David H. Saunders

Stroke: a randomized trial of exercise or relaxation.

OBJECTIVES: To determine the feasibility and effect of exercise training after stroke.

Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis

Context Time spent in sedentary behaviours (SB) is associated with poor health, irrespective of the level of physical activity. The aim of this study was to evaluate the effect of interventions which included SB as an outcome measure in adults. Methods Thirteen databases, including The Cochrane Library, MEDLINE and SPORTDiscus, trial registers and reference lists, were searched for randomised controlled trials until January 2014. Study selection, data extraction and quality assessment were performed independently. Primary outcomes included SB, proxy measures of SB and patterns of accumulation of SB. Secondary outcomes were cardiometabolic health, mental health and body composition. Intervention types were categorised as SB only, physical activity (PA) only, PA and SB or lifestyle interventions (PA/SB and diet). Results Of 8087 records, 51 studies met the inclusion criteria. Meta-analysis of 34/51 studies showed a reduction of 22 min/day in sedentary time in favour of the intervention group (95% CI −35 to −9 min/day, n=5868). Lifestyle interventions reduced SB by 24 min/day (95% CI −41 to −8 min/day, n=3981, moderate quality) and interventions focusing on SB only by 42 min/day (95% CI −79 to −5 min/day, n=62, low quality). There was no evidence of an effect of PA and combined PA/SB interventions on reducing sedentary time. Conclusions There was evidence that it is possible to intervene to reduce SB in adults. Lifestyle and SB only interventions may be promising approaches. More high quality research is needed to determine if SB interventions are sufficient to produce clinically meaningful and sustainable reductions in sedentary time.

Cardiorespiratory Fitness after Stroke: A Systematic Review:

Cardiorespiratory fitness programs are increasingly used in stroke rehabilitation. Maximal oxygen uptake is the gold standard measurement of cardiorespiratory fitness; however, no recent publications have collated evidence about maximal oxygen uptake levels following stroke. We therefore performed a systematic review of maximal oxygen uptake in stroke survivors, aiming to observe changes in levels over time, and associations with severity of stroke. We searched Medline and Embase until April 2011, and included cross-sectional studies, longitudinal studies, and baseline data from intervention trials. Studies had to recruit at least 10 stroke survivors, and report direct measurement of maximal/peak oxygen uptake. We then compared maximal oxygen uptake with published data from age and gender-matched controls. The search identified 3357 articles. Seventy-two full texts were retrieved, of which 41 met the inclusion criteria. Time since stroke ranged from 10 days to over seven-years. Peak oxygen uptake ranged from 8 to 22 ml/kg/min, which was 26–87% of that of healthy age- and gender-matched individuals. Stroke severity was mild in most studies. Three studies reported longitudinal changes; there was no clear evidence of change in peak oxygen uptake over time. Most studies recruited participants with mild stroke, and it is possible that cardiorespiratory fitness is even more impaired after severe stroke. Maximal oxygen uptake might have been overestimated, as less healthy and older stroke survivors may not tolerate maximal exercise testing. More studies are needed describing mechanisms of impaired cardiorespiratory fitness and longitudinal changes over time to inform the optimal ‘prescription’ of cardiorespiratory fitness programs for stroke survivors.

Physical Activity and Exercise After Stroke Review of Multiple Meaningful Benefits

Although stroke is now the fourth, not the third, most common cause of death in the United States,1 the burden of stroke has increased. Stroke is now the third (fifth in 1990) largest cause of disability-adjusted life years in the developed world.2 Around half of those who do survive stroke are permanently disabled.3 There are a wide range of poststroke problems, including movement and function, mobility, balance, cognition, attention, memory, pain, sensation, perception, emotional problems, and psychological issues. The physical and psychosocial consequences of stroke are complex and long term. Longer-term problems are reported by stroke survivors 1 to 5 years post stroke. The most common include mobility (58%), fatigue (52%), concentration (45%), and falls (44%). Around half of those surviving report that their needs relating to these problems are not being met and this is higher among those who are more disabled.4 Addressing the long-term needs of people during life after stroke is a priority from both a service provision and a research perspective—many uncertainties remain on how best to address long-term post stroke problems. The aim of this review was to assess whether the multiple effects of exercise and physical activity correspond with the outcomes considered most important, by patients and carers, for life after stroke. Physical activity is defined as all human movement produced by the action of skeletal muscle that substantially increases energy expenditure. Physical activity is essential for improving and maintaining physical fitness. Exercise is a subset of physical activity that is planned, structured, and repetitive and is performed deliberately with the intention of improving physical fitness.5 Key indices of physical fitness include cardiorespiratory fitness and muscle strength and power; these determine our capacity to perform and tolerate physical activity. Physical fitness is impaired after stroke. Cardiorespiratory fitness (![Graphic][1] peak) is … [1]: /embed/inline-graphic-1.gif

The feasibility and efficacy of elastic resistance training for improving the velocity of the Olympic Taekwondo turning kick

Jakubiak, N and Saunders, DH. The feasibility and efficacy of elastic resistance training for improving the velocity of the Olympic Taekwondo turning kick. J Strength Cond Res 22: 1194-1197, 2008-In the Olympic sport of Taekwondo (TKD), elastic resistance training (ERT) is often used with the aim of improving kicking performance; however, the efficacy of this has never been examined experimentally. The purpose of this study was to investigate the effect of a TKD-specific, progressive ERT protocol on the velocity of the TKD turning kick. Twelve TKD athletes were randomly allocated to receive either a 4-week intervention of ERT plus usual TKD training (n = 6) or to a control group receiving 4 weeks of usual TKD training only. Kicking velocity from initiation to impact on a target was measured pre- and postintervention using a digital timer and two pressure switches. Kicking velocity improved significantly (by 7%) in the ERT group, whereas there was no improvement in the control group (p < 0.05). These data suggest that ERT is a feasible means of sport-specific resistance training for TKD and that TKD performance could benefit from an improved velocity of the attacking turning kick.

Is fatigue after stroke associated with physical deconditioning? A cross-sectional study in ambulatory stroke survivors

OBJECTIVE To determine the relationship between a measure of fatigue and 2 indices of physical fitness, lower limb extensor power (LLEP) and walking economy. DESIGN This was a cross-sectional study of patients with stroke. Fatigue was assessed by vitality (VIT) score of the Medical Outcomes Study 36-Item Short-Form Health Survey version 2 (SF-36v2). LLEP of the unaffected limb was measured using a lower leg extensor power rig. Walking economy was calculated by measuring oxygen consumption (mL·kg(-1)·m(-1)) during walking at a comfortable speed. Bivariate analyses were performed relating VIT to indices of fitness. Multiple regression analyses were also performed and included age, sex, and either SF-36v2 emotional role function or SF-36v2 mental health, as predictors of VIT. SETTING Community setting. PARTICIPANTS Participants (N=66; 36 men; mean age ± SD, 71.0±9.9y) were all community dwelling, had survived a stroke, were able to walk independently, and had completed their stroke rehabilitation. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES The main outcome measure is SF-36v2 (VIT), with walking economy and LLEP of the limb unaffected by the stroke being independent variables. RESULTS Walking economy was not significantly related to VIT (R=-.024, P=.86, n=60). LLEP was positively related to VIT in bivariate analysis (R=.38, P=.003, n=58). After controlling for age, sex, and SF-36 emotional role function (or SF-36v2 mental health if the extreme outlier was excluded), LLEP remained a significant predictor of VIT. CONCLUSIONS We found an association between fatigue and reduced LLEP. If a larger study confirms these findings, it would support the need to develop and test interventions to increase LLEP as a treatment for fatigue after stroke.

A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes : study characteristics, intervention design, and efficacy

To systematically review physical activity and/or sedentary behavior intervention studies for youth with type 1 diabetes.

Physical Fitness Training for Patients With Stroke: An Updated Review

Graeme J. Hankey, MD, FRACP, FRCP Section Editor Physical fitness is low after stroke and this may cause or exacerbate some common poststroke problems, including disability. It is not known whether improving physical fitness after stroke reduces disability or dependency. The primary aims of the review were to determine whether physical fitness training (cardiorespiratory and/or strength) after stroke reduces death, dependence, and disability at the end of intervention or follow-up. The secondary aims were to determine the effects of fitness training on physical fitness, mobility, physical function, health status and quality of life, mood, and the incidence of adverse events. ### Search Strategy We searched the Cochrane Stroke Group Trials Register (last searched March 2009), the Cochrane Central Register of Controlled Trials (Cochrane Library, 2007, Issue 1), MEDLINE (1966 to March …

Effect of caffeine ingestion on maximal voluntary contraction strength in upper and lower-body muscle groups

Abstract Timmins, TD and Saunders, DH. Effect of caffeine ingestion on maximal voluntary contraction strength in upper- and lower-body muscle groups. J Strength Cond Res 28(11): 3244–3249, 2014—The effect of caffeine on strength-power performance is equivocal, especially with regard to maximal voluntary contraction (MVC) strength. This is partly related to differences in upper- and lower-body musculature. However, there is no evidence to suggest whether this is a product of muscle group location, muscle group size, or both. Consequently, the primary aim of this study was to establish whether the effect of caffeine ingestion on MVC strength in upper- and lower-body muscle groups is significantly different, and if so, to determine whether this is a product of muscle group size. In a randomized, subject-blind crossover manner, 16 resistance-trained men (estimated caffeine intake [mean ± SD] 95.4 ± 80.0 mg·d−1) received either 6 mg·kg−1 of caffeine (CAF) or a placebo (PLA). Isokinetic peak torque of the knee extensors, ankle plantar flexors, elbow flexors and wrist flexors were measured at an angular velocity of 60°·s−1. Statistical analyses revealed a significant increase in isokinetic peak torque from PLA to CAF (p = 0.011) and a significant difference in isokinetic peak torque between muscle groups (p < 0.001). However, there was no significant treatment × muscle group interaction (p = 0.056). Nonetheless, the %improvement in isokinetic peak torque with caffeine increased with muscle group size. In conclusion, a moderate dose of caffeine improves MVC strength in resistance-trained men regardless of muscle group location, whereas the influence of muscle group size remains uncertain. This research may be useful for competitive and recreational athletes aiming to increase strength-power performance.

Longitudinal Associations Between Childhood Obesity and Academic Achievement: Systematic Review with Focus Group Data

PurposeThe purposes of this study were to review the evidence on longitudinal associations between child and adolescent obesity and academic achievement and to provide perceptions of adolescents with obesity and their parents on this topic.Recent FindingsSynthesis of 31 studies (from 17 cohorts) suggested that relationships between obesity and academic achievement are not well established, except for adolescent girls’ maths attainment, potentially mediated by both weight-related bullying and executive cognitive functions. Focus groups with adolescent girls with obesity confirmed experiences of psychosocial distress at school particularly during Physical Education. Adolescents perceived that obesity was not related to academic achievement directly, but by their attitude to school.SummaryInterventions are warranted to promote psychosocial wellbeing and cognitive abilities linked to academic achievement in adolescent girls with obesity. Physical Education should be a positive experience for children and adolescents with obesity.