Aerobic exercise and resistance training for the management of type 2 diabetes mellitus

BACKGROUND
Implementation of a structured physical exercise program can improve glycemic control in patients with type 2 diabetes mellitus.

OBJECTIVE
To evaluate the efficacy of aerobic exercise and resistance training (either alone or in combination) in the management of type 2 diabetes mellitus.

DESIGN AND INTERVENTION
DARE (Diabetes Aerobic and Resistance Exercise) was a 26-week, single-center, parallel-group, randomized, controlled trial of patients with type 2 diabetes mellitus of >6 months' duration. Participants were aged 39-70 years with a baseline [HbA.sub.1c] level 6.6-9.9%. Exclusion criteria included current insulin therapy, regular exercise regime and blood pressure >160/95 mmHg. All participants underwent a 4-week run-in period that comprised 12 sessions of combined aerobic exercise and resistance training; participants who attended [greater than or equal to] 10 sessions were eligible to enter the study. Eligible participants were randomly allocated to one of four groups: aerobic exercise alone; resistance training alone; combined aerobic exercise and resistance training; and no intervention (control group). Exercise was performed three times weekly. The aerobic exercise group progressed from 15-20 min on a treadmill or bicycle ergometer per session at 60% of the maximum heart rate to 45 min per session at 75% of the maximum heart rate. The resistance training group performed 7 different exercises on weight machines per 45 min session, and progressed to 2-3 sets of each exercise at the maximum weight that could be lifted 7-9 times. The combined exercise group performed the full aerobic exercise program plus the full resistance training program. Participants in the control group reverted to their pre-study exercise levels.

OUTCOME MEASURES
The primary outcome measure was the change in [HbA.sub.1c] from baseline. Secondary outcome measures included changes in blood pressure, lipid profile, and body composition.

RESULTS
A total of 251 participants were eligible for intervention. The median session attendance was 80% (aerobic exercise), 85% (resistance training) and 86% (combined exercise). When compared with the control group, the HbA1c levels were reduced by 0.50% in the aerobic exercise group (P = 0.007) and by 0.38% in the resistance training group (P = 0.038). The combined exercise group had an additional reduction of 0.46% when compared with the aerobic exercise group (P = 0.014) and of 0.59% when compared with the resistance training group (P = 0.001). Decreases in [HbA.sub.1c] levels were greatest for participants with a baseline [HbA.sub.1c] level = 7.5% (P <0.001). For participants with a baseline level [HbA.sub.1c] <7.5%, significant improvements in glycemic control were observed in the combined exercise group only (P = 0.002). Changes in blood pressure and lipid profiles did not differ between the groups. By contrast, participation in a structured exercise program improved body composition.

CONCLUSION
Although aerobic exercise or resistance training alone improved glycemic control, additional improvements were observed with the combined exercise regimen.

User participation in the performance assessment of school buildings : a study of six primary schools in the Bellarine Peninsula region

Young children spend a significant portion of their lives at primary school. This research traces the development of school facilities in Victoria and examines the performance of six primary schools from the users' perspective. Performance assessments were carried out using participatory evaluation methods that included Touring Interviews with small groups of students aged from six to twelve years. The study found that participatory evaluation methods with both student and staff users generate significant information to improve school facilities. User comments were analysed with respect to 14 aspects of building quality and serviceability including character, thermal environment, privacy and flexibility. The study concludes that school buildings do not meet a number of key user requirements. Children expressed dissatisfaction with furniture and equipment in their classrooms and the playground, and to a lesser extent with student toilets, security of their school bags and personal privacy. Staff were dissatisfied with the provision of withdrawal areas and specialist spaces. Department of School Education facilities guidelines do not address the concerns of school users or meet user needs.

Pacing strategy and high-intensity cycling performance

This thesis found that a brief maximal acceleration, followed by a steady effort thereafter is the most effective pacing strategy for intense, short-term cycling performance. This strategy leads to an increase in aerobic energy supply early in exercise, which contributes to a faster speed throughout the race.

Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults : baseline results from the RESIDE study

Background: This study investigated the relationship between individual and neighborhood environmental factors and cycling for transport and for recreation among adults living in Perth, Western Australia.
Methods: Baseline cross-sectional data from 1813 participants (40.5% male; age range 18 to 78 years) in the Residential Environment (RESIDE) project were analyzed. The questionnaire included information on cycling behavior and on cycling-specific individual, social environmental, and neighborhood environmental attributes. Cycling for transport and recreation were dichotomized as whether or not individuals cycled in a usual week.
Results: Among the individual factors, positive attitudes toward cycling and perceived behavioral control increased the odds of cycling for transport and for recreation. Among the neighborhood environmental attributes, leafy and attractive neighborhoods, access to bicycle/walking paths, the presence of traffic slowing devices and having many 4-way street intersections were positively associated with cycling for transport. Many alternative routes in the local area increased the odds of cycling for recreation.
Conclusions: Effective strategies for increasing cycling (particularly cycling for transport) may include incorporating supportive environments such as creating leafy and attractive neighborhood surroundings, low traffic speed, and increased street connectivity, in addition to campaigns aimed at strengthening positive attitudes and confidence to cycle.

Reliability of isokinetic strength and aerobic power testing for patients with chronic heart failure

PURPOSE: The objective of this study was to assess the reliability of testing skeletal muscle strength and peak aerobic power in a clinical population of patients with chronic heart failure (CHF).

METHODS: Thirty-three patients with CHF (New York Heart Association (NYHA) Functional Class 2.3 ± 0.5; left ventricular ejection fraction 27% ± 7%; age 65 ± 9 years; 28:5 male-female ratio) underwent two identical series of tests (T1 and T2), 1 week apart, for strength and endurance of the muscle groups responsible for knee extension/flexion and elbow extension/flexion. The patients also underwent two graded exercise tests on a bicycle ergometer to measure peak oxygen consumption (VO_2peak). Three months later, 18 of the patients underwent a third test (T3) for each of the measures. Means were compared using MANOVA with repeated measures for strength and endurance, and ANOVA with repeated measures for VO_2peak.

RESULTS: Combining data for all four movement patterns, the expression of strength increased from T1 to T2 by 12% ± 25% (P < .001; intraclass correlation coefficient [ICC] = 0.89). Correspondingly, endurance increased by 13% ± 23% (P = .004; ICC = 0.87). Peak oxygen consumption was not significantly different (16.2 ± 0.8 and 16.1 ± 0.8 mL·kg^-1·min^-1 for T1 and T2, respectively;P = .686; ICC = 0.91). There were no significant differences between T2 and T3 for strength (2% ± 17%;P = .736; ICC = 0.92) or muscle endurance (-1% ± 15%;P = .812; ICC = 0.96), but VO_2peak decreased from 16.7 ± 1.2 to 14.9 ± 0.9 mL·kg^-1·min^-1 (-10% ± 18%;P = .021; ICC = 0.89).

CONCLUSIONS: These data suggest that in a population of patients with CHF, a familiarization trial for skeletal muscle strength testing is necessary. Although familiarization is not required for assessing oxygen consumption as a single measurement, VO_2peak declined markedly in the 3-month period for which these patients were followed. Internal consistency within patients was high for the second and third strength trials and the first and second tests of VO_2peak.

We close towns for a living : spatial transformation and the Tour de France

This paper explores the ways in which the passage of the Tour de France bicycle race through France produces a distinctive cultural cartography or social map of France. Drawing on Lefebvre's (1991) conceptual triad of spatial practice, representations of space and representational spaces, the paper argues that the Tour de France both represents and is a space that is annually reordered and structured by very particular cultural practices. Through an analysis of the process (and politics) of route selection, the incorporation of iconic landscape and the transformation of civic space as the race moves across the country, the paper foregrounds the socially constructed nature of map making and the role of human intervention in producing and reproducing key cultural cartographies of France through the Tour de France.

Phiction : lies, illusion and the phantasm in photography

A touring exhibition of historic, modern and contemporary photographs from the collection of Horsham Regional Art Gallery, selected by curator James McArdle. This exhibition celebrates the originality and diversity of Australian vision in image and text.

Phiction : lies, illusion and the phantasm in photography

A touring exhibition of historic, modern and contemporary photographs from the collection of Horsham Regional Art Gallery, selected by curator James McArdle. His selection included photographs from the 19th century, with an emphasis on photographs which are not what they seem. The exhibition was designed to make us 'read' photographs more precisely, and appreciate the art of the photographer. This exhibition celebrated the originality and diversity of Australian vision in image and text.

Interventions to promote cycling: a systematic review

Objectives To determine what interventions are effective in promoting cycling, the size of the effects of interventions, and evidence of any associated benefits on overall physical activity or anthropometric measures.

Design Systematic review.

Data sources Published and unpublished reports in any language identified by searching 13 electronic databases, websites, reference lists, and existing systematic reviews, and papers identified by experts in the field.

Review methods Controlled “before and after” experimental or observational studies of the effect of any type of intervention on cycling behaviour measured at either individual or population level.

Results Twenty five studies (of which two were randomised controlled trials) from seven countries were included. Six studies examined interventions aimed specifically at promoting cycling, of which four (an intensive individual intervention in obese women, high quality improvements to a cycle route network, and two multifaceted cycle promotion initiatives at town or city level) were found to be associated with increases in cycling. Those studies that evaluated interventions at population level reported net increases of up to 3.4 percentage points in the population prevalence of cycling or the proportion of trips made by bicycle. Sixteen studies assessing individualised marketing of “environmentally friendly” modes of transport to interested households reported modest but consistent net effects equating to an average of eight additional cycling trips per person per year in the local population. Other interventions that targeted travel behaviour in general were not associated with a clear increase in cycling. Only two studies assessed effects of interventions on physical activity; one reported a positive shift in the population distribution of overall physical activity during the intervention.

Conclusions Community-wide promotional activities and improving infrastructure for cycling have the potential to increase cycling by modest amounts, but further controlled evaluative studies incorporating more precise measures are required, particularly in areas without an established cycling culture. Studies of individualised marketing report consistent positive effects of interventions on cycling behaviour, but these findings should be confirmed using more robust study designs. Future research should also examine how best to promote cycling in children and adolescents and through workplaces. Whether interventions to promote cycling result in an increase in overall physical activity or changes in anthropometric measures is unclear.

Gender differences in recreational and transport cycling : a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints

Background
Gender differences in cycling are well-documented. However, most analyses of gender differences make broad comparisons, with few studies modeling male and female cycling patterns separately for recreational and transport cycling. This modeling is important, in order to improve our efforts to promote cycling to women and men in countries like Australia with low rates of transport cycling. The main aim of this study was to examine gender differences in cycling patterns and in motivators and constraints to cycling, separately for recreational and transport cycling.

Methods
Adult members of a Queensland, Australia, community bicycling organization completed an online survey about their cycling patterns; cycling purposes; and personal, social and perceived environmental motivators and constraints (47% response rate). Closed and open-end questions were completed. Using the quantitative data, multivariable linear, logistic and ordinal regression models were used to examine associations between gender and cycling patterns, motivators and constraints. The qualitative data were thematically analyzed to expand upon the quantitative findings.

Results
In this sample of 1862 bicyclists, men were more likely than women to cycle for recreation and for transport, and they cycled for longer. Most transport cycling was for commuting, with men more likely than women to commute by bicycle. Men were more likely to cycle on-road, and women off-road. However, most men and women did not prefer to cycle on-road without designed bicycle lanes, and qualitative data indicated a strong preference by men and women for bicycle-only off-road paths. Both genders reported personal factors (health and enjoyment related) as motivators for cycling, although women were more likely to agree that other personal, social and environmental factors were also motivating. The main constraints for both genders and both cycling purposes were perceived environmental factors related to traffic conditions, motorist aggression and safety. Women, however, reported more constraints, and were more likely to report as constraints other environmental factors and personal factors.

Conclusion
Differences found in men’s and women’s cycling patterns, motivators and constraints should be considered in efforts to promote cycling, particularly in efforts to increase cycling for transport.

Dreamweavers

Dreamweavers is a touring show Curated by Simon Gregg at the Gippsland Regional Gallery, touring Nationally from 2011 until April 2013.

The exhibition explores the contemporary preoccupation for the Fantastic through a range of national and international art practices, that are united by an enduring fascination with darkness and dark places. Dreamweavers is a multi-sensory experience that is more like entering another world than an art exhibition. It combines sculpture, digital media, photography and painting, in an intoxicating visual feast.

Dreamweavers features the work of six artists. James Gleeson (1915-2008) was Australia’s pre-eminent Surrealist, and one of the country’s most acclaimed twentieth century artists. In his work massive, heaving and largely unidentifiable forms meld with apocalyptic skies and earth in twisted biomorphic shapes.

Key influences on motivations for utility cycling (cycling for transport to and from places)

Issue addressed: 

Buses, cars, bicycles and walkers the influence of the type of human transport on the flight responses of waterbirds

One way to manage disturbance to waterbirds in natural areas where humans require access is to promote the occurrence of stimuli for which birds tolerate closer approaches, and so cause fewer responses. We conducted 730 experimental approaches to 39 species of waterbird, using five stimulus types (single walker, three walkers, bicycle, car and bus) selected to mimic different human management options available for a controlled access, Ramsar-listed wetland. Across species, where differences existed (56% of 25 cases), motor vehicles always evoked shorter flight-initiation distances (FID) than humans on foot. The influence of stimulus type on FID varied across four species for which enough data were available for complete cross-stimulus analysis. All four varied FID in relation to stimuli, differing in 4 to 7 of 10 possible comparisons. Where differences occurred, the effect size was generally modest, suggesting that managing stimulus type (e.g. by requiring people to use vehicles) may have species-specific, modest benefits, at least for the waterbirds we studied. However, different stimulus types have different capacities to reduce the frequency of disturbance (i.e. by carrying more people) and vary in their capacity to travel around important habitat

Sociospatial distribution of access to facilities for moderate and vigorous intensity physical activity in Scotland by different modes of transport

Background People living in neighbourhoods of lower socioeconomic status have been shown to have higher rates of obesity and a lower likelihood of meeting physical activity recommendations than their more affluent counterparts. This study examines the sociospatial distribution of access to facilities for moderate or vigorous intensity physical activity in Scotland and whether such access differs by the mode of transport available and by Urban Rural Classification. Methods A database of all fixed physical activity facilities was obtained from the national agency for sport in Scotland. Facilities were categorised into light, moderate and vigorous intensity activity groupings before being mapped. Transport networks were created to assess the number of each type of facility accessible from the population weighted centroid of each small area in Scotland on foot, by bicycle, by car and by bus. Multilevel modelling was used to investigate the distribution of the number of accessible facilities by small area deprivation within urban, small town and rural areas separately, adjusting for population size and local authority. Results Prior to adjustment for Urban Rural Classification and local authority, the median number of accessible facilities for moderate or vigorous intensity activity increased with increasing deprivation from the most affluent or second most affluent quintile to the most deprived for all modes of transport. However, after adjustment, the modelling results suggest that those in more affluent areas have significantly higher access to moderate and vigorous intensity facilities by car than those living in more deprived areas. Conclusions The sociospatial distributions of access to facilities for both moderate intensity and vigorous intensity physical activity were similar. However, the results suggest that those living in the most affluent neighbourhoods have poorer access to facilities of either type that can be reached on foot, by bicycle or by bus than those living in less affluent areas. This poorer access from the most affluent areas appears to be reversed for those with access to a car.