Obituary Alan John Flisher 16 April 1957 – 18 April 2010

We have lost a friend, a comrade, a superb teacher and academic, a highly accomplished social and medical scientist, a dedicated activist and a teacher, particularly in the sphere of mental health. He was also a devoted family man and leaves his long standing partner Mehrunisa and their nine year old twins, Khaleila and Adam. Alan died in Cape Town of leukaemia at the age of 53 years. He will be sorely missed. At the time of his death he held the Sue Strengmann Chair in Child Psychiatry and Mental Health at the University of Cape Town (UCT). All his formal qualifications – seven in all – were from UCT. He also held an Adjunct Professorship in health promotion at the University of Berger, Norway, and was Director of the Mental Health and Poverty Project at UCT

The relationship of gross upper and lower limb motor competence to measures of health and fitness in adolescents aged 13–14 years

Introduction: Motor competence (MC) is an important factor in the development of health and fitness in adolescence. Aims: This cross-sectional study aims to explore the distribution of MC across 13-14 year old school students and the extent of the relationship of MC to measures of health and fitness across genders. Methods: A total of 718 participants were tested from three different schools in the UK, 311 girls, and 407 boys (aged 13-14 years), pairwise deletion for correlation variables reduced this to 555 (245 girls, 310 boys). Assessments consisted of, body mass index, aerobic capacity, anaerobic power, upper limb and lower limb MC. The distribution of MC and the strength of the relationships between MC and health/fitness measures were explored. Results: Girls performed lower for MC and health/fitness measures compared to boys. Both measures of MC showed a normal distribution and a significant linear relationship of MC to all health and fitness measures for boys, girls, and combined genders. A stronger relationship was reported for upper limb MC and aerobic capacity when compared to lower limb MC and aerobic capacity in boys (t= -2.21, df= 307, p = 0.03, 95%CI -0.253 -0.011). Conclusion: Normally distributed measures of upper and lower limb MC are linearly related to health and fitness measures in adolescents in a UK sample. Trial Registration: NCT0251733

The psychological processes of adaptation and hope in patients with multiple sclerosis: a thematic synthesis

Purpose: The purpose of the current research was to review the lived experiences of patients with multiple sclerosis (MS) in order to extrapolate the psychological process of adaptation. Methods: A thematic synthesis was undertaken within 3 phases: systematic search for literature, critical appraisal of included studies and synthesis of research. Results: A total of 47 studies were included in this review, this included 1146 (812 females, 265 males, and 69 unknown) unique patients with MS (aggregated mean age: 49.3 years [30/47 studies], aggregated time with illness: 12.3 years [28/47 studies]). The critical appraisal of research illustrated that the design of the studies and the reference to reflexivity in studies were not well considered. The synthesis was able to identify a primary response of psychological adaptation as well as distinct coping strategies. A model of emotion, hope, and adjustment was identified. Conclusion: Simple processes of adaptation for people with MS can be considered by clinicians and utilised to promote mental well-being in patients. Clinicians and researchers also need to be aware of the important psychological needs of patients during interactions. Discussion and clinical implications are provided

Understanding the importance of illness narratives in people with Multiple Sclerosis who participated in an exercise rehabilitation trial; a qualitative study

Objectives: To understand how illness narrative master plots may be expressed and associated together and to determine how stories are used to demonstrate the psychological benefits of exercise rehabilitation. Design: A subtle realist paradigmatic position was assumed which utilised a hermeneutic henomenological methodology. Setting: Two community centres within the UK. Participants: A purposive sample of 10 individuals with MS (7 female, 3 male) were included. Individuals were eligible if: (a) they had undertaken at least 8 weeks of an exercise rehabilitation trial, (b) if they were older than 19 years, and (c) could understand English. Intervention: Participants had undertaken at least 8 weeks from a 12-week cycle ergometer randomised control rehabilitation trial. The trial varied the exercise intensity experienced by participants. Main Outcome Measure: A single semi-structured interview with six sub-sections that included elements related to emotional regulation. A categorical content narrative analysis was undertaken. The analysis was supplemented by integrating findings from past research studies. Results: Two themes were identified: (1) Identification of a model of narrative expression. This model establishes how narrative master plots may be associated with each other and broadly represent coping or succumbing responses to the experiences of MS. The transition in expression of master plots is detailed and associated with psychological adaptation to illness (2) The role of physical activity in contributing to psychological benefits of exercise rehabilitation identified through narrative expression. This research highlighted a dominant process of narrative master plot expression from detective, to didactic and then heroic master plot. Conclusion: The research has developed a new model for understanding the cycles related to dominant master narrative plots. Further work is needed to establish these results and future studies are needed to establish if there is feasible way to use illness narrative within clinical environments

Phase II randomised controlled trial of a 6-month self-managed community exercise programme for people with Parkinson's disease.

Background Evidence for longer-term exercise delivery for people with Parkinsons Disease pwP) is deficient. Aim Evaluate safety and adherence to a minimally supported community exercise intervention and estimate effect sizes (ES). Methods Two arm parallel phase II randomised controlled trial with blind assessment. PwP able to walk ≥100meters and with no contraindication to exercise were recruited from the Thames valley, UK and randomised (1:1) to intervention (exercise) or control (handwriting) groups, via a concealed computer-generated list. Groups received a six month, twice weekly program. Exercise was undertaken in community facilities (30minutes aerobic and 30minutes resistance) and handwriting at home, bothwere delivered through workbooks with monthly support visits. Primary outcome was a 2minute walk, with motor symptoms (MDS-UPDRS III), fitness, health and wellbeing measured. Results Between December 2011 and August 2013, n=53 (n=54 analysed) were allocated to exercise and n=52 (n=51 analysed) to handwriting. n=37 adhered to the exercise, most attending ≥1 session/week. Aerobic exercise was performed in 99% of attended sessions and resistance in 95%. Attrition and adverse events(AE) were similar between groups, no Serious AEs (n=2 exercise, n=3 handwriting) were related, exercise group related AEs (n=2) did not discontinue intervention. Largest effects were for motor symptoms (2minute walk ES= 0.20 (95%CI=-0.44:0.45) and MDS-UPDRS III ES=-0.30 (95%CI=0.07:0.54)) in favour of exercise over the 12month follow-up period. Some small effects were observed in fitness and wellbeing measures (ES >0.1). Conclusion pwP exercised safely and the possible long-term benefits observed support substantive evaluation of this community progra

Sensorimotor functioning changes in response to global exercise versus handwriting upper limb exercise training in Parkinson’s disease, results from a phase II randomised controlled trial

Introduction: People with Parkinson’s disease (PwPD) present motor alterations which can impact daily life tasks that require speed and/or accuracy of movement. Objective: A sub analysis of NCT01439022, aiming to estimate the extent to which two different exercise training protocols (global and handwriting upper limb exercise training) impact reaction time, travel speed, and accuracy in PwPD. Methods: Seventy PwPD, right-side dominant were randomised 1:1 into two six-month training protocol groups; 35 PwPD performed global exercise training and 35 performed specific training (handwriting upper limb exercise movements). Assessments of speed-accuracy and trade-off were carried out at baseline, after 3 and 6 months of training, and at a 12-month follow-up. The current study used data from a previous publication of a randomised controlled trial that included a 6-month self-managed community exercise programme for PwPD. For the present study we included only the participants who completed the Fitts’ task during the baseline assessment. Results: In the upper limb assessments, no main effects were found for the number of touches, but the exercise group showed a marginal increase over time on the left side. Error averages on the left side decreased significantly for the exercise group from baseline to 6 and 12 months. The exercise group also presented a lower Error CoV and the Reaction Time CoV increased on the right side. Significant findings for Fitts r on the left side indicated lower values for the exercise group, with improvements continuing at 12 months. Conclusion: We report the potential of global exercise interventions to facilitate improvements in reaction time and travel speed, as well as other motor control metrics, with lasting effects at 12 months, particularly on the non-dominant side

The effect of breaking sitting time with physical activity breaks on cognitive performance in young people with cerebral palsy: an exposure response cross-over feasibility design

Objectives: To assess the feasibility of methods and estimate the potential effect of interrupting sedentary behaviour, with intermittent or continuous physical activity breaks, on cognitive performance in young people with Cerebral Palsy. Methods: A randomised three-arm exposure response cross-over design with process evaluation. Participants were recruited throughout the Thames Valley, UK between 01/11/2018 to 31/03/2020. The three 2 h activity exposure visits included: (i) sitting only (controls), (ii) sitting plus 20 min of moderate-to-vigorous activity burst, or (iii) 4×5 min of moderate-to-vigorous activity bursts, during a 2.5 h sedentary session. Measures of feasibility were sought. Cognitive performance outcomes (using the Eriksen Flanker task and Forward and Backward Digit Span) were delivered before and after the 2 h testing period. Results: 36 participants were randomised (age 13.2±2.7, Gross-Motor Functional Classification System 1–3). Study retention was 83 % across all three interventions and overall missing data for measures was 4 %. A small intervention effect was found in reaction time in the 4×5 min physical activity exposure session compared to the sedentary control condition (0.42; 95 % CI 0.40 to 0.79). There were two research-related minor adverse effects, an allergic reaction to the FreeStyle Libre and feeling faint and vomiting after consumption of glucose solution. Both events were resolved and participants continued with the study. Conclusions: The study design and intervention implementing short bursts of physical activity was feasible and indicated a potential effect on reaction time as a measure of cognitive performance in young people with cerebral palsy

Power, cardiorespiratory fitness and physical activity in young people with cerebral palsy

Objectives: Physical activity (PA) levels in young people with cerebral palsy (YPwCP) remain consistently low. Previous research suggests that fitness parameters such as muscular strength and cardiovascular capacity are interrelated with mobility and PA levels in YPwCP. This study aimed to (1) describe fitness parameters and PA levels in YPwCP, (2) explore associations between fitness parameters and PA, and (3) evaluate the reliability of accelerometer-based PA measurement. Methods: A cross-sectional study was conducted with an embedded test–retest reliability assessment of accelerometermeasured PA over a one-month interval. Participants included 36 YPwCP (19 males, 17 females; mean age 15.5 ± 0.7 years), classified within GMFCS levels I–III. Cardiorespiratory endurance (VO2max)was assessed using an incremental cycle ergometer test, and leg power was measured using the Five- Times Sit-to-Stand (5xSTS). PA was measured via self-report using the Physical Activity Questionnaire for Adolescents (PAQ-A) and via device-measured data using a wrist-worn accelerometer over seven consecutive days. Results: We found low levels of PA. The 5xSTS completion time showed moderate to strong correlations with selfreported PA (ρ=−0.384, p≤0.01) and device-measured vigorous PA (ρ=−0.566, p≤0.01). VO2max was positively but not significantly associated with total PA (ρ=0.173) and moderate-to-vigorous PA (ρ=0.115). Accelerometry demonstrated good reliability (ICC=0.796). Conclusions: These findings suggest that accelerometer has good reliability in YPwCP but highlight low levels of PA measured by self-report and accelerometer. Higher lowerlimb power, assessed by faster 5xSTS test, was associated with greater PA

The relationship between motor competence, physical activity, cardiorespiratory fitness and BMI in UK adolescents

Purpose: This study set out to identify the extent of the relationships between subsections of the Movement Assessment Battery for Children 2nd Edition - MABC2 (manual dexterity, aiming and catching, and balance) to PA, CRF and BMI in adolescents. Methods: Height, BMI, the MABC2, a 20m shuttle run test and wrist-worn accelerometery PA levels (mins) were measured. Multivariable linear regression models, adjusting for sex, height and BMI were used to assess the relationship of the three subsections of the MABC2 with PA, CRF and BMI. Results: A total of 155 adolescents, aged 13-14 years, took part in this study (77 girls, 78 boys). Balance reported significant relationships with moderate to vigorous PA (unstandardised Beta B=0.15, 95%CI 0.02-0.28), vigorous PA (B=0.06, 95%CI 0.02-0.09) and BMI (B=-0.01, 95%CI -0.02-0.005). Balance in addition to aiming and catching skills were both significantly related to adolescent CRF (B=0.30, 95%CI 0.17-0.42 and B=0.29, 95%CI 0.14-0.45, respectively). Conclusion: This study suggests that balance is the strongest correlate skill to achieving the highest intensities of PA and healthier BMI status in adolescents