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ObjectivesCompared with sighted individuals, people with visual impairment have a higher prevalence of chronic conditions and lower levels of physical activity. This review aims to systematically review physical activity interventions for those with a visual impairment and to assess their effectiveness.DesignA systematic review of articles reporting physical activity interventions in visually impaired individuals was conducted. Medline, EMBASE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Physiotherapy Evidence Database were searched in August 2018. Meta-analyses were conducted on randomised controlled trials with the same outcome measure.SettingMost interventions were conducted in a group setting, with some including an at-home, self-directed component.ParticipantsFollowing identification of a recent systematic review of physical activity interventions in children, our review focused on adults aged 18 years and older with a visual impairment.Primary and secondary outcome measuresOutcomes included measures of balance, mobility, mental well-being (eg, quality of life), number of falls, muscle strength, flexibility and gait.ResultsEighteen papers from 17 studies met inclusion criteria. Physical activity components include falls prevention and/or balance-based activities, walking, tai chi, Alexander Technique, Yoga, dance, aerobics and core stability training. Significant results in favour of the intervention were reported most commonly in measures of functional capacity (9/17 studies) and in falls/balance-related outcomes (7/13 studies). The studies identified were generally small and diverse in study design, and risk of bias was high across several categories for most studies. Meta-analyses indicated non-significant effects of the included interventions on the Timed Up and Go, Chair Sit Test and Berg Balance Scale.ConclusionsPhysical activity interventions in individuals with visual impairment incorporating activities such as tai chi, Yoga and dance can have positive results, particularly in physical measures such as mobility and balance. However, when performing a meta-analysis of randomised controlled trials, the evidence for effectiveness is less clear. More studies with larger sample sizes, stronger designs and longer follow-up periods are needed.PROSPERO registration numberCRD42018103638.

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BackgroundThe experience of driving has been suggested to be detrimental to health. One hypothesis is that each exposure elicits an acute stress response, and that repeated exposures may act as a chronic stressor.ObjectiveThe aim of this review is to evaluate and synthesise the evidence on whether driving elicits an acute physiological stress response.MethodsElectronic databases, including CINAHL, PsycINFO and Medline, were searched for original articles written in English from database inception until March 2016. The inclusion criteria of this review included a quantitative examination of an acute physiological stress response to driving, in either on-road or simulated settings, compared to a comparison or control condition. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting criteria.ResultsA total of 27,295 abstracts were screened and 28 full-text manuscripts retrieved. Of these, seven articles met the inclusion criteria including four simulator studies and three on-road studies. All suggested a significant change in at least one physiological outcome, but the strongest evidence was for increases in urine catecholamine and cortisol after driving for long hours on-road; results on other outcomes are limited by the small number of studies or inconsistent findings.ConclusionsOverall, these studies provided moderate evidence to suggest that driving for long hours elicits a stress response over an extended period of time. There is insufficient evidence that driving for a shorter period of time elicits an acute stress response, especially in real, on-road tasks. However, the limited number of studies, small sample sizes, heterogeneity in study objectives, methodologies and physiological outcomes limit conclusions. Future studies could be improved by recruiting a larger sample, utilizing modern stress markers such as heart rate variability, and primarily focusing on the acute physiological stress response to on-road driving.

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ObjectivesThis study aimed to determine the prevalence of physical inactivity and perceived barriers to physical activity among individuals with hypertrophic cardiomyopathy (HCM), and to determine potential demographic, clinical and health-related factors influencing likelihood of meeting physical activity guidelines.MethodsThis was a cross-sectional study of consecutive patients (n=198) with HCM attending a specialist HCM centre from July 2014 to November 2015. The primary outcome measure was physical activity (minutes per day), as measured by self-report (International Physical Activity Questionnaire (IPAQ)) and objective means (ActiGraph accelerometer). For both, participants were classified as meeting guidelines if they did at least 150 min per week of physical activity. Quality of life (Short Form-36 V.2, SF-36v2), barriers to exercise and clinical–demographic data were also collected.ResultsIn total, 54.8% of participants did not meet physical activity recommendations based on IPAQ, and 12.7% did not meet guidelines based on accelerometer data. The most commonly identified barriers to exercise were ‘pain interferes with my exercise’ (33%) and ‘I have an injury/disability that stops me’ (29%). Independent factors associated with meeting guidelines included older age (OR 0.66, 95% CI 0.51 to 0.85, p=0.002), higher education level (OR 2.31, 95% CI 1.08 to 4.93, p=0.03), better physical quality of life (OR 1.05, 95% CI 1.0 to 1.09, p=0.05) and more reported barriers (OR 0.71, 95% CI 0.56 to 0.91, p=0.01).ConclusionsMore than half of the patients with HCM did not meet minimum physical activity recommendations. Several barriers to exercise among individuals with HCM exist, and provide the basis for targeted interventions to promote physical activity and improve overall health in patients with HCM.

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