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Aquatics, health-promoting self-care behaviours and adults with brain injuries
Brain Injury
Abstract
To determine the effect of an aquatic programme on the health promoting behaviours of adults with brain injuries.
Eighteen individuals participated in the programme and were randomly assigned to an experimental (n = 9) or control group (n = 9). Health promoting behaviours, physical self-concept and self-esteem were measured pre- and post-intervention. Significant differences and large effect sizes were found between scores for the experimental group only, indicating an increase in health promoting behaviours, physical self-concept and self-esteem.
Results have useful implications for health professionals as exercise prescription may enhance health promoting behaviours and decrease health care costs after a brain injury.
... One study also measured power output at end of follow-up [34]. In Driver et al. [45], while the location of the intervention is not explicitly stated in the article, given the intervention delivered and the previous work of Driver and colleagues [43,44], we have determined the most likely location for the intervention in this study is the local swimming pool b Classification of intervention delivered in McMillan et al. [54] was confirmed via correspondence with author and lead author of the Hassett et al. [59] Cochrane review There was no clear effect of fitness training on cardiorespiratory fitness at end of follow-up (one study, 40 participants; SMD = 0.05, 95% CI -0.57 to 0.67; Fig. 3B). ...
... Two studies used the General Health Questionnaire as the outcome measure, which give a higher score for a worse outcome [37,54]. To match the other three studies [44,48,55], where a higher score equals a better outcome, we subtracted the mean scores for each group from the maximum possible score for this outcome measure. For one study [48], we used only the physical summary scale of the Medical Outcomes Study Short Form-36 in the analysis. ...
... There was substantial heterogeneity for this outcome (I 2 = 91%; P < 0.01). This is likely explained by one study [44] which found quality of life was rated as significantly better in the intervention group than the control group at end of intervention (one study, 18 participants; SMD = 25.86, 95% CI 16.26 to 35.46). ...
Background
In 2020, the World Health Organization (WHO) released the first global physical activity and sedentary behaviour guidelines for children and adults living with disability. The evidence informing the guidelines though is not specific to people living with traumatic brain injury (TBI), but rather comes from other disabling conditions such as Parkinson’s disease, and stroke. There remains a clear lack of direct evidence of the effects of physical activity for people living with TBI. The objective of this rapid review was to identify direct evidence of the effect of physical activity on health outcomes in people with moderate-to-severe TBI to inform adaptation of the WHO physical activity guidelines into clinical practice guidelines.
Methods
We conducted a rapid systematic review with meta-analysis of randomised controlled trials, including people of any age with moderate-to-severe TBI, investigating physical activity interventions compared to either usual care, a physical activity intervention with different parameters, or a non-physical activity intervention. Four databases (CENTRAL, SPORTDiscus, PEDro, Ovid MEDLINE) were searched from inception to October 8, 2021. The primary outcomes were physical function, cognition, and quality of life.
Results
Twenty-three studies were included incorporating 812 participants (36% females, majority working-age adults, time post-TBI in studies ranged from 56 days (median) to 16.6 years (mean)). A range of physical activity interventions were evaluated in rehabilitation (n = 12 studies), community (n = 8) and home (n = 3) settings. We pooled data from the end of the intervention for eight outcomes. Participation in a virtual reality physical activity intervention improved mobility, assessed by the Community Balance and Mobility Scale (range 0 to 96; higher score indicates better mobility) more than standard balance training (two studies, 80 participants, Mean Difference = 2.78, 95% CI 1.40 to 4.16; low certainty evidence). There was uncertainty of effect for the remaining outcomes, limited by small sample sizes, diverse comparators and a wide range of outcome measures.
Conclusion
This review consolidates the current evidence base for the prescription of physical activity for people with moderate-to-severe TBI. There remains a pressing need for further rigorous research in order to develop practice guidelines to support clinical decision-making when prescribing physical activity in this population.
... All 13 studies included both female and male participants, with an age range between 24 and 65 years, and three studies included more women than men (30,35,38). Ten out of the 13 primary studies investigated the effects of exercise intervention on adults following TBI exclusively (29)(30)(31)(32)(33)(34)(35)(36)(37)(38), while the remaining three articles grouped together a variety of brainrelated injuries that included TBI (26)(27)(28). One study (26) included participants who had suffered strokes and hemorrhages, whereas another included various neurological disorders, including Parkinson's disease, multiple sclerosis, motor neurone disorders, and cerebral palsy (28). ...
... For those studies reporting data, the severity of the TBI ranged from mild to severe (Glasgow Coma Score of 13-15 for mild, 9-12 for moderate and 3-8 for severe) across the 13 studies. Nine out of the 13 reported on cases where the time since injury was 6 months or longer (27,(30)(31)(32)(34)(35)(36)(37)(38), with two studies including participants who had sustained the injury in under 6 months (26,29). Two studies did not specify the time since injury (28,33). ...
... One study documented a considerably lower number of exercise sessions performed per week, with only 44% partaking in ≥1 session, 8% ≥2 sessions and 2% ≥3 sessions (28). Two studies did not present any adherence rates (27,31). All of the studies delivered supervised, structured exercise programmes with the exception of two, whereby one encouraged an unsupervised, but supported self-directed exercise intervention at the local gymnasium (28). ...
Objective: To systematically review the effects of exercise interventions that may enhance quality of life (QOL) in individuals with traumatic brain injury (TBI).
Methods: A systematic search was conducted using five databases up to April 2018. Studies were included if QOL was quantified following an exercise programme for people with a TBI. Methodological
quality was assessed using a validated scoring checklist. Two independent reviewers assessed study inclusion and methodological quality.
Results: Thirteen studies met the inclusion criteria (seven RCTs, six non-RCTs). The median total scores for the quality assessment tool were 26.1 (RCTs), and 21.3 (non-RCTs), out of 33. Eight out of the 13 studies reported improved QOL following an exercise programme. The duration of the interventions varied from 8-12 weeks. The most common programmes involved moderate to vigorous exercise; with a frequency and duration of 3–5 times/week for 30–60 minutes.
Conclusion: Due to the diversity of the exercise training interventions, heterogeneity of patient characteristics, multitude of QOL instruments and outcome domains assessed, it was not possible to draw any
definitive conclusion about the effectiveness of exercise interventions. However, this review identified positive trends to enhance various aspects of QOL measured using a range of assessment tools.
... Previous research suggests that women who engage in higher levels of PA score higher in selfesteem [83,84]. There are only two studies that have assessed and demonstrated the positive impact of WAE on self-esteem [85,86], but none of them in a sample of people with SMI or considering the effect of sex. The increase in self-esteem may be attributed to the supportive and non-judgmental environment provided by the WAE sessions, which can be particularly beneficial for women who may face societal pressures affecting body image and self-worth [87,88]. ...
Physical activity is recognized for its physical and mental health benefits, including reducing sedentary behavior and improving mood, anxiety, and self-esteem. Individuals with severe mental illness tend to be more sedentary, contributing to poorer health outcomes. Water aerobic exercise has shown promise in improving physical and mental health, but sex differences in response to such interventions remain underexplored. This study investigates the effects of a water aerobic exercise intervention on 74 individuals with severe mental illness, focusing on sex differences. Participants engaged in a 45–60 session, once a week for 6 months. Assessments were conducted before and after the intervention and included measures of clinical, functioning, quality of life, and sedentary behavior outcomes. Both men and women significantly reduced sedentary behavior. Men showed significant improvements in self-stigma, functioning, and general quality of life. In contrast, women demonstrated significant improvements in self-esteem. These findings suggest that water aerobic exercise may be effective in reducing sedentary behavior and improving mental health outcomes in individuals with severe mental illness. However, the benefits appear to differ by sex. These results underscore the importance of sex-tailored physical activity interventions in mental health care.
... To overcome potential confounding effects, we used the health-Promoting Lifestyle Profile II (Walker et al., 1987), a valid, reliable, 52-item selfreport questionnaire composed of six subscales comprehensive measure of lifestyle, nutrition, physical activity, health responsibility, spiritual growth, interpersonal relations, and stress management. This approach has been used in longitudinal studies of several diseases (Callaghan, 2005;Driver et al., 2006;Stuifbergen et al., 2006;Thanavaro et al., 2006). However, due to the limitation of the small sample size, and potential medication effect, further studies with larger sample sizes and more robust medication history are required to test the initial findings and elucidate and confirm the role of the potential identified biomarkers. ...
Introduction
The chromosome 22q11.2 deletion syndrome (22q11.2DS) is characterized by a well-defined microdeletion and is associated with a wide range of brain-related phenotypes including schizophrenia spectrum disorders (SCZ), autism spectrum disorders (ASD), anxiety disorders and attention deficit disorders (ADHD). The typically deleted region in 22q11.2DS contains multiple genes which haploinsufficiency has the potential of altering the protein and the metabolic profiles.
Objectives
Alteration in metabolic processes and downstream protein pathways during the early brain development may help to explain the increased prevalence of the observed neurodevelopmental phenotypes in 22q11.2DS. However, relatively little is known about the correlation of dysregulated protein/metabolite expression and neurobehavioral impairments in individuals who developed them over time.
Methods
In this study, we performed untargeted metabolic and proteomic analysis in plasma samples derived from 30 subjects including 16 participants with 22q11.2DS and 14 healthy controls (TD) enrolled in a longitudinal study, aiming to identify a metabolic and protein signature informing about the underlying mechanisms involved in disease development and progression. The metabolic and proteomic profiles were also compared between the participants with 22q11.2DS with and without various comorbidities, such as medical involvement, psychiatric conditions, and autism spectrum disorder (ASD) to detect potential changes among multiple specimens, collected overtime, with the aim to understand the basic underlying mechanisms involved in disease development and progression.
Results
We observed a large number of statistically significant differences in metabolites between the two groups. Among them, the levels of taurine and arachidonic acid were significantly lower in 22q11.2DS compared to the TD group. In addition, we identified 16 proteins that showed significant changes in expression levels (adjusted P < 0.05) in 22q11.2DS as compared to TD, including those involved in 70 pathways such as gene expression, the PI3K-Akt signaling pathway and the complement system. Within participants with 22q11.2DS, no significant changes in those with and without medical or psychiatric conditions were observed.
Conclusion
To our knowledge, this is the first report on plasma metabolic and proteomic profiling and on the identification of unique biomarkers in 22q11.2DS. These findings may suggest the potential role of the identified metabolites and proteins as biomarkers for the onset of comorbid conditions in 22q11.2DS. Ultimately, the altered protein pathways in 22q11.2DS may provide insights of the biological mechanisms underlying the neurodevelopmental phenotype and may provide missing molecular outcome measures in future clinical trials to assess early-diagnosis treatment and the efficacy of response to targeted treatment.
... Regarding the intervention type of exercise, aquatic aerobics (SMD: −0.92) is better than swimming (SMD: −0.51), but these studies lack consistency. Swimming includes swim-learning programs (28,38), swimming training for competition (29,57), and leisure swimming (31,58,59). Swimming in different situations affects people's moods differently. ...
Objective
Exercise has beneficial effects on mood and anxiety symptoms. However, the impact of aquatic exercise on mood and anxiety symptoms has not been clearly confirmed. Therefore, this study aimed to synthesize and systematically analyze evidence available on boosting mental health through aquatic exercise.
Method
A systematic review and meta-analysis were conducted under the PRISMA 2020 guidelines. PubMed, BIOSIS Previews, PsycINFO, Medline, SPORTDiscus, Education Source, and Web of Science Core Collection (WoSCC) were searched in May 2022. The research included the influence of aquatic exercises on mood and anxiety symptoms. After assessing trial quality and completing data extraction, a meta-analysis was carried out through R software. The results were presented as a standardized mean difference (SMD) and the corresponding 95% confidence interval.
Results
A total of 18 original trials were included. People who received aquatic exercise intervention had a statistically significant reduction in mental disorder symptoms compared with before. The results were aquatic exercise [SMD = −0.77, 95% CI (−1.08, −0.47), I² = 77%, P < 0.01], swimming [SMD = −0.51, 95% CI (−1.14, 0.12), I² = 78%, P < 0.01], aquatic aerobics [SMD = −0.92, 95% CI (−1.32, −0.53), I² = 78%, P < 0.01], moderate intensity [SMD = −0.75, 95% CI (−1.07, −0.43), I² = 67%, P < 0.01], and low intensity [SMD = −1.07, 95% CI (−1.08, −0.47), I² = 85%, P < 0.01].
Conclusion
Aquatic exercise could statistically significantly improve mental health. Light aquatic aerobics probably has a better effect on mood and anxiety symptoms. However, given the number and quality of included research, verifying the aforementioned conclusions requires a larger sample of high-quality studies.
... A total of 2633 references were imported for screening, 908 duplicates were removed, 1725 were screened against title/ abstract, 65 full-texts studies were assessed, and 19 studies were retained (, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The selection of sources of evidence for community-based PA interventions after moderate-tosevere TBI is included in Figure 1. ...
Objective:
This scoping review mapped the current evidence about community-based physical activity (PA) interventions for individuals with moderate-to-severe traumatic brain injury (TBI) and identified the reported health-related outcomes, measurement tools used, and considerations given to sex and gender.
Methods:
Searches were conducted in six academic databases for peer-reviewed articles (MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL, SPORTDiscus, and PEDro). PRISMA Scoping Review guidelines were followed. Two reviewers independently screened articles for inclusion and extracted data for the analysis with a modified Consensus on Exercise Reporting Template (CERT). Health-related outcomes were classified with domains of the International Classification of Function, Disability and Health (ICF).
Results:
19 studies were identified. Seven PA intervention types were included. CERT scores varied (M = 12.74, SD = 3.51 items), with limited details for replication. ICF outcomes focused on improving body functions (74%), activities and participation (14%), environmental factors (1%), and other: not covered (11%). Only four studies (21%) stratified their results by sex or gender.
Conclusions:
Identified PA interventions from this review revealed common characteristics that led to improved outcomes. Proposed recommendations aim to improve future research and community practice. There is a pressing need for more sex and gender considerations in PA research after moderate-to-severe TBI.
... Self-esteem was measured in only two studies, both of which demonstrated significant changes. The study by Driver et al. (2006) showed that adults with brain injuries can successfully improve self-esteem when exposed to a swimming exercise intervention. Similarly, patients with haemophilia were shown to be positively impacted by The results of the studies that provided pretest-posttest data have been illustrated in Figure 6. ...
Objectives
The aims of this review were to 1) summarise the breadth and types of research regarding the impact of aquatic exercise on mental health completed to date, 2) provide a clear indication of the intervention type, volume, measurement tools used, and populations best served in relation to this activity and its effectiveness and 3) to identify domains within the literature that can be developed so recommendations can be made for future investigations.
Method
A scoping review was performed under the PRISMA guidelines. A systematic search of Pubmed, SPORTDiscus, PsycInfo and Google Scholar databases was conducted. Studies observing the effect of aquatic exercises on mental health and related parameters were considered for inclusion. The data from the selected studies were then extracted and analysed methodically.
Primary Conditions Measured
Depression, anxiety, mood, self-esteem, and psychological well-being were the primary mental states for which findings could be clearly extracted.
Results
Of the 1635 articles that resulted from the search, 23 articles met all inclusion criteria. Of these, 12 were randomised controlled trials. Cumulatively, the findings of this review trend towards aquatic exercise being effective in generating positive changes in mental health.
Conclusion
Aquatic exercise, specifically winter swimming, leisure swimming, competitive swimming and aquatic aerobics, can be a promising conservative therapy for mental health management. However, it is recommended that further research be conducted to solidify these findings and establish the long-term effects of this intervention on mental health.
Severe acquired brain injury (sABI) is defined as acquired brain damage resulting in coma lasting at least 24 hours, sABI may have traumatic, vascular, anoxic, infective, toxic, or other etiology. Disorders of consciousness (DoC) after sABI include coma, vegetative state, the recently named unresponsive wakefulness syndrome, and minimally conscious state. The emergence from a minimally conscious state is diagnosed when functional communication or functional object use is recovered. The neurorehabilitation approach begins with a holistic neurological evaluation of patients with DoC and management of clinical predictive factors, from the intensive care unit to neurorehabilitation wards. Physical and rehabilitation medicine guidelines provide a bio-psychosocial approach to rehabilitation consistent with the World Health Organization International Classification of Functioning Disability and Health.
Although aquatic-based interventions are increasingly used in the psychiatric rehabilitation services, the effects of this type of community program as an adjuvant therapy for psychosocial problems of people with serious mental illness (SMI) have been under-explored. This research evaluated the feasibility and outcomes of an occupational therapy program consisting of aquatic-based activities (AA-OT program) in the community in Spain. This study is the first randomized controlled trial (RCT) on this topic. This pilot trial was conducted with a sample of 16 adults with SMI who were randomly allocated to the AA-OT program plus treatment as usual or treatment as usual alone (eight in each group). The AA-OT program included activation of daily living skills, warm-up, group activities/tasks, and relaxation. It consisted of two sessions per week over 12 weeks. Outcomes were evaluated at week 0 and 12. A total of 14 participants (87.5%) completed the trial. No adverse events or side-effects were noted. Comparisons between the two groups on change scores showed that participants in the intervention group showed significant improvements in several outcome measures: psychosocial problems (HoNOS), two health-related quality of life scales (SF-36: Physical Functioning and Mental Health), and performance of social activities (Activity and Social Relations scale). Satisfaction with the program was high. In conclusion, the results support the feasibility and potential benefits of this occupational therapy program. 12 weeks of aquatic-based activities in a group intervention may enhance the outcomes of psychiatric rehabilitation improving the severity of psychosocial problems, patient-reported health status, and social relations. This community-based program may be beneficial as a non-pharmacologic method in the illness management and recovery of people with SMI. The findings from this pilot trial need to be confirmed in a large, fully-powered RCT.
In this study we investigated the coping responses of fairly healthy, middle-aged (40-64 years, n = 76) and elderly (65-92 years, n = 106) men to five conflict situations (i.e., decision making, defeat in a competitive circumstance, frustration, authority conflict, and peer disagreement). Coping responses were measured by the Life Situations Inventory, developed to assess three forms of coping: problem-solving, avoidance, and resignation. Scales were based on a 28-item questionnaire and were derived rationally through item analysis. Alpha coefficients ranged from .75 to .82. Elderly subjects used avoidance significantly less often than did middle-aged subjects in handling decision-making and authority-conflict situations. No differences were noted between the age groups in use of problem solving or resignation. Both middle-aged and elderly persons favored use of problem solving in managing all conflicts. Results suggest that studies that do not address potential interactions between age and stress situation may be missing an important element in the age-coping relation.
We developed a multidimensional coping inventory to assess the different ways in which people respond to stress. Five scales (of four items each) measure conceptually distinct aspects of problem-focused coping (active coping, planning, suppression of competing activities, restraint coping, seeking of instrumental social support); five scales measure aspects of what might be viewed as emotion-focused coping (seeking of emotional social support, positive reinterpretation, acceptance, denial, turning to religion); and three scales measure coping responses that arguably are less useful (focus on and venting of emotions, behavioral disengagement, mental disengagement). Study 1 reports the development of scale items. Study 2 reports correlations between the various coping scales and several theoretically relevant personality measures in an effort to provide preliminary information about the inventory's convergent and discriminant validity. Study 3 uses the inventory to assess coping responses among a group of undergraduates who were attempting to cope with a specific stressful episode. This study also allowed an initial examination of associations between dispositional and situational coping tendencies.
The unqualified use of statistical significance tests for interpreting the results of empirical research has been called into question by researchers in a number of behavioral disciplines. This paper reviews what statistical significance tells us and what it does not, with particular attention paid to criticisms of using the results of these tests as the sole basis for evaluating the overall significance of research findings. In addition, implications for adapted physical activity research are discussed. Based on the recent literature of other disciplines, several recommendations for evaluating and reporting research findings are made. They include calculating and reporting effect sizes, selecting an alpha level larger than the conventional .05 level, placing greater emphasis on replication of results, evaluating results in a sample size context, and employing simple research designs. Adapted physical activity researchers are encouraged to use specific modifiers when describing findings as significant.
The purpose of this paper is to lay a conceptual foundation for understanding and studying lesbians in sport. To begin to understand lesbians in sport, it is necessary to critically examine the socialization process. Lesbians are socialized within a homonegative and heterosexist society, where they learn homonegative attitudes. The sport environment is even more hostile toward lesbians, thus escalating the negative impact of homonegativism experienced by lesbians in sport compared to nonsport lesbians. These reactions to homonegativism will be manifested through individuals' mental states (e.g., low self-esteem, low confidence, low satisfaction, high stress) or behaviors (e.g., poor sport performance, substance abuse). However, through exposure to positive social support and successful role models, a positive lesbian identity will be developed. The goals of this framework are to consolidate previous empirical literature about lesbians and apply it to sport and to encourage further conceptualization about lesbians in sport.
One hundred and ninety-four children enrolled in a summer weight loss camp program (64 boys and 130 girls, aged 12.6 ± 2.5 years) and were assessed for body mass and stature on arrival. One hundred and fourteen subjects were assessed for waist circumference, with a subgroup of 14 boys assessed on 8 skinfold thicknesses, 9 circumference measures, and a self-paced walk test to evaluate aerobic performance. A further group of 40 girls were assessed on 3 psychometric variables (self concept, body esteem, and body cathexis). During the camp (located in Massachusetts, U.S.), diet was restricted to 1,400 kcal · day -1, with a daily prescription of structured fun-type, skill-based physical activities and regular behavioral and educational sessions. Paired t tests shoved highly significant improvements (p < .001) in all variables comparing pre and post intervention measures. The improvements in body composition, aerobic performance, and psychometric variables suggest that the camp program was successful in reducing significant risk factors in children's health.