Evidence-based risk assessment and recommendations for physical activity clearance: cognitive and psychological conditions

New parents' sleep, movement, health, and well-being across the postpartum period

OBJECTIVE

The aim of this study was to examine changes and the bi-directional relationship in sleep and movement, and health and well-being among new parents and differences by sex.

METHODS

This secondary data analysis included both conditions from a randomized control trial to improve new parents'physical activity [PA] and recruited couples. Parents (n = 181, 117 couples represented 31.5 ± 4.4 years, 51.3% women, 83.3% White) completed questionnaires on regular overnight sleep duration, PA, mental health (perceived stress), physical health (physical quality of life [PQoL]), and well-being (life satisfaction) at 2-, 4-, 6-, and 8-month postpartum. Random-intercept cross-lagged panel models were stratified by sex to examine changes in sleep and PA with health and well-being across time.

RESULTS

Sleep and stress were interrelated at different times for fathers (2 months), and mothers (8 months). Sleep and PQoL improved across time, with mothers reporting less sleep than fathers at 4 and 6 months. PQoL at 4 months was related to MVPA at 6-months. Life satisfaction and PA at 2 months was related to PA at 4 months.

CONCLUSION

Mothers and fathers experienced different sleep and stress trajectories. Mental health improved postpartum with early connections to PA. Supporting the 24-hour movement behavior cycle and mental health across the parenthood transition may benefit couples.

Prescription and Effects of Cardiorespiratory Training in Individuals with Intellectual Disability: A Systematic Review

This study aims to systematize effects of cardiorespiratory training (CT) programs in individuals with intellectual disability (ID) and identifying the fundamental and structuring aspects for the prescription of CT. This systematic review was carried out through four databases (Pubmed, Web of Science, Scopus, and SPORTDiscus), considering data from the period between 2013 and 2022. From 257 studies, 12 studies were included in this systematic review. Three studies used interval CT, while seven used continuous CT. Seven were carried out in the population with Down syndrome, while only three were carried out with participants with ID. The CT programs had the following characteristics: duration of 8 to 12 weeks, weekly frequency of three sessions, for 20 to 60 min, the intensity of 50% to 80% of maximal heart rate or 70% to 80% of peak oxygen consumption, using an ergometer cycle or an outdoor walking. The studies reported improvements in cardiorespiratory function, lipid, hemodynamic and metabolic profile, body composition, and neuromuscular and cognitive capacity. This review presents characteristics and recommendations that technicians can follow when structuring, prescribing, and implementing CT programs to individuals with ID.

Translation, Cultural Adaptation, and Reproducibility of the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+): The Brazilian Portuguese Version

Background: The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) is the international standard for pre-participation risk stratification and screening. In order to provide a practical and valid screening tool to facilitate safe engagement in physical activity and fitness assessments for the Brazilian population, this study aimed to translate, culturally adapt, and verify the reproducibility of the evidence-based PAR-Q+ to the Brazilian Portuguese language.

Method: Initially, the document was translated by two independent translators, before Brazilian experts in health and physical activity evaluated the translations and produced a common initial version. Next, two English native speakers, fluent in Brazilian Portuguese and accustomed to the local culture, back-translated the questionnaire. These back translations were assessed by the organization in charge of the PAR-Q+, then a final Brazilian version was approved. A total of 493 Brazilians between 5 and 93 yr (39.9 ± 25.4 yr), 59% female, with varying levels of health and physical activity, completed the questionnaire twice, in person or online, 1–2 weeks apart. Cronbach's alpha was used to calculate the internal consistency of all items of the questionnaire, and the Kappa statistic was used to assess the individual reproducibility of each item of the document. Additionally, the intraclass correlation coefficient and its 95% confidence interval (CI) were used to verify the general reproducibility (reliability) of the translated version.

Results: The Brazilian version had an excellent internal consistency (0.993), with an almost perfect agreement in 93.8% of the questions, and a substantial agreement in the other 6.2%. The translated version also had a good to excellent total reproducibility (0.901, 95% CI: 0.887–0.914).

Conclusion: The results show this translation is a valid and reliable screening tool, which may facilitate a larger number of Brazilians to start or increase physical activity participation in a safe manner.

Promoting sport participation during early parenthood: a randomized controlled trial protocol

Background

Adult participation in sport is associated with important positive psychosocial outcomes. Despite the multitude of benefits that have been linked to sport participation, adult participation rates in Canada remain low. Parents with young children represent a demographic that may benefit considerably from sport participation, given the prevalence of inactivity coupled with increased levels of psychosocial distress among this group. This study aims to evaluate the efficacy of two types of sport participation (individual sport and team sport) on key psychosocial outcomes compared with a “personal time” control condition among parents with young children.

Methods/design

The three-arm, parallel design, single-blind, randomized controlled trial will compare a team sport condition, an individual sport condition, and a “personal time” control condition over 3 months. Parents are eligible if they have a child under 13 years of age, are not participating in a sport at baseline, and are not meeting Canadian Physical Activity Guidelines. Psychosocial variables (quality of life, relationship satisfaction, social functioning, parental stress, and enjoyment) will be assessed at baseline, 6 weeks, and 3 months. A total of 161 parents have been recruited thus far from the Greater Victoria region in British Columbia, Canada. The study is ongoing with a target goal of 240 participants and an anticipated completion date of December 2021.

Discussion

This protocol describes the implementation of a randomized controlled trial that evaluates the effectiveness of sport participation for increasing positive psychosocial outcomes. This information could prove useful for future adult sport participation and potentially inform public health initiatives involving parents and families.

Trial registration

ClinicalTrials.gov, NCT02898285. Registered 13 September 2016.

Is abstinence really the best option? Exploring the role of exercise in the treatment and management of eating disorders

Exercise prescription is suggested to help manage exercise abuse and improve overall eating disorder (ED) prognosis. This study explored emerging perceptions of ED health professionals concerning the role of exercise as a supportive treatment for EDs. Semi-structured interviews were conducted with international health professionals (n=13) with expertise in ED treatment. Verbatim transcripts were analyzed through thematic analysis. Four themes were revealed and titled 1) understanding the current state; 2) gaining perspectives; 3) barriers and benefits; 4) one size does not fit all. Within these themes, participants described the current state of exercise in ED treatment and suggested there exists a gap in research knowledge and practice. Participants also identified the implications of incorporating exercise into treatment and how an exercise protocol may be designed. Results enhance the understanding of the role of exercise in ED treatment and how it may further benefit individuals with EDs.

Evaluation of a physical activity intervention for new parents: protocol paper for a randomized trial

Background

Identifying critical life transitions in people’s physical activity behaviors may illuminate the most opportune intervention apertures for chronic disease prevention. A substantive evidence base now indicates that parenthood is one of these critical transition points for physical activity decline. This study will examine whether a brief theory-based intervention can prevent a decline in physical activity among new parents over 6 months following intervention. This study protocol represents the first dyad-based physical activity initiative in the parenthood literature involving both mothers and fathers; prior research has focused on only mothers or only fathers (albeit limited), and has shown only short-term changes in physical activity.

This study will be investigating whether a theory-based physical activity intervention can maintain or improve moderate to vigorous intensity physical activity measured via accelerometry of new parents over a 6 month period following intervention compared to a control group.

Methods

This study is a 6-month longitudinal randomized controlled trial. Parents are measured at baseline (2 months postpartum) with two assessment points at 6 weeks (3.5 months postpartum) and 3 months (5 months postpartum) and a final follow-up assessment at 6 months (8 months postpartum). The content of the theory-based intervention was derived from the results of our prior longitudinal trial of new parents using an adapted theory of planned behavior framework to predict changes in physical activity.

Results

A total of 152 couples have been recruited to date. Sixteen couples dropped out after baseline and a total of 88 couples have completed their 6-month measures.

Discussion

If the intervention proves successful, couple-based physical activity promotion efforts among parents could be a promising avenue to pursue to help mitigate the declines of physical activity levels during parenthood. These findings could inform public health materials and practitioners.

Trial registration

This trial has been registered with the Clinical Trials Registry maintained by the National Library of Medicine at the National Institutes of Health on April 19, 2014. The registration ID is NCT02290808.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4874-7) contains supplementary material, which is available to authorized users.

Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines

INTRODUCTION

Although exercise is an effective intervention for many psychological health issues, it has often been overlooked as a potential adjunct to eating disorder (ED) treatment. Thus, our objective was to summarize the literature by synthesizing themes identified in clinical studies and explicit guidelines or recommendations for the use or management of exercise in ED interventions into a proposed set of guidelines for the use of exercise in ED treatment.

METHODS

A literature search in exercise science, health psychology, and the ED literature was conducted. The focus was to obtain articles that reported on therapeutic effects and/or guidelines for the therapeutic use of exercise in individuals with ED.

RESULTS

Our review identified 11 core themes describing techniques that have been successful in using exercise therapeutically in ED treatment. These 11 guidelines are as follows: employ a team of relevant experts, monitor medical status, screen for exercise-related psychopathology, create a written contract of how therapeutic exercise will be used, include a psychoeducational component, focus on positive reinforcement, create a graded exercise program, begin with mild-intensity exercise, tailor the mode of exercise to the needs of the individual, include a nutritional component, and debrief after exercise sessions.

CONCLUSION

Our review identifies specific guidelines that may enhance ED treatment outcomes. It is the first to summarize divergent literature and synthesizes previous successes that may guide the use of therapeutic exercise in some, but not all ED patients. This review provides a practical set of guidelines for the clinical management and therapeutic use of exercise in ED treatment by focusing on empowering individuals with exercise as a tool for healthy living.

Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer's disease

Background

The impending public health impact of Alzheimer’s disease is tremendous. Physical activity is a promising intervention for preventing and managing Alzheimer’s disease. However, there is a lack of evidence-based public health messaging to support this position. This paper describes the application of the Appraisal of Guidelines Research and Evaluation II (AGREE-II) principles to formulate an evidence-based message to promote physical activity for the purposes of preventing and managing Alzheimer’s disease.

Methods

A messaging statement was developed using the AGREE-II instrument as guidance. Methods included (a) conducting a systematic review of reviews summarizing research on physical activity to prevent and manage Alzheimer’s disease, and (b) engaging stakeholders to deliberate the evidence and formulate the messaging statement.

Results

The evidence base consisted of seven systematic reviews focused on Alzheimer’s disease prevention and 20 reviews focused on symptom management. Virtually all of the reviews of symptom management conflated patients with Alzheimer’s disease and patients with other dementias, and this limitation was reflected in the second part of the messaging statement. After deliberating the evidence base, an expert panel achieved consensus on the following statement: “Regular participation in physical activity is associated with a reduced risk of developing Alzheimer’s disease. Among older adults with Alzheimer’s disease and other dementias, regular physical activity can improve performance of activities of daily living and mobility, and may improve general cognition and balance.” The statement was rated favourably by a sample of older adults and physicians who treat Alzheimer’s disease patients in terms of its appropriateness, utility, and clarity.

Conclusion

Public health and other organizations that promote physical activity, health and well-being to older adults are encouraged to use the evidence-based statement in their programs and resources. Researchers, clinicians, people with Alzheimer’s disease and caregivers are encouraged to adopt the messaging statement and the recommendations in the companion informational resource.

Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process

Physical activity is an effective lifestyle therapy for patients at risk for, or with, documented cardiovascular disease (CVD). Current screening tools — the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) — require updating to align with risk/benefit evidence. We provide evidence-based recommendations to identify individuals with CVD at lower risk, intermediate risk, or higher risk of adverse events when participating in physical activity. Forms of exercise and the settings that will appropriately manage the risks are identified. A computer-assisted search of electronic databases, using search terms for CVD and physical activity risks and benefits, was employed. The Appraisal of Guidelines for Research and Evaluation were applied to assess the evidence and assign a strength of evidence rating. A strength rating for the physical activity participation clearance recommendation was assigned on the basis of the evidence. Recommendations for physical activity clearance were made for specific CVD groups. Evidence indicates that those who are medically stable, who are involved with physical activity, and who have adequate physical ability can participate in physical activity of lower to moderate risk. Patients at higher risk can exercise in medically supervised programs. Systematic evaluation of evidence indicates that clinically stable individuals with CVD may participate in physical activity with little risk of adverse events. Therefore, changes in the PAR-Q should be undertaken and a process of assessment and consultation to replace the PARmed-X should be developed. Patients at lower risk may exercise at low to moderate intensities with minimal supervision. Those at intermediate risk should exercise with guidance from a qualified exercise professional. Patients at higher risk should exercise in medically supervised programs.

Enhancing the effectiveness of clearance for physical activity participation: background and overall process1This paper is one of a selection of papers published in the Special Issue entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal's usual peer-review process

Recent feedback from physical activity (PA) participants, fitness professionals, and physicians has indicated that there are limitations to the utility and effectiveness of the existing PAR-Q and PARmed-X screening tools for PA participation. The aim of this study was to have authorities in exercise and chronic disease management to work with an expert panel to increase the effectiveness of clearance for PA participation using an evidence-based consensus approach and the well-established Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Systematic reviews were conducted to develop a new PA clearance protocol involving risk stratification and a decision-tree process. Evidence-based support was sought for enabling qualified exercise professionals to have a direct role in the PA participation clearance process. The PAR-Q+ was developed to use formalized probes to clarify problematic responses and to explore issues arising from currently diagnosed chronic disease or condition. The original PARmed-X tool is replaced with an interactive computer program (ePARmed-X+) to clear prospective PA participants for either unrestricted or supervised PA or to direct them to obtain medical clearance. Evidence-based validation was also provided for the direct role of highly qualified university-educated exercise professionals in the PA clearance process. The risks associated with exercise during pregnancy were also evaluated. The systematic review and consensus process, conforming to the AGREE Instrument, has provided a sound evidence base for enhanced effectiveness of the clearance process for PA participation of both asymptomatic populations and persons with chronic diseases or conditions.