Perspectives of people with myasthenia gravis on physical activity and experience of physical activity advice from health professionals in the Australian context: a qualitative study.

PURPOSE: Physical activity is an important modifiable determinant of health. There has been a historical aversion to movement in people with myasthenia gravis (MG) due to the pathophysiology of the disease, however, research suggests engagement in physical activity is safe and does not exacerbate symptoms. There are currently no studies investigating the qualitative perspectives of people with MG on physical activity. The aim of this study was to explore perceptions of physical activity, barriers, enablers, and participants' experiences of physical activity advice from health professionals. MATERIALS AND METHODS: Semi-structured interviews were used, with verbatim transcripts analysed using content analysis. RESULTS: Ten adults (median age 64.5 years) living in Australia with generalised MG were interviewed. Key findings were identified: (1) Physical activity is perceived to be important for general health and for MG; (2) Medical management and social support are key enablers; (3) Fatigue and pain are potential barriers; and (4) Experiences with healthcare professionals were considered insufficient and failed to provide disease specific advice regarding MG and physical activity. CONCLUSION: People with MG have unique barriers and enablers to physical activity engagement that clinicians should consider when providing physical activity behaviour change support to this population.

Physical activity is perceived positively by people with myasthenia gravis, both due to the general benefits and disease-specific impacts, however unique barriers such as fatigue and pain can make physical activity engagement challenging.Tailored physical activity behaviour change support is recommended to consider these barriers on an individual level.Effective interprofessional collaboration is important in ensuring medical management is optimised to enable greater physical activity participation, and behaviour change techniques involving social supports may warrant consideration.Health professionals should seek to improve their understanding of myasthenia gravis to deliver evidence-based, person-centred approaches to physical activity promotion in this population.

What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement.

The WHO has called for action to integrate physical activity promotion into healthcare settings, yet there is a lack of consensus on the competencies required by health professionals to deliver effective movement behaviour change support. The objective of this study was to establish key competencies relevant for all health professionals to support individuals to change their movement behaviours. Consensus was obtained using a three-phase Delphi process. Participants with expertise in physical activity and sedentary behaviour were asked to report what knowledge, skills and attributes they believed health professionals should possess in relation to movement behaviour change. Proposed competencies were developed and rated for importance. Participants were asked to indicate agreement for inclusion, with consensus defined as group level agreement of at least 80%. Participants from 11 countries, working in academic (55%), clinical (30%) or combined academic/clinical (13%) roles reached consensus on 11 competencies across 3 rounds (n=40, n=36 and n=34, respectively). Some competencies considered specific to certain disciplines did not qualify for inclusion. Participants agreed that health professionals should recognise, take ownership of, and practise interprofessional collaboration in supporting movement behaviour change; support positive culture around these behaviours; communicate using person-centred approaches that consider determinants, barriers and facilitators of movement behaviours; explain the health impacts of these behaviours; and recognise how their own behaviour influences movement behaviour change support. This consensus defines 11 competencies for health professionals, which may serve as a catalyst for building a culture of advocacy for movement behaviour change across health disciplines.

Exploring impairments and allied health professional utilisation in people with myasthenia gravis: A cross-sectional study.

This study aimed to explore how people with myasthenia gravis experience impairments in vision, dizziness, hearing, and fatigue, and how these relate to balance confidence, community participation, and health-related quality of life. Additionally, this study investigated the utilisation and perception of the allied health role in managing these impairments in the Australian context. Visual and hearing impairments, along with fatigue, were found to be correlated with health-related quality of life and community participation to varying degrees, while visual impairment and dizziness were correlated with balance confidence. Perception and utilisation of allied health professionals was variable; common barriers to better utilisation included participant perception of clinicians having poor knowledge around myasthenia gravis, previous poor experiences with clinicians, uncertainty about the clinicians' role, and lack of awareness that symptoms were associated with myasthenia gravis. Further research exploring clinicians' knowledge of myasthenia gravis is recommended, along with education for people with the disease about symptoms associated and how to appropriately access care.

Perspectives of health professionals on physical activity and sedentary behaviour in hospitalised adults: A systematic review and thematic synthesis.

OBJECTIVE: To explore health professionals' perspectives on physical activity and sedentary behaviour of hospitalised adults to understand factors that contribute to these behaviours in this environment. DATA SOURCES: Five databases (PubMed, MEDLINE, Embase, PsycINFO and CINAHL) were searched in March 2023. REVIEW METHODS: Thematic synthesis. Included studies explored perspectives of health professionals on the physical activity and/or sedentary behaviour of hospitalised adults using qualitative methods. Study eligibility was assessed independently by two reviewers and results thematically analysed. Quality was assessed using the McMaster Critical Review Form and confidence in findings assessed using GRADE-CERQual. RESULTS: Findings from 40 studies explored perspectives of over 1408 health professionals from 12 health disciplines. The central theme identified was that physical activity is not a priority in this setting due to the complex interplay of multilevel influences present in the interdisciplinary inpatient landscape. Subthemes, the hospital is a place for rest, there are not enough resources to make movement a priority, everyone's job is no one's job and policy and leadership drives priorities, supported the central theme. Quality of included studies was variable; critical appraisal scores ranged from 36% to 95% on a modified scoring system. Confidence in findings was moderate to high. CONCLUSION: Physical activity in the inpatient setting is not a priority, even in rehabilitation units where optimising function is the key. A shift in focus towards functional recovery and returning home may promote a positive movement culture that is supported by appropriate resources, leadership, policy, and the interdisciplinary team.

Physical Activity and Sedentary Behaviour in People with Myasthenia Gravis: A Cross-Sectional Study.

BACKGROUND: Despite improvements in the medical management of myasthenia gravis (MG) in recent years, patients continue to report poor health and wellbeing outcomes such as high levels of fatigue, reduced quality of life (QoL), walking limitation and lowered balance confidence. Physical activity has been shown to be associated with these outcomes in other populations, however, there has been limited research in adults with MG. OBJECTIVE: To describe physical activity and sedentary behaviour in adults with MG and to explore associations between these behaviours and fatigue, QoL, balance confidence and walking limitation. METHODS: A self-report online survey was used to assess physical activity, sedentary behaviour, fatigue, QoL, balance confidence and walking limitation in adults with MG. Multiple linear regression was used to examine associations and descriptive statistics were used to analyse participant characteristics, physical activity, and sedentary behaviour. RESULTS: Eighty-five adults with MG were included (mean age 48±16 years). Over half of participants (n = 53, 62.4%) reported sufficient physical activity to meet public health guidelines. Participants reported an average of 9 h/day of sedentary time (mean 9.0±3.5). Physical activity and fatigue (R2 = 0.196), QoL (R2 = 0.330), walking limitation (R2 = 0.305) and balance confidence (R2 = 0.304) were significantly (p < 0.05) and positively correlated, with no associations found for sedentary behaviour. When patterns of physical activity and sedentary behaviour were combined, lower fatigue (R2 = 0.213), higher QoL (R2 = 0.364), reduced walking limitation (R2 = 0.341) and higher balance confidence (R2 = 0.279) was observed in patients who had greater physical activity levels (> 150 mins/week) and lower sedentary time (< 10 h/day). CONCLUSIONS: Higher physical activity and lower sedentary behaviour is associated with favorable health and wellbeing outcomes in adults with MG. Further research is required to ascertain whether these behaviours may be an appropriate target intervention to improve outcomes in this population.

Effects of school-based before-school physical activity programmes on children's physical activity levels, health and learning-related outcomes: a systematic review.

OBJECTIVE: To review and evaluate the impact of school-based, before-school physical activity (PA) programmes on children's PA levels, health and learning-related outcomes. DESIGN: Systematic review. DATA SOURCES: PubMed, PsycINFO, Scopus, Embase and ERIC were searched in January 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: (1) Original research published in English, (2) sample included typically developing school-age children and/or adolescents, (3) examined school-based PA programmes delivered before school, (4) included a comparator and (5) reported associations with PA, physical health, learning-related and/or psychosocial outcomes. Studies examining before-school active transport or sport were excluded. RESULTS: Thirteen articles representing 10 studies were included (published 2012-2020); seven conducted in primary schools. Programmes ranged between 3 weeks and 6 months, primarily operating daily and for 25-40 min. One study examined a programme informed by theory; six incorporated fidelity measures. Data synthesis, considering consistency of findings, showed indeterminate associations for the domains of physical health, learning-related and psychosocial outcomes. Among subdomains, synthesis showed positive associations with before-school and daily PA, cardiorespiratory and muscular fitness, readiness to learn and an inverse association with adiposity. Risk of bias was high/serious or insufficiently detailed across studies and outcome domains, except PA, which included moderate-risk studies. CONCLUSION: There is limited available evidence on school-based, before-school PA programmes, with some positive associations at domain and subdomain levels. Continued research is justified to understand the role of before-school programmes for facilitating PA. Future research should follow recommended practice for intervention design and process evaluation, and address under-represented contexts, including secondary schools. PROSPERO REGISTRATION NUMBER: CRD42020181108.