Andy C.Y. Tse

Effect of Low-intensity Exercise on Physical and Cognitive Health in Older Adults: a Systematic Review

BackgroundIt is well known that physical exercise is important to promote physical and cognitive health in older population. However, inconsistent research findings were shown regarding exercise intensity, particularly on whether low-intensity exercise (1.5 metabolic equivalent tasks (METs) to 3.0 METs) can improve physical and cognitive health of older adults. This systematic review aimed to fill this research gap. The objective of this study is to conduct a systematic review of the effectiveness of low-intensity exercise interventions on physical and cognitive health of older adults.MethodsPublished research was identified in various databases including CINAHL, MEDLINE, PEDro, PubMed, Science Direct, SPORTDiscus, and Web of Science. Research studies published from January 01, 1994 to February 01, 2015 were selected for examination. Studies were included if they were published in an academic peer-reviewed journal, published in English, conducted as randomized controlled trial (RCT) or quasi-experimental studies with appropriate comparison groups, targeted participants aged 65 or above, and prescribed with low-intensity exercise in at least one study arm. Two reviewers independently extracted the data (study, design, participants, intervention, and results) and assessed the quality of the selected studies. Fifteen studies met the inclusion criteria. Quality index ranged from 15 to 18 mean = 18.3 with a full score of 28, indicating a moderate quality. Most of the outcomes reported in these studied were lower limb muscle strength (n = 9), balancing (n = 7), flexibility (n = 4), and depressive symptoms (n = 3).ResultsOut of the 15 selected studies, 11 reported improvement in flexibility, balancing, lower limb muscle strength, or depressive symptoms by low-intensity exercises.ConclusionsThe current literature suggests the effectiveness of low-intensity exercise on improved physical and cognitive health for older adults. It may be a desired intensity level in promoting health among older adults with better compliance, lower risk of injuries, and long-term sustainability.

Analogy Instruction and Speech Performance Under Psychological Stress

To examine the efficacy of explicit and implicit forms of instruction for speech motor performance under conditions of psychological stress. In experiment 1, 20 participants were asked to deliver a formal presentation to validate the modified Trier Social Stress Test (TSST). In experiment 2, 40 participants were instructed explicitly by verbal explanation or implicitly by analogy to speak with minimum pitch variation and were subjected to psychological stress using the modified TSST. Acoustic correlates of pitch height (mean fundamental frequency) and pitch variation (standard deviation of fundamental frequency) significantly increased in experiment 1 when participants delivered a speech under modified TSST condition. In experiment 2, explicitly instructed participants were unable to maintain minimum pitch variation under psychological pressure caused by the modified TSST, whereas analogy-instructed participants maintained minimal pitch variation. The findings are consistent with existing evidence that analogy instructions may result in characteristics of implicit motor learning, such as greater stability of performance under pressure. Analogy instructions may therefore benefit speech motor performance and might provide a useful clinical tool for treatment of speech-disordered populations.

The use of analogy in speech motor performance

Abstract The acoustic correlates of pitch variation were examined in 40 participants who received analogy instructions or explicit instructions that required them to modulate their intonation during speech production. First, using focus group methodology, professional speech-language pathologists were asked to identify analogies that best described minimum pitch variation (monotone), moderate pitch variation (normal intonation), and maximum pitch variation (exaggerated intonation) in speech. The focus group established that an appropriate pitch variation metaphor may be related to imagery of “waves at sea”, with minimum pitch variation represented by a flat calm sea, moderate pitch variation represented by a moderate sea, and maximum pitch variation represented by a choppy sea. Forty adult participants without speech impairments were asked to read aloud a standard paragraph using their habitual pitch variation (control condition). They were then allocated randomly to an analogy or an explicit instruction group and were asked to read aloud different paragraphs with minimum, moderate, or maximum pitch variations. Results revealed that acoustic correlates of pitch variation (standard deviation of fundamental frequency, SDF0) were not different for the control condition, or moderate and maximum pitch variation conditions in the two groups. However, the analogy instruction was significantly more effective than the explicit instruction for inducing minimum pitch variation. Analysis of participants in each group who showed higher than normal pitch variation in the control condition (>.5 SD above the group SDF0) revealed that the analogy instruction was more effective than the explicit instruction in the minimum variation condition. It was concluded that analogy instructions may be a useful tool in speech rehabilitation.

Examining motor learning in older adults using analogy instruction

Objective: Previous studies have reported that analogy promotes stable motor performance under cognitively demanding situations such as stress and fatigue. However, it is unclear whether analogy is useful for motor learning among older adults, or whether the benefits of motor learning by analogy can be generalized to older adults. The present study examined these questions. Methods and design: Groups of young and older table tennis novices learnt to perform a forehand topspin stroke in table tennis, receiving either analogy instruction or a set of explicit instructions. Afterwards, participants were asked to perform a motor task in three testing situations: dual‐task, immediate retention and skill consolidation. Motor performance was assessed using a validated scoring system. Results: Motor performance induced by analogy instruction was comparable to that induced by explicit instruction in both young and older adults. In addition, similar to young adults, the older analogy‐instructed participants demonstrated more robust motor performance than their explicitly instructed counterparts in dual‐task, immediate retention and skill consolidation testing situations. Conclusions: Analogy instruction aided older adults in acquiring new motor skills, and the benefits of analogy to reduce the cognitive demand of motor learning can be generalized to the older population. HighlightsWe examine the feasibility of analogy instruction in motor learning by older adults.We compare the effectiveness of analogy instruction in motor learning between older adults and young adults.Analogy instruction is effective for motor learning by older adults.Analogy instructed motor skill is more durable than explicitly instructed motor skill in both young and older adults.Fewer working memory resources may be required to process analogy instructions than explicit instructions.

Children's conscious control propensity moderates the role of attentional focus in motor skill acquisition

Abstract We investigated whether conscious control propensity moderates the role of attentional focus in motor skill acquisition of children. The propensity for conscious control of elementary school children was determined using an adapted version of the Movement Specific Reinvestment Scale (MSRS) (Masters, Eves, & Maxwell, 2005). They then practiced a darts task using an internal (focus on limb movements), external (focus on the target) or non‐specific focus of attention and performed a transfer test (i.e. 20% increase in distance). After one week, they engaged in a delayed retention test. Results were analyzed using ANOVA with repeated measures. During the initial practice phase, no significant effects were found. However, during the transfer test and delayed retention interactions between conscious control propensity and group emerged, such that children with a high conscious control propensity performed better in the internal focus group and ones with a low propensity did better in the external focus group. These findings suggest childrens motor skill acquisition is most effective when instructions align with their personality predispositions. HighlightsRelationship between conscious control propensity and attentional focus in motor acquisition in children is examined.Children with different conscious control propensities in acquiring a motor task with different attentional focus instructions are compared.Children with a high conscious control propensity performed better in a motor task with the internal focus instruction.Children with a low conscious control propensity performed better in a motor task with the external focus instruction.Attentional focus instructions should be align with personality of learners to yield a desirable motor learning outcomes.

A new statistical model for the Day Reconstruction Method

The Day Reconstruction Method (DRM) is a method to measure ones subjective affective status by soliciting information in a questionnaire about the previous days activities. We developed a new model to examine the association of daily activities, the friendliness of interacting partners, and time‐of‐day on net affect scores among 10,377 adults participating in the World Health Organizations Study on global ageing and adult health (SAGE). A multilevel regression was fitted and the time‐of‐day effect was modeled by restricted cubic spline. The net affect score was a serpentine curve; stable from 4 a.m. to 6 a.m., increased from 7 a.m. to 12 noon, and became stable onwards. Participants had the highest net affect scores during religious activities (0.48, 95% confidence interval [CI]: 0.44, 0.53), and they enjoyed leisure activities, exercising, and household responsibilities more than work. Compared with events that lacked interacting partners, activities with very friendly interacting partners were associated with higher net affect scores (0.21, 95% CI: 0.19, 0.22), but events with slightly friendly interacting partners, slightly irritating or very irritating partners had lower net affect scores. To conclude, researchers using DRM for assessing well‐being status across time should include the type of activities and the friendliness of the interacting partners.

Analogy motor learning by young children: a study of rope skipping

Abstract Research in psychology suggests that provision of an instruction by analogy can enhance acquisition and understanding of knowledge. Limited research has been conducted to test this proposition in motor learning by children. The purpose of the present study was to examine the feasibility of analogy instructions in motor skill acquisition by children. Thirty-two children were randomly assigned to one of the two instruction protocols: analogy and explicit instruction protocols for a two-week rope skipping training. Each participant completed a pretest (Lesson 1), three practice sessions (Lesson 2–4), a posttest and a secondary task test (Lesson 5). Children in the analogy protocol displayed better rope skip performance than those in the explicit instruction protocol (p < .001). Moreover, a cognitive secondary task test indicated that children in the analogy protocol performed more effectively, whereas children in the explicit protocol displayed decrements in performance. Analogy learning may aid children to acquire complex motor skills, and have potential benefits related to reduced cognitive processing requirements.

The quality of the reported sample size calculations in randomized controlled trials indexed in PubMed

BACKGROUND There are limited data on the quality of reporting of information essential for replication of the calculation as well as the accuracy of the sample size calculation. We examine the current quality of reporting of the sample size calculation in randomized controlled trials (RCTs) published in PubMed and to examine the variation in reporting across study design, study characteristics, and journal impact factor. We also reviewed the targeted sample size reported in trial registries. METHODS We reviewed and analyzed all RCTs published in December 2014 with journals indexed in PubMed. The 2014 Impact Factors for the journals were used as proxies for their quality. RESULTS Of the 451 analyzed papers, 58.1% reported an a priori sample size calculation. Nearly all papers provided the level of significance (97.7%) and desired power (96.6%), and most of the papers reported the minimum clinically important effect size (73.3%). The median (inter-quartile range) of the percentage difference of the reported and calculated sample size calculation was 0.0% (IQR -4.6%;3.0%). The accuracy of the reported sample size was better for studies published in journals that endorsed the CONSORT statement and journals with an impact factor. A total of 98 papers had provided targeted sample size on trial registries and about two-third of these papers (n=62) reported sample size calculation, but only 25 (40.3%) had no discrepancy with the reported number in the trial registries. CONCLUSIONS The reporting of the sample size calculation in RCTs published in PubMed-indexed journals and trial registries were poor. The CONSORT statement should be more widely endorsed.

Study protocol for a randomised controlled trial examining the association between physical activity and sleep quality in children with autism spectrum disorder based on the melatonin-mediated mechanism model

Introduction Sleep disturbance is commonly observed in children with autism spectrum disorders (ASD). Disturbed sleep may exacerbate the core symptoms of ASD. Behavioural interventions and supplemental melatonin medication are traditionally used to improve sleep quality, but poor sustainability of behavioural intervention effects and use of other medications that metabolise melatonin may degrade the effectiveness of these interventions. However, several studies have suggested that physical activity may provide an effective intervention for treating sleep disturbance in typically developing children. Thus, we designed a study to examine whether such an intervention is also effective in children with ASD. We present a protocol (4 December 2017) for a jogging intervention with a parallel and two-group randomised controlled trial design using objective actigraphic assessment and 6-sulfatoxymelatonin measurement to determine whether a 12-week physical activity intervention elicits changes in sleep quality or melatonin levels. Methods and analysis All eligible participants will be randomly allocated to either a jogging intervention group or a control group receiving standard care. Changes in sleep quality will be monitored through actigraphic assessment and parental sleep logs. All participants will also be instructed to collect a 24-hour urine sample. 6-sulfatoxymelatonin, a creatinine-adjusted morning urinary melatonin representative of the participant’s melatonin levels, will be measured from the sample. All assessments will be carried out before the intervention (T1), immediately after the 12-week intervention or regular treatment (T2), 6 weeks after the intervention (T3) and 12 weeks after the intervention (T4) to examine the sustainability of the intervention effects. The first enrolment began in February 2018. Ethics and dissemination Ethical approval was obtained through the Human Research Ethics Committee, Education University of Hong Kong. The results of this trial will be submitted for publication in peer-reviewed journals. Trial registration number NCT03348982.

Diagnosis checking of statistical analysis in RCTs indexed in PubMed

Statistical analysis is essential for reporting of the results of randomized controlled trials (RCTs), as well as evaluating their effectiveness. However, the validity of a statistical analysis also depends on whether the assumptions of that analysis are valid.