Evaluation of an intervention focusing on children to promote physical activity in the entire community: Feasibility, effectiveness and sustainability over time.

Regular physical activity (PA) during childhood is associated with physical, mental, emotional and social health benefits. The constant practice of PA is considered one of the best buys available in public health. The World Health Organization (WHO) recommends to perform at least 60 minutes per day of moderate to vigorous PA for children and adolescents in order to obtain health benefits. However, globally, this level of PA is hardly achieved. Children and adolescent who do not reach the recommended levels of PA are defined as physically inactive and nowadays physical inactivity constitutes a new type of pandemic. For this reason, the WHO launched a global action plan addressing physical activity with a goal of reducing physical inactivity in children and youth. The plan also included recommendation to improve individual and community health and contribute to the social, cultural and economic development of all nations. Worldwide, children and adolescents spend a significant amount of time in school and for this reason the school represents a fundamental educational setting that can play a pivotal role increasing students’ PA. Opportunities to be physically active should not be considered purely in relation to when children attend physical education classes but also making physical activity available during the school day, such as physically active lessons, and multicomponent PA interventions. Since school-based PA interventions are quite numerous, the present thesis focused on interventions delivered during school hours and that integrate small doses of PA as part of routine instruction. This type of intervention is called “Active Breaks.” Active Breaks consists of brief 5–15 minutes sessions of PA led by teachers who introduce short bursts of PA into the academic lesson. In light of this the present thesis aims to evaluate the feasibility, efficacy and sustainability of an Active Breaks intervention targeting children to promote PA.

Physical activity and osseointegration: "step forward" to improve the quality of life of a trans-femoral amputee person

Lower limb amputation is an event that inevitably changes the lifestyle of the person with a significant impact on quality of life. The socket-type prosthesis entails that the residual limb is in direct contact with the socket which often implies numerous disadvantages. Osseointegrated prosthesis is a solution that avoids skin problems because not include the presence of the socket. In this type of prosthesis, a stem is surgically inserted inside the medullary canal and connected with the external prosthetic limb. Therefore, this thesis aims to highlight and explore the main strengths and problems of osseointegrated prostheses and to examine the role of physical activity, with attention to functional capacity and bone quality. The objectives of the thesis will be developed through 5 studies: (I) A gait analysis of a 44 years-old male patient who underwent surgery for the implantation of an osseointegrated prosthesis; (II) A systematic review to investigate the state of stump bone quality in patients with limb amputations; (III) A systematic review of the technologies involved in such devices has been carried out to identify the most fruitful ones in improving bone quality; (IV) A systematic review investigating the topic of physical activity and bone turnover biomarkers; (V) A systematic review to investigate the effects of physical activity interventions combined with drug treatments on bone biomarkers in people with osteopenia and osteoporosis. The integrated prosthesis is a good solution for people with lower limb amputation who cannot use their traditional socket-type prosthesis. Although many objectives have already been achieved, there are still many aspects that we can improve. These include the creation of a multidisciplinary path that support patients along their path, with particular attention to the pre-surgery and the post-rehabilitation phase that is still lacking even if of fundamental impact in determining the quality of life.

Physical activity as a tool to improve the quality of life for individuals with hip or knee osteoarthritis

Total hip and knee replacements (THR/TKR) are considered the gold standard surgical treatments for end-stage osteoarthritis (OA), effectively alleviating pain, enhancing joint mobility and quality of life (QoL). Maintaining an active lifestyle and regular physical activity (PA) is crucial for these patients, as it can increase bone density and stability of joint prosthesis. This thesis aims to: (1) systematically review recommendations from healthcare professionals; (2) explore interventions promoting an active lifestyle post-THR and TKR; (3) investigate the primary causes of stiffness post-TKR; (4) design an exercise protocol to enhance QoL post-THR and TKR; (5) evaluate orthopedic surgeons' attitudes toward PA for patients post-THR/TKR; and (6) assess changes in QoL after a specifically designed PA intervention. The initial review revealed consensus on permissible sports activities post-surgery, but few studies addressed interventions targeting PA behaviors. Subsequently, findings highlighted key factors contributing to post-TKR stiffness, including mispositioned components, psychological distress, and obesity. Building on these insights, a PA intervention was implemented, followed by a survey investigating orthopedic surgeons' attitudes towards PA, which demonstrated a general positive attitude. Lastly, a pilot randomized controlled trial demonstrated significant enhancements in QoL, physical function, and clinical outcomes following a three-month adapted PA intervention. Future research should focus on raising awareness among individuals and healthcare professionals, fostering engagement in PA programs, and promoting active lifestyles. PA represents a valuable strategy for mitigating the burden of chronic diseases on society.