"It's a Very Good Second Option": Older Adults' Experience of Telehealth.

INTRODUCTION: The growing ability to provide online services has enabled the proliferation of exercise-based telehealth interventions; however, adoption in older adults may be impacted by low digital literacy and "technophobia." OBJECTIVES: The aim of this study was to explore the experience of community and aged-care dwelling older adults following exercise-based telehealth services to provide insights that could guide future telehealth exercise delivery. DESIGN: Semi-structured interviews for qualitative analysis. METHODS: Participants (age ≥60) who had completed at least one online exercise session from a registered health professional were recruited through a combination of purposeful and snowball sampling methods via their exercise facility or provider. A semi-structured interview guide was used by 2 interviewers to investigate participants' experiences and a "critical friends" approach used to identify common themes. RESULTS: Thirteen interviews with 21 participants were conducted from 2 different facilities. Analysis identified meaning units within 3 themes and subthemes. Technology subthemes related to digital confidence prior to telehealth and changes during interventions, as well as the usability of technology for telehealth. Clinical practice subthemes described the different motivations to exercise, perceived benefits of telehealth, important implications for practitioners, and perceptions of safety. The social connection theme related to the social benefits of telehealth. CONCLUSIONS: Older adults in our sample were technologically confident and capable of performing exercise sessions delivered via telehealth. They notice benefits from this form of exercise delivery however, prefer face-to-face exercise delivery.

Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses.

People with osteoarthritis often experience pain and depression. These meta-analyses examined and compared nonpharmacological randomized controlled trials (RCTs) for pain and symptoms of depression in people living with osteoarthritis. RCTs published up until April 2022 were sourced by searching electronic databases EMBASE, PUBMED & MEDLINE, Web of Science, CINAHL and PEDro. Random-effects meta-analyses were performed to calculate pooled effect sizes (ES) and 95% confidence intervals (CI) for pain and depression. Subgroup analyses examined intervention subtypes. For pain, 29 interventions (n = 4382; 65 ± 6.9 years; 70% female), revealed a significant effect on reducing pain (ES = 0.43, 95% CI [0.25, 0.61], p < 0.001). Effect sizes were significant (p < 0.001) for movement meditation (ES = 0.52; 95% CI [0.35, 0.69]), multimodal approaches (ES = 0.37; 95% CI [0.22, 0.51]), and psychological therapy (ES = 0.21; 95% CI [0.11, 0.31]), and significant (p = 0.046) for resistance exercise (ES = 0.43, 95% CI [- 0.07, 0.94]. Aerobic exercise alone did not improve pain. For depression, 28 interventions (n = 3377; 63 ± 7.0 years; 69% female), revealed a significant effect on reducing depressive symptoms (ES = 0.29, 95% CI [0.08, 0.49], p < 0.001). Effect sizes were significant for movement meditation (ES = 0.30; 95% CI [0.06, 0.55], p = 0.008) and multimodal interventions (ES = 0.12; 95% CI [0.07, 0.18], p < 0.001). Resistance/aerobic exercise or therapy alone did not improve depressive symptoms. Mind-body approaches were more effective than aerobic/resistance exercise or therapy alone for reducing pain and depression in people with osteoarthritis.Systematic review registration: PROSPERO CRD42022338051.

Reliability of Fitness Assessments in Children With Emotional and Behavioral Difficulties.

PURPOSE: Examine the reliability of field-based fitness assessments in school-aged children with emotional or behavioral difficulties (EBD). Understanding the impact of fitness on physical activity participation for children with EBD is limited by our ability to reliably measure it. METHODS: Fifteen children aged 7-12 years with EBD completed 7 assessments-standing broad jump, overhead throw, grip strength, isometric plank hold, isometric wall squat, unilateral heel raise, and modified 6-minute walk test-in a random order on 2 separate occasions. Intraclass correlation coefficients (ICCs) were computed to evaluate reliability. RESULTS: ICCs ranged from .65 to .99 representing moderate to excellent reliability for all assessments. Shorter assessments requiring less attention and behavior regulation tended to demonstrate higher ICC values while assessments with greater attention or behavioral regulation demands tended to have lower ICC values. CONCLUSION: Results demonstrate varied reliability for fitness tests in children with EBD. Practitioners can use grip strength and standing broad jump assessments with confidence. Other assessments have good reliability but greater variability indicating they may be a challenge for some children with EBD.

Move your mind: embedding accredited exercise physiology services within a hospital-based mental health service.

OBJECTIVE: Despite support for the role of exercise in improving physical and mental health for various psychiatric disorders, few service implementation evaluations within diverse hospital environments exist. This study presents the feasibility and implementation of a clinical exercise physiology service within a hospital mental health service. METHOD: Feasibility and service data were collected from databases and self-report (consumer and staff) for 6 months from the commencement of new exercise services (gym and group sessions) for community and inpatients (one secure and three open wards). RESULTS: One hundred and twenty consumers engaged with exercise services with 70 direct referrals over the 6-month audit period (mean age 40 ± 13 years (19-69); 41% male). The overwhelming reason for referral was related to weight loss/management (65.7%), with the majority of patients (51%) presenting with schizophrenia spectrum and other psychotic disorders. Further, 549 exercise service interactions were delivered and 78% gym attendees and 69% group session attendees rated the exercise sessions as 'Good' or 'Great', and intention to return ranged from 78% for inpatient gym sessions to 91% for community gym sessions. CONCLUSIONS: Embedding exercise physiology into a mental health service is feasible and well accepted and the evaluation of long-term consumer outcomes in 'real-world' will serve as a crucial step.

Exploring associations between neuromuscular performance, hypermobility, and children's motor competence.

OBJECTIVES: To evaluate if neuromuscular performance and hypermobility are factors associated with children's motor competence. DESIGN: Cross-sectional observation study. METHODS: Data was collected on 60 children aged 6-12 years; motor competence was determined using the Movement Assessment Battery for Children-2 test, with children classified into 3 groups (Typically Developing n=30; 'At Risk' of low motor competence (LMC) n=9; LMC n=21). Neuromuscular performance was determined utilising the Resistance Training Skills Battery for Children (RTSBc), 5-repetition maximum (5RM) leg press and Biodex dynamometry to assess isometric and isokinetic peak torque of the knee flexors and extensors. Hypermobility was measured using the Beighton and Lower Limb Assessment Score. RESULTS: Between-groups MANCOVA revealed typically developing children scored significantly higher on the RTSBc than those 'at risk' of LMC (p=0.021) and those in the LMC group (p<0.001). 5RM scores also differed between groups, with typically developing children achieving significantly higher scores than the LMC group. No differences were found between groups for isometric or isokinetic measures of strength. Sequential regression analysis revealed neuromuscular performance variables explained 44.7% of the variance in motor competence, with RTSBc (p<0.001) and 5RM (p=0.019) emerging as positive significant predictors. Hypermobility failed to explain significant variance in motor competence beyond that explained by neuromuscular performance. CONCLUSIONS: Neuromuscular performance of children varies according to levels of motor competence, with those with LMC performing poorly on tasks requiring multi-joint movement. Furthermore, neuromuscular performance predicted almost half the variance observed in motor competence and highlights a novel intervention strategy.

The effect of parental logistic support on physical activity in children with, or at risk of, movement difficulties.

OBJECTIVES: In a sample of children with, or at risk of, movement difficulties, (1) To test the direct effects of children's perceptions of parents' logistic support for physical activity on children's physical activity-related self-perceptions and on children's physical activity levels, and (2) To explore the indirect relationship between children's perceptions of parents' logistic support for physical activity and children's physical activity levels through children's physical activity-related self-perceptions. DESIGN: Cross-sectional observation study. METHODS: Data were collected from 120 children aged 6 to 12 years; movement proficiency levels were determined using the movement assessment battery for children-2 test. Children's perspectives of parental support for physical activity were captured using the Activity Support Scale for Multiple Groups child report. Children's self-perceptions towards physical activity were reported with the Children's Self- perceptions of Adequacy in and Predilections for physical activity, and time spent in physical activity were measured using accelerometers. RESULTS: There was no significant direct effect between perceived levels of parents' logistic support for physical activity and children's physical activity. A significant indirect relationship between these variables was discovered, with higher perceived levels of parent logistical support for physical activity predicting stronger perceptions of adequacy (i.e., confidence) toward physical activity participation among children, which in turn was associated with increased physical activity minutes. CONCLUSIONS: The results demonstrate that irrespective of a child's movement ability, children's perceptions of parents' logistic support for physical activity indirectly and positively predicts children's physical activity levels, via children's confidence for physical activity.

Physiological characteristics, self-perceptions, and parental support of physical activity in children with, or at risk of, developmental coordination disorder.

Children with low movement proficiency have been identified as having poorer physiological and psychosocial outcomes; however, the varied measurement approaches used to assess these outcomes have varied resulting in conflicting evidence regarding the presence and magnitude of differences compared to Typically Developing (TD) children. Additionally, there has been limited research into the role of parental support for physical activity (PA) in this group. We compared children with varying levels of movement proficiency on physiological characteristics and self-perceptions regarding PA. In addition, these children's parents were compared on physiological characteristics and support of their children's PA. Children (N = 117) aged 6 to 12 years, along with their parent/guardian, participated in this study. Children were classified according to the Movement Assessment Battery for Children-2 test (Typically Developing (TD) = 60; At Risk = 19; Developmental Coordination Disorder (DCD) = 38). Children's PA, muscle strength, cardio-respiratory fitness (CRF), body composition, and self-perceptions regarding PA were assessed, with parents assessed on CRF, body composition, and PA support. Compared to TD children, children with DCD had lower PA (p = 0.036), predilection (p ≤0.001) and adequacy (p ≤0.001) regarding PA, higher body fat percentage (p = 0.019), and received less logistic support (i.e., transportation) from their parents (p = 0.012). TD children had increased muscle strength compared to the DCD (p ≤ 0.001) and At Risk (p ≤ 0.001) groups. Results indicated that, relative to TD children, children with DCD have multiple physiological deficits, receive less parental logistic support for PA involvement, and report lower scores on psychological constructs that are predictive of PA involvement.

Reliability and validity of the adapted Resistance Training Skills Battery for Children.

OBJECTIVES: Resistance training (RT) is emerging as a training modality to improve motor function and facilitate physical activity participation in children across the motor proficiency spectrum. Although RT competency assessments have been established and validated among adolescent cohorts, the extent to which these methods are suitable for assessing children's RT skills is unknown. This project aimed to assess the psychometric properties of the adapted Resistance Training Skills Battery for Children (RTSBc), in children with varying motor proficiency. DESIGN: Repeated measures design with 40 participants (M age=8.2±1.7years) displaying varying levels of motor proficiency. METHODS: Participants performed the adapted RTSBc on two occasions, receiving a score for their execution of each component, in addition to an overall RT skill quotient child (RTSQc). Cronbach's alpha, intra-class correlation (ICC), Bland-Altman analysis, and typical error were used to assess test-retest reliability. To examine construct validity, exploratory factor analysis was performed alongside computing correlations between participants' muscle strength, motor proficiency, age, lean muscle mass, and RTSQc. RESULTS: The RTSBc displayed an acceptable level of internal consistency (alpha=0.86) and test-retest reliability (ICC range=0.86-0.99). Exploratory factor analysis supported internal test structure, with all six RT skills loading strongly on a single factor (range 0.56-0.89). Analyses of structural validity revealed positive correlations for RTSQc in relation to motor proficiency (r=0.52, p<0.001) and strength scores (r=0.61, p<0.001). CONCLUSIONS: Analyses revealed support for the construct validity and test-retest reliability of the RTSBc, providing preliminary evidence that the RTSBc is appropriate for use in the assessment of children's RT competency.

Adaptation of the Resistance Training Skills Battery for Use in Children Across the Motor Proficiency Spectrum.

PURPOSE: The study aim was to adapt the Resistance Training Skills Battery for use in children and assess its interrater and intrarater reliability. The RTSBc provides an assessment of resistance training (RT) skill competency and an indication of readiness to perform RT. The RTSBc includes 6 basic RT skills. Scoring for individual RT skills is based on the number of performance criteria correctly demonstrated and a gross resistance training skills quotient for children (RTSQc) is calculated by summing the individual skill scores. METHODS: Twenty participants (mean age = 8.2 ± 1.8 years) were assessed while performing the RTSBc on 2 occasions. The 3 raters completing the assessments had varying levels of movement analysis and RT experience and received training in how to appraise RT skill competency using the RTSBc. RESULTS: Interrater reliability for the 3 raters was very good for the RTSQc (ICC = 0.92) and individual RT skills (ICC range = 0.82-0.94). Intrarater reliability of the live rater was also very good for the RTSQc (ICC = 0.97) and individual RT skills (ICC range = 0.87-0.95). CONCLUSION: This study has demonstrated the interrater and intrarater reliability of the RTSBc for children with varying levels of motor proficiency. The RTSBc can be used reliably within and between-raters to assess the RT skill competency of children.

A randomised controlled trial comparing the effects of a 12-week supervised exercise versus usual care on outcomes in haematological cancer patients.

PURPOSE: Following treatment, haematological cancer (HEM) patients exhibit significant physical deconditioning and psychological distress. Exercise has been shown as a clinically effective and safe intervention for cancer patients, with the potential to reverse the deleterious effects following treatment. Our aim was to investigate the efficacy of a 12-week exercise rehabilitation on cancer-related fatigue (CRF) and associated outcomes in HEM patients post-treatment. METHODS: Patients with a HEM were recruited to participate in a 12-week exercise rehabilitation intervention post-treatment. Pre-, post- and follow-up assessments were conducted on outcome measures including CRF, quality of life (QoL), psychological distress, cardiovascular fitness, muscle strength (MS) and body composition. Patients were given tailored exercise programmes comprising aerobic and resistance exercises, carried out three times per week for 12 weeks in local gyms and clinics. Usual-care participants were offered a delayed, tailored 12-week exercise intervention after the initial study period. RESULTS: Thirty-seven patients (49 % recruitment rate) were randomly assigned to the 12-week exercise rehabilitation (n = 18) or usual care (n = 19) with a 91 % adherence to the exercise intervention. Following the exercise programme, significant improvements were seen in CRF (p = 0.01), cardiovascular fitness (p ≤ 0.001), QoL (p ≤ 0.001), MS (p ≤ 0.001) and body composition (p = 0.001), with moderate to large effects for all primary outcomes. Patient follow-up at 24 weeks demonstrated outcome maintenance in the exercise rehabilitation group and significant improvements in outcomes in usual-care patients following participation in a delayed exercise programme. There were no adverse reactions or study withdrawals. CONCLUSIONS: A 12-week exercise rehabilitation programme resulted in significant statistical (p ≤ 0.05) and clinical improvements in CRF and additional outcomes in HEM patients following treatment. Additionally, a 12-week delayed exercise programme showed similar significant improvements in patient outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000450213.

Positive patient experiences in an Australian integrative oncology centre.

BACKGROUND: The purpose of this study was to explore the experiences of cancer patients' utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia. METHODS: Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61±12 y; female n=45; male n=21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients' perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified. RESULTS: Of the 66 participants, 100% indicated they would "recommend complementary therapies to other patients" and 92% stated "CIT would play a significant role in their future lifestyle". A mean score of 8±1 indicated an improvement in participants' perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control. CONCLUSIONS: Exploration of patients' experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery.

Characteristics and quality of life of patients presenting to cancer support centres: patient rated outcomes and use of complementary therapies.

BACKGROUND: In order to effectively target and provide individualised patient support strategies it is crucial to have a comprehensive picture of those presenting for services. The purpose of this study was to determine the characteristics and patient rated outcomes of individuals presenting to SolarisCare cancer support centres and their choices regarding complementary and integrated therapies (CIT). METHODS: A cohort with a current or previous cancer diagnosis aged 18 - 87 years presenting to a SolarisCare centre during a 5-day period completed a questionnaire. Four SolarisCare centres participated in the trial including regional and metropolitan locations. Outcomes included medical and demographic characteristics, CIT variables and patient rated outcomes (PROs) including quality of life (QoL). RESULTS: Of the 95 participants (70.3%) who completed the survey, the mean age was 60.5 years with 62% currently receiving treatment. Eighty percent of the sample had at least one other comorbid condition, with the most popular CIT being relaxation massage. Of the PROs, QoL was significantly lower than norms for the Australian population and other mixed cancer populations. No notable differences were seen between genders, however significantly poorer outcomes were found for the younger age group. Fifty percent of the population did not meet physical activity recommendations, and musculoskeletal symptoms explained between 25-27% of variance in QoL. CONCLUSIONS: A greater understanding of the health profiles of patients presenting to supportive care centres and their use of CIT, provides Western Australian health professionals with key information to ensure the safety of supportive care practices, as well as fosters optimal patient outcomes and enhances the integration of supportive care strategies within mainstream medical care.