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David S. Walsh and Paul M. Wright

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Elena López-Cañada, José Devís-Devís, Alexandra Valencia-Peris, Sofía Pereira-García, Jorge Fuentes-Miguel and Víctor Pérez-Samaniego

Background: This study describes the prevalence, frequency, and type of physical activity and sport (PAS) practiced by trans persons before and after their gender disclosure (GD). Methods: A face-to-face survey was administered to 212 Spanish trans persons, aged from 10 to 62 years old. McNemar and chi-square tests were used to determine significant differences. Results: About 75.5% of the trans persons in this study engaged in PAS and more than 50% did so ≥3 times/week, which is similar as in the general Spanish population. Participation was higher in trans men (78.7%) than trans women (72%). However, GD emerges as a key issue in characterizing trans persons’ PAS participation. A group of 14.5% of them stopped activity after GD. Participation in nonorganized PAS was higher than in organized PAS, and this difference is greater after GD because most participants gave up organized PAS in favor of nonorganized PAS. Trans persons preferred individual sports and activities than team sports before and after GD, and the top 3 activities were jogging, walking, and bodybuilding. Trans men participation was higher than trans women in team PAS, whereas individual PAS were equally practiced before and after GD. Participation in football, swimming, basketball, dancing, and volleyball declined after GD, whereas bodybuilding increased in trans men. Conclusions: The results show that the high involvement of trans persons coincides with strategies used to hide or conceal their gender identities when participating in PAS. A decrease in PAS participation is observed after GD probably because it is an acute potential period of anxiety, discrimination, and victimization caused by trans persons’ body exposure.

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Nikita Rowley, James Steele, Matthew Wade, Robert James Copeland, Steve Mann, Gary Liguori, Elizabeth Horton and Alfonso Jimenez

Objectives: To examine if exercise referral schemes (ERSs) are associated with meaningful changes in physical activity in a large cohort of individuals throughout England, Scotland, and Wales from The National Referral Database. Methods: Data were obtained from 5246 participants from 12 different ERSs, lasting 6–12 weeks. The preexercise referral scheme and changes from the preexercise to the postexercise referral scheme in self-reported International Physical Activity Questionnaire scores were examined. A 2-stage individual patient data meta-analysis was used to generate the effect estimates. Results: For the pre-ERS metabolic equivalent (MET) minutes per week, the estimate (95% confidence interval [CI]) was 676 MET minutes per week (539 to 812). For the change in MET minutes per week, the estimate (95% CI) was an increase of 540 MET minutes per week (396 to 684). Changes in the total PA levels occurred as a result of increases in vigorous activity of 17 minutes (95% CI, 9 to 24), increases in moderate activity of 29 minutes (95% CI, 22 to 36), and reductions in sitting of −61 minutes (95% CI, −78 to −43), though little change in walking (−5 min; 95% CI, −14 to 5) was found. Conclusions: Most participants undergoing ERSs are already “moderately active.” Changes in PA behavior associated with participation are through increased moderate to vigorous PA and reduced sitting. However, this was insufficient to change the International Physical Activity Questionnaire category, and the participants were still “moderately active.”

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Emmanuel Gomes Ciolac, José Messias Rodrigues da Silva and Rodolfo Paula Vieira

Background: The progressive dysfunction of the immune system during aging appears to be involved in the pathogenesis of several age-related disorders. However, regular physical exercise can present “antiaging” effects on several physiological systems. Methods: A narrative review of studies investigating the chronic effects of exercise and physical activity on the immune system and its association with age-related chronic diseases was carried out according to the guidelines for writing a narrative review. Results: There is compelling evidence suggesting that age-related immune system alterations play a key role on the pathophysiology of atherosclerosis, hypertension, chronic heart failure, type 2 diabetes, obesity, arthritis, and chronic obstructive pulmonary disease. On the other hand, the regular practice of physical activity appears to improve most of the inflammatory/immunological processes involved in these diseases. Conclusion: Epidemiological, experimental, and clinical studies permit us to affirm that regular physical activity improves immunomodulation and may play a key role in the prevention and treatment of several age-related chronic diseases. However, further studies are needed to better describe the prophylactic and therapeutic effects of physical exercise in specific organs of older individuals, as well as the mechanisms involved in such response.

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Alison Griffin, Tim Roselli and Susan L. Clemens

Background: Health benefits of physical activity (PA) accrue with small increases in PA, with the greatest benefits for those transitioning from inactivity to any level of PA. This study examined whether self-reported PA time in Queensland adults changed between 2004 and 2018. Methods: The Queensland government conducts regular cross-sectional telephone surveys. Between 2004 and 2018, adults aged 18–75 years answered identical questions about their weekly minutes of walking, moderate PA, and vigorous PA. Hurdle regression estimated the average annual change in weekly minutes of PA overall and by activity type, focusing on sociodemographic differences in trends. Results: The sample size averaged 1764 (2004–2008) and 10,188 (2009–2018), totaling 107,171 participants aged 18–75 years. Unadjusted PA increased by 10 minutes per week per year (95% confidence interval [CI], 8.8–11.1) overall, with increases for most subgroups. Adjusted PA increased by 10.5 minutes per week per year (95% CI, 9.4–11.7). Trends differed by employment—employed adults and those not in the labor force increased by 14.3 (95% CI, 12.8–15.8) and 2.2 minutes per week per year (95% CI, 0.4–4.0), respectively, with no increase for unemployed adults. The increases were due to both an increased prevalence of doing any activity and an increased average duration among active adults. Conclusions: Since 2004, PA time has increased for Queensland adults, with substantial variability by employment status.

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Paul M. Wright and David Walsh

Don Hellison (1938–2018) was a leader and trailblazer in sport and physical education pedagogy. Early in his career, he was an advocate for humanistic physical education. His engaged approach to scholarship culminated in the development of the Teaching Personal and Social Responsibility (TPSR) model, which is now recognized as a best practice for promoting social and emotional learning in physical education. The TPSR model has also been widely applied in the field of sport-based youth development. This is the introduction to the special issue devoted to Don’s life and legacy. It provides opening comments from the guest editors and a brief overview of the articles in the special issue.

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Emily Budzynski-Seymour, Rebecca Conway, Matthew Wade, Alex Lucas, Michelle Jones, Steve Mann and James Steele

Background: Physical activity (PA) promotes health and well-being. For students, university represents a transitional period, including increased independence over lifestyle behaviors, in addition to new stressors and barriers to engaging in PA. It is, therefore, important to monitor PA trends in students to gain a greater understanding about the role it might play in physical and mental well-being, as well as other factors, such as attainment and employability. Methods: Cross-sectional surveys were conducted in 2016 in Scottish universities and colleges, and in 2017 in universities and colleges across the United Kingdom, and the data were pooled for the present study (N = 11,650). Cumulative ordinal logistic regression was used to model the association between PA levels and mental and personal well-being, social isolation, and perceptions of academic attainment and employability. Results: Only 51% of the respondents met the recommended levels of moderate to vigorous PA per week. There was a linear relationship between PA levels and all outcomes, with better scores in more active students. Conclusions: UK university students are insufficiently active compared with the general population of 16- to 24-year olds. Yet, students with higher PA report better outcomes for mental and personal well-being, social isolation, and perceptions of academic attainment and employability.

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Daniel C. McFarland, Alexander G. Brynildsen and Katherine R. Saul

Most upper-extremity musculoskeletal models represent the glenohumeral joint with an inherently stable ball-and-socket, but the physiological joint requires active muscle coordination for stability. The authors evaluated sensitivity of common predicted outcomes (instability, net glenohumeral reaction force, and rotator cuff activations) to different implementations of active stabilizing mechanisms (constraining net joint reaction direction and incorporating normalized surface electromyography [EMG]). Both EMG and reaction force constraints successfully reduced joint instability. For flexion, incorporating any normalized surface EMG data reduced predicted instability by 54.8%, whereas incorporating any force constraint reduced predicted instability by 43.1%. Other outcomes were sensitive to EMG constraints, but not to force constraints. For flexion, incorporating normalized surface EMG data increased predicted magnitudes of joint reaction force and rotator cuff activations by 28.7% and 88.4%, respectively. Force constraints had no influence on these predicted outcomes for all tasks evaluated. More restrictive EMG constraints also tended to overconstrain the model, making it challenging to accurately track input kinematics. Therefore, force constraints may be a more robust choice when representing stability.

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Christopher J. Burcal, Sunghoon Chung, Madison L. Johnston and Adam B. Rosen

Background: Region-specific patient-reported outcomes (PROs) are commonly used in rehabilitation medicine. Digital versions of PROs may be implemented into electronic medical records and are also commonly used in research, but the validity of this method of administration (MOA) must be established. Purpose: To determine the agreement between and compare the test–retest reliability of a paper version (FAAM-P) and digital version (FAAM-D) of the Foot and Ankle Ability Measure (FAAM). Study Design: Randomized, nonblinded, crossover observational study. Methods: A total of 90 adults were randomized to complete the FAAM-P or FAAM-D first, and then completed the second MOA (first day [D1]). The FAAM-D was a digital adaptation of both FAAM-P subscales on Qualtrics. Identical test procedures were completed 1 week later (D2). Data were removed if a participant scored 100% on both MOA, reported injury between D1 and D2, or did not complete both MOA. Agreement was assessed on 46 participants between the 2 MOA using intraclass correlation coefficients (ICC) at D1. There was good-to-excellent test–retest reliability for the FAAM activities of daily living. Results: The authors observed good agreement between the FAAM-P and FAAM-D for the activities of daily living (ICC = .88) and sport scales (ICC = .87). Test–retest reliability was good-to-excellent for the FAAM activities of daily living (FAAM-P: ICC = .87; FAAM-D: ICC = .89) and sport (FAAM-P: ICC = .71; FAAM-D: ICC = .91). Conclusions: The MOA does not appear to affect the responses on the FAAM; however, the authors observed slightly higher reliability on the FAAM-D. The FAAM-D is sufficient to be used for generating practice-based evidence in rehabilitation medicine.