Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.Methods-Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain.Results-After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P < .00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P < .003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01).Address correspondence to Mary Stuart, ScD, Health Administration and Policy Program, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. stuart@umbc.edu. Drs Stuart and Benvenuti contributed to this work equally.For reprints and permission queries, please visit SAGE's Web site at http://www.sagepub.com/journalsPermissions.nav. NIH Public Access Author ManuscriptNeurorehabil Neural Repair. Author manuscript; available in PMC 2011 January 20. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusion-APA-stroke appears to be safe, feasible, and efficacious in a community setting. KeywordsStroke; Exercise; Community; Rehabilitation Stroke is one of the leading causes of death and long-term disability. 1 The Framingham study found that at 6 months following a stroke (ie, after the period of natural recovery 2 ) 50% of stroke survivors aged 65 years or older had some hemiparesis and 30% were unable to walk without assistance. 3 Due in part to the sedentary lifestyle associated with these limitations, the stroke survivor is at increased risk of diabetes, glucose intolerance, heart disease, subsequent stroke death, and depression. 4,5 There is substantial evidence supporting a protective role for exercise in the prevention of stroke. 1 For stroke survivors, increasing evidence also links exercise to improved cardiovascular health, with decreased ris...

This research examined extracurricular activity (ECA) effects on students’ experiences, outcomes and future job prospects. A survey of diverse undergraduate students, along with alumni and potential employer interviews, revealed differences in students’ engagement with ECAs beyond the classroom. Variations between ‘traditional’ and ‘widening participation’ student groups emerged, with older and ethnic minority students spending more time with non-university ECAs, engaged in family, religious and solitary activities. Lower socio-economic status (SES) students spent more time working, and less time engaging in ECAs. Alumni reflected ECAs as key to developing self-identity, social networks and career prospects/pathways. Employers stressed the value of ECAs for ‘distinguishing’ candidates, providing evidence of cultural fit, leadership, commitment, and ‘selling’ original activities. As (university-linked) ECAs were key for undergraduate outcomes and graduate employment prospects, emerging ethnic, age and SES patterns of engagement have implications for persistent inequalities in employment (despite widening participation agendas)

Home- and community-based exercise for arm paresis is safe and effective. Telerehabilitation interventions will need additional enhancements to improve effectiveness. The optimal upper extremity exercise prescription poststroke remains to be established.

Objectives To identify factors that were predictive of improved pain status among older adults with chronic back pain participating in the Adaptive Physical Activity (APA) program and to identify factors that were predictive of adherence to APA. Methods An observational cohort study of 392 older adults (ages 50–88) with chronic back pain participating in APA for 12 months. APA was a community-based group exercise program given for 1-hour, twice weekly, in local gyms. Primary outcome measures were improved pain based on a global rating of change evaluation and adherence to the APA program (defined as participation in >75% of exercise sessions). Potential predictor variables were entered into multivariate logistic regression models to determine the most accurate set of variables for predicting improved pain and adherence. Results Presence of depressive symptoms, poor self-rated health and adherence to APA were the best predictors of improved pain status, with adherence being the strongest predictor [Odds Ratio:13.88 (95% CI: 8.17, 23.59)] Better physical function, longer pain duration and positive rating of the trainer were all positively associated with adherence to APA; whereas poor self-rated health and further distance from the gym were inversely associated. Conclusions Given that adherence to APA is the key predictor of improved back pain, future efforts should focus on strategies to improve adherence. Our data suggest that enhanced training of exercise trainers, development of separate classes for people with different functional levels and use of psychosocial interventions to reduce health pessimism and depression may be potential targets for improving adherence.

Immediate pigment darkening (IPD) occurs in human skin upon exposure to ultraviolet-A and visible radiation. The spectral changes that occur during IPD were measured with a rapid scanning reflectance spectrophotometer (RS) which employs optical fiber bundles for delivery and detection of light between 400 and 750 nm. The radiation dose dependence and wavelength dependence (334-549 nm irradiation) of IPD were studied by both the classical visual grading method and by spectrophotometric scoring using the RS system. The spectral changes that occur at long wavelengths with IPD mimic the natural absorption spectrum of melanin. Therefore, the IPD was scored in terms of the apparent change in melanin optical density, using the method Kollias and Baqer [Photochem. Photobiol. 43, 49-54 (1986)], based on reflectance in the 620-720 nm range. The nonlinearity of the visual grading method is demonstrated. The degree of IPD is first-order with respect to delivered dose and saturates after high doses. The maximum amount of IPD attained at saturation is greater for shorter wavelengths. Extrapolation of the reflectance data suggests the longest wavelength capable of eliciting IPD is about 470 nm.