Carer-supported home-based exercises designed to target physical activity levels and functional mobility after stroke: a scoping review.

PURPOSE: To explore the literature on carer-supported home-based exercise programs for people after stroke, as a form of physical activity. The review focus was to examine the training carers receive, the content of programs, and investigate the physical activity levels and functional mobility of people after stroke. MATERIALS AND METHODS: A scoping review was undertaken, guided by Joanna Briggs Institute methodology. The concept of home-based carer-supported exercise, in people after stroke, was searched across five databases. Outcomes of interest were physical activity levels and functional mobility. RESULTS: We screened 2285 references and included 10 studies: one systematic review, five randomised controlled trials, one trial with non-equivalent control, and four uncontrolled studies. Carer training ranged from one to twelve sessions. Exercise interventions commonly including walking, other whole body functional exercises and balance activities. In eight studies interventions were in addition to standard care. Five studies reported significant between-group differences for functional mobility, favouring the intervention. One study reported physical activity levels. CONCLUSION: There was large variation in the volume and content of training provided to carers. Physical activity levels were infrequently objectively reported. Future studies should include greater details on their protocols to allow for replication and implementation into clinical practice.

Carer-supported home-based exercises may improve functional mobility once home after a stroke.The optimal length, content, and model of delivery of carer training, so carers can provide better targeted home-based exercise support to people after stroke, is not known.Better monitoring of participation in home-based exercise and reporting of short and long-term physical activity is needed.

Omega-3 dietary Fatty Acid status of healthy older adults in Tasmania, Australia: an observational study.

OBJECTIVES: To determine the dietary and supplement intake of omega-3 (n-3) polyunsaturated fatty acids (PUFA) of older Tasmanian adults; their plasma n-3 PUFA status and the relationship between n-3 PUFA intake and plasma status. DESIGN: Cross-sectional study. SETTING: Launceston and surrounding regions, Tasmania, Australia. PARTICIPANTS: Seventy-three community-dwelling older adults: 23 men aged 70 ± 6.1 years and 50 women aged 70 ± 6.7 years. MEASUREMENTS: A validated, semi-quantitative food frequency questionnaire estimated dietary PUFA intake. The plasma phospholipid fraction of venous blood samples was analysed for fatty acid content. Anthropometric data was recorded. RESULTS: Thirty-five participants (48%) regularly ingested a fish oil supplement. Their plasma n-3 PUFA profile contained significantly more eicosapentaenoic acid (EPA) (odds ratio 3.14; 95% CI 1.37% to 7.30%; p<0.05) and docosahexaenoic acid (DHA) (odds ratio 2.64; 95% CI 1.16% to 6.01%; p<0.05) than non-supplement users. Fish and meat were the main dietary sources of n-3 PUFAs. Participants most commonly consumed fish 3-4 times per week. Significant associations of dietary α-linolenic acid (ALA), EPA, docosapentaenoic acid (DPA) and DHA with plasma n-3 PUFAs were noted but not always between dietary and plasma counterparts. CONCLUSION: Without the use of fish oil supplements, most study participants were unable to meet the recommended daily intake of 0.5g EPA and DHA combined; however, the plasma n-3 PUFA profile of non-supplement-users was still robust compared to other Australian and overseas studies.

Persistent elevation of central pulse pressure during postural stress in patients with type 2 diabetes mellitus.

An abnormal increase or decrease in blood pressure (BP) in response to postural stress is associated with increased risk of developing hypertension and stroke. However, the haemodynamic responses contributing to changes in central BP with postural stress are not well characterised. We aimed to determine this in controls compared to patients with type 2 diabetes mellitus (T2DM), whom we hypothesised would have an abnormal postural response. 41 participants (20 control, 21 T2DM) underwent measurement of brachial and central BP (by radial tonometry), with simultaneous bioimpedance cardiography (to determine stroke volume (SV) and cardiac output (CO)) and heart rate variability in seated and standing postures. Systemic vascular resistance (SVR; mean arterial pressure/CO), and arterial elastance (EA; end systolic pressure/SV) were calculated. Postural changes were defined as seated minus standing values. Central pulse pressure (PP) was higher in patients with T2DM and did not change from seated-to-standing positions, whereas there was a significant decrease upon standing in controls (P<0.05). The change in central systolic BP (SBP) correlated with change in SVR and EA in controls (r=0.67 and 0.68, P<0.05, respectively), but not in patients with T2DM (r=-0.05 and r=0.03, P>0.05, respectively). SV was the only significant correlate of change in central SBP in T2DM patients (r=0.62, P<0.05) and this was not observed in controls (r=-0.08 P>0.05). We conclude that central haemodynamic responses to postural stress are altered in patients with T2DM and result in persistent elevation of central PP while standing. This may contribute to increased cardiovascular risk associated with T2DM.

Postprandial platelet aggregation: effects of different meals and glycemic index.

BACKGROUND/OBJECTIVES: Hyperglycaemia is associated with increased platelet aggregation that increases the risk of thrombosis in people with type-2 diabetes and cardiovascular disease. Low glycemic index (GI) meals high in carbohydrate or moderately high in protein have been shown to acutely reduce postprandial excursions of plasma glucose and insulin compared with high carbohydrate high GI meals. However, it is not known whether these differences in glucose and insulin profile also impact on postprandial platelet aggregation. This study aimed to investigate the acute effects of three iso-energetic meals, on measures of postprandial platelet aggregation, in healthy individuals. SUBJECTS/METHODS: A randomised cross-over study compared the acute effects of a high GI high carbohydrate (HGI-HC), a low GI high carbohydrate (LGI-HC) and a low GI moderately high in protein and fat (LGI-MPF) meal on postprandial platelet aggregation, glucose, insulin and triglyceride concentrations. Comparisons were made at fasting, 60 and 120 min postprandially. RESULTS: A total of 32 volunteers (mean ± s.d.; age 59.9 ± 11.7 years, BMI 27.1 ± 3.7 kg/m(2)) participated in the study. Results showed significant reductions in maximum platelet aggregation postprandially with nonsignificant differences (all P > 0.29) between the three meals. Glucose and insulin were significantly (both P < 0.001) higher at 60 min postprandially on the HGI-HC meal compared with both LGI-HC and LGI-MPF meals. Triglycerides were not significantly different (all P > 0.25) between the three test meals. CONCLUSION: In healthy individuals platelet aggregation is reduced postprandially but this decrease is similar between meals of different GI that induce different glucose and insulin responses.

The effect of 4-week chilli supplementation on metabolic and arterial function in humans.

OBJECTIVE: To investigate the effects of regular chilli ingestion on some indicators of metabolic and vascular function. DESIGN: A randomized cross-over dietary intervention study. SETTING: Launceston, Australia. SUBJECTS: Healthy free-living individuals. INTERVENTION: Thirty-six participants (22 women and 14 men), aged 46+/-12 (mean+/-s.d.) years; BMI 26.4+/-4.8 kg/m(2), consumed 30 g/day of a chilli blend (55% cayenne chilli) with their normal diet (chilli diet), and a bland diet (chilli-free) for 4 weeks each. Metabolic and vascular parameters, including plasma glucose, serum lipids and lipoproteins, insulin, basal metabolic rate, blood pressure, heart rate, augmentation index (AIx; an indicator of arterial stiffness), and subendocardial-viability ratio (SEVR; a measure of myocardial perfusion), were measured at the end of each diet. In a sub-study, during week 3 of each dietary period, the vascular responses of 15 subjects to glyceryl-trinitrate (GTN) and salbutamol were also studied. RESULTS: For the whole group, there were no significant differences between any of the measured parameters when compared at the end of the two dietary periods. When analysed separately, men had a lower resting heart rate (P=0.02) and higher SEVR (P=0.05) at the end of the chilli diet than the bland diet. In the sub-study, baseline AIx on the chilli diet was lower (P<0.001) than on the bland diet, but there was no difference in the effects of GTN and salbutamol between the two diets. CONCLUSION: Four weeks of regular chilli consumption has no obvious beneficial or harmful effects on metabolic parameters but may reduce resting heart rate and increase effective myocardial perfusion pressure time in men.

Dietary supplementation with chickpeas for at least 5 weeks results in small but significant reductions in serum total and low-density lipoprotein cholesterols in adult women and men.

AIM: To compare the effects of a chickpea-supplemented diet and those of a wheat-supplemented diet on human serum lipids and lipoproteins. METHODS: Forty-seven free-living adults participated in a randomized crossover weight maintenance dietary intervention involving two dietary periods, chickpea-supplemented and wheat-supplemented diets, each of at least 5 weeks duration. RESULTS: The serum total cholesterol and low-density lipoprotein cholesterol levels were significantly lower (both p < 0.01) by 3.9 and 4.6%, respectively, after the chickpea-supplemented diet as compared with the wheat-supplemented diet. Protein (0.9% of energy, p = 0.01) and monounsaturated fat (3.3% of total fat, p < 0.001) intakes were slightly but significantly lower and the carbohydrate intake significantly higher (1.7% of energy, p < 0.001) on the chickpea-supplemented diet as compared with the wheat-supplemented diet. Multivariate analyses suggested that the differences in serum lipids were mainly due to small differences in polyunsaturated fatty acid and dietary fibre contents between the two intervention diets. CONCLUSIONS: Inclusion of chickpeas in an intervention diet results in lower serum total and low-density lipoprotein cholesterol levels as compared with a wheat-supplemented diet.

Effects of a high monounsaturated fat, tomato-rich diet on serum levels of lycopene.

OBJECTIVE: To compare the effect of a modified fat, monounsaturated-fat-enriched diet and a high-carbohydrate low-fat diet with high lycopene content on the serum concentration of lycopene and other carotenoids. DESIGN: A randomised crossover dietary intervention study. SETTING: Melbourne, Australia--Healthy free-living men. SUBJECTS: A total of 13 healthy males between the age of 20 and 70 y, recruited via advertisements in newspapers and university newsletter. INTERVENTION: A randomised dietary intervention with two diets of 14 days each. The two diets were--(1) high-fat monounsaturated-fat-enriched (MUFA) and (2) high-carbohydrate low-fat (HCLF). Both the diets contained the same basic foods and a controlled carotenoid content high in lycopene. RESULTS: A significant increase in serum total lycopene occurred, by 126% on the MUFA diet (P <0.001) and 108% on the HCLF diet (P=0.001). A reduction in serum cryptoxanthin (27% on MUFA diet and 25% on HCLF) and alpha-carotene (43% on the MUFA diet and 25% on the HCLF diet) was observed. No change was observed for the other carotenoids. Comparing the end of the two diets, no statistically significant difference was observed for lycopene or the other carotenoids. CONCLUSION: In all, 15% of energy from fat or 38% of energy from fat (predominantly monounsaturated fat) in the diet does not have a significant differential effect on serum lycopene. SPONSORSHIP: The study was partially funded by the Grains Research Development Corporation, Canberra and Meadow Lea Foods Ltd, Mascot, Australia. HJ Heinz, Melbourne, Australia provided the tomato products and some funds for their carotenoid analysis.