Effects of home-based exergaming on child social cognition and subsequent prediction of behavior.

The use of exergames may be one viable way to increase child physical activity, but investigation of its effects on motivation over time and prediction of adherence have seen little research attention. The purpose of this study was to compare the effect of two cycling exergame interventions (single-player, multi-player) among children aged 9-12 years on motivational variables (theory of planned behavior) and to explore whether these variables could predict objective assessment of playtime across 6 weeks. Sixty-nine insufficiently active children were recruited through advertisements within the community/schools and randomized to either the single play condition (n = 30) or multi-player condition (n = 39). Exergaming use was recorded objectively via game logs and motivational variables were assessed after a familiarization session, at 2 weeks, and at 4 weeks. Participants played the exergames M = 133.45 (SD = 81.27) minutes in week 1 to M = 77.23 (SD = 84.09) minutes in week 6. The two exergame conditions did not result in differences among theory of planned behavior variables (P > .05). Mean levels of these constructs declined across the first 4 weeks (P < .05), with the exception of injunctive norm. Positive bivariate associations (P < .05) between game play and perceived control (0-6 weeks), and intention (weeks 3-4 and weeks 5-6) were identified, but only affective attitude (assessed at week 2) predicted (P < .05) game play (3-4 weeks) in a multivariate examination of the theory of planned behavior model. The results demonstrate that social cognitive motives wane across time when exposed to repeated exergame play.

A systematic review and meta-analysis of exercise and exercise hypertension in patients with aortic coarctation.

Exercise hypertension is a common occurrence among individuals with aortic coarctation. Although exercise is known to be beneficial among the general population, the risks and benefits of exercise among those with aortic coarctation are less clear. This systematic review evaluates the benefits and risks of exercise for persons with aortic coarctation. Electronic databases were systematically searched (that is, MEDLINE and EMBASE) and key reviews cross-referenced to identify articles for inclusion. Original research articles reporting exercise among individuals with aortic coarctation were included. From 2608 individual citations, 68 eligible articles were identified. Aerobic exercise stress tests were found to be useful for determining exercise hypertension experiences post-surgical repair (N=5), and other long-term secondary findings (N=3). Experiences of exercise hypertension were associated with abnormal cardiac and/or aortic geometry and cardiac function (N=7). Exercise capacity was generally found to be similar to non-aortic coarctation controls post surgery (N=6). Exercise hypertension was experienced by 27% of participants, including 10% of adults and 43% of children/youth. Individuals who experience exercise hypertension experience greater increases in systolic blood pressure with exercise. No investigations identified evaluated forms of exercise other than aerobic stress tests and no exercise training programs have been conducted to date. Exercise stress tests can be valuable in this population for determining exercise hypertension, especially in the year post-surgical repair. Additional research is urgently needed to accurately assess the benefits and risks of exercise and exercise hypertension, and applicability of exercise restrictions for this population.

Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT.

BACKGROUND: Preclinical studies have reported that a single treadmill session performed 24h prior to doxorubicin provides cardio-protection. We aimed to characterize the acute change in cardiac function following an initial doxorubicin treatment in humans and determine whether an exercise session performed 24h prior to treatment changes this response. METHODS: Breast cancer patients were randomized to either 30min of vigorous-intensity exercise 24h prior to the first doxorubicin treatment (n=13), or no vigorous exercise for 72h prior to treatment (control, n=11). Echocardiographically-derived left ventricular volumes, longitudinal strain, twist, E/A ratio, and circulating NT-proBNP, a marker of later cardiotoxicity, were measured before and 24-48h after the treatment. RESULTS: Following treatment in the control group, NT-proBNP, end-diastolic and stroke volumes, cardiac output, E/A ratio, strain, diastolic strain rate, twist, and untwist velocity significantly increased (all p≤0.01). Whereas systemic vascular resistance (p<0.01) decreased, and ejection fraction (p=0.02) and systolic strain rate (p<0.01) increased in the exercise group only. Relative to control, the exercise group had a significantly lower NT-proBNP (p<0.01) and a 46% risk reduction of exceeding the cut-point used to exclude acute heart failure. CONCLUSION: The first doxorubicin treatment is associated with acutely increased NT-proBNP, echocardiographic parameters of myocardial relaxation, left ventricular volume overload, and changes in longitudinal strain and twist opposite in direction to documented longer-term changes. An exercise session performed 24h prior to treatment attenuated NT-proBNP release and increased systolic function. Future investigations should verify these findings in a larger cohort and across multiple courses of doxorubicin.

The vascular health status of a population of adult Canadian Indigenous peoples from British Columbia.

Indigenous populations currently experience greater cardiovascular disease burdens. However, subclinical vascular structure and function among these populations is not well known. This investigation evaluated vascular structure and function among Canadian Indigenous populations. Blood pressure, body composition, pulse-wave velocity (PWV), baroreceptor sensitivity (BRS), arterial compliance and intima-media thickness (IMT) were measured. Vascular measures were evaluated across sexes and age groups. Vascular assessments were conducted among 55 Indigenous adults (38±18 years, 29 Female), including both First Nations (N=36) and Métis (N=19) individuals. Some differences in vascular measures were found between males and females, respectively (spectral BRS: 9.6±6.8 ms mm Hg(-1) vs 16.9±10.0 ms mm Hg(-1), P=0.01; small arterial compliance: 8.9±3.7 ml mm Hg(-1) × 100 vs 6.4±2.3 ml mm Hg(-1) × 100, P=0.004), with similar measures of overall IMT (0.61±0.14 mm vs 0.57±0.08 mm, P=0.19) and central PWV (5.7±2.5 m s(-1) vs 5.1±2.3 m s(-1), P=0.58). Greater IMT, and lower BRS and arterial compliance were identified among older adults. This relatively healthy population demonstrated healthy vascular measures, with poorer measures among older individuals.

Temporal response of arterial stiffness to ultra-marathon.

The purpose of this investigation was to characterize the arterial stiffness of male ultra-marathon runners (n = 9) using pulse wave velocity (cfPWV) and radial tonometry over the course of an ultra-marathon and during recovery. Measures were collected at rest, immediately following 45 km/75 km of running, then following 60 and 90 min of recovery. No statistical difference was found between baseline cfPWV and normative values. The cfPWV of ultra-endurance runners decreased at 45 km (3.4 ± 1.6 m/s, p=0.006), followed by an increase (1.6 ± 1.8 m/s, p = 0.04) toward baseline levels at the 75 km mark. Radial tonometry measures also indicated small artery stiffness was transiently increased after 75 km. The amount of training time (r = 0.82, p = 0.007) and the duration of a typical training session (r = 0.73, p = 0.03) were correlated strongly with persisting decrements in large artery compliance at 60 min of recovery. The finding that arterial stiffness decreased at the 45 km distance and then reverted back toward baseline levels with prolonged running, may indicate a role of exercise duration or accumulated stress for affecting vascular compliance. At present, it is premature to suggest that athletes should alter training or racing practices to protect vascular health.

A systematic review of physical activity levels in Native American populations in Canada and the United States in the last 50 years.

Physical activity is beneficial for many chronic conditions. However, activity levels of Native Americans are not well known. This systematic review investigated if Native American populations achieve the recommended physical activity levels, compared current and past activity levels, and assessed the ability of exercise training programmes to improve health outcomes among this population. Electronic databases (e.g. MEDLINE, EMBASE) were searched and citations were cross-referenced. Included articles reported physical activity levels or investigations among Native Americans. This search identified 89 articles: self-report (n = 61), accelerometry and pedometry (n = 10), metabolic monitoring (n = 10) and physical activity interventions (n = 17). Few adults were found to meet the physical activity recommendations (27.2% [95% confidence interval = 26.9-27.5%] self-report, 9% [4-14%] accelerometry). Among children/youth, 26.5% (24.6-28.4%) (self-report) to 45.7% (42.3-49.1%) (pedometry/accelerometry) met the recommendations. Adults and children/youth were generally identified as physically inactive (via doubly labelled water). Overall, Native American adults reported lower activity levels since 2000, compared to 1990s, although similar to 1980s. Few physical activity interventions employed strong methodologies, large sample sizes and objective outcome measures. There is a clear need to increase Native American populations' physical activity. Additional research is required to evaluate exercise training programmes among this population.

Effects of training status on arterial compliance in able-bodied persons and persons with spinal cord injury.

STUDY DESIGN: An investigation on large and small artery compliance in 36 able-bodied persons and persons with spinal cord injury (SCI). OBJECTIVE: To evaluate the effect of various training states (endurance-trained vs untrained) on arterial compliance in individuals with chronic SCI of traumatic origin and in able-bodied individuals (matched for age, sex, height, and weight). SETTING: Tertiary rehabilitation center in Canada. METHODS: Large and small artery compliance were measured at the radial artery and physical activity was assessed via questionnaire. RESULTS: There was no significant difference in large artery compliance between groups. Small artery compliance was reduced markedly (5.8±3.1 ml mm Hg(-1) × 100) in untrained persons with SCI, in comparison to all other groups. Small artery compliance of endurance-trained individuals with SCI was slightly (4%) higher than that observed in the untrained able-bodied individuals (8.6±1.5 vs. 8.2±1.4 ml mm Hg(-1) × 100, respectively). Endurance-trained, able-bodied persons had greater small artery compliance (10.6±2.3 ml mm Hg(-1) × 100) in comparison to the all other groups. CONCLUSION: Endurance training is related to increased small artery compliance in able-bodied individuals and persons with SCI (who are matched for age, sex, height and weight). Endurance training may attenuate the decline in small artery compliance seen with SCI.

Systemic arterial compliance following ultra-marathon.

There is a growing interest in training for and competing in race distances that exceed the marathon; however, little is known regarding the vascular effects of participation in such prolonged events, which last multiple consecutive hours. There exists some evidence that cardiovascular function may be impaired following extreme prolonged exercise, but at present, only cardiac function has been specifically examined following exposure to this nature of exercise. The primary purpose of this study was to characterize the acute effects of participation in an ultra-marathon on resting systemic arterial compliance. Arterial compliance and various resting cardiovascular indices were collected at rest from 26 healthy ultra-marathon competitors using applanation tonometry (HDI CR-2000) before and after participation in a mountain trail running foot race ranging from 120-195 km which required between 20-40 continuous hours (31.2±6.8 h) to complete. There was no significant change in small artery compliance from baseline to post race follow-up (8.5±3.4-7.7±8.2 mL/mmHgx100, p=0.65), but large artery compliance decreased from 16.1±4.4 to 13.5±3.8 mL/mmHgx10 (p=0.003). Participation in extreme endurance exercise of prolonged duration was associated with acute reductions in large artery compliance, but the time course of this effect remains to be elucidated.

Comparing the Finapres and Caretaker systems for measuring pulse transit time before and after exercise.

We aimed to compare the Finapres system, which is designed for accurate intra-arterial amplitude measurement, to the Caretaker system, which is designed for temporal accuracy of intra-arterial measurement, in regard to measurement of pulse transit time (PTT) at baseline and following an endurance exercise session. Pulse transit time was evaluated between the R-wave of the ECG and the foot of the arterial waveform using either the Finapres (fpPTT) or Caretaker (ctPTT). 23 participants were measured before and after completion of endurance exercise. When comparing PTT values before and after an exercise intervention within devices, ctPTT was significantly different following exercise (P=0.03); however, the Finapres obtained values did not differ significantly. Before exercise, there was no significant relationship between devices, however, after exercise a significant moderate correlation was observed (r=0.45, P=0.02). Significant differences existed between ctPTT and fpPTT (P< 0.001). The Caretaker system appears to be more accurate at detecting changes in PTT occurring as a result of a single aerobic exercise session. This may be due to the servo-controller feedback loop in the waveform contour predicting algorithm within the Finapres system, which is not present in the Caretaker unit. The Finapres system also appears to have an inherent delay in pulse contour reporting.

The development of evidence-informed physical activity guidelines for adults with spinal cord injury.

OBJECTIVES: To systematically develop evidence-informed physical activity guidelines to improve physical fitness in people with spinal cord injury (SCI). SETTING: This study was conducted in Canada. METHODS: The Appraisal of Guidelines, Research and Evaluation II guideline development protocol was used to develop exercise guidelines to improve physical capacity and muscular strength. The evidence base for the guideline development process consisted of a systematic review and quality appraisal of research examining the effects of exercise on physical fitness among people with SCI. A multidisciplinary expert panel deliberated the evidence and generated the guidelines. Pilot testing led to refinement of the wording and presentation of the guidelines. RESULTS: The expert panel generated the following guidelines: for important fitness benefits, adults with a SCI should engage in (a) at least 20 min of moderate to vigorous intensity aerobic activity two times per week and (b) strength training exercises two times per week, consisting of three sets of 8-10 repetitions of each exercise for each major muscle group. CONCLUSION: People with SCI, clinicians, researchers and fitness programmers are encouraged to adopt these rigorously developed guidelines.

The prevalence of overweight and obesity in British Columbian Aboriginal adults.

Overweight and obesity among Aboriginal populations has been a growing challenge within Canada. This investigation aimed to identify the prevalence of overweight and obesity within British Columbian adult Aboriginal populations including both on and off reserve individuals through direct measurement. Further, this study stratified the variations in these rates according to age, gender and geographic region. Weight, height and waist circumference (WC) were measured via standardized procedures, and body mass index (BMI) was calculated. The mean body composition indicators were above recommended for men (BMI = 30.3 ± 5.6 kg m(-2) ; WC = 104.2 ± 14.7 cm) and women (BMI = 30.9 ± 7.2 kg m(-2); WC= 99.3 ± 17.1 cm), respectively. Rates of obesity for men and women were similar, 48.4% and 48.7%, respectively, and showed significant increases with age. Abdominal obesity (AO) was significantly greater among female participants, 69.0% compared with 52.7% in men, while both genders also demonstrated significant increases in AO with age. Both obesity and AO rates were found to be significantly greater in the Northern and Interior regions of the province in comparison to the Vancouver/Lower Mainland region. Alarmingly high rates of obesity and AO were observed in this population in men and women at every age and geographic region.

A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury.

STUDY DESIGN: All randomized controlled trials, prospective cohort, case-controlled, pre-post studies and case reports that assessed exercise interventions, which influence arterial structure and function after spinal cord injury (SCI), were included. OBJECTIVE: To review systematically the evidence for exercise as a therapy to alter arterial function in persons with SCI. SETTING: Literature searches were conducted for appropriate articles using several electronic databases (e.g. MEDLINE, EMBASE). METHODS: Three independent reviewers evaluated each investigation's quality, using the Physiotherapy Evidence Database Scale for randomized controlled trials and Downs and Black Scale for all other studies. Results were tabulated and levels of evidence assigned. RESULTS: A total of 283 studies were found through the systematic literature search. Upon review of the articles, 27 were included. The articles were separated into those investigating arterial benefits, resulting from either acute bouts of exercise or long-term exercise interventions. The ability of both acute and long-term exercise interventions to improve arterial structure and function in those with SCI was supported by limited to moderate methodological quality. Upper body wheeling is the most commonly examined exercise therapy for improving arterial function. It appears from the evidence that a variety of exercise interventions, including passive exercise, upper body wheeling, functional electrical stimulation and electrically stimulated resistance exercise, can improve arterial function in those living with SCI. CONCLUSIONS: Although the quality and volume of evidence is low, the literature supports exercise as a useful intervention technique for improving arterial function in those with SCI.

The challenge of low physical activity during the school day: at recess, lunch and in physical education.

PURPOSE: To describe physical activity (PA) intensity across a school day and assess the percentage of girls and boys achieving recommended guidelines. METHODS: The authors measured PA via accelerometry in 380 children (8-11 years) and examined data representing (1) the whole school day, (2) regular class time, (3) recess, (4) lunch and (5) scheduled physical education (PE). Activity was categorised as sedentary (SED), light physical activity (LPA) or moderate to vigorous physical activity (MVPA) using age-specific thresholds. They examined sex differences across PA intensities during each time period and compliance with recommended guidelines. RESULTS: Girls accumulated less MVPA and more SED than boys throughout the school day (MVPA -10.6 min; SED +13.9 min) recess (MVPA -1.6 min; SED +1.7 min) and lunch (MVPA -3.1 min; SED +2.9 min). Girls accumulated less MVPA (-6.2 min), less LPA (-2.5 min) and more SED (+9.4 min) than boys during regular class time. Fewer girls than boys achieved PA guidelines during school (90.9% vs 96.2%), recess (15.7% vs 34.1%) and lunch (16.7% vs 37.4%). During PE, only 1.8% of girls and 2.9% of boys achieved the PA guidelines. Girls and boys accumulated similar amounts of MVPA, LPA and SED. CONCLUSION: The MVPA deficit in girls was due to their sedentary behaviour as opposed to LPA. Physical activity strategies that target girls are essential to overcome this deficit. Only a very small percentage of children met physical activity guidelines during PE. There is a great need for additional training and emphasis on PA during PE. In addition schools should complement PE with PA models that increase PA opportunities across the school day.

Challenges, concerns and common problems: physiological consequences of spinal cord injury and microgravity.

INTRODUCTION: Similarities between the clinical presentation of individuals living with spinal cord injury (SCI) and astronauts are remarkable, and may be of great interest to clinicians and scientists alike. OBJECTIVES: The primary purpose of this review is to outline the manner in which cardiovascular, musculoskeletal, renal, immune and sensory motor systems are affected by microgravity and SCI. METHODS: A comprehensive review of the literature was conducted (using PubMed) to evaluate the hallmark symptoms seen after spaceflight and SCI. This literature was then examined critically to determine symptoms common to both populations. RESULTS: Both SCI and prolonged microgravity exposure are associated with marked deteriorations in various physiological functions. Atrophy in muscle and bone, cardiovascular disturbances, and alterations in renal, immune and sensory motor systems are conditions commonly observed not only in individuals with SCI, but also in those who experience prolonged gravity unloading. CONCLUSION: The preponderance of data indicates that similar physiological changes occur in both SCI and prolonged space flight. These findings have important implications for future research in SCI and prolonged space flight.

The effects of functional electrical stimulation leg cycle ergometry training on arterial compliance in individuals with spinal cord injury.

STUDY DESIGN: A prospective intervention of functional electrical stimulation leg cycle ergometry (FES-LCE) of four women with spinal cord injury (SCI). OBJECTIVE: To evaluate the effect of FES-LCE training on arterial compliance in individuals with chronic SCI of traumatic origin. SETTING: Tertiary rehabilitation center in Canada. METHODS: Large and small artery compliance were measured at the radial artery before and after a 3-month training program using FES-LCE. RESULTS: There was no significant change in large artery compliance after FES-LCE (16.0+/-4.2 to 16.8+/-6.1 ml mm Hg(-1) x 10, P=NS). There was a marked (63%) increase in small artery compliance after the FES training program (4.2+/-1.8 to 6.9+/-3.2 ml mm Hg(-1) x 100, P<0.05). CONCLUSION: It appears that FES-LCE is effective in improving small artery compliance in females with SCI.

An active school model to promote physical activity in elementary schools: action schools! BC.

OBJECTIVE: To assess the impact of an active school model on children's physical activity (PA). DESIGN: 16-month cluster randomised controlled trial. SETTING: 10 elementary schools in Greater Vancouver, BC. PARTICIPANTS: 515 children aged 9-11 years. INTERVENTION: Action Schools! BC (AS! BC) is an active school model that provided schools with training and resources to increase children's PA. Schools implemented AS! BC with support from either external liaisons (liaison schools, LS; four schools) or internal champions (champion schools, CS; three schools). Outcomes were compared with usual practice (UP) schools (three schools). MAIN OUTCOME MEASUREMENTS: PA was measured four times during the study using pedometers (step count, steps/day). RESULTS: Boys in the LS group took 1175 more steps per day, on average, than boys in the UP group (95% CI: 97 to 2253). Boys in the CS group also tended to have a higher step count than boys in the UP group (+804 steps/day; 95% CI: -341 to 1949). There was no difference in girls' step counts across groups. CONCLUSIONS: The positive effect of the AS! BC model on boys' PA is important in light of the current global trend of decreased PA.

A prediction model for estimating pulmonary oxygen uptake during the 6-minute walk test in organ transplant recipients.

We developed a multivariate prediction equation for estimating the highest obtainable pulmonary oxygen uptake (VO2p) during the 6-minute walk test (6-MWT) in 54 organ transplant recipients: heart/heart-double-lung (n=14), kidney/kidney-pancreas (n=16), liver (n=14), double lung (n=8), bone marrow (n=2). They were of age, 48+/-12 years. Participants performed a 6-MWT during which expired gases were collected and analyzed with a portable metabolic system interfaced with a wireless heart rate monitor. The following variables significantly contributed to the model for predicting the highest obtainable 6-MWT VO2p: 6-MWT distance (m), age (years), gender (male=0, female=1), resting heart rate, peak heart rate, weight (kg), and transplant type (kidney/kidney-pancreas=1, other=0), where: VO2p=1.253+0.022 (6-MWT distance)+0.112 (age) -3.192 (gender) -0.104 (resting heart rate)+0.127 (peak 6-MWT heart rate)-0.084 (weight)+2.116 (transplant type). The explanatory variables in our final model accounted for 78% of the variance in 6-MWT VO2p. In conclusion, the addition of an easily estimated 6-MWT VO2p will provide added clinical information of functional capacity following an exercise rehabilitation intervention or during routine follow-up for organ transplant recipients.