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Silva GO, Cunha PM, Oliveira MD, Christofaro DGD, Tebar WR, Gerage AM, Kanegusuku H, Correia MA, Ritti-Dias RM. Patterns of sedentary behavior in adults: A cross-sectional study. Front Cardiovasc Med 2023; 10:1116499. [PMID: 36993993 PMCID: PMC10042287 DOI: 10.3389/fcvm.2023.1116499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionSedentary behavior (SB) has been associated with adverse health outcomes, however, it is not completely clear whether total time in SB during the day or prolonged uninterrupted SB are interrelated. The aim of the current study was to describe the different patterns of SB of adults, their relationships, and associated factors.MethodsThe sample included 184 adults aged ranging from 18 to 59 years old. SB was objectively measured by an accelerometer and the following SB pattern parameters were obtained: total time in sedentary bouts, mean time of sedentary bouts, and total time in sedentary breaks. Demographic data (age and sex), anthropometry [weight, height, body mass index (BMI)], blood pressure (BP), medical history (self-reported comorbid conditions), and cardiac autonomic modulation, were assessed to identify factors associated with SB. Multiple linear regressions were used to analyze the relationship between SB parameters and the associated factors.ResultsThe parameters of SB indicated 2.4 (0.9) h/day for total time in sedentary bouts, 36.4 (7.9) min for the mean time of sedentary bouts, and 9.1 (1.9) h/day for the total time in sedentary breaks. Multiple adjusted regression indicated that age was the only factor associated with SB patterns (p < 0.05) after adjustment for confounding variables (sex, age, BMI, dyslipidemia, systolic and diastolic BP). Young adults (18–39 years old) spent more time in sedentary bouts and less time in uninterrupted sedentary bouts compared to middle-aged adults (40–59 years old) (2.58 (0.88) h/day vs. 2.13 (0.90) h/day, respectively; p = 0.001 and 34.5 (5.8) min 18–39 years old vs. 38.8 (9.6) min 40–59 years old; p ≤ 0.001; respectively). The total time in sedentary breaks was similar between age groups (p = 0.465). The total time in sedentary bouts was significantly correlated with the mean time of sedentary bouts (r = −0.58; p ≤ 0.001), and with the total time in sedentary breaks (r = −0.20; p = 0.006). The mean time of sedentary bouts was significantly related to the total time in sedentary breaks (r -= 0.19; p = 0.007).Discussion and ConclusionIn conclusion, age seems to be a relevant factor associated with sedentary behavior with young adults spending more time in SB and accumulating this behavior in a higher amount of sedentary bouts compared to middle-aged adults.
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Affiliation(s)
- Gustavo O. Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
| | - Paolo M. Cunha
- Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEP), Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Max D. Oliveira
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
| | - Diego G. D. Christofaro
- Faculty of Science and Technology, Sao Paulo State University (Unesp), Presidente Prudente, Brazil
| | - William R. Tebar
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Aline M. Gerage
- Physical Education Department, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Hélcio Kanegusuku
- Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEP), Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Marilia A. Correia
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
| | - Raphael M. Ritti-Dias
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
- Correspondence: Raphael M. Ritti-Dias
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Mathunny JJ, Karthik V, Devaraj A, Jacob J. A scoping review on recent trends in wearable sensors to analyze gait in people with stroke: From sensor placement to validation against gold-standard equipment. Proc Inst Mech Eng H 2023; 237:309-326. [PMID: 36704959 DOI: 10.1177/09544119221142327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the review is to evaluate wearable sensor placement, their impact and validation of wearable sensors on analyzing gait, primarily the postural instability in people with stroke. Databases, namely PubMed, Cochrane, SpringerLink, and IEEE Xplore were searched to identify related articles published since January 2005. The authors have selected the articles by considering patient characteristics, intervention details, and outcome measurements by following the priorly set inclusion and exclusion criteria. From a total of 1077 articles, 142 were included in this study and classified into functional fields, namely postural stability (PS) assessments, physical activity monitoring (PA), gait pattern classification (GPC), and foot drop correction (FDC). The review covers the types of wearable sensors, their placement, and their performance in terms of reliability and validity. When employing a single wearable sensor, the pelvis and foot were the most used locations for detecting gait asymmetry and kinetic parameters, respectively. Multiple Inertial Measurement Units placed at different body parts were effectively used to estimate postural stability and gait pattern. This review article has compared results of placement of sensors at different locations helping researchers and clinicians to identify the best possible placement for sensors to measure specific kinematic and kinetic parameters in persons with stroke.
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Affiliation(s)
- Jaison Jacob Mathunny
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Varshini Karthik
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Ashokkumar Devaraj
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - James Jacob
- Department of Physical Therapy, Kindred Healthcare, Munster, IN, USA
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Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev 2021; 6:CD012996. [PMID: 34184251 PMCID: PMC8238669 DOI: 10.1002/14651858.cd012996.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Affiliation(s)
- David H Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Karianne Backx
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
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4
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Hassett L, Ada L, Hellweg S, Paul S, Alzahrani M, Dean C. Active and sedentary bouts in people after stroke and healthy controls: An observational study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1845. [PMID: 32301560 DOI: 10.1002/pri.1845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/08/2020] [Accepted: 03/23/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Understanding how both active and sedentary time is accumulated in people after stroke may help to better target interventions to reduce stroke recurrence. This study aimed to determine the difference between stroke and healthy controls in (a) time spent in sedentary and active behaviour, (b) frequency of short and long active and sedentary bouts and (c) time spent in short and long active and sedentary bouts. METHODS Analysis of secondary outcomes from a cross-sectional study. Participants were 42 community-dwelling people after stroke and 21 age-matched healthy controls. An activity monitor was used to collect free-living active and sedentary behaviour. Total active (standing and walking) and sedentary (lying, reclining and sitting) time was calculated in minutes per day. Bouts were categorized as short (<5 min, 5-15 min, 15-30 min) or long (>30 min). The frequency of and time spent in each bout were calculated. RESULTS Relative to wear time, the stroke group spent 10% (95% confidence interval [CI] 3 to 17) more time in sedentary behaviour and had fewer long active bouts than the healthy controls. The stroke group spent 7% (95% CI 1-13) less time in long active bouts and 11% (95% CI 2-20) more time in long sedentary bouts than the healthy controls. CONCLUSIONS Community-dwelling people after stroke spent less time in active behaviour and accumulated more sedentary time in bouts longer than 30 min compared with healthy controls. Increasing active time and breaking up long sedentary time warrants investigation in people after stroke.
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Affiliation(s)
- Leanne Hassett
- School of Health Sciences/Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Ada
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Hellweg
- Department of Neurological Rehabilitation, Rehaklinik Bellikon, Bellikon, Switzerland
| | - Serene Paul
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matar Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Catherine Dean
- Department of Health Professionals, Director of Physiotherapy, Macquarie University, Sydney, New South Wales, Australia
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Adriano LS, Dionísio AP, Abreu FAPD, Carioca AAF, Zocolo GJ, Wurlitzer NJ, Pinto CDO, de Oliveira AC, Sampaio HADC. Yacon syrup reduces postprandial glycemic response to breakfast: A randomized, crossover, double-blind clinical trial. Food Res Int 2019; 126:108682. [PMID: 31732062 DOI: 10.1016/j.foodres.2019.108682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 12/20/2022]
Abstract
Yacon is a root rich in fructooligosaccharides (FOS), which act as prebiotics. Numerous studies have shown promising results in the technological aspects of producing yacon syrup. However, uncertainties exist concerning whether yacon syrup can modulate postprandial glucose and lipid profiles. In order to assess the effect of yacon syrup on postprandial glucose, insulin and triglyceride (TG) responses, a randomized, crossover, double-blind clinical intervention with 40 women (20 normal weight and 20 grade I obese) was performed. Participants underwent two-arms of intervention with at least a one-week wash-out period between visits. On each intervention day, after 12 h of fasting, an aliquot of blood was collected. For intervention A, volunteers consumed breakfast +40 g of placebo, whereas for intervention B, participants consumed breakfast +40 g of yacon syrup (14 g of FOS). Blood samples were drawn at 15, 30, 45, 60, 90, and 120 min. Glucose and insulin concentrations were lowered after yacon syrup intake as compared to placebo at following times: 30 min for glucose and 15, 30 and 45 min for insulin. In conclusion, yacon syrup has a postprandial decreasing effect glucose and insulin concentrations in adult women. This effect was not evident for triglyceride concentration. Clinical trial registry: RBR-33wf46. Available in: http://www.ensaiosclinicos.gov.br/rg/RBR-33wf46/.
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Affiliation(s)
- Lia Silveira Adriano
- Department of Nutrition, State University of Ceara, 60714-903 Fortaleza, CE, Brazil; Department of Nutrition, University of Fortaleza, 60811-905 Fortaleza, CE, Brazil
| | - Ana Paula Dionísio
- Embrapa Agroindústria Tropical, Dra Sara Mesquita Street, 2270, 60511-110 Fortaleza, CE, Brazil.
| | | | | | - Guilherme Julião Zocolo
- Embrapa Agroindústria Tropical, Dra Sara Mesquita Street, 2270, 60511-110 Fortaleza, CE, Brazil
| | - Nedio Jair Wurlitzer
- Embrapa Agroindústria Tropical, Dra Sara Mesquita Street, 2270, 60511-110 Fortaleza, CE, Brazil
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Hanna E, Janssen H, Crowfoot G, Mason G, Vyslysel G, Sweetapple A, Callister R, English C. Participation, Fear of Falling, and Upper Limb Impairment are Associated with High Sitting Time in People with Stroke. Occup Ther Health Care 2019; 33:181-196. [PMID: 30890006 DOI: 10.1080/07380577.2019.1587675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this cross-sectional, exploratory study was to explore associations between sitting time and (1) participation, (2) fear of falling, and (3) upper limb impairment after stroke. High sitting time was associated with less participation in meaningful activities involving standing or walking (ρ = -0.519, p = 0.023). A greater fear of falling (ρ = 0.579, p = 0.012) and having an impaired upper limb (mean difference 18.7%, 95% CI: 5.3-32.1, p = 0.012) were associated with greater sitting time. Providing support for stroke survivors to participate in meaningful activities while reducing sitting time is an important consideration when planning occupational therapy interventions, particularly for individuals with an arm impairment and/or those with a fear of falling.
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Affiliation(s)
- Ella Hanna
- a School of Health Sciences , University of Newcastle , Newcastle , Australia
| | - Heidi Janssen
- a School of Health Sciences , University of Newcastle , Newcastle , Australia.,b Community Stroke Team and Hunter Stroke Service , Community and Aged Care Services-Greater Newcastle Cluster , Newcastle , Australia.,c NHMRC Centre for Research Excellence in Stroke Recovery and Rehabilitation , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia
| | - Gary Crowfoot
- a School of Health Sciences , University of Newcastle , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia.,e Centre for Research Excellence in Stroke Recovery and Rehabilitation , Florey Institute of Neuroscience and Hunter Medical Research Institute , Australia
| | - Gillian Mason
- c NHMRC Centre for Research Excellence in Stroke Recovery and Rehabilitation , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia
| | - Glade Vyslysel
- f Westlakes Community Rehabilitation Team , Community and Aged Care Services-Greater Newcastle Cluster , Newcastle , Australia
| | - Anne Sweetapple
- g Community Stroke Team , Community and Aged Care Services-Greater Newcastle Cluster , Newcastle , Australia
| | - Robin Callister
- h School of Biomedical Science and Pharmacy , University of Newcastle , Newcastle , Australia.,i Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Newcastle , Australia
| | - Coralie English
- a School of Health Sciences , University of Newcastle , Newcastle , Australia.,c NHMRC Centre for Research Excellence in Stroke Recovery and Rehabilitation , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia
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Mackie P, Crowfoot G, Janssen H, Dunstan DW, Bernhardt J, Walker FR, Patterson A, Callister R, Spratt NJ, Holliday E, English C. Breaking up sitting time after stroke - How much less sitting is needed to improve blood pressure after stroke (BUST-BP-Dose): Protocol for a dose-finding study. Contemp Clin Trials Commun 2019; 13:100310. [PMID: 30740549 PMCID: PMC6355726 DOI: 10.1016/j.conctc.2018.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 11/06/2022] Open
Abstract
Excessive sitting is detrimentally associated with cardiovascular disease and all-cause mortality. Frequent breaks in prolonged sitting can improve cardiometabolic responses in non-stroke populations. However, this has not been established in stroke survivors. This study will determine the most effective dose of activity breaks that (i) produce clinically meaningful improvements in mean systolic blood pressure (primary outcome), postprandial glucose, and insulin responses (secondary outcomes), and (ii) is safe and feasible. We hypothesis that systolic blood pressure, postprandial insulin, and glucose responses will improve with increasing doses of activity and be most effective at the maximum safe and feasible dose of activity. Thirty participants in the most effective dose will provide 80% power to detect a within-person, between-condition, difference of 3.5 mmHg in systolic blood pressure assuming a SD of 15 mmHg, within-person correlation of 0.9, and α = 0.05. Stroke survivors will complete 3 experimental conditions in a within-participant, dose escalation design including (i) uninterrupted sitting (8 h), (ii) Dose 1: uninterrupted sitting with bouts of light-intensity exercises while standing (initial dose involves two 5-min breaks), and (iii) Dose 2: two additional 5-min breaks above Dose 1. Ambulatory blood pressure will be collected every 30 min during experimental conditions and hourly for 24-h post-experimental conditions. Blood samples will be collected every 30 min during 2-h postprandial periods. This study will identify the most effective dose of light-intensity exercises while standing to improve cardiometabolic responses in stroke survivors.
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Affiliation(s)
- Paul Mackie
- School of Health Sciences, University of Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle and Hunter Medical Research Institute, NSW, Australia.,National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia
| | - Gary Crowfoot
- School of Health Sciences, University of Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle and Hunter Medical Research Institute, NSW, Australia.,National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia
| | - Heidi Janssen
- School of Health Sciences, University of Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle and Hunter Medical Research Institute, NSW, Australia.,National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia.,Hunter Stroke Service, Hunter New England Local Health District, NSW, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, VIC, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, VIC, Australia
| | - Julie Bernhardt
- National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia.,Florey Institute of Neuroscience and Mental Health, VIC, Australia
| | - F Rohan Walker
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle and Hunter Medical Research Institute, NSW, Australia.,National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia.,School of Biomedical Science and Pharmacy, University of Newcastle, NSW, Australia
| | - Amanda Patterson
- School of Health Sciences, University of Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle and Hunter Medical Research Institute, NSW, Australia
| | - Robin Callister
- School of Biomedical Science and Pharmacy, University of Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle and Hunter Medical Research Institute, NSW, Australia
| | - Neil J Spratt
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle and Hunter Medical Research Institute, NSW, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle and Hunter Medical Research Institute, NSW, Australia.,National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia
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Thingstad P, Askim T, Beyer MK, Bråthen G, Ellekjær H, Ihle-Hansen H, Knapskog AB, Lydersen S, Munthe-Kaas R, Næss H, Pendlebury ST, Seljeseth YM, Saltvedt I. The Norwegian Cognitive impairment after stroke study (Nor-COAST): study protocol of a multicentre, prospective cohort study. BMC Neurol 2018; 18:193. [PMID: 30477436 PMCID: PMC6260901 DOI: 10.1186/s12883-018-1198-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Early and late onset post-stroke cognitive impairment (PCI) contributes substantially to disability following stroke, and is a high priority within stroke research. The aetiology for PCI is complex and related to the stroke itself, brain resilience, comorbid brain diseases, prestroke vulnerability and complications during the hospital stay. The aim of the Norwegian Cognitive Impairment After Stroke study (Nor-COAST) is to quantify and measure levels of cognitive impairments in a general Norwegian stroke population and to identify biological and clinical markers associated with prognosis for cognitive disorders following incident stroke. The study will be organised within five work packages: 1) Incidence and trajectories 2) Pathological mechanisms 3) Development of a risk score 4) Impact of physical activity and 5) Adherence to secondary prevention. METHODS Nor-COAST is an ongoing multicentre (five participating hospitals), prospective, cohort study with consecutive inclusion during the acute phase and with follow-up at three and 18 months, and at three years. Inclusion criteria are stroke defined according to the WHO criteria. During the recruitment period from 18.05.2015 to 31.03.2017, 816 participants have been included. Cognitive impairment will be classified according to the DSM-5 criteria using a consensus group. Cognitive function is assessed by a standardised neuropsychological test battery, the Montreal Cognitive Assessment, Trail making A and B, ten-word immediate and delayed recall test, the Controlled Oral Word Association, Global Deterioration Scale and proxy based information by and the Ascertain Dementia 8 item informant questionnaire. Biomarkers include magnetic resonance imaging, routine blood samples and bio-banking. Clinical assessments include characteristics of the stroke, comorbidity, delirium, frailty and tests for cognitive and physical function, sensor based activity monitoring and adherence to secondary prophylaxis. DISCUSSION Nor-COAST is the first Norwegian multicentre study to quantify burden of PCI that will provide reliable estimates in a general stroke population. A multidisciplinary approach aiming to identify biomarkers and clinical markers of overall prognosis will add new knowledge about risk profiles, including pre-stroke vulnerability and modifiable factors such as physical activity and secondary prophylaxis of relevance for clinical practice and later intervention studies. TRIAL REGISTRATION ClinicalTrials.gov: NCT02650531 . Retrospectively registered January 8, 2016. First participant included May 18, 2015.
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Affiliation(s)
- Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona K. Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Bråthen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clin. Neurophysiology, St Olavs University hospital, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Internal Medicine, Stroke Unit, St. Olavs University Hospital, Trondheim, Norway
| | - Hege Ihle-Hansen
- Department of Geriatrics, Oslo University Hospital, Oslo, Norway
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | | | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine, Regional Centre for Child and Youth Mental Health and Child Care, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | - Halvor Næss
- Department of neurology, Haukeland University Hospital, Bergen, Norway
- Stavanger University Hospital, Stavanger, Norway
- Institute of clinical medicine, University of Bergen, Bergen, Norway
| | - Sarah T. Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | | | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatrics, St. Olavs University Hospital, Trondheim, Norway
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9
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English C, Janssen H, Crowfoot G, Callister R, Dunn A, Mackie P, Oldmeadow C, Ong LK, Palazzi K, Patterson AJ, Spratt NJ, Walker FR, Bernhardt J, Dunstan DW. Breaking up sitting time after stroke (BUST-stroke). Int J Stroke 2018; 13:921-931. [PMID: 30226448 DOI: 10.1177/1747493018801222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES People with stroke sit for long periods each day, which may compromise blood glucose control and increase risk of recurrent stroke. Studies in other populations have found regular activity breaks have a significant immediate (within-day) positive effect on glucose metabolism. We examined the effects of breaking up uninterrupted sitting with frequent, short bouts of light-intensity physical activity in people with stroke on post-prandial plasma glucose and insulin. METHODS Randomized within-participant crossover trial. We included people between 3 months and 10 years post-stroke, ambulant with minimal assistance and not taking diabetic medication other than metformin. The three experimental conditions (completed in random order) were: sitting for 8 h uninterrupted, sitting with 3 min bouts of light-intensity exercise while standing every 30 min, or sitting with 3 min of walking every 30 min. Meals were standardized and bloods were collected half- to one-hourly via an intravenous cannula. RESULTS A total of 19 participants (9 female, mean [SD] age 68.2 [10.2]) completed the trial. The majority ( n = 12, 63%) had mild stroke symptoms (National Institutes of Stroke Scale score 0-13). There was no significant effect of experimental condition on glucose (mean [SD] positive incremental area [+iAUC] mmol·L·h-1 under the curve during sitting 42.3 [29.5], standing 47.4 [23.1], walking 44.6 [26.5], p = 0.563) or insulin (mean + iAUC pmol·L·h-1 sitting 14,161 [7,560], standing 14,043 [8,312], walking 14,008 [8,269], p = 0.987). CONCLUSION Frequent, short bouts of light-intensity physical activity did not have a significant effect on post-prandial plasma glucose and insulin in this sample of people with stroke. Further studies are needed to identify strategies that improve inactivity-related glucose metabolism after stroke.
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Affiliation(s)
- Coralie English
- 1 School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia.,2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - Heidi Janssen
- 1 School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia.,2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia.,3 Hunter Stroke Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Gary Crowfoot
- 1 School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia.,2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - Robin Callister
- 4 School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Ashlee Dunn
- 4 School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Paul Mackie
- 1 School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia.,2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - Christopher Oldmeadow
- 5 Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Lin K Ong
- 2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia.,6 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Kerrin Palazzi
- 5 Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Amanda J Patterson
- 7 School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Neil J Spratt
- 2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia.,8 Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - F Rohan Walker
- 2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia.,6 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Julie Bernhardt
- 2 Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - David W Dunstan
- 9 Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,10 Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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10
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English C, Janssen H, Crowfoot G, Bourne J, Callister R, Dunn A, Oldmeadow C, Ong LK, Palazzi K, Patterson A, Spratt NJ, Walker FR, Dunstan DW, Bernhardt J. Frequent, short bouts of light-intensity exercises while standing decreases systolic blood pressure: Breaking Up Sitting Time after Stroke (BUST-Stroke) trial. Int J Stroke 2018; 13:932-940. [DOI: 10.1177/1747493018798535] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Stroke survivors sit for long periods each day. Uninterrupted sitting is associated with increased risk of cardiovascular disease. Breaking up uninterrupted sitting with frequent, short bouts of light-intensity physical activity has an immediate positive effect on blood pressure and plasma clotting factors in healthy, overweight, and type 2 diabetic populations. Aim We examined the effect of frequent, short bouts of light-intensity physical activity on blood pressure and plasma fibrinogen in stroke survivors. Methods Prespecified secondary analyses from a three-armed randomized, within-participant, crossover trial. Participants were 19 stroke survivors (nine female, aged 68 years old, 90% able to walk independently). The experimental conditions were sitting for 8 h uninterrupted, sitting with 3 min bouts of light-intensity exercise while standing every 30 min, or sitting with 3 min of walking every 30 min. Blood pressure was measured every 30 min over 8 h and plasma fibrinogen at the beginning, middle, and end of each day. Intention-to-treat analyses were performed using linear mixed models including fixed effects for condition, period, and order, and a random intercept for participant to account for repeated measures and missing data. Results Sitting with 3 min bouts of light-intensity exercise while standing every 30 min decreased systolic blood pressure by 3.5 mmHg (95% CI 1.7–5.4) compared with sitting for 8 h uninterrupted. For participants not taking antihypertensive medications, sitting with 3 min of walking every 30 min decreased systolic blood pressure by 5.0 mmHg (95% CI −7.9 to 2.0) and sitting with 3 min bouts light-intensity exercise while standing every 30 min decreased systolic blood pressure by 4.2 mmHg (95% CI −7.2 to −1.3) compared with sitting for 8 h uninterrupted. There was no effect of condition on diastolic blood pressure (p = 0.45) or plasma fibrinogen levels (p = 0.91). Conclusion Frequent, short bouts of light-intensity physical activity decreases systolic blood pressure in stroke survivors. However, before translation into clinical practice, the optimal duration and timing of physical activity bouts needs to be determined. Clinical trial registration Australian and New Zealand Clinical Trials Registry http://www.anzctr.org.au ANZTR12615001189516.
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Affiliation(s)
- Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - Heidi Janssen
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
| | - Gary Crowfoot
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - Josephine Bourne
- School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Ashlee Dunn
- School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia
| | - Lin K Ong
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Kerrin Palazzi
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia
| | - Amanda Patterson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Neil J Spratt
- Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - FR Walker
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - David W Dunstan
- Physical Activity, Baker Heart and Diabetes Institute, Melbourne, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Julie Bernhardt
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
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A Community-Based, Bionic Leg Rehabilitation Program for Patients with Chronic Stroke: Clinical Trial Protocol. J Stroke Cerebrovasc Dis 2017; 27:372-380. [PMID: 29097056 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/16/2017] [Accepted: 09/07/2017] [Indexed: 11/20/2022] Open
Abstract
Stroke is a major global health problem whereby many survivors have unmet needs concerning mobility during recovery. As such, the use of robotic-assisted devices (i.e., a bionic leg) within a community setting may be an important adjunct to normal physiotherapy in chronic stroke survivors. This study will be a dual-center, randomized, parallel group clinical trial to investigate the impact of a community-based training program using a bionic leg on biomechanical, cardiovascular, and functional outcomes in stroke survivors. Following a baseline assessment that will assess gait, postural sway, vascular health (blood pressure, arterial stiffness), and functional outcomes (6-minute walk), participants will be randomized to a 10-week program group, incorporating (1) a physiotherapy plus community-based bionic leg training program; (2) physiotherapy only; or (3) usual care control. The training program will involve participants engaging in a minimum of 1 hour per day of bionic leg activities at home. Follow-up assessments, identical to baseline, will occur after 10 weeks, and 3 and 12 months postintervention. Given the practical implications of the study, the clinical significance of using the bionic leg will be assessed for each outcome variable. The potential improvements in gait, balance, vascular health, and functional status may have a meaningful impact on patients' quality of life. The integration of robotic devices within home-based rehabilitation programs may prove to be a cost-effective, practical, and beneficial resource for stroke survivors.
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Borschmann KN, Ekinci EI, Iuliano S, Churilov L, Pang MYC, Bernhardt J. Reducing sedentary time and fat mass may improve glucose tolerance and insulin sensitivity in adults surviving 6 months after stroke: A phase I pilot study. Eur Stroke J 2017; 2:144-153. [PMID: 31008309 PMCID: PMC6453210 DOI: 10.1177/2396987317694469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/27/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Deranged glycaemic control is common post-stroke, increasing risks of recurrent stroke and development of diabetes. The aim of the study is to examine glucose metabolism in relation to body composition, physical activity and sedentary time post-stroke. PATIENTS AND METHODS Observational study: Non-diabetic adults, unable to walk independently, were recruited within 2 weeks of first stroke. Primary outcome: 2-h glucose level (mmol/l, oral glucose tolerance test), assessed at baseline and 6 months. Homeostasis Model Assessment of Insulin Sensitivity, total body fat and lean mass (dual energy X-ray absorptiometry), sedentary time (lying or sitting), standing and walking (PAL2 accelerometer) were assessed at baseline, 1, 3 and 6 months. Generalised estimating equations were used to examine change over time and associations between outcome measures. RESULTS Thirty-six participants (69.5 years (standard deviation 11.7), 13 (36.1%) female, moderate stroke severity (National Institute of Health Stroke Scale 11.5 (interquartile range 9.75, 16)). Within 6 months, adjusting for age and National Institute of Health Stroke Scale, every month 2-h glucose reduced by 4.5% (p < 0.001), Homeostasis Model Assessment of Insulin Sensitivity improved 3% (p = 0.04) and fat mass decreased 490 g (95% confidence interval 325, 655; p = 0.01). For every extra kilogram of body fat, 2-h glucose increased by 1.02 mmol/L (95% confidence interval 1.01, 1.02; p = 0.001); Homeostasis Model Assessment of Insulin Sensitivity reduced by 0.98% (95% confidence interval 0.97, 0.99; p = 0.001). Time spent sedentary reduced from 98.5% of measurement period (interquartile range 94.3, 99.8) to 74.3% (interquartile range 65.5, 88.6), by 2.8% monthly (95% confidence interval 1.8, 3.9, p < 0.001). For every additional 5% sedentary time, 2-h glucose increased by 1.05 mmol/L (95% confidence interval 1.04, 1.07; p < 0.001). CONCLUSION Reducing sedentary time and fat mass within 6 months of stroke may improve glucose tolerance and insulin resistance.
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Affiliation(s)
- Karen N Borschmann
- School of Health Science, La Trobe
University, Australia
- Florey Institute of Neuroscience and
Mental Health, University of Melbourne, Australia
| | - Elif I Ekinci
- Department of Medicine, University of
Melbourne, Australia
- Endocrine Centre, Austin Health,
Australia
- Menzies School of Health Research,
Darwin, Australia
| | - Sandra Iuliano
- Department of Medicine, University of
Melbourne, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and
Mental Health, University of Melbourne, Australia
| | - Marco YC Pang
- Department of Rehabilitation Sciences,
Hong Kong Polytechnic University, Hong Kong
| | - Julie Bernhardt
- School of Health Science, La Trobe
University, Australia
- Florey Institute of Neuroscience and
Mental Health, University of Melbourne, Australia
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