Fleur van Rens

Mental health has received little attention in preprofessional and professional circus despite the performance demands, cognitive skill, and emotional labor required. This review aimed to consolidate the literature, identify research gaps, and guide practice priorities for mental health in preprofessional and professional circus artists. A narrative review of the literature was conducted based on the International Olympic Committee’s 2019 consensus statement for mental health in elite athletes. Articles reported on mental health symptoms and disorders ( n = 13) and interventions ( n = 3) in preprofessional and professional circus contexts. Circus artists may experience more symptoms of depression, anxiety, fatigue, and disordered eating compared to the general population. Mental health symptoms may be related to discipline, age, gender, professional status, coping resources, environmental demands, and injury. There is insufficient evidence to support the development of best practice guidelines; however, multidisciplinary collaboration to support mental health appears to be important for preprofessional and professional circus artists. (PsycInfo Database Record (c) 2025 APA, all rights reserved) (Source: journal abstract)

Background
Poor vision compromises quality of life and participation in different daily life activities of children such as, sports, leisure time, interactive play and social interaction. The purpose of this cross - sectional study is to investigate participation and quality of life of children with visual impairment (VI) and blindness compared with normally sighted peers.

Methodology
Children aged 7–17 years with blindness (n = 100), moderate to severe VI (n = 100) and normal sight (n = 100) completed Nepalese versions of the Participation and activity inventory children and youth (PAI-CY 7–12 and 13–17), L. V. Prasad functional vision questionnaires (LVP-FVQ II) and Pediatric Eye Questionnaires (PedEyeQ 5–11 and 12–17). The measurement properties of PAI -CY was studied. All (sub) scores were compared between three groups. Associations between the severity of VI and outcomes were assessed with age and sex adjusted linear regression analyses.

Results
Children with blindness scored worse than children with VI, who scored worse than normally sighted children on the PAI-CY 7–12, the physical functioning subscale of the PAI-CY 13–17 and the LVP-FVQ II(p = < 0.001).However, for the psychosocial functioning subscale of PAI-CY 13–17, children with blindness scored better than children with VI(p = < 0.01). On the PedEyeQ, young children (5–11) with blindness on all subscales, and older children (12–17 years) with blindness on the functional vision subscale scored worse than children with VI(p = < 0.01).Regression models showed that both moderate/severe VI and blindness were significantly associated with worse PAI-CY, LVP-FVQ II, PedEyeQ 5–11 and PedEyeQ 12–17 functional vision subscale scores(p = < 0.01).

Conclusion
Younger children with blindness showed worse participation and quality of life compared to children with VI, whereas results for older children showed a mixed pattern with children with blindness showing better participation in psychosocial domain. Appropriate low vision rehabilitation interventions are needed for children with VI and blindness to increase their participation and quality of life to the level of their normally sighted peers as far as possible. Future studies could include children who do not attend school and may have worse participation and quality of life than children in our study.

Purpose: While formative research has identified healthcare providers (HCPs) as an avenue for exercise behaviour change in persons with multiple sclerosis (MS), with some work developing initial theories, no research has examined HCPs’ perceptions and expectations about their training needs to promote exercise behaviour change. Therefore, we aimed to undertake an exploratory realist analysis to build initial program theories regarding HCP training on home-based exercise prescription and behaviour change support for persons with MS; to understand how training works, for whom and under what circumstances.

Methods: Four online focus groups were conducted with fifteen HCPs who were either in public or private practice, including physiotherapists (PT; n=8), accredited exercise physiologists (AEP; n=4) and occupational therapists (OT; n=3). Two independent researchers conducted a realist evaluation with realist analysis of interview transcripts through identifying and developing CMOCs (context, mechanism and outcome configurations) codebooks, synthesised as demi-regularities (DRs).

Results: We identified 14 recurring patterns (DRs) illustrating multiple perceived outcomes of training (e.g., engagement, utilisation, satisfaction, and knowledge) generated by various mechanisms (e.g., training program content, delivery, mixed pedagogies, inclusion of content related to other health conditions and time constraints). Interestingly, these mechanisms were triggered by all three professional contexts (PTs, AEPs and OTs).

Conclusions: Preliminary theories from this realist evaluation indicate that online training for exercise behavioural change prescription can be a feasible part of HCPs’ professional development and routine care for persons with MS. Training incorporating evidence-based principles and benefitting HCP’s knowledge and skills facilitates participation. However, several extrinsic factors (e.g., client adherence, content limited only to MS) are barriers requiring attention to allow for the broader implementation of HCP training on exercise promotion as part of routine MS care.

Objective:
Exercise is a salient component in delaying disability progression in multiple sclerosis (MS). This study considers personal preferences regarding exercise program prescription and the resources needed to facilitate exercise.

Design:
Cross-sectional study.

Setting:
Community online, Australia.

Participants:
Adults with MS.

Independent variables:
Participants completed online questionnaires on current exercise and sport, and preferences toward exercise prescription variables, facilitative resource needs, and delivery method.

Main outcomes:
We established preference responses for the entire sample, and separately, we used logistic regression and analysis of variance to compare preferences between participants stratified according to (1) geographical rurality (ie, metro vs rural and remote) and (2) current exercise engagement (ie, active, moderately active, and insufficiently active).

Results:
Fifty people with a diagnosis of MS completed the survey. Participants had mild disability; most were metro-dwelling (74%) and physically active (58%). Preferences included a program of at least 6 months (70%), where exercise sessions are performed 5 d/wk (38%) at a moderate intensity (50%). Half (50%) of responders wanted to participate in sports for exercise. There was a significant difference in the preference toward higher-intensity exercise in active persons compared with inactive persons. Facilitative resources selected included a behavioral exercise coach (80%) who provides MS-specific information (46%) and behavioral change strategies (41%).

Conclusions:
Persons with mild MS are interested in participating in various exercises and sports. Encouraging participation will have long-term benefits. We recommend that HCPs and researchers consider individual social factors, in addition to patient symptoms and disability, when designing exercise programs for an Australian MS population.

Purpose : Little is known about objectively measured physical activity (PA) levels in children with visual impairment (VI). The aim of this study was to compare objective PA levels of children with VI and normal sight across different times of the regular school day and weekend days.

Methods : One hundred children with VI and 100 normally sighted peers aged 7 to 17 years from integrated schools for the blind in Nepal wore an actigraph on their non-dominant wrist for one week. PA outcomes included mean activity counts per minute and the proportion of waking time engaging sedentary PA, or performing light, moderate and vigorous intensity PA. Activity count per minute was modelled using a series of generalised linear mixed effects models (assuming a gamma distribution for activity counts, and binomial distribution for PA proportions ) with vision , age, sex, time of day (before, during, or after school or weekend) and a vision by time of day interaction entered as fixed effects and a random intercept fitted for each child.

Results : Data of 83 children with VI and 77 normally sighted peers were included. Mean activity count per minute was lower in the children with VI (p<0.001), especially during and after school.
Vision by time of day interactions showed that children with VI were less sedentary than normally sighted children before school (55 %, CI 95%:53 %-57 % vs 62 %, CI 95%:60 %-64%) and on weekend (41%, CI95%: 39%-43% vs 45 %, CI 95%:43%-47%) yet more sedentary during school (36%, CI95%:34%-37% vs 30 %, CI95%:29%-32%). They also spent more time performing light PA across all periods of the day but spent less time performing moderate PA at school and vigorous PA during all periods of the day (p<0.001)

Conclusions : Our findings indicate that children with VI are participating in light and moderate PA and they do not perform as much vigorous PA as children with normal sight especially during school hours. There is a need for guidance to promote more intense PA programs in schools which are tailored for children with VI

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

Purpose: To compare objective physical activity (PA) levels of children with visual impairment (VI) and children with normal sight.

Methods: One hundred children with VI and 100 age- and gender-matched normal-sighted peers 7 to 17 years of age wore an ActiGraph for 1 week. Activity count per minute (cpm) was modeled using a series of generalized linear mixed-effects models including vision, age, sex, time of day, and vision by time of day interaction. PA outcomes included mean counts per minute and proportion of time spent on sedentary, light, moderate, and vigorous intensity PA.

Results: Data of 83 children with VI and 77 normal-sighted peers were included. Mean counts per minute were lower in children with VI (P < 0.001), especially during and after school. Children with VI were less sedentary (55%; 95% confidence interval [CI], 53–57) than children with normal sight before school (62%; 95% CI, 60–64) and over weekends: children with VI, 41% (95% CI, 39–43); children with normal sight, 45% (95% CI, 43–47). Yet, children with VI were more sedentary during school (36%; 95% CI, 34–37) compared with children with normal sight (30%; 95% CI, 29–32). They also spent more time performing light PA and less time performing moderate PA at school and vigorous PA across all periods of day (P < 0.001).

Conclusions: Children with VI participated in light and moderate PA but did not perform as much vigorous PA as children with normal sight, especially during school hours.

Translational Relevance: There is a need to promote more intense PA programs in schools tailored for children with VI.

Background
Many people with MS do not meet the recommended exercise regime to elicit health benefits. This study aimed to determine the feasibility, safety, acceptability, and appropriateness of an exercise intervention delivered online to persons with MS that meets current exercise recommendations and behaviour change principles.

Methods
Seventy-two participants (age: 43.3 ± 13.3 years) with mild to moderate MS were stratified according to previous exercise behaviour and block-randomised into one of three groups: Control (CON; n = 24), General Exercise (GE; n = 24) who at screening did not meet current exercise recommendations, and Advanced Exercise, (AE; n = 24) who at screening met the current exercise recommendations. GE and AE groups received a four-month online-supervised, behaviour change theory-based exercise program and were assessed at baseline, four-months, five-months, and eleven-months for physical activity participation. The feasibility of process, resources, management, and scientific outcomes was assessed.

Results
Of 198 potential participants, 143 met the eligibility criteria (72 %), and 72 were randomised. Fifty-three participants completed the intervention (74 % immediate retention), and 44 were retained at the six-month follow-up (61 %). Personnel time was 369 h, and total per-participant cost was Au$1036.20. Adherence rate to ≥70 % of exercise sessions was 73 % (GE) and 38 % (AE). The GE group observed a small magnitude of improvement in physical activity (d = −0.23).

Conclusions
An online exercise program embedded with behaviour interventions for either GE or AE appears feasible, acceptable, appropriate and safe and may show long-term efficacy in increased exercise behaviours for persons with mild to moderate MS.

Trial registration: ANZCRT number ACTRN12619000228189p.

Background
The growing importance of telehealth in multiple sclerosis (MS) necessitates an understanding of current practices and training needs of health professionals. We aimed to evaluate the knowledge, preparedness, and training preferences of Australian allied health professionals (AHPs) in telehealth exercise therapy and exercise behavioural change for MS patients to inform the development of educational training.

Methods
An online survey was completed by 58 Australian AHPs, including 34 physiotherapists, 14 exercise physiologists, and 10 occupational therapists, focusing on their current practices, preparedness, and training preferences in telehealth exercise and behavioural change for MS. The survey included multiple-choice, Likert scale, and free-text response questions. Data were analysed using binary and multinomial logistic regressions.

Results
Not all AHPs were aware of MS exercise guidelines (67% awareness), with exercise physiologists showing the highest familiarity. There was a significant understanding of the difference between physical activity and exercise, though definitions often lacked clarity. Most AHPs (91%) employed behavioural change strategies in their practice, especially goal-setting (95%), identifying facilitators (67%), and reinforcing progress (66%). While most (72%) felt prepared in promoting exercise to MS clients, there were differences in confidence levels concerning the prescription, modification, and teaching of telehealth exercise programs, with occupational therapists have significant less confidence in those domains compared to other AHPs. Most AHPs expressed interest in additional training, with a preference for online workshops focusing on exercise prescription for MS, behaviour change, and telehealth delivery methods.

Conclusion
In our Australian AHP sample we identified that a quarter to a third of AHPs in MS care may not be confident or prepared to promote telehealth exercise and behavioural change to people with MS. Moreover, the findings highlight some disparity in knowledge and confidence levels amongst different AHPs concerning exercise therapy for MS, indicating the need for tailored multidisciplinary training programs. Such programs should address profession-specific educational gaps and training preferences, ensuring effective and safe telehealth exercise prescription in MS care.

The objective of this research was to validate a single, trunk-mounted wearable sensor (Optimeye S5, Catapult Australia, Melbourne) to measure the cadence of swimming strokes, cycling pedals and running strides in a triathlon. While similar validations have been performed in swimming and running, it is a novel application in cycling, and thus, across a whole triathlon. Seven triathletes were recruited to participate in a sprint distance triathlon which was filmed and simultaneously measured by a single, trunk-mounted wearable sensor. To validate the wearable sensor, individual swimming strokes, cycling pedal strokes and running strides were manually counted by viewing the wearable sensor data and video footage. While analysing cycling data, changes in cycling subtask performances were noticed, thus, a secondary analysis in cycling was conducted to investigate. The 95% limits of agreement analysis indicated the sensor validly measured swimming strokes (mean bias = −0.034 strokes), cycling pedal strokes (mean bias = −0.09 strokes) and running strides (mean bias = 0.00 strides) with minimal to no bias ( p > 0.05). Further analysis of cycling revealed the wearable sensor is an acceptably valid tool to measure the duration of out of saddle riding (mean bias = 0.08 s), however, significant differences in the duration of in saddle riding (mean bias = −0.5 s) and coasting were identified (mean bias = 0.39 s). A single trunk mounted wearable sensor is a valid tool to measure movement cadence in a triathlon, however, further validation is required to generate a full understanding of cycling subtask performances.

Purpose: To examine the impact of oral contraceptive (OC) phases on performance, physiological, and subjective responses to prolonged, intensive exercise when carbohydrate (CHO) stores are reduced.

Methods: Ten well-trained female cyclists using monophasic OC completed 4 identical trials (>150 min) under conditions of in-trial 60-g·h −1 CHO supplementation (CHO+) or placebo (CHO−) during the sugar- (SUG) and active-pill (ACT) phases of their OC cycle. Each trial comprised two 400-kcal time trials (TT) separated by 1 hour of submaximal cycling at first ventilatory threshold.

Results: Change in completion time from TT 1 to TT 2 was minimized in CHO+ compared with CHO− (4.06 [2.55] vs 6.08 [5.33] min; P = .019, effect size = −0.36). An interaction effect of OC and CHO was observed for time to complete TT ( P = .006), mean TT power ( P = .002), mean TT heart rate ( P = .002), and posttrial emotional balance ( P = .020) and negative emotional state ( P = .033). In ACT, mean TT power and heart rate were higher in CHO+ when compared with CHO−, resulting in faster TTs in CHO+ and improved post-trial emotional well-being. When CHO was not supplemented, TT power and heart rate were higher in SUG when compared with ACT, resulting in faster TTs in SUG and improved post-trial emotional balance.

Conclusion: CHO depletion during ACT negatively influenced TT performance and emotional well-being when compared with SUG. Irrespective of OC pill phase, CHO supplementation should be prioritized to sustain performance and improve post-exercise recovery–stress balance.