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Wrist accelerometer temporal analysis as a prognostic tool for aged care residents: A sub-study of the ReMInDAR trial.
Andrade, AQ, Lim, R, Kelly, TL, Parfitt, G, Pratt, N, Roughead, EE
Journal of the American Geriatrics Society. 2023;(4):1124-1133
Abstract
BACKGROUND Objective measures for screening, prioritizing, and planning care for frail individuals are essential for appropriate aged care provision. This study evaluates metrics derived from actigraphy measures (captured by wrist accelerometer) as a digital biomarker to identify frail individuals at risk of adverse outcomes, including death, hospitalization, and cognitive decline. METHODS This was a secondary study using data from a randomized controlled trial assessing the effectiveness of an ongoing pharmacist service in residential aged care facilities. Three metrics are studied and compared: the Frailty Index, the daily time spent in light time activity, and the temporal correlation of the actigraphy signal, measured by detrended fluctuation analysis. The association between actigraphy-derived metrics at baseline and adverse events within 12 months (death, cognitive decline, and hospitalizations) was assessed using logistic regression. RESULTS Actigraphy records were available for 213 participants living in aged-care, median age of 85 years. Individuals with higher temporal correlation (activity is less random) were at lower risk of death (Standardized OR: 0.49; 95% CI 0.34, 0.7, p < 0.001) and hospitalization (Standardized OR: 0.57; 95% CI 0.42, 0.77, p < 0.001) in 12 months, but there was no difference in cognitive decline (Standardized OR: 1; 95% CI 0.74, 1.35, p = 0.98). The predictive model that included temporal correlation had an area under the curve of 0.70 (CI 0.60-0.80) for death and 0.64 (CI 0.54-0.72) for hospitalization. CONCLUSION Temporal correlation of the actigraphy signal from aged care residents was strongly associated with death and hospitalization, but not cognitive decline. Digital biomarkers may have a place as an objective, accurate, and low-cost patient metric to support risk stratification and clinical planning.
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Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial).
Roughead, EE, Pratt, NL, Parfitt, G, Rowett, D, Kalisch-Ellett, LM, Bereznicki, L, Merlin, T, Corlis, M, Kang, AC, Whitehouse, J, et al
Age and ageing. 2022;(4)
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Abstract
OBJECTIVE To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions. DESIGN AND SETTING Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities. PARTICIPANTS Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine. INTERVENTION Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months. COMPARATOR Usual care (Residential Medication Management Review) provided by accredited pharmacists. OUTCOMES Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life. RESULTS 248 persons (median age 87 years) completed the study; 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: -0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength. CONCLUSIONS The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.
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What are the effects of scuba diving-based interventions for clients with neurological disability, autism or intellectual disability? A systematic review.
Naumann, K, Kernot, J, Parfitt, G, Gower, B, Winsor, A, Davison, K
Diving and hyperbaric medicine. 2021;(4):355-360
Abstract
INTRODUCTION Recreational scuba diving has existed for over 70 years with organisations emerging that teach individuals with disabilities to dive. It is unclear what the physical and psychosocial effects of scuba interventions might be. This systematic review explores evidence for the effects of scuba diving in individuals with neurological disability, intellectual disability and autism. METHODS The databases Medline, EMBASE, Ovid Emcare, and SportDiscus were searched. Included papers described a scuba-based intervention for clients with a neurological disability, intellectual disability and autism, with physical or psychosocial outcomes explored in the paper. Quality of the included papers was assessed using the McMaster Appraisal Tools, with descriptive data synthesis completed to explore the physical and psychosocial effects of the interventions. RESULTS Four papers met the inclusion criteria: a cross-sectional investigation, a phenomenological study, a case-control study and a multiple case study. The quality of the papers was low to moderate. Papers addressed the psychosocial effects of scuba diving, including motivation to participate, participant experiences, the effect on cognition and physical self-concept. One study reported an increase in self-concept for the majority of participants. An increase in understanding instructions and in visual attention was reported in another. Enjoyment of the activity was reported and motivators to be involved in scuba diving for people with disabilities included fun and excitement. No papers addressed functional outcomes. CONCLUSIONS Whilst scuba diving interventions appear to enhance physical self-concept and are enjoyable, conclusive evidence regarding effectiveness could not be determined. Research in this area is extremely limited.
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What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis.
Mitchell, BL, Lock, MJ, Davison, K, Parfitt, G, Buckley, JP, Eston, RG
British journal of sports medicine. 2019;(21):1341-1351
Abstract
OBJECTIVE Assess the role of exercise intensity on changes in cardiorespiratory fitness (CRF) in patients with cardiac conditions attending exercise-based cardiac rehabilitation. DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO and Web of Science. ELIGIBILITY CRITERIA FOR SELECTION Studies assessing change in CRF (reported as peak oxygen uptake; V̇O2peak) in patients post myocardial infarction and revascularisation, following exercise-based cardiac rehabilitation. Studies establishing V̇O2peak via symptom-limited exercise test with ventilatory gas analysis and reported intensity of exercise during rehabilitation were included. Studies with mean ejection fraction <40% were excluded. RESULTS 128 studies including 13 220 patients were included. Interventions were classified as moderate, moderate-to-vigorous or vigorous intensity based on published recommendations. Moderate and moderate-to-vigorous-intensity interventions were associated with a moderate increase in relative V̇O2peak (standardised mean difference±95% CI=0.94±0.30 and 0.93±0.17, respectively), and vigorous-intensity exercise with a large increase (1.10±0.25). Moderate and vigorous-intensity interventions were associated with moderate improvements in absoluteV̇O2peak (0.63±0.34 and 0.93±0.20, respectively), whereas moderate-to-vigorous-intensity interventions elicited a large effect (1.27±0.75). Large heterogeneity among studies was observed for all analyses. Subgroup analyses yielded statistically significant, but inconsistent, improvements in CRF. CONCLUSION Engagement in exercise-based cardiac rehabilitation was associated with significant improvements in both absolute and relative V̇O2peak. Although exercise of vigorous intensity produced the greatest pooled effect for change in relative V̇O2peak, differences in pooled effects between intensities could not be considered clinically meaningful. REGISTRATION Prospero CRD42016035638.
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Promoting physical activity in rural Australian adults using an online intervention.
Mitchell, BL, Smith, AE, Rowlands, AV, Fraysse, F, Parfitt, G, Lewis, NR, Dollman, J
Journal of science and medicine in sport. 2019;(1):70-75
Abstract
OBJECTIVES Rural Australian adults are consistently identified as insufficiently active, likely due to challenges implementing community-based physical activity programs in rural settings. On-line strategies to promote physical activity may be particularly effective in rural settings where isolation and scarcity of qualified support are potential barriers. The Rural Environments and Community Health (REACH) study evaluated the effectiveness of an online-delivered walking intervention among South Australian rural adults. DESIGN Randomised controlled study design. METHODS A twelve-week intervention, with six- and twelve-month follow-up, was conducted. Participants (n=171; 50.6±12.5years), recruited through flyers, local newspapers and radio, were randomised to comparison or intervention groups and received a pedometer. The intervention group received access to the REACH website and personalised step goals based on ratings of perceived exertion and daily affect. The comparison group received a paper diary and generic step goals. Outcome measures were accelerometry-assessed sedentary, light (LPA) and moderate-to-vigorous (MVPA) physical activity. Linear mixed models assessed changes over the intervention and follow-ups. RESULTS Sedentary time decreased, and LPA and MVPA increased in both groups across the intervention (p<0.05). The intervention group demonstrated a larger increase in LPA at six-month follow-up relative to comparison (p<0.05). Both groups decreased sedentary time, overall and in bouts ≥30min, between baseline and twelve-month follow-up (p<0.05). From baseline to twelve-month follow-up, MVPA (total min and bouts ≥10min) declined more in the comparison group than the intervention group (p<0.05). CONCLUSION While increased physical activity and decreased sedentary time were observed in both groups during the intervention period, maintenance was only observed for LPA at six-month follow-up in the intervention group. By twelve-month follow-up, post-intervention improvements had largely disappeared, suggesting that additional research is needed to identify ways to improve long-term adherence.
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Effect of a 12-Week Online Walking Intervention on Health and Quality of Life in Cancer Survivors: A Quasi-Randomized Controlled Trial.
Frensham, LJ, Parfitt, G, Dollman, J
International journal of environmental research and public health. 2018;(10)
Abstract
Cancer survivors are at an increased risk of experiencing physical and psychological ill-effects following cancer treatment. Rural cancer survivors are at a greater risk of future health problems following a cancer diagnosis compared to their urban counterparts. Physical activity has been targeted as a health promotion priority in cancer survivors. Research indicates that a large portion of cancer survivors do not meet physical activity recommendations. The purpose of this quasi-randomized controlled trial was to test the effectiveness of an online 12-week walking intervention designed for cancer survivors, and to explore its impact on physical health indicators and quality of life outcomes. Steps Toward Improving Diet and Exercise among cancer survivors (STRIDE) is an online resource designed according to Social Cognitive Theory and Self Determination Theory, based on individualized step goal setting. Measures of physiology, physical fitness, and quality of life were taken at the baseline, post-intervention, and three-month follow-up in an Intervention group (n = 46) and active Control group (n = 45). The Control group was provided with a pedometer but did not have access to the online program. Three-factor repeated measures ANOVAs indicated that there were improvements in physical fitness (p < 0.01), systolic blood pressure (p < 0.01), diastolic blood pressure (p < 0.01), waist girth (p < 0.01), mental health (p < 0.05), social functioning (p < 0.01), and general health (p < 0.01), but an increase in bodily pain (p < 0.01), from the baseline to week 12 and the three-month follow-up, irrespective of group allocation. Pedometer interventions, delivered with or without online support and step goal setting, show promise for improving the overall health of cancer survivors, at least in the short term.
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Comparison of two low-fat diets, differing in protein and carbohydrate, on psychological wellbeing in adults with obesity and type 2 diabetes: a randomised clinical trial.
Watson, NA, Dyer, KA, Buckley, JD, Brinkworth, GD, Coates, AM, Parfitt, G, Howe, PRC, Noakes, M, Murphy, KJ
Nutrition journal. 2018;17(1):62
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The psychological burden of living with type 2 diabetes (T2D) has far reaching effects, negatively impacting quality of life, physical health and emotional wellbeing. It has been suggested that health-related quality of life (HRQoL) changes in response to weight status however this has not yet been explored in individuals with T2D. The aim of this randomised controlled study was to compare the effects of high protein and high carbohydrate diets, combined with moderate intensity exercise, on psychological wellbeing and HRQoL in 61 overweight adults with T2D. Participants enrolled in a 12-week weight loss period followed by a 12-week weight maintenance phase and blood glucose levels and various quality of life factors were assessed. This trial found in overweight adults with T2D, improvements in several psychological wellbeing and HRQoL were seen in response to modest weight loss and improvements in blood sugar levels. Improvements were seen in both high protein and high carbohydrate group, though a high protein diet may be better for maintaining control of blood glucose levels thus improving feelings of vitality. Based on this study, the authors conclude that it is imperative to address and support the psychological aspects of patients managing T2D.
Abstract
BACKGROUND Although higher-protein diets (HP) can assist with weight loss and glycemic control, their effect on psychological wellbeing has not been established. The objective of this study was to compare the effects of a HP and a higher-carbohydrate diet (HC), combined with regular exercise, on psychological wellbeing both during weight loss (WL) and weight maintenance phases (WM). METHODS In a parallel RCT, 61 adults with T2D (mean ± SD: BMI 34.3 ± 5.1 kg/m2, aged 55 ± 8 years) consumed a HP diet (29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%), with moderate intensity exercise, for 12 weeks of WL and 12 weeks of WM. Secondary data evaluating psychological wellbeing was assessed using: Problems Areas in Diabetes (PAID); Diabetes-39 Quality of Life (D-39); Short Form Health Survey (SF-36); Perceived Stress Scale-10 (PSS-10) and the Leeds Sleep Evaluation Questionnaire (LSEQ) at Weeks 0, 12 and 24 and evaluated with mixed models analysis. RESULTS Independent of diet, improvements for PAID; D-39 diabetes control; D-39 severity of diabetes; SF-36 physical functioning and SF-36 general health were found following WL (d = 0.30 to 0.69, P ≤ 0.04 for all) which remained after 12 weeks of WM. SF-36 vitality improved more in the HP group (group x time interaction P = 0.03). Associations were seen between HbA1c and D-39 severity of diabetes rating (r = 0.30, P = 0.01) and SF-36 mental health (r = - 0.32, P = 0.003) and between weight loss and PAID (r = 0.30, P = 0.01). CONCLUSION Several improvements in diabetes-related and general psychological wellbeing were seen similarly for both diets following weight loss and a reduction in HbA1c with most of these improvements remaining when weight loss was sustained for 12 weeks. A HP diet may provide additional increases in vitality. TRIAL REGISTRATION The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12613000008729 ) on 4 January 2013.
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Reductions in food cravings are similar with low-fat weight loss diets differing in protein and carbohydrate in overweight and obese adults with type 2 diabetes: A randomized clinical trial.
Watson, NA, Dyer, KA, Buckley, JD, Brinkworth, GD, Coates, AM, Parfitt, G, Howe, PRC, Noakes, M, Murphy, KJ
Nutrition research (New York, N.Y.). 2018;:56-66
Abstract
Food cravings are common in type 2 diabetes (T2D). Higher-protein diets are effective in improving satiety but their effect on cravings is unclear. It was hypothesized that a high protein (HP) diet would provide greater reductions in cravings than an isocaloric higher-carbohydrate diet (HC). In a randomized controlled trial, 61 adults (54% males) with T2D (means ± SD: BMI 34.3 ± 5.1 kg/m2; aged 55 ± 8 years) consumed either a HP diet (mean across study: 29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%) for 12-weeks each of weight loss (WL) and weight maintenance (WM). The Food Craving Inventory (FCI), measuring types of foods craved and the General Food Craving Questionnaires measuring traits (G-FCQ-T) and states (G-FCQ-S) were assessed at Weeks 0, 12 and 24. Weight changes were similar between groups (means ± SEM: WL: -7.8 ± 0.6 kg, WM: -0.6 ± 0.4 kg). No group effects or group x time interactions were found for any outcome (P ≥ .07). Independent of group, all food cravings (except carbohydrates) and G-FCQ-T subscales decreased over the 24-week study (P ≤ .04) with sweets and fast food cravings, loss of control and emotional cravings reducing following WL (P ≤ .03). Obsessive preoccupation with food decreased following both phases (WL: P = .03; WM: P = .001). Weight was associated with several FCI subscales (r ≥ 0.24, P ≤ .04). In conclusion, both the HP and HC diets provided significant reductions in food cravings after similar weight losses which were maintained when weight was stabilized.
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Submaximal Exercise-Based Equations to Predict Maximal Oxygen Uptake in Older Adults: A Systematic Review.
Smith, AE, Evans, H, Parfitt, G, Eston, R, Ferrar, K
Archives of physical medicine and rehabilitation. 2016;(6):1003-12
Abstract
OBJECTIVE To evaluate and discuss the accuracy of submaximal exercise-based equations to predict maximum oxygen uptake (V˙o2max), validated using direct gas analysis, in older apparently healthy adults. DATA SOURCES Studies were identified by searching 5 electronic databases and manually scanning reference lists of included articles from the respective inception of each database through April 2015. STUDY SELECTION Studies were included if they used at least 1 submaximal exercise-based variable in the prediction, the actual V˙o2max was directly measured using a gas analysis device, and if participants were apparently healthy older adults (mean age ≥65y). Eligible studies were required to report at least 1 validity statistic (eg, Pearson product-moment correlation [r]) and either a predicted and measured V˙o2max value or a directional significant difference between the measured and predicted V˙o2max values. No limits were placed on year of publication, but only full-text, published articles in the English language were included. DATA EXTRACTION Nine articles and 13 equations were retained from the systematic search strategy. If the same prediction equation was used across multiple trials, data from the most accurate trial were reported. DATA SYNTHESIS Submaximal equations predicted directly measured V˙o2max with a moderate to strong correlation strength (r range, 0.4-0.9). Predicted V˙o2max significantly differed from directly measured in 2 of the 13 equations. The preferred mode of ergometry was walking or running (7 equations); a stepping protocol was the most accurate (R(2)=0.9, not significant between predicted and measured V˙o2max). CONCLUSIONS Factors to consider when choosing a submaximal exercise-based equation are the accuracy of the equation, the population tested, the mode of ergometry, the equipment availability, and the time needed to conduct familiarization sessions.
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Validity of Submaximal Step Tests to Estimate Maximal Oxygen Uptake in Healthy Adults.
Bennett, H, Parfitt, G, Davison, K, Eston, R
Sports medicine (Auckland, N.Z.). 2016;(5):737-50
Abstract
BACKGROUND Aerobic capacity (VO2max) is a strong predictor of health and fitness and is considered a key physiological measure in the healthy adult population. Submaximal step tests provide a safe, simple and ecologically valid means of assessing VO2max in both the general population and a rehabilitation setting. However, no studies have attempted to synthesize the existing knowledge regarding the validity of the multiple step-test protocols available to estimate VO2max in the healthy adult population. OBJECTIVES The objective of this study was to systematically review literature on the validity and reliability of submaximal step-test protocols to estimate VO2max in healthy adults (age 18-65 years). DATA SOURCES AND STUDY SELECTION A systematic literature search of the MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library databases was performed. The search returned 690 studies that underwent the initial screening process. To be included, the study had to (1) have participants deemed to be healthy and aged between 18 and 65 years; (2) assess VO2max by means of a submaximal step test against a graded exercise test (GXT) to volitional exhaustion; and (3) be available in English. Reference lists from included articles were screened for additional articles. DATA ANALYSIS AND STUDY APPRAISAL METHODS The primary outcome measures used were the validity statistics between the actual measured VO2max and predicted VO2max values, and the reported direction of the statistically significant difference between the measured VO2max and the predicted VO2max. The Quality Assessment Tool for Quantitative Studies was used to assess the risk of bias in each included study, and was adapted to the type of quantitative study design used. RESULTS The combined database search produced 690 studies, from which 644 were excluded during the screening process. Following full-text assessment, a further 39 studies were excluded based on the eligibility criteria detailed previously. Four additional studies were located via the reference lists of the included studies, leaving 11 studies that fulfilled the inclusion criteria and which compared eight different step-test protocols against a direct measure of VO2max incurred during a maximal GXT. Validity measures varied, with a broad range of correlation coefficients reported across the 11 studies (r = 0.469-0.95). Of the 11 studies, two reported reliability measures, demonstrating good test-retest reliability [mean -0.8 ± 3.7 mL kg(-1) min(-1) (±7.7 % of the mean measured VO2max)]. CONCLUSIONS Considering the relationship between VO2max and various markers of health, the use of step tests as a measure of health in both the general adult population and rehabilitation settings is advocated. Step tests provide a simple, effective and ecologically valid method of submaximally assessing VO2max that can be implemented in a variety of situations within the general adult population. Future research is needed to assess the reliability of the majority of the step-test procedures reviewed. Based on the validity measures, submaximal step-test protocols are an acceptable means of estimating VO2max in the generally healthy adult population. For tracking changes in cardiorespiratory fitness, the Chester Step test appears to be an appropriate tool due to its high test-retest reliability.