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Gold J, Holden D, Parratt J, Yiannikas C, Ahmad R, Sedhom M, Giovannoni G. Effect of teriflunomide on Epstein-Barr virus shedding in relapsing-remitting multiple sclerosis patients: Outcomes from a real-world pilot cohort study. Mult Scler Relat Disord 2022; 68:104377. [PMID: 36544305 DOI: 10.1016/j.msard.2022.104377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Given its potential antiviral activity, we investigated the effect of teriflunomide on EBV in patients with relapsing-remitting MS (RRMS). METHODS Saliva samples were collected at home and analysed for EBV DNA presence in patients with RRMS treated with teriflunomide for ≥3 months. RESULTS The proportion of patients with detectable EBV in the teriflunomide cohort was lower than in the reference cohorts. The proportion of samples with EBV DNA or shedding from teriflunomide-treated patients was reduced relative to each reference cohort (P<0.0001; >5.8 virus copies/µL cut-off). CONCLUSION This pilot study demonstrated the feasibility of at-home saliva sample collection and revealed a possible effect of teriflunomide on EBV shedding.
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Affiliation(s)
- Julian Gold
- Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; The Albion Centre, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - David Holden
- Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
| | - John Parratt
- The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Con Yiannikas
- The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Raghib Ahmad
- Australian Digital Health Agency, Sydney, NSW, Australia.
| | - Mamdouh Sedhom
- Sanofi Australia Pty Ltd, Macquarie Park, NSW, Australia.
| | - Gavin Giovannoni
- Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
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Huynh TLT, Silveira SL, Motl RW. Systematic review of participant characteristics in theory-based behavior change interventions for physical activity in multiple sclerosis: are we missing those with the greatest potential for lifelong benefits? Disabil Rehabil 2022; 44:5784-5803. [PMID: 34334057 DOI: 10.1080/09638288.2021.1954705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined participant characteristics, particularly disease duration, in theory-based physical activity behavior change trials in multiple sclerosis (MS) and summarized theoretical frameworks and changes in physical activity outcomes. MATERIALS AND METHODS PubMed, CINAHL, Embase, and Scopus were searched to identify potential trials. One reviewer screened titles and abstracts, and two reviewers then independently screened full-text articles based on predetermined eligibility criteria. Data were extracted by one reviewer and checked by a second reviewer. RESULTS Among 33 trials reviewed, only one trial reported a mean disease duration of less than five years (i.e., 4.5 years) for the sample. The remaining trials included samples with a mean disease duration of 6.7 years or longer. The most common theories used were Social Cognitive Theory, Trans-theoretical Model, and Motivational Interviewing. The effects on physical activity were heterogeneous; device-measured outcomes increased in 41.4% of studies, self-reported outcomes improved in 72.4%. Adherence (≥80%) was reported in 34.5% of studies. CONCLUSIONS There is little focus on persons with MS in the early disease course in physical activity behavior change interventions. Future research should include comprehensive theoretical approaches for more homogeneous effects across outcome measures when targeting those in the early stage and all MS populations.IMPLICATIONS FOR REHABILITATIONTheory-based physical activity behavior change interventions have not included persons with multiple sclerosis (MS) in the early disease course (<5 years since diagnosis).Disease duration has not been a criterion used to include or exclude participants in the reviewed theory-based behavior change interventions for physical activity in people with MS.The theory-based behavior change interventions in this review positively affected short-term physical activity levels in people with MS.
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Affiliation(s)
- Trinh L T Huynh
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Robert W Motl
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Silveira SL, Huynh T, Kidwell A, Sadeghi-Bahmani D, Motl RW. Behavior Change Techniques in Physical Activity Interventions for Multiple Sclerosis. Arch Phys Med Rehabil 2021; 102:1788-1800. [PMID: 33549545 DOI: 10.1016/j.apmr.2021.01.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify and summarize the behavior change techniques (BCTs) included in behavior change interventions for promoting physical activity in persons with multiple sclerosis (MS). DATA SOURCES PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Complete, Scopus, and Embase were initially searched in November 2019, and data extraction began in June 2020. STUDY SELECTION The inclusion criteria for studies were: adults older than 18 years with diagnosed MS, English language, clinical trial designs (ie, pre-post or randomized controlled trials), group or individual interventions, and home or community-based settings wherein physical activity was defined as a primary or secondary outcome. Exclusion criteria for studies included protocol manuscripts pending results, case studies, studies focused on populations with multiple chronic diseases, and interventions targeting multiple behaviors. Two researchers completed screening for study selection, and a third researcher served as a referee. Of the initially identified 8681 studies, 54 studies met selection criteria. DATA EXTRACTION Data extraction was completed by 3 researchers. Each article was coded by 2 of the 3 researchers, and a fourth researcher resolved discrepancies. Data extracted from each paper included study title, authors, country, year, sample size, study design, intervention details, physical activity outcomes, and BCTs. DATA SYNTHESIS Thirty-eight unique behavior change interventions were identified, and 53 of the 93 possible BCTs were included across the studies. The mean number of BCTs per study was 15, and studies and effect sizes across studies ranged from 0.04-1.49. CONCLUSIONS This review provides a comprehensive overview of BCTs as the active ingredients in behavior change interventions targeting physical activity in MS. Results from this study provide a compendium for future intervention development for increasing physical activity and improving overall health in MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL.
| | - Trinh Huynh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Ariel Kidwell
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Dena Sadeghi-Bahmani
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
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Kinnett-Hopkins D, Motl R. Results of a feasibility study of a patient informed, racially tailored home-based exercise program for black persons with multiple sclerosis. Contemp Clin Trials 2018; 75:1-8. [DOI: 10.1016/j.cct.2018.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
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Beran RG, Stepanova D, Beran ME. Justification for conducting neurological clinical trials as part of patient care within private practice. Int J Clin Pract 2016; 70:365-71. [PMID: 27040457 DOI: 10.1111/ijcp.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re-imbursement of trial-related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up-to-date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry-sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start-Up Managers or Drug Safety Associates.
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Affiliation(s)
- R G Beran
- Liverpool Hospital, Sydney, NSW, Australia
- Griffith University, Gold Coast and Brisbane, Qld, Australia
- Strategic Health Evaluators, Sydney, NSW, Australia
| | - D Stepanova
- Strategic Health Evaluators, Sydney, NSW, Australia
| | - M E Beran
- Strategic Health Evaluators, Sydney, NSW, Australia
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Streber R, Peters S, Pfeifer K. Systematic Review of Correlates and Determinants of Physical Activity in Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:633-645.e29. [PMID: 26751247 DOI: 10.1016/j.apmr.2015.11.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/16/2015] [Accepted: 11/20/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To review the current evidence regarding correlates and determinants of physical activity (PA) in persons with multiple sclerosis (pwMS). DATA SOURCES PubMed and Scopus (1980 to January 2015) and reference lists of eligible studies. STUDY SELECTION Eligible studies include adults with multiple sclerosis; have a cross-sectional or prospective observational design; or examine the effect of a theory-based intervention trial on PA, including a mediation analysis. Eligible studies also apply a quantitative assessment of PA and correlates or proposed mediators and are published in English or German language. DATA EXTRACTION Two reviewers independently evaluated the risk of bias, extracted data, and categorized variables according to the International Classification of Functioning, Disability and Health. DATA SYNTHESIS Consistency and the direction of associations were evaluated with a semiquantitative approach. Fifty-six publications with data from observational studies and 2 interventional studies provided evidence for 86 different variables. Consistent correlates of PA were the disability level, walking limitations in particular, PA-related self-efficacy, self-regulation constructs, employment status, and educational level. One interventional study provided evidence for a causal relation between self-regulation and PA. However, 59 of the 86 investigated variables in observational studies are based on 1 or 2 study findings, and most results stem from cross-sectional designs. CONCLUSIONS Beside the importance of the general disability level and walking limitations, the results highlight the importance of personal factors (eg, PA-related self-efficacy, self-regulatory constructs, sociodemographic factors). Limitations and implications of the current review are discussed. Research that is more rigorous is needed to better understand what affects PA in pwMS.
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Affiliation(s)
- René Streber
- Institute of Sport Science and Sport, Division Exercise and Health, Department Psychology and Sport Science, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Peters
- Institute of Sport Science and Sport, Division Exercise and Health, Department Psychology and Sport Science, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Klaus Pfeifer
- Institute of Sport Science and Sport, Division Exercise and Health, Department Psychology and Sport Science, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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Carter A, Humphreys L, Snowdon N, Sharrack B, Daley A, Petty J, Woodroofe N, Saxton J. Participant recruitment into a randomised controlled trial of exercise therapy for people with multiple sclerosis. Trials 2015; 16:468. [PMID: 26470880 PMCID: PMC4608102 DOI: 10.1186/s13063-015-0996-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background The success of a clinical trial is often dependant on whether recruitment targets can be met in the required time frame. Despite an increase in research into the benefits of exercise in people with multiple sclerosis (PwMS), no trial has reported detailed data on effective recruitment strategies for large-scale randomised controlled trials. The main purpose of this report is to provide a detailed outline of recruitment strategies, rates and estimated costs in the Exercise Intervention for Multiple Sclerosis (ExIMS) trial to identify best practices for future trials involving multiple sclerosis (MS) patient recruitment. Methods The ExIMS researchers recruited 120 PwMS to participate in a 12-week exercise intervention. Participants were randomly allocated to either exercise or usual-care control groups. Participants were sedentary, aged 18–65 years and had Expanded Disability Status Scale scores of 1.0–6.5. Recruitment strategies included attendance at MS outpatient clinics, consultant mail-out and trial awareness-raising activities. Results A total of 120 participants were recruited over the course of 34 months. To achieve this target, 369 potentially eligible and interested participants were identified. A total of 60 % of participants were recruited via MS clinics, 29.2 % from consultant mail-outs and 10.8 % through trial awareness. The randomisation yields were 33.2 %, 31.0 % and 68.4 % for MS clinic, consultant mail-outs and trial awareness strategies, respectively. The main reason for ineligibility was being too active (69.2 %), whilst for eligible participants the most common reason for non-participation was the need to travel to the study site (15.8 %). Recruitment via consultant mail-out was the most cost-effective strategy, with MS clinics being the most time-consuming and most costly. Conclusions To reach recruitment targets in a timely fashion, a variety of methods were employed. Although consultant mail-outs were the most cost-effective recruitment strategy, use of this method alone would not have allowed us to obtain the predetermined number of participants in the required time period, thus leading to costly extensions of the project or failure to reach the number of participants required for sufficient statistical power. Thus, a multifaceted approach to recruitment is recommended for future trials. Trial registration International Standard Randomised Controlled Trial Registry number: ISRCTN41541516; date registered: 5 February 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0996-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anouska Carter
- The Centre for Sport and Exercise Science, Health and Wellbeing Research Institute, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.
| | - Liam Humphreys
- The Centre for Sport and Exercise Science, Health and Wellbeing Research Institute, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.
| | - Nicky Snowdon
- The Centre for Sport and Exercise Science, Health and Wellbeing Research Institute, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.
| | - Basil Sharrack
- Academic Department of Neuroscience, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Amanda Daley
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
| | | | - Nicola Woodroofe
- Biomedical Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - John Saxton
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Northumbria, UK.
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Carter A, Daley A, Humphreys L, Snowdon N, Woodroofe N, Petty J, Roalfe A, Tosh J, Sharrack B, Saxton JM. Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial. Mult Scler 2014; 20:1112-22. [DOI: 10.1177/1352458513519354] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/12/2013] [Indexed: 01/07/2023]
Abstract
Background: Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis (P wMS). Objective: The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in P wMS to nine months of follow-up. Methods: We conducted a parallel-arm, randomised controlled trial: 120 P wMS (Expanded Disability Status Scale (EDSS) 1.0–6.5) randomised to a three-month exercise intervention plus usual care, or usual care only. Two supervised plus one home-exercise session (weeks 1–6) were followed by one supervised and two home-exercise sessions (weeks 7–12). Cognitive-behavioural techniques promoted long-term exercise behaviour change. Outcomes were blindly assessed at baseline and at three and nine months after randomisation. The primary outcome was self-reported exercise behaviour (Godin Leisure Time Exercise Questionnaire (GLTEQ)). Secondary outcomes included fatigue and health-related quality of life (HRQoL). Results: The intervention increased self-reported exercise (9.6 points; 95% CI: 2.0 to 17.3 points; p = 0.01) and improved fatigue ( p < 0.0001) and many HRQoL domains ( p ≤ 0.03) at three months. The improvements in emotional well-being ( p = 0.01), social function ( p = 0.004) and overall quality of life ( p = 0.001) were sustained for nine months. Conclusion: This pragmatic approach to implementing exercise increases self-reported exercise behaviour, improves fatigue and leads to a sustained enhancement of HRQoL domains in P wMS.
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Affiliation(s)
- A Carter
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - A Daley
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - L Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - N Snowdon
- Centre for Health and Social Care Research, Sheffield Hallam University, UK
| | - N Woodroofe
- Biomedical Research Centre, Sheffield Hallam University, UK
| | - J Petty
- Multiple Sclerosis Society, UK
| | - A Roalfe
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - J Tosh
- School of Health and Related Research, University of Sheffield, UK
| | - B Sharrack
- Neurology Department, Sheffield Teaching Hospitals Foundation Trust, UK
| | - JM Saxton
- School of Rehabilitation Sciences, University of East Anglia, UK
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Tosh J, Dixon S, Carter A, Daley A, Petty J, Roalfe A, Sharrack B, Saxton JM. Cost effectiveness of a pragmatic exercise intervention (EXIMS) for people with multiple sclerosis: economic evaluation of a randomised controlled trial. Mult Scler 2014; 20:1123-30. [DOI: 10.1177/1352458513515958] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
Background: Exercise is a safe, non-pharmacological adjunctive treatment for people with multiple sclerosis but cost-effective approaches to implementing exercise within health care settings are needed. Objective: The objective of this paper is to assess the cost effectiveness of a pragmatic exercise intervention in conjunction with usual care compared to usual care only in people with mild to moderate multiple sclerosis. Methods: A cost-utility analysis of a pragmatic randomised controlled trial over nine months of follow-up was conducted. A total of 120 people with multiple sclerosis were randomised (1:1) to the intervention or usual care. Exercising participants received 18 supervised and 18 home exercise sessions over 12 weeks. The primary outcome for the cost utility analysis was the incremental cost per quality-adjusted life year (QALY) gained, calculated using utilities measured by the EQ-5D questionnaire. Results: The incremental cost per QALY of the intervention was £10,137 per QALY gained compared to usual care. The probability of being cost effective at a £20,000 per QALY threshold was 0.75, rising to 0.78 at a £30,000 per QALY threshold. Conclusion: The pragmatic exercise intervention is highly likely to be cost effective at current established thresholds, and there is scope for it to be tailored to particular sub-groups of patients or services to reduce its cost impact.
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Affiliation(s)
- J Tosh
- School of Health and Related Research, University of Sheffield, UK
| | - S Dixon
- School of Health and Related Research, University of Sheffield, UK
| | - A Carter
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - A Daley
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - J Petty
- Multiple Sclerosis Society, UK
| | - A Roalfe
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - B Sharrack
- Neurology Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - JM Saxton
- School of Rehabilitation Sciences, University of East Anglia, UK
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Carter AM, Daley AJ, Kesterton SW, Woodroofe NM, Saxton JM, Sharrack B. Pragmatic exercise intervention in people with mild to moderate multiple sclerosis: A randomised controlled feasibility study. Contemp Clin Trials 2013; 35:40-7. [DOI: 10.1016/j.cct.2013.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 04/10/2013] [Accepted: 04/12/2013] [Indexed: 11/16/2022]
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Encouraging participation in health initiatives: parkrun. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.6.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Blake H. Physical activity and exercise in the treatment of depression. Front Psychiatry 2012; 3:106. [PMID: 23233842 PMCID: PMC3516810 DOI: 10.3389/fpsyt.2012.00106] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 11/21/2012] [Indexed: 12/02/2022] Open
Affiliation(s)
- Holly Blake
- Faculty of Medicine and Health Sciences, Queen's Medical Centre, University of Nottingham Nottingham, UK
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