Introduction: The benefits of pulmonary rehabilitation (PR) are well established, but there is a lack of access to centre-based PR programs, due to travel distance or long waiting lists. In Australia physiotherapists and accredited exercise physiologists (AEPs) are accredited to provide PR but no funding stream exists in private practices. Aim: to ascertain whether physiotherapists and AEPs in private practices were interested in delivering PR, the resources available within practices to provide a PR program, and alignment to business models. Methods: An online survey using 5-point Likert scales, discrete categorical, numerical and free text responses was distributed to Australian physiotherapists and AEPs through national professional bodies, Primary Health Networks, Lung Foundation Australia and researcher networks between November 2023 and August 2024. Recruitment was through broad reaching strategies, such as newsletters and social media, and more targeted approaches to increase responses. Quantitative data was analysed by descriptive statistics and free text responses by thematic analysis. Results: The survey was opened by n=299, with 245 (82%) eligible responses received from 182 (74%) physiotherapists and 63 (26%) AEPs from all Australian states, and metropolitan, rural and remote areas. 99% of participants were aware of the benefits of PR, with 91% expressing an interest in providing PR in their practice with many having suitable resources and space (Table 1). 92% agreed or strongly agreed that a Medicare funding stream would be an enabler. 86% agreed or strongly agreed providing PR in their practice aligned with their business model. A subgroup analysis comparing the two professions showed significantly more AEPs were interested in providing PR in their practices (p=0.005), and more AEPs already conduct group exercise classes (Table 1). Analysis of the free text responses revealed lack of a funding source, inadequate referral pathways and some practice features were barriers to providing group exercise in private practices. However, clinicians viewed group exercise as a way to increase reach of interventions and provide additional benefits to one-to-one treatment through peer support. Conclusion: Physiotherapists and AEPs are interested in providing PR in private practices and have appropriate space and resources to conduct PR programs. However, without a funding scheme provision of PR may not be sustainable from a business model perspective for either profession.

Background Knee stiffness is a common complaint experienced during prolonged periods of sedentary behaviour, including following prolonged sitting, in both healthy and people with musculoskeletal conditions. Reduction of self-reported knee stiffness is important to patient-centred outcomes. Our aim was to obtain pilot data to determine the timeframe for knee stiffness onset in healthy populations. Methods Forty-two participants (20–76 years) with no diagnosed chronic musculoskeletal condition were recruited. After pilot testing, perceived knee joint stiffness and pain (Visual Analogue Scale) were measured while sitting (at 15, 30, 60, and 90 ​min) with the knee joint held at 90°. Correlations between knee stiffness after 90 ​min of sitting and baseline demographic data, and knee range of motion were analysed. Results Greater levels of self-reported stiffness were observed (mean ​± ​SD) after sitting still for 30 (1.8 ​± ​1.6; p ​< ​0.001), 60 (3.4 ​± ​2.4; p ​< ​0.001) and 90 ​min (4.1 ​± ​2.6; p ​< ​0.001) compared to baseline (n ​= ​31). Increase of self-reported pain occurred by 60 and 90 ​min of sitting (p ​< ​0.001). Minimal clinical important difference (MCID) (±2 ​cm) in stiffness occurred by 60 ​min of sitting (+2.6 ​cm) with pain not reaching MCID by 90 ​min. Self-reported stiffness at 90 ​min of sitting was negatively correlated with participant age (r ​= ​−0.433, p ​= ​0.004). Conclusions Healthy adults begin to experience knee stiffness when sitting still after 30 ​min, though this was only clinically relevant by 60 ​min. Moving the joint, even whilst still sitting, helped to alleviate joint stiffness and pain, which may assist in providing advice to all adults on sedentary behaviours.

BACKGROUND:The concept of cognitive reserve may explain inter-individual differences in susceptibility to neuropathological changes. Studies suggest that experiences over a lifetime impact on cognitive reserve, and it is hypothesised that following a dementia diagnosis, greater reserve levels are linked to accelerated disease progression. OBJECTIVE:To investigate the longitudinal impact of cognitive reserve on cognitive and functional abilities, physical activity and quality of life in people with dementia. DESIGN:Longitudinal cohort design. SETTING AND PARTICIPANTS:Participants were 1537 people with mild-to-moderate dementia at baseline, 1183 at 12 months follow-up and 851 at 24 months follow-up, from the IDEAL study. METHODS:A comprehensive latent measure of cognitive reserve incorporated domains from all stages of life: education, occupational attainment and later-life engagement in leisure activities. The impact of cognitive reserve on cognition, functional abilities, physical activity and quality of life at baseline and over time was investigated using latent growth curve modelling. RESULTS:Higher cognitive reserve was associated with better cognition, fewer functional difficulties, more physical activity and better quality of life at baseline but was associated with accelerated cognitive decline and greater dependence over time. After 2 years, those with higher initial reserve were estimated to still have better cognition than those with low reserve. CONCLUSIONS:Cognitive reserve may be important in initially delaying dementia progression but is linked with accelerated deterioration once dementia becomes clinically evident, likely because of the more advanced neuropathological stage of the condition. Engagement in leisure activities is a potentially modifiable domain of cognitive reserve warranting further investigation.

Objectives: To investigate the frequency and location of reported injuries among ultra-endurance participants competing in different sports. Design: Cross-sectional. Method: Ultra-endurance runners, cyclists and triathletes were recruited via a social media advertisement to participate in a web-based questionnaire. The questionnaire asked for information on demographics, competition history, training characteristics, and self-reported injury. Descriptive analyses and prevalence rates were calculated to determine differences between sports. Results: Of the 258 participants (age:46 +/- 11 years; 33% female), 129 (50%) self-reported an injury within the past 12 months. Despite high frequency of reported injury, only 10% of injuries resulted in 'severe' pain and 7% resulted in stopping participation. The lower extremity, and specifically the knee, ankle and foot, were the most common injury locations. Prevalence ratios for injury over the past 12 months was similar across running, cycling, and triathlon, with no statistically significant differences. However, cyclists demonstrated a significantly higher prevalence of knee injuries since starting ultra-endurance participant compared to runners after adjusting for covariates (PR: 1.62; 95% CI: 1.15-2.28, p = 0.006). Conclusions: Ultra-endurance participants self-report a considerable number of lower extremity injuries, yet this is similar across sports, and both the level of pain and impact on performance impact is generally low.

OBJECTIVES:Pets may be beneficial for people living with dementia but understanding of longitudinal benefits is limited. This study investigated whether having a pet was associated with differences over time in 'living well', cognition, functional ability, depression or loneliness. METHOD:This study utilised 3 assessment timepoints from the IDEAL Programme, a longitudinal cohort study of people with mild-to-moderate dementia. The relationships between having a pet, a dog, and caring for a pet (vs no pet/no dog/not caring) and outcome changes were assessed using mixed effects models with data from 1,532 people with dementia at baseline, 1,173 at 12-months and 846 people at 24 months. RESULTS:People with dementia with a pet had slower decline in informant-rated well-being, satisfaction with life, and self-rated functional ability over time than those with no pet. Those with a dog had slower decline in self-rated quality of life and functional ability, cognitive function, and informant-rated well-being and functional ability than those with a different pet or no pet. CONCLUSION:Having a pet may be beneficial for people living with dementia, with dogs offering additional benefits. Enabling people living with dementia to have a pet could help them maintain their independence and ability to live well for longer.

BACKGROUND:The benefits of pulmonary rehabilitation (PR) are well established, but there is limited access to centre-based PR programs. In Australia, physiotherapists and accredited exercise physiologists (AEPs) are licensed to provide PR in private practices in primary care but no funding stream exists. The aim of this study was to ascertain whether physiotherapists and AEPs in private practices are interested in delivering PR, whether the resources available within private practices can provide PR and ascertain alignment to business models. METHODS:An online survey was distributed to Australian physiotherapists and AEPs working in private practices through national professional bodies, Primary Health Networks, Lung Foundation Australia and researcher networks from November 2023 to 2August 2024. The survey used 5-point Likert scales and assessed participants' interest in providing PR in their private practice, whether their resources and business model would support this, and whether group exercise aligned with their private practices' business model. RESULTS:The survey was opened by 299 people, with 245 (82%) eligible responses received from 182 (74%) physiotherapists and 63 (26%) AEPs. Nearly all (99%) participants were aware of the benefits of PR, with 91% interested in providing PR in their practice and 92% agreeing a government-based funding model would encourage this. Most practices had suitable resources to provide PR, and 86% agreed or strongly agreed that providing PR aligned with their business model. Data from free-text responses supported the quantitative data. CONCLUSIONS:Private practice physiotherapists and AEPs are interested in providing PR and many have appropriate resources; however, a government-based funding model would be needed to enable this.

Physiotherapy has emerged as an important health strategy to deliver lifestyle, exercise and physical activity for people with knee osteoarthritis. However, little is known about the extent to which physiotherapists adhere to clinical practice guidelines. This study aimed to explore the perspectives and care patterns of physiotherapists in Sydney, Australia on their delivery of knee osteoarthritis care and how this aligns with the 2019 Osteoarthritis Research Society International (OARSI) guidelines. We invited thirty-three physiotherapists from nine private practices in metropolitan Sydney to partake in a semi-structured interview. The interviews were digitally recorded and transcribed verbatim. The data collected were analysed deductively using content analysis, comparing guidelines to current care patterns, while their perspectives were inductively analysed through thematic analysis. Thirty physiotherapists participated (age range 22–63 years, 17 male and 13 female). Interview responses indicated that most physiotherapists were satisfied with their care of knee osteoarthritis patients. Most physiotherapists delivered “core” guideline-based care of education and land-based exercise. Recommendations of modalities of exercise, including hydrotherapy and manual therapy, were discussed and were perceived to be beneficial despite not being “core” clinical guideline recommendations. Current treatment strategies focussed on disease severity, symptom presentation and/or patient exercise history with little emphasis on education about osteoarthritis pathophysiology and drug-based pain relief. The thematic analysis identified two over-arching themes; (1) capacity to deliver and awareness of evidence-based care and (2) perceived recommendations for future physiotherapy management. Participants identified notable areas of potential service improvement including developing stronger and more effective reimbursement models, increased consult times and improved patient access. The study provided unique insights towards physiotherapists’ current usual knee osteoarthritis care and their perceived barriers to delivering guideline-based care. Thus, informing a need for future studies to focus on developing specific and detailed guidelines if physiotherapists are to align more closely to the core guideline-based recommendations. This study was part of a larger study, with the full protocol published and registered at ClinicalTrials (ACTRN12620000188932, ACTRN12620000218998) 19/02/2020).

BACKGROUND:Explicit education about exercise-induced hypoalgesia (EIH) reduces experimental pain after a single exercise session in pain-free individuals. However, the effect in people with chronic pain is unclear. This study aimed to determine the effect of EIH education on pain during and following exercise in people with knee osteoarthritis (OA). METHODS:All procedures were administered online. Participants were randomised to receive 15-min of explicit EIH education or 15-min of general education about knee OA. Participants then completed a questionnaire on their beliefs about exercise and pain, followed by a bout of home-based lower limb resistance exercise. Pain intensity (0-10) was assessed before, during and immediately after exercise. RESULTS:40 participants completed the study (67.3 ± 10.8 years old, 73 % female). Participants only somewhat agreed pain could be reduced following a single session of exercise and that the education changed what they thought about exercise and pain, but these beliefs were not significantly different between groups (p = 0.053 and p = 0.104, respectively). Pain was similar between groups (adjusted mean difference [95 % CI]) during exercise (0.51 [-0.72 to 1.74], p = 0.410) and following exercise (-0.75 [-1.62 to 1.11], p = 0.087. Compared to baseline, pain (mean difference [95 % CI]) was lower during exercise (-1.01 [-1.66 to -0.36], p = 0.003) and following exercise (-0.96 [-1.5 to -0.42], p < 0.001). CONCLUSION:A single exercise session reduces pain in people with knee OA, but this was not influenced by pre-exercise education about EIH. Further research is needed to understand if and how EIH can be modulated in people with knee OA.

PURPOSE:Determine the feasibility of painful exercise for people with knee osteoarthritis (KOA) to inform a future randomised controlled trial. Materials and methods: People with KOA were randomised into painful (INT) or non-painful (CON) exercise groups. Both groups performed supervised exercise twice per week for 6 weeks and received standardised education. Feasibility was assessed using participant recruitment and retention rates as well as exercise adherence and compliance. Secondary outcomes included pain, function, strength, pressure pain threshold, psychosocial measures, global impression of change, and adverse events. RESULTS:Twenty participants (67.4 ± 8.9 years old; 18 females) were randomised and 18 completed the study. Feasibility was supported by satisfactory rates of recruitment (INT 89%, CON 89%) and retention (INT 91%, CON 100%) as well as exercise adherence (INT 91%, CON 92%) and compliance (INT 72%, CON 81%). Outcomes improved similarly between groups, except for strength which increased more in INT compared to CON (13.0 [0.2-25.9] kg). Four participants (3 INT, 1 CON) took analgesic medication for exercise-induced pain exacerbations. No other adverse events were reported. CONCLUSION:When combined with education, painful exercise is feasible for KOA. Future research comparing the effectiveness and safety of painful exercise in KOA is warranted. REGISTRATION:ACTRN12622001231730.

Objectives Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers’ outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers’ stress, positive experiences of caregiving, and social networks Methods Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers ( n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used Results On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers’ health conditions increased, their stress increased whereas their social network diminished Discussion Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks

Family carers of people with dementia have reported increased caring demands during the COVID-19 pandemic. The aim of this qualitative study is to explore seven family carers’ accounts of dementia caregiving one year into the COVID-19 pandemic in England in relation to carer resilience. Themes describe the complex challenges of caring during the pandemic, with interviewees burned out and ‘caring beyond capacity’ due to unmet needs within the caring role, therein highlighting the limitations of building individual resilience only. Timely practical support for carers is essential to protect their well-being and to ward against the potential consequences of carer burnout.

ObjectiveFamily relationships influence how people appraise their own aging and how their appraisals impact their health. We analyzed felt age (FA) among family caregivers of people with dementia.Methods and measuresWe used a stratified sample of 1,020 spousal and 202 adult-child caregivers from the IDEAL study. We estimated cross-sectional associations and bidirectional influences between caregivers' FA and their health and wellbeing (depression, number of health conditions, stress, positive aspects of caregiving) over 2 years.ResultsAmong spousal caregivers, 25% had a younger FA and 36% had an older FA. Among adult-child caregivers, 21.8% had a younger FA and 36.1% had an older FA. In spousal and adult-child caregivers an older FA was cross-sectionally associated with higher depression, number of health conditions, and stress, and fewer positive aspects of caregiving. In spousal caregivers, hours of care per day moderated the association between FA and depression, and FA was associated with stress 1 year later.ConclusionCaregiving may impact FA and its relationship with health. We urge continued research on the connections between caregiving and FA, and how interventions might support caregivers' positive views on their own aging, which will translate views on aging scholarship to meaningfully improve caregivers' lives.

Abstract Background People with different types of dementia may have distinct symptoms and experiences that affect their quality of life. This study investigated whether quality of life varied across types of dementia and over time. Methods The participants were 1555 people with mild-to-moderate dementia and 1327 carers from the IDEAL longitudinal cohort study, recruited from clinical services. As many as possible were followed for up to 6 years. Diagnoses included were Alzheimer’s disease, vascular dementia, mixed Alzheimer’s and vascular dementia, Parkinson’s disease dementia, dementia with Lewy bodies, and frontotemporal dementia. Self- and informant-rated versions of the Quality of Life in Alzheimer’s Disease scale were used. A joint model, incorporating a mixed effects model with random effects and a survival model to account for dropout, was used to examine whether quality of life varied by dementia type at the time of diagnosis and how trajectories changed over time. Results The strongest associations between dementia type and quality of life were seen around the time of diagnosis. For both self-ratings and informant ratings, people with Parkinson’s disease dementia or dementia with Lewy bodies had lower quality of life scores. Over time there was little change in self-rated scores across all dementia types (− 0.15 points per year). Informant-rated scores declined over time (− 1.63 points per year), with the greatest decline seen in ratings by informants for people with dementia with Lewy bodies (− 2.18 points per year). Conclusions Self-rated quality of life scores were relatively stable over time whilst informant ratings showed a steeper decline. People with Parkinson’s disease dementia or dementia with Lewy bodies report particularly low levels of quality of life, indicating the importance of greater attention to the needs of these groups.

Background and objective Type 2 diabetes affects over half a million older Australians. Australian Medicare group exercise and education interventions can support older adults' diabetes management. However, the feasibility and acceptability of accredited exercise physiologist (AEP)-delivered services are yet to be assessed. This study aimed to assess the feasibility, acceptability and preliminary efficacy of a Medicare type 2 diabetes group exercise and education intervention for older adults. Methods This study was a single-arm feasibility, acceptability and preliminary efficacy trial of an AEP-delivered type 2 diabetes group service for older adults with the condition. Participants attended the diabetes clinic once per week for eight weeks, through Medicare, for a group exercise and education session. Attendance, participation, enjoyment, suitability, usefulness and pre-post clinical health outcomes were assessed. Results The intervention was feasible and acceptable, with 40 participants (mean [+/- standard deviation] age 71.8 +/- 4.5 years [range 65-81 years]; 45% female) attending 87% of sessions. Almost all participants (97%) strongly agreed that the program was enjoyable. Participants also improved fitness and cardiometabolic health outcomes. Discussion More Australians should be referred to and attend Medicare-subsidised exercise physiologist-delivered group sessions. The potential for additional sessions to achieve greater physical activity engagement and diabetes self-management should be further investigated. Feasibility, acceptability and efficacy of a pilot exercise physiology group service for older people with type 2 diabetes

Background Most people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being. Methods Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia ( n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used. Results On average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer’s and vascular) dementia had more health conditions than those with Alzheimer’s disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time. Conclusions People with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being.

There is a growing evidence base that identifying positive experiences in providing care can have a beneficial influence on carer wellbeing. However, there is a need to better understand what carers identify as the positive aspects of care-giving. The aim of this study is to explore the satisfying aspects of providing care to people with dementia. This study utilised Time 1 data from 1,277 carers of people in the mild-to-moderate stages of dementia taking part in the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort study. Responses from 900 carers who answered the open-ended question ‘What is your greatest satisfaction in caring for your relative/friend?’ were analysed using thematic analysis. From the responses, 839 carers detailed satisfactions. Eight themes were identified, pertaining to three groups of beneficiaries: carers, people with dementia and the dyad. Perceived benefits for carers included identifying aspects of personal growth, seeing glimpses of the person, feeling they were making a difference and doing their duty. For the person with dementia, these included retaining independence, receiving good quality care and being happy. Dyadic benefits concerned the continuation of the relationship between carer and person with dementia. The findings highlight the need to take a dyadic approach when conceptualising positive experiences in providing care. Further research is needed to understand the role these positive experiences play and to develop interventions. Professionals working with carers should identify and validate these experiences.