, but the exercise group showed a marginal increase over time on the left side. Error averages on the left side decreased significantly for the exercise group from baseline to 6 and 12 months. The exercise group also presented a lower Error CoV and the Reaction Time CoV increased on the right side. Significant findings for Fitts r on the left side indicated lower values for the exercise group, with improvements continuing at 12 months. Conclusion. We report the potential of global exercise interventions to facilitate improvements in reaction time and travel speed, as well as other motor control metrics, with lasting effects at 12 months, particularly on the non-dominant side.

Objectives. To assess the feasibility of methods and estimate the potential effect of interrupting sedentary behaviour, with intermittent or continuous physical activity breaks, on cognitive performance in young people with Cerebral Palsy. Methods. A randomised three-arm exposure response cross-over design with process evaluation. Participants were recruited throughout the Thames Valley, UK between 01/11/2018 to 31/03/2020. The three 2 h activity exposure visits included: (i) sitting only (controls), (ii) sitting plus 20 min of moderate-to-vigorous activity burst, or (iii) 4×5 min of moderate-to-vigorous activity bursts, during a 2.5 h sedentary session. Measures of feasibility were sought. Cognitive performance outcomes (using the Eriksen Flanker task and Forward and Backward Digit Span) were delivered before and after the 2 h testing period. Results. 36 participants were randomised (age 13.2±2.7, Gross-Motor Functional Classification System 1–3). Study retention was 83 % across all three interventions and overall missing data for measures was 4 %. A small intervention effect was found in reaction time in the 4×5 min physical activity exposure session compared to the sedentary control condition (0.42; 95 % CI 0.40 to 0.79). There were two research-related minor adverse effects, an allergic reaction to the FreeStyle Libre and feeling faint and vomiting after consumption of glucose solution. Both events were resolved and participants continued with the study. Conclusions. The study design and intervention implementing short bursts of physical activity was feasible and indicated a potential effect on reaction time as a measure of cognitive performance in young people with cerebral palsy.

Background. Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing. Methods. Movement Assessment Battery for Children-2nd edition was used to identify 48 children with probable developmental coordination disorder (13.9 ± 0.05 yrs., 27% male) and 37 typically developed (13.9 ± 0.10 yrs., 54% male). While instrumented with an inertial measurement unit, both groups performed a novel rhythmic stepping task and with a concurrent auditory stroop test (dual-task), underwent seven weeks of intervention with step training with rhythmic cuing and were tested for retention five weeks post-intervention. Findings. Initially, the group with probable developmental coordination disorder had a higher variability of step timing (coefficient of variation: 0.08 ± 0.003-typically developed – 0.09 ± 0.004-probable developmental coordination disorder, p < 0.05) and a frequency of peak power spectral density further from the target 0.5 Hz (0.50 ± 0.002 Hz-typically developed – 0.51 ± 0.003 Hz-probable developmental coordination disorder, p < 0.05), and were more affected by the dual-task: power spectral density at 0.5 Hz (−7.2 ± 3.3%-typically developed – -13.4 ± 4.6%- prob_DCD, p < 0.05) and stroop test errors (6.4 ± 1.1%-typically developed – -11.1 ± 2.4%- probable developmental coordination disorder, p < 0.05). The intervention led to similar improvements in both groups in coefficient of variation of step timing (0.12 ± 0.01-Pre – 0.07 ± 0.002-Post, p < 0.05), frequency of the peak power spectral density (0.51 ± 0.005 Hz-Pre – 0.50 ± 0.001 Hz-Post, p < 0.05) and relative power spectral density bandpower (3.2 ± 0.2%-Pre – 5.9 ± 0.3%-Post, p < 0.05). All improvements were retained after five weeks post-training. Interpretation. Rhythmic cueing shows strong promise for enhan

Developmental coordination disorder (DCD) is characterized by motor learning deficits that are poorly understood within whole-body activities context. Here we present results of one of the largest nonrandomized interventional trials combining brain imaging and motion capture techniques to examine motor skill acquisition and its underpinning mechanisms in adolescents with and without DCD. A total of 86 adolescents with low fitness levels (including 48 with DCD) were trained on a novel stepping task for a duration of 7 weeks. Motor performance during the stepping task was assessed under single and dual-task conditions. Concurrent cortical activation in the prefrontal cortex (PFC) was measured using functional near-infrared spectroscopy (fNIRS). Additionally, structural and functional magnetic resonance imaging (MRI) was conducted during a similar stepping task at the beginning of the trial. The results indicate that adolescents with DCD performed similarly to their peers with lower levels of fitness in the novel stepping task and demonstrated the ability to learn and improve motor performance. Both groups showed significant improvements in both tasks and under single- and dual-task conditions at post-intervention and follow-up compared to baseline. While both groups initially made more errors in the Stroop task under dual-task conditions, at follow-up, a significant difference between single- and dual-task conditions was observed only in the DCD group. Notably, differences in prefrontal activation patterns between the groups emerged at different time points and task conditions. Adolescents with DCD exhibited distinct prefrontal activation responses during the learning and performance of a motor task, particularly when complexity was increased by concurrent cognitive tasks. Furthermore, a relationship was observed between MRI brain structure and function measures and initial performance in the novel stepping task. Overall, these findings suggest that strategies that ad

Purpose: This study set out to identify the extent of the relationships between subsections of the Movement Assessment Battery for Children 2nd Edition - MABC2 (manual dexterity, aiming and catching, and balance) to PA, CRF and BMI in adolescents. Methods: Height, BMI, the MABC2, a 20m shuttle run test and wrist-worn accelerometery PA levels (mins) were measured. Multivariable linear regression models, adjusting for sex, height and BMI were used to assess the relationship of the three subsections of the MABC2 with PA, CRF and BMI. Results: A total of 155 adolescents, aged 13-14 years, took part in this study (77 girls, 78 boys). Balance reported significant relationships with moderate to vigorous PA (unstandardised Beta B=0.15, 95%CI 0.02-0.28), vigorous PA (B=0.06, 95%CI 0.02-0.09) and BMI (B=-0.01, 95%CI -0.02-0.005). Balance in addition to aiming and catching skills were both significantly related to adolescent CRF (B=0.30, 95%CI 0.17-0.42 and B=0.29, 95%CI 0.14-0.45, respectively). Conclusion: This study suggests that balance is the strongest correlate skill to achieving the highest intensities of PA and healthier BMI status in adolescents.

Flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue and fatigability. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with Parkinson's (pwP) have been performed. Objectives. To determine the feasibility and estimate potential effect of flavonoid-rich cocoa on fatigue and fatigability in pwP. Methods. This was a randomised (1:1) double-blind placebo controlled feasibility study in which 30 pwP were recruited from the European Parkinson Therapy Centre, Italy (trial registration: NCT03288155). During a six day intervention participants consumed a high (10.79 mg/g) or low flavonoid cocoa (1.02 mg/g) beverage (18 g Cocoa with 200 ml Rice milk) once daily. Potential effect on fatigue and fatigability was measured (baseline to day 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation. Results. From July 2017 to May 2018, 30 pwP were recruited and randomised and allocated to high (n = 15) or low (n = 15) flavonoid groups and included in analysis. Missing data was less than 5% and adherence to intervention of all allocated individuals was 97%. There was a small effect on fatigability (6 min walk test: ES 0.11 (95%CI = −0.11-0.26); Z = 0.81). There were two adverse events (one in the control and one in the intervention group). Conclusion. The consumption of cocoa is feasible and well received in pwP, and further investigation on the effect on fatigability is warranted.

Rationale: The proportion of adults aged above 60 is rapidly increasing and by 2050 they will comprise almost one fourth of total world population. However, with moderate disability rates also increasing, there is great need for older people to maintain overall well-functioning. Physical and cognitive functioning play a major role in daily activities and determine life quality of older people. Maintaining walking ability is crucial for independent living and walking speed is predictive of overall health, survival and better physical and cognitive functioning. Rates of functional decline vary interindividual and between sexes, with women living longer but with higher comorbidity rates than men. Part of this variability in functional trajectories is attributable to modifiable lifestyle factors, with diet being of great interest. Specific nutrients and presumably healthy diets have been associated with better physical and cognitive performance in older people. Research gap: Evidence for diet quality in line with current dietary guidelines and objective measures of well-functioning, important for older people, is limited. In addition, considering well-known differences in eating and ageing trajectories between men and women, it is highly underexplored whether the effect of diet on overall functioning of older people is sex-specific. Finally, evidence for whether accumulation of healthy dietary exposure over time may exert additional benefits on overall functioning in later life, is scarce. Aim: To investigate the overall and sex-specific prospective associations between diet quality in late midlife and over a 27-year period in adulthood and objective measures of walking speed in older life, indicating survival and physical and cognitive functioning. Methods: This thesis used dietary data (five-day food diaries) of men and women from four time points of the 1946 MRC National Survey of Health and Development birth cohort (N=5,362) when participants were at ages 36, 43, 53

The gut microbiome comprises the community of microorganisms in the intestinal tract. Research suggests that an altered microbiome may play a role in a wide range of disorders including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Methods. 42 participants with ME/CFS with Irritable Bowel Syndrome (IBS) were allocated into one of two groups, 21 were treated with standard oral approaches, which centred around various nutritional remedies, probiotics, prebiotics, dietary advice and lifestyle advice. The second group who had mostly failed using oral approaches, were treated with Faecal Microbiome Transplantation (FMT). Each patient received 10 Implants, each from a different screened donor, and the Implants were processed under anaerobic conditions. The transplant is delivered via a paediatric rectal catheter, which is inserted through the anus to reach the lower part of the sigmoid colon. The results were assessed on a percentage basis before and after treatment, 0% being no improvement, 100% being maximum improvement. An exact non-parametric Mann-Whitney (one-tailed) test was used to compare medians from those on FMT compared with those receiving oral approaches only. On clinical experience over many years, the only way to judge improvement in Chronic Fatigue Syndrome as there is no test for Chronic Fatigue Syndrome, is my clinical assessment. Results. The median for the FMT group was found to be significantly higher compared to the oral treatment group (Mann-Whitney U = 111.5, p = .003). Therefore, the FMT group improved to a greater extent (z = −2.761). Conclusion. This study shows that FMT is a safe and a promising treatment for CFS associated with IBS. Adequately powered randomised controlled trials should be carried out to assess the effectiveness of FMT in patients with CFS and IBS.

Background: Diet could have implications for disease progression and management in people with Parkinson’s disease (PwP). However, the knowledge of diet intake patterns in PwP is limited. Objectives: We set out to assess the feasibility of collecting diet data in PwP to determine food and nutrient intake, in order to compare to national nutrition guidelines and thus understand the habits in this population. Methods: In this cross-sectional feasibility study, PwP were approached through local support groups throughout the Thames Valley and were asked to complete a Food Frequency Questionnaire. Eligibility criteria included a self-reported neurologist confirmed diagnosis of Parkinson’s disease. Completeness of questionnaires was reported and 80% was considered appropriate for each measure including demographic information. Results: Response rate was 61% and missing data rate for the 121 returned questionnaires was 74%; however, of the 90 used for analysis there was 100% completion of the questionnaires. Compared to the UK government guidelines, protein was significantly higher for both males and females and fluid intake was lower for both genders (p < 0.001). There were several other differences in nutrient intake compared to guidelines. Conclusion: We observed high levels of engagement from PwP and found that assessing food and nutrient patterns in PwP was feasible. Importantly, the diet was generally healthy overall, yet there were specific nutrients that may affect medication metabolism in PwP that were found to be high. Therefore further research into this emerging and important area is warranted.

Symptoms of Parkinson’s can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person’s quality of life. To date, studies looking into exercise interventions for people with Parkinson’s (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon’s test followed by a Mann–Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p < 0.05) with a moderate effect found for the change in sedentary and light activities in the overnight hours for both groups, over time (0.32 and 0.37-0.38, resp.). There was no impact on self-reported fatigue or sleep. Conclusion. The observed moderate effect on sedentary and light activities overnight could suggest an objective improvement in sleep patterns for individuals participating in both exercise and handwriting interventions. This supports the need for further studies to investigate the role of behavioural interventions for nonmotor symptoms.

Five to six percent of young people have movement impairment (MI) associated with reduced exercise tolerance and physical activity levels which persist into adulthood. To better understand the exercise experience in MI, we determined the physiological and perceptual responses during and following a bout of exercise performed at different intensities typically experienced during sport in youth with MI. Thirty-eight adolescents (11±18 years) categorised on the Bruininks-Oseretsky Test of Motor Proficiency-2 Short-Form performed a peak oxygen uptake bike test (V_ O2peak) test at visit 1 (V1). At visits 2 (V2) and 3 (V3), participants were randomly assigned to both low-intensity (LI) 30min exercise at 50% peak power output (PPO50%) and high-intensity (HI) 30s cycling at PPO100%, interspersed with 30s rest, for 30min protocol (matched for total work). Heart rate (HR) and rating of perceived exertion (RPE) for legs, breathing and overall was measured before, during and at 1, 3 and 7-min post-exercise (P1, P3, P7). There was a significant difference in V_ O2peak between groups (MI:31.5±9.2 vs. NMI:40.0±9.5ml.kg-1.min-1, p<0.05). PPO was significantly lower in MI group (MI:157±61 vs. NMI:216±57 W)(p<0.05). HRavg during HI-cycling was reduced in MI (140±18 vs. 157±14bpm, p<0.05), but not LI (133±18 vs. 143±17bpm, p>0.05). Both groups experienced similar RPE for breathing and overall (MI:7.0±3.0 vs. NMI:6.0±2.0, p>0.05) at both intensities, but reported higher legs RPE towards the end (p<0.01). Significant differences were found in HRrecovery at P1 post-HI (MI:128±25.9 vs. NMI:154±20.2, p<0.05) but not for legs RPE. Perceived fatigue appears to limit exercise in youth with MI in both high and low-intensity exercise types. Our findings suggest interventions reducing perceived fatigue during exercise may improve exercise tolerance and positively impact on engagement in physical activities.

Background. Dietary interventions including consumption of flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with MS (pwMS) have been performed. The hypothesis is that the consumption of a flavonoid-rich pure cocoa beverage will reduce fatigue in pwMS. The aim of this study is to determine the feasibility and potential outcome of running a trial to evaluate this hypothesis. Methods. Using a randomised (1:1) double-blind placebo-controlled feasibility study, 40 men and women (20 in each trial arm) with a recent diagnosis (< 10 years) of relapsing and remitting MS (RRMS) and who are over 18 years of age will be recruited from neurology clinics and throughout the Thames Valley community. During a 6-week nutrition intervention period, participants will consume the cocoa beverage, high flavonoid or low flavonoid content, at breakfast daily. At baseline, demographic factors and disease-related factors will be assessed. Fatigue, activity and quality of life, in addition to other measures, will be taken at three visits (baseline, week 3 and week 6) in a university setting by a researcher blinded to group membership. Feasibility and fidelity will be assessed through recruitment and retention, adherence and a quantitative process evaluation at the end of the trial. We will describe demographic factors (age, gender, level of education) as well as disease-related factors (disease burden scores, length of time diagnosed with MS) and cognitive assessment, depression and quality of life and general physical activity in order to characterise participants and determine possible mediators to identify the processes by which the intervention may bring about change. Feasibility (recruitment, safety, feasibility of implementation of the intervention and evaluation, protocol adherence and data completion) and potent

Background. Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activities in hospital inpatients. This study’s goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels during inpatient stroke rehabilitation and the short-term effects on simple functional activities, primarily mobility. Methods/design. A randomized controlled trial will be undertaken within the stroke rehabilitation wards of the 2nd affiliated hospital of Anhui University of Traditional Chinese Medicine, Hefei, China. The study participants will be stroke survivors who meet inclusion criteria for the study, primarily: able to participate, no more than four months after stroke, and walking independently before stroke. Participants will all receive standard local rehabilitation and will be randomly assigned either to receive regular feedback about activity levels, relative to a daily goal tailored by the smart watch over five time periods throughout a working day, or to no feedback, but still wearing the Smart watch. The intervention will last up to three weeks, ending sooner if discharged. The data to be collected in all participants includes measures of: daily activity (Smart watch measure); mobility (Rivermead Mobility Index and ten metre walking time); independence in personal care (the Barthel ADL index); overall activities (the WHO Disability Assessment Scale, 12-item version); and quality of life (the Euro-Qol 5L5D). Data will be collected by masked assessors at baseline, three weeks or at discharge (whichever is the sooner); and a reduced data set at 12 weeks by telephone interview. The primary outcome will be change in daily accelerometer activity scores. Secondary outcomes are compliance and adherence to wearing the watch, and changes in mobility, independence in personal care activities, and health-related quality o

Mastery of many tasks in daily life requires role differentiated bimanual hand use with high spatiotemporal cooperation and minimal interference. The authors investigated developmental changes in the performance of a disparate bimanual movement task requiring sequenced movements. Age groups were attributed to changes in CNS structures critical for bimanual control such as the corpus callosum (CC) and the prefrontal cortex; young children (5–6 years old), older children (7–9 years old), and adolescents (10–16 years old). Results show qualitative changes in spatiotemporal sequencing between the young and older children which typically marks a phase of distinct reduction of growth and myelination of the CC. Results show qualitative changes in spatiotemporal sequencing between the young and older children, which coincides with distinct changes in the growth rate and myelination of the CC. The results further support the hypothesis that CC maturation plays an important role in the development of bimanual skills.

This paper presents a study of the movements of a humanoid head-and-neck robot called Eddie. Eddie has a musculo-skeletal structure similar to that found in human necks enabling it to perform head movements that are comparable with human head movements. This study compares the movements of Eddie with those of a more conventional robotic neck structure and with those of a human head. Results show that Eddie’s movements are perceived as significantly more natural and by trend more lifelike than the conventional head’s. No differences were found with respect to the impression of humanlikeness, consciousness, and elegance.

Objectives: To investigate the acute and adaptation cardiovascular and metabolic training responses in people with Parkinson’s (pwP). Design: 1) A cross sectional study of exercise response of pwP compared to sedentary controls,2) an interventional study of exercise training in pwP. Setting: Community leisure facilities. Participants: pwP (n=83) & sedentary controls (n=55) Interventions: Study (1) included participants from a two arm parallel single blind phase II Randomised Controlled Trial (RCT), that undertook a baseline maximal incremental exercise test and study (2) included those randomised to the exercise group in the RCT, who completed a six-month weekly exercise programme (n=37). The intervention (study (2) was a prescribed exercise program consisting of sessions lasting 60 minutes, twice a week over a six-month period. The control group followed the same protocol which derived the same cardio respiratory parameters, except the they were instructed to aim for a cadence of ~60rpm and the unloaded phase lasted 3minutes with an initial step of 25watts. Primary and secondary outcome measures: Stepwise incremental exercise test to volitional exhaustion was the primary outcome measure. Results: Study (1) showed higher maximum values for heart rate, VO2l.min-1, VCO2l.min-1 and Ventilation l.min-1 for the control group; Respiratory Exchange Ratio (RER), perceived exertion and O2 Pulse (VO2l.min-1/ HR) did not differ between groups. In study (2), for pwP who adhered to training (n=37), RER increased significantly and although there was no significant change in aerobic capacity or heart rate response, reduced blood pressure was found. Conclusions: An abnormal cardiovascular response to exercise was observed in pwP compared to controls. After the exercise programme, metabolic deficiencies remained for pwP. These observations add to the pathogenic understanding of PD, acknowledge an underling metabolic contribution and support that certain cardiovascular symptoms may i

Mastery of many tasks in daily life requires role differentiated bimanual hand use with high spatiotemporal cooperation and minimal interference. The authors investigated developmental changes in the performance of a disparate bimanual movement task requiring sequenced movements. Age groups were attributed to changes in CNS structures critical for bimanual control such as the corpus callosum (CC) and the prefrontal cortex; young children (5–6 years old), older children (7–9 years old), and adolescents (10–16 years old). Results show qualitative changes in spatiotemporal sequencing between the young and older children which typically marks a phase of distinct reduction of growth and myelination of the CC. Results show qualitative changes in spatiotemporal sequencing between the young and older children, which coincides with distinct changes in the growth rate and myelination of the CC. The results further support the hypothesis that CC maturation plays an important role in the development of bimanual skills.

Context. Current research suggests that dark cocoa may reduce fatigue; however, the effect on fatigue in people with MS (pwMS) has never been established. The objective of this feasibility study was to explore the acute effect of high flavonoid cocoa on measures of fatigue and glycaemic response. Methods. This was a randomised crossover participant blind exploratory study in 12 participants (2 male and 10 female) with MS-related fatigue (>4 on the Fatigue Severity Scale; FSS). After fasting overnight, participants consumed the high flavonoid cocoa drink (350 mg gallic acid equivalents {GAE}/g) or a low flavonoid cocoa control (120 mg GAE/g), consuming the alternative drink on the next visit. Fatigue was self-reported on a 100 mm visual analogue scale at 30-min time intervals for 2 h post cocoa consumption and every 2 h for the rest of the day. Fatigability was monitored using a 6 min walk test (6MWT) at the end of the visit (2 h), and activity monitors worn for 24 h commencing at 12 noon on the day of testing. The feasibility of performing the trial including outcome measures was documented. Results. A moderate effect was found in self-reported fatigue throughout the day in favour of the high flavonoid group (Cohen's d 0.32, 95% non-central t CI −0.57 to 1.20). Fatigability measures did not change. Participants consumed and enjoyed the cocoa, all participants completed the study and outcome measures were accepted. Conclusion. The results of this study support further trials to investigate the feasibility and efficacy of pure cocoa as a dietary supplement for fatigue in pwMS.