Children with Hemiparesis Arm and Movement Project (CHAMP): protocol for a multisite comparative efficacy trial of paediatric constraint-induced movement therapy (CIMT) testing effects of dosage and type of constraint for children with hemiparetic cerebral palsy.

INTRODUCTION: The Children with Hemiparesis Arm and Movement Project (CHAMP) addresses two pressing issues concerning paediatric constraint-induced movement therapy (CIMT): effects of two dosages and two types of constraint on functional outcomes. Systematic reviews conclude that CIMT is one of the most efficacious treatments, but wide variations in treatment protocols, outcome measures and patient characteristics have prevented conclusions about potential effects of dosage levels and constraint methods. METHODS AND ANALYSIS: CHAMP is a multisite comparative efficacy randomised controlled trial of 135 children (2-8 years) with hemiparetic cerebral palsy. The 2×2 factorial design tests two dosage levels-60 hours (3.0 hours/day, 5 days/week × 4 weeks) and 30 hours (2.5 hours/day, 3 days/week × 4 weeks) and two constraint conditions-full-arm, full-time cast and part-time splint, plus usual and customary (UCT) controls, yielding five groups: (1) 60 hours CIMT+full-time cast, (2) 60 hours CIMT+part-time splint, (3) 30 hours CIMT+full-time cast, (4) 30 hours CIMT+part-time splint and (5) UCT. Trained therapists deliver the standardised ACQUIREc protocol for CIMT. Blinded assessments at baseline, end of treatment, and 6 and 12 months post treatment include the Assisting Hand Assessment, and subscales from the Peabody Developmental Motor Scales-2 and modified Quality of Upper Extremity Skills Test. Parents complete the Pediatric Motor Activity Log and Pediatric Evaluation of Disability Inventory. A new Fidelity of Implementation Rehabilitation Measure monitors treatment delivery. Data analyses involve repeated-measures multivariate analysis of co-variance controlling for selected baseline variables. ETHICS AND DISSEMINATION: Ethics boards at site universities approved the study protocol. To promote equipoise, parents of UCT controls are offered ACQUIREc after 6 months. A Data Safety and Monitoring Committee reviews results regularly, including measures of child and family stress. We will disseminate CHAMP results via peer-reviewed publications and presentations to professional and advocacy organisations. TRIAL REGISTRATION NUMBER: NCT01895660; Pre-results.

Daily Well-Being Benefits of Physical Activity in Older Adults: Does Time or Type Matter?

Purpose of the Study: There is little debate that maintaining some level of physical activity in later life conveys positive benefits both physically and psychologically. What is less understood is the extent to which the type of activity or the length of time spent doing it matters when it comes to these benefits on the daily level. Here, we investigated (a) whether the presence of daily purposeful exercise (Exercise) or non-exercise physical activity (Activity) is sufficient for experiencing day-level benefits, or if time spent matters, and (b) whether there are differential well-being benefits of Exercise and Activity on the daily level. Design and Methods: Older adults (N = 127; aged 60-95, Mage = 79.4) filled out surveys for 14 days, reporting daily Exercise and Activity behaviors as well as Positive and Negative Affect (PA/NA), Perceived Stress (PS), Perceived Health (PH), and Sleep Quality (SQ). Results: Multilevel regression models showed that for purposeful exercise, more time spent was beneficial for PA, NA, and PH, but for PS, only the presence of exercise was important (time did not matter). For non-exercise activity, time did not have as great an influence as presence-doing any form of activity was beneficial for both PA and SQ. Exercise and Activity had largely independent (additive) effects. Implications: Results reveal that both purposeful exercise and non-exercise activity convey independent daily well-being benefits, and that for some aspects of daily well-being, duration does matter. Findings can be applied in the development of physical activity education or engagement programs for older adults.