Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews The Physical Effect of Exergames in Healthy Elderly-A Systematic Review. Dietary and physical activity strategies to prevent type 2 diabetes in South Asian adults: protocol for a systematic review Validity of physical activity monitors during daily life in patients with COPD What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol The value of a continuous ambulatory activity monitor to quantify the amount and intensity of daily activity in patients with rheumatoid arthritis. Intrapersonal, social and physical environmental determinants of moderate-to-vigorous physical activity in working-age women: a systematic review protocol A randomised controlled trial of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review Measurement of physical activity to assess health effects in free-living populations. Barriers and facilitators to the implementation of physical activity policies in schools: A systematic review. Relations Between Autonomous Motivation and Leisure-Time Physical Activity Participation: The Mediating Role of Self-Regulation Techniques. The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review A Description of the Trials, Reviews, and Practice Guidelines Indexed in the PEDro Database How Physically Active Are People with Stroke in Physiotherapy Sessions Aimed at Improving Motor Function? A Systematic Review Performance of thigh-mounted triaxial accelerometer algorithms in objective quantification of sedentary behaviour and physical activity in older adults The Health-e-AME Faith-Based Physical Activity Initiative: Description and Baseline Findings Technology-adaptable interventions for treating depression in adults with cognitive impairments: protocol for a systematic review “Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review” INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Effectiveness of Manual Physical Therapy for Painful Shoulder Conditions: A Systematic Review Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines
Background The evidence that higher levels of physical activity and /or lower levels of physical inactivity are associated with beneficial health-related outcomes stems mainly from observational studies . Findings from these studies often differ from r and omised controlled trials and systematic review s currently demonstrate mixed results , due partly to heterogeneity in physical activity interventions , method ologies used and population s studied . As a result , translation into clinical practice has been difficult . It is therefore essential that an overview is carried out to compare and contrast systematic review s , and to identify those physical activity interventions that are the most effective in preventing and /or treating major chronic disease . This protocol has been registered on PROSPERO 2013 : CRD42013003523 . Methods We will carry out an overview of Cochrane systematic review s. We will search the Cochrane Data base of Systematic Review s for systematic review s of r and omised controlled trials that have a primary focus on disease-related outcomes . We will restrict review s to those in selected major chronic diseases . Two authors will independently screen search outputs , select studies , extract data and assess the quality of included review s using the assessment of multiple systematic review s tool ; all discrepancies will be resolved by discussing and reaching a consensus , or by arbitration with a third author . The data extraction form will summarise key information from each review , including details of the population ( s ) ( for example , disease condition ) , the context ( for example , prevention , treatment or management ) , the participants , the intervention(s ) , the comparison(s ) and the outcomes . The primary outcomes of interest are the prevention of chronic disease and /or improved outcomes , in the treatment or management of chronic disease . These outcomes will be summarised and presented for individual chronic diseases ( for example , any change in blood pressure in hypertension or glucose control in diabetes ) . Secondary outcomes of interest are to describe the structure and delivery of physical activity interventions  across chronic disease conditions and adverse events associated with physical activity . Discussion We anticipate that our results could inform research ers , guideline groups and policymakers of the most efficacious physical activity interventions in preventing and /or managing major chronic disease Exergames have been suggested as an innovative approach to enhance physical activity in the elderly . The objective of this review was to determine the effectiveness of exergames on vali date d quantitative physical outcomes in healthy elderly individuals . We used Centre for Review and Disseminations guidance to conduct systematic review s. Four electronic data bases were search ed . We included r and omized controlled trials ( RCTs ) , the study participants were healthy elderly individuals , and the intervention of interest was exergaming . The title and abstract screening of the 1861 citations identified 36 studies as potentially eligible for this review , and an additional nine were identified from reference lists . The full text screening identified seven studies with a total of 311 participants , all reporting RCTs with low-to-moderate method ological quality . Six of the seven studies found a positive effect of exergaming on the health of the elderly . However , the variation of intervention approaches and outcome data collected limited the extent to which studies could be compared . This review demonstrates how exergames have a potential to improve physical health in the elderly . However , there is a need for additional and better- design ed studies that assess the effectiveness and long-term adherence of exergames design ed specifically for the elderly Introduction Type 2 diabetes ( T2D ) is a major health concern among population s of South Asian ethnicity . Although dietary and physical activity interventions may reduce the risk of T2D , the effectiveness has been moderate among South Asians . This might ( in part ) be because this subgroup follows strategies that were originally developed for interventions among other population s. Therefore , this review aims to assess the evidence for the current dietary and physical activity strategies recommended in T2D prevention intervention studies and guidelines for South Asians . Methods and analysis Included will be all studies and guidelines on dietary and /or physical activity strategies to prevent T2D in adult South Asians . Two review ers will search online data bases from their start until the present date for published and unpublished experimental/quasiexperimental studies , with at least an abstract in English . References of identified articles and key review s will be screened for additional studies . Guidelines will be identified by search es in online data bases and websites of public organisations . Finally , expert consultations will be held to supplement any missing information . Trial quality will be assessed with the Quality Assessment Tool for Quantitative Studies Data , and guidelines with the Appraisal of Guidelines for Research & Evaluation II . Data on the strategies recommended , targeting and evidence on effectiveness will be extracted by two review ers and presented in tabular and narrative forms . Recommendations will be compared with the National Institute for Health and Care Excellence guidelines [ PH35 ] . Overall findings on  dietary and physical activity recommendations , as well as findings for specific subgroups ( eg , by sex ) , will be discussed . Ethics and dissemination Ethics assessment is not required . Start date : 1 January 2016 , finishing and reporting date 31 July 2016 . Results will be published in a peer- review ed scientific journal , the project report of EuroDHYAN ( www.eurodhyan.eu ) and in a PhD dissertation . Trial registration number The protocol is registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) registration number CRD42015027067 Symptoms during physical activity and physical inactivity are hallmarks of chronic obstructive pulmonary disease ( COPD ) . Our aim was to evaluate the validity and usability of six activity monitors in patients with COPD against the doubly labelled water ( DLW ) indirect calorimetry method . 80 COPD patients ( mean±sd age 68±6 years and forced expiratory volume in 1 s 57±19 % predicted ) recruited in four centres each wore simultaneously three or four out of six commercially available monitors vali date d in chronic conditions for 14 consecutive days . A priori validity criteria were defined . These included the ability to explain total energy expenditure ( TEE ) variance through multiple regression analysis , using TEE as the dependent variable with total body water ( TBW ) plus several physical activity monitor outputs as independent variables ; and correlation with activity energy expenditure ( AEE ) measured by DLW . The Actigraph GT3X ( Actigraph LLC , Pensacola , FL , USA ) , and DynaPort MoveMonitor ( McRoberts BV , The Hague , the Netherl and s ) best explained the majority of the TEE variance not explained by TBW ( 53 % and 70 % , respectively ) and showed the most significant correlations with AEE ( r=0.71 , p<0.001 and r=0.70 , p<0.0001 , respectively ) . The results of this study should guide users in choosing valid activity monitors for research or for clinical use in patients with chronic diseases such as COPD . This study vali date s six activity monitors in the field against indirect calorimetry ( DLW ) in patients with COPD Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) OBJECTIVE To examine the reliability , validity , and responsiveness of a continuous ambulatory activity monitor in patients with rheumatoid arthritis ( RA ) . METHODS Forty-one patients with RA , participating in a r and omized controlled trial examining the effect of an intensive exercise program  , were assessed by means of the  Dynaport ADL ( activities of daily living ) monitor ( AM ) .  The time spent on activities ( locomotion , st and ing , and active sitting ) during 24 hours and the intensity of trunk movement during these activities were recorded . To determine test-retest reliability 20 patients were reassessed with the AM one week after the first assessment . Construct validity of the AM was determined by comparing the AM results with physical fitness measures ( muscle strength , endurance , joint mobility ) , disease activity , and functional status . As well , 37 patients were assessed 18 months after the first assessment to determine responsiveness . RESULTS All AM measurements showed satisfactory test-retest reliability ( ICC 0.63 - 0.76 ) . AM measures were significantly associated with physical fitness , functional status , and disease activity , indicating construct validity of the AM . The AM could discriminate between patients with improvement and deterioration in physical fitness , indicating sufficient responsiveness of AM variables . CONCLUSION This study shows the value of an ambulatory activity monitor to quantify both the amount and intensity of physical activity of patients with RA during a day in their own environment . The ambulatory activity monitor seems to be a promising instrument for research into rehabilitation of patients with RA Background The majority of North American adult females do not meet current physical activity recommendations ( 150 min of moderate-to-vigorous intensity physical activity ( MVPA ) per week accrued in ≥10 min bouts ) ultimately placing themselves at increased risk of morbidity and mortality . Working-age females face particular challenges in meeting physical activity recommendations as they have multiple dem and s , including occupational , family and social dem and s. To develop effective interventions to increase MVPA among working-age females , it is necessary to identify and underst and the strongest modifiable determinants influencing these behaviours . Therefore , the objective of this systematic review is to examine the available evidence to identify intrapersonal , social and environmental determinants of MVPA among working-age females . Methods / Design Six electronic data bases will be search ed to identify all prospect i ve cohort studies that report on intrapersonal , social and /or environmental determinants of  MVPA  in working-age females . Grey literature sources including theses , published conference abstract s and websites from relevant organizations will also be included . Articles that report on intrapersonal ( e.g. health status , self-efficacy , socio-economic status ( SES ) , stress , depression ) , social environmental ( e.g. crime , safety , area SES , social support , climate and capital , policies ) , and environmental ( e.g. weather , workplace , home , neighbourhood , recreation environment , active transportation ) determinants of MVPA  in a working-age ( mean age 18–65 years ) female population will be included . Risk of bias will be assessed within and across all included studies using the Tool to Assess Risk of Bias in Cohort Studies and the Grade s of Recommendation , Assessment , Development and Evaluation approach . Harvest plots will be used to synthesize results across all determinants , and meta-analyses will be conducted where possible among studies with sufficient homogeneity . Discussion This review will provide a comprehensive examination of evidence in this field and will serve to highlight gaps for future research on the determinants of MVPA in working-age females and ultimately inform intervention design . Systematic review registration PROSPERO : CRD42014009750 Introduction Childhood overweight and obesity tracks into adulthood , increasing the risk of developing future chronic disease . Implementing initiatives promoting healthy eating and physical activity in childcare setting s has been identified as a priority to prevent excessive child weight gain . Despite this , few trials have been conducted to assess the effectiveness of interventions to support population -wide implementation of such initiatives . The aim of this study is to assess the effectiveness of a multicomponent intervention in increasing the implementation of healthy eating and physical activity policies and practice s by centre-based childcare services . Methods and analysis The study will employ a parallel group r and omised controlled trial design . A sample of 128 childcare services in the Hunter region of New South Wales , Australia , will be recruited to participate in the trial . 64 services will be r and omly allocated to a 12-month implementation intervention . The remaining 64 services will be allocated to a usual care control group . The intervention will consist of a number of strategies to facilitate childcare service implementation of healthy eating and physical activity policies and practice s. Intervention strategies will include implementation support staff , securing executive support , consensus processes , staff training , academic detailing visits , performance monitoring and feedback , tools and re sources , and a communications strategy . The primary outcome of the trial will be the prevalence of services implementing all healthy eating and physical activity policies and practice s targeted by the intervention . To assess the effectiveness of the intervention , telephone surveys with nominated supervisors and room leaders of childcare services will be conducted at baseline and immediately postintervention . Ethics and dissemination The study was approved by the Hunter New Engl and Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee . Study findings will be disseminated widely through peer- review ed publications and conference presentations . Trial registration number Australian Clinical Trials Registry ACTRN12612000927820 Background To counteract decline in physical performance and physical activity in older patients during hospitalization , multiple physical interventions were developed . However , it is unknown whether these are effective in this particular population . This systematic review aim ed to identify the effect of physical interventions on physical performance and physical activity in older patients during hospitalization . Methods The systematic search included PubMed , EMBASE , Cinahl , the Trials data base of The Cochrane Library and SPORTd iscus from inception to 22 November 2017 . Studies were included if the mean age of the patient cohort was 65 years and older and the effect of physical interventions on  physical performance or physical activity  was evaluated during hospitalization . Results Fifteen r and omized controlled trials met the inclusion criteria . Overall , the effect of physical interventions on physical performance was inconsistent . Patient tailored interventions , i.e. continuously adapted to the capabilities of the patient were not found to be superior over interventions that were not . Physical activity as outcome measure was not addressed . Reporting of intensity of the interventions and adherence were frequently lacking . Conclusions Evidence for the effect of physical interventions on physical performance in older patients during hospitalization was found uncertain . Further research on the efficacy of the intervention is needed , comparing types of intervention with detailed reporting of frequency , intensity and duration For physical activity surveys that would identify relations to chronic diseases , quality of life , and longevity , the method of choice remains the question naire , especially if it can be st and ardized and administered in uniform fashion to large population s. A sample question naire derived largely from epidemiological experience with the Harvard Alumni Health Study is presented that requests anthropometric estimates ; physician-diagnosed diseases by year of onset ; contemporary physical activities including walking , stair-climbing , and recreational pursuits ; food-frequency data that estimate nutrient values and caloric intakes ; and social habits affecting health . The question naire presents opportunities for cross-sectional , retrospective , and prospect i ve studies . Personal characteristics , physical activities , and other elements of lifestyle may be used as predictor or outcome variables in testing specific hypotheses . Representative surveys are described that have vali date d and used question naires of various complexities , some complemented by measures of physiological fitness . The epidemiological survey question naire , when properly design ed and administered , can measure effectively energy intake , energy retention , energy expenditure , physiological fitness , quality of life , and health maintenance Research consistently indicates that schools fail to implement m and atory physical activity policies . This review aim ed to describe factors ( barriers and facilitators ) that may influence the implementation of school physical activity policies which specify the time or intensity that physical activity should be implemented and to map these factors to a theoretical framework . A systematic search was undertaken in six data bases for quantitative or qualitative studies published between 1995-March 2016 that examined teachers ' , principals ' or school administrators ' reported barriers and /or facilitators to implementing m and ated school physical activity policies .  Two independent review ers screened texts , extracted and coded data from identified articles using the Theoretical Domains Framework ( TDF ) . Of the 10,346 articles identified , 17 studies met the inclusion criteria ( 8 quantitative , 9 qualitative ) . Barriers and facilitators identified in qualitative studies covered 9 and 10 TDF domains respectively . Barriers and facilitators reported in quantitative studies covered 8 TDF domains each . The most common domains identified were : ' environmental context and re sources ' ( e.g. , availability of equipment , time or staff ) , ' goals ' ( e.g. , the perceived priority of the policy in the school ) , ' social influences ' ( e.g. , support from school boards ) , and ' skills ' ( e.g. , teachers ' ability to implement the policy ) . Implementation support strategies that target these factors may represent promising means to improve implementation of  physical activity policies and increase physical activity among school-aged children . Future studies assessing factors that influence school implementation of physical activity policies would benefit from using a comprehensive framework to help identify if any domains have been overlooked in the current literature . REGISTRATION This review was prospect ively registered with PROSPERO ( CRD42016051649 ) on the 8th December 2016 This study tested the predictive validity of a multitheory process model in which the effect of autonomous motivation from self-determination theory on physical activity participation is mediated by the adoption of self-regulatory techniques based on control theory .  Finnish adolescents ( N = 411 , aged 17 - 19 ) completed a prospect i ve survey including vali date d measures of the predictors and physical activity , at baseline and after one month ( N = 177 ) . A sub sample used an accelerometer to objective ly measure physical activity  and further vali date the  physical activity self-report assessment tool  ( n = 44 ) . Autonomous motivation statistically significantly predicted action planning , coping planning , and self-monitoring . Coping planning and self-monitoring mediated the effect of autonomous motivation on physical activity , although self-monitoring was the most prominent . Controlled motivation had no effect on self-regulation techniques or physical activity . Developing interventions that support autonomous motivation for physical activity may foster increased engagement in self-regulation techniques and positively affect physical activity behavior This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty This perspective provides an overview of the r and omized controlled trials , systematic review s , and evidence -based clinical practice guidelines in physical therapy . Data from the Physiotherapy Evidence Data base ( PEDro ) are used to describe key events in the history of physical therapy research and the growth of evidence of effects of interventions used in the various subdisciplines of physical therapy . The 11,494 records that were identified reveal a rich history of physical therapy research dating back to the first trial in 1929 . Most of the r and omized controlled trials , systematic review s , and evidence -based clinical practice guidelines in physical therapy have been published since the year 2000 . This rapid growth presents a challenge for physical therapists who want to keep up to date in clinical practice Background . Targeted physical activity drives functional recovery after stroke . This review aim ed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions . Summary of Review . A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions . Seven studies were included ; six observational and one r and omised controlled trial . People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration . The most common activities practice d in a physiotherapy session were walking , sitting , and st and ing with a mean ( SD ) practice time of 8.7 ( 4.3 ) , 4.5 ( 4.0 ) , and 8.3 ( 2.6 ) minutes , respectively . Conclusion . People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity . In light of dosage studies , practice time may be insufficient to drive optimal motor recovery Accurate monitoring of sedentary behaviour and physical activity is key to investigate their exact role in healthy ageing . To date , accelerometers using cut-off point models are most preferred for this , however , machine learning seems a highly promising future alternative . Hence , the current study compared between cut-off point and machine learning algorithms , for optimal quantification of sedentary behaviour and physical activity intensities in the elderly . Thus , in a heterogeneous sample of forty participants ( aged ≥60 years , 50 % female ) energy expenditure during laboratory-based activities ( ranging from sedentary behaviour through to moderate-to-vigorous physical activity ) was estimated by indirect calorimetry , whilst wearing triaxial thigh-mounted accelerometers . Three cut-off point algorithms and a R and om Forest machine learning model were developed and cross-vali date d using the collected data . Detailed analyses were performed to check algorithm robustness , and examine and benchmark both overall and participant-specific balanced accuracies . This revealed that the four models can at least be used to confidently monitor sedentary behaviour and moderate-to-vigorous physical activity . Nevertheless , the machine learning algorithm outperformed the cut-off point models by being robust for all individual ’s physiological and non-physiological characteristics and showing more performance of an acceptable level over the whole range of physical activity intensities . Therefore , we propose that R and om Forest machine learning may be optimal for objective assessment of sedentary behaviour and physical activity in older adults using thigh-mounted triaxial accelerometry This article provides an overview of the development , implementation , and baseline findings from a statewide faith-based physical activity ( PA ) initiative . The 3-year program is training African Method ist Episcopal volunteers across South Carolina to implement  programs to increase  PA  in their congregations . To date , 98 churches have been trained . Interviews done with a r and om sample ( n = 39 ) indicated that 54 % are implementing at least one PA program . The baseline telephone survey  ( N = 571 ) estimates that 27.8 % of the population is regularly active  , 54.9 % underactive , and 17.3 % sedentary . Baseline rates of regular PA  were higher in those who were younger , healthier , and nonsmokers . Challenges to date have included obtaining rosters and implementing a large-scale program with limited re sources . Interest in the program has been strong and supported by church leaders . Current efforts are on training additional churches and working with those already trained to support sustainability Background Depression is a common comorbidity in individuals with cognitive impairment . Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression , and may have poorer outcomes in areas such as recovery and quality of life . However , the stigmatization of mental health disorders , cost barriers and physical disabilities may prevent these individuals from seeking mental health care . An online , self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population . We aim to inform the design of such an intervention through a systematic review by answering the following research question : among adults with cognitive impairment ( including those with acquired brain injuries or neurodegenerative diseases ) , which technology-amenable interventions have been shown to effectively decrease symptoms of depression ? Specifically , psychotherapeutic and /or behavioural interventions that could be delivered in a self-guided , online system will be included . Methods Comprehensive electronic search es will be conducted in MEDLINE , EMBASE , PsycINFO and CINAHL . Additional studies will be obtained through manually search ing the references of relevant systematic review s , contacting primary authors of select articles and tracking conference proceedings and trial registries . Article titles and abstract s will be screened using predefined eligibility criteria , and then judged for their amenability to the proposed self-help , technology-based intervention . The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion . Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-r and omized trials , controlled before-after studies and interrupted time series . The primary outcome will be a change in score on a vali date d depression scale , and adverse events will be documented as a secondary outcome . After data extraction from selected articles , pooling of data and meta- analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified . Alternatively , plain language summaries will be developed . The quality of evidence will be assessed using the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system . Systematic review registration PROSPERO Background Calcaneal apophysitis , also commonly known as sever ’s disease , is a condition seen in children usually aged between 8–15 years . Conservative therapies , such as taping , heel lifts and orthotic intervention are accepted management practice s for calcaneal apophysitis , though there is very little high quality research examining the efficacy of such treatment modalities . Previous narrative literature review s and opinion pieces provide some evidence for the use of heel raises or orthoses . The aim of this manuscript was to complete a systemic review on the treatment options for calcaneal apophysitis as measured by pain reduction and maintenance of physical activity . Methods A search strategy completed by two review ers examined nine data bases from inception to May 2012 . Search terms included heel pain , children , adolescent , calcaneal apophysitis , sever ’s disease , treatment , and management ( full text publications , human studies ) . Systematic review s , r and omised control trials , case series , and case studies were included . The reference lists of the selected articles were also examined . The methodology , quality and risk of bias was examined and assessed using the PEDro scale . Results Nine articles were retrieved including three clinical trials involving r and omisation , two case series , two retrospective case review s , and two case reports . Effect size calculations and a meta analysis were unable to be completed due to the limited data reported within the literature . Numerous treatment options were reported throughout the literature , though few were examined against a control or alternate treatment option in well- design ed trials . The limited evidence indicated that orthoses provided greater short-term pain relief than heel raises . Health practitioners should view these results with caution , as there were apparent method ological problems with the employed study design and limited follow-up of participants . Conclusion There is limited evidence to support the use of heel raises and orthoses for children who have heel pain related to calcaneal apophysitis . Further research is needed to generate higher quality evidence with larger sample sizes , and vali date d measures of pain and function to establish effective treatment approaches for children with calcaneal apophysitis & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy OBJECTIVE Changes in physical activity are thought to play an important role in maintaining symptoms in chronic fatigue syndrome ( CFS ) . The aim of this study was to describe intraindividual physical activity patterns in more detail and to identify pervasively passive patients . METHODS With help of a movement-sensing device , physical activity levels were registered continuously over a 12-day period in 277 CFS patients . Within this registration period , the 10 largest activity peaks were computed . The intensity and duration of these activity peaks and their subsequent rest periods were described and compared to those of 47 healthy controls . In addition , the patients ' 12 daily activity scores were used to identify patients who were characterised by low levels of physical activity throughout the registration period . RESULTS The CFS sample had less intense and shorter activity peaks , while the average rest periods that followed these peaks lasted longer . Approximately one-fourth of the CFS sample differed distinctly from the control group and was labelled as pervasively passive . CONCLUSION The measurements and classification of actual physical activity levels were found to reduce heterogeneity in the CFS population and therefore could provide the opportunity to optimise behavioural intervention protocol s for CFS Abstract Multiple disease-specific systematic review s on the effectiveness of physical therapy intervention for shoulder dysfunction have been inconclusive . To date , there have been two systematic review s that examined manual therapy specifically but both considered effects within diagnoses . The purpose of this systematic review was to identify the effectiveness of manual therapy to the glenohumeral joint across all painful shoulder conditions . A search of MEDLINE , CINAHL , Web of Science , and Cochrane Central Register of R and omized Controlled Trials for articles date d 1996 to June 2009 was performed . Inclusion for review were  manual therapy performed to the glenohumeral joint only ; non-surgical painful shoulder disorders ; subjects 18 - 80 years ; and outcomes of range of motion , pain , function , and /or quality of life . Quality assessment was performed using the PEDro scale with subsequent data extraction . Seventeen related articles were found with seven fitting the inclusion criteria . The average PEDro score was 7.86 , meeting the cutoff score for high quality . Significant heterogeneity in outcome measures prohibited meta- analysis . Five studies demonstrated benefits utilizing manual therapy for mobility , and four demonstrated a trend towards decreasing pain values . Functional outcomes and quality -of-life measures varied greatly among all studies . Manual therapy appears to increase either active or passive mobility of the shoulder . A trend was found favoring manual therapy for decreasing pain , but the effect on function and quality of life remains inconclusive . Future research utilizing consistent outcome measurements is necessary Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes
For total EE , correlation coefficients were statistically significantly lower in uniaxial compared to multisensor devices .
For active EE , correlations were slightly but not significantly lower in uniaxial compared to triaxial and multisensor devices .
The high level of heterogeneity in the validation studies is only partly explained by the type of activity monitor and the activity monitor outcome .
Triaxial and multisensor devices tend to be more valid monitors .
The assessment of physical activity in healthy population s and in those with chronic diseases is challenging .
The aim of this systematic review was to identify whether available activity monitors ( AM ) have been appropriately vali date d for use in assessing physical activity in these groups .