Freya MacMillan

Proprioception and muscle torque deficits in children with hypermobility syndrome

OBJECTIVES Sensorimotor deficits such as impaired joint proprioception and muscle weakness have been found in association with hypermobility syndrome (HMS) in adults. HMS is more common in children than adults, yet such deficits have not been adequately investigated in paediatric populations. It is therefore uncertain as to what sensorimotor deficits are present in children with HMS. This study investigated knee joint proprioception and muscle torque in healthy children and those with HMS. METHODS Thirty-seven healthy children (mean age +/- s.d. = 11.5 +/- 2.6 yrs) and 29 children with HMS (mean age +/- s.d. = 11.9 +/- 1.8 yrs) participated in this study. Knee joint kinaesthesia (JK) and joint position sense (JPS) were measured, with the absolute angular error (AAE) calculated as the absolute difference between the target and perceived angles. Knee extensor and flexor muscle torque was assessed and normalized to body mass. Mann-Whitney U-tests were performed to compare JK, JPS and muscle torque between the two groups. RESULTS Children with HMS had significantly poorer JK and JPS compared with the controls (both P < 0.001). Knee extensor and flexor muscle torque was also significantly reduced (both P < 0.001) in children with HMS compared with their healthy counterparts. CONCLUSIONS The findings of this study demonstrated that knee joint proprioception was impaired in children with HMS. They also had weaker knee extensor and flexor muscles than healthy controls. Clinicians should be aware of these identified deficits in children with HMS, and a programme of proprioceptive training and muscle strengthening may be indicated.

Increasing older adults’ walking through primary care: results of a pilot randomized controlled trial

Background. Physical activity can positively influence health for older adults. Primary care is a good setting for physical activity promotion. Objective. To assess the feasibility of a pedometer-based walking programme in combination with physical activity consultations. Methods. Design: Two-arm (intervention/control) 12-week randomized controlled trial with a 12-week follow-up for the intervention group. Setting: One general practice in Glasgow, UK. Participants: Participants were aged ≥65 years. The intervention group received two 30-minute physical activity consultations from a trained practice nurse, a pedometer and a walking programme. The control group continued as normal for 12 weeks and then received the intervention. Both groups were followed up at 12 and 24 weeks. Outcome measures: Step counts were measured by sealed pedometers and an activPALTM monitor. Psychosocial variables were assessed and focus groups conducted. Results. The response rate was 66% (187/284), and 90% of those randomized (37/41) completed the study. Qualitative data suggested that the pedometer and nurse were helpful to the intervention. Step counts (activPAL) showed a significant increase from baseline to week 12 for the intervention group, while the control group showed no change. Between weeks 12 and 24, step counts were maintained in the intervention group, and increased for the control group after receiving the intervention. The intervention was associated with improved quality of life and reduced sedentary time. Conclusions. It is feasible to recruit and retain older adults from primary care and help them increase walking. A larger trial is necessary to confirm findings and consider cost-effectiveness.

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.

Can physical activity interventions for adults with type 2 diabetes be translated into practice settings? A systematic review using the RE-AIM framework

ABSTRACTDespite the strong evidence base for the efficacy of physical activity in the management of type 2 diabetes, a limited number of physical activity interventions have been translated and evaluated in everyday practice. This systematic review aimed to report the findings of studies in which an intervention, containing physical activity promotion as a component, has been delivered within routine diabetes care. A comprehensive search was conducted for articles reporting process data relating to components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and/or Maintenance) framework. Twelve studies met the selection criteria. Of the nine studies which measured physical activity as an outcome, eight reported an increase in physical activity levels, five of which were significant. Tailoring recruitment, resources and intervention delivery to the target population played a positive role, in addition to the use of external organisations and staff training. Many interventions were of short duration and lacked long-term follow-up data. Findings revealed limited and inconsistent reporting of useful process data.

Vigorous intensity exercise for glycemic control in patients with type 1 diabetes.

Regular physical activity has substantial health benefits in persons with type 1 diabetes, including reduced risk of complications and cardiovascular mortality as well as improved self-rated quality of life. Despite these benefits, individuals with type 1 diabetes are often less active than their peers without diabetes. When factors such as time constraints, work pressure and environmental conditions are often cited as barriers to physical activity in the general population, 2 additional major factors may also explain the low rates of physical activity in young people with type 1 diabetes: (1) fear of hypoglycemia both during and after (particularly overnight) exercise and (2) a lack of empiric evidence for the efficacy of physical activity for achieving optimal glycemic control. A number of acute exercise trials recently showed that the inclusion of vigorous intensity physical activity in conventional moderate intensity (i.e. walking and light cycling) exercise sessions may overcome these barriers. No studies have tested the efficacy of high-intensity physical activity on glycemic control (A1C) or post-exercise hypoglycemia in a randomized controlled trial. This article summarizes the literature related to the role of physical activity for the management of blood glucose levels in individuals with type 1 diabetes and provides a rationale for the need of a randomized controlled trial examining the effects of vigorous-intensity physical activity on blood glucose control.

Physical Activity and School Engagement in Youth: A Systematic Review and Meta-Analysis.

Physical activity is associated with numerous health benefits in youth; however, these benefits could extend further than health, into education. Our aim was to systematically review and combine in meta-analyses evidence concerning the association between physical activity and the dimensions of school engagement, including behavior (e.g., time-on-task), emotions (e.g., lesson enjoyment), and cognition (e.g., self-regulated learning). We conducted meta-analyses using structural equation modeling on results from 38 studies. Overall, physical activity had a small, positive association with school engagement (d = .28, I2 = .86), 95% confidence interval [.12, .46]. This association was moderated by study design, with significant associations shown in randomized controlled trials but not in studies employing other designs. Risk of bias was also a significant effect moderator, as studies with a low risk of bias showed significant associations but not high risk of bias studies. Altogether, these results suggest that physical activity could improve school engagement.

Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndrome

BACKGROUND Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS. AIM To investigate the between-days repeatability of joint proprioception and muscle torque in these groups. METHODS Twenty children (10 healthy and 10 with HMS), aged eight to 15 years, were assessed on two separate occasions (one week apart) for joint kinaesthesia (JK), joint position sense (JPS), and the extensor and knee flexor muscle torque of the knee. JK was measured using threshold to detection of passive movement. JPS was measured using the absolute angular error (AAE; the absolute difference between the target and perceived angles). Knee extensor and flexor muscle torque was normalized to body weight. RESULTS Intra-class correlation coefficients (ICC) for JK, extensor and flexor muscle torque were excellent in both groups (range 0.83 to 0.98). However, ICC values for JPS tests were poor to moderate in the two groups (range 0.18 to 0.56). 95% limits of agreement (LOA) were narrow in both cohorts for JK and muscle torque (indicating low systematic error) but wide for the JPS tests. 95% LOA also demonstrated that the measuring instruments used in this study had low between-days systematic error. CONCLUSIONS Based on ICC and 95% LOA, the repeatability of JK and muscle torque measurements was excellent in both healthy children and those with HMS. The JPS test can only be assessed with poor to moderate repeatability. The use of the JPS test in these children should be undertaken with caution.

Supporting participation in physical education at school in youth with type 1 diabetes : perceptions of teachers, youth with type 1 diabetes, parents and diabetes professionals

It is not clear how best to support youth with type 1 diabetes to participate in physical education (PE) at school. The aim of this study was to explore perceptions of facilitators and barriers to PE in youth with type 1 diabetes and to determine how schools can help these individuals to be physically active. Interviews and focus groups were conducted with youth with type 1 diabetes aged 7–9 (n = 8) and 12–14 (n = 8) years with type 1 diabetes, their parents (n = 16), diabetes professionals (n = 9) and schoolteachers (n = 37). Data were thematically analysed. Four main themes were identified relating to support needs of youth with diabetes in school in general and specifically in PE lessons: (1) differences between primary and secondary schools; (2) areas requiring address in all schools; (3) what teachers can do to help accommodate youth with type 1 diabetes; and (4) what schools can do to help accommodate youth with type 1 diabetes. Diabetes support varied across schools. Primary schools in particular could improve communication between schools and primary specialist PE teachers regarding youth with type 1 diabetes to aid participation in PE. Diabetes knowledge was limited among all teachers. Participants felt that diabetes could be used as an excuse to sit out of PE and that teachers’ fears could facilitate this. Improved and consistent diabetes management training and guidance on the responsibilities of teachers is necessary. Better communication between schools, teachers, parents, youth with type 1 diabetes and diabetes professionals is also required. The findings have helped produce suggestions for practice and research on how to improve support for youth with type 1 diabetes in schools in general and specifically in PE lessons.

Using programme theory to strengthen research protocol and intervention design within an RCT of a walking intervention

This article provides a practical example of how to apply a theory-driven approach to research intervention and protocol design. It illustrates how reflection on both intervention theory and programme theory can inform and refine the: implementation of the intervention; research design; specification of research questions and tools; and, identify the contribution each research stage makes in the accumulation of policy-relevant learning. The article presents the logic models, associated theory and learning from the development of a pilot randomized control trial/feasibility study of a walking intervention targeting older adults.

Building physical activity and sedentary behavior support into care for youth with type 1 diabetes: Patient, parent and diabetes professional perceptions

To explore stakeholders perceptions of physical activity (PA) and sedentary behaviour support in youth with type 1 diabetes (T1D), to aid intervention development.