Physical activity promotion in persons with spinal cord injuries: Barriers and facilitators in low-resource communities.

Background: A spinal cord injury is a devastating and life-changing event that presents the affected individual with multiple challenges throughout life. Physical activity can help mitigate some of these challenges; however, in low-resource communities where opportunities for physical activity are scarce, these challenges are often exacerbated and multiple. Objective: This study aimed to identify the barriers and facilitators to physical activity, specifically in individuals with spinal cord injuries, in low-resourced communities. Methods: A total of 57 adults (> 20 years) with a spinal cord injury living in the Western Cape, South Africa completed the self-developed research questionnaire. Results: A total of 289 barriers and 290 facilitators were reported. The most frequently reported barriers were lack of transport (n = 35), impairment type (n = 32), lack of trained volunteers and appropriate programmes (n = 19 each) and lack of information received from therapists following discharge (n = 10). The most frequently reported facilitators were support from family (n = 38), the 'enjoyment' of physical activity and the fact that 'it made me feel good' (n = 37); safe and accessible facilities were reported by 25 participants and 12 participants reported that higher-quality programmes and better-trained staff would help them to be more physically active. Conclusion: Individuals with a spinal cord injury face many barriers in being physically active. Yet it is evident that people with spinal cord injuries in low-resourced communities are eager to participate and improve their health and physical function. However, this will only realise if practitioners reduce the barriers to access, provide relevant training to staff and volunteers, educate their patients about the importance of physical activity post discharge, and create tailored programmes in safe and accessible community facilities.

Pet-saúde interprofissionalidade: um relato de experiência durante a semana de campanha nacional da hanseníase em uma unidade básica de saúde, Belém, Pará / Education through work for an interprofessional health program: an experience report during the national leprosy campaign in a public service unity in Belém of Pará

A hanseníase é uma doença infectocontagiosa, transmissível, de notificação persistente, considerada uma questão de saúde pública no Brasil. Este estudo é um relato de experiência, que objetivou descrever a vivência de uma atividade extensionista, desenvolvida em uma Unidade Básica de Saúde (UBS), por acadêmicos dos Cursos de Enfermagem, Odontologia, Nutrição e Medicina, da Universidade Federal do Pará (UFPA). Dentro deste contexto, as atividades de promoção à saúde consistiram na elaboração e aplicação de instrumentos lúdicos e participação ativa dos graduandos na comunidade, em uma abordagem sobre a doença durante a semana do "janeiro roxo". Assim, a partir de uma atuação interprofissional, buscou-se reduzir o estigma social da doença, além de proporcionar uma reflexão aos estudantes do PET-saúde sobre a importância da informação preventiva, como agentes promotores de saúde, na prevenção, diagnóstico e tratamento da hanseníase.

Leprosy is an infectious, transmissible, persistent notifiable disease that has become a public health problem in Brazil. This study is an experience report that aimed to describe the experience of an extensionist activity, carried out in a Basic Health Unit (UBS), developed by nursing, dentistry, nutrition, and medicine students at the Federal University of Pará/UFPA. Given this, health promotion activities consisted of developing and applying playful instruments and active participation of undergraduate students in the community approaching the disease during the "Purple January" week. Thus, through an interprofessional action, to reduce the social stigma of the disease, besides providing a reflection to the PET-health students about the importance of preventive information, as health-promoting agents, in the prevention, diagnosis, and treatment of leprosy.

Characterisation of the responsive properties of two running-specific prosthetic models.

BACKGROUND: The need for information regarding running-specific prosthetic properties has previously been voiced. Such information is necessary to assist in athletes' prostheses selection. OBJECTIVES: This study aimed to describe the characteristics of two commercially available running-specific prostheses. STUDY DESIGN: The running-specific prostheses were tested (in an experimental setup) without the external interference of athlete performance variations. METHODS: Four stiffness categories of each running-specific prosthetic model (Xtend™ and Xtreme™) were tested at seven alignment setups and three drop masses (28, 38 and 48 kg). Results for peak ground reaction force (GRFpeak), contact time ( tc), flight time ( tf), reactive strength index (RSI) and maximal compression (Δ L) were determined during controlled dropping of running-specific prostheses onto a force platform with different masses attached to the experimental setup. RESULTS: No statistically significant differences were found between the different setups of the running-specific prostheses. Statistically significant differences were found between the two models for all outcome variables (GRFpeak, Xtend > Xtreme; tc, Xtreme > Xtend; tf, Xtreme > Xtend; RSI, Xtend > Xtreme; Δ L, Xtreme > Xtend; p < 0.05). CONCLUSION: These findings suggest that the Xtreme stores more elastic energy than the Xtend, leading to a greater performance response. The specific responsive features of blades could guide sprint athletes in their choice of running-specific prostheses. Clinical relevance Insights into the running-specific prosthesis (RSP) properties and an understanding of its responsive characteristics have implications for athletes' prosthetic choice. Physiologically and metabolically, a short sprint event (i.e. 100 m) places different demands on the athlete than a long sprint event (i.e. 400 m), and the RSP should match these performance demands.

"A More Equitable Society": The Politics of Global Fairness in Paralympic Sport.

The Paralympic Movement explicitly sets out to create a more equitable society and promote participation for all and fairness in disability sport. This is primarily achieved through the use of a range of interventions with less attention given to how economic factors may hinder access and achievement in Paralympic sport. We investigated how country-level economic variables influence the level of participation and achievement in the 2015 International Paralympic Committee (IPC) Athletics Championships held in Doha. We used multiple regression analysis to show how levels of participation and achievement in the Championships were significantly determined by economic factors independent of population size. Our data show that in spite of the ideals of inclusion and fairness within the Paralympic Movement and the considerable effort expended on the use of technologies to achieve this, economic factors continue to exert a statistically significant influence on both the level of participation and achievement of Paralympic athletes. LMICs participate at lower levels and achieve fewer medals when compared to HICs. These differences are particularly marked in events that have a high cost of participation. Our findings raise questions regarding the use of current technologies and the level to which they are able to truly disrupt the politics of global inequality in sport.

Obesidade abdominal e fatores associados em adultos atendidos em uma clínica escola / Abdominal obesity and associated factors among adults attending a university health center / Obesidad abdominal y factores asociados en adultos asistidos en una clínica escuela

Objetivo: Determinar a prevalência de obesidade abdominal e identificar associação entre fatores socioeconômicos e estilo de vida em adultos atendidos numa clínica escola em São Luís, Brasil. Métodos: Estudo retrospectivo e transversal, realizado entre março e abril de 2015, com 1.022 prontuários de adultos de ambos os sexos, atendidos numa clínica escola, nos últimos cinco anos. Foram coletadas informações sobre dados socioeconômicos (sexo, idade, estado civil, renda familiar e escolaridade), antropométricos (peso atual, altura, IMC e CC) e estilo de vida (tabagismo, ingestão de álcool e atividade física). A variável dependente foi a obesidade abdominal, definida pela razão cintura/estatura (RCest). Realizou-se análise multivariada pelo método regressão logística. Resultados: A prevalência de obesidade abdominal foi de 79,8%, de acordo com a RCest e, segundo IMC, o excesso de peso correspondeu a 77,1%. Verificou-se que as idades de 30 a 59 anos foram fator de risco para obesidade abdominal para ambos os sexos e, quando estratificada, para o sexo feminino. Porém, com relação ao sexo masculino, somente a faixa etária de 50 a 59 anos foi fator de risco (OR=5,76; IC=1,13-29,35; p=0,035). Viver com companheiro (OR=1,53; IC=1,07-2,18; p=0,017) e consumir álcool (OR=1,62; IC=1,09-2,40; p=0,015) apresentaram risco para ambos os sexos, sendo este também fator de risco para o sexo masculino (OR=2,46; IC=1,02-5,95; p=0,045). Conclusão: Observou-se alta prevalência de obesidade abdominal, que se mostrou associada à faixa etária de 30 a 59 para mulheres e 50 a 59 anos para homens, à convivência com o companheiro e ao consumo de álcool para ambos os sexos.

Objective: To determine the prevalence of abdominal obesity and identify the association between socioeconomic factors and lifestyle among adults attending a university health center. Methods: Retrospective and cross-sectional study conducted between March and April 2015 with 1,022 medical records of adults of both genders attending a university health center in the last five years. We collected sociodemographic data (gender, age, marital status, household income and education), anthropometric data (current weight, height, BMI and WC) and information on lifestyle (smoking, drinking and physical activity). The dependent variable was abdominal obesity, defined by the waist-height ratio (WHtR). Multivariate analysis was performed using the logistic regression method. Results: The prevalence of abdominal obesity was 79.8% according to WHtR and, according to BMI, excessive weight accounted for 77.1%. It was found that the ages 30-59 years were a risk factor for abdominal obesity for both genders, and for women when stratified. However, with regard to men, only the age group 50-59 years constituted a risk factor (OR=5.76; CI=1.13-29.35; p=0.035). Living with a partner (OR=1.53; CI=1.07-2.18; p=0.017) and drinking (OR=1.62; CI=1.09-2.40; p=0.015) constituted risk factors for both genders and also for men (OR=2.46; CI=1.02- 5.95; p=0.045). Conclusion: There was a high prevalence of abdominal obesity and it was associated with the age groups 30-59 years for women and 50-59 years for men, and living with a partner and drinking for both genders.

Objetivo: Determinar la prevalencia de obesidad abdominal e identificar su asociación con los factores socioeconômicos y estilo de vida de adultos asistidos en una clínica escuela de São Luís, Brasil. Métodos: Estudio retrospectivo y transversal realizado entre marzo y abril de 2015 en 1.022 historiales clínicos de adultos de ambos los sexos, asistidos en una clínica escuela em los últimos cinco años. Se recogieron informaciones de datos socioeconómicos (el sexo, la edad, el estado civil, la renta familiar y la escolaridad), antropométricos (el peso actual, la altura, el IMC y la CC) y estilo de vida (el tabaquismo, la ingesta de alcohol y la actividad física). La variable dependiente fue la obesidad abdominal que fue definida por la razón cintura/estatura (RCest). Se realizó un análisis multivariado por el método de regresión logística. Resultados: La prevalencia de la obesidad abdominal fue del 79,8%, según la RCest y según el IMC, el exceso de peso correspondió al 77,1%. Se verificó que las edades entre 30 y 59 años fueron factor de riesgo para la obesidad abdominal para ambos los sexos y, al estratificar, para el sexo femenino. Sin embargo, respecto al sexo masculino solamente la franja de edad entre 50 y 59 años fue factor de riesgo (OR=5,76; IC=1,13-29,35; p=0,035). Vivir con un compañero (OR=1,53; IC=1,07-2,18;p=0,017) y consumir alcohol (OR=1,62; IC=1,09-2,40; p=0,015) fueron identificados como riesgo para ambos los sexos y este último ha sido también un factor de riesgo para el sexo masculino (OR=2,46; IC=1,02-5,95; p=0,045). Conclusión: Se observo alta prevalencia de obesidad abdominal que estuvo asociada a la franja de edad entre 30 y 50 años para las mujeres y 50 y 59 años para los hombres, a la convivencia con el compañero y al consumo de alcohol para ambos los sexos.

Site-Specific Bone Mineral Density Is Unaltered Despite Differences in Fat-Free Soft Tissue Mass Between Affected and Nonaffected Sides in Hemiplegic Paralympic Athletes with Cerebral Palsy: Preliminary Findings.

OBJECTIVE: This study investigated bone mineral density (BMD, g/cm), fat mass (FM, kg), and fat-free soft tissue mass (FFSTM, kg) in Paralympic athletes with cerebral palsy (CP) using dual-energy x-ray absorptiometry. METHODS: Bone mineral density, BMD Z scores (standard deviations), FM, and FFSTM were measured for the whole body and at the lumbar spine, femoral neck, and total hip sites on both nonaffected and affected sides of 6 athletes with hemiplegic CP. RESULTS: There were no differences between nonaffected and affected sides with respect to site-specific BMD and BMD Z scores and FM. Fat-free soft tissue mass was significantly lower on the affected side in both upper and lower limbs (15% lower; P < 0.05). CONCLUSION: The present study is the first to describe similar BMD between sides, symmetry in FM, and asymmetry in FFSTM in Paralympic athletes with CP. These findings have important consequences for rehabilitation, as they indicate the potential for positive physiological adaptation as a result of exercise training over long periods of time.

Effects of Induced Volitional Fatigue on Sprint and Jump Performance in Paralympic Athletes with Cerebral Palsy.

OBJECTIVE: This study investigated performance, neuromuscular characteristics, and fatigue in Paralympic athletes with cerebral palsy (CP) during a maximal explosive performance trial, compared with well-trained, sprint-specific able-bodied athletes. DESIGN: Six Paralympic athletes with hemiplegic CP and 12 able-bodied athletes performed one 40-m sprint test (in seconds) and Vertical Jump Tests off both legs (in centimeters), the affected leg individually (in centimeters), and the nonaffected leg individually (in centimeters) before and after an adapted Multistage Shuttle Run Test to exhaustion. Electromyography of five bilateral muscles was measured for mean amplitude (percentage maximum activation). RESULTS: The 40-m sprint test, Vertical Jump Test off both legs, and Vertical Jump Test off the affected leg were significantly compromised in the CP group, whereas the Vertical Jump Test off the nonaffected leg was similar between groups (P < 0.05). Both groups fatigued similarly in performance and electromyography. Affected side electromyography was higher than nonaffected electromyography in the Vertical Jump Test off both legs and Vertical Jump Test off the affected leg in both groups. CONCLUSIONS: The similarity in fatigue between CP and able-bodied groups confirms that Paralympic athletes with CP may have overcome deficits associated with CP documented in sedentary children. The identified asymmetry may assist with a deeper understanding of performance deficits in CP, as it is indicated that activity generated by both legs is performed toward the capacity of the affected leg.

Paralympic Sprint Performance Between 1992 and 2012.

UNLABELLED: The Paralympic Games have undergone many changes since their inception in 1960, one being the advances made in running-specific prostheses (RSPs) for track athletes with lower-limb amputations. PURPOSE: To investigate the sprinting-performance changes in athletes with lower-limb amputations since 1992 to assess whether the influence of developments in RSP technology is evident. METHODS: The results of the Olympic and Paralympic Games ranging between 1992 and 2012 for the 100-m and 200-m were collected, and performance trends, percentage change in performance, and competition density (CD) were calculated. RESULTS: The results indicate that the greatest performance increases were seen in athletes with lower-limb amputations (T42 = 26%, T44 = 14%). These performance improvements were greater than for Olympic athletes (<3%), as well as Paralympic athletes from other selected classes (<10%). The T42 and T44 classes also showed the lowest CD values. DISCUSSION: These results suggest that although there is an overall trend for improved Paralympic sprint performances, RSP technology has played a noteworthy role in the progression of performances of athletes with amputations. It is also hypothesized that the difference in the performance improvements between the T42 and T44 classes is due to the level of disability and therefore the extent to which technology is required to enable locomotion. CONCLUSION: It is evident that RSP technology has played a significant role in the progression of performances in athletes with lower-limb amputations.

A descriptive comparison of sprint cycling performance and neuromuscular characteristics in able-bodied athletes and paralympic athletes with cerebral palsy.

OBJECTIVE: This study investigated the sprint cycling performance and neuromuscular characteristics of Paralympic athletes with cerebral palsy (CP) during a fatiguing maximal cycling trial compared with those of able-bodied (AB) athletes. DESIGN: Five elite athletes with CP and 16 AB age- and performance-matched controls performed a 30-sec Wingate cycle test. Power output (W/kg) and fatigue index (%) were calculated. Electromyography was measured in five bilateral muscles and expressed in mean amplitude (mV) and median frequency (Hz). RESULTS: Power output was significantly higher in the AB group (10.4 [0.5] W/kg) than in the CP group (9.8 [0.5] W/kg) (P < 0.05). Fatigue index was statistically similar between the AB (27% [0.1%]) and CP (25% [0.1%]) groups. Electromyographic mean amplitude and frequency changed similarly in all muscle groups tested, in both affected and nonaffected sides, in the CP and AB groups (P < 0.05). Neuromuscular irregularities were identified in the CP group. CONCLUSIONS: The similarity in fatigue between the CP and AB groups indicates that elite athletes with CP may have a different exercise response to others with CP. The authors propose that this may result from high-level training over many years. This has rehabilitative implications, as it indicates near-maximal adaptation of the CP body toward normal levels.