An Individual vs Parent Supported Physical Activity Intervention in Adolescents with Intellectual Disabilities.

INTRODUCTION: Moderate-to-vigorous physical activity (MVPA) is inadequate in adolescents with intellectual and developmental disabilities (IDD). This report describes the results of an 18-mo. clinical trial in adolescents with IDD which compared changes in accelerometer assessed daily MVPA, gross motor quotient and leg press strength between participants randomized to an exercise intervention delivered to adolescents only (AO) or to the adolescent and a parent (A + P). METHODS: The 18-mo. trial included a 6-mo. active intervention, 6-mo. maintenance interventions, and a 6-mo. no-contact follow-up. Adolescents in both arms were asked to attend 40 min. remotely delivered group video exercise sessions (0-6 mos. =3 sessions·wk-1., 7-12 mos. =1 session·wk-1). In the A + P arm, one parent/guardian was asked to attend all group remote video exercise sessions and a monthly remotely delivered 30-min. educations/support session with their adolescent across the 12-mo. intervention. RESULTS: Adolescents (n = 116) with IDD (age ~ 16 yrs., 52% female) were randomized to the AO (n = 59) or A + P (n = 57) arms. Mixed modeling, controlling for baseline MVPA and season, indicated minimal but statistically significant changes in MVPA across 6 (p = 0.006), 12 (p < 0.001), and 18 mos. (p < 0.001). However, the change in MVPA in the two intervention arms did not differ significantly at any time point (all p > 0.05). Similarly, gross motor quotient and leg press strength improved significantly over time (p < 0.001) and these changes did not differ between intervention arms (all p > 0.05). CONCLUSIONS: Parental involvement had no impact on changes in daily MVPA, gross motor quotient or leg press strength in response to a remotely delivered exercise intervention in adolescents with IDD.

2024 Wheelchair Compendium of Physical Activities: An update of activity codes and energy expenditure values.

PURPOSE: This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium. The Wheelchair Compendium aims to curate existing knowledge of the energy expenditure for wheelchair physical activities (PAs). METHODS: A systematic review of the published energy expenditure of PA for wheelchair users was completed between 2011 and May 2023. We added these data to the 2011 Wheelchair Compendium data that was compiled previously in a systematic review through 2011. RESULTS: A total of 47 studies were included, and 124 different wheelchair PA reported energy expenditure values ranging from 0.8 metabolic equivalents for wheelchair users (filing papers, light effort) to 11.8 metabolic equivalents for wheelchair users (Nordic sit skiing). CONCLUSION: In introducing the updated 2024 Wheelchair Compendium, we hope to bridge the resource gap and challenge the prevailing narratives that inadvertently exclude wheelchair users from physical fitness and health PAs.

The association between cardiovascular health and cognition in adults with Down syndrome.

INTRODUCTION: Evidence in the general population suggests that predictors of cardiovascular health such as moderate to vigorous physical activity (MVPA), cardiorespiratory fitness, and systolic blood pressure are associated with cognitive function. Studies supporting these associations in adults with Down syndrome (DS) are limited. The purpose of this study was to examine the associations between systolic blood pressure, cardiorespiratory fitness, and MVPA on cognition in adults with DS. METHODS: This is a cross-sectional analysis using baseline data from a trial in adults with DS. Participants attended a laboratory visit where resting blood pressure, cardiorespiratory fitness (VO2 Peak), and cognitive function (CANTAB® DS Battery) were obtained. The cognitive battery included tests measuring multitasking, episodic memory, and reaction time. Physical activity (accelerometer) was collected over the week following the laboratory visit. Pearson correlations and linear regressions were used to measure the impact of systolic blood pressure, cardiorespiratory fitness, and MVPA on cognitive outcomes. RESULTS: Complete data was available for 72 adults with DS (26.8 ± 9.3 years of age, 57% female). At baseline, VO2 Peak (21.1 ± 4.2 ml/kg/min) and MVPA were low (14.4 ± 14.4 min/day), and systolic blood pressure was 118.3 ± 13.3 mmHg. VO2 Peak was correlated with simple movement time (rho = - 0.28, p = 0.03) but was not significant using a linear regression controlling for age and sex. Systolic blood pressure was significantly associated with episodic memory (first attempt memory score: ß = - 0.11, p = 0.002; total errors: ß = 0.58, p = 0.001) and reaction time (five-choice movement time: ß = 4.11, p = 0.03; simple movement time: ß = 6.14, p = 0.005) using age- and sex-adjusted linear regressions. No associations were observed between MVPA and multitasking, episodic memory, or reaction time. CONCLUSION: Predictors of cardiovascular health, including cardiorespiratory fitness and systolic blood pressure, were associated with some aspects of cognition in adults with DS. While future research should examine the role of improved cardiovascular health on delaying decreases in cognitive function and dementia in adults with DS, we recommend that health care providers convey the importance of exercise and cardiovascular health to their patients with DS. TRIAL REGISTRATION: NCT04048759, registered on August 7, 2019.

The association of increased body mass index on cardiorespiratory fitness, physical activity, and cognition in adults with down syndrome.

BACKGROUND: Obesity is a significant risk factor for Alzheimer's disease; however, this association has not been explored in adults with Down syndrome. OBJECTIVE: To examine the association of obesity, assessed by body mass index (BMI), with factors related to Alzheimer's disease risk including cardiorespiratory fitness, physical activity, and cognition in adults with Down syndrome. METHODS: Adults with Down syndrome attended a laboratory visit where BMI, cardiorespiratory fitness (VO2 peak), and cognitive function (CANTAB® DS Battery) were obtained. Physical activity (accelerometer) was collected over the week following the laboratory visit. Wilcoxon rank sum tests were used to evaluate differences in cardiorespiratory fitness, sedentary time, moderate-to-vigorous physical activity (MVPA), and cognition between adults with obesity (BMI≥ 30 kg/m2) and those with healthy weight or overweight (BMI <30 kg/m2). Spearman correlations and linear regressions were used to measure the impact of BMI on cardiorespiratory fitness, MVPA, sedentary time, and cognition. RESULTS: Data was collected for 79 adults with Down syndrome (26.7 ± 9.0 years of age, 54% female, 54% with obesity). VO2 peak was significantly lower in participants with obesity (18.4 ± 2.5 ml/kg/min) compared to those with healthy weight or overweight (22.9 ± 4.0 ml/kg/min, p < 0.001). BMI was negatively associated with cardiorespiratory fitness (rho = -0.614, p < 0.001). No associations were observed between BMI and physical activity or cognition. CONCLUSIONS: Lower BMI was associated with improved cardiorespiratory fitness. However, no associations were observed between BMI and cognition or physical activity. NCT REGISTRATION: NCT04048759.

Androgen Deprivation and Sleep Disturbance: A Mixed Methods Pilot Study of Remote Assessment and Intervention.

BACKGROUND: Men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) are at risk for cardiovascular comorbidities and cognitive changes. Interventional research involves in-person assessment of physical fitness/activity and cognitive function, which has been negatively affected by the COVID-19 pandemic. Androgen deprivation therapy-related hot flashes and nocturia increase risk for insomnia. Insomnia is associated with fatigue and may exacerbate ADT-related cognitive changes. OBJECTIVES: The purpose of this mixed-methods pilot was to (1) determine feasibility/acceptability of remotely assessing physical fitness/activity, cognitive function, and sleep; (2) deliver telehealth cognitive behavioral training for insomnia (teleCBT-I) to improve sleep; and (3) garner qualitative feedback to refine remote procedures and teleCBT-I content. METHODS: Fifteen men with PC receiving ADT completed a 4-week teleCBT-I intervention. Videoconferencing was used to complete study assessments and deliver the weekly teleCBT-I intervention. RESULTS: Self-report of sleep quality improved ( P < .001) as did hot flash frequency ( P = .04) and bother ( P = .025). Minimal clinically important differences were detected for changes in insomnia severity and sleep quality. All sleep logs indicated improvement in sleep efficiency. Remote assessment of fitness/cognitive function was demonstrated for 100% of participants. Sufficient actigraph wear time allowed physical activity/sleep assessment for 80%. Sleep actigraphy did not demonstrate significant changes. CONCLUSIONS: Remote monitoring and teleCBT-I are feasible/acceptable to men with PC on ADT. Further research to confirm teleCBT-I efficacy is warranted in this population. IMPLICATIONS FOR PRACTICE: Preliminary efficacy for teleCBT-I interventions was demonstrated. Remote assessments of physical fitness/activity, sleep, and cognitive function may enhance clinical trial access for rural or economically disadvantaged PC survivors.

The Family Nutrition and Physical Activity Survey: Comparisons with Obesity and Physical Activity in Adolescents with Autism Spectrum Disorder.

Adolescents with autism spectrum disorder (ASD) are at a heightened risk for obesity. Family-level measures of nutrition and physical activity may help explain factors contributing to disproportionate rates of weight gain. Twenty adolescents with ASD participated in baseline testing for a study to assess the feasibility of remotely-delivered yoga. Parents completed the Family Nutrition and Physical Activity (FNPA) survey and anthropometrics and physical activity were assessed in the adolescents. A median split was applied to the FNPA score to create high and low obesogenic environments and nonparametric O'Brien's multiple endpoint tests were used to evaluate the differences. Between-group differences were found in anthropometrics (p = 0.01) but not physical activity (p = 0.72). Implications for a multifaceted family-based approach to obesity prevention are discussed.

A Remotely Delivered Yoga Intervention for Adolescents with Autism Spectrum Disorder: Feasibility and Effectiveness for Improving Skills Related to Physical Activity.

This study evaluated the feasibility of remotely delivered yoga for improving four physical activity-related skills: motor skills, strength, balance, and flexibility in adolescents with autism spectrum disorder (ASD). Nineteen of 20 participants enrolled (age 13.2 ± 2.2 years; 60% male) completed the 12-week intervention and attended 83% of the scheduled yoga sessions. Overall, physical activity-related skills improved pre to post intervention (Φ = 0.90, p = 0.005, 95% CI 0.72-1.0). Specifically, significant increases in leg strength (12.5%, p = 0.039), flexibility (40.3%, p = 0.008), and dynamic balance on the right (11.1%, p = 0.001) and left legs (8.1%, p = 0.003) were observed across 12 weeks. These results demonstrate the feasibility and potential effectiveness of yoga to improve physical activity-related skills in adolescents with ASD.

The promotion of physical activity for the prevention of Alzheimer's disease in adults with Down Syndrome: Rationale and design for a 12 Month randomized trial.

Nearly all individuals with Down Syndrome (DS) display pathology associated with Alzheimer's disease (AD) beginning as early as age 30. Previous research in typically developed adults suggests that increased moderate-to-vigorous physical activity (MVPA) may improve cognitive function and protect against age-related structural and functional changes in the brain; however, the potential impact of increased MVPA on the development of AD in adults with DS has not been evaluated. Despite the potential positive impact of MVPA on cognition and AD risk, participation in MVPA among young adults with DS is low. The limited research evaluating strategies for increasing MVPA in adults with DS has been unsuccessful in increasing MVPA. Results from our preliminary investigation where we remotely delivered real-time MVPA, led by a trained health educator, to groups of adults with DS in their homes via video conferencing on a tablet computer demonstrated high attendance, increased MVPA during group sessions, and improvements in cognitive function. However, the sustainability, impact on total daily MVPA, optimal session frequency, and potential impacts on cognitive function and brain health of remotely delivered group MVPA sessions in adults with DS are unknown. Therefore, we will conduct a trial in 80 non-demented adults with DS to determine the feasibility and potential efficacy of remotely delivered group MVPA sessions to increase daily MVPA, relative to a usual care control. Secondarily we will assess the impact of MVPA on cardiovascular fitness, quality of life, cognitive function and brain parameters related to AD. NCT REGISTRATION: NCT04048759.

The Feasibility of Remotely Delivered Exercise Session in Adults With Alzheimer's Disease and Their Caregivers.

Adults with Alzheimer's disease (AD) and their caregivers represent a segment of the population with low levels of moderate-intensity physical activity (MPA) and limited options for increasing MPA. The purpose of this study was to evaluate the feasibility of a group video conference approach for increasing MPA in adults with AD and their caregivers. Adults with AD and their caregivers attended 30-min group exercise sessions three times per week for 12 weeks. Exercise sessions and support sessions were delivered in their homes on a tablet computer over video conferencing software. Nine adults with AD/caregiver dyads enrolled, and seven completed the 12-week intervention. Adults with AD attended 77.3% of the group exercise sessions, and caregivers attended 79.2% of group exercise sessions. Weekly MPA increased in both adults with AD (49%) and caregivers (30%). Exercise delivered by group video conferencing is a feasible and potentially effective approach for increasing MPA in adults with AD and their caregivers.

Remote delivery of weight management for adults with intellectual and developmental disabilities: Rationale and design for a 24 month randomized trial.

Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0-6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.

Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial.

BACKGROUND: In 1999, we reported safety and efficacy data for short-course nevirapine from a Ugandan perinatal HIV-1 prevention trial when 496 babies were followed up to age 14-16 weeks. Safety and efficacy data are now presented for all babies followed up to 18 months of age. METHODS: From November, 1997, to April, 1999, HIV-1 infected pregnant women in Kampala, Uganda, were randomly assigned nevirapine (200 mg at labour onset and 2mg/kg for babies within 72 h of birth; regimen A) or zidovudine (600 mg orally at labour onset and 300 mg every 3 h until delivery, and 4 mg/kg orally twice daily for babies for 7 days, regimenB). Infant HIV-1 testing was done at birth, age 6-8 and 14-16 weeks, and age 12 months by HIV-1 RNA PCR, and by HIV-1 antibody at 18 months. HIV-1 transmission and HIV-1-free survival were assessed using Kaplan-Meier analysis. We recorded adverse experiences through 6-8 weeks postpartum for mothers, and 18 months for babies. Efficacy analyses were by intention to treat. FINDINGS: We enrolled 645 mothers to the study: 313 were assigned regimen A, 313 regimen B, and 19 placebo. Eight mothers were lost to follow-up before delivery. 99% of babies were breastfed (median duration 9 months). Estimated risks of HIV-1 transmission in the zidovudine and nevirapine groups were 10.3% and 8.1% at birth (p=0.35); 20.0% and 11.8% by age 6-8 weeks (p=0.0063); 22.1% and 13.5% by age 14-16 weeks (p=0.0064); and 25.8% and 15.7% by age 18 months (p=0.0023). Nevirapine was associated with a 41% (95% CI 16-59) reduction in relative risk of transmission through to age 18 months. Both regimens were well-tolerated with few serious side-effects. INTERPRETATION: Intrapartum/neonatal nevirapine significantly lowered HIV-1 transmission risk in a breastfeeding population in Uganda compared with a short intrapartum/neonatal zidovudine regimen. The absolute 8.2% reduction in transmission at 6-8 weeks was sustained at age 18 months (10.1% [95% CI 3.5-16.6]). This simple, inexpensive, well-tolerated regimen has the potential to significantly decrease HIV-1 perinatal transmission in less-developed countries.