Adapted Physical Activity Program Research Articles

Innovative Treatments to Counteract Endothelial Dysfunction in Chronic Kidney Disease Patients.

In chronic kidney disease (CKD) patients, several risk factors contribute to the development of endothelial dysfunction (ED), which can be described as an alteration in the cell structure or in the function of the endothelium. Among the well-known CKD-related risk factors capable of altering the production of endothelium-derived relaxing factors, we include asymmetric dimethylarginine increase, reduced dimethylarginine dimethylamine hydrolase enzyme activity, low-grade chronic systemic inflammation, hyperhomocysteinemia, oxidative stress, insulin resistance, alteration of calcium phosphorus metabolism, and early aging. In this review, we also examined the most important techniques useful for studying ED in humans, which are divided into indirect and direct methods. The direct study of coronary endothelial function is considered the gold standard technique to evaluate if ED is present. In addition to the discussion of the main pharmacological treatments useful to counteract ED in CKD patients (namely sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonist), we elucidate innovative non-pharmacological treatments that are successful in accompanying the pharmacological ones. Among them, the most important are the consumption of extra virgin olive oil with high intake of minor polar compounds, adherence to a plant-dominant, low-protein diet (LPD), an adaptive physical activity program and, finally, ketoanalogue administration in combination with the LPD or the very low-protein diet.

Adapted physical activity as part of the pre-habilitation program

Adapted physical activity (APA) is one of the pillars of prehabilitation. The creation and personalization of an APA program is based on an assessment carried out by the APA teacher, who identifies the patient's obstacles and levers. The aim of this personalized program assessment is to support the person being cared for in adopting a more active and less sedentary lifestyle, and to ensure that these changes have a positive impact on their health. Relying on resources in the city and on the patient's caregivers are all ways of reinforcing the patient's adherence to APA.

Effect of Adapted Physical Activity in Patients With Advanced Pancreatic Cancer: The APACaP GERCOR Randomized Trial.

The impact of adapted physical activity (APA) on health-related quality of life (HRQoL) in patients with advanced pancreatic ductal adenocarcinoma (aPDAC) is unknown. This study evaluated whether APA in addition to standard care improved HRQoL in patients who have aPDAC who are receiving first-line chemotherapy. Patients with locally advanced/metastatic PDAC and an ECOG performance status of 0 to 2 were randomized (1:1) to receive standard care (standard arm) or standard care plus a home-based 16-week APA program (APA arm). The primary objective was the effect of the APA program on 3 dimensions of the EORTC QLQ-C30: global health status, physical function, and fatigue at week 16 (W16), with a one-sided type I error of 0.017 for each dimension. The primary HRQoL analysis was performed in patients with available baseline and W16 scores for the dimensions (ie, the modified intention-to-treat population 1 [mITT1]), and secondary longitudinal HRQoL analyses using the mixed model for repeated measures (MMRM) and time until definitive deterioration (TUDD) methods were performed in the mITT1 population and in patients with baseline and at least one follow-up questionnaire (mITT2 population). A difference of ≥5 points was considered to be clinically relevant. Of 326 included patients, 313 were randomized to the standard (n=157) or APA (n=156) arms. In the mITT1 population (n=172), the mean differences in global health status, physical function, and fatigue at W16 adjusted from baseline were -0.98 (SD, 23.9; P=.39), -2.08 (SD, 21.3; P=.26), and 4.16 (SD, 29.2; P=.17), respectively, showing a non-statistically significant benefit with APA. In the mITT2 population (n=259), APA was associated with statistically significant and clinically relevant improvement in 5 and 8 dimensions of the HRQoL in the longitudinal MMRM and TUDD analyses, respectively. APA improved several dimensions of HRQoL in patients with aPDAC receiving first-line chemotherapy and standard care.

O.4.1-2 Linking lymphocyte T phenotype to physical capacities in a geriatric population: the VIF-APAS study

Abstract Purpose Potential mediators contributing to chronic inflammation in aging have both local and systemic impacts that likely promote physical decline. Supporting data in aged mice link modification of T cells to exercise performance leading to novel hypotheses involving the anti-inflammatory regulatory T cells (Tregs) in age-related changes in tissues. We investigated in a geriatric cohort whether physical markers of early signs of frailty and their reversibility would alter circulating Tregs prevalence and subtypes regarding their markers of senescence, function, and migration to tissues. Methods Geriatric patients able to walk without technical help, were included in a 12-weeks adapted physical activity (APA) program (NCT04080063). Multidisciplinary tools were used to assess the various aspects of human movement and frailty (isokinetic testing, bioelectric impedancemetry, nutrition, etc.). Relative NK, CD8+ and CD4+ T cells proportions were determined using flow cytometry in extracted peripheral blood monocytes. The transcription factor (FoxP3), the IL-2 receptor (CD25), the senescence (KLRG1) and migration (CCR4) markers were detected using intracellular staining and flow cytometry to discriminate the associated cell subsets and Tregs. Results 66 women (82.8 ± 6 yrs) and 23 men (82.3 ± 4 yrs) took part in the study. Only 42% had a compliance rate in the APA program over 70%. 44%, were frail, 44% pre-frail and 12% non-frail (Fried criteria). In a representative sample (n = 19), the prevalence of NK cells was 3 times higher in frail subjects. The consideration of markers (Foxp3, CD25, and CCR4) was shown to discriminate an association with some specific physical parameters that are characteristic of neuromuscular and metabolic functions: %CCR4+ cells among NK cells was negatively related to leg extensors maximum strength, and the absence of CD25 in Tregs (CD4+Foxp3+) cells was negatively related to walking distance and speed. Conclusions Our preliminary results that need to be confirmed seem to show differences in immune cell markers depending on the frailty status. This study will participate in determining immunometabolic biomarkers of frailty and vitality in a geriatric population. The aim is to promote personalized strategies to predict and counteract inflammaging in an early stage, and to accompany and evaluate adapted physical activity strategies.

Community-based physical activity promotion confers broad-spectrum benefits for military veterans with chronic and complex conditions: evidence from 4 years of rehabilitation consultant referrals

IntroductionVeterans experience a high incidence of chronic and complex health conditions requiring a holistic approach to health and well-being. The Adapted Physical Activity Program (APAP) is a theory-based programme developed...

Description of supportive care and feasibility of physical exercise program to improve quality of life in advanced melanoma patients.

Physical activity is the first-line treatment of cancer-related fatigue. It has shown benefits on patient's quality of life (QoL) when practiced during and after treatment. New treatments have drastically changed the prognosis of melanoma. Still, few data are available about research program of supportive care in advanced melanoma. The primary outcome was to assess the feasibility of setting up a prospective study evaluating the benefits of Adapted Physical Activity (APA) on the QoL of patients with advanced melanoma. Feasibility was defined with a combination of five criteria including completion of questionnaire, recruitment, participant retention, patient adhesion to supportive care, and absence of adverse event. Between September 2019 and March 2021, 271 melanoma patients were questioned. Around 60% of stage IV melanoma patients were interested in support care. Patient retention at 3 months was sufficient. Only one patient could not be evaluated after 3 months of enrolment because of deterioration of the general state. Adhesion to exercise and sessions was good. Supervised APA program appeared to be safe and well tolerated as no adverse events or discontinuations were reported. Setting up a prospective research program evaluating the benefits of physical activity in advanced melanoma patients seems feasible. With melanoma becoming a chronic disease, supportive care may reduce fatigue, improve QoL and help maintain a healthy lifestyle. Data supporting its benefits on this survivor population are needed.

Physical Activity Program for the Survival of Elderly Patients With Lymphoma: Study Protocol for Randomized Phase 3 Trial.

The practice of regular physical activity can reduce the incidence of certain cancers (colon, breast, and prostate) and improve overall survival after treatment by reducing fatigue and the risk of relapse. This impact on survival has only been demonstrated in active patients with lymphoma before and after treatment. As poor general health status reduces the chances of survival and these patients are most likely to also have sarcopenia, it is important to be able to improve their physical function through adapted physical activity (APA) as part of supportive care management. Unfortunately, APA is often saved for patients with advanced blood cancer. As a result, there is a lack of data regarding the impact of standardized regular practice of APA and concomitant chemotherapy as first-line treatment on lymphoma survival. This study aimed to assess the impact of a new and open rehabilitation program suitable for a frail population of patients treated for diffuse large B-cell lymphoma (DLBCL). PHARAOM (Physical Activity Program for the Survival of Elderly Patients with Lymphoma) is a phase 3 randomized (1:1) study focusing on a frail population of patients treated for DLBCL. The study will include 186 older adult patients with DLBCL (aged >65 years) receiving rituximab and chemotherapy. Overall, 50% (93/186) of patients (investigational group) will receive APA along with chemotherapy, and they will be supervised by a dedicated qualified kinesiologist. The APA program will include endurance and resistance training at moderate intensity 3 times a week during the 6 months of chemotherapy. The primary end point of this study will be event-free survival of the patients. The secondary end points will include the overall survival, progression-free survival, prevalence of sarcopenia and undernutrition, and patients' quality of life. This study will be conducted in accordance with the principles of the Declaration of Helsinki. Recruitment, enrollment, and data collection began in February 2021, and 4 participants have been enrolled in the study as of July 2022. Data analysis will begin after the completion of data collection. Future outcomes will be published in peer-reviewed health-related research journals and presented at national congress, and state professional meetings. This publication is based on protocol version 1.1, August 3, 2020. The PHARAOM study focuses on highlighting the benefits of APA intervention on survival during the period of first-line treatment of patients with DLBCL. This study could also contribute to our understanding of how an APA program can reduce complications such as sarcopenia in patients with lymphoma and improve their quality of life. By documenting the prevalence and relationship between sarcopenia and exercise load, we might be able to help physicians plan better interventions in the care of patients with DLBCL. ClinicalTrials.gov NCT04670029; https://clinicaltrials.gov/ct2/show/NCT04670029. DERR1-10.2196/40969.

Predictors of women's attendance in a home-based adapted physical activity program during localized breast cancer treatment.

The objective of this study is to evaluate predictors for attendance in a home-based adapted physical activity (APA) program for women with breast cancer during chemotherapy and radiotherapy treatment. This retrospective study was based on two prospective studies (SAPA and APAC), including a total of 73 patients with localized breast cancer during their treatment period. The same APA program lasting 27weeks was proposed and registered. It consisted of three physical activity sessions (two aerobic and one strength training) per week. The predictors (age, height, body weight, body mass index (BMI), VO2peak, 6-min walking test distance (6MWT), fatigue (MFI), quality of life (EORTC-QLQ), anxiety and depression (HADS), and previous physical activity (IPAQ)) were evaluated before the APA program. According to the multivariate regression analysis, the baseline 6MWT distance and quality of life were predictive of good attendance in the APA program. The univariate analysis showed that initial VO2peak, body weight, BMI, and fatigue influenced attendance in the APA program. This study helps to better understand the profile of patients who would be participative or non-participative in an APA program. 6MWT distance and quality of life accounted for 19% of attendance in an APA program before the start of treatment. These correlations between the initial predictors of women with breast cancer and their attendance in the APA program during their treatment period make it possible to adapt physical activity professional practices to these patients.

P07-02 Prescription of adapted physical activity: expectations of patients consulting general practitioners in the department of Yvelines

BackgroundSince 2016, French law has allowed general practitioners to prescribe adapted physical activity (APA) to patients with long-term health conditions. Studies have demonstrated that physicians are interested in this practice but very few have surveyed patient expectations.ObjectiveThe objective of this work was to study patients' expectations regarding the prescription of APA.MethodsThis is a quantitative descriptive study treating data obtained from a survey carried out in general practice offices in the department of Yvelines between June and September 2019. The inclusion criteria for patients were: above 18 years old and present in the waiting room.Results252 patients were surveyed in 9 doctors' offices. We received 90% of responses. Prescription of APA is a good idea for 95.2% of patients, 80.2% were motivated to join an APA program and 67.4% thought that prescription of APA would increase their motivation. The main constraints to physical activity practice were lack of time (59.9%) and lack of motivation (31.7%). The main practices that would help patients to better adhere to an APA program were group sessions supervised by a professional (64.7%) pursued by a follow up with their doctor (41.7%). 53.2% of patients considered that it would be important to monitor their physical activity through a connected device. Factors independently associated with the motivation to participate in the APA program were a female gender (p > 0.01), a bachelor's degree (p = 0.01), a general opinion that prescription of physical activity is a good idea (p > 0.01).ConclusionOur results revealed an enthusiasm with patients for APA prescription, which is interesting for the promotion of PA in general medicine.

Participatory co-creation of an adapted physical activity program for adults with moderate-to-severe traumatic brain injury.

BackgroundResearch about using physical activity (PA) to improve health, quality of life, and participation after moderate-to-severe traumatic brain injury (TBI) is receiving growing attention. However, best-practices for maintaining PA participation after TBI have yet to be defined. In this context, a team of researchers and stakeholders with a moderate-to-severe TBI (including program participants and peer mentors) participated in a co-creation process to optimize a 9-month, 3-phased, community-based, adapted PA program named TBI-Health.PurposeThe study aimed to provide a detailed account of the participation in and co-creation of a new TBI-Health Program to enhance sport and exercise participation for adults with moderate-to-severe TBI. Specifically, we carried out an in-depth exploration of the perceived experiences and outcomes of users over one cycle of the program to assist the co-creation process.MethodsAn interpretive case study approach was used to explore the experiences and outcomes of the participatory co-creation within and across phases of the TBI-Health program. A purposeful sample of fourteen adults with moderate-to-severe TBI (program participants n = 10; peer mentors n = 4) were involved in audio-recorded focus groups after each program phase. Reflexive thematic analyses within and across the phases identified three higher-order themes.ResultsProgram Participation included barriers, facilitators, sources of motivation and suggested modifications to optimize the program; Biopsychosocial Changes highlighted perceived physical, psychological, and social outcomes, by self and others, that resulted from program participation; PA Autonomy emphasized transitions in knowledge, sex- and gender-related beliefs, and abilities related to exercise and sport participation.ConclusionsStudy findings suggest the TBI-Health program can increase autonomy for and reduce barriers to PA for adults with moderate-to-severe TBI, which results in increased PA participation and important physical, psychological, and social benefits. More research is needed about the TBI-Health program with larger samples.

Adapted physical activity in patients (Pts) with advanced pancreatic cancer (APACaP): Results from a prospective national randomized GERCOR trial.

4007 Background: The benefit of adapted physical activity (APA) on health-related quality of life (HRQoL) in Pts with advanced pancreatic ductal adenocarcinoma (aPDAC) treated by chemotherapy (CTx) has never been prospectively assessed. Methods: Pts with aPDAC and ECOG performance status (PS) 0–2 were randomized 1:1 to receive usual care (UC) including first-line CTx at the investigator’s choice (standard arm), or UC plus a home-based 16-week APA program (APA arm). The APA program consisted of personalized aerobic and resistance exercises, with a weekly remote supervision by an APA professional trainer, and unsupervised sessions with a family member or friend (APA partner). The primary objective was the effect on HRQoL at week 16 (W16) measured by 3 dimensions of the EORTC QLQ-C30, global health status (GHS), physical functioning (PF), and fatigue (FA), with a one-sided type I error of 0.016 for each dimension. The primary HRQoL analysis was performed in Pts with available baseline and W16 scores for the 3 targeted dimensions (mITT1). Secondary analyses of HRQoL changes by the mixed model for repeated measures (MMRM) and time until definitive deterioration (TUDD) methods included Pts with baseline and ≥1 follow-up score (mITT2). Differences > 5 points in scores were considered clinically significant. Results: A total of 313 Pts (median age: 64 years; men: 55%, ECOG PS 0-1: 93%; metastatic: 77%; FOLFIRINOX: 78%, gemcitabine-based: 13%) were included from 11/2014 to 10/2020 (standard arm: n = 157, APA arm: n = 156). In the mITT1 population (n = 172), mean differences in HRQoL at W16 adjusted from baseline were -0.98 (SD 23.87; p = 0.39), -2.08 (SD 21.34; p = 0.26), and 4.16 (SD 29.18; p = 0.18) for GHS, PF, and FA, respectively. In the mITT2 population (n = 259), APA was associated with significant improvements in 5 (GHS, PF, cognitive functioning [CF], social functioning [SF], appetite loss) and 8 (GHS, CF, emotional functioning [EF], SF, insomnia, constipation, pain, financial difficulties) dimensions of HRQoL by MMRM and TUDD, respectively (Table). Secondary endpoints, including overall survival, progression-free survival, and chemotherapy toxicity will be presented. Conclusions: APA in combination with usual care improved several dimensions of HRQoL in Pts with aPDAC receiving first-line CTx. Clinical trial information: NCT02184663. [Table: see text]

Feasibility and Impact of Adapted Physical Activity (APA) in Cancer Outpatients Beginning Medical Anti-Tumoral Treatment: The UMA-CHAPA Study.

Simple SummaryPhysical activity may reduce the risk of overall cancer incidence and improve survival in cancer patients. The beneficial effects of physical activity are also described in cancer survivors but remains poorly known during systemic cancer treatment. Therefore, we studied the feasibility of an adapted physical activity (APA) program in cancer outpatients beginning a medical anti-tumoral treatment for a digestive, lung, hematological, or dermatological cancer. We also studied the impact of APA on fatigue, anxiety, depression, and handgrip strength.Adapted physical activity (APA) improves quality of life and cancer outcomes. The aim of this study was to assess the feasibility of an APA program in outpatients beginning medical anticancer treatment. The secondary objective was to assess the impact of APA on fatigue, anxiety, depression, and handgrip strength (HGS). This prospective study was conducted between January and July 2017. Among 226 patients beginning treatment in the unit for a digestive, lung, hematological, or dermatological cancer, 163 were included. Adherence to the APA program was defined as more than or equal to one one-hour session per week for 3 months. The first evaluation was conducted at 3 months (M3), and the second evaluation at 6 months (M6). A total of 163 patients were included (mean age 62.5 ± 14.3); 139 (85.3%) agreed to follow the APA program. At M3, 106 of them were evaluated, of which 86 (81.1%) declared that they had followed the program. Improvement in anxiety was observed at M3 (−1.0 ± 3.2; p = 0.002) but there was no significant change in fatigue or depression. HGS decreased significantly (−1.2 ± 5.5; p = 0.04). The APA program was feasible in cancer outpatients beginning medical anticancer treatment. APA should be part of standard support care.

Correlations Between Physical Activity Level, Quality of Life, and Cognitive Performance in Elderly Individuals Engaging in Multi-Year Dance Activities.

It is well-acknowledged that cognitive and physical decline associated with aging can be prevented or reduced with the engagement in regular physical activity (PA). Dance activities combine cardiovascular, cognitive, and coordinative demands, providing a popular leisure PA among elderly. This study examined the correlations between quality of life (QoL), cognitive and physical performance, and PA level in older adults who participated in at least 10 years of amateur ballroom dancing. <br/>Methods: The study was designed as an observational study. A sample of 20 (10 men; age range: 65 to 80 years; BMI: 26.3 ± 3.0 kg/m²) amateur senior dancers were compared with a sample of 18 (8 men; age range: 65 to 75 years; BMI: 25.5 ± 2.4 kg/m²) non-sedentary individuals (control group) following an adapted PA program. Quality of life and cognitive functioning assessment tools were administered: 36 Health Status Survey (SF-36v2), Montreal Cognitive Assessment (MoCA), and Cognitive Reserve Index questionnaire (CRIq). Physical performance was measured with their preferred walking speed (PWS), and level of moderate to vigorous physical activity (MVPA) was evaluated using a multi-sensor activity monitor. <br/>Results: Participants presented a good SF-36v2 physical component and a very good mental com- ponent summary, a total MoCA score within the limits, and an average total CRIq score. Their PWS and daily MVPA were high. Differences neither in the three questionnaires nor in PWS and PA level were observed between groups. A significant, moderate, and positive correlation was found between PWS and SF-36v2 physical component summary score. <br/>Conclusion: Ballroom dancing seems to allow elderly individuals to maintain good cognitive and physical abilities, QoL, an acceptable normal cognitive reserve, notable physical performance, and PA level to the same extent as an adapted PA program. Both types of PA seem to be able to contrast the mental and physical decline associated with aging.

Barriers and Facilitators of Physical Activity Participation among Children and Adolescents with Intellectual Disabilities: A Scoping Review.

Background: Children and adolescents with intellectual disabilities (ID) have low levels of physical activity (PA). Understanding factors influencing the PA participation of this population is essential to the design of effective interventions. The purposes of this study were to identify and map the barriers and facilitators of PA participation among children and adolescents with ID. Methods: A scoping review was conducted in accordance with established methodology. Articles were evaluated for relevance using predetermined inclusion criteria in eight databases. Extracted barriers and facilitators were classified using the social ecological model as individual, interpersonal, or environmental factors. Results: Thirty-two studies published between 1992 and 2020 were included (24 quantitative, 6 qualitative, and 2 mixed-method). Thirty-four factors were identified. The most commonly reported barriers included disability-specific factors, low self-efficacy, lack of parental support, inadequate or inaccessible facilities, and lack of appropriate programs. The most commonly reported facilitators included high self-efficacy, enjoyment of PA, sufficient parental support, social interaction with peers, attending school physical education (PE) classes, and adapted PA programs. Conclusions: Continued exploration of factors influencing PA participation is required among children and adolescents with ID. Future interventions should involve families, schools, and wider support network in promoting their PA participation together.

Development and evaluation of an adapted physical activity program in anorexia nervosa inpatients: A pilot study.

Problematic use of physical activity is frequent in subjects with anorexia nervosa (AN). Although it increases resistance to therapeutic treatment, paradoxically, physical activity in AN can also improve mental and physical health. Based on the literature review we hypothesized that adding an adapted physical activity (APA) program to treatment programs could be more beneficial than a total suppression of physical activities. We designed this open study to evaluate the outcome of AN inpatients after an APA program implementation as well as the perceived effect of APA. Forty-one women with AN (17.2 (±2.5) years old, BMI of 16.86 (±2.0)) were included. An eight-session (1 h30/session/week) standardized APA program was delivered and evaluated by structured questionnaires assessing exercise dependence, perceived physical activity, eating disorder (ED) symptoms, body mass index (BMI), along with an interview before and after the APA program. Twenty-nine women complete the PA program and evaluation. BMI and perceived PA score significantly increased, ED and exercise dependence scores significantly decreased (p < .01). Participants appreciated the program. The inpatient program which included APA program helped AN inpatients in decreasing their ED symptoms and their dependence to PA, without any deleterious effect on BMI. Furthermore, APA was appreciated by participants.

Prescription of physical activity: expectations of patients consulting in primary care in Yvelines

Abstract Background Since 2016, French law has allowed general practitioners to prescribe adapted physical activity (APA) to patients with long-term health conditions. Studies have demonstrated that physicians are interested in this practice but very few have surveyed patient expectations. Objective The objective of this work was to study patients' expectations regarding the prescription of APA. Materials and Methods This is a quantitative descriptive study treating data obtained from a survey carried out in general practice offices in the department of Yvelines between June and September 2019. The inclusion criteria for patients were: above 18 years old and present in the waiting room. Results 252 patients were surveyed in 9 doctors' offices. We received 90 % of responses. Prescription of APA is a good idea for 95,2 % of patients, 80,2 % were motivated to join an APA program and 67,4 % thought that prescription of APA would increase their motivation. The main constraints to physical activity practice were lack of time (59,9 %) and lack of motivation (31,7 %). The main practices that would help patients to better adhere to an APA program were group sessions supervised by a professional (64,7 %) pursued by a follow up with their doctor (41,7 %). 53,2 % of patients considered that it would be important to monitor their physical activity through a connected device. Factors independently associated with the motivation to participate in the APA program were a female gender (p &amp;lt; 0,01), a bachelor's degree (p = 0,01), a general opinion that prescription of physical activity is a good idea (p &amp;lt; 0,01). Conclusions Our results revealed an enthusiasm with patients for APA prescription, which is interesting for the promotion of PA in general medicine. Key messages Our results revealed an enthusiasm with patients for prescription of physical activity. Prescribing physical activity to patients seems to be an innovative way to promote physical activity.

Do Written Resources Help or Hinder Equitable and Inclusive Physical Activity Promotion?

ABSTRACT To sensitize individuals, organizations, and communities to the sociostructural barriers individuals with disabilities face, Mace et al. (1997) advanced seven principles of universal design (as cited by the Center for Excellence in Universal Design, n.d.). Each principle provides guidance on how spaces, products, and services can be developed or adapted to encourage usability by all individuals. Researchers and practitioners in adapted physical activity (APA) have worked to further extend the application of the principles of universal design into the physical domain, which helps expand opportunities for all to fully participate within exercise, sport, and physically active recreation. A less scrutinized sociostructural barrier in APA promotion is the suitability of materials used to teach adults experiencing disability ways to adapt leisure and exercise routines (Thomas & Cardinal, 2020a). However, on the basis of a recent meta-analysis (Thomas et al., 2018), knowledge of the degree suitability issues pervading materials used in routine APA promotion strategies or programs is limited. Further, it appears research has yet to gauge the prevalence of suitability issues in physical activity promotion from a broader universal design framework. These gaps in kinesiology knowledge represent fruitful lines of future research. In this essay, we present recommendations for future research toward addressing suitability knowledge gaps within APA promotion. Consistent with the call for leadership beyond college and university campuses to drive change as experts (NAKHE Newsletter, 2019, p. 4), such lines of inquiry would promote the dissemination of resources that support efforts to bring about full participation in the physical domain.

The Effect of Peer-Mediated Adaptive Physical Activity Program on Problem Behaviors of Mentally Handicapped Students

The aim of this study was to investigate the effect of peer-mediated adaptive physical activity program on problem behaviors of mentally handicapped students. Eight mentally handicapped students and eight peer students with normal development participated in this study, which was designed according to a sequential descriptive design. In the research, peer education program was applied to the peer students in line with the skills expected to be exhibited during the practices. In the study, Problem Behavior Sub-Scale (PBS), which is one of the subscales of Social Skills Rating System (SSRS) developed by Gresham and Elliot (1990) and Turkish adaptation by Sucuoglu and Ozokcu (2005) was used as a quantitative data collection tool. As a qualitative data collection tool, semi-structured interview form was used. The Friedman test was used to analyze the quantitative data, and Wilcoxon Signs test was used to determine the source of the difference. Significance value was determined as 0.05. In the analysis of qualitative data, content analysis was applied. The quantitative findings of the study showed that the peer-mediated APA program was effective on the problem behaviors of mentally handicapped students and that the skills acquired as a result of the practice were maintained by the children three weeks after the completion of the practices. In the qualitative findings, the teachers stated that after the peer-mediated APA program, there were positive developments in the ability of mentally handicapped students to experience push-pull, touch discomfort, fear, trust, power control with their peers and to act in accordance with the instructions. The obtained qualitative and quantitative findings showed that peer mediated APA program had positive effects on the problem behaviors of mentally handicapped students.

A bio-psycho-social approach in elderly population: outcome of adapted physical activity in patients with osteoarthritis.

The beneficial effect of physical activity on a large spectrum of diseases is well known, with particular importance for elderly people. Among the different types of activity, adapted physical activity (APA) has been applied in a number of disease-related physical deficit. The purpose of this study is to determine the outcome of a six months APA program in elder patients with osteoarthritis concerning physical and functional health and as second endpoint to determine the potential effect of AFA on reducing the risk of institutionalization. The clinical indexes used to assess the outcome included the Blaylock Risk Assessment Screening Score (BRASS), the Psychological General Well Being Index (PGWBI), the Cumulative Illness Rating Scale (CIRS), the Short Physical Performance Battery (SPPB), and the visual analogue scale (VAS). A significant difference (p = 0.047) between the pre-APA and the post-APA value was found for BRASS, and highly significant differences (p <0.0001) were found for SPBB and VAS. These findings show that a six months APA program in elder patients with osteoarthritis improves physical function, reduces pain intensity and decreases the risk of institutionalization. Moreover the positive outcome of APA we found in elder patients with osteoarthritis suggests a more frequent use of such rehabilitation approach, also evaluating its economic impact on this disease.

Adherence to an adapted physical activity program in sedentary adults

Background/Objective. Physical exercise plays a key role in the prevention and prognosis of chronic diseases. Despite this evidence, a low percentage of patients regularly perform physical activity. A better understanding of the variables associated with poor adherence may help to develop some strategies to encourage people to participate in exercise interventions. This study investigated the factors influencing adherence to an Adapted Physical Activity (APA) program in subjects suffering from Acute Coronary Syndrome (ACS) clinically stable, Type 2 diabetes, or metabolic syndrome. Secondary end point was to test the efficacy of the exercise training on fitness parameters (VO 2 , Speed and Time) by 1 km test. Methods. The program was planned in two phases. Phase 1: individual and supervised training free program for 4 weeks; Phase 2: paid training supervised program involved small groups of 4-6 participants for 8 weeks. Results. 117 patients (50-64 years, 49 men and 68 women) started the APA program, but only 32 patients (17 men and 15 women) completed phase 2. As collected during telephone interviews, the main factors that influenced adherence including health status, work commitments or family problems. Regarding the physical efficacy, an improvement of the three fitness parameters was observed in the 32 patients who completed the 12 weeks of the APA program. Conclusions. The identification of factors that can influence adherence to exercise programs is the first step in planning and improving health interventions. These parameters have an important public health interest.