Physical Activity in Clinical Population (Week 7)

Question 1

state 2 facts about non-communicable diseases (NCDs) morbidity and mortality (WHO., 2021)

Answer 1

1) non-communicable diseases (NCDs) are the greatest cause of morbidity and mortality globally each year

2) NCDs kill approx. 41 million people annually
- this is approx. 60% of all deaths

(WHO., 2021)

Question 2

what is the mortality of the following diseases reported by (WHO., 2021):

1) CV disease
2) cancers
3) respiratory diseases
4) diabetes

Answer 2

1) CV diseases = 17.9 million per year
2) cancers = 9.2 million per year
3) respiratory diseases = 4.1 million per year
4) diabetes = 1.5 million per year

Question 3

state 5 non-communicable diseases (NCDs) stated in the ‘IOC Consensus Statement’ (Matheson et al., 2013)

Answer 3

1) CV disease
2) diabetes
3) cancer
4) COPD
5) hypertension
6) obesity
7) neurodegenerative disease
8) metabolic syndrome
9) arthritis
10) rheumatoid arthritis
11) osteoarthritis
12) depression

Question 4

what 3 facts did the (WHO., 2021) give about ‘living with chronic disease’ ?

Answer 4

1) results from genetic, physiological, environmental, and behavioural factors
2) affects all age groups, regions, and countries
3) long duration

Question 5

what are the 3 main disease burdens of NCDs as outlined by (WHO., 2021) ?

Answer 5

1) reduced quality of life
2) reduced independence
3) impaired psychological health and well-being

Question 6

what is the financial burden of NCDs as identified by (WHO., 2021) ?

Answer 6

• NCDs cost the global economy $33 billion between 2005 - 2015
• in 20 years time, it is estimated to have cost the global economy $33 trillion overall

Question 7

is there a silver lining when it comes to NCDs ?

Answer 7

• chronic diseases are largely preventable (modifiable factors) and the main causes are lifestyle factors (Lee et al., 2012)
• the health of individuals who live with chronic diseases can be improved (Matheson et al., 2013)

Question 8

what was the statement given by the ‘IOC President’ Dr Jacques Rogge ?

Answer 8

‘the problem is acute, the solution is at hand. it is a grim picture, except for one thing: we can do something about it’

Question 9

(Lee et al., 2012) stated that PA has strong evidence for the reduced rates of many things. state 3 of those things

Answer 9

1) all-case mortality
2) CHD
3) hypertension
4) stroke
5) metabolic syndrome
6) T2 diabetes
7) breast cancer
8) colon cancer
9) depression
10) falling

Question 10

there was 4 main health benefits associated with PA as identified by (Lee et al., 2012). what are they ?

Answer 10

1) increased cardio-respiratory and muscle fitness
2) improved bone health
3) increased functional health
4) improved cognitive function

Question 11

what was the purpose of the study done by (Martin Ginis et al., 2021) ‘A Global Perspective’

Answer 11

• to identify the health benefits of PA to those living with non-communicable diseases
• people living with a disability are 16-62% less likely to meet PA guidelines than people who aren’t

Question 12

what were the findings to ‘A Global Perspective’ (Martin Ginis et al., 2021)

Answer 12

• the meta-analysis highlighted the following health benefits of PA for individuals all with significant effect sizes compared to control groups:

1) cardiovascular fitness
2) musculoskeletal fitness
3) cardio-metabolic risk factors
4) brain and mental health problems

• the health benefits can be achieved with less than 150 mins MVPA / week

Question 13

what did (Martin Ginis et al., 2021) say about PA interventions for individuals with NCDs

Answer 13

researchers need to design theory-based interventions to target barriers to increased quantity and quality of PA

Question 14

what is primary prevention ? (Gyurcsik et al., 2020)

Answer 14

• primary prevention is the use of strategies to reduce the risk of future health problems
  e. g. - targeting ‘at risk’ individuals to take up a sport
  e. g. - immunisation programmes

Question 15

why use primary prevention ? (2 points)

Gyurcsik et al., 2020

Answer 15

1) we have a very low PA participation rate in the Uk
2) this means that there is a large number of people that we can reach and use PA as a prevention strategy to prevent future NCDs

Question 16

state 3 benefits of primary prevention as highlighted by (Gyurcsik et al., 2020)

Answer 16

1) weight maintenance
2) psychological affect benefits
3) cardiovascular fitness improvements
4) emotion regulation
5) mental health

Question 17

what is tertiary prevention (management) ?

Gyurcsik et al., 2020

Answer 17

management (tertiary prevention) aims to prevent deterioration of disease, maintain or improve physical function, and enhance the quality of life

Question 18

what did (Gyurcsik et al., 2020) identify as the main barrier to primary and tertiary prevention ?

Answer 18

adherence

Question 19

what quote did (Nikiphorou et al., 2021) say about self-management ?

Answer 19

“self-management is critical to the management of LT conditions that aims to improve independence and quality of life and empower patients to be more proactive decision makers in the management of their illnesses”

(Nikiphorou et al., 2021)

Question 20

state 3 facts about what it is meant by the key term - self-management

(Gyurcsik et al., 2020)

Answer 20

• the duration of living with an NCD is very long and the contact these individuals have with the HCPs is minimal
• disease is affected by personal behaviour
• self-management provides a sense of control and psychological empowerment

Question 21

state, and explain, 3 facts about the role of HCPs

Answer 21

1) the management of chronic diseases is began with primary health care professionals
- their role is to get patients healthy enough to be more physically active

2) allied health professionals have a greater impact on health behaviours
- their aim is to support the uptake, adherence, and maintenance of the activity

3) both HCP groups help develop self-regulatory skills with the client
- this allows independence and a higher quality of life for the patients

Question 22

state, and explain, 3 challenges to self-management implementation (Gyurcsik et al., 2020)

Answer 22

1) primary HCPs lack training in behaviour change techniques
- should be trained in theories of behaviour change (e.g - SDT, self-efficacy)

2) primary HCPs report a lack of time to support PA promotion and adherence
- short contact periods and feel as if there are more important things to say or go over

3) not all HCPs promote or endorse the role of PA as a self-regulatory management approach
- appears it comes down to whether the HCP is active themselves, not due to their training or their time available

Question 23

what is ‘Moving Medicine’ ? (3 things)

Answer 23

1) an online resource aimed at helping healthcare professionals integrate PA conversations into routine clinical care
2) this should help to overcome some of the barriers that HCPs report
3) it teaches them methods of implementation as well as behaviour change models

Question 24

state 4 examples of organisations that help with the planning and designing of interventions

Answer 24

1) ‘National Institute for Health and Care Excellence’ (NICE)
2) ‘National Institute for Health Research’
3) ‘Medicine Research Council’
4) ‘DECIPHer’

Question 25

what is the ‘Medical Research Council Intervention Evaluation Framework’, and what are the steps in it ?

(Campbell et al., 2020)

Answer 25

• ‘a framework for how we develop and apply new interventions’

1) development
2) feasibility/piloting
3) evaluation
4) implementation

Question 26

state and explain the first phase of the ‘Medical Research Council Intervention Evaluation Framework’

(Campbell et al., 2020)

Answer 26

1) Development

• identifying the evidence base
• identifying/developing theory
• modelling process and outcomes

Question 27

state and explain the second phase of the ‘Medical Research Council Intervention Evaluation Framework’

(Campbell et al., 2020)

Answer 27

2) Feasibility / Piloting

• testing procedures
• estimating recruitment
• determining sample size

Question 28

state and explain the third phase of the ‘Medical Research Council Intervention Evaluation Framework’

(Campbell et al., 2020)

Answer 28

3) Evaluation

• assessing effectiveness (RCTs - test if its more effective than other strategies)
• understanding the change process
• assessing cost-effectiveness

Question 29

state and explain the fourth phase of the ‘Medical Research Council Intervention Evaluation Framework’

(Campbell et al., 2020)

Answer 29

4) Implementation

• dissemination
• surveillance and monitoring
• LT follow up

Question 30

explain the ‘Systematic Programme of Intervention Design’ framework

Answer 30

1) Systematic review of evidence
- benefits and risks
- barriers and facilitators

2) Intervention and design
- co-design
- theory

3) Intervention delivery and evaluation
- outcomes
- process

Question 31

what was the purpose of the following study:

‘Rheumatoid arthritis, Cardiovascular Disease, and Physical Activity - A Systematic Review’ (Metsois et al., 2008)

Answer 31

a systematic review to investigate the effectiveness of exercise interventions on improving disease related characteristics in individuals who suffer from rheumatoid arthritis (RA)

Question 32

what were the methods to the following study:

‘Rheumatoid arthritis, Cardiovascular Disease, and Physical Activity - A Systematic Review’ (Metsois et al., 2008)

Answer 32

six databases were searched to identify publications from 1974 to 2006 in English regarding RA and exercise interventions

Question 33

(Metsois et al., 2008) identified that PA levels in the RA community are very low. what were the 3 main reasons identified for this ?

Answer 33

1) fear of disease aggravation
2) misperception of damage

3) indefensible approach of HCPs
- lack knowledge
- scared to give wrong advise

Question 34

state 3 points to describe what Rheumatoid Arthritis is (Metsois et al., 2008)

Answer 34

• an autoimmune disease where the immune system attacks synovial fluid in the joints causing restricted movements’
• no known cure; it requires early diagnosis and treatment
• aim of treatment is to slow down the disease progression

Question 35

what were the 3 main findings from the following paper:

‘Rheumatoid arthritis, Cardiovascular Disease, and Physical Activity - A Systematic Review’ (Metsois et al., 2008)

Answer 35

1) exercise is effective at reversing joint damage in people living with RA
2) RA exercise programmes should be aimed at reducing CV disease risks
3) should base interventions of client preference, current inflammation and damage of their joints, their CV health, and the available resources to them for exercise

Question 36

what is NRAS (3 points)

Answer 36

‘National Rheumatoid Arthritis Society’ (NRAS)

• a charity supporting the self-management of people living with rheumatoid arthritis
• founded in 2001 by Alice Bosworth

Question 37

what 3 recommendations did (Metsois et al., 2008) about RA in the following paper:

‘Rheumatoid arthritis, Cardiovascular Disease, and Physical Activity - A Systematic Review’ (Metsois et al., 2008)

Answer 37

1) little research into the role of exercise to control the risk of, or management of, CV disease in RA individuals
2) little knowledge is known on the optimal levels, timing, and environment required for exercise
3) to need for identifying educational and behavioural interventions that facilitate LT adherence to exercise

Question 38

what was the aim of the following study:

‘Fostering Autonomous Motivation, PA, and CV fitness in in RA’ (Rouse et al., 2014)

Answer 38

a RCT of 22 studies looking at exercise interventions for RA to identify the barriers preventing them from PA participation

Question 39

state 4 disease specific barriers identified by (Rouse et al., 2014) in the following paper:

‘Rheumatoid arthritis, Cardiovascular Disease, and Physical Activity - A Systematic Review’ (Metsois et al., 2008)

Answer 39

1) pain and fatigue (although some studies found this to be the reason some RA individuals DID exercise)
2) reduced mobility and stiffness (linked to fear)
3) lack of provision of exercise programmes for individuals with RA
4) a general lack of knowledge relating to exercise causing fear (especially when exercise is not prescribed by their HCP)

Question 40

what was the purpose of the following study:

‘Autonomous Motivation, CV Fitness, and Exercise in RA - Randomised Control Trial’ (Rouse et al., 2021)

Answer 40

can ‘self determination theory’ based interventions foster need satisfaction, autonomous regulation, well-being, and PA behaviour in patients with RA ?

Question 41

what was the study design to the following study (5 points):

‘Autonomous Motivation, CV Fitness, and Exercise in RA - Randomised Control Trial’ (Rouse et al., 2021)

Answer 41

1) a 2-arm RCT (n = 115) –> SDT + exercise, or exercise control
2) completed content form, survey, bloods, exercise assessment, and an assisted IPAQ at baseline
3) assessment informed a tailored PA programme which the control and intervention group received as well as a free gym membership to complete over 3 months
4) trained PA advisors to support behaviour change and deliver gym sessions with patients
5) same assessments taken at 3, 6 and 12 months

Question 42

what were the 3 purposes of the ‘1 to 1’ consultations in the following study:

‘Autonomous Motivation, CV Fitness, and Exercise in RA - Randomised Control Trial’ (Rouse et al., 2021)

Answer 42

• acknowledge positive and negative experiences
• link the benefits with patients valued life goals
• support barrier self-efficacy

Question 43

what was the purpose of the ‘trained fitness advisors’ in the following study:

‘Autonomous Motivation, CV Fitness, and Exercise in RA - Randomised Control Trial’ (Rouse et al., 2021)

Answer 43

• provide exercise choice and encourage ownership of exercise
• accept the clients views unconditionally
• demonstrate time and attention to each client

Question 44

what was the purpose of the ‘month 3 consultation’ in the following study:

‘Autonomous Motivation, CV Fitness, and Exercise in RA - Randomised Control Trial’ (Rouse et al., 2021)

Answer 44

• reflect on the benefits from the exercise intervention

- support autonomy to continue the PA programme post intervention

Question 45

what were the results from the following study:

‘Autonomous Motivation, CV Fitness, and Exercise in RA - Randomised Control Trial’ (Rouse et al., 2021)

Answer 45

• despite showing improved quality of motivation for exercise, no changes in physiological or other psychological health outcomes were observed between the intervention and the control group
• this suggests that more intensive support is needed when initiating an exercise programme to achieve health benefits in RA

Question 46

what is the prevalence of arthritis, and why use PA self management? (Gyurcsik et al., 2020)

Answer 46

• 1 in 5 adults > 18 live with arthritis
• i in 2 adults > 50 live with some form of arthritis
• arthritis management is complex, and PA is one of the many self-management strategies

Question 47

state 3 psychological factors important for activity adherence with those who suffer from arthritis (Gyurcsik et al., 2020)

Answer 47

• self-regulatory efficacy is a predictor of arthritis self-management use
• main focus has been on self-regulatory efficacy to overcome barriers and to schedule and plan activity
• arthritis pain acceptance also helps with activity adherence

Question 48

state 3 facts of the importance of HCPs with self-management with those who suffer from arthritis (Gyurcsik et al., 2020)

Answer 48

• primary HCPs lack training and time to help patients learn about PA and its benefits on arthritis
• people with pain identified that the allied HCPs of PA providers are a key source for the delivery of integrated counselling
• at present (2020), activity providers do not receive any training in integrated counselling

Question 49

state 2 facts about ‘knowledge translation initiatives’ for those suffering from arthritis (Gyurcsik et al., 2020)

Answer 49

• the Centres for Disease Control and Prevention (CDC) recommends PA programmes for the treatment and self-management of arthritis
• these programmes do not systematically target psychological skills, and evidence is lacking about the effects of LT activity adherence to the WHO recommended level

Question 50

state 3 facts to the importance of self-management and PA in people who suffer from diabetes (Gyurcsik et al., 2020)

Answer 50

• 1 in 10 Americans suffer from diabetes
• aerobic guidelines recommend 150 mins MVPA per week
• diabetes management is complex, and PA is recommended for self-management

Question 51

state 2 psychological factors important for activity adherence for those who suffer from diabetes (Gyurcsik et al., 2020)

Answer 51

• both task and self-regulatory efficacy beliefs essential for involvement in more self-management behaviours
• goal setting and relapse prevention appear to be essential for diabetics

Question 52

state 2 facts about the importance of HCPs when treating diabetes (Gyurcsik et al., 2020)

Answer 52

• self-management education and support from HCPs is fundamental in PA use
• diabetes educators have low SE to educate and prescribe PA. interventions need to target these HCPs ability to do so

Question 53

state 2 facts about ‘knowledge translation initiatives’ for those suffering from diabetes (Gyurcsik et al., 2020)

Answer 53

• evidence showed a 58% reduction in developing T2 diabetes via PA (DPP., 2008)
• ‘Moving Medicine’ addresses methods to help HCPs self-efficacy in educating and prescribing PA for self-management

Question 54

what 3 recommendations does (Gyurcsik., 2020) give for future research in PA as a self-management tool for people living with NCDs ?

Answer 54

1) more research needed to identify unique psychological factors that promote adherence in people living with a specific chronic disease
2) a focus is needed on moderators of PA
3) PA and HCP specialists should receive behaviour change training, and be trained in integrated counselling

Question 55

state 4 barriers identified by (Lidegaurd et al., 2016) individuals with T2 diabetes believe they face to PA

Answer 55

1) functional limitations of their body
2) logistical challenges, including a lack of time and awareness of where to exercise in the local area
3) inability to find others to do PA with
4) goal-setting and self-monitoring

Question 56

state 3 barriers identified by (Barnet et al., 2013) that individuals with cancer believe they face to PA

Answer 56

1) cancer related symptoms
2) bad weather, lack of knowledge, time constraints
3) lack of knowledge, skill, and social support

Question 57

state 4 barriers identified by (Robinson et al., 2018) that individuals with COPD believe they face to PA

Answer 57

1) lack of self-efficacy
2) lack of social support
3) lack of prescription of exercise from HCPs
4) lack of opportunities to exercise with their condition

Question 58

state 4 NCDs identified in the review by (Pederson & Saltin., 2006) that you looked at for evidence at prescribing PA for self-management

Answer 58

1) anxiety
2) schizophrenia
3) multiple sclerosis
4) bronchial asthma

Question 59

explain the back ground to the following condition identified by (Pederson & Saltin., 2006) - anxiety

Answer 59

• 5% of the world population suffer from anxiety (women more than men)
• anxiety disorders are associated with a reduced quality of life (Donnellan et al., 2010)
• anxiety appears as a symptom in many other mental illnesses (such as depression)

Question 60

explain the back ground to the following condition identified by (Pederson & Saltin., 2006) - schizophrenia

Answer 60

• a group of mental disorders characterised by abnormal thoughts and emotions
• symptoms include social withdrawal, lack of energy, issues with cognition and body image
• approx. 25% recovery rate
• dopamine hypothesis: develops due to an over-sensitivity of dopamine in the prefrontal cortex

Question 61

explain the back ground to the following condition identified by (Pederson & Saltin., 2006) - multiple sclerosis

Answer 61

• chronic disease resulting from progressive disability
• 30 per 100,000 globally
• develops between ages 20 - 40
• recurring neurological deficits in different parts of the NS caused by local demyelination
• causes paralysis, ataxia, weakness, fatigue…

Question 62

explain the background to the following condition identified by (Pederson & Saltin., 2006) - bronchial asthma

Answer 62

• a chronic inflammatory disorder
• allergies are a massive cause of asthma (e.g. - hay fever)
• environmental factors (e.g. - tobacco) can lead to its development
• PA can cause acute bronchoconstriction

Question 63

what is the evidence of using PA as a self-management tool in the following condition (Pederson & Stalin., 2006) - anxiety

Answer 63

• limited knowledge of exercise effects on anxiety (Bartley et al., 2013)
• shown to decrease anxiety and tension, but unsure if effects are enduring (Bartley et al., 2013)
• a meta-analysis from 2010 concluded that exercise reduces anxiety in individuals who suffer from other chronic diseases (Herring et al., 2010)

Question 64

what is the evidence of using PA as a self-management tool in the condition of the following exercise as identified by (Pederson & Stalin., 2006) - schizophrenia

Answer 64

• psychometric measures significantly improved from exercise from 90 mins MVPA per week (Firth et al., 2015)
• regular PA reduces negative symptoms (Beebe et al., 2005)
• PA improves concentration, attention, and body image (Chaddock et al., 2010)

Question 65

what is the evidence of using PA as a self-management tool in the following condition (Pederson & Stalin., 2006) - multiple sclerosis

Answer 65

• can improve symptoms with those who have mild symptoms (Chung et al., 2013)
• exercise may slow down the disease process, but more evidence is needed to confirm this (Daglas & Stenager., 2012)
• resistance training improves strength, reduces fatigue, and improves functional capacity (Kjolhede et al., 2012)
• aerobic exercise reduced depressive symptoms (Petejan et al., 1966)

Question 66

what is the evidence of using PA as a self-management tool in the following condition (Pederson & Stalin., 2006) - bronchial asthma

Answer 66

• PA showed marked increases in respiratory fitness (Carson et al., 2013)
• swimming training can be very beneficial (Beggs et al., 2013)
• asthmatic CAN participate in HIT training (Emtner et al., 1966)

Question 67

what are the possible mechanisms identified by (Pederson & Stalin., 2006) to why exercise can be used to treat the following condition - anxiety

Answer 67

• positive feedback from the environment and social contact (Scott., 1960)
• distraction (Bahrke & Morgan., 1978)

Question 68

what are the possible mechanisms identified by (Pederson & Stalin., 2006) to why exercise can be used to treat the following condition - schizophrenia

Answer 68

• distraction from hallucinations
• positive feedback from the environment and social contact (Scott., 1960)
• improved body image (Sell., 1994)

Question 69

what are the possible mechanisms identified by (Pederson & Stalin., 2006) to why exercise can be used to treat the following condition - multiple sclerosis

Answer 69

• individualised and based on the stage that the disease is in
• combination of aerobic and resistance training for those who have mild to moderate symptoms

Question 70

what are the possible mechanisms identified by (Pederson & Stalin., 2006) to why exercise can be used to treat the following condition - bronchial asthma

Answer 70

• PA can induce chronic anti-inflammatory effects in the lungs (Silva et al., 2010)
• PA aids ventilation during expiration

Question 71

what types of training should the people with the following condition do as identified by (Pederson & Stalin., 2006) - anxiety

Answer 71

• aerobic, in small groups, and supervised (Herring et al., 2010)
• 20 to 30 mins MVPA per day

Question 72

what types of training should the people with the following condition do as identified by (Pederson & Stalin., 2006) - schizophrenia

Answer 72

• must be individualised
• aerobic, and in small groups as social support is required (Brown et al., 1999)
• aim to lose weight (improve body image)

Question 73

what types of training should the people with the following condition do as identified by (Pederson & Stalin., 2006) - multiple sclerosis

Answer 73

• the aim of training is to recover muscle strength, co-ordination, and fitness

Question 74

what types of training should the people with the following condition do as identified by (Pederson & Stalin., 2006) - bronchial asthma

Answer 74

• individualised
• aerobic training
• effective warm-up is required for lung function
• doctor supervised exercise programme

Question 75

what is the background to the following systematic review:

‘responsibility of sports and exercise medicine in preventing and managing chronic diseases’ (Matheson et al., 2013)

Answer 75

• physical inactivity is now the fourth leading independent risk factor for death caused by NCDs
• the disparity between our scientific knowledge about NCDs and the practical prevention approaches is an urgent matter

Question 76

what were the findings to the following systematic review:

‘responsibility of sports and exercise medicine in preventing and managing chronic diseases’ (Matheson et al., 2013)

Answer 76

• reductionism is the main treatment approach, fostering a disease based approach and not a health based model of care
• trying to ‘fit’ prevention into a disease based approach has been unsuccessful as the fundamental tenants of prevention are opposed to it

Question 77

what is the recommendation made from the following systematic review:

‘responsibility of sports and exercise medicine in preventing and managing chronic diseases’ (Matheson et al., 2013)

Answer 77

a clinical discipline within medicine is needed to adopt disease prevention as its sole reason for existence to enhance NCD prevention

Question 78

what was the aim of the following study:

‘effects of physical inactivity on major NCDs worldwide - an analysis’ (Lee et al., 2012)

Answer 78

the aim of the study was to estimate how much disease could be averted with a global increase in physical activity

Question 79

what was the method to the following study:

‘effects of physical inactivity on major NCDs worldwide - an analysis’ (Lee et al., 2012)

Answer 79

• calculated a population attributable fraction (PAF) associated with physical inactivity of each NCD
• used lifetime analysis to estimate the gains in lifetime expectancy

Question 80

what were the 3 major findings from the following study:

‘effects of physical inactivity on major NCDs worldwide - an analysis’ (Lee et al., 2012)

Answer 80

• inactivity caused 5.3 million deaths worldwide in 2008
• if inactivity was to be reduced by 10%, 533 000 deaths would be averted every year
• estimated that the elimination of physical inactivity would increase average global life expectancy by 0.4 to 0.9 years

Question 81

state 3 limitations to the following study:

‘effects of physical inactivity on major NCDs worldwide - an analysis’ (Lee et al., 2012)

Answer 81

1) the use of an adjustment factor to estimate the prevalence of PA was based on North America and Europe (not the other continents)
2) estimated the effect on the major NCDs, not minor ones
3) must take into account that some people are physically and mentally incapable of becoming more active