ABSTRACT
The objectives of this work were (a) to adopt the Active Healthy Kids Global Alliance Report Card methodology to evaluate the state of physical activity (PA) for French children and adolescents with disabilities (CAWD) and (b) to identify the strengths, weaknesses, opportunities, and threats (SWOT) perceived by French PA experts for promoting PA among CAWD. The harmonized Active Healthy Kids Global Alliance Report Card development process was used to assign a grade to the 10 common PA indicators. SWOT templates were completed by PA experts and then collapsed in a summary figure. Despite increasing efforts to provide active opportunities to CAWD, concerning low grades were assigned to behavioral indicators. SWOT analysis provided important insights for the promotion of PA in CAWD. This work highlighted the need for the inclusion of CAWD in a comprehensive national PA surveillance system and for more efficient strategies promoting PA specifically targeting CAWD in France.
Subject(s)
Disabled Children , Exercise , Sedentary Behavior , Health Promotion , Health Policy , France , Humans , Male , Female , Child , Adolescent , SportsABSTRACT
The French therapeutic communities ("Appartements de Coordination Therapeutique (ACT)") are mostly members of the "National Federation of Accommodation for HIV+ and other chronic diseases. They provide accommodation for people living with chronic conditions (HIV hepatitis, cancers...) and in a situation of high psychosocial frailty. As a result of their coordinated multidisciplinary intervention, these structures provide the required support to access health care and facilitate social inclusion. They are designed to provide an appropriate response to people with cumulative medical and social conditions (chronic diseases, precariousness, addictions and other comorbidities). Our innovative local experiment integrates Adapted Physical Activities (APA) into the global medical and social follow-up, in line with the patient's individual health care project. The characteristics of each APA project (nature of the activities proposed, intensity, duration, frequency, individual vs. team activity and accompanying methods) are defined on an individual basis, according to the user's motivations and inputs from the support team (medical, psychological and social coordination). The follow-up ensured by our APA professionals allows the residents to participate in a regular and attractive physical activity and could contribute to their social inclusion. The multidisciplinary approach proposed by ACTs determines the beneficial effects observed in such vulnerable patients.
Subject(s)
Chronic Disease/therapy , Motor Activity/physiology , Precision Medicine , Therapeutic Community , Exercise Therapy/methods , Female , France/epidemiology , Humans , Interdisciplinary Communication , Male , Patient Care Team/organization & administration , Patient Care Team/standards , Poverty , Precision Medicine/methods , Precision Medicine/standards , Public Housing , Quality of Health Care , Quality of Life , Vulnerable PopulationsABSTRACT
Resting and exercise cardiac function, skeletal muscle oxygenation and whole-body aerobic exercise capacities were evaluated prospectively in cardiac symptom-free HIV men receiving antiretroviral therapies and in healthy controls matched for age, physical activity, smoking and body surface area. HIV patients showed resting cardiac dysfunction, altered cardiac responses to exercise and depressed exercise tolerance. Exercise stroke volume kinetics and muscle oxygenation were impaired in HIV patients, especially in those with resting diastolic dysfunction.
Subject(s)
Exercise/physiology , HIV Infections/physiopathology , Ventricular Dysfunction, Left/virology , Adult , Anaerobic Threshold/physiology , Antiretroviral Therapy, Highly Active , Electrocardiography , Exercise Test , Exercise Tolerance/physiology , HIV Infections/complications , HIV Infections/drug therapy , Humans , Male , Middle Aged , Muscle, Skeletal/metabolism , Prospective Studies , Stroke Volume/physiology , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Although cardiotoxic effects of highly active antiretroviral therapy (HAART) are a growing concern, there is a lack of prospective studies of subclinical involvement of the heart in human immunodeficiency virus (HIV)-infected patients. This study evaluated noninvasively cardiac morphologic characteristics and function in HIV-positive (HIV(+)) men receiving HAART for > or =2 years with no clinical evidence of cardiovascular disease. Echocardiography at rest, including tissue Doppler imaging and exercise testing, were performed in 30 HIV(+) men (age 42.1 +/- 4.7 years, duration of HIV infection 10.4 +/- 4.7 years, duration of HAART 5.3 +/- 2.1 years) and 26 age-matched healthy controls. At rest, HIV(+) patients had similar left ventricular (LV) mass indexed to height(2.7) (40.6 +/- 9.5 vs 37.5 +/- 9.3 g/m; p >0.05), but a higher prevalence of LV diastolic dysfunction (abnormal relaxation or pseudonormal filling pattern in 64% of patients vs 12% of controls; p <0.001). LV systolic function indexes were significantly lower (ejection fraction 60.4 +/- 8.7% vs 66.9 +/- 6.9%; p <0.01, and tissue Doppler imaging peak systolic velocity 11.4 +/- 1.6 vs 13.5 +/- 2.2 cm/s; p <0.001). Pulmonary artery pressure was higher in patients compared with controls (32.1 +/- 5.4 vs 26.1 +/- 6.5 mm Hg; p <0.001). Exercise testing showed decreased exercise tolerance in HIV(+) patients, with no case of myocardial ischemia. In conclusion, subclinical cardiac abnormalities are frequently observed in HIV(+) patients on HAART. The usefulness of systematic noninvasive screening in this population should be considered. GECEM study no. 30: National Agency for AIDS Research (ANRS).
