Exercise Management Research Articles

Understanding the delivery of the Falls Management Exercise Programme (FaME) across the U.K.

1) Map FaME delivery across the UK, 2) explore and understand delivery of the FaME programme in practice. Sequential exploratory mixed methods. 1) survey of n=247 Postural Stability Instructor (PSIs) across the UK, 2) purposively sampled n=23 PSIs to take part in interviews. Quantitative data was described descriptively due to low sample size, and qualitative data coded using thematic analysis. Instructors pre-dominantly delivered classes in a community-setting, were mostly White British females with a range of experience. Most respondents were exercise instructors, physiotherapists, or therapist assistants. Only 136 (55.1%) respondents currently delivered the programme. The essential components of the FaME programme that instructors did not implement routinely were backward chaining, floorwork and Tai Chi. Five main themes emerged from qualitative data: individual, delivery and set-up, evidence-based delivery, motivational strategies, and instructor-based factors. Most instructors reported fidelity to most components of FaME and shared barriers and facilitators to delivering classes. This study gives a UK overview of the implementation of FaME. PSIs present a complex picture of the ways set-up and delivery of evidence-based programmes in practice can influence older adults' attendance, adherence and experience of the programme, and barriers and facilitators to delivery of the programme with fidelity.

Exercise in the management of polycystic ovary syndrome: A position statement from Exercise and Sports Science Australia

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition amongst females of reproductive age, leading to lifelong cardiometabolic, reproductive, psychological, and dermatologic symptoms as well as a reduced quality of life. Lifestyle interventions, which can include structured exercise programmes delivered by appropriately trained exercise professionals such as clinical exercise physiologists, are considered first-line strategies in PCOS management due to their therapeutic effects on various health outcomes and quality of life. This position statement builds on the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS and describes the role of the exercise professional in the context of the multidisciplinary care team which includes physicians and allied health professionals. This position statement aims to equip exercise professionals with a broad understanding of the pathophysiology of PCOS, how it is diagnosed and managed in clinical practice, and evidence- and consensus-based recommendations for physical activity and exercise in PCOS management. In line with the physical activity recommendations for the general public, individuals with PCOS should aim to undertake between 150 to 300min of moderate-intensity or 75 to 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week. Additionally, muscle-strengthening activities on two non-consecutive days per week are recommended to maintain health and prevent weight gain. For further health benefits and to achieve modest weight loss, individuals with PCOS should aim for a minimum of 250min of moderate-intensity or 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week, plus muscle-strengthening activities on two non-consecutive days per week. Adolescents with PCOS should aim for a minimum of 60min moderate- to vigorous-intensity activity each day, incorporating muscle- and bone-strengthening activities three times per week. Finally, exercise professionals should consider the significant psychological burden, including weight stigma, and the high prevalence of comorbidities amongst individuals with PCOS and take appropriate measures to deliver safe and efficacious exercise interventions.

Protocol of exercises for home management of the hemiplegic patient

Background: Stroke represents the second cause of death and the first cause of disability in adults worldwide. Hemiplegia is the main sequel of ischemic stroke. It presents muscular alterations such as spasticity and lack of coordination. It also produces abnormalities in balance and gait, increasing the rate of falls. Physical rehabilitation through exercises is essential. There is not enough information for the caregiver to perform the exercises. Objective: to implement an exercise protocol to improve the home management of the hemiplegic patient that favors the reduction of spasticity and the risk of falls. Methods: It is a longitudinal, analytical study with a quantitative approach. It was developed in 15 people with hemiplegia by the Home Care Project for People with Disabilities of Palora Canton, Ecuador. The ages were from 20 to 64 years. The intervention was performed 3 times a week in each home. The Tinetti test and the Ashworth test were used for the initial evaluation. For the final evaluation, the Wilcoxon method was used. Results: a predominance was evidenced in the female gender 53.3% and the age range between 27 to 63 years 86.7% in the hypothesis testing of the Tinetti test (risk of falls) and Ashworth test (spasticity) where the results the value p<0.001 (asymptotic significance) With this data, the null hypothesis is rejected. Conclusions: It was determined that the exercise protocol for home management of the hemiplegic patient decreases the risk of falls and spasticity.

“ANYTHING WOULD BE A WIN IF YOU’RE STRUGGLING.” – EXPLORING EXERCISE AND PHYSICAL ACTIVITY IN PEOPLE LIVING WITH IDIOPATHIC HYPERSOMNIA

INTRODUCTION Idiopathic hypersomnia (IH) is a debilitating sleep condition characterised by excessive daytime sleepiness. The potential to moderate symptoms through lifestyle factors such as physical activity has not been explored, and current management focuses on medication. Exercise reduces fatigue and increases energy in the general population, and while some publications note physical activity as a potential avenue to manage symptoms of IH, there is no specific evidence related to exercise in this condition. The aim of this project was to explore the experiences of people living with IH in relation to: self-efficacy and exercise, exercise for symptom management, diagnosis related sources of information to support exercise, perceived ideal exercise prescription and the interaction between exercise and current management strategies and treatment approaches. METHODS Qualitative data was collected through semi-structured interviews with 14 participants. This was transcribed and analysed using a modified codebook analysis to construct overarching themes and subthemes. RESULTS Three overarching themes were constructed. The first theme described a lack of exercise advice, outlined the interaction between exercise and condition management strategies and symptoms and outlined the diverse range of activities people with IH engage with. The second theme explored the positive and negative factors of exercise self-efficacy, as well as reported barriers and facilitators of exercise. The third theme “A consumer-led exercise prescription” details a best practice (FITT) potential exercise prescription informed by the opinions and experiences of people with IH. DISCUSSION This is the first study exploring exercise and physical activity in people living with IH. It provides valuable insight regarding potential future exercise interventions for clinicians, future researchers and people living with IH.

Comparing Pilates and Gym Ball Exercises for Primary Dysmenorrhea Management: An Empirical Study.

Primary dysmenorrhea, commonly known as menstrual cramps, is a prevalent gynecological issue that impacts many women in their childbearing age. It manifests as reoccurring, cramp-like lower abdominal pain, usually commencing right prior to or during the menstrual period. These painful sensations can be severe, extending to the lower back and upper thighs can greatly disrupt a woman's daily life and overall well-being. The optimal exercise approach is needed for individuals seeking relief from primary dysmenorrhea, allowing healthcare providers and women themselves to make informed decisions regarding their treatment options. Though many forms of exercise interventions exist in the treatment of primary dysmenorrhea,this study aimsto compare two forms of intervention namely pilates and gym ball exercises on pain and menstrual distress among women with Primary Dysmenorrhea. This experimental comparative study was carried out with 30 young female participants over a 12-week period. Participant recruitment was done through a simple random sampling method. The criteria of inclusion encompassed young females aged 17-25 years, those in good health, and those experiencing primary dysmenorrhea. Exclusion criteria included secondary dysmenorrhea, medication use, polycystic ovarian syndrome, bleeding disorders, positive pregnancy tests, breastfeeding, and other medical conditions. Group A received Pilates exercises, while Group B underwent Gym ball exercises. The assessment of both groups' menstrual distress levels was conducted using the Moos Menstrual Distress Questionnaire (MDQ) and pain scores using the Visual Analog Scale (VAS). In the statistical analysis, Group A (Pilates Exercises) showed a significantly lower mean value (2.60) on the VAS compared to Group B (Swiss Ball Exercises) (5.46), with both groups experiencing a notable reduction in post-test scores (p ≤ 0.001). Additionally, on the MOOS MDQ score, Group A (Pilates Exercises) achieved a lower mean value (79.33) compared to Group B (Swiss Ball Exercises) (103.26), with both groups demonstrating a significant decrease in post-test scores (p ≤ 0.001). In conclusion, this study underscores the significance of exercise therapy, particularly Pilates exercises, as a holistic approach to addressing primary dysmenorrhea, improving physical well-being, and enhancing the overall quality of life.

Effects of dual-task resistance exercise on cognition, mood, depression, functional fitness, and activities of daily living in older adults with cognitive impairment: a single-blinded, randomized controlled trial

BackgroundRegular exercise is emphasized for the improvement of functional capacity and independence of older adults. This study aimed to compare the effects of a dual-task resistance exercise program and resistance exercise on cognition, mood, depression, physical function, and activities of daily living (ADL) in older adults with cognitive impairment.MethodsA total of 44 older adults participated in the study. Participants were randomly allocated to an experimental group (n = 22) performing a dual-task resistance exercise program for cognitive function improvement and a control group (n = 22) performing a resistance exercise program. Both groups performed the exercise for 40 min per session, three times a week, for 6 weeks (18 sessions). Cognition, mood, depression, functional fitness, and ADL were quantified before and after the intervention using the Mini-Mental State Examination (MMSE), profile of mood states (POMS), geriatric depression scale (GDS), senior fitness test (SFT), and Korean version of ADL, respectively.ResultsThere was a significant time and group interaction on the MMSE (p = 0.044). There were no significant time and group interactions in the POMS, GDS, SFT, or ADL. Cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after dual-task resistance exercise, and cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after resistance exercise.ConclusionsDual-task resistance exercise is more effective than resistance exercise in improving cognitive function in older adults with cognitive impairment. Both dual-task resistance exercise and resistance exercise improves mood, depression, functional fitness, and ADL after the intervention. We propose using dual-task resistance exercises for cognitive and physical health management in the older adults with cognitive impairment.Trial registrationThis study was registered with the Clinical Research Information Service (WHO International Clinical Trials Registry Platform) (Registration ID, KCT0005389; Registration date, 09/09/2020).

Hospital preparedness assessment for road traffic accidents with mass casualties: a cross-sectional study in Kurdistan Province, Iran

BackgroundRoad traffic accidents (RTAs) are predicted to become the world’s seventh leading cause of death by 2030. Given the significant impact of RTAs on public health, effective hospital preparedness plays a pivotal role in managing and mitigating associated health and life-threatening issues. This study aims to meticulously evaluate the preparedness of selected hospitals in western Iran to handle road traffic accidents with mass casualties (RTAs-MC).MethodsThe study employed a descriptive-analytical approach, utilizing a reliable and valid questionnaire to measure hospitals’ preparedness levels. Descriptive statistics (frequency distribution and mean) were utilized to provide an overview of the data, followed by analytical statistics (Spearman correlation test) to examine the relationship between hospital preparedness and its dimensions with the hospital profile. Data analysis, performed using SPSS software, categorized preparedness levels as weak, moderate, or high.ResultsThe study found that hospitals in Kurdistan province had a favorable preparedness level (70.30) to respond to RTAs-MC. The cooperation and coordination domain had the highest preparedness level (98.75), while the human resource management (59.44) and training and exercise (54.00) domains had the lowest preparedness levels. The analysis revealed a significant relationship between hospital preparedness and hospital profile, including factors such as hospital specialty, number of beds, ambulances, staff, and specialized personnel, such as emergency medicine specialists.ConclusionEnhancing preparedness for RTAs-MC necessitates developing response plans to improve hospital profile, considering the region’s geographic and topographic features, utilizing past experiences and lessons learned, implementing of Hospital Incident Command System (HICS), providing medical infrastructure and equipment, establishing communication channels, promoting cooperation and coordination, and creating training and exercise programs.

Risk assessment and source analysis of heavy metals in soil around an asbestos mine in an arid plateau region, China

Asbestos is widely used in construction, manufacturing, and other common industrial fields. Human activities such as mining, processing, and transportation can release heavy metals from asbestos into the surrounding soil environment, posing a health hazard to the mining area's environment and its surrounding residents. The purpose of the present study was to determine the extent of ecological and human health damage caused by asbestos pollution, as well as the primary contributors to the contamination, by examining a large asbestos mine and the surrounding soil in China. The level of heavy metal pollution in soil and sources were analyzed using methods such as the geo-accumulation index (Igeo), potential ecological risk index (RI), and positive matrix factorization (PMF) model. A Monte Carlo simulation-based health risk model was employed to assess the health risks of heavy metals in the study area’s soil to human beings. The results showed that the concentrations of As, Pb, Cr, Cu, and Ni in the soil were 1.74, 0.13, 13.31, 0.33, and 33.37 times higher than the local soil background values, respectively. The Igeo assessment indicated significant accumulation effects for Ni, Cr, and As. The RI evaluation revealed extremely high comprehensive ecological risks (RI ≥ 444) in the vicinity of the waste residue heap and beneficiation area, with Ni exhibiting strong individual potential ecological risk (Eir ≥ 320). The soil health risk assessment demonstrated that As and Cr posed carcinogenic risks to adults, with mean carcinogenic indices (CR) of 1.56E − 05 and 4.14E − 06, respectively. As, Cr, and Cd posed carcinogenic risks to children, with mean CRs of 1.08E − 04, 1.61E − 05, and 2.68E − 06, respectively. Cr also posed certain non-carcinogenic risks to both adults and children. The PMF model identified asbestos contamination as the primary source of heavy metals in the soil surrounding the asbestos mining area, contributing to 79.0%. According to this study, it is recommended that management exercise oversight and regulation over the concentrations of Ni, Cr, Cd, and As in the soil adjacent to asbestos mines, establish a designated control zone to restrict population activities, and locate residential zones at a safe distance from the asbestos mine production zone.

Negotiating epistemic asymmetries during crisis management exercises: Pre-emptive and corrective practices

Abstract This study investigates interactional practices to negotiate epistemic asymmetries in multinational crisis management training in which English is used as a lingua franca (ELF). More specifically, we focus on exercises that include patrolling as well as other activities in which the trainees move by and interact in a vehicle. These exercises can be seen as “high stakes” environments that make orientation to urgency and safety issues relevant in the coordination of social conduct. Drawing on video recordings and ethnographic field notes from two United Nations military observer courses and using conversation analysis (CA), we examine moments in the exercises where the trainees orient to knowledge-related (i.e., epistemic) asymmetries in the upcoming or ongoing task. The analysis shows how these moments emerge and become solved in the moment-by-moment organization of interaction via utilization of verbal, linguistic and multimodal resources. We illustrate how some moments in the exercises allow the implementation of pre-emptive practices, whereas others call for corrective strategies and halting the ongoing task-related activity. The study sheds light on the situated practices the trainees use to establish mutual understanding and to advance goal-oriented activities in a mobile environment, and it promotes the temporal and sequential organization of social actions as key for collaborative work in crisis management training.

Knowledge, attitude and utilisation of evidence-based therapeutic exercises in knee osteoarthritis management in Nigeria.

In Nigeria, there is a disparity among physiotherapists regarding therapeutic exercise as a core treatment for patients with knee osteoarthritis (OA). The attitudes and beliefs of physiotherapists could influence this. To investigate Nigerian physiotherapists' knowledge, attitude, and utilisation of evidence-based therapeutic exercises. A mixed-method of cross-sectional survey and focus group discussion. Secondary and tertiary health institutions in Nigeria. Physiotherapists consecutively sampled from the selected institutions. Participants' knowledge, attitude and utilisation of evidence-based therapeutic exercises for the management of knee OA. This study revealed that 81% of physiotherapists in Nigeria had a fair knowledge of evidence-based practice and the efficacy of therapeutic exercises in managing knee OA. Despite this fair knowledge, 95.3% had a poor attitude. The important emerging categories/themes are treatment preference, clinical experience, and strength of evidence. Physiotherapists in Nigeria have a fair knowledge of evidence-based therapeutic exercises in managing patients with knee OA, although there is a poor attitude and disparity between the use and current recommendations. The research received no funding from a commercial or non-profit organisation.

Promoting pain coping skills in haemophilia: A remote intervention integrating exercise and pain education.

Chronic joint pain is a significant and widespread symptom in people with haemophilia (PWH). Despite medical advancements, effective pain management remains challenging. This study presents an innovative approach that integrates remote physical exercises, pain neuroscience education, and coping strategies to address chronic pain in PWH. The remote intervention consisted of sixteen 5-min videos encompassing physical exercises for chronic pain management and pain education strategies. These videos formed an 8-week remote intervention program. Clinical and physical assessments were conducted before and after the intervention. A total of thirty-one PWHs, with a median age of 34 years (ranging from 16 to 59years), completed the remote intervention. The study revealed significant improvements in pain intensity, disability, and physical performance among PWH with chronic pain. Enhanced functional capacity was evident in the Timed Up and Go and Single Leg Stance tests, accompanied by improved scores on the Functional Independence Score in Haemophilia (FISH). Although lacking a control group, our findings are consistent with other successful exercise and pain education programs. This innovative intervention holds promise for managing chronic pain in PWH, underscoring patient empowerment, education, and collaboration. Notably, our study stands out by uniquely combining pain education and coping strategies, bolstering evidence for effective pain management.

A maturity model to guide inter-organisational crisis management and response exercises

This paper proposes a six-step maturity ladder for inter-organizational collaborative capability in crisis management and response operations. The paper argues that collaborative crisis management and response can be seen as a case of complex adaptive systems, where awareness of the organizational context of crisis response, technical interoperability, and individual relations are drivers that enable rapid and successful mobilization of crisis response. The maturity ladder provides a link between the capabilities necessary for collaboration possessed by individual crisis response entities and the overall system maturity in terms of collaborative crisis management capability. It can inter alia be used as a basis for a discussion when inter-organizational exercises are appropriate and when focus must remain on the development of the capabilities of individual crisis response entities.

Abstract P349: Physical Activity Perceptions and Engagement of Patients Prescribed an Anti-Obesity Medication in a Medical Weight Loss Clinic

Introduction: Physical activity (PA) may elicit important health benefits when coupled with contemporary anti-obesity medications (AOM). However, currently there is little known about perceptions of PA and associated PA engagement of patients receiving these AOM therapies. Hypothesis: We assessed the hypothesis that PA would differ by perceptions of confidence to engage in PA, current and future importance of PA, and PA amount in patients receiving AOM treatment within the context of a medical weight loss clinic. Methods: An electronic survey was distributed to patients in a clinical research registry who were receiving treatment with an AOM at a university medical center-based weight loss clinic. The survey included questions about their perceived confidence to do structured PA or exercise regularly (PA-CONFIDENCE) and perceived importance of structured PA or exercise for management of their body weight currently (PA-IMPORTANCE) or in the future (PA-FUTURE). Participants also reported their current level of PA. Results: Survey responses were received from 96 patients. For these analyses, data were examined for patients currently prescribed a GLP-1 AOM (83 patients). High PA-CONFIDENCE was reported by 44.6% of participants, with 34.9% and 20.5% reporting moderate and low PA-CONFIDENCE, respectively. PA was 154±117 min/wk, 107±105 min/wk, and 76±77 min/wk for high, moderate, and low PA-CONFIDENCE (p=0.033). Participating in ≥150 min/wk of PA was reported by 54.1% with high, 20.7% with moderate, and 11.8% with low PA-CONFIDENCE (p=0.002). Ratings of PA-IMPORTANCE were 63.9% for high, 28.9% for moderate, and 7.2% for low. Participating in ≥150 min/wk of PA was reported by 48.2% with high, 12.5% with moderate, and 0% with low PA-IMPORTANCE (p=0.002). Ratings of PA-FUTURE were 79.5% for high, 18.1% for moderate, and 2.4% for low. Current participation in ≥150 min/wk of PA was reported by 33.7% with high, 12.5% with moderate, and 0% with low PA-FUTURE (p=0.002). Conclusions: Less than one-half of patients prescribed an AOM report confidence to engage in regular structured PA, and of those with high confidence only approximately one-half achieve current public health recommendations for PA. While more than one-half of patients report that PA is important, less than one-half engage in the recommended amount of PA. Strategies are needed to increase perceived confidence to perform and importance of PA in AOM treated patients, and to increase PA participation.

Development and Reliability Review of an Assessment Tool to Measure Competency in the Seven Elements of the Risk Management Process: Part Three—Evaluation of the Group Results from the RISK Tool

This study used ratings to form teams of participants with different risk management competence levels to determine if a collectively optimised team performed a risk management exercise better than a marginally or a sub-optimised team. This paper also determined whether team performance was better than individual performance on a risk management exercise. An experimental group was split into three teams of six participants based on their individual risk scenario exercise outcomes. The collectively optimised team had at least one member rated as having some high-level or expert competency in one of the seven risk management process elements. So, jointly, the group had this competency level in all elements. Similarly, the marginally optimised team’s members were rated as having just above average or high-level competency in the seven elements. Likewise, the sub-optimised team’s members were rated as having just above average competency, just below average, or no competency in the seven elements. Each team undertook the risk scenario exercise, and two observers rated their performances, as recorded on a video camera. The results were that the collectively optimised team performed better in each of the seven risk management elements than the other teams (the marginally optimised or the sub-optimised team). However, a significant difference was only evident between the collectively optimised and sub-optimised teams across all elements. Also, the teams performed better in each of the seven elements than individuals. These results imply that a team collectively optimised in the seven elements of the risk management process can better perform a risk management process than a sub-optimised team. These competency outcomes could be used to assemble risk management teams that are collectively optimised, leading to better results from the risk management process.

Neuroplasticity in the pathogenesis and treatment of chronic pain syndrome: new research and therapeutic perspectives

Recent research and therapeutic outlooks examine the impact of neuroplasticity on the progression and management of chronic pain syndrome. Aims: To review neurobiological basis as well as neuroplastic mechanisms in chronic pain syndrome, exploring bidirectional relationship and innovative therapies and to evaluate efficacy/safety of diverse treatments like TENS, rTMS, pharmacotherapies, and exercise in chronic pain management. Study design: A narrative literature review. Place and Duration of Study: 2019 to 2024. Methodology: A narrative review was conducted using the keywords “Neuroplasticity" AND "Chronic Pain" on PubMed yielded a total of 333 publications. Out of the total publications, 21 were deemed directly relevant, probably providing valuable perspectives on the link between neuroplasticity and chronic pain. Results: Results showed that out of the 11 studies analysed, 7 investigated the bidirectional relationship between chronic pain and neuroplasticity. Additionally, 4 studies reviewed pharmacological methods, 2 studies discussed personalised management and mechanistic profiling, and 7 explored neuromodulation and non-pharmacological interventions. Various neurophysiological correlates of chronic pain were studied, including somatosensory and cortical neurophysiology profiles but Central sensitisation and neuroinflammation were the explored key mechanisms. Activity-dependent plasticity, neuroplasticity in pain modulation, and cortical plasticity are extensively explored, revealing changes in neural activity, synaptic strength, and brain structure. Research explores the connection between chronic pain and neuroplasticity, examining how they impact each other and highlighting the constant interaction between pain perception and neural plasticity. Innovative therapeutic strategies include neuromodulation techniques, pharmacological interventions, personalised pain management, and multimodal approach. Non-invasive brain stimulation, transcutaneous electrical nerve stimulation , and home-based focused tDCS show promise in chronic pain management. Conclusion: In summary, these findings highlighted the multifaceted nature of chronic pain and the on-going efforts to develop effective therapeutic interventions, showcasing a dynamic field of research aiming to improve the lives of those suffering from chronic pain.

Role of strengthening exercises in management and prevention of overuse sports injuries of lower extremity: a systematic review.

Overuse injuries are common in sports involving jumping, running, and landing, due to the repetitive nature of these activities and the strain they place on the lower extremity. The objective of the study was to determine the role of strengthening exercises in the management of overuse sports injuries of lower extremity and its effects on prevention of injury recurrence. This study employed a systematic review design. The author extracted and reviewed the papers for this study in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and then used the PEDro scale to rate the articles' quality. For the most recent and well-developed primary data, several electronic databases including Google Scholar, PubMed Central, MEDLINE, Cochrane Library, and PEDro were exhaustively searched. Inclusion criteria were based on PICO (T) model and included study population, intervention nature, outcome measures, time period, methodological quality, and linguistic extent. The data synthesis involved analyzing randomized control/clinical trials on strengthening exercises for lower extremity overuse sports injuries in athletes, considering outcomes including muscle strength, pain scores, return to sports, and injury prevention. The methodological quality of the recruited articles ranged from excellent to fair on PEDro scale. Three included studies investigated the effects of strengthening exercises on management of lower extremity injuries of athletes. Four studies evaluated its role on prevention from recurrence of injuries. This study has concluded that strength training plays a fundamental role in management and prevention of overuse injuries. It not only improves the muscle performance, fitness level, speed and agility in sports but also decreases the pain, and aids in early recovery from an injury.

Does Capital Structure Affect Profitability of Listed Ghanaian Firms?

ABSTRACT: Capital structure is one of the crucial decisions managers must make that can affect a firm's short-term and long-term value maximization prospects. Though extant studies have shown capital structure significantly affects profits, researchers have struggled to find an optimal mix of capital structure ideal for value maximization due to the influence of macro and micro factors. There is therefore the need for this to be properly studied contextually. Building on the Pecking Order Theory, this study examines the capital structure effects on profitability from a short-term, long-term, and total debt financing perspective on listed Ghanaian firms between 2003 and 2013. An unbalanced panel data of 23 listed manufacturing and service firms that are listed on the Ghanaian Stock Exchange are subjected to robust maximum likelihood heteroskedastic linear estimation models. Three main regressions that are run explain the short-term debt, long-term debt and total debt effect on firm profitability. The results show that short-term debt exhibits a positive effect on return on equity (ROE), whilst the relationship reverses for long-term debt, indicating that short-term financing was beneficial to firms rather than long-term financing. Also, total debt exhibited a negative and non-significant effect on return on equity. The author also found that firm liquidity exhibited a more pronounced positive effect on profitability for firms with short-term debt than long-term debt. Financial risk negatively affected the returns of only firms with short-term debt. Market share had a pronounced positive effect on ROE across firms whilst firm age exhibited a less pronounced positive effect on firm profits. Firm size and growth had increasing profit effects but was not significant in the dataset. Financial risk also negatively affected profits, but this was only significant in firms with short-term debt structures. This study finds that managers need to adopt more short-term debt financing rather than long-term financing as the former leads to more profits. There is a need for policymakers to develop long-term debt financing structures to compete in the Ghanaian debt market. It is also recommended that managers exercise due care when supplementing equity capital with debt.

Agents’ context-specific conduct in making strategic investment decisions

PurposeThis study aims to explore how managers exercise agency in strategic investment decisions (SIDs) by drawing on their knowledgeability of the strategic context. Specifically, the authors address the role of position–practice relations and irresistible causal forces in this conduct.Design/methodology/approachThe authors examine SID-making (SIDM) practices in four case organisations operating in highly competitive markets, conducting interviews with managers at various levels and analysing company documents. Drawing on strong structuration theory, the authors show how managerial decision makers draw upon their knowledge of organisational context when exercising agency in SIDs.FindingsThe authors provide insights into how SIDM behaviour, specifically agents’ conduct, is shaped by a combination of position–practice relations and the agents’ comprehension of their organisation’s context.Research limitations/implicationsThe authors extend the SIDM literature by surfacing the issue of how actors’ conjuncturally-specific knowledge of external structures shapes the general dispositions they draw on in exercising agency in practice.Originality/valueThe authors extend the SIDM literature by surfacing the issue of how actors’ conjuncturally-specific knowledge of external structures shapes the general dispositions they draw on in exercising agency in practice. Particularly, the authors contribute to this literature by identifying irresistible causal forces and illuminating why actors might not resist in SIDM processes, despite having the potential to do so.

“You don’t know what you don’t know”: Knowledge, attitudes, and current practice of physiotherapists in recognising and managing metabolic syndrome, a mixed methods study

ObjectivesTo determine the knowledge, attitudes, and current practice of primary care physiotherapists in recognising and managing clients with metabolic syndrome. DesignMixed-methods research design comprising an online survey and focus groups. ParticipantsAustralian and English physiotherapists (n = 183) working in a primary care setting responded to the survey. Twelve physiotherapists participated in focus groups. ResultsMetabolic syndrome was not on physiotherapists radar. They did not screen for metabolic syndrome nor provide management for it in primary care. Although most physiotherapists had some awareness of metabolic syndrome, they were not knowledgeable. Physiotherapists reported a need to focus on their clients’ presenting condition, and there was uncertainty on whether metabolic syndrome management was within their scope of practice. Despite this, physiotherapists felt they had an important role to play in exercise and physical activity prescription for chronic disease management and were keen to further their knowledge and skills related to metabolic syndrome. Survey responses and focus group data were convergent. ConclusionPhysiotherapists working in primary care settings are well-placed to identify metabolic risk factors in their clients and provide physical activity interventions to enhance management but currently lack knowledge to embed this in clinical practice. Training and resources are required to enable physiotherapists to identify and manage metabolic syndrome within their practice. Contribution of paper•Primary care physiotherapists have limited knowledge about metabolic syndrome and are not currently identifying and managing it in their practice.•Physiotherapists require education on the link between metabolic syndrome and musculoskeletal conditions, so they can promote healthy behaviours as an important component of management that may support a reduction in future chronic disease.

The effect of exercise on quality of life, fatigue, and pain management in older women: A cross-sectional study in Greece

Background: Frequently, the contribution of exercise to the elderly and the associated benefits of such activities are discussed. Aim: This paper deals with the contribution of exercise to the levels of quality of life, fatigue, and pain management. Method: Then, quantitative and cross-sectional research is carried out to investigate the contribution of physical exercise to the levels of quality of life, fatigue, and pain management in women over 60 years of age. For the data collection, the questionnaire used consisted of the Missoula—VITAS Quality of Life Index (MVQOLI), the Pain Assessment Questionnaire (PSeQ), and the Fatigue Assessment Scale (FAS). Results: From the statistical analysis made between exercise and quality of life, fatigue, and pain management of the women over 60 who participated in the research, it follows that women undergoing exercise show a better quality of life and less fatigue, while no statistically significant difference was detected in terms of pain management. Conclusion: It seems that exercise affects positively quality of life and fatigue. Potential implications must be addressed in order to organize more exercise programs, particularly for older people.