Menopause and the role of physical activity - The views and knowledge of women aged 40-65.

Menopause marks the end of female reproductive capacity. It is defined as the point after cessation of the menstrual cycle for 12 months (Nursat et al., 2008). Awareness about menopause has increased over the last decade, yet studies have shown that women still lack knowledge regarding the subject. Likewise, awareness of women between the age of 40-65 on the potential role of physical activity prior to and during menopause in women is unclear. Women (n = 162) aged 40-65 years completed a survey rating their knowledge, answered fact-based questions and reported their experiences of menopause. Their levels of, and beliefs on, the role physical activity on symptoms and menopause associated disease risk were also collected. Women reported their confidence in their current knowledge level at 67% reflecting 37% higher rating than an estimate of their knowledge 10 years ago. Their factual knowledge score was 56%. Knowledge was primarily gained through friends and family and almost half (46%) had not spoken to a healthcare professional. Frustration was expressed with lack of knowledge and support of healthcare and others. Women using HRT (44%) had mixed attitudes towards its role. A high proportion were active and felt that physical activity can help manage symptoms and impact long-term health consequences of menopause. Menopause education strategies for women, healthcare professionals and others need to be improved. Lack of education may be causing women to struggle and feel negatively towards this life stage. Physical activity was viewed positively for the symptoms and a treatment during menopause and long-term health.

The promotion of homebased physical activity for people with lung cancer and cachexia, a qualitative study of healthcare professionals, patients and carers.

PURPOSE: There is some evidence of the benefits of physical activity (PA) in patients with lung cancer; however, there is a lack of understanding of acceptable PA for patients with established cachexia and how to facilitate sustainable behaviour change to promote PA. Therefore, this study explored the views of healthcare professionals (HP), patients with lung cancer and cachexia, and their carers on preferences for, barriers and facilitators of homebased PA. METHODS: This qualitative study involved ten telephone interviews with HPs and face-to-face interviews with seven patients with lung cancer and cachexia and their carers. Interviews were transcribed and analysed thematically. The Capability, Opportunity, Motivation and Behaviour (COM-B) model was used as a framework for the thematic cross-group analysis. RESULTS: The types of homebased PA suggested by patients with lung cancer and cachexia (n = 7), their carers (n = 7) and HPs (n = 10) were functional, flexible, individualised and initially of short duration and low intensity. PA was influenced by themes within physical and psychological Capability, physical and social Opportunities as well as automatic and reflective Motivation. CONCLUSION: Based on a behaviour change theory, principles to promote homebased PA were developed. These principles need to be integrated into tools to promote PA in people with lung cancer and weight loss. IMPLICATIONS FOR CANCER SURVIVORS: The application of the proposed principles by clinicians will promote physical activity, enhancing the function and wellbeing of patients with lung cancer and reducing burden on carers.

Health and Wellbeing in Higher Education: A Comparison of Music and Sport Students Through the Framework of Self Determination Theory.

Students in Higher Education report high levels of mental health issues and psychological distress. Paradoxical findings on performance-orientated students, such as athletes and musicians, suggest that the demands of highly skilled vocations may enhance wellbeing while being detrimental to physical and mental health. To provide timely and appropriate help, institutions need to understand what areas of health and wellbeing are compromised in different student groups. In this study, we compared performance-orientated (music and sport) students to other students and the general population on a selection of wellbeing (WHO5, PWS, and WEMWBS), mental and physical health (K10, SF12, and PHQ9), and trait measures (TIPI, LOT-R, and PCS). Through an online survey (N = 273), data were collected from bachelor and master students (n = 135 music, n = 67 sport, n = 71 controls). Students' scores were compared to the general population, where norm values were available, and analyzed within and between groups. Multiple regression was performed to investigate trait measures as predictors of wellbeing. All groups scored significantly below population norms for wellbeing and mental health. One third were classed as having moderate to severe depression. Musicians scored higher openness to experience than athletes. While sport students showed a highly homogenous within-group profile, music students' scores differed significantly across study courses (e.g., performance and composition). Predictors for wellbeing were: optimism and emotional stability (all students); additionally conscientiousness (sport and music); and perceived competence (music only). As expected, students reported more health and wellbeing issues than general population. Distinct profiles of wellbeing were apparent for performance-orientated students. Results are in line with Self Determination Theory and suggest the need for institutions to embed health and wellbeing into a 'living curriculum' to accommodate the needs of different student groups. The WHO5 emerged as a parsimonious yet sensitive measure for mental health and wellbeing in student populations.

Fit to Perform: A Profile of Higher Education Music Students' Physical Fitness.

The physical demands of music making are well acknowledged, but understanding of musicians' physical and fitness profiles is nonetheless limited, especially those of advanced music students who are training to enter music's competitive professional landscape. To gain insight into how physical fitness is associated with music making, this study investigated music students' fitness levels on several standardized indicators. Four hundred and eighty three students took part in a fitness screening protocol that included measurements of lung function, flexibility (hypermobility, shoulder range of motion, sit and reach), strength and endurance (hand grip, plank, press-up), and sub-maximal cardiovascular fitness (3-min step test), as well as self-reported physical activity (IPAQ-SF). Participants scored within age-appropriate ranges on lung function, shoulder range of motion, grip strength, and cardiovascular fitness. Their results for the plank, press-up, and sit and reach were poor by comparison. Reported difficulty (22%) and pain (17%) in internal rotation of the right shoulder were also found. Differences between instrument groups and levels of study were observed on some measures. In particular, brass players showed greater lung function and grip strength compared with other groups, and postgraduate students on the whole were able to maintain the plank for longer but also demonstrated higher hypermobility and lower lung function and cardiovascular fitness than undergraduate students. Seventy-nine percent of participants exceeded the minimum recommended weekly amount of physical activity, but this was mostly based on walking activities. Singers were the most physically active group, and keyboard players, composers, and conductors were the least active. IPAQ-SF scores correlated positively with lung function, sit and reach, press-up and cardiovascular fitness suggesting that, in the absence of time and resources to carry out comprehensive physical assessments, this one measure alone can provide useful insight into musicians' fitness. The findings show moderate levels of general health-related fitness, and we discuss whether moderate fitness is enough for people undertaking physically and mentally demanding music making. We argue that musicians could benefit from strengthening their supportive musculature and enhancing their awareness of strength imbalances.

The Relationship Between Occupational Demands and Well-Being of Performing Artists: A Systematic Review.

Background: Performing artists are exposed to a range of occupational demands from organisational, interpersonal and intrapersonal sources, which may impact their well-being. The aim of this systematic review was to evaluate and synthesise the literature where researchers have considered the relationship between occupational demands and well-being in performing artists. Methods: A mixed-methods systematic review was conducted including professional and student performing artists. Quantitative, qualitative and mixed-methods study designs were eligible for inclusion in the review. A total of 14 databases were searched from their inception through to October 2017, including MEDLINE, EMBASE, and Scopus. Critical appraisal was conducted using the Mixed-Methods Appraisal Tool and results presented as a narrative synthesis. Results: A total of 20 studies were included in the review, comprising of quantitative (n = 7), qualitative (n = 9) and mixed-methods (n = 4) study designs. Several frameworks of occupational stress and well-being were explored in relation to the results. Organisational, social and emotional demands were associated with lower well-being. Conversely, music-making, performance activities and social support were reported to be resources and were related to higher well-being. Conclusion: This systematic review highlights the need for researchers in this field to adopt methodologically robust study designs, which are informed by appropriate theoretical frameworks. The paucity of high quality and theoretically informed research in this area is a hindrance to the development of evidence-based interventions for this population.

A longitudinal study of muscle strength and function in patients with cancer cachexia.

PURPOSE: Patients with cancer frequently experience an involuntary loss of weight (in particular loss of muscle mass), defined as cachexia, with profound implications for independence and quality of life. The rate at which such patients' physical performance declines has not been well established. The aim of this study was to determine the change in muscle strength and function over 8 weeks in patients with already established cancer cachexia, to help inform the design and duration of physical activity interventions applicable to this patient group. METHODS: Patients with thoracic and gastrointestinal cancer and with unintentional weight loss of > 5% in 6 months or BMI < 20 plus 2% weight loss were included. Physical and functional assessments (baseline, 4 weeks, 8 weeks) included isometric quadriceps and hamstring strength, handgrip, standing balance, 10-m walk time and timed up and go. RESULTS: Fifty patients (32 male), mean ± SD age 65 ± 10 years and BMI 24.9 ± 4.3 kg/m2, were recruited. Thoracic cancer patients had lower muscle strength and function (p < 0.05). Despite notable attrition, in patients who completed all assessments (8 thoracic and 12 gastrointestinal), there was little change in performance over 8 weeks (p > 0.05). Baseline variables did not differentiate between completers and non-completers (p > 0.05). CONCLUSIONS: More than a third of patients with established cancer cachexia in our study were stable over 8 weeks, suggesting a subgroup who may benefit from targeted interventions of reasonable duration. Better understanding the physical performance parameters which characterise and differentiate these patients has important clinical implications for cancer multidisciplinary team practice.

Predicting psychological distress of informal carers of individuals with major depression or bipolar disorder.

Caring for someone with a mental illness is associated with high levels of burden and psychological distress. Understanding these factors could be important to prevent the development of physical and mental health problems in carers. The purpose of the present study was to determine the contribution of coping styles and social support in predicting the psychological distress reported by informal carers (IC) of individuals with major depression or bipolar disorder. IC (n = 72) of adults with a diagnosed depressive illness were recruited from mental health organizations within the community setting. Carers completed the General Health Questionnaire, Brief COPE, and Social Support Questionnaire. Multiple linear regression analysis revealed that 63% of the variance in psychological distress could be accounted for by adaptive and maladaptive coping styles and perceived quantity and satisfaction with social support. Satisfaction with social support (ß = -0.508, P < 0.001) and maladaptive coping (ß = 0.369; P < 0.001) were significant predictors of psychological distress. These findings suggest that interventions should consider coping styles, specifically the interaction between maladaptive behaviours and enhancement of quality of support, to assist carers to manage psychological distress, especially earlier in the caring role.

Patients with established cancer cachexia lack the motivation and self-efficacy to undertake regular structured exercise.

OBJECTIVES: Patients with advanced cancer frequently suffer a decline in activities associated with involuntary loss of weight and muscle mass (cachexia). This can profoundly affect function and quality of life. Although exercise participation can maintain physical and psychological function in patients with cancer, uptake is low in cachectic patients who are underrepresented in exercise studies. To understand how such patients' experiences are associated with exercise participation, we investigated exercise history, self-confidence, and exercise motivations in patients with established cancer cachexia, and relationships between relevant variables. METHODS: Lung and gastrointestinal cancer outpatients with established cancer cachexia (n = 196) completed a questionnaire exploring exercise history and key constructs of the Theory of Planned Behaviour relating to perceived control, psychological adjustment, and motivational attitudes. RESULTS: Patients reported low physical activity levels, and few undertook regular structured exercise. Exercise self-efficacy was very low with concerns it could worsen symptoms and cause harm. Patients showed poor perceived control and a strong need for approval but received little advice from health care professionals. Preferences were for low intensity activities, on their own, in the home setting. Regression analysis revealed no significant factors related to the independent variables. CONCLUSIONS: Frequently employed higher intensity, group exercise models do not address the motivational and behavioural concerns of cachectic cancer patients in this study. Developing exercise interventions which match perceived abilities and skills is required to address challenges of self-efficacy and perceived control identified. Greater engagement of health professionals with this group is required to explore potential benefits of exercise.

Fit to Perform: An Investigation of Higher Education Music Students' Perceptions, Attitudes, and Behaviors toward Health.

Making music at the highest international standards can be rewarding, but it is also challenging, with research highlighting pernicious ways in which practicing and performing can affect performers' health and wellbeing. Several studies indicate that music students' perceptions, attitudes, and behaviors toward health and healthy living are less than optimal, especially considering the multiple physical and psychological demands of their day-to-day work. This article presents the results of a comprehensive screening protocol that investigated lifestyle and health-related attitudes and behaviors among 483 undergraduate and postgraduate students (mean age = 21.29 years ± 3.64; 59% women) from ten conservatoires. The protocol included questionnaires measuring wellbeing, general health, health-promoting behaviors, perfectionism, coping, sleep quality, and fatigue. On each measure, the data were compared with existing published data from similar age groups. The results indicate that music students have higher levels of wellbeing and lower fatigue than comparable samples outside of music. However, they also reveal potentially harmful perceptions, attitudes, and behaviors toward health. Specifically, engagement in health responsibility and stress management was low, which along with high perfectionistic strivings, limited use of coping strategies, poor sleep quality, and low self-rated health, paints a troubling picture both for the music students and for those who support their training. The findings point to the need for more (and more effective) health education and promotion initiatives within music education; in particular, musicians should be better equipped with mental skills to cope with constant pressure to excel and high stress levels. In part, this calls for musicians themselves to engage in healthier lifestyles, take greater responsibility for their own health, and be aware of and act upon health information in order to achieve and sustain successful practice and performance. For that to happen, however, music educators, administrators, and policy makers must play an active role in providing supportive environments where health and wellbeing is considered integral to expert music training.

Stage call: Cardiovascular reactivity to audition stress in musicians.

Auditioning is at the very center of educational and professional life in music and is associated with significant psychophysical demands. Knowledge of how these demands affect cardiovascular responses to psychosocial pressure is essential for developing strategies to both manage stress and understand optimal performance states. To this end, we recorded the electrocardiograms (ECGs) of 16 musicians (11 violinists and 5 flutists) before and during performances in both low- and high-stress conditions: with no audience and in front of an audition panel, respectively. The analysis consisted of the detection of R-peaks in the ECGs to extract heart rate variability (HRV) from the notoriously noisy real-world ECGs. Our data analysis approach spanned both standard (temporal and spectral) and advanced (structural complexity) techniques. The complexity science approaches-namely, multiscale sample entropy and multiscale fuzzy entropy-indicated a statistically significant decrease in structural complexity in HRV from the low- to the high-stress condition and an increase in structural complexity from the pre-performance to performance period, thus confirming the complexity loss theory and a loss in degrees of freedom due to stress. Results from the spectral analyses also suggest that the stress responses in the female participants were more parasympathetically driven than those of the male participants. In conclusion, our findings suggest that interventions to manage stress are best targeted at the sensitive pre-performance period, before an audition begins.

Music Regulators in Two String Quartets: A Comparison of Communicative Behaviors between Low- and High-Stress Performance Conditions.

In ensemble performances, group members use particular bodily behaviors as a sort of "language" to supplement the lack of verbal communication. This article focuses on music regulators, which are defined as signs to other group members for coordinating performance. The following two music regulators are considered: body gestures for articulating attacks (a set of movements externally directed that are used to signal entrances in performance) and eye contact. These regulators are recurring observable behaviors that play an important role in non-verbal communication among ensemble members. To understand how they are used by chamber musicians, video recordings of two string quartet performances (Quartet A performing Bartók and Quartet B performing Haydn) were analyzed under two conditions: a low stress performance (LSP), undertaken in a rehearsal setting, and a high stress performance (HSP) during a public recital. The results provide evidence for more emphasis in gestures for articulating attacks (i.e., the perceived strength of a performed attack-type body gesture) during HSP than LSP. Conversely, no significant differences were found for the frequency of eye contact between HSP and LSP. Moreover, there was variability in eye contact during HSP and LSP, showing that these behaviors are less standardized and may change according to idiosyncratic performance conditions. Educational implications are discussed for improving interpersonal communication skills during ensemble performance.

A randomized feasibility study of a 12-week community-based exercise program for people with Huntington's disease.

BACKGROUND AND PURPOSE: The beneficial role of exercise as a treatment approach in Huntington's disease (HD) has support from both preclinical work and small-scale studies; however, there have been no controlled studies of gym-based exercise in people with HD. This phase 2 randomized trial (ISRCTN 59910670) assessed feasibility, safety, acceptability, and benefit of a structured exercise program. METHODS: Thirty-one participants (16 men; mean [SD] age = 50.4 [11.4] years) were randomly allocated to intervention (n = 16) or control group (usual care; n = 15). The intervention entailed a weekly supervised gym session of stationary cycling and resistance exercises, and a twice weekly independent home-based walking program. Retention and adherence rates and adverse events were recorded. Acceptability was determined from subjective reports of tolerability and physiological measures recorded during the gym sessions. Assessment of benefit included measures of physical abilities, disease severity, and quality of life (36-Item Short Form Health Survey). Analysis of covariance was used to test outcomes of interest. RESULTS: The retention rate was 81% (9 of the 11 individuals who started the intervention completed it) and of the 9 who completed the program, 7 attended more than 75% (9/12) of the gym sessions. There were no related adverse events and the intervention was well tolerated by most participants. The between-group effect estimate for the Mental Component Summary score of the 36-Item Short Form Health Survey (n = 9; intervention, n = 13; control) was 7 (95% CI: 0.4-13.7) Moderate effect sizes for cognitive outcomes and measures of walking were also observed. DISCUSSION AND CONCLUSIONS: Observed effect sizes for clinical outcomes suggest the structured exercise program has benefit for persons with HD; larger scale trials are warranted.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A60) for more insights from the authors.

Complexity of physiological responses decreases in high-stress musical performance.

For musicians, performing in front of an audience can cause considerable apprehension; indeed, performance anxiety is felt throughout the profession, with wide ranging symptoms arising irrespective of age, skill level and amount of practice. A key indicator of stress is frequency-specific fluctuations in the dynamics of heart rate known as heart rate variability (HRV). Recent developments in sensor technology have made possible the measurement of physiological parameters reflecting HRV non-invasively and outside of the laboratory, opening research avenues for real-time performer feedback to help improve stress management. However, the study of stress using standard algorithms has led to conflicting and inconsistent results. Here, we present an innovative and rigorous approach which combines: (i) a controlled and repeatable experiment in which the physiological response of an expert musician was evaluated in a low-stress performance and a high-stress recital for an audience of 400 people, (ii) a piece of music with varying physical and cognitive demands, and (iii) dynamic stress level assessment with standard and state-of-the-art HRV analysis algorithms such as those within the domain of complexity science which account for higher order stress signatures. We show that this offers new scope for interpreting the autonomic nervous system response to stress in real-world scenarios, with the evolution of stress levels being consistent with the difficulty of the music being played, superimposed on the stress caused by performing in front of an audience. For an emerging class of algorithms that can analyse HRV independent of absolute data scaling, it is shown that complexity science performs a more accurate assessment of average stress levels, thus providing greater insight into the degree of physiological change experienced by musicians when performing in public.

Influence of fitness and physical activity on cardiovascular reactivity to musical performance.

OBJECTIVE: The current study examines the relationships between physical activity and fitness and reactivity to a musical performance stressor (MPS). Numerous studies suggest that being fitter and more physically active has a beneficial effect on individuals' cardiovascular responses to laboratory-based mental challenges. The results are equivocal regarding the transfer of such benefits to real world contexts such as musical performance. PARTICIPANTS: Forty six advanced music students completed this assessment. METHOD: All participants completed a 20-min pre-performance assessment of heart rate (HR), HR variability (HRV) and blood pressure. Participants also completed baseline measures and a sub-maximal fitness assessment on a separate day. RESULTS: A positive association between fitness and HR pre-MPS was found. Fitness was also positively associated with root mean square SD RR(interval) before the MPS. Higher fitness was related to lower state anxiety post-MPS. CONCLUSIONS: Implications of the findings are discussed in relation to classical musicians' day-to-day work and performance.

Exploring autonomic nervous system dysfunction in patients with cancer cachexia: a pilot study.

INTRODUCTION: Abnormalities of the autonomic nervous system (ANS) have been associated with cachexia. METHODS: In nine cancer patients who had lost weight and nine age-matched healthy volunteers heart rate variability (HRV) components were determined, together with serum cortisol and urinary catecholamines/metanephrines. RESULTS: Compared to volunteers, patients exhibited a global reduction in HRV parameters, significantly so for high frequency, low frequency and total power (median values ms(2) 103 vs. 313, 62 vs. 148 and 316 vs. 736 respectively, P<0.05). Biochemical values did not differ. CONCLUSION: Our results suggest the presence of ANS dysfunction in patients with cancer cachexia, with reduction in both sympathetic and parasympathetic components.

The effect of a supported exercise programme in patients with newly diagnosed Type 2 diabetes: a pilot study.

The aim of this study was to examine the effectiveness of either a standard care programme (n = 9) or a 12-week supported exercise programme (n = 10) on glycaemic control, ß-cell responsiveness, insulin resistance, and lipid profiles in newly diagnosed Type 2 diabetes patients. The standard care programme consisted of advice to exercise at moderate to high intensity for 30 min five times a week; the supported exercise programme consisted of three 60-min supported plus two unsupported exercise sessions per week. Between-group analyses demonstrated a difference for changes in low-density lipoprotein cholesterol only (standard care programme 0.01 mmol · L(-1), supported exercise programme -0.6 mmol · L(-1); P = 0.04). Following the standard care programme, within-group analyses demonstrated a significant reduction in waist circumference, whereas following the supported exercise programme there were reductions in glycosylated haemoglobin (6.4 vs. 6.0%; P = 0.007), waist circumference (101.4 vs. 97.2 cm; P = 0.021), body mass (91.7 vs. 87.9 kg; P = 0.007), body mass index (30.0 vs. 28.7 kg · m(-2); P = 0.006), total cholesterol (5.3 vs. 4.6 mmol · L(-1); P = 0.046), low-density lipoprotein cholesterol (3.2 vs. 2.6 mmol · L(-1); P = 0.028), fasting ß-cell responsiveness (11.5 × 10(-9) vs. 7.0 × 10(-9) pmol · kg(-1) · min(-1); P = 0.009), and insulin resistance (3.0 vs. 2.1; P = 0.049). The supported exercise programme improved glycaemic control through enhanced ß-cell function associated with decreased insulin resistance and improved lipid profile. This research highlights the need for research into unsupported and supported exercise programmes to establish more comprehensive lifestyle advice for Type 2 diabetes patients.