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Purpose: The R ehabilitation I nterventions for I ndividuals with a S pinal Cord Injury in the C ommunity (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D)., Materials and Methods: An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation., Results: EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings., Conclusions: RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Background: Individuals living with a physical disability have reported difficulty in meeting their healthy living and leisure needs which could be a result of poor accessibility., Objective: This qualitative study aimed to understand the relative accessibility of physical activity from the perspective of individuals living with a physical disability in Quebec, Canada., Methods: Twenty semi-structured interviews were conducted with current, past, non-members, and staff members of an adapted physical activity program. A qualitative approach with an inductive thematic analysis was used to interpret the data., Results: We identified five overarching themes focusing on participants' experiences related to access: (i) physical activity opportunities; (ii) social interactions; (iii) relationships; (iv) infrastructure; (v) policies and public services. Participants highlighted that access to physical activity programming is shaped by a complex interaction of these overarching themes and their sub-themes., Conclusions: Access to physical activity opportunities for individuals living with a physical disability cannot be understood in isolation from the broader public policies, infrastructure, social interactions, and relationships that shape their experiences. Policy makers and other health and recreational professionals must consider these broader factors when recommending or creating physical activity opportunities for individuals with physical disabilities., Competing Interests: Declaration of competing interest All authors have no conflict of interest to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Exertional dyspnea is a cardinal feature of chronic obstructive pulmonary disease (COPD) and a major cause of activity limitation. Although dual bronchodilation is more effective than bronchodilator monotherapy at improving resting pulmonary function, it is unclear to which extent this translates into superior relief of exertional dyspnea., Methods: We conducted a randomized controlled, double-blind, cross-over trial comparing indacaterol 110 µg/glycopyrronium 50 µg once daily (OD) with tiotropium 50 µg OD in patients with moderate to severe COPD and resting hyperinflation (functional residual capacity >120% of predicted value). The primary outcome was Borg dyspnea score at the end of a 3-min constant speed shuttle test after 3 weeks of treatment. Secondary outcomes included changes in Borg dyspnea score after the first dose of study medication, expiratory flows and lung volumes. Statistical analysis was conducted using a cross-over analysis of variance model with repeated measurements., Results: A total of 50 patients with COPD and a mean forced expiratory volume in 1 s of 54 ± 11% (mean ± SEM) predicted participated in the cross-over phase of the trial. Compared with baseline, there was a decrease in dyspnea after the first dose of medication with indacaterol/glycopyrronium [mean -1.00, 95% confidence interval (CI) -1.49 to -0.52] but not with tiotropium alone (mean -0.36, 95% CI -0.81 to 0.08). The reduction in dyspnea after the first dose was statistically significant between the two treatments (mean difference of -0.64, 95% CI -1.11 to -0.17). Despite indacaterol/glycopyrronium providing further bronchodilation and lung deflation throughout the trial, the reduction in dyspnea was not sustained at 3 weeks of treatment (mean between-treatment difference at 3 weeks of 0.09, 95% CI -0.44 to 0.61)., Conclusion: In comparison with bronchodilator monotherapy, indacaterol/glycopyrronium provided greater immediate exertional dyspnea relief, although this difference was not sustained after 3 weeks of therapy despite evidence of further bronchodilation and lung deflation. The reviews of this paper are available via the supplemental material section.

Denervation and mitochondrial impairment are implicated in age-related skeletal muscle atrophy and may play a role in physical frailty. We recently showed that denervation modulates muscle mitochondrial function in octogenarian men, but this has not been examined in elderly women. On this basis, we tested the hypothesis that denervation plays a modulating role in mitochondrial impairment in skeletal muscle from prefrail or frail elderly (FE) women. Mitochondrial respiratory capacity and reactive oxygen species emission were examined in permeabilized myofibers obtained from vastus lateralis muscle biopsies from FE and young inactive women. Muscle respiratory capacity was reduced in proportion to a reduction in a mitochondrial marker protein in FE, and mitochondrial reactive oxygen species emission was elevated in FE versus young inactive group. Consistent with a significant accumulation of neural cell adhesion molecule-positive muscle fibers in FE (indicative of denervation), a 50% reduction in reactive oxygen species production after pharmacologically inhibiting the denervation-mediated reactive oxygen species response in FE women suggests a significant modulation of mitochondrial function by denervation. In conclusion, our data support the hypothesis that denervation plays a modulating role in skeletal muscle mitochondrial function in FE women, suggesting therapeutic strategies in advanced age should focus on the causes and treatment of denervation., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The enhancement of post-operative care is under constant evolution and, with the addition of enhanced recovery programs, is changing the traditional in-hospital paradigm. Despite these advances, there is a clear lack of focus regarding early post-surgical mobilization, which has been identified as an important aspect of recovery. This pilot study investigates the feasibility of initiating resistance exercise to promote early mobilization in colorectal cancer patients during the in-hospital period., Method: Patients participated in a supervised progressive resistance exercise program, adapted to their physical ability (either in bed, seated or standing), within the first 24 h following surgery. They were seen each day during the hospital stay and encouraged to continue exercising upon discharge. All patients were asked to return to the lab at four weeks after surgery for re-evaluation to establish recovery., Results: Patient compliance to the in-hospital program was high, with 90% of patients engaging in exercise on the first post-operative day (POD 1) and no adverse effects reported during study. By POD 2, over 70% of patients met enhanced recovery after surgery (ERAS) recommendations., Conclusion: It is feasible to initiate a progressive post-operative resistance exercise program in patients undergoing colorectal resection. The results suggest the positive aspects of incorporating resistance exercise into post-operative care. This may facilitate a clear and easy to implement exercise intervention that can take into consideration patient physical status and limited facility space in the hospital environment., (Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Purpose: The primary aim was to assess the accuracy of common prediction equations, the Harris-Benedict (HB) and the Mifflin St. Jeor (MSJ) equations, for estimating resting energy expenditure (REE) among people with spinal cord injury (SCI) against actual REE measurements. The secondary aim was to cross-validate the Buchholz et al. energy prediction equation created for people with SCI., Methods: A metabolic cart with canopy was used to measure the actual REE. The HB, MSJ, and the Buchholz et al. equations were used for the prediction of REE., Results: Thirty-nine participants (31 males and 8 females) were enrolled in this cross-sectional study. The REEs significantly differed from one another, F(1.52, 57.68) = 52.04, P < 0.001, where both the HB (M = 1703.06, SD = 265.1) and the MSJ (M = 1628.92, SD = 233.8) energy predictions were significantly higher (P < 0.001) than the measured REE (M = 1394.05, SD = 298.7). In contrast, the Buchholz et al. equation did not differ from the measured REE., Conclusions: Our data show that the HB and MSJ equations do not accurately predict the energy needs of this community. Using a SCI-specific equation would improve estimates of REE, such as the Buchholz et al. equation. More research into energy equations for this population may help health care professionals better tailor dietary requirements for weight management.

Objective: To determine why athletes decide not to seek medical attention during a game or practice when they believe they have suffered a concussion., Design: A retrospective survey., Setting: University Sport Medicine Clinic., Participants: A total of 469 male and female university athletes from several varsity team sports were participated in the study., Main Outcome Measures: Athletes were surveyed about the previous 12 months to identify specific reasons why those athletes who believed they had suffered a concussion during a game or practice decided not to seek attention at that time, how often these reasons occurred, and how important these reasons were in the decision process., Results: Ninety-two of the 469 athletes (19.6%) believed they had suffered a concussion within the previous 12 months while playing their respective sport, and 72 of these 92 athletes (78.3%) did not seek medical attention during the game or practice at least once during that time. Sports in which athletes were more likely to not reveal their concussion symptoms were football and ice hockey. The reason "Did not feel the concussion was serious/severe and felt you could still continue to play with little danger to yourself," was listed most commonly (55/92) as a cause for not seeking medical attention for a presumed concussion., Conclusions: A significant percentage of university athletes who believed they had suffered a concussion chose not to seek medical attention at the time of injury. Improved education of players, parents, and coaches about the dangers of continuing to play with concussion symptoms may help improve reporting., Clinical Relevance: Medical staff should be aware that university athletes who believe they have suffered a concussion may choose not to volunteer their symptoms during a game or practice for a variety of personal and athletic reasons.

Background: This study is part of a larger community-based participatory research (CBPR) project to develop, implement, and evaluate the physical activity component of a school-based wellness policy. The policy intervention is being carried out by community stakeholders and academic researchers within the Kahnawake Schools Diabetes Prevention Project, a well-established health promotion organization in the Indigenous community of Kahnawake, Quebec., Methods: We explored how a group of stakeholders develop a school physical activity policy in a participatory manner, and examined factors serving as facilitators and barriers to the development process. This case study was guided by an interpretive description approach and draws upon data from documentary analysis and participant observation., Results: A CBPR approach allowed academic researchers and community stakeholders to codevelop a physical activity policy that is both evidence-based and contextually appropriate. The development process was influenced by a variety of barriers and facilitators including working within existing structures, securing appropriate stakeholders, and school contextual factors., Conclusions: This research offers a process framework that others developing school-based wellness policies may use with appropriate modifications based on local environments., (© 2014, American School Health Association.)

This study explored body-related emotional experiences of pride in young adult males (n=138) and females (n=165). Data were collected using a relived emotion task and analyzed using inductive content analysis. Thirty-nine codes were identified and grouped into six categories (triggers, contexts, cognitive attributions, and affective, cognitive, and behavioral outcomes) for each of two themes (hubristic and authentic pride). Hubristic pride triggers included evaluating appearance/fitness as superior. Cognitions centered on feelings of superiority. Behaviors included strategies to show off. Triggers for authentic pride were personal improvements/maintenance in appearance and meeting or exceeding goals. Feeling accomplished was a cognitive outcome, and physical activity was a behavioral strategy. Contexts for the experience of both facets of pride primarily involved sports settings, swimming/beach, and clothes shopping. These findings provide theoretical support for models of pride as it applies to body image, and advances conceptual understanding of positive body image., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The objectives of this study were to test the associations between physical self-discrepancies (actual:ideal and actual:ought) and physical activity behavior, and to examine whether motivational regulations mediate these associations using self-discrepancy (Higgins, 1987) and organismic integration (Deci & Ryan, 1985) theories as guiding frameworks. Young women (N = 205; M(age) = 18.87 years, SD = 1.83) completed self-report questionnaires. Main analyses involved path analysis using a polynomial regression approach, estimation of direct and indirect effects, and evaluation of response surface values. Agreement between actual and ideal (or ought) physical self-perceptions was related to physical activity both directly and indirectly as mediated by the motivational regulations (R(2) = .24-.30). Specifically, when actual and ideal self-perceptions scores were similar, physical activity levels increased as actual and ideal scores increased. Furthermore, physical activity levels were lower when the discrepancy was such that ideal or ought self were higher than actual self. These findings provide support for integrating self-discrepancy and organismic integration theories to advance research in this area.

Purpose: The association between physical activity (PA) and inflammation has been established in adults, yet little is known about this relationship in youth. This study examined the relationship between vigorous PA and C-reactive protein (CRP) in adolescents., Methods: Data were available for 1 520 adolescents, aged 13 and 16 years, in a province-wide survey of a representative sample of youth in Québec, Canada. Participants completed questionnaires assessing VPA, pubertal stage, body image, and health problems; they provided a fasting blood sample for CRP; and they had height and weight measured., Results: In sex-specific multivariable logistic regression models, VPA was protective of elevated CRP in boys (OR=0.60, 95%CI=0.37-0.99) independent of weight status, pubertal stage, anti-inflammatory/antibiotic medication, and smoking. CRP and physical activity were not related in girls (OR=1.12, 95%CI=0.69-1.82)., Conclusions: In addition to many known health benefits of VPA, the current findings provide evidence that VPA may protect against low-grade systemic inflammation in boys. These data provide further support for the importance of promoting healthy PA levels in youth.

Background: The association between inflammation and obesity is well documented; however, there is little evidence linking physiological markers of inflammation and psychosocial factors such as body image. This study examined the relation between body image and C-reactive protein (CRP)., Methods: Data were available for 1503 adolescents aged 13 and 16 years in a province-wide survey of a representative sample of youth in Quebec, Canada. Participants completed questionnaires assessing body image indicators of social pressures to lose weight and personal body shape discrepancies, provided a fasting blood sample for CRP, and had height and weight measured., Results: In separate multivariable logistic regression models for girls and boys, body shape discrepancy was positively associated with CRP (boys: OR=2.6, 95% CI=1.4-4.8; girls: OR=2.2, 95% CI=1.2-4.3) independent of body mass index, puberty status and socio-demographic variables., Conclusions: Adverse biological markers of cardiometabolic risk and negative body image are associated in adolescence. These findings suggest that, in addition to the well-known psychological problems, negative body image perceptions may also threaten adolescent's physical health.