TY - JOUR AU - Uemura, Kosuke AU - Miyagami, Taiju AU - Saita, Mizue AU - Uchida, Takuro AU - Yuasa, Shun AU - Kondo, Keita AU - Miura, Shun AU - Matsushita, Mizuki AU - Shirai, Yuka AU - Misawa, Baku Richard AU - Naito, Toshio PY - 2024/11/11 TI - Trends in Exercise-Related Internet Search Keywords by Sex, Age, and Lifestyle: Infodemiological Study JO - JMIR Form Res SP - e59395 VL - 8 KW - exercise prescriptions KW - sex KW - age KW - lifestyle KW - internet search keywords KW - infodemiology KW - demographic KW - physical activity N2 - Background: Exercise prescription by physicians is beneficial for initiating or intensifying physical activity. However, providing specific exercise prescriptions is challenging; therefore, few physicians prescribe exercise. Objective: This infodemiological study aimed to understand trends in exercise-related internet search keywords based on sex, age, and environmental factors to help doctors prescribe exercise more easily. Methods: Search keyword volume was collected from Yahoo! JAPAN for 2022. Ten exercise-related terms were analyzed to assess exercise interest. Total search activities were analyzed by sex and age. Characteristic scores were based on the Japanese prefecture. By performing hierarchical cluster analysis, regional features were examined, and Kruskal-Wallis tests were used to assess relationships with population and industry data. Results: The top-searched term was ?Pilates? (266,000 queries). Male individuals showed higher interest in activities such as ?running? (25,400/40,700, 62.4%), ?muscle training? (65,800/111,000, 59.3%), and ?hiking? (23,400/40,400, 57.9%) than female individuals. Female individuals exhibited higher interest in ?Pilates? (199,000/266,000, 74.8%), ?yoga? (86,200/117,000, 73.7%), and ?tai chi? (45,300/65,900, 68.7%) than male individuals. Based on age, search activity was highest in the 40-49 years age group for both male and female individuals across most terms. For male individuals, 7 of the 10 searched terms? volume peaked for those in their 40s; ?stretch? was most popular among those in their 50s; and ?tai chi? and ?radio calisthenics? had the highest search volume for those in their 70s. Female individuals in their 40s led the search volume for 9 of the 10 terms, with the exception of ?tai chi,? which peaked for those in their 70s. Hierarchical cluster analysis using a characteristic score as a variable classified prefectures into 4 clusters. The characteristics of these clusters were as follows: cluster 1 had the largest population and a thriving tertiary industry, and individuals tended to search for Pilates and yoga. Following cluster 1, cluster 2, with its substantial population, had a thriving secondary industry, with searches for radio calisthenics and exercise bike. Cluster 4 had a small population, a thriving primary industry, and the lowest search volume for any term. Cluster 3 had a similar population to that of cluster 4 but had a larger secondary industry. Conclusions: Male individuals show more interest in individual activities, such as running, whereas female individuals are interested in group activities, such as Pilates. Despite the high search volume among individuals in their 40s, actual exercise habits are low among those in their 30s to 50s. Search volumes for instructor-led exercises are higher in cluster 1 than in other cluster areas, and the total number of searches decreases as the community size decreases. These results suggest that trends in search behavior depending on sex, age, and environment factors are essential when prescribing exercise for effective behavioral change. UR - https://formative.jmir.org/2024/1/e59395 UR - http://dx.doi.org/10.2196/59395 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59395 ER - TY - JOUR AU - Palucci Vieira, H. Luiz AU - Clemente, Manuel Filipe AU - Chang Marquez, Armando Felipe AU - Rea Olivares, Manuel Walter AU - Vargas Villafuerte, R. Kelly AU - Carpes, P. Felipe PY - 2024/11/4 TI - Accuracy Standards of Wearable Technologies for Assessment of Soccer Kicking: Protocol for a Systematic Literature Review JO - JMIR Res Protoc SP - e57433 VL - 13 KW - skill-related performance KW - shooting KW - team sports KW - sports engineering KW - measurement error KW - validity KW - reliability KW - quality control N2 - Background: Wearable technology is widely applied in performance monitoring, an integral part of sports and exercise sciences. The kick movement in soccer exemplifies a sports technique that could benefit from appropriate biomechanics assessment methodologies. However, the accuracy of wearables in quantifying soccer kick mechanics, particularly under field conditions, remains unclear. Objective: This study aims to present a protocol for a systematic review to discuss the measurement properties (validity, reliability, and/or accuracy aspects) of wearable technology systems explicitly used to measure ball-kicking features in soccer. Methods: This review protocol was preregistered in the Open Science Framework. A total of 2 authors will perform searches in major electronic databases using specific keyword combinations in PubMed, Physical Therapy and Sports Medicine, Web of Science, ProQuest, IEEE Xplore, EBSCOHost, and Scopus. Following a specific population, intervention, comparison, outcome framework (population: soccer players and/or collected human data in a football-related environment; intervention: at least 1 wearable used; comparator: criterion measures, repeated testing sessions and/or actual values; outcome: ball kicking data), studies will be screened based on predetermined inclusion and exclusion criteria. The methodological quality of the included studies will be assessed using the ?consensus-based standards for the selection of health measurement instruments? checklist (in studies concerning validity or reliability) or the ?quality assessment of diagnostic accuracy studies? tool (in studies concerning accuracy). Data extraction will be conducted to determine the level of evidence according to the ?best evidence synthesis method,? and an evidence gap map will be constructed. The Cohen ? coefficient will be used to estimate the interevaluator agreement. Results: This ongoing systematic review has completed database searches and is currently in the screening phase. Depending on the number and consistency of studies, results may be presented by meta-analysis or qualitative synthesis, with subgroup analyses considering factors such as gender, age, and playing level. The final results are expected by July 2024, with manuscript submission anticipated by November 2024. Conclusions: Our study will provide a comprehensive summary of the highest level of evidence available on the use of wearables for the assessment of soccer kick mechanics, providing practical guidance for athletes and sports sciences professionals regarding the validity and reliability aspects of using wearable technology to measure ball-kicking features in soccer. Trial Registration: OSF registries https://osf.io/zm3j6 International Registered Report Identifier (IRRID): DERR1-10.2196/57433 UR - https://www.researchprotocols.org/2024/1/e57433 UR - http://dx.doi.org/10.2196/57433 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57433 ER - TY - JOUR AU - Masoudi, Ameen AU - Chemane, Nomzamo AU - Useh, Ushotanefe AU - Bello, Bashir AU - Magida, Nontembiso PY - 2024/11/1 TI - Effectiveness of Self-Management Programs Among Athletes With Patellofemoral Pain Syndrome: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e58340 VL - 13 KW - patellofemoral pain syndrome KW - athletes KW - self-management KW - chronic pain KW - pain management KW - systematic review N2 - Background: Patellofemoral pain syndrome is a highly prevalent overuse knee injury in athletic populations associated with pain and functional limitations, exacerbated by activities such as running, pivoting, cycling, and jumping. Self-management programs empowering athletes to take an active role in controlling their symptoms for chronic musculoskeletal conditions such as patellofemoral pain syndrome have grown in popularity. However, the efficacy of self-management programs specifically for athletes with patellofemoral pain syndrome is unclear due to limited and heterogeneous evidence. Objective: The systematic review study will evaluate the effectiveness of self-management programs on pain and function, in athletes with patellofemoral pain syndrome. Methods: PubMed/MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases will be systematically searched using terms related to ?patellofemoral pain syndrome,? ?self-management,? and ?athletes.? Interventional studies that are randomized and nonrandomized controlled trials will be included, comparing self-management programs to other treatments or control conditions among athletes with patellofemoral pain syndrome. Four reviewers will independently screen studies, extract data using the COVIDENCE software, and assess the quality of the study and evidence using the Pedro scale of risk of bias tool and GRADE approach, respectively. If feasible, a meta-analysis will be performed using the RevMan (version 5.4; the Cochrane Collaboration). Results: The systematic review is currently in the search phase, with the authors refining search strings for the selected databases. The final search strings are expected to be ready by March 2024, and the review is projected to be completed by July 2024. Conclusions: This systematic review protocol outlines a rigorous methodology for evaluating the effectiveness of self-management programs among athletes with patellofemoral pain syndrome. The findings will inform clinical practice and guide the development of tailored interventions to optimize outcomes for athletes with patellofemoral pain syndrome. Trial Registration: PROSPERO CRD42023492746; https://tinyurl.com/c5jze9ca International Registered Report Identifier (IRRID): PRR1-10.2196/58340 UR - https://www.researchprotocols.org/2024/1/e58340 UR - http://dx.doi.org/10.2196/58340 UR - http://www.ncbi.nlm.nih.gov/pubmed/39485375 ID - info:doi/10.2196/58340 ER - TY - JOUR AU - Pérez-Muñoz, Milagros AU - Rodríguez-Costa, Isabel AU - Lebrijo-Pérez, Gerard AU - Pecos-Martín, Daniel AU - Gallego-Izquierdo, Tomás AU - Pérez-Martín, Yolanda PY - 2024/10/1 TI - Design of a Health Education Program to Manage Chronic Neck Pain: Protocol for a Development Study JO - JMIR Res Protoc SP - e56632 VL - 13 KW - neck pain KW - chronic pain KW - physiotherapy KW - health education KW - emotional expression KW - biopsychosocial model N2 - Background: Chronic neck pain (CNP) needs attention to its physical, cognitive, and social dimensions. Objective: We aimed to design a health education program (HEP) with a biopsychosocial approach for patients with CNP. Methods: A literature search on CNP, health education, and biopsychosocial models was carried out. Seven physiotherapists with expertise in HEPs and chronic pain participated in three teams that evaluated the literature and prepared a synthesis document in relation to the three target topics. Experts compiled the information obtained and prepared a proposal for an HEP with a biopsychosocial approach aimed at patients with CNP. This proposal was tested in the physiotherapy units of primary care health centers belonging to the East Assistance Directorate of Madrid, and suggestions were included in the final program. Results: The HEP for CNP with a biopsychosocial approach consists of 5 educational sessions lasting between 90 and 120 minutes, carried out every other day. Cognitive, emotional, and physical dimensions were addressed in all sessions, with particular attention to the psychosocial factors associated with people who have CNP. Conclusions: The proposed HEP with a biopsychosocial approach emphasizes emotional management, especially stress, without neglecting the importance of physical and recreational exercises for the individual?s return to social activities. The objective of this program was to achieve a clinically relevant reduction in perceived pain intensity and functional disability as well as an improvement in quality of life in the short and medium term. Trial Registration: ClinicalTrials.gov NCT02703506; https://clinicaltrials.gov/study/NCT02703506 International Registered Report Identifier (IRRID): DERR1-10.2196/56632 UR - https://www.researchprotocols.org/2024/1/e56632 UR - http://dx.doi.org/10.2196/56632 UR - http://www.ncbi.nlm.nih.gov/pubmed/39353191 ID - info:doi/10.2196/56632 ER - TY - JOUR AU - Du, Yan AU - Wei, Gao-Xia AU - He, Yichao AU - Ning, Hongting AU - Roberts, Penny AU - Golob, Edward AU - Yin, Zenong PY - 2024/9/19 TI - Current Evidence of the Application of Music in Tai Chi Exercise: Scoping Review JO - Asian Pac Isl Nurs J SP - e60104 VL - 8 KW - Tai Chi KW - exercise KW - music KW - synergetic effects KW - review KW - scoping review KW - thematic analysis KW - health outcome KW - motivation KW - performance KW - dissemination KW - implementation KW - public health KW - data extraction N2 - Background: Music has frequently been used in movement exercises to enhance health benefits. However, scientific evidence regarding the application of music to Tai Chi practice is limited. Objective: This scoping review aims to understand how music has been used in Tai Chi practice and whether music could be applied to Tai Chi practice to help optimize its benefits. Methods: PubMed, CINAHL, CNKI, and Weipu databases were searched. We included studies that compare Tai Chi practice experience or health outcomes between individuals practicing Tai Chi with music and those practicing Tai Chi without music. Studies published through September 2022 were identified. Two researchers (YD and YH) independently performed study selection and data extraction. Thematic analysis was used to summarize and categorize the findings of the included studies. Results: Seven studies were included in this review. All 7 included studies are experimental studies. Practicing Tai Chi with music might lead to positive perceptions of Tai Chi practice (eg, motivation, concentration, enjoyment, compliance, and performance) and higher evaluations of Tai Chi instructional quality, especially for Tai Chi beginners. The effects of incorporating music into Tai Chi practice on health outcomes are inconclusive due to the heterogeneities of the sample size, and the intervention components, lengths, and frequencies of the included studies. Conclusions: Applying music to Tai Chi practice may result in positive Tai Chi practice experience and adherence, particularly for beginners, which could help improve the dissemination and implementation of Tai Chi interventions for public health. However, whether applying music to Tai Chi practice leads to synergetic effects on health outcomes needs further investigation. UR - https://apinj.jmir.org/2024/1/e60104 UR - http://dx.doi.org/10.2196/60104 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60104 ER - TY - JOUR AU - Lee, Audrey AU - Dionicio, Patricia AU - Farcas, Emilia AU - Godino, Job AU - Patrick, Kevin AU - Wyckoff, Elijah AU - Loh, J. Kenneth AU - Gombatto, Sara PY - 2024/2/29 TI - Physical Therapists? Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study JO - JMIR Hum Factors SP - e55246 VL - 11 KW - low back pain KW - physical therapy KW - physical therapist KW - wearable sensor KW - technology acceptance model KW - motion tape KW - kinesiology tape N2 - Background: Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists? acceptance of Motion Tape remains unexplored. Objective: The primary aim of this research study was to evaluate physical therapists? acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists? recommendations for future device development. Methods: Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis. Results: Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context. Conclusions: Several themes related to Motion Tape?s wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape?s potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice. UR - https://humanfactors.jmir.org/2024/1/e55246 UR - http://dx.doi.org/10.2196/55246 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421708 ID - info:doi/10.2196/55246 ER - TY - JOUR AU - Chae, Joo Han AU - Kim, Ji-Been AU - Park, Gwanmo AU - O'Sullivan, Michael David AU - Seo, Jinwook AU - Park, Jung-Jun PY - 2023/9/12 TI - An Artificial Intelligence Exercise Coaching Mobile App: Development and Randomized Controlled Trial to Verify Its Effectiveness in Posture Correction JO - Interact J Med Res SP - e37604 VL - 12 KW - home workout KW - mobile assistant KW - deep-learning KW - posture correction KW - physical activity KW - exercise KW - social distance KW - COVID-19 KW - mobile device KW - workout N2 - Background: Insufficient physical activity due to social distancing and suppressed outdoor activities increases vulnerability to diseases like cardiovascular diseases, sarcopenia, and severe COVID-19. While bodyweight exercises, such as squats, effectively boost physical activity, incorrect postures risk abnormal muscle activation joint strain, leading to ineffective sessions or even injuries. Avoiding incorrect postures is challenging for novices without expert guidance. Existing solutions for remote coaching and computer-assisted posture correction often prove costly or inefficient. Objective: This study aimed to use deep neural networks to develop a personal workout assistant that offers feedback on squat postures using only mobile devices?smartphones and tablets. Deep learning mimicked experts? visual assessments of proper exercise postures. The effectiveness of the mobile app was evaluated by comparing it with exercise videos, a popular at-home workout choice. Methods: Twenty participants were recruited without squat exercise experience and divided into an experimental group (EXP) with n=10, age=21.90 (2.18), and BMI=20.75 (2.11); and a control group (CTL) with n=10, age=22.60 (1.95), and BMI=18.72 (1.23) using randomized controlled trials. A data set with over 20,000 squat videos annotated by experts was created and a deep-learning model was trained using pose estimation and video classification to analyze the workout postures. Subsequently, a mobile workout assistant app, Home Alone Exercise, was developed, and a 2-week interventional study, in which the EXP used the app while the CTL only followed workout videos, showed how the app helps people improve squat exercise. Results: The EXP significantly improved their squat postures evaluated by the app after 2 weeks (Pre: 0.20 vs Mid: 4.20 vs Post: 8.00, P=.001), whereas the CTL (without the app) showed no significant change in squat posture (Pre: 0.70 vs Mid: 1.30 vs Post: 3.80, P=.13). Significant differences were observed in the left (Pre: 75.06 vs Mid: 76.24 vs Post: 63.13, P=.02) and right (Pre: 71.99 vs Mid: 76.68 vs Post: 62.82, P=.03) knee joint angles in the EXP before and after exercise, with no significant effect found for the CTL in the left (Pre: 73.27 vs Mid: 74.05 vs Post: 70.70, P=.68) and right (Pre: 70.82 vs Mid: 74.02 vs Post: 70.23, P=.61) knee joint angles. Conclusions: EXP participants trained with the app experienced faster improvement and learned more nuanced details of the squat exercise. The proposed mobile app, offering cost-effective self-discovery feedback, effectively taught users about squat exercises without expensive in-person trainer sessions. Trial Registration: Clinical Research Information Service KCT0008178 (retrospectively registered); https://cris.nih.go.kr/cris/search/detailSearch.do/24006 UR - https://www.i-jmr.org/2023/1/e37604/ UR - http://dx.doi.org/10.2196/37604 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/37604 ER - TY - JOUR AU - Caelers, Inge AU - Boselie, Toon AU - van Hemert, Wouter AU - Rijkers, Kim AU - De Bie, Rob AU - van Santbrink, Henk PY - 2023/6/20 TI - The Variability of Lumbar Sequential Motion Patterns: Observational Study JO - JMIR Biomed Eng SP - e41906 VL - 8 KW - lumbar spine KW - cinematographic recordings KW - sequence KW - motion pattern KW - flexion KW - extension KW - rotation KW - physiological KW - musculoskeletal KW - motion KW - spine KW - upper lumbar KW - observational study KW - physiological motion N2 - Background: Physiological motion of the lumbar spine is a topic of interest for musculoskeletal health care professionals since abnormal motion is believed to be related to lumbar complaints. Many researchers have described ranges of motion for the lumbar spine, but only few have mentioned specific motion patterns of each individual segment during flexion and extension, mostly comprising the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion is still lacking. For the lower cervical spine, a consistent pattern of segmental contributions in a flexion-extension movement in young healthy individuals was described, resulting in a definition of physiological motion of the cervical spine. Objective: This study aimed to define the lumbar spines? physiological motion pattern by determining the sequence of segmental contribution in sagittal rotation of each vertebra during maximum flexion and extension in healthy male participants. Methods: Cinematographic recordings were performed twice in 11 healthy male participants, aged 18-25 years, without a history of spine problems, with a 2-week interval (time point T1 and T2). Image recognition software was used to identify specific patterns in the sequence of segmental contributions per individual by plotting segmental rotation of each individual segment against the cumulative rotation of segments L1 to S1. Intraindividual variability was determined by testing T1 against T2. Intraclass correlation coefficients were tested by reevaluation of 30 intervertebral sequences by a second researcher. Results: No consistent pattern was found when studying the graphs of the cinematographic recordings during flexion. A much more consistent pattern was found during extension, especially in the last phase. It consisted of a peak in rotation in L3L4, followed by a peak in L2L3, and finally, in L1L2. This pattern was present in 71% (15/21) of all recordings; 64% (7/11) of the participants had a consistent pattern at both time points. Sequence of segmental contribution was less consistent in the lumbar spine than the cervical spine, possibly caused by differences in facet orientation, intervertebral discs, overprojection of the pelvis, and muscle recruitment. Conclusions: In 64% (7/11) of the recordings, a consistent motion pattern was found in the upper lumbar spine during the last phase of extension in asymptomatic young male participants. Physiological motion of the lumbar spine is a broad concept, influenced by multiple factors, which cannot be captured in a firm definition yet. Trial Registration: ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID): RR2-10.2196/14741 UR - https://biomedeng.jmir.org/2023/1/e41906 UR - http://dx.doi.org/10.2196/41906 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875682 ID - info:doi/10.2196/41906 ER - TY - JOUR AU - Rozenberg, Dmitry AU - Al Kaabi, Noor AU - Camacho Perez, Encarna AU - Nourouzpour, Sahar AU - Lopez-Hernandez, Laura AU - McGillis, Laura AU - Goligher, Ewan AU - Reid, Darlene W. AU - Chow, Chung-Wai AU - Ryan, M. Clodagh AU - Kumbhare, Dinesh AU - Huszti, Ella AU - Champagne, Kateri AU - Raj, Satish AU - Mak, Susanna AU - Santa Mina, Daniel AU - Clarke, Hance AU - Mittal, Nimish PY - 2023/3/20 TI - Evaluation and Management of Dyspnea in Hypermobile Ehlers-Danlos Syndrome and Generalized Hypermobility Spectrum Disorder: Protocol for a Pilot and Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e44832 VL - 12 KW - Ehlers-Danlos Syndrome KW - generalized hypermobility spectrum disorders KW - inspiratory muscle training KW - rehabilitation KW - exercise KW - mobile phone N2 - Background: Dyspnea is a prevalent symptom in individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD), yet its contributors have not been identified. One known contributor to dyspnea is respiratory muscle weakness. The feasibility and effectiveness of inspiratory muscle training (IMT) in combination with standard-of-care rehabilitation (aerobic, resistance, neuromuscular stabilization, and balance and proprioception exercises) in improving respiratory muscle strength and patient-reported outcomes in patients with hEDS or G-HSD have not been evaluated. Objective: This study aims to evaluate dyspnea, respiratory muscle strength, and patient-reported outcome measures (PROMs) in hEDS or G-HSD compared with healthy controls and to assess the feasibility of a randomized controlled trial of IMT and standard-of-care rehabilitation for improving respiratory muscle strength, exercise capacity, and PROMs compared with standard-of-care rehabilitation in hEDS and G-HSD. Methods: The study will include 34 participants with hEDS or G-HSD and 17 healthy, age- and sex-matched controls to compare respiratory muscle structure and function and PROMs. After baseline assessments, participants with hEDS or G-HSD will be randomized into the intervention group and provided IMT combined with Ehlers-Danlos Syndrome standard-of-care rehabilitation or into the usual care group, and provided only standard-of-care rehabilitation for 8 weeks. The intervention group will be prescribed IMT in their home environment using the POWERbreathe K5 IMT device (POWERbreathe International Ltd). IMT will comprise 2 daily sessions of 30 breaths for 5 days per week, with IMT progressing from 20% to 60% of the baseline maximal inspiratory pressure (MIP) over an 8-week period. Feasibility will be assessed through rates of recruitment, attrition, adherence, adverse events, and participant satisfaction. The primary pilot outcome is MIP change over an 8-week period in hEDS or G-HSD. Secondary outcomes will include the evaluation of dyspnea using Medical Research Council Scale and 18-point qualitative dyspnea descriptors; diaphragmatic thickening fraction using ultrasound; respiratory muscle endurance; pulmonary function; prefrontal cortical activity using functional near-infrared spectroscopy; aerobic capacity during cardiopulmonary exercise testing; quality of life using Short Form-36; and scores from the Depression, Anxiety, and Stress scale-21. These measures will also be performed once in healthy controls to compare normative values. Multivariable regression will be used to assess the contributors to dyspnea. Paired 2-tailed t tests will be used to assess the changes in MIP and secondary measures after 8 weeks of IMT. Results: Study recruitment began in August 2021 and, with several disruptions owing to COVID-19, is expected to be completed by December 2023. Conclusions: This study will provide a better understanding of the factors associated with dyspnea and the feasibility and effectiveness of IMT combined with standard-of-care rehabilitation. IMT may be a novel therapeutic strategy for improving respiratory muscle function and patient-reported outcomes in individuals with hEDS or G-HSD. Trial Registration: ClinicalTrials.gov NCT04972565; https://clinicaltrials.gov/ct2/show/NCT04972565 International Registered Report Identifier (IRRID): DERR1-10.2196/44832 UR - https://www.researchprotocols.org/2023/1/e44832 UR - http://dx.doi.org/10.2196/44832 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939815 ID - info:doi/10.2196/44832 ER - TY - JOUR AU - Verma, Kumar Arun AU - Singh, Girish AU - Patwardhan, Kishor PY - 2022/4/29 TI - Patterns of Physical Activity Among University Students and Their Perceptions About the Curricular Content Concerned With Health: Cross-sectional Study JO - JMIRx Med SP - e31521 VL - 3 IS - 2 KW - physical activity KW - university students KW - university KW - exercise KW - students KW - inactive KW - curricula KW - healthy lifestyle KW - higher education N2 - Background: University students are at risk of losing their focus on maintaining healthy levels of physical activity because of their engagements with curricular and cocurricular activities. In India, the physical activity levels of the adult population have been reported to be declining in the recent years. However, studies focusing on university students pertaining to their physical activity are lacking in the Indian context. Moreover, a question that has not been properly addressed is the following: ?do the curricula in higher education promote physical activity?? Objective: Our paper aims at describing the physical activity levels of the students in a large public-funded central university located in northern India. The study also aims at capturing the student perceptions about the emphasis they receive on leading a physically active lifestyle during their routine curricular activities. Methods: This is a cross-sectional descriptive study and uses International Physical Activity Questionnaire?Long Form to record physical activity among 4586 students. Stratified sampling method was used to enroll the students from each stream (faculty). Out of 30,667 students, about 15% were included from each faculty. The study was conducted between 2016 and 2019. To capture the student perceptions, we used a newly developed 5-item scale. Results: From a total of 4586 participants in the study, 2828 (61.7%) were male and 1758 (38.3%) were female students. The mean age of our sample was 22.34 (SD 3.12) years. Our results indicate that about 14.5% (n=666) of all students in the study fall under the ?Inactive? category. Furthermore, the perception about the curricular content pertaining to physical activity varied widely between the students of different streams. Conclusions: Our sample reported a better physical activity pattern in comparison to the reported overall physical activity levels of the adult population of India. Our results also suggest that health-related topics are inadequately represented in many of the streams of higher education in the university. UR - https://med.jmirx.org/2022/2/e31521 UR - http://dx.doi.org/10.2196/31521 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725547 ID - info:doi/10.2196/31521 ER - TY - JOUR AU - Henrique, Bazzanello Patrícia Paula AU - Perez, Pelle Fabrízzio Martin AU - Becker, Cemin Osvaldo Henrique AU - Bellei, Andrei Ericles AU - Biduski, Daiana AU - Korb, Arthiese AU - Pochmann, Daniela AU - Dani, Caroline AU - Elsner, Rostirola Viviane AU - De Marchi, Bertoletti Ana Carolina PY - 2021/10/13 TI - Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e32729 VL - 10 IS - 10 KW - elderly women KW - exergame KW - epigenome KW - cognition KW - kinesiotherapy N2 - Background: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. Objective: We aim to evaluate the effects of kinesiotherapy with exergaming on older women?s epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. Methods: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. Results: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. Conclusions: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. Trial Registration: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. International Registered Report Identifier (IRRID): DERR1-10.2196/32729 UR - https://www.researchprotocols.org/2021/10/e32729 UR - http://dx.doi.org/10.2196/32729 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643543 ID - info:doi/10.2196/32729 ER - TY - JOUR AU - Cashin, G. Aidan AU - Lee, Hopin AU - Bagg, K. Matthew AU - Wand, M. Benedict AU - O'Hagan, Edel AU - Rizzo, N. Rodrigo R. AU - Stanton, R. Tasha AU - Moseley, Lorimer G. AU - McAuley, H. James PY - 2021/7/2 TI - Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial JO - JMIR Res Protoc SP - e26053 VL - 10 IS - 7 KW - chronic low back pain KW - mediation analysis KW - mechanism evaluation KW - protocol N2 - Background: Chronic low back pain (CLBP) is a global health problem associated with an increasing burden on individuals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence. Objective: This protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation. Methods: We will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses. Results: Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia. Conclusions: The RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000610538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/26053 UR - https://www.researchprotocols.org/2021/7/e26053 UR - http://dx.doi.org/10.2196/26053 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255720 ID - info:doi/10.2196/26053 ER - TY - JOUR AU - Lorenz, Arnold Kent AU - Yeshurun, Shlomo AU - Aziz, Richard AU - Ortiz-Delatorre, Julissa AU - Bagley, Robert James AU - Mor, Merav AU - Kern, Marialice PY - 2021/5/17 TI - A Handheld Metabolic Device (Lumen) to Measure Fuel Utilization in Healthy Young Adults: Device Validation Study JO - Interact J Med Res SP - e25371 VL - 10 IS - 2 KW - resting metabolic rate KW - Lumen KW - ParvoMedics TrueOne 2400 KW - validation KW - respiratory exchange ratio KW - metabolism KW - fuel utilization KW - indirect calorimetry KW - breath KW - lung KW - respiratory KW - young adult KW - measurement KW - testing N2 - Background: Metabolic carts measure the carbon dioxide (CO2) produced and oxygen consumed by an individual when breathing to assess metabolic fuel usage (carbohydrates versus fats). However, these systems are expensive, time-consuming, and only available in health care laboratory settings. A small handheld device capable of determining metabolic fuel usage via CO2 from exhaled air has been developed. Objective: The aim of this study is to evaluate the validity of a novel handheld device (Lumen) for measuring metabolic fuel utilization in healthy young adults. Methods: Metabolic fuel usage was assessed in healthy participants (n=33; mean age 23.1 years, SD 3.9 years) via respiratory exchange ratio (RER) values obtained from a metabolic cart as well as % CO2 from the Lumen device. Measurements were performed at rest in two conditions: fasting, and after consuming 150 grams of glucose, in order to determine changes in metabolic fuel usage. Reduced major axis regression and simple linear regression were performed to test for agreement between RER and Lumen % CO2. Results: Both RER and Lumen % CO2 significantly increased after glucose intake (P<.001 for both) compared with fasting conditions, by 0.089 and 0.28, respectively. Regression analyses revealed an agreement between the two measurements (F1,63=18.54; P<.001). Conclusions: This study shows the validity of Lumen for detecting changes in metabolic fuel utilization in a comparable manner with a laboratory standard metabolic cart, providing the ability for real-time metabolic information for users under any circumstances. UR - https://www.i-jmr.org/2021/2/e25371 UR - http://dx.doi.org/10.2196/25371 UR - http://www.ncbi.nlm.nih.gov/pubmed/33870899 ID - info:doi/10.2196/25371 ER - TY - JOUR AU - Enciso, James AU - Variya, Dhruval AU - Sunthonlap, James AU - Sarmiento, Terrence AU - Lee, Mun Ka AU - Velasco, James AU - Pebdani, N. Roxanna AU - de Leon, D. Ray AU - Dy, Christine AU - Keslacy, Stefan AU - Won, Soonmee Deborah PY - 2021/1/19 TI - Electromyography-Driven Exergaming in Wheelchairs on a Mobile Platform: Bench and Pilot Testing of the WOW-Mobile Fitness System JO - JMIR Rehabil Assist Technol SP - e16054 VL - 8 IS - 1 KW - exergaming KW - gamercising KW - mobile health KW - wheelchair exercises KW - wireless electromyography KW - mobile phone N2 - Background: Implementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. However, these exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements. Objective: This study aims to develop a mobile phone app that implements electromyography (EMG)-driven exergaming, to test the feasibility of using this app to enable people in wheelchairs to perform exergames independently and flexibly in their own home, and to assess the perceived usefulness and usability of this mobile health system. Methods: We developed an Android mobile phone app (Workout on Wheels, WOW-Mobile) that senses upper limb muscle activity (EMG) from wireless body-worn sensors to drive 3 different video games that implement upper limb exercises designed for people in wheelchairs. Cloud server recordings of EMG enabled long-term monitoring and feedback as well as multiplayer gaming. Bench testing of data transmission and power consumption were tested. Pilot testing was conducted on 4 individuals with spinal cord injury. Each had a WOW-Mobile system at home for 8 weeks. We measured the minutes for which the app was used and the exergames were played, and we integrated EMG as a measure of energy expended. We also conducted a perceived usefulness and usability questionnaire. Results: Bench test results revealed that the app meets performance specifications to enable real-time gaming, cloud storage of data, and live cloud server transmission for multiplayer gaming. The EMG sampling rate of 64 samples per second, in combination with zero-loss data communication with the cloud server within a 10-m range, provided seamless control over the app exergames and allowed for offline data analysis. Each participant successfully used the WOW-Mobile system at home for 8 weeks, using the app for an average of 146 (range 89-267) minutes per week with the system, actively exergaming for an average of 53% of that time (39%-59%). Energy expenditure, as measured by integrated EMG, was found to be directly proportional to the time spent on the app (Pearson correlation coefficient, r=0.57-0.86, depending on the game). Of the 4 participants, 2 did not exercise regularly before the study; these 2 participants increased from reportedly exercising close to 0 minutes per week to exergaming 58 and 158 minutes on average using the WOW-Mobile fitness system. The perceived usefulness of WOW-Mobile in motivating participants to exercise averaged 4.5 on a 5-point Likert scale and averaged 5 for the 3 participants with thoracic level injuries. The mean overall ease of use score was 4.25 out of 5. Conclusions: Mobile app exergames driven by EMG have promising potential for encouraging and facilitating fitness for individuals in wheelchairs who have maintained arm and hand mobility. UR - http://rehab.jmir.org/2021/1/e16054/ UR - http://dx.doi.org/10.2196/16054 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464221 ID - info:doi/10.2196/16054 ER -