Feasibility and effectiveness of a 24-weeks outdoor exercise program on the physical and mental health of persons with schizophrenia.

Outdoor exercise can be a novelty and effective therapeutic strategy to achieve positive physical and mental health outcomes in persons with schizophrenia. The aim of this study was to assess the feasibility and effectiveness of a 24-weeks outdoor exercise program in the physical and mental health of persons with schizophrenia. Fifty-two outpatients with schizophrenia were conveniently assigned to a 24-weeks walking/jogging combined with cycling outdoor program (n = 23, male = 14) or control group (n = 29, male = 20). Demographic and clinical measures were collected. Physical health was evaluated using anthropometric measures, 6 min walk test, Eurofit and accelerometer. Mental health was evaluated using self-esteem, motivation for exercise and quality of life questionnaires. Attendance rate to the outdoor program was 92 %. The exercise program significantly decreased participant's body mass index and improved functional exercise capacity and balance. No effects were reported in the self-esteem, motivation for physical activity and quality of life. Significant decreases were found in abdominal strength, hand grip and self-esteem levels of the control group. The outdoor exercise combining walking/jogging and cycling was an effective intervention to decrease body mass index and to improve physical fitness. It can be suggested as a therapeutic approach with an important impact on the management of schizophrenia.

Physical education teachers' attitudes toward inclusion of students with disabilities in Saudi Arabia.

The attitudes of physical education (PE) teachers toward inclusion are critical to the successful provision of inclusive teaching for students with disabilities. Therefore, the purpose of this study was to investigate the attitudes of Saudi Arabian PE teachers toward the inclusion of students with disabilities in PE classes and the effect of sociodemographic variables (e.g., gender and length of teaching experience) on their attitudes toward inclusion. A total of 1,314 PE teachers (M age = 41.09, SD = 9.40, females = 42.8%) completed the Arabic version of the Sentiments, Attitudes, and Concerns about Inclusive Education-Revised Scale (SACIE-R). Analyses found that, in general, PE teachers had moderately positive attitudes toward the inclusion of students with disabilities in PE lessons. A significant difference was found between the two genders in their attitudes toward inclusion. Specifically, female PE teachers demonstrated more positive attitudes toward inclusion than males. Multiple linear regression analysis, meanwhile, showed that the length of teaching experience and the experience of teaching a student with a disability were significant predictors of participants' attitudes toward inclusion. Our findings highlighted the importance of reconsidering the quality of PE teachers' experiences and interactions with students with disabilities as a means to improving their attitudes, which in turn would translate into successful inclusion.

Atitudes e Autoeficácia dos Professores de Educação Física em Relação à Inclusão: Estudo Centrado na Região de Lisboa - Portugal / Attitudes and Self-Efficacy of Physical Education Teachers Towards The Inclusion: Study Focused on the Lisbon Region - Portugal

RESUMO: Os objetivos deste estudo foram analisar a atitude e a autoeficácia de professores de Educação física (EF) portugueses, determinar a relação entre as atitudes e a autoeficácia dos professores de EF em relação à inclusão de alunos com deficiência e avaliar o efeito das variáveis independentes (género, tempo de serviço docente, formação complementar em EF Inclusiva e docência ao aluno com deficiência nas aulas de EF e no Desporto Escolar) sobre as dimensões das atitudes e nas dimensões da autoeficácia. Participaram do estudo 115 professores de EF portugueses. Para analisar as atitudes, foram utilizadas a versão portuguesa do Multidimentional Attitudes toward Inclusive Education e a versão portuguesa do Self-Efficacy Scale for Physical Education Teacher Education Majors towards Children with Disabilities. Os resultados indicaram que, de uma forma geral, os professores de EF revelam atitudes mais positivas na dimensão comportamental e são mais confantes para ensinar alunos com deficiência intelectual. Identificaram-se relações positivas entre as diferentes dimensões das atitudes e da autoeficácia. Na análise comparativa das atitudes e da autoeficácia, observaram-se diferenças estatisticamente significativas nas dimensões cognitiva e de deficiência intelectual na variável "formação complementar em EF Inclusiva" e nas dimensões deficiência intelectual e visual na variável "Docência a alunos com deficiência". De um modo geral, os participantes reportaram atitudes positivas e são confantes em relação à inclusão de alunos com deficiência. A investigação futura deverá comparar as atitudes e a autoeficácia antes e após um programa prático de intervenção ao nível da EF inclusiva.

ABSTRACT: The objectives of this study were to analyze the attitude and self-efficacy of Portuguese Physical Education (PE) teachers, to determine the relationship between PE teachers' attitudes and self-efficacy regarding the inclusion of students with disabilities, and to evaluate the effect of independent variables (gender, length of teaching service, additional training in Inclusive PE and teaching students with disabilities in PE classes and School Sports) on the dimensions of attitudes and in the dimensions of self-efficacy. One hundred and fifteen Portuguese PE teachers participated in the study. To analyze the attitudes, the Portuguese version of the Multidimensional Attitudes to Inclusive Education was used, and the Portuguese version of the Self-Efficacy Scale for Physical Education Teacher Education Majors towards Children with Disabilities was used. The results indicated that, in general, PE teachers show more positive attitudes in the behavioral dimension and are more confident in teaching students with intellectual disabilities. Positive relationships were identified between the different dimensions of attitudes and self-efficacy. In the comparative analysis of attitudes and self-efficacy, statistically, differences were observed in the cognitive and intellectual disability dimensions in the variable "additional training in inclusive PE" and the intellectual and visual disability dimensions in the variable "Teaching students with disabilities". Overall, participants reported positive attitudes and are confident about the inclusion of students with disabilities in PE classes. Future research should compare attitudes and self-efficacy before and after a practical intervention program at the level of inclusive PE.

Validity and Reliability of a Test Battery to Assess Change of Directions with Ball Dribbling in Para-footballers with Cerebral Palsy.

The purpose of this study was to evaluate the content and construct validity and between-sessions reliability of four agility tests requiring ball dribbling in football players with cerebral palsy (CP) with implications for classification and training. A sample of 35 football players with CP from three different countries took part in the study. They performed four tests in two sessions 72 h apart: i) 20 m in a straight line, ii) forward slalom with short changes of direction, iii) forward slalom with wide changes of direction and iv) square course. The Kappa coefficient was used to test content validity, obtaining moderate to almost perfect agreement results. Construct validity was also demonstrated with very large to almost perfect correlations between tests and sessions. Good reliability was found using intra-class coefficients (>0.86), standard error of measurement (<10.8%) and Cronbach´s alpha (>0.86). The comparisons between CP profiles (i.e. sport classes) demonstrated that those with mild impairment performed faster, and those with impairment of ataxia and dyskinesia performed worse. The four tests could have applications in classification, but may also be applied by the CP football coaches to improve athlete agility and football skills.

Dietary Intake, Adherence to Mediterranean Diet and Lifestyle-Related Factors in People with Schizophrenia.

The purpose of this study was to examine the dietary intake of both inpatients and outpatients with schizophrenia in the Portuguese population as a potential key contributing factor to the poor physical health profiles, and understand the relationship of diet quality to other lifestyle factors. Participants of this cross-sectional study completed a semi quantitative food frequency questionnaire. Diet quality was determined by adherence to the Mediterranean Diet. In addition participants completed the International Physical Activity Questionnaire-Short-Form and Pittsburgh Sleep Quality Index. Tobacco smoking was assessed through a series of general questions. A total of 100 patients (50% inpatients and 28% female) with schizophrenia were included in the final analysis. Patients reported a high consumption of caffeine, while deficits were evident for fibre and folate intakes, when compared to the European Food Safety Authority recommendations. Both inpatients and outpatients reported poor to moderate diet quality. Smokers reported poorer diet quality when compared to non-smokers (p < 0.001). Dietary intake, and its relationship to other lifestyle components, should be considered for intervention, in order to improve physical health of people living with schizophrenia.

Association of lifestyle-related factors and psychological factors on quality of life in people with schizophrenia.

In people with schizophrenia several factors are associated with poor quality of life (QoL), namely, lifestyle-related factors and psychological factors. However, there has been little research on the impact of these factors on QoL. Therefore, the relation between lifestyle-related factors, psychological factors, and QoL in people with schizophrenia was assessed. A cross-sectional study was conducted among 115 patients (25% women, 50% inpatients). QoL was measured by World Health Organisation Quality of Life- Brief Version. Lifestyle-related factors were assessed, namely physical activity (International Physical Activity Questionnaire- Short Form), sleep quality (Pittsburgh Sleep Quality Index) and dietary intake (Mediterranean Diet score). Psychological factors such as self-esteem (Rosenberg Self-Esteem Scale) and autonomous motivation (Behavioural Regulation Questionnaire- version 3) were also measured. Regression analyses were performed to identify significant predictors of QoL. Results showed that self-esteem predicted better global, physical, psychological and environmental QoL. Physical activity predicted better global and physical QoL, while sedentary time predicted poor social and environmental QoL. Identifying predictors of QoL has implication for the effective design and delivery of lifestyles interventions, including physical activity, dietary education and smoking cessation in people with schizophrenia. Adopting healthy lifestyles may lead to improved physical health, psychological well-being and QoL in this population.

Autonomous motivation and quality of life as predictors of physical activity in patients with schizophrenia.

AIM: Being physically active is a complex behaviour in patients with schizophrenia. Several factors were identified as barriers to achieving active behaviours in this population. Therefore, the purpose of this study was to investigate among a number of barriers what predicts the most on physical activity (PA) in patients with schizophrenia. METHODS: A total of 114 patients (28♀) with schizophrenia were included. Body mass index (BMI) was calculated. Autonomous and controlled motivation (Behavioural Regulation in Exercise Questionnaire - 3), self-esteem (Rosenberg Self-esteem scale), quality of life (World Health Organization Quality of Life Scale - Brief version) and functional exercise capacity (6-minute walk test - 6MWT) were evaluated. Multiple Regression Analysis was applied to assess the effect of these variables on Total PA per week (International Physical Activity Questionnaire - short version). RESULTS: Autonomous motivation and domains of quality of life were positively correlated with Total PA per week. Stepwise multiple regression analyses showed that of all the candidate factors to predict PA, autonomous motivation and global domain of quality of life were found as significant predictors. CONCLUSION: Our findings help to understand the importance of autonomous motivation and quality of life for PA in patients with schizophrenia. Knowledge about these predictors may provide guidance to improve PA behaviour in this population.

Behavioural Regulation in Exercise Questionnaire in people with schizophrenia: construct validity of the Portuguese versions.

PURPOSE: People with schizophrenia have low physical activity levels that can be explained by the restriction in motivation. The Behavioural Regulation in Exercise Questionnaire-2 is a 19-item scale commonly used to assess five different motivational subtypes for physical activity. However, there are limited psychometric analyses of this version in the schizophrenia context. Moreover, there is a lack of information related to the psychometric properties of version 3 of this questionnaire, with 24 items and six different motivational subtypes. The aim of this study was to examine the construct validity of both Portuguese versions in people with schizophrenia. METHODS: A total of 118 persons with schizophrenia were included (30 women). Cronbach's alpha was used for internal consistency, Pearson's correlation for the retained motivation-types, confirmatory factor analysis for the structural validity of version 2 and exploratory factor analysis for the factor structure of version 3. RESULTS AND CONCLUSIONS: Analyses of version 2 provided an adequate fit index for the structure of the five factors. Exploratory analyses suggested retaining 2 factors of version 3. The results of this study suggest that version 3 was an appropriate measure to assess controlled and autonomous motivation for physical activity in people with schizophrenia and support its use in clinical practice and research. Implications for Rehabilitation This study supports the need to identify the reasons why people with schizophrenia practice physical activity. For that purpose, it is important to use valid and cost-effective instruments. The Portuguese version of BREQ-2 confirmed a 5-factor model and showed adequate fit for the application in people with schizophrenia. However, the incremental indices values were lower than expected. The Portuguese version of BREQ-3 showed acceptable psychometric properties to assess controlled and autonomous motivation for physical activity in people with schizophrenia.

Reliability and validity of 6MWT for outpatients with schizophrenia: A preliminary study.

Although the 6-minute walk test (6MWT) has been widely used in patients with schizophrenia, there is a lack of scientific evidence about its reliability and validity in this population. The first goal of this study was to explore the test-retest reliability of the 6MWT and to identify the associated parameters that contribute to the variability of the distance walked during the 6MWT in outpatients with schizophrenia. The second goal was to assess the criterion validity of the 6MWT in men with schizophrenia. Fifty one outpatients with schizophrenia participated in the study. To test-retest reliability (men=39; women=12), participants performed the 6MWT twice within 3 days interval. To test criterion validity (men=13), peak oxygen uptake (VO2peak) was measured on a treadmill. For the associated parameters with the distance walked (n=51), medications use, smoking behavior, body and bone composition, and physical activity levels were analyzed. No significant differences between the means of the two 6MWTs were found. The intraclass correlation coefficient was 0.94 indicating good reliability. 6MWT correlated significantly with VO2peak (r=0.67) indicating criterion validity. Height, body fat mass, smoking behavior and minutes of PA/week were significantly associated with the 6MWT. Results suggest that 6MWT shows good reliability for individuals with schizophrenia and good validity for the small sample of male participants in this study.

Quality of life and physical activity levels in outpatients with schizophrenia.

OBJECTIVES: To assess quality of life (QoL) and physical activity (PA) levels of outpatients with schizophrenia and healthy controls matched for age, gender, body mass index (BMI), hip circumference, waist circumference, and waist-to-hip ratio. Additionally, the present study investigated associations between PA levels, QoL, and anthropometric and behavioral measures among outpatients with schizophrenia. METHODS: Thirty-two outpatients with schizophrenia and 32 individuals without mental illness were included in the study. QoL and PA levels were assessed by the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-Bref) and by GT3X triaxial accelerometers, respectively. RESULTS: Outpatients with schizophrenia had poorer QoL and lower vigorous PA levels compared with healthy controls (p < 0.05). The group with schizophrenia showed a significant association between higher weight and lower scores in the mental health domain of the WHOQOL-Bref. A higher BMI was also significantly associated with lower scores in the physical health domain of the WHOQOL-Bref. Schizophrenic patients with smoking behaviors were associated with fewer steps per day and with less moderate to vigorous PA. CONCLUSIONS: This study seeks to shed some light upon the lifestyle of patients with schizophrenia. New psychosocial approaches should focus on PA, weight, and smoking management, thereby helping these patients to improve their QoL.

A prática desportiva dos estudantes universitários e suas relações com as autopercepções físicas, bem-estar subjectivo e felicidade / University students' sport practice and its relations with physical self-perceptions, subjective well-being and happiness

A presente investigação analisou as relações entre a prática desportiva de estudantes universitários e o modo como estes se percepcionavam a si próprios e às suas vidas. Participaram nesta investigação 2284 estudantes de ambos os sexos, com idades entre os 18 e os 30 anos (M = 21,87 ±2,37), que preencheram um questionário sobre a sua prática desportiva, bem como versões portuguesas do Physical Self-Perception Profile (Fox & Corbin, 1989), da Subjective Happiness Scale (Lyubomirsky & Lepper, 1999), da Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) e da Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). Em geral, a análise dos resultados revelou que os indivíduos que possuíam mais confiança física e que avaliavam a sua vida mais positivamente praticavam desporto mais regularmente; porém, verificou-se igualmente que quem se percebia menos forte fisicamente e tinha uma auto-estima mais baixa também praticava desporto mais regularmente do que os pares.

The purpose of this study was to examine the relationships between university students' sport practice and the way they perceived themselves and their lives. Participated in this investigation 2284 male and female students, with ages between 18 and 30 years (M = 21.87 ±2.37), who filled out a questionnaire to assess their levels of sport practice, as well the Portuguese versions of the Physical Self-Perception Profile (Fox & Corbin, 1989), the Subjective Happiness Scale (Lyubomirsky & Lepper, 1999), the Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) and the Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). Overall, the analysis of the results showed that students who were more physically confident and evaluated their lives more positively did sport more regularly; however, results also showed that students who reported lower levels of physical strength and self-esteem practiced sport more regularly than their peers.

A prática desportiva dos estudantes universitários e suas relações com as autopercepções físicas, bem-estar subjectivo e felicidade / University students' sport practice and its relations with physical self-perceptions, subjective well-being and happiness

A presente investigação analisou as relações entre a prática desportiva de estudantes universitários e o modo como estes se percepcionavam a si próprios e às suas vidas. Participaram nesta investigação 2284 estudantes de ambos os sexos, com idades entre os 18 e os 30 anos (M = 21,87 ±2,37), que preencheram um questionário sobre a sua prática desportiva, bem como versões portuguesas do Physical Self-Perception Profile (Fox & Corbin, 1989), da Subjective Happiness Scale (Lyubomirsky & Lepper, 1999), da Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) e da Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). Em geral, a análise dos resultados revelou que os indivíduos que possuíam mais confiança física e que avaliavam a sua vida mais positivamente praticavam desporto mais regularmente; porém, verificou-se igualmente que quem se percebia menos forte fisicamente e tinha uma auto-estima mais baixa também praticava desporto mais regularmente do que os pares.(AU)

The purpose of this study was to examine the relationships between university students' sport practice and the way they perceived themselves and their lives. Participated in this investigation 2284 male and female students, with ages between 18 and 30 years (M = 21.87 ±2.37), who filled out a questionnaire to assess their levels of sport practice, as well the Portuguese versions of the Physical Self-Perception Profile (Fox & Corbin, 1989), the Subjective Happiness Scale (Lyubomirsky & Lepper, 1999), the Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) and the Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). Overall, the analysis of the results showed that students who were more physically confident and evaluated their lives more positively did sport more regularly; however, results also showed that students who reported lower levels of physical strength and self-esteem practiced sport more regularly than their peers.(AU)

Osteossarcoma: tratamento e fatores progn¢sticos / Osteosarcoma: treatment and prognostic factors

O osteossarcoma é um tumor ¢sseo maligno que acomete principalmente adolescentes e adultos jovens, cujo tratamento combinado de quimioterapia pré-operat¢ria (neo-adjuvante), cirurgia e quimioterapia p¢s-operat¢ria tem aumentado significativamente o tempo de sobrevida destes pacientes, sendo o fator progn¢stico mais importante o grau de necrose tumoral.