Feasibility of a physical activity intervention for children and adolescents with anxiety and depression.

BACKGROUND: Physical activity is identified as a key modifiable factor towards good short- and long-term mental health and has shown positive effects on anxiety and depression in children and adolescents. However, physical activity-based interventions are not a part of standard mental health care and evidence on the effect of such interventions is still lacking. A transdiagnostic, physical activity-based intervention was developed as a supplement to routine clinical care for youth in specialized child and adolescent mental health services. METHODS: /design. The feasibility of the physical activity intervention (Confident, Active, and Happy Youth) was evaluated in an open-label study by assessing the recruitment process, acceptability, intervention suitability, contentment, and preliminary intervention effects in the form of youth and parent-rated anxiety and depressive symptoms. Physical activity levels were objectively measured using Actigraph™ physical activity sensors, and progression to a definitive study was evaluated in accordance with a priori criteria. RESULTS: In total 21 of 25 eligible youth consented to participate, two dropped out of the intervention and 19 completed (76% of eligible participants). The retention rate among consenting participants was 89% and mean attendance to sessions was 83%. The suitability of the intervention was rated as good by the youth and their parents, and intervention contentment was rated high. Changes in youth and parent-rated symptom measures following the intervention were negligible, except for parent-rated anxiety symptoms assessed at 10-month follow-up. Accelerometer data indicated lower levels of moderate to vigorous activity during sessions than intended. No adverse effects were noted. CONCLUSION: This feasibility study met the pre-determined progression criteria to a definitive study. Thus, a larger trial with longer follow-up should be conducted to explore the effect of the intervention. TRIAL REGISTRATION: ClnicalTrials.gov, NCT05049759. Retrospectively registered, 20.09.2021.

Laryngeal response to high-intensity exercise in healthy athletes.

Introduction: Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems. The current diagnostic approach rests on evaluation of laryngeal obstruction visualised by laryngoscopy performed continuously throughout a maximal exercise test (continuous laryngoscopy exercise (CLE) test) in patients who present with compatible symptoms. Laryngeal responses to high-intensity exercise in endurance athletes are not well described, potentially leading to inaccurate reference values and increasing the risk of misdiagnosing EILO. Aim: To investigate laryngeal responses to high-intensity exercise in a healthy population of endurance athletes with no self-reported perception of respiratory problems. Methods: A cross-sectional study was conducted at Haukeland University Hospital, Bergen, Norway, inviting amateur and professional athletes with no self-reported breathing problems who performed endurance training minimum four sessions weekly. Thirty-six eligible athletes completed a questionnaire detailing exercise habits and past and current respiratory symptoms. They performed a standardised CLE test from which cardiopulmonary exercise data and corresponding laryngeal responses were recorded. The CLE tests were evaluated in retrospect by two independent raters according to preset criteria providing a CLE score. The CLE score rates the severity of laryngeal obstruction during moderate and maximum exercise on the glottic and supraglottic regions on a scale ranging from 0 (no obstruction) to 3 (maximum obstruction). Results: Twenty-nine (81%) athletes (15 females) aged 15-35 years completed a CLE test. Ten participants (33%) had a supraglottic CLE subscore of 2 or 3. Among these, two also had a glottic CLE subscore of 2 or 3. Notably, none had isolated glottic obstruction. Conclusion: In healthy well-trained endurance athletes with no prior perception of respiratory symptoms, the laryngeal response to high-intensity exercise was diverse. Supraglottic laryngeal obstruction was observed in one-third of the athletes. The findings underline that a diagnosis of EILO should rest on observed laryngeal obstruction supported by compatible symptoms.

Development and feasibility testing of a physical activity intervention for youth with anxiety and depression: a study protocol.

BACKGROUND: Anxiety and depressive disorders in children and adolescents are highly prevalent and account for more than half of all youth psychiatric disorders. Left untreated, anxiety, and depression lead to numerous detrimental outcomes, including reduced quality of life, psychiatric, and somatic comorbidity and even reduced lifespan. This puts a large strain on child and adolescent mental healthcare services (CAMHS) to provide effective treatments. However, even when provided the best evidence-based treatment, between 40-50% of patients continue to report significant symptom burdens. Thus, there is an immediate need for supplemental and/or new treatment approaches. Physical activity as a supplementary treatment may be such an approach. However, research investigating this approach within this population is scant. This protocol paper describes the development and feasibility trial of a physical activity-based intervention targeting anxiety and depressive symptoms in youth treated in CAMHS. METHODS/DESIGN: The study is based on the UK Medical Council Research Framework (MRC) for developing and evaluating complex interventions. Feasibility and acceptability of the physical activity intervention (confident, active, and happy youth) will be evaluated in an uncontrolled open-label trial using qualitative and quantitative data. Twenty youths with anxiety and/or depressive symptoms will be recruited. Acceptability of assessment procedures, the intervention, and perceived benefits and barriers to participation will be assessed, and qualitative interviews with participants, caregivers, and referring specialists will explore contextual and practical factors associated with intervention delivery. Physical activity will be measured using the Actigraph GT3X+ monitor at baseline, and post-intervention and change in anxiety and depression will be assessed. DISCUSSION: This study will contribute to the development of supplementary physical treatment interventions for youth with anxiety and depression in contact with CAMHS. The goal is to examine new avenues of treatment that ultimately may improve upon current treatment outcomes of anxiety and depression. This work will be in preparation for a future definitive randomized controlled trial (RCT) of this approach, in line with the MRC Framework. TRIAL REGISTRATION: ClnicalTrials.gov, NCT05049759 . Registered on August 19, 2021. Retrospectively registered.

The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study.

BACKGROUND: Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. OBJECTIVE: The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). METHODS: The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. RESULTS: Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. CONCLUSIONS: The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35838.

Theoretical Rationale for Design of Tasks in a Virtual Reality-Based Exergame for Rehabilitation Purposes.

Virtual reality games are playing a greater role in rehabilitation settings. Previously, commercial games have dominated, but increasingly, bespoke games for specific rehabilitation contexts are emerging. Choice and design of tasks for VR-games are still not always clear, however; some games are designed to motivate and engage players, not necessarily with the facilitation of specific movements as a goal. Other games are designed specifically for the facilitation of specific movements. A theoretical background for the choice of tasks seems warranted. As an example, we use a game that was designed in our lab: VR Walk. Here, the player walks on a treadmill while wearing a head-mounted display showing a custom-made virtual environment. Tasks include walking on a glass bridge across a drop, obstacle avoidance, narrowing path, walking in virtual footsteps, memory, and selection tasks, and throwing and catching objects. Each task is designed according to research and theory from movement science, exercise science, and cognitive science. In this article, we discuss how for example walking across a glass bridge gives perceptual challenges that may be suitable for certain medical conditions, such as hearing loss, when perceptual abilities are strained to compensate for the hearing loss. In another example, walking in virtual footsteps may be seen as a motor and biomechanical constraint, where the double support phase and base of support can be manipulated, making the task beneficial for falls prevention. In a third example, memory and selection tasks may challenge individuals that have cognitive impairments. We posit that these theoretical considerations may be helpful for the choice of tasks and for the design of virtual reality games.

The Female Menstrual Cycles Effect on Strength and Power Parameters in High-Level Female Team Athletes.

PURPOSE: The female menstrual cycle (MC) is characterized by hormonal fluctuations throughout its different phases. However, research regarding its effect on athletic performance in high level athletes is sparse. The aim of this study was to (i) investigate the female MCs effect on strength and power performance in highly trained female team athletes throughout the MC and (ii) examine whether eumenorrheic participants with natural hormonal fluctuations displayed enhanced performance in the follicular phase (FP) versus the luteal phase (LP), compared to controls using hormonal contraceptives. MATERIALS AND METHODS: A total of 29 athletes (Age 21.2 ± 3.3 years; weight 65.6 ± 8.7 kg; height 170.2 ± 8.0 cm; and fat free mass 52.7 ± 7.1) completed the study after a 6-week testing period (8 eumenorrheic participants and 21 hormonal contraceptive controls). Participants were recruited from the team sports soccer, handball and volleyball. Testing protocol consisted of maximal voluntary isometric grip strength, 20-m sprint, countermovement jump and pneumatic leg-press. Based on self-reported use of hormonal contraceptives, participants were divided into non-hormonal contraceptive group and hormonal contraceptive group, the latter working as a control group. Differences in performance between the FP and LP were investigated. MC phase was confirmed by serum hormonal levels through venous blood samples in the non-hormonal contraceptive group. RESULTS: There were no statistically significant changes for the two different phases of the MC, in terms of physical performance for the whole group. Further, there was no significant difference between groups during the MC for any of the outcome variables, maximal voluntary isometric grip strength F(3.29) = 0.362; 20-m sprint F(3.24) = 0.710; countermovement jump F(3.26) = 2.361; and leg-press F(3.26) = 1.746. CONCLUSION: In high level female team athletes, no difference in performance was observed based on hormonal contraceptive status. This suggests that the MC does not alter acute strength and power performance on a group level in high level team athletes.

Reliability of maximum oxygen uptake in cardiopulmonary exercise testing with continuous laryngoscopy.

AIMS: A cardiopulmonary exercise test (CPET) is the gold standard to evaluate symptom-limiting exercise intolerance, while continuous laryngoscopy performed during exercise (CLE) is required to diagnose exercise-induced laryngeal obstruction. Combining CPET with CLE would save time and resources; however, the CPET data may be distorted by the extra equipment. We therefore aimed to study whether CPET with CLE influences peak oxygen uptake (V'O2 peak) and other gas exchange parameters when compared to a regular CPET. METHODS: Forty healthy athletes without exercise-related breathing problems, 15-35 years of age, performed CPET to peak exercise with and without an added CLE set-up, in randomised order 2-4 days apart, applying an identical computerised treadmill protocol. RESULTS: At peak exercise, the mean difference (95% confidence interval) between CPET with and without extra CLE set-up for V'O2 peak, respiratory exchange ratio (RER), minute ventilation (V'E) and heart rate (HR) was 0.2 (-0.4 to 0.8) mL·kg-1·min-1, 0.01(-0.007 to 0.027) units, 2.6 (-1.3 to 6.5) L·min-1 and 1.4 (-0.8 to 3.5) beats·min-1, respectively. Agreement (95% limits of agreement) for V'O2 peak, RER and V'E was 0.2 (±3.7) mL·kg-1·min-1, 0.01 (±0.10) units and 2.6 (±24.0) L·min-1, respectively. No systematic or proportional bias was found except for the completed distance, which was 49 m (95% CI 16 to 82 m) longer during CPET. CONCLUSION: Parameters of gas exchange, including V'O2 peak and RER, obtained from a maximal CPET performed with the extra CLE set-up can be used interchangeably with data obtained from standard CPET, thus preventing unnecessary additional testing.

The impact of motor task and environmental constraints on gait patterns during treadmill walking in a fully immersive virtual environment.

BACKGROUND: Virtual environments (VE) are increasingly used in rehabilitation settings for gait training, and positive effects are reported. However, little is known about how walking under environmental constraints and solving motor tasks in fully immersive VEs impact gait patterns. RESEARCH QUESTION: How are gait patterns in healthy adults impacted by walking under environmental constraints and solving motor tasks on a treadmill, in a fully immersive VE? METHODS: 29 healthy adults (age: 28.9±4.8 yrs) were included. Basic gait parameters (step length, cadence, walk ratio) and gait variability in the anteroposterior, mediolateral and vertical directions were measured using an inertial sensor attached to the lower back. A familiarisation treadmill walk >2 min was performed, followed by 200 m familiarisation walk in the VE with no task or environmental constraints The participants were then exposed to height, two grabbing tasks, a balancing task and narrow-path walking. Gait patterns were captured for 15-25 seconds during each of the conditions. The Simulator Sickness Questionnaire was completed before and after the session. RESULTS: Gait regularity decreased when solving all the motor tasks, and under all the environmental constraints, except when being familiarised to height exposure, where regularity returned to pre-exposure levels. Step length and walk ratio decreased, and cadence increased during height exposure and while performing the grabbing tasks and the balancing task. The different tasks and environments appeared to have specific impact on gait patterns. There was no increase in simulator sickness symptoms. SIGNIFICANCE: Gait patterns were impacted by solving motor tasks, and by environmental constraints, in healthy young adults, suggesting increased need for balance control. We suggest that VE-training on a treadmill holds potential for improving gait and balance control.