The Effect of Periodization on Training Program Adherence

The present research aimed to study the effect of three different training periodization (traditional, reverse, and free training) on the aerobic performance, motivation, and adherence of physically active athletes. We analysed the adherence to three different periodization training programs: traditional, reverse, and free training periodization on the adherence of amateur triathletes. For this aim, the individual adherence, motivation, and aerobic performance time and heart rate (in a 1000 m running test) were evaluated before and after the completion of the three different 8-week periodization programs. The level of adherence to the reverse periodization was significantly higher than in traditional and free training. The number of dropouts in reverse and traditional periodization was similar but lower than in the free training. Finally, neither of the periodization programs improved aerobic performance and reverse training periodization decreased heart rate of participants in a 1000 m running test.

Online delivery of a family-based dating violence prevention program for youth who have been exposed to intimate partner violence: Protocol for an acceptability and feasibility study (Preprint)

BACKGROUND Children who are exposed to intimate partner violence (IPV) between caregivers are at increased risk for becoming involved in dating violence during adolescence. Yet, to date, few adolescent dating violence (ADV) prevention programs have been developed for and/or evaluated with IPV-exposed youth. One exception is Moms and Teens for Safe Dates (MTSD), an evidence-based ADV prevention program for IPV-exposed mothers or maternal caregivers (moms) and their teens. MTSD consists of a series of booklets that families complete together in a home that include interactive activities to promote positive family communication and healthy teen relationships. We developed an online-adapted version of the MTSD program, entitled, eMoms and Teens for Safe Dates (eMTSD), to provide a delivery format that may: increase program appeal for digitally oriented teens; lower dissemination costs; lower reading burden for low-literacy participants; and incorporate built in cues and reminders to boost program adherence. OBJECTIVE This is a protocol for a research study that has three main objectives: (1) to assess of the acceptability of eMTSD; (2) to identify the feasibility of the research process, including program adherence and participant recruitment and assessment; and (3) to explore the acceptability, feasibility, and preliminary efficacy of two features —text reminders and the creation of an “action plan” for engaging with the program—that may increase program uptake and completion. METHODS Approximately 80 moms and their teens will be invited to complete eMTSD, which includes six 30-minute online modules, over a 6-week period. Moms will be recruited through community organizations and via social media advertising and will be eligible to participate if they have at least one 12–16-year-old teen living with them, experienced IPV after the teen was born, are not currently living with an abusive partner, and have access to an internet-enabled device. Using a factorial design, enrolled dyads will be randomized to four “adherence support” groups (n=20 dyads per group): (1) text reminders and action planning, (2) text reminders only, (3) action planning only, and (4) no adherence supports. All participants will complete brief online assessments at enrollment, after each module is completed, after the full program is completed, and 12-weeks post enrollment. Program adherence will be tracked using website usage metrics. RESULTS Data collected will be synthesized to assess acceptability of the program and feasibility of study procedures. Exploratory analysis will examine the impacts of adherence supports on program completion levels. In November 2021 ethical approval was received and recruitment was initiated. Data collection is expected to continue until December 2022. CONCLUSIONS Online delivery of a family-based healthy relationships program for IPV-exposed teens may offer a convenient, low-cost, engaging approach to preventing ADV. Findings from the study are expected to guide future research.

125Clinical & demographic determinants of self-reported diet program adherence in people living with multiple sclerosis

Background A range of diets have been recommended for people living with MS, ranging from low or no-meat Swank-inspired diets, to the modified Palaeolithic Wahls diet. While the clinical efficacy of these diets to modulate MS progression is uncertain, the popularity of these diets amongst people living with MS is manifest. Methods Data derived from the 5-year review of the HOLISM international cohort study. Self-reported adherence to diets were queried, ranging 1-5. Adherence was restricted to ≥ 12months adherence, and then dichotomised: those reporting 4-5/5 adherence defined 2nd-most adherent, 3-5/5 adherence defined 3rd-most adherent. Determinants of adherence were evaluated by log-binomial regression, adjusted for age, sex, socioeconomic status (SES), education, and fatigue. Due to low numbers, only the Overcoming MS (OMS), Swank and Wahls diets were quantitatively evaluated. Results 458/952 (48.1%) reported following MS-specific diets for ≥12months; 61.8% followed OMS, 12.7% Swank, 3.5% Wahls, 0.9% Ashton-Embry, 0.9% McDougal, 5.7% other. OMS adherence (2nd-most) was more common among males, higher SES, lower disability, less fatigue, and fewer comorbidities. Wahls adherence (2nd-most) was more common among participants with progressive MS or greater disability. Swank adherence (2nd-most) did not vary by any parameter. Analogous results were found using the 3rd-most adherent definition. Conclusions These results indicate that MS-specific diet adherence is common in this patient population, but uptake is highly heterogenous between demographic and clinical subgroups. Further study of diet uptake among MS patients is indicated, particularly as the efficacy of these diets in MS is yet uncertain. Key messages There is evidence for a marked tribalisation of diet adherence between the OMS, Swank, and Wahls diets, the former being more common among less clinically active RRMS participants and Wahls more common among more clinically active progressive participants.

Participant experiences of a post-release electronic monitoring program for domestic violence in New South Wales, Australia

Electronic monitoring has been increasingly used internationally with recent implementation in Australia for those convicted of domestic violence offenses. It is timely and important to gain a better understanding of the physical, psychological, social, and offending-related experiences and impacts of electronic monitoring on this group to inform further implementation. This study describes the experiences of individuals who were subject to a post-release electronic monitoring program for domestic violence in the state of New South Wales, Australia. Semi-structured phone interviews were conducted with 16 men who had recently experienced electronic monitoring. Thematic analysis was used to investigate common themes across participants’ experiences. Demographic and basic quantitative health data were also collected. Five themes were identified: (a) confusion regarding program practices, (b) awareness and pressure of monitoring, (c) social exclusion effects, (d) felt and enacted stigmatization, and (e) “for them not for me.” The findings reveal participants were highly aware of their being monitored, with a mix of positive and negative responses to this cognizance. Being electronically monitored had several flow-on effects on participants’ lives, creating challenges in social spheres across work and personal life. Stigma, both felt and enacted, featured heavily in participants’ responses. Individual factors that may affect program adherence were also identified, including education level and intent to commit a crime. Further quantitative work will be useful for informing a more complete understanding of the relationship between program experiences and outcomes such as reoffending and post-release community integration.

Telephone support improves early engagement with a web-based pain program – a randomized controlled trial investigating the effect of adjunct telephone support on adherence and outcomes of the “Reboot Online” pain management program (Preprint)

BACKGROUND Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician supported guidance can be an important feature in online interventions however the optimal level of therapist guidance and expertise required to improve adherence remains unclear. OBJECTIVE To evaluate whether augmenting the existing Reboot Online program with additional telephone support by a clinician, improves program adherence and effectiveness, relative to the online program alone METHODS A two-armed, CONSORT-compliant registered randomized controlled trial (RCT), with one-to-one group allocation was conducted. It compared an online multidisciplinary pain management program Reboot Online combined with telephone support (n=44), with Reboot Online alone (n=45) as the control group. Participants were recruited via online social media and existing THISWAYUP networks. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified via three metrics; (i) completion of the program (ii) the number of participants who enrolled into the program, (iii) the number of participants who commenced the program. Data on adherence were collected automatically via the THIS WAY UP platform. Secondary measures of clinical effectiveness were also collected. RESULTS Reboot Online combined with telephone support had a positive effect on enrolment and commencement of the program compared to Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (93.2%) into the course compared to the control group (77.8%) (χ2 = 4.23, p = 0.04), Further, more participants from the intervention group commenced the course compared to the control group (90.9% versus 60.0% respectively, χ2 = 11.42, p = 0.001). Of those participants enrolled in the intervention group, 43.2% completed the course (19/44) and of those in the control group 31.1% completed the course (14/45). When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (47.5%) versus control groups (51.8%) (χ2 = 1.39, p = 0.24). CONCLUSIONS Telephone support improves participants’ registration, program commencement and engagement in early phase of the internet intervention; however, it did not appear to impact on overall course completion or efficacy. CLINICALTRIAL The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001076167), and the protocol was followed as per the registry. The study was approved by the Human Research Ethics Committee (2019/ETH08682) of St Vincent’s Hospital Sydney, Australia.

Patient and Parent Experiences with Group Telerehabilitation for Child Survivors of Acute Lymphoblastic Leukemia

Background: Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. ALL and its treatment cause altered bone-mineral homeostasis, which can contribute to musculoskeletal late adverse effects (LAEs). With the increasing number of childhood cancer survivors, LAEs are reported often, and are aggravated by inactive lifestyles. A telerehabilitation program is proposed to strengthen the muscle–bone complex and prevent future impairment. Objective: This study aimed to explore and better understand patient and parent experience of a telerehabilitation program after completion of ALL treatment. Methods: ALL survivors (n = 12), 75% girls, 7.9 to 14.7 years old, within six months to five years of treatment, were recruited to participate in the proposed study, along with a parent. The 16-week group program included 40 potential home-based physical activities, with monthly progression, supervised by a kinesiologist, through an online telerehabilitation platform. Patients could be included in the study if they joined during the first month of intervention of their group (minimum 12 weeks of intervention). A semi-structured post-intervention interview was conducted with the patients and their parent during the final assessment, along with a review of the kinesiologist’s clinical notes, to obtain a portrait of the participants’ experience with the telerehabilitation program. Overarching themes were identified by one author and confirmed by two senior authors before extracting the various aspects of each theme. Results: Of the 12 patients recruited, three were excluded from the analysis because they did not complete the minimum 12 weeks of intervention (one = relapse, one = failure to meet technical requirements, and one = abandoned due to parent’s disinterest). The nine patients who completed the program (six girls; 10.93 ± 2.83 years) had a mean adherence of 89%. The overarching themes identified were the program modalities (group approach with patient–parent paired training, supervised by a kinesiologist), the telerehabilitation system, the participants’ perception of the benefits, and recommendations and suggestions from the families. Both patients and parents expressed very high satisfaction with the program and perceived benefits. Conclusion: Participants appreciated the program and reported they would all recommend it to other families in similar situations. The telerehabilitation method of service delivery was perceived by some as decisive in choosing to participate, while the supervision and intra- and inter-family interactions were the motivating factors that were key to program adherence.

Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders’ Input

Background Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords.

Implementation of Calf Endurance Training in a Touring Group of Professional Circus Performers: A Feasibility Study

BACKGROUND: Demanding performance schedules in modern professional circus can result in less time for injury rehabilitation and strength and conditioning for injury prevention. Lower limb injuries are a common injury presentation in Cirque du Soleil touring show performers. OBJECTIVE: To examine the feasibility of introducing a calf raise exercise program in an established professional touring circus show over a 9-week period. METHODS: Twenty-nine professional Cirque du Soleil circus performers were recruited (mean age 31.28 [SD 4.99] yrs). Performers completed the Oslo Sports Trauma Research Centre Overuse (OSTRC) questionnaire each week for 18 weeks. In the second 9-week period, performers completed one set of single-leg calf raises to fatigue on each limb, once per day, every workday. Health problems between each 9-week period were compared. Feasibility was measured via program adherence and an end-of-study survey. Calf endurance was assessed by measuring the number of single leg calf raises to fatigue. RESULTS: Adherence was high throughout the program, with 93.5% of all exercise sessions completed. Endurance increased by a mean of 22.62 (SD 27.99) calf raises. No significant changes in the prevalence of self-reported soreness and injury were found: 51.9 (95%CI 44.4, 57.5) of the population reported lower limb injuries during the pre-intervention period and 52.5 (95%CI 49.2, 55.8) during the intervention. Similarly, no significant changes were found in severity scores: 20.7 (95%CI 17.7, 23.7) pre-intervention and 20.9 (95%CI 19.4, 22.4) during intervention. CONCLUSION: A single-leg calf raise exercise program can be feasibly introduced into a touring, performing professional circus show without increasing injury numbers or self-reported soreness. Furthermore, gains in calf raise endurance can be obtained during a 9-week intervention period.