Shaun Teo

Introduction: Prospective data quantifying physical activity (PA) levels in Australian youth with type 1 diabetes (T1D) are lacking. Structured questionnaire instruments may provide useful information, but have not been evaluated in youth with T1D. The objective of this study was to evaluate the validity of three paediatric PA questionnaires in young people with T1D and their ability to differentiate those not meeting PA guidelines of 60 min of moderate-to-vigorous PA (MVPA) per day from those who do. Methods: Eighty youth with T1D (42 boys, 38 girls; age: 13.1 ± 2.6 years; body mass index: 20.2 ± 3.9 kg·m−2; glycosylated haemoglobin: 58.5 ± 10.1 mmol/mol; T1D duration: 5.4 ± 3.1 years) wore an Actigraph GT3x accelerometer for 7 days and on day 8 completed three self-report PA instruments: (i) the Physical Activity Questionnaire (PAQ), (ii) Previous Day Physical Activity Recall (PDPAR), and (iii) a Single-Item Physical Activity Scale (SIPAS). Validity coefficients for each instrument using accelerometry-derived MVPA minutes were determined using Spearman’s correlation coefficient. Receiver operator characteristic (ROC) curves were generated and optimal cut-points determined. Results: Mean daily MVPA minutes were 46.6 ± 25.5 min; 21/80 participants (26%) achieved an average of ≥60 MVPA minutes per day. The PAQ had the highest validity coefficient (r = 0.53; p < 0.001), followed by the single-item tool (r = 0.39; p < 0.001) and PDPAR (r = 0.09; p = 0.4). Area under the ROC curve was 0.7, 0.5, and 0.7 for the PAQ, PDPAR, and single-item tools, respectively. Optimal cut-points for sensitivity and specificity were (i) a PAQ composite score of 2.8 (66.1% and 66.7%), (ii) 75 MVPA minutes on the PDPAR (59.3% and 47.6%), and (iii) 4.5 days on the SIPAS (71.2% and 38.1%). Conclusion: The PAQ has moderate-to-high criterion validity and showed moderate ability to discriminate between T1D youth meeting PA guidelines from those who do not. The single-item question had low-to-moderate construct validity, while the PDPAR did not correlate with objectively measured PA levels. The feasibility of incorporating the PAQ into clinical care for youth with T1D warrants further evaluation.

Background:
A novel mobile health (mHealth) app “acT1ve,” developed using a co-design model, provides real-time support during exercise for young people with type 1 diabetes (T1D).

Objective:
This study aimed to demonstrate the noninferiority of acT1ve compared with “treatment as usual” with regard to hypoglycemic events.

Methods:
Thirty-nine participants living with T1D (age: 17.2, SD 3.3 years; HbA1c: 64, SD 6.0 mmol/mol) completed a 12-week single-arm, pre-post noninferiority study with a follow-up qualitative component. During the intervention, continuous glucose monitoring (CGM) and physical activity were monitored while participants used acT1ve to manage exercise. CGM data were used to assess the number of hypoglycemic events (<3.9 mmol/L for ≥15 minutes) in each phase. Using a mixed effects negative binomial regression, the difference in the rates of hypoglycemia between the preapp and app-use phases was analyzed. Participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS) questionnaire postintervention. All interviews were audio-recorded for transcription, and a deductive content analysis approach was used to analyze the participant interviews. The uMARS Likert scores for each subscale (engagement, functionality, esthetics, and information) were calculated and reported as medians with IQRs.

Results:
The rates of hypoglycemia were similar for both the preapp and app-use phases (0.79 and 0.83 hypoglycemia events per day, respectively). The upper bound of the CI of the hypoglycemia rate ratio met the prespecified criteria for noninferiority (rate ratio=1.06; 95% CI 0.91-1.22). The uMARS analysis showed a high rating (≥4 out of 5) of acT1ve by 80% of participants for both functionality and information, 72% for esthetics, and 63% for overall uMARS rating. Content analysis of the interview transcripts identified 3 main themes: “Provision of information,” “Exercising with the App,” and “Targeted Population.”

Conclusions:
The mHealth app “acT1ve,” which was developed in collaboration with young people with T1D, is functional, acceptable, and safe for diabetes management around exercise. The study supports the noninferiority of acT1ve compared with “treatment as usual” with regards to hypoglycemic events.

Exercise is recommended to improve sleep, but the role of exercise intensity is unclear. In addition, whether obesity interacts with exercise intensity to affect sleep is unknown.

PURPOSE: To investigate the effects of exercise intensity and obesity on parameters related to sleep quality (sleep efficiency [SE], sleep onset latency [SOL], wake after sleep onset [WASO], and awakenings).

METHODS: Six adults with obesity (OB; 2 M/4F; age: 35.7 ± 9.7 y; BMI: 34.4 ± 2.9; VO2peak: 21.4 ± 3.2 mL/kg/min) and seven normal weight adults (NW; 4 M/3F; age: 33.4 ± 14.5 y; BMI: 22.9 ± 1.9 kg/m2; VO2peak: 32.4 ± 5.6 mL/kg/min) completed a maximal graded cardiopulmonary peak oxygen uptake (VO2peak)/lactate threshold (LT) test on a cycle ergometer to determine exercise intensity for 3 randomized control or calorically matched exercise bouts: a) CON, no exercise; b) MOD, the power output (PO) at LT; c) HIGH, the PO associated with 75% of the difference between LT and VO2peak. Each visit occurred in the morning between 08:00-09:00 h. Sleep variables were recorded with Philips Respironics Actiwatch Spectrum Plus monitors. Participants wore the watch the day before each testing visit and through the night after the testing visit. The Cole-Kripke algorithm was used to score the actigraphy data. 2x3 mixed model ANOVAs were utilized to assess the effect of obesity status and exercise intensity on each sleep parameter using delta scores of the night before and night after each condition. Data are reported as mean ± SD.

RESULTS: NW slept an average of 7.8 ± 1.35 hrs, and OB slept an average of 7.15 ± 1.4 hrs; sleep duration was not significantly different in any group or condition (p = 0.51-0.99). Compared with CON, MOD was associated with a lower SE (-2.8 ± 5.3% vs + 3.4 ± 6.2%, p < 0.01) and higher SOL (+5.1 ± 12.2 vs -9.3 ± 20.4 minutes, p < 0.05). Sleep parameters were not different between HIGH and CON or HIGH and MOD (all;p > 0.05). Regardless of condition, SE was higher in the OB group compared with NW (+2.6 ± 6% vs -1.4 ± 5.1 %, p = 0.01).

CONCLUSION: SE and SOL may be affected by moderate intensity exercise. In addition, obesity status may impact the quality of sleep.

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.

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.

Exercise is effective for multiple sclerosis (MS) symptom and disease management and can be digitally-delivered. How Australian healthcare professionals (HCP; physiotherapists (PT), exercise physiologists (EP), occupational therapists (OT) prescribe or deliver exercise to MS clients remains unclear. We determined current HCP practices, confidence, and preferences on exercise prescription, and personal educational preferences on telehealth exercise for MS.

Australian neurological HCP completed online surveys. Logistic regression and ANOVA compared responses between HCP, stratified to profession. Four focus groups and thematic analyses were conducted on needs and preferences towards designing educational programs on telehealth exercise delivery for MS.

Fifty-eight HCP responded (34 PT; 14 EP; 10 OT). Differences existed in the familiarity of different professions with current exercise guidelines for MS (EP: 85.7%; PT: 67.6%; OT: 40%). Profession differences existed on confidence to prescribe telehealth exercise (EP 85%; PT 80%; OT 35%; p<0.001). HCP were interested in education on telehealth exercise for MS (EP 100%; PT 91.2%; OT 70%). However, OT (60%) preferred focusing on behavior change, while EP (78.6%) and PT (73.5%) preferred delivering both exercise and behavior change. HCP (N=15) of all professions participated in the focus groups. Main facilitators towards education on telehealth exercise and behaviour change were to increase reach to clients who: live remotely, lack time, and/or face financial restrictions, and increasing professional skills in exercise delivery in MS care. Barriers and concerns included lack of time for education and suitability with current practice. Training resources should address HCP needs to improve exercise delivery in MS care.

Introduction: Community sport coaches in Western Australia lack an understanding, the confidence, and knowledge in supporting young people with Type 1 diabetes (T1D). This study aims to identify what T1D educational resources are required to upskill coaches in Western Australia.

Methods: Semi-structured online interviews were conducted with i) young people living with T1D, ii) parents of young people living with T1D and iii) community sport coaches. The questions explored i) past experiences of T1D management in community sport ii) the T1D information coaches should be expected to know about and iii) the format of resources to be developed. Thematic analysis of interview transcripts was performed, and the themes identified were used to guide resource development.

Results: Thirty-two participants (16 young people living with T1D, 8 parents, 8 coaches) were interviewed. From the interviews, young people wanted coaches to have a better understanding of what T1D is and the effect it has on their sporting performance, parents wanted a resource that explains T1D to coaches, and sports coaches wanted to know the actions to best support a player living with T1D. All groups identified that signs and symptoms of hypoglycaemia and hyperglycaemia needed to be a key component of the resource. Sports coaches wanted a resource that is simple, quick to read and available in a variety of different formats.

Conclusion: The interviews resulted in valuable information gained from all groups and have reinforced the need for the development of specific resources to increase community knowledge and provide support for players with T1D, parents and sport coaches.

Introduction

Inclusion body myositis (IBM) is the most commonly acquired skeletal muscle disease of older adults involving both autoimmune attack and muscle degeneration. As exercise training can improve outcomes in IBM, this study assessed whether a combination of testosterone supplementation and exercise training would improve muscle strength, physical function and quality of life in men affected by IBM, more than exercise alone.

Methods

This pilot study was a single site randomised, double-blind, placebo-controlled, crossover study. Testosterone (exercise and testosterone cream) and placebo (exercise and placebo cream) were each delivered for 12 weeks, with a two-week wash-out between the two periods. The primary outcome measure was improvement in quadriceps isokinetic muscle strength. Secondary outcomes included assessment of isokinetic peak flexion force, walk capacity and patient reported outcomes, and other tests, comparing results between the placebo and testosterone arms. A 12-month Open Label Extension (OLE) was offered using the same outcome measures collected at 6 and 12-months.

Results

14 men completed the trial. There were no significant improvements in quadriceps extension strength or lean body mass, nor any of the secondary outcomes. Improvement in the RAND Short Form 36 patient reported outcome questionnaire ‘emotional wellbeing’ sub-category was reported during the testosterone arm compared to the placebo arm (mean difference [95% CI]: 6.0 points, [95% CI 1.7,10.3]). The OLE demonstrated relative disease stability over the 12-month period but with a higher number of testosterone-related adverse events.

Conclusions

Adding testosterone supplementation to exercise training did not significantly improve muscle strength or physical function over a 12-week intervention period, compared to exercise alone. However, the combination improved emotional well-being over this period, and relative stabilisation of disease was found during the 12-month OLE. A longer duration trial involving a larger group of participants is warranted.

Purpose
Athletes regularly perform resistance training, yet it is unknown how best to monitor its intensity. This study compared different resistance exercise intensity metrics to determine their sensitivity to manipulating work rate (via altering inter-set rest and load).

Methods
Following baseline testing for 10- and 3-repetition maximum (RM; squat and bench press), fourteen trained participants completed four volume-matched protocols in a randomised order: 3x10 with 85% 10RM, 60 s rest (3x1060s); 3x10 with 85% 10RM, 180 s (3x10180s); 8x3 with 85% 3RM, 120 s (8x3120s); 8x3 with 85% 3RM, 300 s (8x3300s). Internal intensity was quantified via rate of oxygen consumption (), heart rate, blood lactate concentration, and rating of perceived exertion (RPE). External intensity was assessed via previously developed “Training-Intensity” (TI) and “Intensity-Index” (II) metrics, and from exercise work rate (expressed as kg∙min-1 and joules∙min-1).

Results
Internal intensity and work-rate metrics were highest for 3x1060s, followed by 3x10180s, 8x3120s and 8x3300s (p≤0.027). TI and II were higher for 8x3 than 3x10 protocols (p<0.001), but not different within these configurations. Internal intensity measures were more strongly correlated with work rate (r = 0.37–0.96) than TI and II (r = -0.42–0.33) metrics.

Conclusions
Work rate corroborated objective internal intensity metrics during resistance exercise, with the highest work rate session (3x1060s) also eliciting greater RPE scores than other protocols. In contrast, the TI and II did not agree with other intensity measures, likely because they do not consider rest periods. Practitioners can plan for the physiological and perceptual demands of resistance training by estimating work rate.