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Background/Aims: Functional neurological disorder is increasingly common in paediatric neurological practice, yet the role and scope for occupational therapy and physiotherapy intervention remains unclear. The aim of this systematic review was to evaluate if occupational therapy and/or physiotherapy interventions improve activity and participation for children and adolescents with functional neurological disorder compared to usual care. Methods: CINAHL, Embase and Medline were searched until May 2023. Eligibility criteria were applied by two reviewers independently. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Data were synthesised narratively and the certainty of evidence assessed using a Grading of Recommendations, Assessment, Development and Evaluation approach. Results: A total of eight non-randomised studies (n=451 participants, mean age 13.2 years) were selected. There was very low certainty evidence that for approximately three in four participants, inpatient or outpatient multidisciplinary programmes involving physiotherapy and/or occupational therapy led to recovery at the end of the programme, with recovery and school attendance retained at 12 months. Two studies provided very low certainty evidence that two in three participants attending multidisciplinary programmes were independent on all Pediatric Functional Independence Measure items at programme discharge. Conclusions: There is insufficient evidence to suggest routine occupational therapy and/or physiotherapy interventions improve activity and participation function for children and adolescents with functional neurological disorder compared to usual care. Implications for practice: The implications for clinical practice for allied health professionals are ambiguous because of the low-quality of the available evidence. Until further research is conducted to support clinical practice, clinicians must rely on the combination of their clinical expertise and the best available evidence to guide practice. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction: Motivational interviewing (MI) proficiency may erode quickly, limiting its effectiveness. We examined whether health professionals completing a 2-day workshop, with 3 to 5 hours of personalized coaching, and twice-yearly group reflections sustained proficiency for the duration of a hip fracture rehabilitation trial and whether intervention was implemented as intended. Methods: A fidelity study was completed as part of a process evaluation of the trial that tested whether physical activity increased among hip fracture patients randomly allocated to receive MI (experimental) compared with dietary advice (control) over ten 30-minute sessions. Twelve health professionals (none were proficient in MI before trial commencement) delivered the intervention for up to 952 days. Two hundred experimental sessions (24% of all sessions, 83 patients) were randomly selected to evaluate proficiency using the MI Treatment Integrity scale; along with 20 control sessions delivered by four dietitians. Linear mixed-effects regression analyses determined whether proficiency was sustained over time. Dose was assessed from all experimental sessions (n = 840, 98 patients). Results: Intervention was implemented as intended; 82% of patients received at least eight 30-minute sessions. All motivational interviewers were proficient, whereas dietitians did not inadvertently deliver MI. Time had no effect on MI proficiency (est < 0.001/d, P =.913, 95% CI, −0.001 to 0.001). Discussion: MI proficiency was sustained in a large trial over 2.6 years by completing a 2-day workshop, 3 to 5 hours of personalized coaching, and twice-yearly group reflections, even for those without previous experience; further research needs to establish the maximum duration of training effectiveness. [ABSTRACT FROM AUTHOR]

Objective. My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods. This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability, reach and demand, practicality, integration, limited efficacy testing and adaptations. Results. Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical, and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion. My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation. [ABSTRACT FROM AUTHOR]

Music listening is widely used during exercise, but effects on physical activity are unknown. This review aimed to examine the effectiveness of music listening on physical activity of adults. Searches were conducted until September 2022. Eligible randomised controlled trials examined intentional music listening to enhance physical activity in adults. Trials were assessed using the Revised Cochrane risk-of-bias tool. The GRADE approach assessed certainty of evidence. One high and two low risk-of-bias trials (113 participants, 63–68 years) from cardiac and pulmonary rehabilitation programs were included. Moderate certainty evidence favoured music listening for total amounts of physical activity (n = 112, δ = 0.32, 95% CI = −0.06–0.70) and weekly moderate intensity physical activity (n = 88, MD = 52 min, 95% CI = −8–113). Low certainty evidence favoured music listening for exercise capacity (6-min walk test) (n = 79, MD = 101 metres, 95% CI = 2.32–199.88). There is imprecise, moderate certainty evidence that music listening increases physical activity by a small amount in older adults. Future research including adults of all ages with and without health conditions might investigate music listening with focussed behaviour change interventions. There is uncertainty in the current evidence but listening to music may lead to small increases physical activity in older adults with health conditions. Listening to music while walking may lead to improved exercise capacity. Rehabilitation professionals might consider using music listening as an adjunct with focussed behaviour change interventions aiming to increase physical activity. [ABSTRACT FROM AUTHOR]

Purpose: To determine if a consumer co‐designed infographic increased knowledge of physical activity and self‐efficacy for exercise after total knee joint replacement surgery. Methods: Forty‐four adults with primary knee joint replacement surgery were recruited from a public and a private hospital in Melbourne, Australia. Participants were randomly allocated to an experimental or control group. The experimental group received a consumer co‐designed infographic. All participants received usual care. Primary outcome measures were knowledge of physical activity and self‐efficacy for exercise. Outcomes were administered at baseline, week 1 and week 6. Semi‐structured interviews with experimental group participants explored the acceptability, implementation and efficacy of the infographic. Results: There were no between‐group differences for knowledge of physical activity at week 1 (MD −0.02 units, 95% CI −0.9 to 0.9) or week 6 (MD 0.01 units, 95% CI −0.9 to 0.9). Self‐efficacy for exercise increased at week 1 (MD 14.2 units, 95% CI 2.9–25.4) but was not sustained. Qualitative data showed that the infographic was embraced by some participants but not by others. Conclusions: A consumer co‐designed infographic did not improve knowledge of physical activity but may have had a short‐term positive effect on self‐efficacy for exercise after knee joint replacement. Trial registration ACTRN12621000910808. [ABSTRACT FROM AUTHOR]

Background: Exercise and physical activity interventions improve short-term outcomes for people with metabolic syndrome, but long-term improvements are reliant on sustained adherence to lifestyle change for effective management of the syndrome. Effective ways of improving adherence to physical activity and exercise recommendations in this population are unknown. This systematic review aims to determine which interventions enhance adherence to physical activity and/or exercise recommendations for people with metabolic syndrome. Methods: Electronic databases MEDLINE, PubMed, CINAHL, SPORTdiscuss and ProQuest were searched to July 2022. Risk of bias was assessed using the Cochrane risk of bias tool and overall certainty of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation approach. Results: Four randomized controlled trials with 428 participants (mean age 49– 61 years) were included. There was very low certainty evidence from two trials that goal setting interventions may improve adherence to physical activity recommendations over three to six months. There was low certainty evidence from two trials that self-monitoring and feedback interventions increased adherence to physical activity interventions over 12 months for people with metabolic syndrome. Conclusion: Clinicians and researchers may consider using behavior change strategies such as goal setting, monitoring and feedback in interventions for people with metabolic syndrome to increase adherence to physical activity and exercise recommendations over 3 to 12 months, but high-quality evidence is lacking. [ABSTRACT FROM AUTHOR]

Background: Long-term adherence to exercise or physical activity (EPA) is necessary for effective first-line management of metabolic syndrome (MetS). Little is known about the determinants of adherence in this population. This systematic review aims to identify the determinants of adherence to EPA in people with MetS. Methods: Six databases (MEDLINE, CINAHL Complete, PubMed, PsycINFO, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies published before April 26, 2021. Primary research studies investigating factors affecting EPA adherence in adults with MetS in outpatient settings were included. Risk of bias was assessed using the QUIPS (Quality in Prognostic Factor Studies) and CASP (Critical Appraisal Skills Program) tools, for quantitative and qualitative methodologies, respectively. Results: Four quantitative studies (n = 766) and one qualitative (n = 21) study were included in the review, evaluating 34 determinants of adherence to EPA in MetS. Limited evidence was found for an association between ten determinants and non-adherence to EPA: lower self-rated health, lower baseline EPA, lower high-density lipoprotein cholesterol (HDL-C), fewer walk-friendly routes within 1 km, less consciousness raising, lower self-re-evaluation, lower self-liberation, reporting more arguments against EPA (cons), lower social support, and fewer positive psychological constructs. There was limited evidence of no association or conflicting evidence for the remaining 24 determinants. Conclusion: A small number of included studies, most of low methodological quality, resulted in limited confidence in the findings for all determinants. The identified determinants associated with non-adherence are all potentially modifiable, thus further high-quality studies are required to increase confidence in the determinants of EPA in people with MetS, and test interventions. [ABSTRACT FROM AUTHOR]

Background: Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise-based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective: We aimed to evaluate the efficacy of a group exercise-based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods: A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results: The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions: This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to explore patient perceptions of and motivations for physical activity after total knee joint replacement. Methods: Participants were purposively sampled after completing a public outpatient rehabilitation exercise group. Semistructured interviews were completed with 22 participants (mean age 70 years, 45% women) 6 to 12 months after total knee joint replacement. Interviews were audiotaped and transcribed verbatim. Themes were identified by an inductive and iterative process of data analysis. Results: The main theme to emerge was participants were in the dark about physical activity. Participants were typically not familiar with physical activity guidelines and had difficulty distinguishing between low‐ and moderate‐intensity physical activity. Three subthemes were identified: 1) people prioritize participation in meaningful life situations after total knee joint replacement, 2) rehabilitation was perceived to not explicitly address moderate‐intensity physical activity levels, and 3) other health and social reasons replaced knee osteoarthritis as barriers to physical activity. Conclusion: Limited understanding of physical activity recommendations, prioritization of participation in meaningful life situations, rehabilitation that was impairment focused, and other health and social reasons appeared to contribute to low levels of moderate‐intensity physical activity in adults after knee joint replacement. Addressing being in the dark about physical activity may be an important first step to increase the effectiveness of behavioral interventions designed to promote physical activity after total knee joint replacement. [ABSTRACT FROM AUTHOR]

To evaluate feasibility of scaling up a 12-week community-based exercise program (FitSkills) in which young people with disability exercise with a student mentor. Within a stepped wedge cluster randomised trial, seven domains of feasibility were assessed: demand, implementation, acceptability, practicality, adaptation, integration, and expansion. Of the 163 participants with disability (61 females; 20.8 ± 5 y) and 226 mentors who enrolled, 123 participants and mentors completed FitSkills. Population demand was estimated at 9% of members of participating organisations. Most participants (76%) completed the twice-weekly program within 12 weeks, attending 79% of sessions (mean 18.9 ± 4.7). Key program elements valued by participants were the mentor, tailored exercise, and regular program schedule. Majority (87%) of mentors were recruited from physiotherapy, occupational therapy, and exercise science courses. Positives for participants were perceived benefits and organisational support, and for mentors, understanding disability. Communication and scheduling were burdens. Three serious and 28 non-serious adverse events occurred. Adaptations (additional screening, risk analysis, extra mentor support, or in-person consultation) enabled 29 young people with complexity to participate. The number of trial sites was expanded to 11 to accommodate participants. Scaling-up FitSkills is feasible, but with caveats related to communication, scheduling, and efficiency of recruitment. Key elements valued by participants as part of the successful scale-up of a community-based exercise program (FitSkills) across a large metropolitan city included a peer-mentor, tailored exercise, and organisational support structure. FitSkills can be adapted to include young people with complex disability with additional supports including screening, risk analysis, and professional support for the peer-mentor. The benefits of FitSkills, including social connectedness for young people with a disability and normalisation of disability for mentors, outweigh the burdens of participation. Communication with program organisers and scheduling logistics between the young person, their family/carers and peer mentors are important factors to manage for the successful implementation of FitSkills. [ABSTRACT FROM AUTHOR]

Background Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. Objective This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients. Methods Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesised with random-effects meta-analyses and meta-regression analyses, applying Grades of Recommendation, Assessment, Development and Evaluation criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction. Results Twenty randomised controlled trials of behaviour change interventions involving 2,568 participants (weighted mean age 67 years) included six trials with a high risk of bias. There was moderate-certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14–0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05–0.53) and feedback (excluding high risk of bias trials) (SMD 0.35, 95% CI 0.11–0.60) were independently associated with increased physical activity. Conclusions Targeted behaviour change interventions were associated with increases in physical activity in hospitalised patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital. [ABSTRACT FROM AUTHOR]

Background/aims: Factors that influence functional ability in older adults after rehabilitation are not well understood. The aim of this study was to investigate how older people function in their community after being discharged from inpatient rehabilitation. Methods: A cross-sectional study was undertaken of community-dwelling older adults (n=86, 75 ± 6 years) discharged from rehabilitation in the previous 12 months. Basic functional independence was assessed using the Functional Independence Measure and complex functional independence was assessed using the Frenchay Activities Index. Multiple regression analyses were conducted to assess any association between predetermined factors and function. Results: Functional Independence Measure scores and physical activity levels after being discharged accounted for 50% of the variance in basic function (R2=0.50, F=40.75, P<0.001). Frenchay Activities Index scores, physical activity, age, sex and migrant status accounted for 68% of variance in complex function (R2=0.68, F=29.75, P<0.001). Conclusions: Clinicians are encouraged to implement strategies to improve function at discharge from rehabilitation and to promote physical activity among older people at risk of poor function following rehabilitation. [ABSTRACT FROM AUTHOR]

To determine the feasibility of conducting a definitive randomised trial to evaluate the efficacy of custom-fitted footwear for increasing physical activity in children and adolescents with Down syndrome. Assessor-blinded, parallel-group randomised pilot study. Thirty-three children and adolescents with Down syndrome were randomly allocated to a custom-fitted footwear group (Clarks® footwear) or a wait-list control group. Six feasibility domains were evaluated at baseline, 6 and 12 weeks; demand (recruitment), implementation (co-interventions and adherence), acceptability, practicality (adverse events), limited efficacy testing (physical activity, disability associated with foot and ankle problems, and gait parameters), and adaptation (shoe-fit). Three participants were recruited per month. The use of co-interventions was common with six control group participants purchasing new footwear during the study. Mean adherence was 35 h/week in the custom-fitted footwear group, and there were few minor adverse events. There were trends for differences in physical activity favouring the custom-fitted footwear, but no trends for differences in disability associated with foot and ankle problems or gait parameters. The fit of the custom-fitted footwear was no better than participants' regular footwear. A definitive randomised trial is feasible. However, recruitment, use of co-interventions and footwear fit need further consideration. Conducting a definitive randomised trial to determine the efficacy of custom-fitted footwear in increasing physical activity in children and adolescents with Down syndrome is feasible. Custom-fitted footwear may improve physical activity in children and adolescents with Down syndrome. Commercially available footwear may not be suitable for children and adolescents with Down syndrome due to their unique foot shape. [ABSTRACT FROM AUTHOR]

Supporting children and adolescents with cancer to be physically active can improve medium- and long-term health outcomes. To assess the feasibility of CanMOVE, a 10-week complex, theoretically-informed, behaviour change intervention to promote physical activity for children and adolescents undergoing acute cancer treatment. A feasibility study using a single-group, repeated measures, mixed methods design. Participants completed CanMOVE, which included provision of a Fitbit (child/adolescent and carer) and structured support from a physical therapist. Feasibility domains of demand, acceptability, implementation, practicality, limited efficacy, and integration were evaluated. Data sources included service level data, objective assessment of physical activity, physical function, and health-related quality of life; and qualitative data collected via semi-structured interviews with participants and focus groups with staff. Twenty children/adolescents (median age 13yrs, interquartile-range 9–14) with a mix of cancer diagnoses, 20 parents, and 16 clinicians participated. There was high demand with 95% enrolment rate. CanMOVE was acceptable for participants. All feasibility thresholds set for implementation were met. Under practicality , there were no serious adverse events related to the intervention. Limited efficacy data indicated CanMOVE showed positive estimates of effect in influencing child/adolescent physical activity behaviour, physical function, and health-related quality of life. Positive impacts were also seen in parent and staff attitudes towards physical activity promotion. To improve integration into the clinical setting, it was suggested the duration and scope of CanMOVE could be expanded. CanMOVE was feasible to implement in a paediatric cancer setting. CanMOVE is appropriate to be tested in a large-scale trial. [ABSTRACT FROM AUTHOR]

Background and Purpose: To investigate whether physical activity levels are predictive of short‐term changes in physical function for people discharged to independent living in the community following withdrawal of rehabilitation services after hip fracture; and to describe short‐term recovery in physical activity, physical function, walking confidence, health‐related quality of life and walking participation. Methods: This prospective cohort study comprised 57 older adults (39 females, mean age 80.4, SD 8.4 years) living independently in the community after hip fracture. Accelerometer‐based physical activity, physical function (Functional Independence Measure [FIM], de Morton Mobility Index, Frenchay Activities Index and Participation in outdoor walking), walking confidence and health‐related quality of life were measured after discharge from rehabilitation services (baseline) and 12 weeks later. Multiple linear regression analyses determined the ability of physical activity (daily steps), walking self‐confidence, health‐related quality of life and demographic factors (age, sex and time since fracture) to predict Week 12 physical function using Week 0 physical function as a covariate. Results: Participants at baseline averaged 4439 daily steps which did not change 12 weeks later. There were small increases in all measures of physical function and walking confidence, but not health‐related quality of life. Increased walking self‐confidence was associated with an increase in FIM total, FIM mobility and de Morton Index scores. Physical activity did not predict change in measures of physical function. Conclusions: Walking confidence of adults discharged from rehabilitation services after hip fracture had a greater association with short‐term recovery of physical function than level of physical activity. Community‐dwelling adults continue to make small short‐term improvements in physical function and walking confidence after discharge home and withdrawal of rehabilitation services. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of behavioural interventions on levels of physical activity after hip or knee joint replacement. Materials and methods: A systematic review with meta-analysis of randomised controlled trials to determine the effectiveness of behavioural interventions to increase physical activity levels after hip or knee joint replacement. Six databases were searched. Standardised mean differences (SMD) were calculated. The GRADE approach was used to evaluate the level of evidence of each meta-analysis. Results: From a yield of five trials, physical activity was quantified as active minutes per day, daily energy expenditure and daily steps. There was low to moderate-quality evidence from three meta-analyses with observed positive effects that could not conclude whether behavioural interventions increased physical activity in active minutes per day (SMD = 0.18, 95% CI −0.14, 0.51), daily energy expenditure (SMD = 0.31, 95% CI −0.24, 0.87) or daily steps (MD = 844.7, 95% CI −178.6, 1,868.0). Conclusions: The effectiveness of behavioural interventions to address the low levels of physical activity levels observed after hip or knee joint replacement remains uncertain. Physical activity levels after hip or knee joint replacements fail to meet recommended daily activity guidelines, increasing the associated risk of cardiovascular disease and early mortality. Rehabilitation interventions that target behaviour change may have an impact in increasing physical activity levels after hip or knee joint replacement surgery. The optimal type and timing of behavioural interventions to effectively increase physical activity levels in this cohort remains unclear. Rehabilitation professionals are advised to highlight the benefits of meeting physical activity recommendations (150 min of moderate-intensity aerobic physical activity or 75 min of vigorous-intensity aerobic physical activity per week) to people who have undergone hip or knee joint replacement, and that behavioural intervention may support patients to meet these recommendations. [ABSTRACT FROM AUTHOR]

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the acute glyacaemic response to accumulated or single bout walking exercise in apparently healthy adults.Design: Three arm, randomised crossover control study.Methods: Ten adults (age: 50±12.6 y; BMI 29.0±5.4kgm-2) completed three separate trials comprising three 10-min walking bouts after breakfast, lunch, and dinner (APPW), a single 30-min walking bout after dinner only (CPPW), or a no-exercise control (NOEX). Participants walked on a treadmill at a moderate intensity of 55%-70% heart rate reserve. Two-hour postprandial glucose response was assessed using a continuous glucose monitor.Results: There was a difference in the pattern of the glucose response between the trials during the two hours following dinner (p<0.001). Postprandial dinner glucose concentrations were not different between APPW and CPPW but were up to 1.01mmolL-1 lower than NOEX (partial eta2=0.21, p=0.041).Conclusions: Ten minutes of moderate intensity walking completed 30min after each meal lowers postprandial dinner glucose concentrations in comparison to no-exercise, and reduces glucose by a similar magnitude as a single 30-min bout after the evening meal. Short bouts of exercise after each meal may be recommended to minimise glucose elevations after dinner that might increase risk of cardiometabolic disease. [ABSTRACT FROM AUTHOR]

In women with gestational diabetes mellitus, does the addition of a consumer co-created infographic to usual education about gestational diabetes mellitus improve knowledge about physical activity and self-efficacy to exercise? A randomised trial with concealed allocation, a blinded assessor and intention-to-treat analysis. Sixty-nine women diagnosed with gestational diabetes mellitus. In addition to gestational diabetes education, the experimental group received a paper copy of a consumer co-created infographic about physical activity during a gestational diabetes pregnancy. The control group received gestational diabetes education alone. Participants completed outcome measures at baseline and again 1 week later. Knowledge of physical activity in a gestational diabetes mellitus pregnancy was assessed using a 19-item questionnaire modified to reflect current physical activity guidelines, with a total score from 0% (worst) to 100% (best). Self-efficacy was measured using the nine-item Self-Efficacy for Exercise Scale, with a total score from 0 (not confident) to 10 (very confident). Provision of the infographic led to a clinically important between-group difference in knowledge (MD 12%, 95% CI 10 to 15) and self-efficacy (MD 2.5 units, 95% CI 1.9 to 3.0). In women with gestational diabetes mellitus, short-term knowledge about physical activity and self-efficacy to exercise were improved when usual education was supplemented with a consumer co-created infographic that provided specific and relevant information about physical activity during a gestational diabetes mellitus pregnancy. ACTRN12619001207101. [ABSTRACT FROM AUTHOR]

Aim: To explore the barriers to and facilitators of physical activity for young people with cerebral palsy in specialist schools.Method: Eleven focus groups involving 73 participants (10 young people with cerebral palsy, 13 parents of children with cerebral palsy, 27 teachers, 23 therapists) were held at two specialist schools. Focus groups were audio-recorded and transcribed verbatim. Transcripts were analysed using inductive thematic analysis by two researchers, independently.Results: Four main themes emerged from the focus groups: school priorities; student factors; staffing and environment; and roles and relationships. Physical activity was promoted when academic work and physical activity were seen as equally important school priorities. Student factors that reduced physical activity included fluctuating health, school absences, and protracted rehabilitation after surgery. The staffing and environment unique to specialist schools played a pivotal role in assisting students to be active, as was the importance of collaborative, relationship-based care.Interpretation: Physical activity programmes developed in specialist schools need to take into consideration complexities associated with the age, developmental stage, and academic requirements of young people with cerebral palsy. Particularly for adolescents, motivation was discussed as having a substantial influence on physical activity participation. These findings may assist school leadership teams, clinicians, and teachers in planning physical activity interventions.What This Paper Adds: Specialist schools offer custom-built environments that promote physical activity and inclusion for students with physical impairments. Therapists and teaching staff work creatively and collaboratively to incorporate an 'all-day' approach to providing physical activity opportunities. Balancing time spent on physical activity versus academic work can cause tension. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety and effectiveness of augmenting physiotherapy with family-assisted therapy, to inform a future, fully powered trial. Design: Parallel pilot randomized controlled trial. Setting: Transition Care Program. Participants: Thirty-five older adults with multimorbidity, recently hospitalized, with a mean age of 84.1 years (SD = 6.1 years) and mean Modified Barthel Index of 67.8 units (SD = 19.2 units), and 40 family members. Interventions: The control group (n = 18) received usual physiotherapy care. The experimental group (n = 17) received usual physiotherapy care and family-assisted therapy from a family member trained by a physiotherapist. Main measures: Primary outcomes were falls-related self-efficacy measured by the Short Falls Efficacy Scale – International and falls during the intervention period. Secondary outcomes included daily steps, EQ-5D-3L (three-level version of the EuroQoL five-dimensional health-related quality of life questionnaire) and ICECAP-O (ICEpop CAPability measure for Older people), Modified Barthel Index and Modified Caregiver Strain Index. Results: There were no between-group differences for falls-related self-efficacy. Relative to the control group, the experimental group was observed to have a reduced risk of falling (relative risk = 0.38, 95% confidence interval (CI) = 0.09–1.60) and a reduced falls rate (incidence rate ratio = 0.22, 95% CI = 0.04–1.20) was of borderline statistical significance. The experimental group walked a mean of 944 daily steps more than the control group (95% CI = 139–1748) and had a significant reduction in activity limitation. There were no between-group differences for quality of life or caregiver strain. Conclusion: Augmenting physiotherapy with family-assisted therapy is feasible for older people transitioning from hospital to the community. A fully powered randomized controlled trial is indicated. [ABSTRACT FROM AUTHOR]

Purpose: To explore the perceptions of people with severe knee osteoarthritis and increased cardiovascular risk about participating in a walking program. Methods: Qualitative study using semistructured interviews for people with severe knee osteoarthritis and increased cardiovascular risk who participated in a 12-week walking program. Interviews were audiotaped, transcribed verbatim, member-checked, coded and themes developed using thematic analysis. Findings were triangulated with quantitative data including pain, function and cardiovascular risk factors from previously reported data. Results: Twenty-one participants were interviewed after the completion of the walking program. The main theme identified was the preoccupation with the knee including pain, damage and the view that surgery was required. Three subthemes to emerge were (i) the perception of functional, cardiovascular and psychosocial benefits with the walking program; (ii) that supervision, monitoring and commitment were important enablers; and (iii) external factors such as ill-health, weather and the environment were key barriers. The perceived functional and cardiovascular benefits converged with results from quantitative data. Conclusions: Even when patients with severe osteoarthritis of the knee report other benefits from participating in a walking program, the core theme to emerge was their preoccupation with knee pain, knee damage and the view that they needed a knee replacement. Implications for Rehabilitation: Patients with severe osteoarthritis of the knee and moderate cardiovascular risk reported functional, cardiovascular and psychosocial benefits from participating in a walking program. Despite patients reporting functional, cardiovascular and psychosocial benefits, the core theme to emerge was their preoccupation with knee pain, knee damage and the view that they needed a knee replacement. The core theme highlights the challenges in promoting physical activity for patients with severe knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Objective: To determine whether patients have better outcomes when exercise instructions are provided using multimedia approaches compared with verbal or written instructions. Data sources: Electronic databases (MEDLINE, EMBASE, CINAHL, and PsychInfo) searched up to October 2018. Study selection: Randomized controlled trials exploring exercise-based interventions for health conditions, and comparing instructions provided using multimedia approaches with conventional verbal or written instructions. Results: Fourteen trials from seven countries were included, with a total of 2156 participants. Diagnoses included orthopaedic, neurological, pulmonary, cardiac, and women's health conditions. A meta-analysis of three trials (140 participants) provided very low-quality evidence that multimedia exercise instructions may be more effective than written instructions in improving exercise adherence (standardized mean difference (SMD) 0.60, 95% confidence interval (CI) –0.06 to 1.25). Two of nine trials that could not be included in the meta-analysis for adherence due to heterogeneity reported that multimedia exercise instructions were more effective than written instructions in improving exercise adherence. Four other meta-analyses (three trials each) found low- to high-quality evidence that provision of exercise instructions using multimedia is no more beneficial than paper-based instructions for patient-related outcomes of pain intensity (SMD 0.09, 95% CI –0.47 to 0.28); uptake of physical activity (SMD 0.07, 95% CI −0.08 to 0.23); or physical (SMD 0.21, –0.21 to 0.64) or emotional (SMD 0.16, 95% CI −0.04 to 0.36) domains of health-related quality of life. Conclusion: Multimedia approaches to exercise instruction may result in increased adherence compared with instructions provided in written or verbal format, but there is insufficient evidence to determine whether this results in improved patient outcomes. [ABSTRACT FROM AUTHOR]

Usual care after hip or knee joint replacement does not adequately address the problem of low physical activity levels. We aimed to determine whether exercise delivered in a group setting in the early stage of outpatient rehabilitation influenced self-reported physical activity levels after hip or knee joint replacement. A case series of 79 participants referred to a 6-week outpatient orthopaedic exercise group after total hip or knee replacement were evaluated using the International Physical Activity Questionnaire (IPAQ) short form. Physical function was evaluated using Osteoarthritis Research Society International (OARSI) recommended performance-based tests (30 s Chair Stand Test, 40 m Fast Pace Walk Test, Stair Climb Test, Timed Up and Go Test, 6 Minute Walk Test). Measures were assessed at admission, discharge and 6 weeks after group discharge. Non-parametric analysis was conducted for IPAQ scores. Analysis of functional measures was conducted with linear mixed models with time modelled as a repeated measure. Standard multiple regression and correlation analysis were conducted. Fifty-four participants completed the study. Self-reported activity levels improved significantly at program discharge but not at 6-week follow-up. All performance-based measures improved significantly at program discharge. Fast-paced walking and 6 Minute Walk Test measures continued to improve at 6-week follow-up. Group dynamics present in an outpatient rehabilitation exercise program may increase physical activity levels during group participation but not after group cessation. Performance in all functional measures improved at group discharge. [ABSTRACT FROM AUTHOR]

Abstract Questions What are the attitudes of women diagnosed with gestational diabetes mellitus (GDM) towards physical activity during pregnancy? What are the perceived barriers to and enablers of physical activity during pregnancy in women with GDM? Design A qualitative study with phenomenology and interpretative description as theoretical frameworks. Participants Pregnant women experiencing an uncomplicated singleton pregnancy, diagnosed with GDM, and aged 18 to 40 years were recruited using purposive sampling. Method Semi-structured interviews were recorded, transcribed verbatim and returned to participants for member checking. Three researchers independently and thematically analysed the qualitative data using an inductive method. Data were coded and compared, and themes were developed, discussed and defined. Recruitment continued until data saturation. Emergent themes were sent to participants and peer reviewed for confirmation. Results The participants were 27 women, with mean age 32 years (SD 3), mean gestation 30 weeks (SD 5), mean pre-pregnancy body mass index 26 kg/m2 (SD 5), and born in 10 different countries. The process of communicating information about physical activity (messaging) was the main theme to emerge. Sub-themes included: wanting information about physical activity from credible sources; wanting clear, specific information about safe physical activity during a GDM pregnancy; receiving information at GDM diagnosis because this event triggered women's desire to be more physically active; understanding why physical activity is important to improving outcomes for themselves and their babies; and wanting information about flexible, convenient and practical physical activity options. Conclusion To feel confident and safe about being physically active during pregnancy, women with GDM wanted clear, simple and GDM-specific messages from credible sources. Health professionals can support women with a GDM pregnancy with targeted physical activity messages. [ABSTRACT FROM AUTHOR]

Abstract Question Does adding weekly, physiotherapist-delivered motivational interviewing to outpatient oncology rehabilitation for cancer survivors increase physical activity levels and improve physical and psychosocial outcomes that are typically impaired in this cohort? Design Randomised controlled trial with blinded outcome assessment, concealed allocation and intention-to-treat analysis. Participants A heterogeneous sample of 46 cancer survivors (n = 29 female; mean age 59 years) participating in a public outpatient oncology rehabilitation program. Intervention Participants were randomly allocated to receive oncology rehabilitation (n = 24) or oncology rehabilitation with motivational interviewing delivered once weekly for 7 weeks via telephone by a physiotherapist (n = 22). Outcome measures The primary outcome was amount of physical activity of at least moderate intensity completed in 10-minute bouts, measured by an accelerometer worn continuously for 1 week. Secondary outcomes included other measures of physical activity, sedentary behaviour, physical function, psychosocial function, and quality of life. Results When added to oncology rehabilitation, motivational interviewing caused no appreciable increase in the amount of moderate-intensity physical activity (MD –1.2 minutes/day, 95% CI –2.5 to 0.02). Among many secondary outcomes, the only statistically significant result was a small effect on nausea, which probably represents a Type I error. However, several secondary outcomes related to lower-intensity physical activity had non-significant confidence intervals that included large effects such as: sedentary time (SMD –0.67, 95% CI –1.32 to 0.02), light-intensity physical activity (SMD 0.56, 95% CI –0.12 to 1.21) and daily step count (SMD 0.37, 95% CI –0.30 to 1.02). Conclusion Adding motivational interviewing to oncology rehabilitation did not increase moderate-intensity physical activity. Favourable trends on measures of lower-intensity physical activity suggest that motivational interviewing should be further investigated for its effects on reducing sedentary time and improving light-intensity physical activity for cancer survivors participating in rehabilitation. Trial registration ANZCTR 12616001079437. [Dennett AM, Shields N, Peiris CL, Prendergast LA, O'Halloran PD, Parente P, Taylor NF (2018) Motivational interviewing added to oncology rehabilitation did not improve moderate-intensity physical activity in cancer survivors: a randomised trial. Journal of Physiotherapy 64: 255–263] [ABSTRACT FROM AUTHOR]

Objective: What effect does regular exercise have on oxidative stress in people with Down syndrome?Design: Systematic review with meta-analyses.Methods: A systematic review with meta-analyses was conducted. Six databases were searched from inception until August 2017. Studies where included if participants with Down syndrome (any age) had completed an exercise program of at least 6 weeks duration and at least one biomarker measured the generation or removal of reactive oxidative species. Data were extracted using a customised form. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias assessment tool. Effect sizes were calculated and meta-analyses completed for clinically homogeneous data using a random effects model.Results: Seven studies (11 articles) involving 144 inactive participants investigated the effect of moderate intensity aerobic exercise. No pattern emerged for how most biomarkers responded with non-significant pooled effect sizes and high levels of heterogeneity observed. The exception was catalase which increased significantly after exercise (standardised mean difference 0.39, 95%CI 0.04-0.75; I2 15%). Available studies were at high risk of bias. Two of five studies that measured more than one biomarker reported a decrease in oxidative stress with increased antioxidant activity after exercise but the other three (including one small randomised controlled trial) reported increased oxidative stress with variable change in antioxidant activity.Conclusions: There remains uncertainty about the effect of exercise on oxidative stress in people with Down syndrome.Review Registration: PROSPERO CRD42016048492. [ABSTRACT FROM AUTHOR]

Question What are the attitudes, barriers and enablers to physical activity perceived by pregnant women? Design In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework. Participants Pregnant women. Intervention Not applicable. Outcome measures Attitudes and perceived barriers and enablers to physical activity during pregnancy. Results Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity. Conclusion Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women’s positive attitudes into increased physical activity participation. Registration PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24–32] [ABSTRACT FROM AUTHOR]

BackgroundInadequate physical activity is a problem for people with Down syndrome and objective monitoring using accelerometers may be inaccurate in this population. MethodThis was a cross-validation and reliability study comparing two triaxial accelerometers (the SenseWear and RT3) to a criterion measure (the OxyCon Mobile) in 10 young people (Mage = 20 ± 2) with Down syndrome. A ROC curve analysis was conducted to determine intensity thresholds from RT3 activity counts. ResultsDuring self-selected pace walking, the accelerometers overestimated energy expenditure and had large limits of agreement (SenseWear: −0.5–3.6 METs; RT3: −0.2–2.7 METs). At this pace, SenseWear armband step counts were highly correlated with observed steps (r = .98) but underestimated steps by up to 12%. We developed RT3 thresholds that demonstrated good to excellent sensitivity and specificity in classifying physical activity intensity. ConclusionsSenseWear steps and RT3 activity count thresholds can be used to monitor physical activity in young people with Down syndrome, although energy expenditure estimates should be used with caution in this population. [ABSTRACT FROM PUBLISHER]

BackgroundFoot problems may limit physical activity in children with Down syndrome. This prospective cohort study investigated the association of foot posture, deformity, and footwear fit with activity. MethodFoot posture of 50 children with Down syndrome (22 girls, 28 boys;Mage = 10.5 years) was assessed using the arch index and deformities were documented. Footwear fit compared the difference in length and width of shoes with participants’ feet. Physical activity was measured using accelerometers. ResultsMean arch index (0.29 ± 0.08) was indicative of flat feet. Footwear fit was too short for five participants, too long for 26 participants, and too narrow for 29 participants. Regression analysis for the 20 participants adherent with wearing an accelerometer found no association of foot posture or deformity with activity. Footwear fit was negatively associated with activity (p = .03). ConclusionPreliminary data suggest poor footwear fit is associated with reduced physical activity in children with Down syndrome. [ABSTRACT FROM PUBLISHER]

Question What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures? Design Systematic review of controlled trials. Participants Adults following an upper limb fracture. Intervention Any exercise therapy program, including trials where exercise was delivered to both groups provided that the groups received different amounts of exercise. Outcome measures Impairments of body structure and function, activity limitations and participation restrictions. Results Twenty-two trials were identified that evaluated 1299 participants with an upper limb fracture. There was insufficient evidence from 13 trials to support or refute the effectiveness of home exercise therapy compared with therapist-supervised exercise or therapy that included exercise following distal radius or proximal humeral fractures. There was insufficient evidence from three trials to support or refute the effectiveness of exercise therapy compared with advice/no exercise intervention following distal radius fracture. There was moderate evidence from five trials (one examining distal radius fracture, one radial head fracture, and three proximal humeral fracture) to support commencing exercise early and reducing immobilisation in improving activity during upper limb rehabilitation compared with delayed exercise and mobilisation. There was preliminary evidence from one trial that exercise to the non-injured arm during immobilisation might lead to short-term benefits on increasing grip strength and range of movement following distal radius fracture. Less than 40% of included trials reported adequate exercise program descriptions to allow replication according to the TIDieR checklist. Conclusion There is emerging evidence that current prescribed exercise regimens may not be effective in reducing impairments and improving activity following an upper limb fracture. Starting exercise early combined with a shorter immobilisation period is more effective than starting exercise after a longer immobilisation period. Registration CRD42016041818. [Bruder AM, Shields N, Dodd KJ, Taylor NF (2017) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. Journal of Physiotherapy 63: 205–220] [ABSTRACT FROM AUTHOR]

Purpose: To explore the perceived effects of an aerobic exercise program delivered in specialist schools for young people with cerebral palsy with high support needs. Methods: In-depth interviews were completed with 8 students with cerebral palsy, 10 parents, 8 teachers and 7 physiotherapists. Interviews were audio-recorded, transcribed verbatim and independently coded by two researchers. Data were analyzed using thematic analysis. Results: Two themes emerged: one about program impact and the second about influential design features. Exercise was perceived as important, and participants indicated that the program had resulted in positive physical (e.g., improved ease of mobility, fitness and stamina) and psychosocial (e.g., happiness, social experience, challenge) impacts. The school setting, program staff and student attitudes were key features of the program. Conclusions: These data converge with those from a randomized controlled trial and attribute physical and psychosocial benefits to a specialist school-based exercise program for young people with cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety, adherence, and estimates of effect of an aerobic exercise program in specialist schools for young people with cerebral palsy. Methods: Nineteen students with cerebral palsy were randomly allocated to an intervention group who completed an aerobic exercise program (27 sessions over nine weeks) or a control group who completed social/art activities over the same time. Results: There were no serious adverse events and the exercise program was completed with high rates of attendance (77%) and adherence to target heart rate zones (79%). Effect sizes favored the intervention group for measures of cardiovascular performance (sub-maximal treadmill test, effect size d = 0.7; muscle power sprint test, d = 0.9) and participation (Preference for Active-Physical Activities, d = 0.6). Conclusions: An aerobic exercise program in specialist schools for young people with cerebral palsy, that may improve measures of cardiovascular performance, can be completed safely, with moderately high levels of adherence. [ABSTRACT FROM AUTHOR]

Objective: To evaluate effects of participant-selected music on older adults’ achievement of activity levels recommended in the physical activity guidelines following cardiac rehabilitation. Design: A parallel group randomized controlled trial with measurements at Weeks 0, 6 and 26. Setting: A multisite outpatient rehabilitation programme of a publicly funded metropolitan health service. Subjects: Adults aged 60 years and older who had completed a cardiac rehabilitation programme. Interventions: Experimental participants selected music to support walking with guidance from a music therapist. Control participants received usual care only. Main measures: The primary outcome was the proportion of participants achieving activity levels recommended in physical activity guidelines. Secondary outcomes compared amounts of physical activity, exercise capacity, cardiac risk factors, and exercise self-efficacy. Results: A total of 56 participants, mean age 68.2 years (SD = 6.5), were randomized to the experimental (n = 28) and control groups (n = 28). There were no differences between groups in proportions of participants achieving activity recommended in physical activity guidelines at Week 6 or 26. Secondary outcomes demonstrated between-group differences in male waist circumference at both measurements (Week 6 difference −2.0 cm, 95% CI −4.0 to 0; Week 26 difference −2.8 cm, 95% CI −5.4 to −0.1), and observed effect sizes favoured the experimental group for amounts of physical activity (d = 0.30), exercise capacity (d = 0.48), and blood pressure (d = −0.32). Conclusions: Participant-selected music did not increase the proportion of participants achieving recommended amounts of physical activity, but may have contributed to exercise-related benefits. [ABSTRACT FROM AUTHOR]

Background: Music listening during exercise is thought to increase physiological arousal and enhance subjective experience, and may support physical activity participation among older adults with cardiac disease. However, little is known about how music preferences, or perceptions of music during exercise, inform clinical practice with this population.Objective: Identify predominant musical characteristics of preferred music selected by older adults, and explore participants' music listening experiences during walking-based exercise following cardiac rehabilitation.Methods: Twenty-seven participants aged 60 years and older (21 men, 6 women; mean age = 67.3 years) selected music to support walking over a 6-month intervention period, and participated in post-intervention interviews. In this two-phase study, we first identified predominant characteristics of participant-selected music using the Structural Model of Music Analysis. Second, we used inductive thematic analysis to explore participant experiences.Results: Predominant characteristics of participant-selected music included duple meter, consistent rhythm, major key, rounded melodic shape, legato articulation, predictable harmonies, variable volume, and episodes of tension with delayed resolution. There was no predominant tempo, with music selections ranging from slow through to medium and fast. Four themes emerged from thematic analysis of participant interviews: psycho-emotional responses, physical responses, influence on exercise behavior, and negative experiences.Conclusions: Findings are consistent with theory and research explaining influences from music listening on physiological arousal and subjective experience during exercise. Additionally, for older adults with cardiac disease, a holistic approach to music selection considering general well-being and adjustment issues, rather than just exercise performance, may improve long-term lifestyle changes and compliance with physical activity guidelines. [ABSTRACT FROM AUTHOR]

Objective: To investigate if motivational interviewing improved physical activity, self-efficacy, quality of life, mobility and mental health in people living in the community after hip fracture. Design: Single-blind randomized controlled trial. Setting: Community. Participants: A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group (n = 14) or an intervention group (n = 16). Intervention: All participants received usual care. The intervention group also received eight weekly sessions of motivational interviewing as additional input, with the control group having no additional matching input. Main outcomes: The primary outcome was physical activity levels as measured by an accelerometer (steps taken per day, time spent walking per day, and time spent sitting or lying each day). Secondary outcomes included self-efficacy (confidence about walking and not falling), health-related quality of life, mobility and mental health. Results: Relative to usual care, the motivational interviewing group took significantly more steps per day (mean = 1237 steps, 95% confidence interval (CI) 12 to 2463), walked for longer per day (mean = 14.4 minutes, 95% CI 0.6 to 28.8), had improved self-efficacy evidenced by being more confident about walking (mean = 1.6 units out of 10, 95% CI 0.3 to 2.9) and not falling (mean = 1.1 units out of 10, 95% CI 0.3 to 1.9) and improved health-related quality of life and mental health. Conclusion: This study provides preliminary evidence that motivational interviewing can result in clinically meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture. [ABSTRACT FROM AUTHOR]

Purpose:To find out how much physical activity in the form of walking can be tolerated by adults admitted for inpatient rehabilitation after hip fracture. Method:Using a phase I dose–response design, in addition to usual scheduled rehabilitation care participants without cognitive impairment were supervised to walk for a prescribed length of time on 5 consecutive days. Doses started at 3 min and were escalated when three participants successfully completed a dose. Secondary outcomes included physical activity and the Ambulatory Self-Confidence Questionnaire (ASCQ). Results:The maximum tolerated dose of walking for the 13 participants (4 men and 9 women; mean age 81 years, SD 10) was 6 min. At 10 min only 1 of 5 participants was able to complete the dose. The main reason for not tolerating the prescribed dose was fatigue. Participants had relatively low levels of daily physical activity (mean 507 steps/day), and lacked confidence in their walking (ASCQ mean 4.6). Conclusion:Physical activity guidelines for older people are not appropriate for patients in active inpatient rehabilitation recovering from hip fracture where other factors such as fatigue may limit physical activity levels. These results can be taken into account when designing rehabilitation programmes after hip fracture.Implications for RehabilitationHip fracture is a common and serious fracture with ongoing disability for which people require inpatient rehabilitation to prepare for return to independent living in the community.The maximum tolerated dose of walking of 6 minutes suggests physical activity guidelines for older people are not applicable for those receiving active inpatient rehabilitation after hip fracture.The maximum tolerated dose of walking of 6 minutes during inpatient rehabilitation suggests rehabilitation programmes be structured to allow adequate time for recovery. [ABSTRACT FROM AUTHOR]

Purpose: To examine if individualised resistance training increases the daily physical activity of adolescents and young adults with bilateral spastic cerebral palsy (CP).Method: Young people with bilateral spastic CP were randomly assigned to intervention or to usual care. The intervention group completed an individualised lower limb progressive resistance training programme twice a week for 12 weeks in community gymnasiums. The primary outcome was daily physical activity (number of steps, and time sitting and lying). Secondary outcomes included muscle strength measured with a one-repetition maximum (1RM) leg press and reverse leg press. Outcomes were measured at baseline, 12 weeks and 24 weeks.Results: From the 36 participants with complete data at 12 weeks, there were no between-group differences for any measure of daily physical activity. There was a likely increase in leg press strength in favour of the intervention group (mean difference 11.8 kg; 95% CI −1.4 to 25.0). No significant adverse events occurred during training.Conclusions: A short-term resistance training programme that may increase leg muscle strength was not effective in increasing daily physical activity. Other strategies are needed to address the low-daily physical activity levels of young people with bilateral spastic CP.Implications for RehabilitationProgressive resistance training may increase muscle strength but does not lead to increases in daily physical activity of young people with bilateral spastic cerebral palsy (CP) and mild to moderate walking disabilities.Other strategies apart from or in addition to resistance training are needed to address the low daily physical activity levels of young people with bilateral spastic CP and mild to moderate walking disabilities. [ABSTRACT FROM PUBLISHER]

A systematic review and narrative synthesis of theories was conducted to examine the modulating effects of music listening on health-related exercise and physical activity. Searches were conducted on multiple bibliographic databases from the earliest available date until April 2013 using the key terms of music, physical activity and theory and related synonyms. Two reviewers independently screened retrieved texts using the inclusion and exclusion criteria. The quality of included texts was appraised using a checklist, and key concepts were recorded and synthesised using inductive thematic analysis. The narrative synthesis comprised 23 theoretical texts representing three contexts: therapeutic outcomes, sports and exercise performance, and auditory-motor processing. The quality appraisal demonstrated some limitations in the reporting of evidence informing theories. Analysis across all texts identified a main theme, cortical and subcortical stimulation and response, and two sub-themes, physiological arousal and subjective experience. These themes contributed to a common hypothesis that music could promote behavioural change with increased exercise adherence and participation. A meta-theory is presented, offering a framework for clinical practice and research. Music therapists might use the meta-theory to inform music listening interventions in programmes that aim to increase levels of physical activity. [ABSTRACT FROM AUTHOR]

Background and Purpose Hip fractures are very common in older adults and result in serious health consequences. Early mobilization post-surgical intervention for hip fractures is very important. The purpose of this study was to determine physical activity levels during an acute inpatient admission of patients after surgery for hip fracture. Methods The observational study was completed on an orthopaedic ward in an acute general hospital. Twenty patients (18 women, mean age ± standard deviation, 79.1 ± 9.3 years) post-surgical intervention for a hip fracture were included. Physical activity levels were measured using an accelerometer to record the percentage of time spent in lying/sitting, standing and walking, number of steps taken and average energy expenditure. Results Physical activity levels were extremely low, with participants spending an average of 99% of the day either lying or sitting and a little more than 1% of the day either standing or walking (16 min). Participants took an average of 35.7 ± 80.4 steps per day. Patients received more physiotherapy intervention on weekdays compared with weekends. There was no significant difference in activity levels between weekdays to weekends. No measures of physical activity were associated with length of stay. A mild to moderate association ( r = 0.26-0.41) was observed between the measures of physical activity and the amount of physiotherapy received during the weekdays. Discussion Physical activity levels during an acute inpatient admission surgery for hip fracture are very low. Patients may have difficulty completing basic activities of daily living post-discharge into the community. Physical activity should be optimized as early in the rehabilitation process as able. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

BackgroundWe investigated if a physical activity program for young adults with Down syndrome was feasible using a phase II, single-blind, randomised controlled trial. MethodSixteen adults with Down syndrome (8 women, 8 men,Mage = 21.4 ± 3.2 years) were randomly assigned to an intervention, in which participants were asked to complete 150 minutes of walking each week for 8 weeks, or a control group, in which participants completed an 8-week program of social activities. The outcomes assessed by an assessor blind to group allocation included feasibility, safety, waist circumference, walking capacity, physical activity, and wellbeing. Data were analysed using analysis of covariance. ResultsThe participants logged an average of 175 minutes per week walking (range: 146–262 minutes). No adverse events occurred. Sample size estimation for a phase III study suggests 41 participants per group would be required to demonstrate a significant difference. ConclusionsThis phase II trial provided preliminary evidence that a walking program is feasible and safe for young adults with Down syndrome with mild to moderate intellectual disability. [ABSTRACT FROM AUTHOR]

Aim The aim of the study was to describe daily physical activity levels of adolescents and young adults with bilateral spastic cerebral palsy ( CP) and to identify factors that help predict these levels. Method Daily physical activity was measured using an accelerometer-based activity monitor in 45 young people with bilateral spastic CP (23 males, 22 females; mean age 18y 6mo [ SD 2y 5mo] range 16y 1mo-20y 11mo); classified as Gross Motor Function Classification System ( GMFCS) level II or III and with contractures of <20° at hip and knee. Predictor variables included demographic characteristics (age, sex, weight) and physical characteristics (gross motor function, lower limb muscle strength, 6min walk distance). Data were analyzed using the information-theoretic approach, using the Akaike information criterion ( AIC) and linear regression. Results Daily activity levels were low compared with published norms. Gross Motor Function Measure Dimension-E ( GMFM-E; walking, running, and jumping) was the only common predictor variable in models that best predicted energy expenditure, number of steps, and time spent sitting/lying. GMFM Dimension-D (standing) and bilateral reverse leg press strength contributed to the models that predicted daily physical activity. Interpretation Adolescents and young adults with bilateral spastic CP and mild to moderate walking disabilities have low levels of daily activity. The GMFM-E was an important predictor of daily physical activity. [ABSTRACT FROM AUTHOR]

The article presents the meta-analysis and systematic review of randomized controlled trials to determine the use of motivational interviewing to increase the physical activity of people having chronic health conditions. The trials indicate the modest physical activity improvements in chronic health disease patients due to the addition of motivational interviewing. It points out the absence of conclusive evidence for functional exercise capacity or cardiorespiratory fitness.

Highlights: [•] Progressive resistance training is effective and safe for people with Down syndrome. [•] Increases in lower limb muscle strength were maintained at 6-months. [•] The effect of progressive resistance training on work task performance is unclear. [•] PRT conferred benefits in physical activity levels 6-months after the programme. [Copyright &y& Elsevier]

Question: Are ambulant patients who are admitted for inpatient rehabilitation for a lower limb orthopaedic condition active enough to meet current physical activity guidelines? Design: Prospective observational study. Participants: Adults admitted for inpatient rehabilitation for a lower limb orthopaedic condition who were cognitively alert and able to walk independently or with assistance. Outcome measures: Participants wore an activity monitor for three full days. Daily time spent in moderate intensity physical activity was used to determine whether the levels of physical activity recommended in clinical guidelines were achieved. Results: Fifty-four participants with a mean age of 74 years (SD 11) took a median of 398 (IQR 140 to 993) steps per day and spent a median of 8 (IQR 3 to 16) minutes walking per day. No participant completed a 10-minute bout of moderate intensity physical activity during the monitoring period. One participant accumulated 30 minutes of moderate intensity physical activity and nine participants accumulated 15 minutes of moderate intensity physical activity in a day. Physical activity was associated with shorter length of stay (r=−0.43) and higher functional status on discharge (r=0.39). Conclusions: Adults with lower limb orthopaedic conditions in inpatient rehabilitation are relatively inactive and do not meet current physical activity guidelines for older adults. Results of this study indicate that strategies to increase physical activity are required. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture.Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender.Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p < 0.001) were negatively associated with meeting higher physical activity thresholds.Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture.Older people are often physically inactive after hip fracture, which can lead to negative health outcomes and increased risk of mortality.The potentially modifiable psychological factors of walking self-confidence and anxiety are associated with meeting recommended physical activity levels after hip fracture.Therapists should include assessment of psychological factors to help guide rehabilitation of patients after hip fracture.Older people are often physically inactive after hip fracture, which can lead to negative health outcomes and increased risk of mortality.The potentially modifiable psychological factors of walking self-confidence and anxiety are associated with meeting recommended physical activity levels after hip fracture.Therapists should include assessment of psychological factors to help guide rehabilitation of patients after hip fracture. [ABSTRACT FROM AUTHOR]