Activity-based Interventions Research Articles

Interventions Promoting Physical Activity Among Older Adults: A Systematic Review and Meta-Analysis.

Frequent participation in physical activity (PA) has benefits across the lifespan but is particularly important for older adults. PA levels are either measured by objective or self-reported survey methods. Objective PA measurement is used to increase accuracy. This systematic review investigated the effect of physical activity-based interventions on objectively measured PA levels among community-dwelling adults aged 60 years and older. Literature searches were conducted in five electronic databases and four clinical trial registries. Randomized controlled trials investigating the effect of physical activity-based interventions on objectively measured PA levels (e.g., accelerometers or pedometers) in community-dwelling adults aged 60 years and older compared with no/minimal intervention were considered eligible. Data were pooled using the most conservative estimates reported from each study using the standardized mean difference (SMD). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the overall quality of the evidence. Fourteen published trials and 3 ongoing trials were identified. There were significant effects favoring physical activity-based interventions compared with minimal intervention at short-term (less than or equal to 3 months) (SMD: 0.30, 95% CI: 0.17 to 0.43) and intermediate-term (more than 3 months and less than 12 months; SMD: 0.27, 95% CI: 0.06 to 0.49) follow-ups. The quality of evidence was moderate according to GRADE (downgraded for risk of bias). Our findings suggest that physical activity-based interventions may increase objectively measured PA levels in community-dwelling older adults. Further studies are still needed to identify the optimal dose, intensity, and mode of delivery of physical activity-based interventions.

Effectiveness of interventions for the reversal of a metabolic syndrome diagnosis: An update of a meta-analysis of mixed treatment comparison studies

ResumenIntroducción. El conocer las intervenciones más efectivas para revertir el síndrome metabólico es clave para el diseño de estrategias clínicas de prevención de enfermedades como la diabetes mellitus de tipo 2 y la enfermedad cardiovascular.Objetivo. Sintetizar el tamaño del efecto de las intervenciones disponibles para revertir un diagnóstico de síndrome metabólico. Materiales y métodos. Se hizo la búsqueda en Embase y Medline, incluyendo los ensayos clínicos en los que la variable “respuesta” se definía como la reversión del diagnóstico del síndrome metabólico. Se categorizaron las intervenciones en cuatro dimensiones: 1) estilo de vida (dieta y ejercicio); 2) farmacia; 3) combinación de estilo de vida y farmacia, y 4) grupos de control; finalmente, se hizo una comparación mixta de tratamientos.Resultados. Se detectaron dos estudios adicionales a los incluidos en el metaanálisis publicado por Dunkley, et al., en el 2012. Se estimó que las intervenciones relacionadas con el estilo de vida tuvieron 2,61 veces (intervalo de credibilidad entre 1,00 y 5,47) más probabilidades de revertir el síndrome metabólico que las de los grupos de control y las relacionadas con los tratamientos farmacéuticos, una probabilidad de 3,39 veces más que las del grupo de control, pero con un intervalo de credibilidad entre 0,81 y 9,99. Las intervenciones sobre el estilo de vida tuvieron 1,59 veces más probabilidades de revertir el síndrome metabólico que las del tratamiento farmacéutico. Conclusión. Las estrategias basadas en la dieta y la actividad física de las personas, tuvieron una mayor probabilidad de ser más efectivas para revertir el diagnóstico de síndrome metabólico.

The Regaining of Traditional Street: Combining Street Network Configuration with Temporary Urban Interventions

Observations and Axial analysis models are combined into Space Syntax to study the corresponding relationship between a street network and how temporary urban interventions in a traditional shopping street in Little India, Kuala Lumpur, may affect public life. Little India was chosen as the case study because of its historical and cultural significance. The study aims to explore the most important temporary urban interventions - activity-based interventions in traditional shopping street through the spatial logic of street network. Static snapshots and people-following were conducted in Little India, to observe activity and movement during a whole day on a weekday and a weekend day. Two (2) parameters in Space Syntax were chosen including global integration and local integration to measure its urban interventions, activities, and movement among visitors in traditional shopping streets. The result indicates that there is a certain correlation among these parameters with the following spatial configurative analyses; all lines analyses and segment based angular analyses. It finds significant relationships between global integration and local integration, and the activity pattern. It is proposed in this paper that streets with a high degree of integration and adjacent to main streets; Jalan Tun Sambanthan is a key factor for carrying forward temporary urban interventions in Little India. More attention should be paid to the street network to preserve diversity, make the streets active, and importantly to improve public life.

Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese.

The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese. This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions. Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes. Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.

Commentary on "Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese".

“How could I apply this information?” The research addresses a very relevant topic related to the importance of promoting physical fitness levels in adolescent girls who are overweight or obese and resulted in statistically significant increases in aerobic and anaerobic fitness, muscle strength, balance and dexterity, and the adequacy subscore of the self-efficacy measure. Clinicians could use either interventions with girls to improve fitness, as no differences between the study groups were observed. Choosing between computer-based training and functional training might be influenced by the preference and ability of a given child at a given time or the availability of equipment. The study systematically increased loading and challenge over time, which may be useful for clinicians running group-based exercise therapy programs. In practice, greater personalization and potential gain are possible through exercise prescription based on the individual holistic assessment of physical health and fitness. The study used suitable outcome measures and field tests although some may/may not be appropriate for clinical settings (eg, 20MST). “What should I be mindful about when applying this information?” The authors do not report whether body mass index was based on objective or subjective measurements and children with severe obesity were excluded. As such, readers working with children with obesity should interpret results with caution. Although daily guidelines of 60 minutes of moderate-vigorous activity are recommended for child health, participants were asked to engage in the prescribed protocol only, which in practice would not be recommended. Implementation into practice would be facilitated by a cost comparison between the interventions in terms of time, equipment, and space resources. Similarly, whether this protocol achieves fitness improvements in boys should be explored. Grace O'Malley, PhD, MSc, BSc (Physio) W82GO Weight Management Service, Temple Street Children's University Hospital Dublin, Ireland Ailish Malone, PhD, BSc (Physio), MISCPS School of Physiotherapy, Royal College of Surgeons in Ireland Dublin, Ireland

A Systematic Review Examining the Exercise Parameters Required to Induce the Repeated Bout Effect: Implications for Acute Care Physical Therapists

Background: Acute care physical therapists regularly use therapeutic exercise to target body structures and functions as a supplement to or even replacing activity-based interventions. Interestingly, little is known regarding the mechanism of action explaining how exercise enables future activity and participation. One potential mechanism of action is the repeated bout effect (RBE), which is the phenomenon that a single bout of exercise provides protective adaptations for future exercise/physical activity. Purpose: To perform a systematic review examining the exercise parameters required to induce the RBE and explore how the results apply to acute care physical therapists. Data Sources: Academic Search Complete, CINAHL, MasterFILE Premier, MEDLINE, PsycINFO, and SPORTDiscus. Study Selection: The search included articles appearing before January 1, 2017. The following were the inclusion criteria: human subjects, randomized controlled trial design, published in English, treatment and control group engaged in exercise, lower extremity exercise intervention, and pre- and postintervention creatine kinase blood marker measurement. Data Extraction and Quality Assessment: Three reviewers extracted data and then assessed the methodological quality of the included articles. Results: Of the 1780 potential studies, seven were included. The RBE can be induced with exercise that includes an eccentric component, as well as with maximal voluntary isometric contractions at elongated muscle lengths. Concentric-only exercise does not induce the RBE and could instead blunt it. Stretching does not induce the RBE; however, it does not blunt it. Conclusion: The RBE enhances a person's tolerance for future exercise/physical activity. Consequently, the use of exercise to induce the RBE would be advantageous during initial and subsequent acute care physical therapist interventions. Future research is needed to specifically address the precise dose needed to induce the RBE in middle-aged and older adults, those with acute and chronic diseases, and women of all ages.

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis

ObjectivesTo identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or...

Effects of Activity-Based Interventions and Parent Involvement on Social Interaction Skills in Children With Autism Spectrum Disorder

Abstract Date Presented 04/05/19 The study identified parents’ perspectives on the effects of activity-based interventions and parent involvement on social interaction skills in children with autism. The qualitative and quantitative data indicate that parents perceive improvement in the social behaviors of their children following activity-based group sessions in which the parents are actively involved. The study supports the value of activity-based intervention and the impact of social environment on occupational performance. Primary Author and Speaker: Emily Mike Additional Authors and Speakers: Donna Eichhorn

Effects of Weight-Loss Interventions on Short-Chain Fatty Acid Concentrations in Blood and Feces of Adults: A Systematic Review

Short-chain fatty acids (SCFAs, mainly acetate, propionate, and butyrate), which are primarily derived from the gut microbiome, may exert anti-inflammatory and immunomodulatory effects, and regulate energy homeostasis. It has been suggested that weight loss may affect SCFA metabolism, but a systematic review of intervention studies is lacking. We aimed to systematically assess the effects of dietary, physical activity-based, and surgical weight-loss interventions among overweight [body mass index (BMI) 25-29.9kg/m2)] or obese (BMI ≥30kg/m2) adults (≥18 y) on concentrations of acetate, propionate, butyrate, and total SCFAs in blood, urine, or feces. We conducted a systematic literature search in PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to April 30, 2018 for randomized and nonrandomized weight-loss trials among overweight or obese adults, in which the concentrations of individual and total SCFAs were assessed. A total of 9 studies consisting of 2 randomized parallel-arm trials, 4 crossover trials, and 3 nonrandomized clinical or surgical trials were included. In the majority of studies, changes in fecal SCFA concentrations were assessed, whereas changes in serum SCFAs were reported from 1 trial. Individual and total SCFA concentrations either remained unchanged or decreased significantly following weight loss. Three of the dietary interventions that resulted in decreased SCFA concentrations were low (≤5% of energy) in total carbohydrates. Most of the studies had a high risk of bias. Decreases in SCFA concentrations may accompany weight loss induced by bariatric surgery or dietary restriction among overweight or obese adults, particularly when carbohydrate intake is reduced. However, findings were inconsistent and based on studies with high to unclear risk of bias, and small sample sizes. Because measurements of fecal SCFAs may not be ideal due to limited sample standardization, well-powered trials with repeated blood measurements of SCFAs are required. This review was registered at PROSPERO as CRD42018088716.

Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review.

Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia.MethodA systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017.ResultsThe search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis.Clinical implicationsThe most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.

Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews.

To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions. Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence. This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007-2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data. The effectiveness of educational nursing interventions was inconsistent on quality of life (QoL), attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients' coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue. Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions. Implementation of these nursing interventions into clinical practice is important to improve patients' knowledge and QoL as well as reducing various symptoms and side effects related to cancer and its treatment.

A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial

Because of the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking. To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence, and to examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months. Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were willing to temporarily forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice-weekly group classes and once-weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group), or a nonspecific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months. Of the 56 women randomized (28 to yoga, 28 to control), the mean age was 65.4 (±8.1) years (range, 55-83 years), the mean baseline incontinence frequency was 3.5 (±2.0) episodes/d, and 37 women (66%) had urgency-predominant incontinence. A total of 50 women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P= .19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P= .07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P= .045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. A total of 48 nonserious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice. Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program, and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women's clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.

The effectiveness of exercise-based interventions for preventing or treating postpartum depression: a systematic review and meta-analysis.

Postpartum depression can have detrimental effects on both a mother's physical and mental health and on her child's growth and emotional development. The aim of this study is to assess the effectiveness of exercise/physical activity-based interventions in preventing and treating postpartum depressive symptoms in primiparous and multiparous women to the end of the postnatal period at 52weeks postpartum. Electronic databases were searched for published and unpublished randomised controlled trials of exercise/physical activity-based interventions in preventing and treating depressive symptoms and increasing health-related quality of life in women from 4 to 52weeks postpartum. The results of the studies were meta-analysed and effect sizes with confidence intervals were calculated. The Grading of Recommendations Assessment and Development and Evaluation (GRADE) system was used to determine the confidence in the effect estimates. Eighteen trials conducted across a range of countries met the inclusion criteria. Most of the exercise interventions were aerobic and coaching compared to usual care, non-intervention and active controls. Small effect sizes of exercise-based interventions in reducing depressive symptoms were observed collectively and the quality of evidence was low across the individual studies. Although exercise-based interventions could create an alternative therapeutic approach for preventing major depression in postpartum women who experience subthreshold elevated depressive symptoms, the clinical effectiveness and the cost-effectiveness of exercise-based and physical activity interventions need to be better established. There is a need for further more rigorous testing of such interventions in high-quality randomised controlled trials against active control conditions before large-scale roll-out of these interventions in clinical practice is proposed.

Advanced Assessment of the Upper Limb in Tetraplegia: A Three-Tiered Approach to Characterizing Paralysis.

Background: More than half of all individuals who sustain a spinal cord injury (SCI) experience some degree of impairment in the upper limb. Functional use of the arm and hand is of paramount importance to these individuals. Fortunately, the number of clinical trials and advanced interventions targeting upper limb function are increasing, generating optimism for improved recovery and restoration after SCI. New interventions for restoring function and improving recovery require more detailed examination of the motor capacities of the upper limb. Objectives: The purpose of this article is to introduce a three-tiered approach to evaluating motor function, with specific attention to the characteristics of weak and fully paralyzed muscles during acute rehabilitation. The three tiers include (1) evaluation of voluntary strength via manual muscle testing, (2) evaluation of lower motor neuron integrity in upper motor neuron-paralyzed muscles using surface electrical stimulation, and (3) evaluation of latent motor responses in paralyzed muscles that exhibit a strong response to electrical stimulation, using surface electromyographic recording electrodes. These characteristics contribute important information that can be utilized to mitigate potential secondary conditions such as contractures and identify effective interventions such as activity-based interventions or reconstructive procedures. Our goal is to encourage frontline clinicians - occupational and physical therapists who are experts in muscle assessment - to consider a more in-depth analysis of paralysis after SCI. Conclusion: Given the rapid advancements in SCI research and clinical interventions, it is critical that methods of evaluation and classification evolve. The success or failure of these interventions may depend on the specific characteristics identified in our three-tiered assessment. Without this assessment, the physiological starting point for each individual is unknown, adding significant variability in the outcomes of these interventions.

Activity-based Rehabilitation Interventions of the Neurologically Impaired Upper Extremity: Description of a Scoping Review Protocol.

Introduction: A scoping review provides a means to synthesize and present a large body of literature on a broad topic, such as methods for various upper extremity activity-based therapy (ABT) interventions. Objectives: To describe our scoping review protocol to evaluate peer-reviewed articles focused on ABT interventions for individuals with neurologically impaired upper extremities. Methods: At Jefferson College of Health Professions and Sidney Kimmel Medical College at Jefferson, Philadelphia, the authors will follow this protocol to conduct a scoping review by establishing a research question and conducting a search of bibliographic databases to identify relevant studies. Using specific inclusion and exclusion criteria, abstracts will be screened and full-text articles will be reviewed for inclusion in charting, summarizing, and reporting results of appropriate studies. Conclusion: This protocol will guide the scoping review process to develop a framework for establishing a noninvasive ABT intervention informed by evidence for individuals with neurologically impaired upper extremities.

A systematic review of physical activity-based behaviour change interventions reaching men with prostate cancer.

Men who are survivors of prostate cancer report a variety of psychological and physical factors contributing to a lower quality of life, and physical activity can assist to mitigate these issues. This review aims to provide a summary of physical activity behaviour change trials targeting prostate cancer survivors, assess the feasibility of these interventions and, if possible, identify intervention and study characteristics associated with significant intervention effects. Four databases (PubMed, CINAHL, PsycINFO and EMBASE) were systematically searched for randomised controlled trials containing at least one behavioural outcome relating to physical activity published up until July 2016. Forward and backwards, hand, key author citation searching and known research were also considered. From a total of 13, 828 titles, the search resulted in 12 studies (6 prostate cancer only and 6 mixed cancer interventions), eight of which found positive results most often related immediately to post-intervention aerobic activity. Factors relating to efficacy were not conclusive due to the heterogeneity of studies and lack of cancer-specific data in mixed cancer trials. Future research focusing on intervention reach, maintenance of intervention effects and resistance training outcomes is needed. There is preliminary evidence to suggest that a variety of physical activity behaviour change interventions targeting men with a history of prostate cancer can be efficacious, at least in the short term. Experimental studies are required to identify key intervention features. Physical activity interventions can assist prostate cancer survivors in relation to short-term lifestyle change, though more evidence is required to improve the clarity of factors related to efficacy.

A systematic review of physical activity-based interventions in shift workers.

Shift workers are at increased risk of a range of chronic diseases and there is evidence to suggest that these risks can be ameliorated by physical activity. Little is known however about the efficacy of physical activity interventions in shift workers. The aim was therefore to critically review the literature to improve understanding of the efficacy of physical activity promotion initiatives for this occupational group.A systematic review of randomized controlled trials of physical activity in shift workers was conducted in 2016–2017 following the Preferred Reported Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Only seven studies were found.None of the studies measured changes in physical activity behaviour or reported on the timing or setting of the intervention protocols. Instead, most focused on health-related outcomes including body composition, fitness and sleep. Almost all provided physical activity ‘prescriptions’ with walking or ‘aerobic activity’ as the primary intervention mode and most reported significant improvements in one of the outcome measures.Although the findings suggest that physical activity may mitigate intermediate risk factors associated with non-communicable diseases (NCD) in shift workers, the studies offer little insight into physical activity behaviour change in this occupational group. Future research should assess actual changes in physical activity behaviour, and its determinants, as well as the reach and uptake of intervention strategies in this challenging population group.

Cultural Beliefs, Perceptions, and Practices of Young Adult Offspring of African Immigrants Regarding Healthy Eating and Activity.

African immigrants and their offspring are increasing in the United States. Yet little is known about the beliefs, perceptions, and practices of second-generation African immigrants regarding healthy eating and physical activities within the context of culture and environment. Five small group interviews using a focused ethnography qualitative method were conducted with 20 college-age students who were offspring of African immigrants. Data were analyzed using Leininger's four phases of analysis. Four themes emerged: (1) family, community, and religious ties to traditional African foods; (2) traditional African cuisine as healthy and american foods as nonhealthy; (3) eating patterns vary according to availability and resources; and (4) exercise patterns have familial, peer-driven, and generational influences. African food was a connection to family and the African community. Food choices and activities were strongly influenced by accessibility, social structures, and the environment. Dietary and activity-based interventions should include both American and African influences.

Vitamin D Status and Cardiovascular Risk in Obesity: Effect of Physical Activity in Nonvitamin D Supplemented Adolescents.

The relationship among inadequate vitamin D status, obesity, and cardiometabolic risk and the potential impact of physical activity-based interventions on vitamin D status are poorly characterized in children. This study aimed to address these issues. We studied a total of 21 adolescents (15 obese and 6 normal weight; age: 14-18 years; Tanner stage>IV). Adolescents with obesity (n = 15) underwent a randomized controlled (8 in the intervention group and 7 in the control group) 3-month physical activity-based lifestyle intervention. 25-Hydroxy vitamin D [25(OH)D] by mass spectrometry, adiponectin, leptin, high-sensitivity C-reactive protein (CRP), insulin, and glucose were measured and body composition was assessed by dual-energy x-ray absorptiometry (DXA). Analysis of covariance and mixed-effects model were used to compare mean change in 25(OH)D between intervention and nonintervention groups. Bootstrap method was used to validate the estimates and principle component analysis reduced the variables in the data for adjustment. 25(OH)D was lower (P < 0.001) in the obese versus lean adolescents. Homeostasis model assessment-insulin resistance, CRP, fat mass (FM), and body mass index z-score were negatively correlated with baseline 25(OH)D, while adiponectin showed a positive correlation. After adjustment for baseline biomarkers of cardiometabolic risk, the concentration of 25(OH)D increased in the obese intervention group (P = 0.06), but not in the nonintervention group. Fat-free mass increased and FM decreased (P < 0.05 for both) in the intervention group. The magnitudes of increase in 25(OH)D and decrease in FM directly correlated (P < 0.05). The increase in circulating 25(OH)D concentration by physical activity-based lifestyle-only intervention in adolescents with obesity, who did not receive vitamin D supplementation, suggests a putative independent role of physical activity-based interventions in the regulation of vitamin D status and potentially in the mitigation of risk factors of cardiovascular disease.

A development study and randomised feasibility trial of a tailored intervention to improve activity and reduce falls in older adults with mild cognitive impairment and mild dementia

BackgroundPeople with dementia progressively lose abilities and are prone to falling. Exercise- and activity-based interventions hold the prospect of increasing abilities, reducing falls, and slowing decline in cognition. Current falls prevention approaches are poorly suited to people with dementia, however, and are of uncertain effectiveness. We used multiple sources, and a co-production approach, to develop a new intervention, which we will evaluate in a feasibility randomised controlled trial (RCT), with embedded adherence, process and economic analyses.MethodsWe will recruit people with mild cognitive impairment or mild dementia from memory assessment clinics, and a family member or carer. We will randomise participants between a therapy programme with high intensity supervision over 12 months, a therapy programme with moderate intensity supervision over 3 months, and brief falls assessment and advice as a control intervention. The therapy programmes will be delivered at home by mental health specialist therapists and therapy assistants. We will measure activities of daily living, falls and a battery of intermediate and distal health status outcomes, including activity, balance, cognition, mood and quality of life. The main aim is to test recruitment and retention, intervention delivery, data collection and other trial processes in advance of a planned definitive RCT. We will also study motivation and adherence, and conduct a process evaluation to help understand why results occurred using mixed methods, including a qualitative interview study and scales measuring psychological, motivation and communication variables. We will undertake an economic study, including modelling of future impact and cost to end-of-life, and a social return on investment analysis.DiscussionIn this study, we aim to better understand the practicalities of both intervention and research delivery, and to generate substantial new knowledge on motivation, adherence and the approach to economic analysis. This will enable us to refine a novel intervention to promote activity and safety after a diagnosis of dementia, which will be evaluated in a definitive randomised controlled trial.Trial registrationClinicalTrials.gov: NCT02874300; ISRCTN 10550694.