The association between dynamic balance and executive function: Which dynamic balance test has the strongest association with executive function? A systematic review and meta-analysis.

AIM: The aging global population poses increasing challenges related to falls and dementia. Early identification of cognitive decline, particularly before noticeable symptoms manifest, is crucial for effective intervention. This review aims to determine the dynamic balance test most closely associated with executive function, potentially serving as a biomarker for cognitive decline. RECENT FINDINGS: Based on recent reviews, inhibitory control, a component of executive function, holds significance in influencing balance performance. Studies suggest that the strength of the correlation between cognition and balance tends to be domain-specific and task-specific. Despite these findings, inconclusive evidence remains regarding the connection between executive function and various dynamic balance assessments. Our review identifies a significant association between all dynamic balance tests and executive function, albeit with varying strengths. Notably, a medium effect size is observed for the Timed Up and Go and Functional Reach Test, a small effect size for balance scales, and a strong effect size for postural sway. This review underscores a clear relationship between dynamic balance task performance and executive function. Dynamic posturography holds potential as a clinical biomarker for early detection of cognitive decline, with a note of caution due to observed heterogeneity and limited studies.

An international perspective on young stroke incidence and risk factors: a scoping review.

BACKGROUND: Stroke among younger age groups is increasing globally. While there is a focus on research conducted on people under 65 years who have had a stroke, there is a paucity of data on the incidence and risk factors of stroke among younger people (≤ 30 years). This scoping review examines evidence on incidence and risk factors for perinatal, paediatric and young adult stroke globally. METHODS: The review was guided by the Joanna Briggs Institute's scoping review methodology. A systematic search was conducted on 23rd March 2022 across Medline Ovid, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The eligibility criteria included all study designs providing information on the incidence and risk factors of stroke among young people (≤ 30 years) in the last ten years. RESULTS: A total of 5750 articles were identified. After screening, 471 articles (224 cohort studies (47.6%), 164 case studies/case series (34.8%), 35 reviews (7.4%), 30 case-control (6.4%) and 18 combinations of designs (3.8%) were included. There was data from 50 different countries, 199 studies were from high-income countries, upper and middle income (n = 38), lower middle-income (n = 39), low-income (n = 3) countries, international study (n = 7) and a further 185 articles did not state the country of research. Most of the studies (63%) focused on risk factors while incidence constituted 37%. Incidence data were reported heterogeneously across studies, leading to an inability to synthesise data. The three most frequently reported risk factors for perinatal stroke were infections, cardiac conditions, and intrapartum factors. Vasculopathies, infection and cardiac conditions accounted for most reported risk factors for paediatric stroke, while chronic conditions such as diabetes mellitus, vasculopathies and cardiac conditions accounted for the most reported risk factors among young adults. CONCLUSION: This review has highlighted different stroke risk factors for each age cohort of people under 30 years. The low number of epidemiological studies suggests that further research of this type is needed to fully understand the incidence and risk factors in young stroke. A standardised reporting of age groupings of incidence data is imperative to enable the comparison of data from different geographical locations.

The Association Between Cognitive Domains and Postural Balance among Healthy Older Adults: A Systematic Review of Literature and Meta-Analysis.

PURPOSE OF REVIEW: This review aims to explore which cognitive domain is more closely associated with which type of balance (static or dynamic). RESENT FINDING: Based on recent reviews, inhibitory control, a part of cognition, plays a crucial role in balance performance. Previous reviews report significant links between cognition, mobility, and physical function in older adults. However, evidence regarding the relationship between cognition and balance scores remains inconclusive. The strength of association between cognition and balance appears to be domain-specific and task-specific. Executive function exhibits the strongest correlation with balance, while episodic memory shows a small link with dynamic balance. Processing speed and global cognition demonstrate moderate correlations. Additionally, there is a slight association between cognitive domains and static balance. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions for managing balance-related concerns that are domain-specific and task-specific.

Stroke survivors' perceptions of the factors that influence engagement in activity outside dedicated therapy sessions in a rehabilitation unit: A qualitative study.

OBJECTIVE: To investigate stroke survivors' perceptions of factors influencing their engagement in activity outside of dedicated therapy sessions during inpatient rehabilitation. DESIGN: Qualitative study. SETTING: Four metropolitan rehabilitation units in Australia. PARTICIPANTS: People undertaking inpatient rehabilitation after stroke. METHODS: Semi-structured interviews conducted in person by a speech pathologist A stepped iterative process of inductive analysis was employed until data saturation was achieved with themes then applied against the three domains of the Theory of Planned Behaviour (perceived behavioural control, social norms and attitude). RESULTS: Interviews of 33 stroke survivors (60% female, median age of 73 years) revealed five themes (i) uncertainty about how to navigate and what was available for use in the rehabilitation unit restricts activity and (ii) post-stroke mobility, fatigue and pre- and post-stroke communication impairments restrict activity (perceived behavioural control); (iii) unit set up, rules (perceived and actual) and staff expectations influence activity and (iv) visiting family and friends are strong facilitators of activity (social norms), and (v) personal preferences and mood influence level of activity (attitude). CONCLUSION: At the individual level, stroke survivors perceived that their ability to be active outside of dedicated therapy sessions was influenced by their impairments, including mood, and their attitude towards and preference for activity. At the ward level, stroke survivors perceived that their ability to be active was influenced by ward set-up, rules and staff expectations. Visitors were perceived to be important facilitators of activity outside of therapy sessions.

Evaluating the impact of a training program to support transitioning from the hospital to the community for people after stroke: a community case study.

BACKGROUND: The transitions in care along the stroke recovery path are challenging, particularly in finding mechanisms to continue one's recovery once at home. We aim to evaluate the impact of training physiotherapists and fitness instructors from one regional community together to deliver an evidence-based group exercise program starting in the hospital and transitioning to the community using an implementation approach. METHODS: The evidenced based exercise program Fitness and Mobility Exercise (FAME) for stroke was chosen as the intervention. Data from interviews with stakeholders (community centre and health authority hospital staff including a physiotherapy navigator) was transcribed and themes evaluated using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. These data were supplemented by information collected as a quality assurance project within the health authority. RESULTS: Two programs were established; one in the community centre (run over 15 months by fitness instructors) and one in the regional hospital (run over 12 months by a rehabilitation assistant under the direction from a physiotherapist). Transitions in care were facilitated by implementing the same evidence-based group exercise class in both the hospital and community setting, so people living with stroke could seamlessly move from one to another. An existing physiotherapist navigator service also was valued as a support for the transitions between the two centres for people with stroke. The hospital group accessed group-based physiotherapy service on average 31 days earlier than they were able to in a one-to-one format. CONCLUSIONS: This case study described the implementation of the Fitness and Mobility Exercise (FAME) program in one community and the use of a physiotherapist navigator to assist transition between them. After a community training workshop, FAME programs were established within the health authority and the community centre. FAME program participants within the health authority benefited from reduced wait times to access hospital outpatient physiotherapy service. Improvements in function were measured in and reported by the people after stroke attending either the health authority or community centre FAME groups.

The knowledge, barriers and opportunities to improve nutrition and physical activity amongst young people attending an Australian youth mental health service: a mixed-methods study.

BACKGROUND: Mental illnesses are the leading cause of disability in young people, and lifestyle interventions in young people at risk of mental illness remain a priority. Opportunities to improve nutrition and physical activity among young people through youth mental health services remain unclear. This study aimed to determine the knowledge and behaviors towards nutrition and physical activity, the barriers and enablers to improving behaviors, and the preferred providers and sources of information for nutrition and physical activity among a sample of young people attending a youth mental health service. METHODS: A mixed-method study was conducted in regional Tasmania, Australia in a sample of young people (15-25 years) attending a youth mental health service (headspace). A quantitative survey (n = 48) determined young people's nutrition and physical activity knowledge, behaviors, barriers and enablers to achieving recommendations, and their preferred providers and sources of information. Structured interviews and a focus group further explored these concepts (n = 8), including the role of the mental health service as a provider of this support. RESULTS: The majority of participants did not meet national recommendations for nutrition and physical activity, despite possessing a high level of knowledge regarding their importance for mental health. Improving mental health was a common enabling factor for participants choosing to alter diet and physical activity habits, but also the leading barrier for participating in physical activity. Young people wanted to receive information from reputable health providers, ideally through social media sources. headspace was seen as an important potential provider of this information. CONCLUSIONS: Our results indicate that there is a clear need to improve diet and physical activity habits to enhance mental and physical health outcomes in this at-risk group, and youth mental health services could provide further interventions to support their clients. Specialized staff (e.g. dietitians and exercise physiologists) may provide additional benefits alongside existing mental health care support.

Piloting an interprofessional chronic pain management program: Perspectives of health students and community clients.

Interprofessional learning (IPL) is vital for developing work-ready graduates of tertiary health professions and enhancing outcomes of patients with chronic pain. Twenty-two students from six health professions participated in or co-facilitated components of a 6-week group chronic pain management program. Twelve community clients with chronic pain and one family member participated. The program was piloted through the University of Tasmania Exercise Physiology Clinic and consisted of an initial assessment, weekly 1-hour group education sessions, and a 1-hour individualized, supervised exercise session. The program was evaluated using a constructivist approach via an investigator developed survey. Seven students and nine clients responded. A conventional content analysis was undertaken. Three categories were identified from students: Importance of IPL, Understanding Chronic Pain, and Improvement Suggestions. Three categories were identified from clients including Beneficial Aspects, Positive Peer Support, and Positive Pain Outcomes. Results indicate the program was beneficial for student learning and improved pain outcomes for participants. The model demonstrates value to student IPL and the potential to flexibly offer a real-world learning experience across many health professions, whilst addressing some of the common challenges associated with implementing IPL within curricula. The outcomes offer ways to explore sustainable implementation of the program long term.

An Innovative STRoke Interactive Virtual thErapy (STRIVE) Online Platform for Community-Dwelling Stroke Survivors: A Randomized Controlled Trial.

OBJECTIVE: To investigate the STRoke Interactive Virtual thErapy (STRIVE) intervention on upper-extremity clinical outcomes in community-dwelling stroke survivors. DESIGN: Assessor-blinded randomized controlled trial. SETTING: Study screening and testing was conducted in a university clinic. Participants completed the virtual therapy (VT) intervention in a community-based stroke support group setting. PARTICIPANTS: Of 124 stroke survivors initially assessed, 60 participants were recruited (time poststroke, 13.4±8.9 y). Participants were allocated to either VT or control group using a block randomization design and were stratified by sex. INTERVENTIONS: Participants were randomized to receive 8 weeks of VT or usual care. The intervention consisted of approximately 45 minutes of twice weekly VT training on the Jintronix Rehabilitation System. MAIN OUTCOME MEASURES: Between-group differences in the Fugl-Meyer Upper Extremity scale and Action Research Arm Test score were joint primary outcomes in this study. RESULTS: Significant between-group differences for the Fugl-Meyer Upper Extremity scale were seen at the end of the intervention (F1, 1=5.37, P=.02, d=0.41). No significant differences were observed with the Action Research Arm Test. No adverse events were reported. CONCLUSIONS: We demonstrated clinically meaningful improvements in gross upper extremity motor function and use of the affected arm after a VT intervention delivered via a community-based stroke support group setting. This data adds to the contexts in which VT can be used to improve upper limb function. Use of VT in community-based rehabilitation in chronic stroke recovery is supported.

Evaluation and facilitation of intervention fidelity in community exercise programs through an adaptation of the TIDier framework.

BACKGROUND: Despite high quality evidence supporting multiple physical and cognitive benefits of community-based exercise for people after stroke, there is little understanding on how to facilitate uptake of these research findings to real-world programs. A common barrier is a lack of standardised training for community fitness instructors, which hampers the ability to train more instructors to deliver the program as it was designed. Scaling up program delivery, while maintaining program fidelity, is complex. The objective of this research is to explore novel use of the Template for Intervention Description and Replication (TIDier) framework to evaluate and support implementation fidelity of a community exercise program. METHODS: We embedded intervention fidelity evaluation into an inaugural training program for fitness instructors who were to deliver the Fitness and Mobility Exercise Program for stroke, which has established efficacy. The training program consisted of a face-to-face workshop followed by 3 worksite 'audit and feedback coaching cycles' provided over 3 iterations of the 12-week program offered over 1 year. A modified TIDIER checklist (with 2 additional criteria) was used within the training workshop to clarify the key 'active ingredients' that were required for program fidelity, and secondly as a basis for the audit and feedback process enabling the quantitative measurement of fidelity. Data were collected from audits of observed classes and from a survey provided by fitness instructors who implemented the program. RESULTS: We demonstrated the feasibility of the TIDier checklist to capture 14 essential items for implementation evaluation of a complex exercise intervention for people with chronic health conditions over 3 iterations of the program. Based on the audit tool, program fidelity was high and improved over time. Three content areas for workplace coaching (intensity monitoring, space, and educational tips) were identified from the audit tool and were addressed. CONCLUSION: Training of staff to deliver exercises to high need populations utilising workshops and workplace coaching that used the TIDier framework for training, onsite audit and feedback resulted in a high level of fidelity to the program principles. A novel checklist based on the TIDier framework was useful for embedding implementation fidelity in complex community-based interventions.

Perspectives on the prospective development of stroke-specific lower extremity wearable monitoring technology: a qualitative focus group study with physical therapists and individuals with stroke.

BACKGROUND: Wearable activity monitors that track step count can increase the wearer's physical activity and motivation but are infrequently designed for the slower gait speed and compensatory patterns after stroke. New and available technology may allow for the design of stroke-specific wearable monitoring devices, capable of detecting more than just step counts, which may enhance how rehabilitation is delivered. The objective of this study was to identify important considerations in the development of stroke-specific lower extremity wearable monitoring technology for rehabilitation, from the perspective of physical therapists and individuals with stroke. METHODS: A qualitative research design with focus groups was used to collect data. Five focus groups were conducted, audio recorded, and transcribed verbatim. Data were analyzed using content analysis to generate overarching categories representing the stakeholder considerations for the development of stroke-specific wearable monitor technology for the lower extremity. RESULTS: A total of 17 physical therapists took part in four focus group discussions and three individuals with stroke participated in the fifth focus group. Our analysis identified four main categories for consideration: 1) 'Variability' described the heterogeneity of patient presentation, therapy approaches, and therapeutic goals that are taken into account for stroke rehabilitation; 2) 'Context of use' described the different settings and purposes for which stakeholders could foresee employing stroke-specific wearable technology; 3) 'Crucial design features' identified the measures, functions, and device characteristics that should be considered for incorporation into prospective technology to enhance uptake; and 4) 'Barriers to adopting technology' highlighted challenges, including personal attitudes and design flaws, that may limit the integration of current and future wearable monitoring technology into clinical practice. CONCLUSIONS: The findings from this qualitative study suggest that the development of stroke-specific lower extremity wearable monitoring technology is viewed positively by physical therapists and individuals with stroke. While a single, specific device or function may not accommodate all the variable needs of therapists and their clients, it was agreed that wearable monitoring technology could enhance how physical therapists assess and treat their clients. Future wearable devices should be developed in consideration of the highlighted design features and potential barriers for uptake.

Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials.

OBJECTIVE: The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians. DATA SOURCES: EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search. REVIEW METHODS: Randomized controlled trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria. RESULTS: A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination of interventions). Four used educational interventions alone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteria indicated that this body of literature was of low quality. This review found higher efficacy of trials which targeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877 patients) that trials which included both site facilitation and tailoring for local factors were effective in changing clinical practice. The effect size of these varied (odds ratio: 1.63-4.9). Education interventions alone were not effective. CONCLUSION: A large range of interventions are used to facilitate clinical practice change. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.

Exercising on Different Unstable Surfaces Increases Core Abdominal Muscle Thickness: An Observational Study Using Real-Time Ultrasound.

BACKGROUND: The training of abdominal muscles has a positive impact on the functional capacity of healthy adults, being applied practically in fields of athletics and fitness through rehabilitation for lower back pain. OBJECTIVE: The study compares abdominal muscle activity while performing graded isometric exercises on stable and unstable surfaces. The authors also examined perceived stability and comfort for the different surfaces. METHODS: A total of 30 young, healthy adults performed 3 graded isometric exercises on a Pilates table, foam roller, and Oov (a newly developed tool). Ultrasound investigation measured transversus abdominis, internal oblique abdominis, and external oblique abdominis thickness during each task, comparing muscle thickness between conditions using general linear modeling. RESULTS: Core abdominal activation was greater on the foam roller than the Oov and Pilates table during crook lying (bilateral leg support). Both Oov and foam roller elicited greater contralateral transversus abdominis and internal oblique abdominis thickness than the Pilates table during tabletop and straight leg raises (unilateral leg exercises). For transversus abdominis only, the foam roller elicited more muscle thickness than the Oov during straight leg raises. The Oov was rated more comfortable than the foam roller. DISCUSSION: Exercises performed on the Oov and foam roller elicit core greater abdominal muscle thickness than those performed on a Pilates table. Unilateral leg exercises in a supine position elicit more contralateral muscle thickness than those with bilateral leg support. CONCLUSIONS: These results provide information to support choices in exercise progression from flat stable to more unstable surfaces and from those with bilateral foot support to unilateral foot support. The Oov was more comfortable that the foam roller, and this may help with exercise adherence.

Exercise for reducing falls in people living with and beyond cancer.

BACKGROUND: Current treatment modalities for cancer have been successful in achieving improved survivorship; however, they come with a number of long-term adverse effects. Accidental falls are a common and clinically significant adverse event in people living with and beyond cancer and rates are higher than in the rest of the population. OBJECTIVES: To assess the effects of prescribed or provided exercise for reducing accidental falls, and falls risk factors of strength, flexibility and balance, in people living with and beyond cancer. SEARCH METHODS: We searched the following electronic databases from inception to 10 July 2018, with no restrictions: CENTRAL, MEDLINE, Embase, and seven other databases. We searched clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) for ongoing trials, and reference lists of reviews and retrieved articles for additional studies. SELECTION CRITERIA: We included all randomised controlled trials investigating exercise interventions versus no treatment, usual care or non-exercise interventions on falls incidence or falls risk factors in adults living with and beyond cancer (18 years of age or older at diagnosis). We excluded cross-over studies and studies in acute or inpatient hospice care. DATA COLLECTION AND ANALYSIS: At least two review authors independently completed data extraction for included papers. We used Covidence software to manage screening, data collection and extraction. We assessed evidence using GRADE and presented results in a 'Summary of findings' table. MAIN RESULTS: Eleven studies (835 participants) compared exercise to usual care. No studies compared exercise with no treatment or non-exercise interventions. The quality of the evidence was very low for the primary outcome rates of falls, and very low to low for the secondary outcomes. We downgraded the evidence due to study limitations (risk of bias), and issues of imprecision due to small sample sizes, inconsistency and indirectness. All studies were at high risk of bias for blinding of participants and personnel due to inability to blind participants to an exercise intervention. Risk of bias was generally low or unclear for other categories.There was generally little information on the important outcomes comparing exercise to usual care.Rates of falls and number of fallers: one study (223 participants) measured accidental falls, but reported neither the rate of falls or the number of fallers; there was no difference in the number of falls between exercise and usual care (very low-quality evidence).Strength: 10 studies (813 participants) reported on strength outcomes. Two analyses favoured exercise over usual care: quadriceps strength (2 studies, 72 participants; mean difference (MD) 8.99 kg, 95% confidence interval (CI) 1.29 to 16.70; low-quality evidence), and leg press (4 studies, 388 participants; MD 21.1 kg, 95% CI 8.47 to 33.74; low-quality evidence). In one analysis of the Sit-to-Stand Test, there was no difference between exercise and usual care (4 studies, 214 participants; standardised mean difference (SMD) -0.45, 95% CI -1.05 to 0.14; very low-quality evidence).Flexibility: one study (21 participants) reported on flexibility for Sit-and-Reach Distance (MD 2.05 cm, 95% CI 0.59 to 3.51; very low-quality evidence).Balance: five studies (350 participants) measured three different balance outcomes. Two analyses favoured exercise over usual care: postural balance (4 studies, 127 participants; standardised mean difference (SMD) 0.44, 95% CI 0.08 to 0.79; very low-quality evidence), and Backward Walk Test (2 studies, 280 participants; SMD -0.24, 95% CI -0.48 to -0.01; low-quality evidence). There was no difference between exercise and usual care for the Timed Up-and-Go Test (1 study, 15 participants; MD -0.35 seconds, 95% CI -1.47 to 0.77; low-quality evidence).Number of people sustaining a fall-related fracture: the quality of the evidence for exercise reducing fall-related fractures was very low.Adverse events: a single study (223 participants) noted some temporary muscle soreness on initiation of exercise or when there was an increase in the weight lifted. As no occurrence data were reported, we could not assess this variable further. No studies reported musculoskeletal injury. Analysis indicated that there was very low-quality evidence that exercise did not increase fatigue. AUTHORS' CONCLUSIONS: There is a paucity of evidence for exercise training to reduce fall rates in people living with and beyond cancer. Exercise training may improve strength, flexibility and balance for people in this population, but the evidence is very low quality.

The efficacy of interactive, motion capture-based rehabilitation on functional outcomes in an inpatient stroke population: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of novel interactive, motion capture-rehabilitation software to usual care stroke rehabilitation on physical function. DESIGN: Randomized controlled clinical trial. SETTING: Two subacute hospital rehabilitation units in Australia. PARTICIPANTS: In all, 73 people less than six months after stroke with reduced mobility and clinician determined capacity to improve. INTERVENTIONS: Both groups received functional retraining and individualized programs for up to an hour, on weekdays for 8-40 sessions (dose matched). For the intervention group, this individualized program used motivating virtual reality rehabilitation and novel gesture controlled interactive motion capture software. For usual care, the individualized program was delivered in a group class on one unit and by rehabilitation assistant 1:1 on the other. MAIN MEASURES: Primary outcome was standing balance (functional reach). Secondary outcomes were lateral reach, step test, sitting balance, arm function, and walking. RESULTS: Participants (mean 22 days post-stroke) attended mean 14 sessions. Both groups improved (mean (95% confidence interval)) on primary outcome functional reach (usual care 3.3 (0.6 to 5.9), intervention 4.1 (-3.0 to 5.0) cm) with no difference between groups ( P = 0.69) on this or any secondary measures. No differences between the rehabilitation units were seen except in lateral reach (less affected side) ( P = 0.04). No adverse events were recorded during therapy. CONCLUSION: Interactive, motion capture rehabilitation for inpatients post stroke produced functional improvements that were similar to those achieved by usual care stroke rehabilitation, safely delivered by either a physical therapist or a rehabilitation assistant.

Is self-reporting workplace activity worthwhile? Validity and reliability of occupational sitting and physical activity questionnaire in desk-based workers.

BACKGROUND: With the advent of workplace health and wellbeing programs designed to address prolonged occupational sitting, tools to measure behaviour change within this environment should derive from empirical evidence. In this study we measured aspects of validity and reliability for the Occupational Sitting and Physical Activity Questionnaire that asks employees to recount the percentage of work time they spend in the seated, standing, and walking postures during a typical workday. METHODS: Three separate cohort samples (N = 236) were drawn from a population of government desk-based employees across several departmental agencies. These volunteers were part of a larger state-wide intervention study. Workplace sitting and physical activity behaviour was measured both subjectively against the International Physical Activity Questionnaire, and objectively against ActivPal accelerometers before the intervention began. Criterion validity and concurrent validity for each of the three posture categories were assessed using Spearman's rank correlation coefficients, and a bias comparison with 95 % limits of agreement. Test-retest reliability of the survey was reported with intraclass correlation coefficients. RESULTS: Criterion validity for this survey was strong for sitting and standing estimates, but weak for walking. Participants significantly overestimated the amount of walking they did at work. Concurrent validity was moderate for sitting and standing, but low for walking. Test-retest reliability of this survey proved to be questionable for our sample. CONCLUSIONS: Based on our findings we must caution occupational health and safety professionals about the use of employee self-report data to estimate workplace physical activity. While the survey produced accurate measurements for time spent sitting at work it was more difficult for employees to estimate their workplace physical activity.

The Reliability of Strength Tests Performed In Elevated Shoulder Positions Using a Handheld Dynamometer.

CONTEXT: The reliable measurement of shoulder strength is important when assessing athletes involved in overhead activities. Swimmers' shoulders are subject to repetitive humeral elevation and consequently have a high risk of developing movement-control issues and pain. Shoulder-strength tests performed in positions of elevation assist with the detection of strength deficits that may affect injury and performance. The reliability of isometric strength tests performed in positions of humeral elevation without manual stabilization, which is a typical clinical scenario, has not been established. OBJECTIVE: To establish the relative and absolute intrarater reliability of shoulder-strength tests functional to swimming in 3 body positions commonly used in the clinical setting. DESIGN: Repeated-measures reliability study. SETTING: Research laboratory. SUBJECTS: 15 university students and staff (mean ± SD age 24 ± 8.2 y). INTERVENTION: Isometric shoulder-strength tests were performed in positions of humeral elevation (flexion and extension in 140° abduction in the scapular plane, internal and external rotation in 90° abduction) on subjects without shoulder pain in supine, prone, and sitting. Subjects were tested by 1 examiner with a handheld dynamometer and retested after 48 h. MAIN OUTCOME MEASURES: Relative reliability (ICC3,1) values with 95% CI. Absolute reliability was reported by minimal detectable change (MDC). RESULTS: Good to excellent intrarater reliability was found for all shoulder-strength tests (ICC .87-.99). Intrarater reliability was not affected by body position. MDC% was <16% for every test and ≤11% for tests performed in supine. CONCLUSIONS: Shoulder flexion, extension, and internal- and external-rotation strength tests performed in humeral elevation demonstrated excellent to good intrarater reliability regardless of body position. A strength change of more than 15% in any position can be considered meaningful.

Effect of pilates exercise for improving balance in older adults: a systematic review with meta-analysis.

OBJECTIVES: To investigate the effect of Pilates on balance and falls in older adults, and whether programs tested in prior studies met best-practice recommendations for exercise to prevent falls. DATA SOURCES: MEDLINE, SPORTDiscus, CINAHL, PubMed, Physiotherapy Evidence Database, and The Cochrane Library were searched from earliest record to July 2014. STUDY SELECTION: Randomized and controlled clinical trials evaluating the effect of Pilates on balance and/or falls in older adults. DATA EXTRACTION: Two reviewers independently extracted demographic, intervention, and outcome data. Six studies were included in this review. DATA SYNTHESIS: High-quality studies in this area are lacking. When compared with nonactive control groups, Pilates was shown to improve balance (standardized mean difference [SMD]=.84; 95% confidence interval [CI], .44-1.23; 6 studies) and reduce the number of falls (SMD=-2.03; 95% CI, -2.66 to -1.40; 1 study). Three studies provided sufficient detail to enable assessment of compliance with the recommendation of exercises providing a moderate or high challenge to balance. In these studies, 2% to 36% of exercises were assessed as providing a moderate or high challenge to balance. All studies provided ≥2 hours of exercise per week, and 1 study provided >50 hours of exercise during the study period. CONCLUSIONS: The evidence suggests Pilates can improve balance, an important risk factor for falls in older adults. However, there is limited data on the impact of Pilates on falls. Effects may have been overestimated because of the low methodological quality of studies. Best-practice recommendations were rarely applied in prior studies, indicating greater effects may have been achieved if recommendations were incorporated.

Positive long-term effects of Pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women.

This study investigated the effect of Pilates exercise on physical fall risk factors 12 months after an initial 5-week Pilates intervention. The authors hypothesized that ongoing Pilates participation would have a positive effect on physical fall risk factors in those who continued with Pilates exercise compared with those who ceased. Thirty older ambulatory adults (M = 69 years, SD = 7) participated in Pilates classes for 5 weeks with testing preintevention (Time 1 [T1]) and postintervention (Time 2 [T2]) and 12 months later (Time 3 [T3]). Balance and leg strength were compared using a 2-way analysis of variance with repeated measures. Postural sway, dynamic balance, and function improvements evident after the initial Pilates training (T1-T2) were maintained at T3 (p < .01). Significant differences existed at T3 for dynamic balance and strength between participants who continued performing Pilates (n = 14) and those who had ceased. Balance improvements after a short Pilates intervention were maintained 1 year later in all participants, with increased benefits from ongoing participation.

Serum [25(OH)D] status, ankle strength and activity show seasonal variation in older adults: relevance for winter falls in higher latitudes.

BACKGROUND: seasonal variation exists in serum [25(OH)D] and physical activity, especially at higher latitudes, and these factors impact lower limb strength. This study investigates seasonal variation in leg strength in a longitudinal repeated measures design concurrently with serum vitamin D and physical activity. METHODS: eighty-eight community-dwelling independently mobile older adults (69.2 ± 6.5 years) were evaluated five times over a year, at the end of five consecutive seasons at latitude 41.1°S, recruited in two cohorts. Leg strength, serum [25(OH)D] and physical activity levels were measured. Time spent outside was recorded. Monthly falls diaries recorded falls. Data were analysed to determine annual means and percentage changes. RESULTS: significant variation in [25(OH)D] (±15%), physical activity (±13%), ankle dorsiflexion strength (±8%) and hours spent outside (±20%) (all P < 0.001) was demonstrated over the year, with maximums in January and February (mid-summer). Low mean ankle strength was associated with increased incidence of falling (P = 0.047). Quadriceps strength did not change (±2%; P = 0.53). CONCLUSION: ankle dorsiflexor strength varied seasonally. Increased ankle strength in summer may be influenced by increased levels of outdoors activity over the summer months. Reduced winter-time dorsiflexor strength may predispose older people to increased risk of tripping-related falls, and warrants investigation in a multi-faceted falls prevention programme.

The Health Literacy of First Year Physiotherapy and Speech Pathology Students and Their Perceived Future Roles in Supporting Their Clients' Health Literacy.

BACKGROUND: Allied health professionals are well positioned to assess and support their clients' health literacy (HL); however, they report being deficient in HL knowledge and skills. OBJECTIVE: To explore allied health students' HL and their perceptions of their roles in supporting clients' HL. DESIGN: A mixed-methods cross-sectional study was undertaken in August 2022 amongst allied health students enrolled in graduate-entry masters programs at the University of Tasmania. Data collected included the Health Literacy Questionnaire (HLQ) (n = 30) and qualitative telephone interviews (n = 6). RESULTS: Allied health students' confidence in the knowledge domain of the HLQ was rated as 28.57 from a maximum possible score of 50. Similarly, the students' confidence in the skills domain of the HLQ was rated as 14.87 from a maximum possible score of 25. Four themes were generated from the qualitative interviews: (1) valuing HL, (2) an innate part of their future roles, (3) contributors to their own HL, and (4) advocacy and their decision to study allied health. CONCLUSION: This study provides a preliminary insight into the HL of allied health students and highlights the strong perception held by allied health students that supporting clients' HL is a large component of their future roles.