• Exploring the experiences of living with stroke through narrative

      Nasr, Nasrin; Mawson, Susan; Wright, Peter; Parker, Jack; Mountain, Gail; University of Sheffield; Newcastle University; Bradford University (SAGE Publications, 2016-05-05)
      Chronic illness models are normally used to explain and predict the experience of living with a long-term condition. The aim of this study was to present the findings of narrative interviews with stroke survivors and their family carers to understand their experiences of stroke. We interviewed five people with stroke and three family carers from the United Kingdom. We used thematic analysis to generate themes from their narrative accounts and then linked them to broader theoretical perspectives while influenced by the concept of reinterpretation of life. The narrative accounts of participants are mainly structured based on how their changed bodies poststroke changed their identities and roles and consequently their relationships with others. In this study, we underline the need for using methods like narrative to explain strategies that people use to make sense of their experiences of living with a long-term condition such as stroke.
    • A personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation

      Mawson, Susan; Nasr, Nasrin; Parker, Jack; Davies, Richard; Zheng, Huiru; Mountain, Gail; University of Sheffield; Ulster University, Belfast (JMIR Publications Inc., 2016-01-07)
      In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology–enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.
    • The provision of feedback through computer-based technology to promote self-managed post-stroke rehabilitation in the home

      Parker, Jack; Mawson, Susan; Mountain, Gail; Nasr, Nasrin; Davies, Richard; Zheng, Huiru; University of Sheffield; University of Ulster, Belfast (Taylor and Francis, 2013-10-16)
      Building on previous research findings, this article describes the development of the feedback interfaces for a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation using computer-based technology. Method: Embedded within a realistic evaluative methodological approach, the development of the feedback interfaces for the PSMrS involved the incorporation of existing and emerging theories and a hybrid of health and social sciences research and user-centred design methods. Results: User testing confirmed that extrinsic feedback for home-based post-stroke rehabilitation through computer-based technology needs to be personalisable, accurate, rewarding and measurable. In addition, user testing also confirmed the feasibility of using specific components of the PSMrS. Conclusions: A number of key elements are crucial for the development and potential utilisation of technology in what is an inevitable shift towards the use of innovative methods of delivering post-stroke rehabilitation. This includes the specific elements that are essential for the promotion of self-managed rehabilitation and rehabilitative behaviour change; the impact of the context on the mechanisms; and, importantly, the need for reliability and accuracy of the technology.
    • A personalized self-management rehabilitation system for stroke survivors: A quantitative gait analysis using a smart insole

      Davies, Richard John; Parker, Jack; McCullagh, Paul; Zheng, Huiru; Nugent, Chris; Black, Norman David; Mawson, Susan; Ulster University, Belfast; University of Sheffield (JMIR Publications Inc., 2016-11-08)
      In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges. Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home. A realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a “smart insole” to facilitate measurement of walking activities in a free-living, nonrestrictive environment. Initial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants’ affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use. Our findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants.
    • Assessing walking strategies using insole pressure sensors for stroke survivors

      Munoz-Organero, Mario; Parker, Jack; Powell, Lauren; Mawson, Susan; Universidad Carlos III de Madrid; University of Sheffield (MDPI AG, 2016-10-01)
      Insole pressure sensors capture the different forces exercised over the different parts of the sole when performing tasks standing up such as walking. Using data analysis and machine learning techniques, common patterns and strategies from different users to achieve different tasks can be automatically extracted. In this paper, we present the results obtained for the automatic detection of different strategies used by stroke survivors when walking as integrated into an Information Communication Technology (ICT) enhanced Personalised Self-Management Rehabilitation System (PSMrS) for stroke rehabilitation. Fourteen stroke survivors and 10 healthy controls have participated in the experiment by walking six times a distance from chair to chair of approximately 10 m long. The Rivermead Mobility Index was used to assess the functional ability of each individual in the stroke survivor group. Several walking strategies are studied based on data gathered from insole pressure sensors and patterns found in stroke survivor patients are compared with average patterns found in healthy control users. A mechanism to automatically estimate a mobility index based on the similarity of the pressure patterns to a stereotyped stride is also used. Both data gathered from stroke survivors and healthy controls are used to evaluate the proposed mechanisms. The output of trained algorithms is applied to the PSMrS system to provide feedback on gait quality enabling stroke survivors to self-manage their rehabilitation.
    • Attention deficit hyperactivity disorder: Is there an app for that? Suitability assessment of apps for children and young people with ADHD

      Powell, Lauren; Parker, Jack; Robertson, Naomi; Harpin, Valerie; University of Sheffield; Ryegate Children's Centre, Sheffield Children's NHS Foundation Trust (JMIR Publications Inc., 2017-10-04)
      Attention-deficit/hyperactivity disorder (ADHD) is a complex highly comorbid disorder, which can have a huge impact on those with ADHD, their family, and the community around them. ADHD is currently managed using pharmacological and nonpharmacological interventions. However, with advances in technology and an increase in the use of mobile apps, managing ADHD can be augmented using apps specifically designed for this population. However, little is known regarding the suitability and usability of currently available apps. The aim of this study was to explore the suitability of the top 10 listed apps for children and young people with ADHD and clinicians who work with them. It is hypothesized that mobile apps designed for this population could be more suitably designed for this population. The top 10 listed apps that are specifically targeted toward children and young people with ADHD in the United Kingdom were identified via the Google Play (n=5) and iTunes store (n=5). Interviews were then undertaken with 5 clinicians who specialize in treating this population and 5 children and young people with ADHD themselves, to explore their opinions of the 10 apps identified and what they believe the key components are for apps to be suitable for this population. Five themes emerged from clinician and young people interviews: the accessibility of the technology, the importance of relating to apps, addressing ADHD symptoms and related difficulties, age appropriateness, and app interaction. Three additional themes emerged from the clinician interviews alone: monitoring symptoms, side effects and app effect on relationships, and the impact of common comorbid conditions. The characteristics of the apps did not appear to match well with the views of our sample. These findings suggest that the apps may not be suitable in meeting the complex needs associated with this condition. Further research is required to explore the value of apps for children and young people with ADHD and their families and, in particular, any positive role for apps in the management of ADHD in this age group. A systematic review on how technology can be used to engage this population and how it can be used to help them would be a useful way forward. This could be the platform to begin exploring the use of apps further.
    • The SMART personalised self-management system for congestive heart failure: results of a realist evaluation

      Bartlett, Yvonne K; Haywood, Annette; Bentley, Claire L; Parker, Jack; Hawley, Mark S; Mountain, Gail A; Mawson, Susan; University of Sheffield (Springer Science and Business Media LLC, 2014-11-25)
      Technology has the potential to provide support for self-management to people with congestive heart failure (CHF). This paper describes the results of a realist evaluation of the SMART Personalised Self-Management System (PSMS) for CHF. The PSMS was used, at home, by seven people with CHF. Data describing system usage and usability as well as questionnaire and interview data were evaluated in terms of the context, mechanism and outcome hypotheses (CMOs) integral to realist evaluation. The CHF PSMS improved heart failure related knowledge in those with low levels of knowledge at baseline, through providing information and quizzes. Furthermore, participants perceived the self-regulatory aspects of the CHF PSMS as being useful in encouraging daily walking. The CMOs were revised to describe the context of use, and how this influences both the mechanisms and the outcomes. Participants with CHF engaged with the PSMS despite some technological problems. Some positive effects on knowledge were observed as well as the potential to assist with changing physical activity behaviour. Knowledge of CHF and physical activity behaviour change are important self-management targets for CHF, and this study provides evidence to direct the further development of a technology to support these targets.
    • Stroke patients’ utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation

      Parker, Jack; Mawson, Susan; Mountain, Gail; Nasr, Nasrin; Zheng, Huiru; University of Sheffield; University of Ulster, Belfast (Springer Science and Business Media LLC, 2014-06-05)
      Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery.
    • Developing a personalised self-management system for post stroke rehabilitation; utilising a user-centred design methodology

      Mawson, Susan; Nasr, Nasrin; Parker, Jack; Zheng, Huiru; Davies, Richard; Mountain, Gail; University of Sheffield; University of Ulster, Belfast (Taylor and Francis, 2013-10-16)
      To develop and evaluate an information and communication technology (ICT) solution for a post-stroke Personalised Self-Managed Rehabilitation System (PSMrS). The PSMrS translates current models of stroke rehabilitation and theories underpinning self-management and self-efficacy into an ICT-based system for home-based post-stroke rehabilitation. The interdisciplinary research team applied a hybrid of health and social sciences research methods and user-centred design methods. This included a series of home visits, focus groups, in-depth interviews, cultural probes and technology biographies. The iterative development of both the content of the PSMrS and the interactive interfaces between the system and the user incorporates current models of post-stroke rehabilitation and addresses the factors that promote self-managed behaviour and self-efficacy such as mastery, verbal persuasion and physiological feedback. The methodological approach has ensured that the interactive technology has been driven by the needs of the stroke survivors and their carers in the context of their journey to both recovery and adaptation. Underpinned by theories of motor relearning, neuroplasticity, self-management and behaviour change, the PSMrS developed in this study has resulted in a personalised system for self-managed rehabilitation, which has the potential to change motor behaviour and promote the achievement of life goals for stroke survivors.
    • Providing sources of self-efficacy through technology enhanced post-stroke rehabilitation in the home

      Parker, Jack; Mawson, Susan; University of Sheffield (IOS Press, 2017-09)
    • Identification of walking strategies of people With osteoarthritis of the knee using insole pressure sensors

      Munoz-Organero, Mario; Littlewood, Chris; Parker, Jack; Powell, Lauren; Grindell, Cheryl; Mawson, Sue; Charles III University of Madrid, Madrid, Spain; Keele University; University of Sheffield (Institute of Electrical and Electronics Engineers (IEEE), 2017-06-15)
      Insole pressure sensors capture the different forces exercised over the different parts of the sole when performing tasks standing up. Using data analysis and machine learning techniques, common patterns and strategies from different users to execute different tasks can be extracted. In this paper, we present the evaluation results of the impact that clinically diagnosed osteoarthritis of the knee at early stages has on insole pressure sensors while walking at normal speeds focusing on the effects caused at points, where knee forces tend to peak for normal users. From the different parts of the foot affected at high knee force moments, the forefoot pressure distribution and the heel to forefoot weight reallocation strategies have shown to provide better correlations with the user's perceived pain in the knee for OA users with mild knee pain. This paper shows how the time differences and variabilities from two sensors located in the metatarsal zone while walking provide a simple mechanism to detect different strategies used by users suffering OA of the knee from control users with no knee pain. The weight dynamic reallocation at the midfoot, when moving forward from heel to forefoot, has also shown to positively correlate with the perceived knee pain. The major asymmetries between pressure patterns in both feet while walking at normal speeds are also captured. Based on the described features, automatic evaluation self-management rehabilitation tools could be implemented to continuously monitor and provide personalized feedback for OA patients with mild knee pain to facilitate user adherence to individualized OA rehabilitation.
    • Sensor optimization in smart insoles for post-stroke gait asymmetries using total variation and L1Distances

      Munoz-Organero, Mario; Parker, Jack; Powell, Lauren; Davies, Richard; Mawson, Sue; Universidad Carlos III de Madrid, Madrid, Spain; University of Sheffield; University of Ulster, Belfast (Institute of Electrical and Electronics Engineers (IEEE), 2017-05-15)
      By deploying pressure sensors on insoles, the forces exerted by the different parts of the foot when performing tasks standing up can be captured. The number and location of sensors to use are important factors in order to enhance the accuracy of parameters used in assessment while minimizing the cost of the device by reducing the number of deployed sensors. Selecting the best locations and the required number of sensors depends on the application and the features that we want to assess. In this paper, we present a computational process to select the optimal set of sensors to characterize gait asymmetries and plantar pressure patterns for stroke survivors based upon the total variation and L1 distances. The proposed mechanism is ecologically validated in a real environment with 14 stroke survivors and 14 control users. The number of sensors is reduced to 4, minimizing the cost of the device both for commercial users and companies and enhancing the cost to benefit ratio for its uptake from a national healthcare system. The results show that the sensors that better represent the gait asymmetries for healthy controls are the sensors under the big toe and midfoot and the sensors in the forefoot and midfoot for stroke survivors. The results also show that all four regions of the foot (toes, forefoot, midfoot, and heel) play an important role for plantar pressure pattern reconstruction for stroke survivors, while the heel and forefoot region are more prominent for healthy controls.
    • ADHD: Is there an app for that? A suitability assessment of apps for the parents of children and young people with ADHD

      Powell, Lauren; Parker, Jack; Harpin, Valerie; University of Sheffield; Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre (JMIR Publications Inc., 2017-10-13)
      Attention-deficit hyperactivity disorder (ADHD) is a highly comorbid disorder that can impact significantly on the individual and their family. ADHD is managed via pharmacological and nonpharmacological interventions. Parents also gain support from parent support groups, which may include chat rooms, as well as face-to-face meetings. With the growth of technology use over recent years, parents have access to more resources that ever before. A number of mobile apps have been developed to help parents manage ADHD in their children and young people. Unfortunately many of these apps are not evidence-based, and little is known of their suitability for the parents or whether they are helpful in ADHD management. The aim of this study was to explore the (1) parents’ views of the suitability of the top ten listed apps for parents of children and young people with ADHD and (2) the views of clinicians that work with them on the suitability and value of the apps. The top 10 listed apps specifically targeted toward the parents of children and young people with ADHD were identified via the Google Play (n=5) and iTunes store (n=5). Interviews were then undertaken with 7 parents of children or young people with ADHD and 6 clinicians who specialize in working with this population to explore their opinions of the 10 apps identified and what they believe the key components are for apps to be suitable and valuable for this population. Four themes emerged from clinician and parent interviews: (1) the importance of relating to the app, (2) apps that address ADHD-related difficulties, (3) how the apps can affect family relationships, and (4) apps as an educational tool. Two additional themes emerged from the clinician interviews alone: monitoring ADHD symptoms and that apps should be practical. Parents also identified an additional theme: the importance of the technology. Overall, the characteristics of the current top 10 listed apps did not appear to match well to the views of our sample. Findings suggest that these apps may not fully meet the complex needs of this parent population. Further research is required to explore the value of apps with this population and how they can be tailored to their very specific needs.
    • Involving users in the evaluation of apps for specific health conditions

      Powell, L; Joddrell, P; Parker, Jack; University of Sheffield (IOS Press, 2017-09-30)
      With rapid growth of Internet accessibility over recent years, the way in which we engage with healthcare services and make decisions about our own healthcare has changed. One form of engagement with the Internet is through the use of mobile applications (apps) via mobile devices such as smartphones and tablets. As a result of this, many apps have been developed to target people with varying long term conditions. These apps may aim to help educate individuals about their condition or help them to manage it. Assessing the quality of these apps is crucial especially when considering the risks associated with providing misleading information or unsubstantiated claims. This has led to a growing body of research assessing the quality of apps aimed at people living with varying long term conditions. These attempts have not involved service users to address the suitability of apps for their intended target audiences. This paper presents two examples of how service users and associated healthcare professionals can be involved in the suitability assessment of mobile apps for children and young people with Attention Deficit Hyperactivity Disorder and those living with dementia.
    • 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.
    • 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.
    • 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)
      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.
    • Effects of short-term, medium-term and long-term resistance exercise training on cardiometabolic health outcomes in adults: systematic review with meta-analysis.

      Ashton, Ruth E; Tew, Garry A; Aning, Jonathan J; Gilbert, Stephen E; Lewis, Liane; Saxton, John M; Northumbria University; Freeman Hospital, Newcastle upon Tyne, UK; University of Strathclyde (BMJ, 2018-06-22)
      To examine the effects of short-term, medium-term and long-term resistance exercise training (RET) on measures of cardiometabolic health in adults. Intervention systematic review. MEDLINE and Cochrane Library databases were searched from inception to February 2018. The search strategy included the following keywords: resistance exercise, strength training and randomised controlled trial. s Randomised controlled trials published in English comparing RET≥2 weeks in duration with a nonexercising control or usual care group. Participants were non-athletic and aged ≥18 years. A total of 173 trials were included. Mediumterm and long-term RET reduced systolic blood pressure (−4.02 (95% CI −5.92 to −2.11) mm Hg, p<0.0001 and −5.08 (−10.04 to –0.13)mm Hg, p=0.04, respectively) and diastolic blood pressure (−1.73 (−2.88 to –0.57)mm Hg, p=0.003 and −4.93 (−8.58 to –1.28)mm Hg, p=0.008, respectively) versus control. Medium-term RET elicited reductions in fasted insulin and insulin resistance (−0.59 (−0.97 to –0.21) µU/mL, p=0.002 and −1.22 (−2.29 to –0.15) µU/mL, p=0.02, respectively). The effects were greater in those with elevated cardiometabolic risk or disease compared with younger healthy adults. The quality of evidence was low or very low for all outcomes. There was limited evidence of adverse events. RET may be effective for inducing improvements in cardio metabolic health outcomes in healthy adults and those with an adverse cardio metabolic risk profile.
    • Number of directional changes alters the physiological, perceptual, and neuromuscular responses of netball players during intermittent shuttle running

      Ashton, Ruth; Twist, Craig; University of Chester (Wolters Kluwer, 2015-03-21)
      This study investigated whether an increased number of changes in direction altered the metabolic, cardiovascular, perceptual and neuromuscular responses to intermittent shuttle running. Using a randomized crossover design, ten female netball players completed 30 min of intermittent shuttle running over a 10 m (ISR10) and 20 m (ISR20) linear course. Measures of expired air, heart rate (HR), RPE, blood lactate concentration ([BLa]) and peak torque of knee extensors and flexors were measured. Differences (% ± 90% CL) in VO2 (1.5 ± 5.6%) was unclear between conditions, while HR was possibly higher (1.5 ± 2.5%) and [BLa] very likely lower in ISR20 compared to ISR10 (-32.7 ± 9.9%). RPE was likely lower in the ISR20 compared to the ISR10 condition at 15 (-5.0 ± 5.0%) and mosly likely lower at 30 min (-9.4 ± 2.0%). Sprint times over 20 m were likely slower during ISR20 at mid (3.9 ± 3.2%) but unclear post (2.1 ± 5.4%). Changes in muscle function were not different between ISR10 and ISR20 conditions for knee extension (-0.2 ± 0.9%) but were likely different for knee flexion (-5.7 ± 4.9%). More directional changes during shuttle running increases the physiological and perceptual load on female athletes that also causes a greater reductions in knee extensor torque. These findings have implications for the effective conditioning and injury prevention of female team sport athletes.
    • Cardiopulmonary exercise testing in the COVID-19 endemic phase

      Faghy, Mark A.; 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.