Dr Shelly Coe

Objective
A diagnosis of Parkinson's often leads to uncertainty about the future and loss of perceived control. Peer support may offer a means to address these concerns and promote self-management.

Design
A programme evaluation of the feasibility and potential effects of ‘First Steps’, utilising a pragmatic step wedge approach. Comparing First Steps (intervention) to (control) conditions.
Setting: In the community at four sites in southern England.
Participants: Newly diagnosed (≤ 12months) people with Parkinson's.
Intervention: First Steps was a 2-day peer-conceived, developed and led intervention to support self-management.
Main measures: At 0, 12 and 24 weeks anxiety and depression (Hospital, Anxiety and Depression Scale, HADS), daily functioning (World Health Organisation Disability Assessment Schedule, WHODAS), physical activity, quality of life (EQ5D), carer strain and service utilisation were assessed.

Results
Between February 2018 and July 2019, 36 participants were enrolled into intervention and 21 to control conditions, all were included in statistical analysis. Lost to follow up was n = 1 (intervention) and n = 1 adverse event was reported (control, unrelated). Of the 36 allocated to the intervention n = 22 participants completed both days of First Steps during the study period. Completion of outcome measures was >95% at 24 weeks. Small effects favouring the intervention were found for HADS (odds ratio (OR) = 2.06, 95% confidence interval (CI) 0.24:17.84), Carer Strain Index (OR = 2.22, 95% CI 0.5:9.76) and vigorous (d = 0.42, 95% CI −0.12:0.97) and total physical activity (d = 0.41, 95% CI −0.13:0.95). EQ5D, WHOSDAS and service utilisation, was similar between groups.

Conclusions
First Steps was feasible and safe and we found potential to benefit physical activity, mental health and carer strain. Further research with longer-term follow up is warranted.

Aging is accompanied by a decline in appetite and food intake with associated deficiencies in both macronutrients and micronutrients. The aim of this study was to investigate the impact of adding Iranian brown sumac (Rhus coriaria) (CIBS) into butternut squash soup on sensory evaluation and food intake among older adults (n = 20; >65 years old) and younger adults (n = 20; 18–35 years old). To evaluate the polyphenol content and antioxidant activity of the sumac samples, a Folin–Ciocalteu assay (FCR) and ferric ion reducing antioxidant power (FRAP) assay were used, respectively. L-glutamic acid was assessed using a Megazyme L-glutamic acid assay. Compusense software was used to assess the sensory evaluation attributes of free-living older adults and younger adults receiving different doses of sumac in butternut squash soup. Nutritics software was used to assess food intake following the addition of 0.37 g of sumac to soup. CIBS was selected based on a preliminary assessment in vitro for L-glutamic acid, antioxidant, and polyphenol content of six varieties of sumac. Sensory evaluation results revealed that the difference in perceived intensity of brown color between the soup samples with different doses of CIBS was greater in the younger adults' group (p = .001) than in older adults (p = .037). In addition, the food intake study found that during the ad libitum lunch, older adults consumed more energy (kcal; p = .014), protein (g; p = .025), carbohydrate (g; p = .013), and fat (g; p = .002) after soup with sumac compared to control soup. The overall findings of this study suggest that the addition of sumac to food may have a potential benefit in enhancing ad libitum lunch intake in older adults leading to effective management of malnutrition. This may promote healthy aging and minimize the burden and the consequences of anorexia of aging as main public health concerns.

Background.
The association between diet, symptoms and health related quality of life in children and young people with Juvenile idiopathic arthritis (JIA) is not clearly understood. The objectives of this systematic review and meta-analysis were to explore the evidence for a relationship between nutritional status, dietary intake, arthritis symptoms, disease activity and health-related quality of life in children and young people with JIA considering both observational and interventional studies separately.

Method.
The databases PubMed, CINAHL, PsycINFO, Web of Science and Cochrane were searched in October 2019, updated in September 2020 and October 2021. Searches were restricted to English language, human and age (2–18 years old). Studies were included if they measured the effect of dietary supplements, vitamins or minerals, or diet in general, on quality of life and/ or arthritis symptom management. Two researchers independently screened titles and abstracts. Full texts were sourced for relevant articles. PRISMA guidelines were used for extracting data. For variables (vitamin D and disease activity), a random-effects meta-analysis model was performed. Two authors using a standardized data extraction form, extracted data independently.

Results.
11,793 papers were identified through database searching, 26 studies met our inclusion criteria with 1621 participants. Overall studies quality were fair to good. Results from controlled trial and case control studies with total 146 JIA patients, found that Ɯ-3 PUFA improved the mean active joint count (p

Conclusions.
We were only able to include small studies, of lower design hierarchy, mainly pilot studies. We found some evidence of lower height and weight across studies in JIA, but were unable to confirm an association between diet, symptoms and health-related quality of life in children and young people with JIA. Well-designed, carefully measured and controlled interventional studies of dietary patterns in combination with important contributing factors such as medication and lifestyle behaviours, including physical activity, are required to determine the impact of diet in improving symptoms and growth patterns in children and young people with JIA, with an aim to improve the quality of their life.

In oncological outpatient settings, patients often require nutritional support after they have developed malnutrition. A delayed dietetic referral can lead to increased difficulties in providing therapies and surgery, and to poorer patient outcomes. The audit described in this article aimed to assess the frequency and completeness of patient record documentation of anthropometric measurements in a day treatment unit (DTU) in a single cancer centre in the UK. The underlying goal was to improve anthropometry monitoring procedures to ensure that documentation is sufficient to indicate weight loss and, hence, allow timely referrals for nutrition support. The results show that, for over 80% of patients, it was not possible to identify a weight trend between the latest two treatments received at the hospital. The audit findings highlight the need to improve malnutrition monitoring and to ensure patient records contain updated and accurate anthropometric measurements in order to facilitate medical staff to recognise early malnutrition risk and refer for appropriate nutritional support when needed.

Millet is a grain high in polyphenols and antioxidants, which are bioactive compounds known to influence blood glucose response. The aim of this study was to compare the effect of finger millet muffin and wheat muffin on glycaemic response (GR), insulin response (IR), gastric emptying (GE) and satiety in healthy individuals and people with prediabetes. In a single blind randomised controlled crossover trial at Oxford Brookes Centre for Nutrition and Health, 15 healthy individuals and 14 individuals with prediabetes were recruited between May and December 2017. The participants’ GR (3 hours), IR (3 hours), GE (4 hours) and satiety (4 hours) were measured before and after the consumption of muffins. A mixed method analysis of variance was used to compare GE and the incremental area under the curve (iAUC) for GR and IR between the participant groups and muffins. There was a significant interaction between participants and muffins on IR iAUC at 180 min (p = 0.042). A significant effect of muffins was found on the GR peak (p = 0.013). The millet muffin decreased the GR peak and IR iAUC compared with the wheat muffin in participants with prediabetes. A significant interaction between participants and muffins for GE ascension time Tasc (p = 0.017) was observed; with no effect of muffins on satiety AUC in the participant groups. This study suggested that polyphenol and fibre-rich finger millet may have the potential to influence the management of prediabetes.

Objective: Evidence-based treatment for non-motor symptoms in Parkinson’s (PD) is limited. Lifestyle-based improvements including dietary changes may be a potential management strategy. To investigate the extent to which three dietary indices (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND), Dietary Inflammation Index (DII), and Healthy Diet Indicator (HDI-2020) are associated with overall and individual non-motor symptom severity amongst individuals with Parkinson’s.

Methods: An exploratory cross-sectional analysis of dietary (food frequency questionnaire) and clinical data, including measures of overall non-motor symptom severity, including fatigue, depression, anxiety, apathy, sleep problems, daytime sleepiness, and cognitive impairment.  The relationship between each dietary score and symptom outcome were assessed by linear regression for continuous variables and through general linear model analysis for tertiles of dietary adherence.

Results: None of the dietary indices significantly predicted the total non-motor symptom severity score. The HDI predicted a significant decrease in fatigue scores as measured by the NeuroQol fatigue item (standardised β= - .19, p= .022), after adjusting for age, gender, energy intake, years diagnosed, physical activity level, education, and smoking. Self-reported depression symptoms reduced by .17 (standardised β) for each unit increase in HDI score (p= .035), after controlling for age, gender, energy intake and years diagnosed. No other significant associations were evident between dietary scores and any other non-motor symptoms.

Conclusion: Our results indicate that fatigue and depression in Parkinson’s may be modified by diet; however more research is needed using a larger sample to replicate these findings.

Purpose.
To explore, in a European cohort of people living with Parkinson’s (PD), issues affecting employment and economic consequences, considering age at diagnosis.

Materials and methods.
A cross-sectional survey (European convenience sample). Inclusion criteria were ≥18 years, a PD diagnosis and in work when diagnosed. Data were collected online on demographics, employment status, occupation, and perceived health. For those no longer in paid work, time from diagnosis until loss of employment, reasons for leaving and enablers to stay in work were ascertained.

Results.
Between April and November 2019, n = 692 enrolled and n = 560 were eligible. Those who had lost paid work (n = 190, 34%) reported worse fatigue, sleep, and general health than those still in work (p

Conclusions.
This study confirms lost productivity after a PD diagnosis, especially in those with many years of potential employment ahead. The study also identified potential targets for interventions. Clinical trial registration: Clincaltrials.gov (NCT03905954).

Implications for rehabilitation.

* People with Parkinson’s diagnosed at career establishment or at mid working age risk losing many years of potential employment.

* Most people with Parkinson’s do not receive early intervention to support self-management of problems identified with leaving work early, such as fatigue.

* Adaptations to the work environment and more flexible working patterns were identified factors that may help people remain in work.

Flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue and fatigability.  However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with Parkinson’s (pwP) have been performed. 

Objectives: To determine the feasibility and estimate potential effect of flavonoid-rich cocoa on fatigue and fatigability in pwP.

Methods: This was a randomised (1:1) double-blind placebo controlled feasibility study in which 30 pwP were recruited from the European Parkinson Therapy Centre, Italy (trial registration: NCT03288155). During a six day intervention participants consumed a high (10.79mg/g) or low flavonoid cocoa (1.02mg/g) beverage (18 grams Cocoa with 200ml Rice milk) once daily. Potential effect on fatigue and fatigability was measured (baseline to day 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation.

Results: From July 2017 to May 2018, 30 pwP were recruited and randomised and allocated to high (n=15) or low (n=15) flavonoid groups and included in analysis. Missing data was less than 5% and adherence to intervention of all allocated individuals was 97%. There was a small effect on fatigability (six minute walk test: ES 0.11 (95%CI=-0.11-0.26); Z=0.81).There were 2 adverse events (one in the control and one in the intervention group).

Conclusion: The consumption of cocoa is feasible and well received in pwP, and further investigation on the effect on fatigability is warranted.

Fatigue is a common and pervasive symptom reducing physical activity in people with multiple sclerosis (pwMS). Exercise may reduce fatigue, although evidence to guide optimal prescription is limited. Specifically, supportive evidence for the timing of exercise for fatigue management or the impact of dietary supplements is unavailable. We performed intensive phenotyping of the interrelation of time of day, physical activity levels, and fatigue to evidence exercise prescription in 40 pwMS participating in a six week randomized controlled trial of morning flavonoid intake (n=19) or a control (n=21). Physical activity was measured over seven days by using an accelerometer at baseline, week three and week six. Participants self-reported their fatigue on a 1–10 rating scale at 10 am, 3 pm, and 8 pm daily. Physical activity levels were calculated for 2.5 h before and after fatigue was reported. Generalized estimating equations were used to explore the time of day fatigue profiles, the relationship of physical activity to fatigue, and the effect of morning flavonoids on this relationship. Participants experienced higher fatigue at 8 pm (4.64±2.29) than at 3 pm (4.39±2.28) and 10 am (3.90±2.10) (P0.05). Morning flavonoid cocoa consumption reduced the relationship of fatigue to physical activity (P=0.049) and fatigue to time of the day (P

Objectives
Individuals who have survived cancer may benefit from dietary modifications to improve quality of life and future health outcomes. The aim of this study was to explore dietary habits and experiences of nutritional support in patients with a cancer diagnosis who have received radiotherapy to the pelvic area.

Methods
A mixed-methods approach was used. Individuals diagnosed with a pelvic cancer (anal, bladder, rectal, and cancers of the reproductive organs), either undergoing or having completed pelvic radiotherapy 6 to 24 mo previously, were invited to participate in a postal survey. A purposive subsample was also invited to take part in telephone interviews. Thematic analysis of interview data was undertaken and integrated with data from quantitative analysis.

Results
The survey was completed by 254 (38%) respondents. Two-thirds of respondents (170) reported dietary changes since diagnosis; most notable changes were reduction of sugary foods (48%) and alcohol (41%). Receipt of support from the health care team was significantly associated with dietary change (odds ratio, 3.26; 95% confidence interval, 1.58–6.75); however, only 43% (108) had received dietary support from the health care team. Of the respondents, 68% (171) said they would like to receive additional dietary support. The effect of the condition on diet was highlighted in the theme “Impact of diagnosis and treatments on dietary choices.” Self-management of disease was influenced by personal resources, social resources, comorbidities and disabilities, influence of work, regaining normality, and barriers to dietary changes.

Conclusion
Lack of routine provision of nutritional care to patients after a cancer diagnosis and patient interest in this area highlighted unmet needs in managing diet-related problems and leading a healthy future lifestyle.

Background: Since the beginning of the COVID-19 pandemic, access to fresh food has been restricted, and people are spending more time inside and have limited their physical activity. However, more time at home may have resulted in some positive habits including an increase in cooking. The aim of this review was to assess dietary changes during the first lockdown. Themes and patterns were considered and associations with other lifestyle factors were assessed.

Methods: Between June and July 2020, the PubMed, Google Scholar, and Science Direct databases were searched, and results were screened for eligibility based on title, abstract, and full text. The inclusion criteria of this search included: papers published (or in pre-print) in the year 2020; studies that investigated the impact of COVID-19 lockdown on diet; papers published in English. Exclusion criteria were as follows: papers examining dietary changes in those following a structured diet based on diagnosed conditions or dietetic advice; literature, systematic, or narrative studies reviewing previous research. Researchers agreed on the study characteristics for extraction from final papers.

Results: Four thousand three hundred and twenty-two studies were originally considered with 23 final full-text papers included. Four themes were identified: dietary patterns, dietary habits (favorable), dietary habits (unfavorable), and other (includes physical activity levels, weight gain). A total of 10 studies reported an increase in the number of snacks consumed, while six studies found that participants increased their meal number and frequency during quarantine. Eleven studies reported favorable changes in dietary habits with an increase in fresh produce and home cooking and reductions in comfort food and alcohol consumption. However, nine studies found a reduction in fresh produce, with a further six reporting an increase in comfort foods including sweets, fried food, snack foods, and processed foods. Two studies reported an increase in alcohol consumption. In eight studies participants reported weight gain with seven studies reporting a reduction in physical exercise.

Conclusion: The effect of COVID-19 lockdown both negatively and positively impacted dietary practices throughout Europe and globally, and negative diet habits were associated with other poor lifestyle outcomes including weight gain, mental health issues, and limited physical activity. Both in the short term and if sustained in the long term, these changes may have significant impacts on the health of the population.

To assess the intake of nutrients in people with multiple sclerosis (pwMS) compared to a control population, and to assess the pro/ anti-inflammatory properties of nutrients/ foods and their relationships with fatigue and quality of life. This was a cross sectional study in which 2410 pwMS (686 men; 1721 women, 3 n/a, mean age 53 (11 years)) provided dietary data using a food frequency questionnaire that was hosted on the MS Register for a period of 3 months and this was compared to a cohort of 24,852 controls (11,250 male, 13,602 female, mean age 59 years). Consent was implied by anonymously filling out the questionnaire. A Wilcoxon test was used to compare intake between pwMS and controls, and a bivariate analyses followed by chi2 test were undertaken to identify significance and the strength of the relationship between pro/anti-inflammatory dietary factors and fatigue and EQ-5D. Compared to controls, all nutrients were significantly lower in the MS group (P

Introduction: This study aimed to review diet and nutrition information and support needs of cancer patients who receive pelvic radiotherapy to inform the development of interventions to improve this area of care.
Methods: The systematic review followed the PRISMA guidelines. Six electronic databases were searched for peer-reviewed studies of any design that assessed diet and nutrition needs after a pelvic cancer diagnosis. Narrative synthesis was used to integrate findings. Results: Thirty studies (12 quantitative, 15 qualitative, 3 mixed-methods) were included. Four themes, “content of dietary information”; “sources of information”. “sustaining dietary change”; and “views on the role of diet post-treatment”, summarised evidence about provision of nutritional guidance following diagnosis, but also contrasting views about the role of diet post diagnosis. Qualitative studies contributed considerably more to the synthesis, compared to quantitative studies. Included studies were of moderate to good quality; selection bias in quantitative studies and poor evidence of credibility and dependability in qualitative studies were highlighted. Conclusion: There is some evidence of lack of nutrition support in pelvic cancer survivors, but methodological limitations of included studies may have had an impact on the findings. Future, prospective studies that focus on diet and nutrition needs post-diagnosis are warranted to improve care.

Objectives: A healthy diet has been linked to better physical function in older adults but evidence on the role of cumulative dietary exposure is scarce. Sex differences in the relationship are also underexplored. The objective was to explore the longitudinal association of diet quality in adulthood (from 36–64 y), in line with dietary guidelines, and walking speed as an objective measure of later life physical function.

Methods: Study sample was derived from the Insight 46 (n = 502), a neuroscience sub-study of the longitudinal National Survey of Health and Development, UK. Diet was assessed four times, at age 36 y, 43 y, 53 y and 60–64 y using five-day food diaries, from which the Healthy Eating Index-2015 (HEI) was calculated (0 - low quality, 100 - high quality). Walking speed was estimated in a 10-meter walk test at self-selected pace, using an inertial measurement unit at age 69–71 y. Linear mixed models with random effects and group-based trajectory modeling were used to assess individual and group changes in HEI in adulthood. Multivariable linear regression models with sex as modifier, controlling for multiple characteristics assessed the association between adulthood HEI trajectories and walking speed at 71 y. The final sample was 226 women and 230 men.

Results: Men and women improved diet quality linearly in adulthood (β: 0.6 HEI/y, 95% CI: 0.5, 0.7). Three linear HEI trajectories were identified (21% “Low” βo: 33, β: 3.6; 59% “Medium” βο: 38, β: 6.1; 20% “High” βο: 52, β: 5.5, P rates, higher HEI at each age (β: 4 HEI points, 95% CI: 3, 6) and were

more likely to belong to the “High” HEI trajectory than men (β: 1.97, P increase in predicted HEI trajectory and membership in the “High” vs “Medium”-“Low” HEI trajectories were associated with faster walking speed (β: 0.04 m/s, 95% CI: 0.01, 0.08, β: 0.06 m/s, 95% CI: 0.01, 0.11, respectively). Association was attenuated in multivariable models. No association was observed in men.

Conclusions: In women, higher diet quality in adulthood was associated with faster walking speed in later life. Achieving and maintaining high diet quality in adulthood is likely of importance to yield benefits in physical function.

Funding Sources: Medical Research Council UK Alzheimer’s Research UK Dementias Platform UK Wolfson Foundation UK CLOSER UK.

Background. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) affects approximately 250,000 people in the UK. The condition varies in severity causing long-term physical and cognitive fatigue which is not alleviated by rest. Whilst the pathology is not understood, recent evidence suggests metabolic abnormalities may be associated with the manifestation of symptoms, particularly involving the metabolism of glucose and energy production. The use of ketone bodies as an alternative energy substrate may be beneficial to people with ME/CFS, in order to by-pass the glycolytic pathway, enhance energy production and reduce fatiguing outcomes.

Study Design and Methods. Using a pragmatic collective case study with repeated measures methodology we investigated the feasibility of following a ketogenic diet and potential effects of the high fat, low carbohydrate diet on response to physical activity in people with ME/CFS (n=3) and healthy controls (n=3) using a submaximal exercise stress test both with and without dietary intervention. Exercise tolerance (mins), rate of oxygen consumption (VO2) to workload (75W), respiratory exchange ratio (RER), rate of perceived effort (RPE) and lactate response were measured throughout and descriptive statistics performed.  

Results. We found that the ketogenic diet was followed, with compliance higher in the pwME/CFS. Variations in response following the ketogenic diet was observed across individuals in minutes performed, VO2, HR, RER, and RPE post diet but the KD only limited exercise capacity in the control individuals. Individuals responded differently to the KD but group trends have been reported as means and standard deviation. The KD resulted in a decrease in RER at submax in the controls with a mean change of 0.07 from baseline (0.86 ± 0.1) to post intervention (0.79 ± 0.1) compared to a mean change of 0.02 in the ME/CFS from baseline (1.03 ± 0.1) to post intervention (1.01 ± 0.1). A decrease in VO2 (L/min) at submax showed a mean change of 0.06 (L/min) in the pwME/CFS at baseline (1.34 ± 0.1) to post intervention (1.27 ± 0.2) compared to a mean change of 0.07 (L/min) in the controls at baseline (1.40 ± 0.3) to post intervention (1.33 ± 0.2). HR (bpm) at submax decreased in all individuals, with a mean change of 4 (bpm), with pwME/CFS at baseline (139 ± 8.2) to post intervention (135 ± 14) and control individuals at baseline (107 ± 7.8) to intervention (103 ± 3.2). RPE at submax decreased in the pwME/CFS from baseline (6 ± 1.0) to post intervention (5 ± 2.1) whereas the controls increased from baseline (2 ± 1.0) to post intervention (3 ± 1.5). 

Conclusion. Our observations suggest individualised but metabolic flexibility in healthy individuals is achievable via dietary manipulation showing the ability to switch from glucose to fats under controlled conditions. The different response in substrate utilisation in individuals with ME/CFS suggests that potential metabolic abnormalities may be present in ME/CFS.  Further investigation is now warranted in order to assess whether the KD is beneficial for people with ME/CFS.

Healthy diet has been linked to better age-related physical functioning, but evidence on the relationship of overall diet quality in late midlife and clinically relevant measures of physical functioning in later life is limited. Research on potential sex differences in this relationship is scarce. The aim was to investigate the prospective association between overall diet quality, as assessed by the Healthy Eating Index-2015 at age 60-64y and measures of walking speed seven years later, among men and women from the Insight46, a neuroscience sub-study of the Medical Research Council National Survey of Health and Development. Diet was assessed at age 60-64y using five-day food diaries, from which total HEI-2015 was calculated. At age 69-71y, walking speed was estimated during four 10-meter walks at self-selected pace, using inertial measurement units. Multivariable linear regression models with sex as modifier, controlling for age, follow-up, lifestyle, health, social variables and physical performance were used. The final sample was 164 women and 167 men (n=331). Women had higher HEI-2015 scores and slower walking speed than men. A 10 point increase in HEI-2015 was associated with faster walking speed seven years later among women (B: 0.024, 95% CI: 0.006, 0.043), but not men. The association remained significant in the multivariable model (B: 0.021, 95% CI: 0.003, 0.040). In women in late midlife higher diet quality is associated with faster walking speed. A healthy diet in late midlife is likely to contribute towards better age-related physical capability and sex differences are likely to affect this relationship.

Introduction: Individuals with Duchenne Muscular Dystrophy (DMD) present with progressive loss of motor function which can impair both control of speed and accuracy of movement. Aim: to evaluate movement time during a task at various levels of difficulty and to verify whether the level of difficulty affects the speed and/ or accuracy during the task. Methods: the DMD group comprised of 17 individuals age matched with 17 individuals with typical development (TD group). The task evaluates the relationship between speed and accuracy, consisting of the execution of manual movements (using the mouse of the computer) aimed at a target at three different levels of difficulty (ID). Results: A MANOVA demonstrated statistically significant differences in dispersion data and intercept values between the groups with greater movement time in the DMD group. An ANOVA indicated differences between groups for ID, except for when there was a higher accuracy demand (higher ID). In the other IDs that required lower accuracy demand, individuals in the DMD group had significantly longer movement time when compared to the TD group. Conclusion: These results show that the TD and DMD did not differ in the higher ID, therefore it can be concluded that for those with DMD, motor performance is more affected by speed than accuracy of movement. 

What this paper adds?
It is known that individuals with DMD have considerable motor deficits, however this paper shows that when the task involves higher accuracy compared with speed, people with DMD have performance similar to typically developed peers. This insight is a novel finding and can inform the rehabilitation team, to focus on training of speed, whilst maintaining accuracy for better execution of daily life tasks. 

Aim. The dual aim of this research is to consider the impact of providing the First Steps program on the stories of people with Parkinson’s Disease (PD)  and investigate the psychosocial and emotional mechanisms which may explain this impact. 
Methods. A qualitative study using a subtle realist paradigm and hermeneutic phenomenological methodology was undertaken. A single semi-structured interview was used to consider the impact and experiences of people with PD who completed either the intervention (2-day peer-led behavior intervention using storytelling 6-8 weeks apart) or received telephone support calls as part of the active control group. Descriptive statistics and narrative analysis were undertaken on the results. 
Results. Forty-two participants were invited to participate of whom forty completed the interview. This included 18 from the intervention group and 22 from the active control group. The intervention group identified the value of the program as worth-while, demonstrating improved exercise behavior and coping mechanisms following the intervention. Three major stories (the affirmed, the validated and the transformed story) identified the impact of the intervention. Three internal mechanisms (perceived control, hope and action, and the individual’s mind set) alongside three social mechanisms (social comparison, social control and the first opportunity to share with peers) appeared to explain the impact. 
Conclusion. This study provides exciting and novel evidence for the impact of a peer led psycho-educational intervention for people newly diagnosed with PD. Further research is needed to consider the impact of stories-based approaches on participants and consider a critical evaluation of the mechanisms which may explain changes in stories and self-reported behaviour.

Autism spectrum disorder (ASD) is associated with persistent deficits in social communication and social interaction, including impaired multisensory integration which might negatively impact cognitive and motor skill performance, and hence negatively affect learning of tasks. Considering that tasks in virtual environment may provide an engaging tool as adjuncts to conventional therapies, we set out to compare motor performance between young people with ASD and a typically developing (TD) control group that underwent coincident timing tasks based on Kinect (no physical contact) and on Keyboard (with physical contact) environments. Using a randomized repeated cross-over controlled trial design, fifty young people with ASD and fifty with TD, matched by age and sex were divided into subgroups of 25 people that performed the two first phases of the study (acquisition and retention) on the same device – real or virtual – and then switched to the other device to repeat acquisition and retention phases and finally switched on to a touch screen (transfer phase). Results showed that practice in the virtual task was more difficult (producing more errors), but led to a better performance in the subsequent practice in the real task, with more pronounced improvement in the ASD as compared to the TD group. It can be concluded that the ASD group managed to transfer the practice from a virtual to a real environment, indicating that virtual methods may enhance learning of motor and cognitive skills. A need for further exploration of its effect across a number of tasks and activities is warranted. 

Daily consumption of millet-based foods is associated with a reduced risk of type-2 diabetes. The aim of the present study was to systematically review the literature describing intervention studies that have investigated the effects of consuming different types and forms of millet on the risk factors for type-2 diabetes. A literature search was conducted, using five databases, from May 2016 to January 2017, which identified 57 articles. Search terms included ‘millet’ AND healthy, pre-diabetic or type-2 diabetes AND fasting blood glucose or glycaemic or glycemic response or insulin response or glucose tolerance or insulin sensitivity. Nineteen
studies met the inclusion criteria. Although glycemic and insulin responses differ depending on the millet type and cooking method used, overall, millet has a beneficial effect on fasting and postprandial blood glucose and the plasma-insulin response in healthy individuals and those with type-2 diabetes. It can be concluded that millets do have the potential to play a protective role in the management of type-2 diabetes.

The gut microbiome comprises the community of microorganisms in the intestinal tract. Research suggests that an altered microbiome may play a role in a wide range of disorders including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Methods. 42 participants with ME/CFS with Irritable Bowel Syndrome (IBS) were allocated into one of two groups, 21 were treated with standard oral approaches, which centred around various nutritional remedies, probiotics, prebiotics, dietary advice and lifestyle advice. The second group who had mostly failed using oral approaches, were treated with Faecal Microbiome Transplantation (FMT). Each patient received 10 Implants, each from a different screened donor, and the Implants were processed under anaerobic conditions. The transplant is delivered via a paediatric rectal catheter, which is inserted through the anus to reach the lower part of the sigmoid colon.

The results were assessed on a percentage basis before and after treatment, 0% being no improvement, 100% being maximum improvement. An exact non-parametric Mann-Whitney (one-tailed) test was used to compare medians from those on FMT compared with those receiving oral approaches only. On clinical experience over many years, the only way to judge improvement in Chronic Fatigue Syndrome as there is no test for Chronic Fatigue Syndrome, is my clinical assessment.

Results. The median for the FMT group was found to be significantly higher compared to the oral treatment group (Mann-Whitney U = 111.5, p = .003). Therefore, the FMT group improved to a greater extent (z = −2.761).

Conclusion. This study shows that FMT is a safe and a promising treatment for CFS associated with IBS. Adequately powered randomised controlled trials should be carried out to assess the effectiveness of FMT in patients with CFS and IBS.

Background: Diet could have implications for disease progression and management in people with Parkinson’s disease (PwP). However, the knowledge of diet intake patterns in PwP is limited.
Objectives: We set out to assess the feasibility of collecting diet data in PwP to determine food and nutrient intake, in order to compare to national nutrition guidelines and thus understand the habits in this population. Methods: In this cross-sectional feasibility study, PwP were approached through local support groups throughout the Thames Valley and were asked to complete a Food Frequency Questionnaire. Eligibility criteria included a self-reported neurologist confirmed diagnosis of Parkinson’s disease. Completeness of questionnaires was reported and 80% was considered appropriate for each measure including demographic information. Results: Response rate was 61% and missing data rate for the 121 returned questionnaires was 74%; however, of the 90 used for analysis there was 100% completion of the questionnaires. Compared to the UK government guidelines, protein was significantly higher for both males and females and fluid intake was lower for both genders (p

Written information can be an essential source of support in the promotion of lifestyle changes after a cancer diagnosis. This study aimed to identify and assess the quality of available online Patient Information Materials (PIMs) in relation to diet and nutrition for pelvic cancer patients. The online sources of the National Health Service, cancer centres and charitable organisations throughout the UK were searched. Content was assessed using an evidence-based checklist, and readability with two validated formulas. Consumer feedback was sought through Patient and Public Involvement (PPI) groups. Forty PIMs were identified; four were designed specifically for pelvic cancers (bladder, bowel, prostate) and 36 were generic (relevant for all cancers). Most PIMs had a good content score, with PIMs from charities scoring higher overall than PIMs from cancer centres [32 (4) Vs 23 (11), P

Objective: to examine the extent of effect vitamin D in MS on pathology and symptoms. Methods: A literature search was performed in November 2017 (CRD42018103615). Eligibility criteria: randomised control trials  in English from 2012 to 2018; a clinical diagnosis of MS; interventions containing vitamin D supplementation (vitamin D3 or calcitriol) in disease activity compared to a control/ placebo; improvement in: serum 25(OH)D, relapse rates, disability status by EDSS scores, cytokine profile, quality of life, mobility, T2 lesion load and new T2 or T1 Gd enhancing lesions, safety and adverse effects. Risk of bias was evaluated. Results: Ten studies were selected. The study size ranged from 40 to 94 people. All studies evaluated the use of vitamin D supplementation (ranging from 10 IU to 98,000 IU), comparing to a placebo or low dose vitamin D. The duration of the intervention ranged from 12 to 96 weeks.  One trial found a significant effect on EDSS score, three demonstrated a significant change in serum cytokines level, one found benefits to current enhancing lesions and three studies evaluating the safety and tolerability of vitamin D reported no serious adverse events. Disease measures improved to a great extent overall in those with higher serum 25(OH)D levels. Conclusions: Improvement in disease measures may be more apparent in those with lower baseline vitamin D levels.

The impact of flavonoids on fatigue has not been investigated in Relapsing and Remitting Multiple Sclerosis (RRMS). Objective. To determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS.  Methods. A randomised double-blind placebo-controlled feasibility study in people recently diagnosed with RRMS and fatigue, throughout the Thames Valley (ISRCTN: 69897291). During a six week intervention participants consumed a high or low flavonoid cocoa beverage daily. Fatigue and fatigability were measured at three visits (weeks 0, 3 and 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation. Results. 40 pwMS (10 men, 30 women, age 44 ± 10 yrs) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data was 75%. There was a small effect on fatigue (Neuro-QoL: effect size {ES} 0.04; confidence interval {CI} -0.40-0.48) and a moderate effect on fatigability (six-minute walk test: ES 0.45; CI -0.18 - 1.07). There were seven adverse events (four control, three intervention), only one of which was possibly related and it was resolved.   Conclusion. A flavonoid beverage demonstrates the potential to improve fatigue and fatigability in RRMS. 

There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance. Objective. To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD. Methods. One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9–34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales. Results. All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface. Conclusion. Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434.

Background. Amyotrophic Lateral Sclerosis (ALS) is a rapid progressive neurodegenerative disease, characterized by a selective loss of motor neurons, brain stem and spinal cord which leads to deterioration of motor abilities. Devices that promote interaction with tasks on computers can enhance performance and lead to greater independence and utilization of technology. Objective. To evaluate performance on a computer task in individuals with ALS using three different commonly used non-immersive devices. Method. Thirty individuals with ALS (18 men and 12 women, mean age 59 years, range 44–74 years) with a mean score of 26, (minimum score of 14 and maximum 41) on the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and 30 healthy controls matched for age and gender, participated. All participants were randomly divided into three groups, each using a different device system (motion tracking, finger motion control or touchscreen) to perform three task phases (acquisition, retention and transfer). Results. Both the ALS and control group (CG) showed better performance on the computer task when using the touchscreen device, but there was limited transfer of performance onto the task performed on the Finger Motion control or motion tracking. However, we found that using the motion tracking device led to transfer of performance to the touchscreen. Conclusion. This study presents novel and important findings when selecting interaction devices for individuals with ALS to access technology by demonstrating immediate performance benefits of using a touchscreen device, such as improvement of motor skills. There were possible transferable skills obtained when using virtual systems which may allow flexibility and enable individuals to maintain performance overtime.

Symptoms of Parkinson’s can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person’s quality of life. To date, studies looking into exercise interventions for people with Parkinson’s (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon’s test followed by a Mann–Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p

Context. Current research suggests that dark cocoa may reduce fatigue; however, the effect on fatigue in people with MS (pwMS) has never been established. The objective of this feasibility study was to explore the acute effect of high flavonoid cocoa on measures of fatigue and glycaemic response. Methods. This was a randomised crossover participant blind exploratory study in 12 participants (2 male and 10 female) with MS-related fatigue (>4 on the Fatigue Severity Scale; FSS). After fasting overnight, participants consumed the high flavonoid cocoa drink (350 mg gallic acid equivalents {GAE}/g) or a low flavonoid cocoa control (120 mg GAE/g), consuming the alternative drink on the next visit. Fatigue was self-reported on a 100 mm visual analogue scale at 30-min time intervals for 2 h post cocoa consumption and every 2 h for the rest of the day. Fatigability was monitored using a 6 min walk test (6MWT) at the end of the visit (2 h), and activity monitors worn for 24 h commencing at 12 noon on the day of testing. The feasibility of performing the trial including outcome measures was documented. Results. A moderate effect was found in self-reported fatigue throughout the day in favour of the high flavonoid group (Cohen's d 0.32, 95% non-central t CI −0.57 to 1.20). Fatigability measures did not change. Participants consumed and enjoyed the cocoa, all participants completed the study and outcome measures were accepted. Conclusion. The results of this study support further trials to investigate the feasibility and efficacy of pure cocoa as a dietary supplement for fatigue in pwMS.

Methods: The study was conducted on 20 healthy participants. The study was a one day single blind crossover design. Participants were randomised to either a test smoothie consisting of 15g of baobab extract or a control smoothie without the addition of baobab. Subjective ratings of satiety were taken on visual analogue scales immediately pre consumption and then post consumption, and energy intake at a post ad libitum meal was recorded. 

Results: Subjective measures of hunger were reduced following the test smoothie compared to the control (p

Conclusions: This research has positive implications for the use of baobab for reducing hunger, possibly having a positive effect on weight maintenance.

Extracts from different plant sources have been shown to modify starch digestion from carbohydrate-rich foods and lower resulting glycemia. It was hypothesized that extracts rich in polyphenols, added to white bread, would improve the glycemic response and insulin response and increase satiety in healthy participants. An in vitro dose-response analysis was performed to determine the optimal dose of a variety of extracts (baobab fruit extract, green tea extract, grape seed extract, and resveratrol) for reducing rapidly digestible starch in white bread. The 2 extracts with the greatest sugar reducing potential were then used for the human study in which 13 volunteers (9 female and 4 male) were recruited for a crossover trial of 3 different meals. On separate days, participants consumed a control white bread, white bread with green tea extract (0.4%), and white bread with baobab fruit extract (1.88%). Glycemic response, insulin response, and satiety were measured 3 hours postprandially. Although enriched breads did not reduce glycemic response or hunger, white bread with added baobab fruit extract significantly (P