The effects of the Friendship Online Intervention Program on physical activity, substance abuse, psychosomatic symptoms, and well-being among at-risk youth.

INTRODUCTION: At-risk youth are those who are currently or potentially exposed to physical, mental, or emotional danger. The Friendship Online Intervention Program (FOIP) was created to encourage physical activity (PA) and reduce risky behavior among vocational secondary-school youth in Israel. We wanted to evaluate the effect of FOIP on PA, substance abuse, and psychological factors, including psychosomatic symptoms and well-being. METHODS: From October 2021 to June 2022, nonrandom sampling was employed to select at-risk youth from vocational secondary schools for participation in the FOIP. Before and after the intervention, questionnaires were administered to the intervention and control groups. The effects of FOIP were evaluated by univariate and multivariable analyses. RESULTS: The intervention (n = 103) and control (n = 77) groups showed similar levels of PA, cigarette smoking, and alcohol consumption at the beginning of the study. At follow-up, the intervention group showed a 57% increase in PA versus no change for the control group and decreased levels of smoking compared to the control group (p < .001). Similarly, in the intervention group, the number of psychosomatic symptoms decreased (effect size = 1.68) and life satisfaction increased (effect size = 0.86). Group assignment (intervention or control group) significantly predicted PA level, cigarette smoking, psychosomatic symptoms, and life satisfaction (adjusted R2 = .46, .20, .08, and .28, respectively) with participants in the intervention group showing more favorable results compared with the control group. CONCLUSIONS: FOIP was effective in increasing PA and decreasing risky behaviors among youth. FOIP may help at-risk youth build resilience and promote their physical and mental health.

Cardiovascular risk profiles clusters among children and adolescents with disabilities.

BACKGROUND: Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents' profiles clusters with and without disabilities. METHODS: Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11-19 years old school-aged. RESULTS: The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups. CONCLUSION: This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases.

Using a biopsychosocial approach to examine parental sense of burden and competency associated with raising a child with a physical disability.

BACKGROUND: Parents report both positive and negative experiences associated with raising a child with a physical disability. However, distinctive factors may affect children and families differently. AIMS: Using a biopsychosocial approach, the current study expands on the existing literature on the general impact of raising a child with a disability. METHODS: Participants were 98 parents of children/youth with a physical disability. Parents reported on child's level of physical disability, the impact of the disability on the family (financial, social, personal strain and mastery) and their general health. Data were analysed to examine how different biopsychosocial factors are associated with raising a child with a physical disability. RESULTS: Parents reported that child's disability had a higher social impact, compared with the financial and personal burden, as well as compared with their sense of competency and mastery. Child's level of disability was associated with financial burden, whereas parental emotional distress was associated with parents' personal and social burden, with the latter also associated with parent's religiosity. Total impact was associated with parental emotional distress and educational level. CONCLUSIONS: Altogether, parental characteristics, but not child's characteristics, were associated with greater caregiver burden. Furthermore, the social impact a child's physical disability has on the family exceeded other sources of burden within the family. Providing parents social and emotional support, tailored to their unique biopsychosocial needs, may mitigate burden and distress, and increase sense of competency among families of children with a physical disability.

Long-term outdoor recreation program for adults with intellectual disabilities: Feasibility and effects.

BACKGROUND: While people with intellectual disabilities tend to refrain from physical activity, outdoor physical activity programs increase motivation to engage in physical activity. METHOD: Eighty adults with intellectual disabilities participated in a 12-month outdoor physical activity program. Attendance was used to assess feasibility. Aerobic capacity (6-min walk test), lower extremity endurance (30-s chair stand), and mobility (timed up and go) were assessed at three-time points: before, during, and after the program. Six interviews were also conducted with six staff members and participants. RESULTS: The physical activity program was feasible, with all six groups completing the year-long activity. The six-minute walk and timed-up-and-go tests improved significantly. The qualitative analysis indicates the program's strengths (instructors' qualities and programs' social component) and weaknesses (dependency on weather and bureaucracy). CONCLUSION: Among adults with intellectual disabilities, a long-term outdoor physical activity program is feasible as a means for increasing aerobic capacity and improving mobility ability.

2022 Para Report Card on Physical Activity of Israeli Children and Adolescents With Disabilities.

Children and adolescents with disabilities (CAWD) represent 11% of Israeli children and adolescents. The 10 core indicators of the Global Matrix on Para Report Cards of physical activity (PA) of CAWD were used to create the 2022 Israeli Para Report Card. A panel of four experts reviewed resources and synthesized evidence of PA behaviors and policies for CAWD in Israel, converted the data to grades, and charted subcategories of language, sex, and disability across population. Data sources were surveys, reports, and memberships in sport federations and clubs. Among CAWD, levels of participation in daily PA were poor (<20%; Grade F), and participation of CAWD in sports was even lower (<10%; Grade F). A lack of environmental infrastructure may explain the low levels of participation. Females, Arabic speakers, and physiological CAWD need particular attention. Establishing governmental policies and interventions is required to increase overall PA and participation in sports among CAWD.

"WOT" Do We Know and Do About Physical Activity of Children and Adolescents With Disabilities? A SWOT-Oriented Synthesis of Para Report Cards.

The purpose was to synthesize information gathered from the interpretation and conclusion sections of the Global Matrix of Para Report Cards on the physical activity of children and adolescents with disabilities. The synthesis was based on the strengths, weaknesses, opportunities, and threats framework. The procedure consisted of three stages: (a) the application of the International Classification of Functioning, Disability and Health as the theoretical framework; (b) identifying and aligning Global Matrix indicators and benchmarks with the International Classification of Functioning, Disability and Health components through a Delphi approach; and (c) using content analysis to identify themes from specific report cards. Outcomes reveal that further attention toward including children and adolescents with disabilities in fitness assessments is needed as well as adapted assessment methods. Program availability, equipment and facilities, and professional training emerged as strengths but need further development to overcome weaknesses. Paralympic inspiration was an opportunity, whereas extreme weather conditions presented potential threats to physical activity participation among children and adolescents with disabilities.

Factors associated with Multidisciplinary Healthcare Resource Utilization Following Discharge from Pediatric Rehabilitation: A One-year Follow-up Study.

AIMS: To characterize multidisciplinary healthcare resource utilization (mHRU), including physical, occupational, speech and psychosocial therapy one-year following discharge from prolonged inpatient and outpatient pediatric rehabilitation in Israel and to identify factors associated with long-term mHRU. METHODS: According to Andersen's model of health service use, predisposing (child's age and sex), enabling (district of origin, income level, parental education, insurance) and need factors (injury type, functional status, family psychosocial risk) were collected from parents of children hospitalized for >1 month in a large rehabilitation hospital in Israel, and phone interviews were held 3-months (T1), 6-months (T2) and 12-months (T3) post-discharge. The effect of time and the role of various factors on mHRU, operationalized as number of therapy sessions in the previous 2 weeks, were evaluated. RESULTS: Sixty-one families participated at T1 and T2, and 46 participated at T3. HRU was similar over time. Predisposing factors (age) and need factors (functional status and psychosocial risk) were associated with specific disciplines of mHRU, but enabling factors were not. CONCLUSIONS: mHRU is high and stable 12-months post-discharge. The lack of impact of enabling factors on mHRU, and the discipline-specific impact of predisposing and need factors, support equity of care provision for children following prolonged rehabilitation.

The impact of COVID-19 lockdown on physical activity and weight gain among active adult population in Israel: a cross-sectional study.

BACKGROUND: The COVID-19 outbreak holds public health concerns. The stay-at-home increases sedentary behavior, with unintended adverse outcomes. Since organized recreation and sports facilities were closed, we aimed to study how the crisis of closure affected exercise habits and weight gain among the trainee population in Israel. We examined differences in weight gain among individuals with different PA activities and assessed their ability to adapt to digital media as an alternative training structure. METHODS: A cross-sectional survey consisted of a multiple-choice questionnaire obtained using a web-based survey application. Trainees (1202) who exercised steadily anonymously answered the questionnaire sent by their coaches regarding their activity and weight gain during lockdown times. RESULTS: Results confirmed that 70% of Israelis trained less than their usual routine, 60% used digital media for training, 55% gained weight. Half of the respondents gained more than 2 kg, with an average increase of 1.2 kg. However, those who exhibited a higher physical activity level gained less weight. Using digital media for training was associated with higher physical activity levels. The aged population was less likely to use digital media. CONCLUSIONS: Since increased sedentary behavior could increase the risk for potential worsening of health conditions, health agencies should look for strategies, including digital remote media training to promote physical activity and subsequently, preventing the increased burden of future comorbidities worsening by a sedentary lifestyle. Approval: by the Helsinki ethics committee of Sheba Medical Center (6504-19-SMC).

The Game of Life soccer program: Effect on skills, physical fitness and mobility in persons with intellectual disability and autism spectrum disorder.

BACKGROUND: Soccer is the world's most popular sport. The present authors evaluated the effect of the Game of Life (GOL) soccer initiative on soccer skills, fitness and mobility of adults with intellectual disability (ID) and autism spectrum disorder (ASD). METHODS: The programme is comprised of once-weekly sessions. OUTCOMES: soccer skills, fitness and mobility. Effectiveness was evaluated using within-/between-group analyses (e.g. effect size, ES). RESULTS: Fifty adults with intellectual disability and 19 with ASD (age = 31.80 ± 10.11) participated in this study. From pre-test to post-test, the intellectual disability group improved their soccer skills (ES = 0.437); physical fitness-the intellectual disability group presented trivial ESs, whereas the ASD group showed moderate-to-large ESs; Mobility-only the ASD group presented a significant improvement (ES=-0.435), and the intellectual disability group presented better ability in most outcomes in pre- and post-tests. CONCLUSION: The findings indicated differences in entry-level performance and training impact between the two groups. This should be considered when developing training programmes for soccer players.

[CHARACTERISTICS AND TRENDS OF CONGENITAL AND ACQUIRED LOWER LIMB DEFICIENCY IN CHILDREN AND ADOLESCENTS AT THE SHEBA MEDICAL CENTER].

INTRODUCTION: Lower limb deficiency in childhood has an impact on acquisition of motor skills. Information regarding the characteristics of this population was examined in several countries but not in Israel. AIMS: To provide demographics, clinical and functional characteristics of children with lower limb deficiency in a pediatric rehabilitation department. METHODS: Children with lower limb deficiency participated in this study. The study variables included demographics, and clinical and functional characteristics. The statistical analysis included calculations of frequency, chi-squared tests and correlations. RESULTS: During the years 1998-2015 fifty-eight children with lower extremity deformity were treated/examined in the department (mean age: 6.46+4.70 years; girls, n=21; congenital deformity, n=23; acquired deformity, n=35). The most common congenital and acquired injury was unilateral leg deformity (31% and 35%, respectively). In congenital injury, multi-limb deformity (including an involvement in the upper limb) is more prevalent than bilateral lower limb deformity (p<0.01). In children with congenital deformity, longitudinal deformity is more prevalent than transverse deformity (p<0.03). Among children with acquired injury, in 40% the etiology was sickness-related and in the rest traumatic. Among the traumatic group, 57% of the injuries were terror-related. More than 50% percent of the children underwent a complex surgical procedure (34% and 22% among congenital and acquired injury, respectively). The ambulation level of the sample was lower than expected. CONCLUSIONS: Children who received treatment due to lower limb deformity presented high variability in their characteristics and low ambulation level. Consequently, it is important to create and manage a register for pediatric lower limb deformity.

Pain-free treadmill exercise for patients with intermittent claudication: Are there gender differences?

Intermittent claudication, a common symptom of peripheral arterial disease, results in insufficient blood flow and oxygen supply to lower extremity muscles. Compared to men, women with peripheral arterial disease have a higher rate of mobility loss with peripheral arterial disease due to poorer lower extremity functioning. This study evaluates the effect of supervised pain-free treadmill exercise on improving performance in women with intermittent claudication due to peripheral arterial disease in comparison to men. A total of 26 participants (women, n = 9, 34.62%; mean age = 67.58 ± 5.59 years; averaging 23.46 ± 3.91 visits and 10.46 ± 0.99 weeks in the program) diagnosed with peripheral arterial disease, with symptoms of intermittent claudication, partook in a 45 min treadmill walk, twice per week, below the participant's minimal pain threshold. Female participants' change scores showed 752%, 278% and 115% improvement in mean walking distance, duration and rate, respectively. Men improved 334%, 149% and 80%, respectively. Significant differences (p < 0.05) in pre and post measurements within each group support positive outcomes. No significant differences between groups were observed (Cohen's d effect size > 0.80). Our results suggest that women reap similar benefits from this low-intensity treadmill program in comparison to men.

[PHYSICAL EXERCISE FOR PEOPLE WITH MULTIPLE SCLEROSIS: EFFECTS, RECOMMENDATIONS AND BARRIERS].

This review summarizes the existing knowledge regarding the effects and recommendations for physical training (PTr) in patients with multiple sclerosis (MS). In addition, perceived benefits and barriers to PTr in this population are reviewed. One of the primary aims of rehabilitation for patients with MS is to increase their levels of activity and independence. PTr is a central component in the rehabilitation process. Nonetheless, the use of PTr in the rehabilitation of patients with MS has been a controversial issue for years. Nowadays, strong evidence exists that aerobic training in individuals with MS has a positive effect on overall physical conditioning, gait speed, fatigue, depression and cognition. Unlike aerobic training, the number of studies that investigated strength training effects in this population is limited. However, the available data show that resistance training also has beneficial effects on MS patients. It is important to note, that PTr has no deleterious effects in MS patients. In the various studies, there was diversity with regard to the duration and the frequency of PTr, while intensity was often poorly described. It is recommended that individuals with MS engage in aerobic training (at 60-80% of maximal heart rate), strength training (1-3 sets of 8-15 repetitions), the range of motion, balance and ambulation exercises. Awareness of the benefits of physical activity and sense of achievement are not sufficient to promote exercise participation in persons with MS. Factors relating to physical exertion, sports facilities availability and self-efficacy play an important role in promoting exercise participation.

[PHYSICAL EXERCISE AFTER STROKE: EFFECTS, RECOMMENDATIONS AND BARRIERS].

This review summarizes the knowledge regarding the effects and recommendations for physical training (PTr) post-stroke. In addition, perceived benefits/barriers to PTr post-stroke are reviewed. PTr is an important post-stroke rehabilitation goal. Before beginning a PTr program it is recommended to conduct a physical examination. There is evidence that aerobic training post-stroke has a positive effect on gait and on risk factors for recurrent stroke. Similarly, strength training is also safe and effective. However, this training modality does not improve.gait functions. Neuromuscular training post-stroke is also a recommended training method. In the various studies conducted, there was diversity with regard to duration and frequency of PTr. It is recommended that individuals post-stroke engage in aerobic training 3-5 days a week. During the acute phase, the rating of perceived exertion should be "fairly light" (less or equal to 11 on the Borg scale, which ranges 6-20). In more advanced phases of recovery, one ca exercise at a higher intensity of up to "somewhat hard" (rating of perceived exertion 11-14; 55-80% of maximal heart rate). It is also recommended to conduct strength training (2-3 days per week, 1-3 sets of 10-15 repetitions), and flexibility and neuromuscular training (2-3 days per week). In order to encourage individuals post-stroke to conduct PTr there is a need for social support (from caregivers and family) and to provide PTr consultation. PTr barriers consist of both personal (e.g., depression, knowledge regarding physical activity centers) and environmental (e.g., lack of transportation) factors.

[Physical exercise for people with cerebral palsy: effects, recommendations and barriers].

The management goal of cerebral palsy (CP) is improving functionality, locomotion and independence. Treatment programs commonly encompass adapted physical activity (APA). This review summarizes the knowledge regarding the effects and recommendations for APA in persons with CP. In addition, barriers to APA in this population are reviewed. The available literature on benefits of APA to persons with CP has focused mainly on youth. The components of the APA programs generally consist of strength, aerobic and flexibility training. There is no empirical evidence that strength-training increases spasticity in people with CP. Furthermore, strength-training may increase strength and the ability to perform daily activities. Aerobic-training is especially important as persons with CP typically have low cardiorespiratory fitness and high prevalence of cardiac disease. However, limited published evidence exists on aerobic-training effects in this population. Nonetheless, the evidence suggests that aerobic-training in persons with CP can improve physiological outcomes, yet the influence of these changes on participation has not been investigated sufficiently. Stretching exercise is a common treatment for spasticity. Surprisingly, there is inconclusive evidence for the effectiveness of stretching exercise for persons with CP. Despite the importance attributed to APA for people with CP, low levels of physical activity have been reported in this population. However, when caregivers perceive greater benefits of exercise, individuals with CP are more likely to be active. In contrast, barriers to APA include costs of APA programs, limited means of transportation to APA facilities, lack of information regarding APA facilities and limited appropriate exercising equipment in the APA facilities.

Health Promotion with Long-Term Physical Activity Program for Adults with Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) are at higher risk for developing common chronic diseases. Engagement in physical activity (PA) can prevent health issues; however, people with ASD are known to engage in lower levels of PA in comparison to their peers. This study evaluated the effect of a long-term, 12-month PA intervention on the fitness and quality of life of adults with ASD. A quantitative approach was implemented to assess participants' fitness, functional ability, quality of life, and participation in a range of PA classes at three different time points. Qualitative data were collected via in-depth, semi-structured interviews with three participants with ASD and three staff members. A total of 34 adults with ASD (mean age 39.76 + 7.27) participated in the quantitative part of the study. Approximately 53% of the participants exhibited perseverance and conducted adequate PA each month. Significant improvements were found in one fitness component and two quality-of-life components. Factors revealed for the program's success were the individuals' free choice of the PA classes and supporting people and a budget that tailored the project. Policymakers who plan health promotion programs for adults with ASD should consider long-term PA programs, with freedom of choice among PA modalities and schedules.

Gross motor proficiency deficits among children and adolescents post posterior fossa brain tumor removal vs. traumatic brain injury in the chronic phase of recovery: a cross-sectional study.

Introduction: Acquired brain injury (ABI) is a prevalent diagnosis in pediatric rehabilitation. Gross motor skills are often affected by ABI and limit the ability to participate in various physical activities. However, as ABI injury location is diverse, children and adolescents (youth) with localized ABI, such as ABI in the posterior fossa (ABI-PF) may present unique and different motor disabilities than youth with ABI on account of traumatic brain injury (TBI). Aims: The aims of the study were: (1) to compare gross motor deficits in youth with TBI vs. ABI-PF; and (2) to compare two methods on scoring BOT2 to determine which is better for identifying motor deficits. Methods: Participated in this study youth with TBI (N = 50) and ABI-PF (N = 30). Participants were tested on Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition (BOT2) Upper-Limb Coordination, Balance, Strength, Running Speed and Agility, and Bilateral-Coordination subtests. Motor performance deficits were established using two-standard deviations (2SD) and age-equivalent methods. Between-group differences were assessed via independent t-tests and receiver operating characteristic curves (ROC). Results: According to the 2SD method, motor deficits in the ABI-PF group ranged from 20% to 66.66%, whereas in the TBI group 8%-16%. According to the age-equivalent method, in the TBI and ABI-PF groups 40%-66.0% and 46.66%-76.66% of the youth presented motor deficits, respectively. Moreover, ROC analysis showed that motor performance deficits of both groups in all sub-scales except for Bilateral Coordination differed enough to result in medium area under the curve. Conclusions: Motor deficits post-pediatric ABI are prevalent. In comparison to the TBI group, deficits are greater in the ABI-PF group. Moreover, compared to the 2SD method, the extent of motor deficiency is greater in the age-equivalent method. Therefore, using the later might provide a more valid classification of deficits in gross motor proficiency for youth post-ABI.

Creation and validation of the self-efficacy instrument for physical education teacher education majors toward inclusion.

The purpose was to validate a self-efficacy (SE) instrument toward including students with disability in physical education (PE). Three scales referring to intellectual disabilities (ID), physical disabilities (PD), or visual impairments (VI) were administered to 486 physical education teacher education (PETE) majors. The sample was randomly split, and exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted. After deleting items that did not meet inclusion criteria, EFA item loadings ranged from 0.53 to 0.91, and Cronbach's alpha reliability was high (for ID = .86, PD = .90, and VI = .92). CFA showed that the ID scale demonstrated good goodness-of-fit, whereas in the PD and in the VI scales demonstrated moderate fit. Thus, the content and construct validity of the instrument was supported.

Pediatric Functional Neurological Symptoms Disorder: Walking Ability and Perceived Exertion Post-Pediatric Rehabilitation.

BACKGROUND: Adolescents with functional neurological symptoms disorder (FNSD) commonly present walking abnormalities. Walking is influenced by 'objective' (e.g., fitness) and 'subjective' (e.g., fear) components. Rate of perceived exertion (RPE) reflects the interaction between these two components. This study compared the walking ability and RPE before and after rehabilitation of adolescents with FNSD to adolescents with moderate-to-severe traumatic brain injury (TBI). Factors predicting walking and RPE were also examined. METHODS: Adolescents with FNSD (n = 31) and adolescents with moderate-to-severe TBI (n = 28) aged 6 to 18 years participated in the study. Participants received a multidisciplinary rehabilitation program. Six-minute walk test (6MWT) and RPE were assessed before and after rehabilitation. RESULTS: At pre-test, the TBI group presented lower RPE than the FNSD group (3.38 ± 2.49 and 6.25 ± 2.71, respectively). In the FNSD group, pre-test 6MWT was a significant predictor of post-test 6MWT (adjusted R2 = 0.17; p = 0.01). In the TBI group, post-test 6MWT was significantly predicted by both the pre-test 6MWT and age (adjusted R2 = 0.16; p = 0.04). CONCLUSIONS: Prior to the intervention, adolescents with FNSD perceived walking as a more difficult activity than adolescents with TBI. Post-intervention, although the intervention was effective in terms of changes in 6MWT and RPE, the 'subjective' component still contributed to the elevated RPE of the FNSD group.

A Behavioral Characteristics Observational Measure of Youth with Somatic Symptom Disorder during Physical Rehabilitation.

BACKGROUND: Youth with somatic symptom disorder (SSD) present unique behavioral characteristics. AIMS: To develop and examine the psychometric properties of an observational measure of behavioral characteristics for youth with SSD (the Somatization Behavioral Characteristics Questionnaire, SBCQ). METHODS: N = 80 youth with SSD and 31 with non-SSD impairments participated in this study (age = 13.91 ± 2.72, 14 ± 3.21, respectively; females: n = 61, 14, respectively). Symptom intensity (Children's Somatization Inventory-24; CSI-24), functional disability (Six-Minute Walk Test, walking rate of perceived exertion), and the SBCQ were assessed. SBCQ reliability and validity were examined. RESULTS: SBCQ had acceptable reliability in both groups (Cronbach's α > 0.7). Exploratory factor analysis in the SSD group revealed a three-cluster solution. Significant associations were found between the SBCQ, CSI-24, and functional disability. Both groups differed in the prevalence of all SBCQ behaviors. The greatest differences were in the mismatch between etiology and clinical presentation, and in the exhibited lack of trust in the therapist and "la belle indifference". Receiver operating characteristic analysis showed that the SBCQ has moderate accuracy in discriminating between the two groups (area under the curve = 0.80). Sensitivity and specificity were 82.5% and 73.3%, respectively. CONCLUSIONS: The SBCQ is psychometrically sound. Findings may aid in developing sensitive assessment tools for SSD and continuing education for therapists.