• Vitamin B12 insufficiency induces cholesterol biosynthesis by limiting s-adenosylmethionine and modulating the methylation of SREBF1 and LDLR genes

      Adaikalakoteswari, A; Finer, S; Voyias, P.D; McCarthy, C.M; Vatish, M; Moore, J; Smart-Halajko, M; Bawazeer, N; Al-Daghri, N.M; McTernan, P.G; et al. (BMC, 27/02/2015)
      The dietary supply of methyl donors such as folate, vitamin B12, betaine, methionine, and choline is essential for normal growth, development, and physiological functions through the life course. Both human and animal studies have shown that vitamin B12 deficiency is associated with altered lipid profile and play an important role in the prediction of metabolic risk, however, as of yet, no direct mechanism has been investigated to confirm this.
    • Vitamin B12 deficiency is associated with adverse lipid profile in Europeans and Indians with type 2 diabetes.

      Adaikalakoteswari, A; Jayashri, R; Sukumar, N; Venkataraman, H; Pradeepa, R; Gokulakrishnan, K; Anjana, R.M; McTernan, P.G; Tripathi, G; Patel, V; et al. (BMC, 26/09/2014)
      Metformin, a standard therapy in type 2 diabetes, reduces vitamin B12 levels. Studies linking low vitamin B12 levels and cardiovascular disease are equivocal and suggest improving B12 levels may help in primary prevention. The role of vitamin B12 deficiency on cardiovascular risk factors, especially in type 2 diabetes has not been explored. The aim of this study is to investigate whether vitamin B12 deficiency in type 2 diabetes patients is associated with cardiovascular risk factors in two different ethnic groups in UK and India. Type 2 diabetes patients from two secondary care diabetic centres (Europeans - UK and Indians - India) were studied. Serum vitamin B12, folate and biochemical parameters were measured. The prevalence rates of vitamin B12 deficiency (<191 ng/L) were 27% and 12% in Europeans and Indians, respectively and higher in metformin treated type 2 diabetes patients. In linear regression analysis, after adjusting for all likely confounding factors, vitamin B12 independently associated with triglycerides in both the populations and cholesterol/HDL ratio in Indians. Logistic regression showed type 2 diabetes patients with vitamin B12 deficiency were at significantly higher odds of having coexisting coronary artery disease (CAD) in Europeans with similar but non-significant trend in Indians, after adjusting for all likely confounding factors. The prevalence of vitamin B12 deficiency is common in type 2 diabetes patients and is associated with adverse lipid parameters. Type 2 diabetes management guidelines should include the recommendation for regular testing for B12 levels, especially for those on metformin.
    • PWE-254 Is the macroscopically normal mucosa (MNM) around colorectal cancer really ‘normal’?

      Patel, A; Fang, Y; Moore, J; Williams, N; Tripathi, G; Arasaradnam, R; University of Westminster (BMJ, 22/06/2015)
      Field cancerisation refers to the process whereby cells acquire pro-tumourigenic mutations that predispose to malignant transformation but do not produce morphological change.1Previous colorectal cancer studies have assumed that the macroscopically normal mucosa (MNM) adjacent to a cancer is biologically unaltered. The aim of this study was to determine if the genetic expression profile of the MNM around a cancer or adenoma is different to that found in healthy controls. 15 patients undergoing colonoscopy were recruited over 12 months; 5 healthy controls, 5 with colorectal adenomas and 5 with adenocarcinoma. Two mucosal pinch biopsies were taken in the rectum, right colon and adjacent to polyp or cancer. mRNA was extracted and gene expression was assessed using standard whole genome micro-array analysis. Differentially expressed genes were identified using three methods of analysis: LIMMA (fold change ratio >1.5 and p value <0.05), Robust Regression (RR) (adjusted p value <0.05) and genes that ‘overlap’ when LIMMA (p value <0.001) and RR (adjusted p value <0.1) are used. Functional analysis was performed using DAVID2software to identify important biological processes that were dysregulated. A large number of genes were dysregulated in the MNM adjacent to cancer or adenoma compared with controls (Table 1). Interestingly, the greatest differences were seen between MNM adjacent to cancer and polyp in chromatin organisation, nucleosome processing, nuclear transport and histone assembly. The most significantly upregulated genes consisted of FUT2, CTSA, MUC2 and SDS and downregulated genes consisted of GREM1, SFRP, HIST1H, IL17B and TFF1.
    • Habitual physical activity is associated with circulating irisin in healthy controls but not in subjects with diabetes mellitus type 2

      Al‐Daghri, N.M; Alokail, M.S; Rahman, S; Amer, O.E; Al‐Attas, O.S; Alfawaz, H; Tripathi, G; Sabico, S.; Chrousos, G.P; McTernan, P.G; et al. (Wiley, 22/05/2015)
      Irisin, a novel myokine, has been shown to increase following vigorous exercise, with studies suggesting that it mediates some of the beneficial effects of exercise. Irisin might play a role in ‘browning’ of white adipocytes, thus increasing energy expenditure. The role of irisin in exercise and energy expenditure in subjects with diabetes mellitus type 2 (DMT2) remains largely unknown. We aimed to investigate the association between circulating irisin and habitual physical activity in subjects with and without DMT2. In this cross‐sectional study, 164 Saudi adults: 81 non‐DMT2 controls [age: (mean ± SD) 51·6 ± 10·9; BMI: 29·6 ± 4·3 kg/m2] and 83 DMT2 subjects [age: 54·3 ± 10·3 year; BMI: 29·4 ± 4·7 kg/m2] were studied. Anthropometric and fasting serum biochemical data were collected. Circulating irisin was measured using an enzyme‐linked immunosorbent assay (ELISA). Frequency intensity time (FIT) index was used to assess the level of habitual physical activity. We observed significantly higher levels of irisin in DMT2 subjects than in controls (P < 0·001). FIT index was positively associated (r = 0·20, P = 0·03) with circulating irisin in controls only. Additionally, irisin levels were significantly higher in tertile 3 (0·75 ± 0·07 μg/mL) than tertile 1 (0·49 ± 0·06 μg/mL) of the FIT index in healthy controls, whilst no such relation with physical activity was observed in DMT2 subjects. This cross‐sectional study has shown a weak association of irisin with physical activity levels in healthy controls but not in DMT2 subjects, suggesting the possibility of discordant regulation in the condition of DMT2.
    • Telmisartan reverses antiretroviral-induced adipocyte toxicity and insulin resistance in vitro

      Pushpakom, S.P; Adaikalakoteswari, A; Owen, A; Back, D.J; Tripathi, G; Kumar, S; McTernan, P; Pirmohamed, M; University of Warwick (Sage, 21/02/2018)
      Antiretroviral therapy in HIV-positive patients leads to insulin resistance which is central to the pathogenesis of various metabolic abnormalities and cardiovascular disease seen in this patient group. We have investigated the dose–response relationship of telmisartan, an antihypertensive, on adipocytes in vitro in order to determine whether it may have metabolic beneficial effects. Using in vitro chronic toxicity models (3T3-F442A murine and primary human adipocytes), we evaluated the effects of different concentrations of telmisartan on adipocyte differentiation and adipogenic gene expression using lipid accumulation assays and real-time polymerase chain reaction, respectively. Adipokine secretion and expression of insulin signalling mediators were evaluated using enzyme-linked immunosorbent assays. Telmisartan partially reversed the deleterious effects of antiretrovirals on adipocyte lipid accumulation, expression of adipogenic regulators (peroxisome proliferator receptor-gamma and lipin 1), adipokine secretion and expression of the insulin signalling mediator pAktSer473. The metabolic effects of telmisartan followed a non-monotonic response with the maximal effect observed at 5 µM in the primary human adipocyte model. Telmisartan has beneficial metabolic effects in adipocytes in vitro, but its potential to reduce antiretroviral-induced cardiometabolic disease in HIV-infected individuals needs to be evaluated in a well-designed adequately powered clinical trial.
    • Understanding ‘vulnerability’ and ‘political skill’ in academy middle management during organisational change in professional youth football

      Gibson, Luke; Groom, Ryan; University of Derby; Manchester Metropolitan University (Taylor and Francis, 2020-09-15)
      The use of political skill to further employees’ self-interests and their ability to cope with ambiguity and employment vulnerability during periods of organizational change is an important yet under researched phenomenon. Taking a middle management perspective, the purpose of this paper is to investigate the experiences of Richard, a newly appointed professional youth football Academy Manager during the process of organizational change. Data were collected through semi-structured interviews, formal academy team meetings, co-worker interviews, and informal observations and conversations, which were analyzed through the process of narrative analysis. Findings highlighted the hierarchical sensemaking challenges of vertically ‘managing up’ (e.g. Chairman, Board of Directors, 1st Team Manager) and ‘managing down’ (e.g. academy employees), and horizontally ‘managing across’ (e.g. Head of Coaching) during the process of organizational change. Importantly, managing expectations and influencing significant others, through skilled micro-political activity, was central to successfully negotiating the ambiguity and vulnerabilities of organizational life during change.
    • Worth the weight? Post weigh-in rapid weight gain is not related to winning or losing in professional mixed martial arts

      Kirk, Christopher; Langan-Evans, Carl; Morton, James P.; University of Derby; Liverpool John Moores University (Human Kinetics, 2020-09-01)
      Body mass (BM) manipulation via rapid weight loss (RWL) and rapid weight gain (RWG) is a common practice among mixed martial art (MMA) athletes to ensure qualification for the division in which the athlete wishes to compete. Professional MMA competitors in California are required to weigh in twice: 24 hr prior to competition and immediately prior to the bout after they have typically engaged in RWG. In analyzing data from five MMA events sanctioned by the Californian State Athletic Commission, the authors used Bayesian analyses to compare bout winners (n = 31) and losers (n = 31) in terms of in-competition BM (in kilograms) and the amount of BM regained between the two weigh-ins (in kilograms). These data do not support the hypothesis that differences in in-competition BM (Bayes factor [BF10] = 0.667, d = 0.23) or the amount of BM regained between the two weigh-ins (BF10 = 0.821, d = 0.23) determine winning or losing. In addition, there was no statistical difference between bouts ending via strikes, submission, or decision for either in-competition BM (BF10 = 0.686, ω2 < 0.01) or the amount of BM regained between the two weigh-ins (BF10 = 0.732, ω2 = 0.054). In conclusion, the authors report for the first time that the magnitude of RWG does not predict winning or losing in a professional cohort of MMA athletes. In addition, they also report that MMA athletes typically compete at a BM that is at least 1–2 divisions higher than the division in which they officially weighed-in. These analyses may provide impetus for governing bodies and coaches to enact changes at both professional and amateur levels to reduce negative health consequences associated with extreme RWL and RWG.
    • Using system mapping to help plan and implement city-wide action to promote physical activity

      Cavill, Nick; Richardson, Debra; Faghy, Mark; Bussell, Chris; Rutter, Harry; University of Bristol; University of Derby; University of Bath (PAGEPress Publications, 2020-08-26)
      Background. There is growing interest in conceptualising public health problems such as physical inactivity as the outcome of multiple interacting factors within complex systems. Methods. We worked with stakeholders involved in a city-wide physical activity promotion programme in Derby, UK to prodiuce conceptual maps of the major modifiable drivers of physical activity, and used them to explore ways in which the existing programme took a systems approach, and how it might be enhanced. Semi-structured interviews were subsequently undertaken to assess their views on the contribution of the mapping approach. Results. Feedback from stakeholders described the mapping as valuable, especially in helping to identify the limitations of the original approach taken in the city. Conclusions. Even a very simple application of systems thinking can be a useful tool for disaggregating the key factors driving a system, helping to identify areas that merit greater attention, and supporting effective action.
    • Psychometric properties of the German version of the fears of compassion scales

      Biermann, Miriam; Bohus, Martin; Gilbert, Paul; Vonderlin, Ruben; Cornelisse, Sven; Osen, Bernhard; Graser, Johannes; Brüne, Martin; Ebert, Andreas; Lyssenko, Lisa; et al. (Wiley, 2020-08-18)
      The cultivation of compassion is associated with beneficial effects on physical and psychological health, satisfaction with life and social relationships. However, some individuals, especially those high in psychopathological symptoms or those with particular disorders such as borderline personality disorder (BPD) may demonstrate pronounced fears of engagement in compassionate experiences or behaviours. Furthermore, fears of compassion have been found to impede progress in psychotherapy. The 38‐item fears of compassion scales (FCS) is a self‐report questionnaire for measuring trait levels of fears of compassion (a) one receives from others (FCFO), (b) one feels towards others (FCTO) and (c) one feels for oneself (self‐compassion; FSC). The FCS is an internationally used instrument of proven validity and reliability in both clinical and nonclinical samples. In the present study, a German translation of the FCS including its three subscales was provided, and the psychometric properties were examined in 430 participants from four different samples: (a) a sample from the general population; (b) a mixed sample of psychiatric residential and outpatients; (c) a clinical sample of residential and outpatients with a primary diagnosis of BPD and (d) a sample of healthy control participants. Internal consistencies were excellent for the German version of the FSC and acceptable to excellent for its subscales. Correlations with established measures of mental health demonstrate its validity. Additionally, the German FCS discriminates significantly between individuals from the general population and patients, thus supporting its specificity. The German FCS is suitable to detect potential obstacles in cultivating compassion in psychotherapeutic treatments and beyond.
    • Attachment styles modulate neural markers of threat and imagery when engaging in self-criticism

      Kim, Jeffrey J.; Kent, Kirsty M.; Cunnington, Ross; Gilbert, Paul; Kirby, James N.; Compassionate Mind Research Group, School of Psychology, The University of Queensland, Brisbane, Australia.; The Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia.; University of Derby (Springer Science and Business Media LLC, 2020-08-13)
      Attachment styles hold important downstream consequences for mental health through their contribution to the emergence of self-criticism. To date, no work has extended our understanding of the influence of attachment styles on self-criticism at a neurobiological level. Herein we investigate the relationship between self-reported attachment styles and neural markers of self-criticism using fMRI. A correlation network analysis revealed lingual gyrus activation during self-criticism, a marker of visual mental imagery, correlated with amygdala activity (threat response). It also identified that secure attachment positively correlated with lingual gyrus activation, whilst avoidant attachment was negatively correlated with lingual gyrus activation. Further, at greater levels of amygdala response, more securely attached individuals showed greater lingual gyrus activation, and more avoidantly attached individuals showed less lingual gyrus activation. Our data provide the first evidence that attachment mechanisms may modulate threat responses and mental imagery when engaging in self-criticism, which have important clinical and broader social implications.
    • The physical demands of mixed martial arts: A narrative review using the ARMSS model to provide a hierarchy of evidence

      Kirk, Christopher; Clark, David R; Langan-Evans, Carl; Morton, James P; University of Derby; Liverpool John Moores University (Informa UK Limited, 2020-08-12)
      The physical demands of mixed martial arts (MMA) training and competition is not yet well quantified. The Applied Research Model for the Sport Sciences (ARMSS) provides a framework through which to conduct sport science, determining pertinent questions to test research findings in real-world settings. The aim of this review was to evaluate MMA research within the context of ARMSS to critically analyse our understanding of the physical requirements of MMA training and competition. Research databases were searched, with 70 peer-reviewed articles being discussed in relation to the specific stage of the ARMSS in which their results best fit. MMA research was found to be mostly foundational and descriptive in nature and has generally not developed along systematic lines. The internal and external loads and responses to training and competition have not been adequately identified. Therefore, it is not currently possible to state which variables are key predictors of success, or how coaches can optimally manipulate these variables. We propose that MMA research be refocused to be conducted within ARMSS. Specifically, stage 2 studies describing the physical, physiological and technical demands of MMA training and competition, and stage 3 studies determining the physiological predictors of performance should be initially prioritised.
    • Expanding hermeneutic horizons: Working as multiple researchers and with multiple participants

      Montague, Jane; Phillips, Elly; Holland, Fiona; Archer, Stephanie; University of Derby; University of Cambridge (Sage Publications, 2020-08-10)
      The double hermeneutic is a central feature of interpretative phenomenological analysis (IPA). Typically, this has been considered in relation to individual researchers working with experiential accounts from individual participants. IPA has, however, frequently been applied by multiple researchers; a further layer of complexity occurs when individual or multiple researchers analyse data from group interactions. Little attention has been paid to hermeneutic considerations in these contexts. We present insights into our encounters with multiple hermeneutics as well as our application of the hermeneutic circle; we also consider implications for IPA research. Our multi-vocal approach to analysis requires us to work in a much more integrative manner than is generally represented in IPA literature. Explicitly attending to multiple hermeneutics in focus group situations provides additional insights into the social and cultural contexts within which participants’ experiences exist. This article discusses how the inclusion of multiple hermeneutics adds richness and robustness to IPA.
    • I am great, but only when I also want to dominate: Maladaptive narcissism moderates the relationship between adaptive narcissism and performance under pressure

      Zhang, Shuge; Roberts, Ross; Woodman, Tim; Cooke, Andrew; Bangor University; University of Derby (Human Kinetics, 2020-08)
      Narcissism-performance research has focused on grandiose narcissism but has not examined the interaction between its so-called adaptive (reflecting over-confidence) and maladaptive (reflecting a domineering orientation) components. In this research, we tested interactions between adaptive and maladaptive narcissism using two motor tasks (basketball and golf in Experiments 1-2, respectively) and a cognitive task (letter transformation; Experiment 3). Across all experiments, adaptive narcissism predicted performance under pressure only when maladaptive narcissism was high. In the presence of maladaptive narcissism, adaptive narcissism also predicted decreased pre-putt time in Experiment 2 and an adaptive psychophysiological response in Experiment 3, reflecting better processing efficiency. Findings suggest that individuals high in both aspects of narcissism perform better under pressure thanks to superior task processing. In performance contexts, the terms “adaptive” and “maladaptive” – adopted from social psychology – are over-simplistic and inaccurate. We believe that self-inflated narcissism and dominant narcissism are better monikers for these constructs.
    • Psychological intervention for partners post-stroke: A case report

      Yasmin, Natasha; Riley, Gerard; University of Derby; University of Birmingham (IOS Press, 2020-07-21)
      Following a brain injury, caregiving spouses/partners differ in their perceptions of relationship continuity/discontinuity (i.e. whether the relationship is experienced as similar or different to the pre-injury relationship). Perceptions of continuity are associated with better psychological wellbeing and a better relationship. To conduct a pilot test of an intervention aimed at exploring the possibility of supporting caregiving partners to experience greater continuity within their relationship post-stroke. A post-stroke couple was provided with Integrated Behavioural Couples Therapy for three months, which aimed to increase relationship continuity alongside addressing individual goals identified by the couple. Before and after measures were taken using a battery of six questionnaires evaluating changes in perceptions of continuity, relationship quality, and stress. Quantitative and qualitative data showed post-therapy improvement in all the measures. The study suggested that perceptions of relationship continuity can be improved by therapy, and that such an improvement might have a beneficial impact in terms of relationship quality and psychological wellbeing. The intervention is currently being further developed and evaluated.
    • Integrated sports and respiratory medicine in the aftermath of COVID-19

      Faghy, Mark; Ashton, Ruth; Maden-Wilkinson, Tom; Copeland, Robert; Bewick, Thomas; Andy, Smith; Loosemore, Mike; University of Derby (Elsevier, 2020-07-09)
    • The compassionate vagus: A meta-analysis on the connection between compassion and heart rate variability

      Di Bello, Maria; Carnevali, Luca; Petrocchi, Nicola; Thayer, Julian F.; Gilbert, Paul; Ottaviani, Cristina; Sapienza University of Rome; University of Parma; John Cabot University, Rome; The University of California, Irvine; et al. (Elsevier BV, 2020-06-15)
      In recent years, increasing interest has been devoted to the physiological basis of self and other-oriented compassion. Heart rate variability (HRV) represents a promising candidate for such a role, given its association with soothing emotions and context appropriate prefrontal inhibitory control over threat-defensive responses. The aim of this study was to meta-analyze available studies on the association between compassion and HRV. Random-effect models were used. The analysis performed on sixteen studies that met inclusion criteria, yielded a significant association with a medium effect size (g = .54 95% CI [.24, .84], p < .0001). Results were not influenced by publication bias. After an extreme outlier’s exclusion, the size of the association was still larger in studies that used time or frequency-domain indices of vagally-mediated HRV compared to those that used peak to trough estimates of respiratory sinus arrhythmia. Results are limited by the small number of studies included in the meta-analysis (n = 16) and are discussed in terms of indications for future research, given that existing data are highly heterogeneous and of poor methodological rigor.
    • Cardiopulmonary exercise testing in the COVID-19 endemic phase

      Faghy, Mark; Hull, James; Cooper, Brendan; Sylvester, Karl; University of Derby (Elsevier, 2020-06-11)
      The COVID-19 pandemic has presented significant challenges to healthcare systems across the world. The substantial need to provide acute COVID-19-related care resulted in non-COVID-19 care being immediately curtailed, with significant implications for the provision of normal or ‘routine’ healthcare. As the pressure from acute COVID-19 care begins to regress, it is timely to consider how certain services, including those undertaking physiological measurements, will re-open and how they will function within the constraints dictated by a COVID-19 endemic working environment. Over the past decade, there has been evolving recognition of the importance and value of clinical cardiopulmonary exercise testing (CPET) within healthcare settings.1 Primarily, CPET is used to evaluate the integrative response to incremental exercise, enabling clinicians to characterise cardiorespiratory fitness and reasons for physical impairment. 2 It is recognised that CPET plays an important role in clinical arenas including determining surgical operability and evaluating the risk of perioperative death and postoperative complications.3 It also has a function in supporting pre-operative planning algorithms,4 as well as developing management strategies for pathological conditions (e.g. heart failure)5 and in disease prognostication (e.g. pulmonary hypertension).6 Whilst there is considerable uncertainty regarding the ability to safely undertake CPET at the current time, it remains an integral investigative tool in clinical practice and urgent consideration needs to be given to determine how best to deliver CPET services in the COVID-19 endemic phase.
    • Compassion‐focused therapy for body weight shame: A mixed methods pilot trial

      Carter, Alicia; Gilbert, Paul; Kirby, James N.; The University of Queensland, Brisbane, Queensland, Australia; University of Derby (Wiley, 2020-06-08)
      Individuals with bigger bodies (body mass index greater than 30) often experience body weight shame and are at increased risk for mental health vulnerabilities such as depression and anxiety. To date, there have been no studies specifically designed and pilot tested to help with body weight shame for individuals with bigger bodies that do not have a diagnosed clinical condition. The aim of current study is to investigate the initial feasibility of compassion‐focused therapy (CFT) as a 12‐session group intervention for the reduction in body weight shame for individuals with bigger bodies. The study used a mixed method repeated measure design, with both quantitative and qualitative measures, to assess the initial feasibility of the CFT group‐based intervention. Participants (N = 5) attended a 12‐session/2‐h group CFT programme aimed to directly target body weight shame by cultivating compassion. Measurements were conducted at three time points (pre‐, post‐ and 3‐month follow‐up intervention). Results indicated that CFT had a positive impact on reducing body weight shame, increasing compassion and improving health‐engaging behaviours. Qualitative feedback indicated the importance of the group dynamics to help with the de‐shaming of body appearance for individuals. Results from this feasibility trial are promising, and future research using randomized controlled trial methodologies should be conducted to evaluate the effectiveness of CFT as a treatment option for body weight shame for individuals with bigger bodies.
    • The use of a smartphone app and an activity tracker to promote physical activity in the management of chronic obstructive pulmonary disease: randomized controlled feasibility study

      Bentley, Claire L; Powell, Lauren; Potter, Stephen; Parker, Jack; Mountain, Gail A; Bartlett, Yvonne Kiera; Farwer, Jochen; O'Connor, Cath; Burns, Jennifer; Cresswell, Rachel L; et al. (JMIR Publications Inc., 2020-06-03)
      Chronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR). This study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness. We conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity–based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology. Overall, 47% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation. mHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates.
    • Self-compassion, social rank, and psychological distress in athletes of varying competitive levels

      Walton, Courtney C.; Baranoff, John; Gilbert, Paul; Kirby, James; The University of Queensland, Brisbane; University of Derby (Elsevier BV, 2020-05-29)
      Self-Compassion may be seen as a concept contrary to the aims of athletes engaged in competitive sport. This could be accentuated at more elite levels, where athletes may view concepts like self-criticism and self-judgement as more important for improvement. The current study aimed to better understand how athletes of different competitive levels (from social to international) relate to concepts of self-compassion. Further, we aimed to explore how factors relating to social rank and self-compassion contribute to psychological distress. Cross-sectional online survey. An online survey was distributed, including the following validated questionnaires: Depression Anxiety and Stress Scales, the Self-Compassion Scale, Fears of Compassion Scales, Social Comparison Scale, Forms of Self-Criticising/Attacking & Self-Reassuring Scale, and the Striving to Avoid Inferiority Scale. Two hundred and fifty-three participants responded to the survey, including 115 recreational and 79 competitive athletes. There were no differences between groups on any measure of compassion or social rank. In a multiple linear regression model, lower self-compassion, higher fears of compassion (for self), and higher feelings of inadequacy predicted more pronounced psychological distress in athletes. Contrary to expectation, the results suggest that even highly elite athletes may be open to using self-compassion. Given that reduced self-compassion and sense of social rank contributed to psychological distress in athletes, the results suggest that compassion-based approaches to treating psychological distress in this population may be valid.