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, UK (ISRCTN: 69897291). During a 6-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 people with multiple sclerosis (10 men, 30 women, age 44±10 years) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data were 75%. There was a small effect on fatigue (Neuro-QoL: effect size (ES) 0.04, 95% CI −0.40 to 0.48) and a moderate effect on fatigability (6 min walk test: ES 0.45, 95% CI −0.18 to 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.

Background: The therapeutic effects of exercise from structured activity programmes have recently been questioned; as a result, this study examines the impact of an Individualised Activity Program (IAP) on the relationship with cardiovascular, mitochondrial and fatigue parameters. Methods: Chronic fatigue syndrome (CFS) patients were assessed using Chalder Fatigue Questionnaire (CFQ), Fatigue Severity Score (FSS) and the Fatigue Impact Scale (FIS). VO₂peak, VO₂submax and heart rate (HR) were assessed using cardiopulmonary exercise testing. Mfn1 and Mfn2 levels in plasma were assessed. A Task Force Monitor was used to assess ANS functioning in supine rest and in response to the Head-Up Tilt Test (HUTT). Results: Thirty-four patients completed 16 weeks of the IAP. The CFQ, FSS and FIS scores decreased significantly along with a significant increase in Mfn1 and Mfn2 levels (p = 0.002 and p = 0.00005, respectively). The relationships between VO₂ peak and Mfn1 increase in response to IAP (p = 0.03) and between VO₂ at anaerobic threshold and ANS response to the HUTT (p = 0.03) were noted. Conclusions: It is concluded that IAP reduces fatigue and improves functional performance along with changes in autonomic and mitochondrial function. However, caution must be applied as exercise was not well tolerated by 51% of patients.

Purpose: The purpose of this study was to assess differences in the physiological profiles of completers vs. non-completers following a structured exercise programme (SEP) and the ability to predict non-completers, which is currently unknown in this group. Methods: Sixty-nine patients met the Fukuda criteria. Patients completed baseline measures assessing fatigue, autonomic nervous system (ANS), cognitive, and cardiovascular function. Thirty-four patients completed a home-based SEP consisting of 10–40 min per day at between 30 and 80% actual HR max. Exercise intensity and time was increased gradually across the 16 weeks and baseline measures were repeated following the SEP. Results: Thirty-five patients discontinued, while 34 completed SEP. For every increase in sympathetic drive for blood pressure control as measured by the taskforce, completion of SEP decreased by a multiple of 0.1. For a 1 millisecond increase in reaction time for the simple reaction time (SRT), the probability for completion of SEP also decreases by a multiple of 0.01. For a one beat HRmax increase, there is a 4% increase in the odds of completing SEP. Conclusion: The more sympathetic drive in the control of blood vessels, the longer the reaction time on simple visual stimuli and the lower the HRmax during physical exercise, then the lower the chance of SEP completion in ME/CFS.

Human gait is a significant indicator of overall health and well-being due to its dependence on metabolic requirements. Abnormalities in gait can indicate the presence of metabolic dysfunction, such as diabetes or obesity. However, detecting these can be challenging using classical methods, which often involve subjective clinical assessments or invasive procedures. In this work, a novel methodology known as Criticality Analysis (CA) was applied to the monitoring of the gait of teenagers with varying amounts of metabolic stress who are taking part in an clinical intervention to increase their activity and reduce overall weight. The CA approach analysed gait using inertial measurement units (IMU) by mapping the dynamic gait pattern into a nonlinear representation space. The resulting dynamic paths were then classified using a Support Vector Machine (SVM) algorithm, which is well-suited for this task due to its ability to handle nonlinear and dynamic data. The combination of the CA approach and the SVM algorithm demonstrated high accuracy and non-invasive detection of metabolic stress. It resulted in an average accuracy within the range of 78.2% to 90%. Additionally, at the group level, it was observed to improve fitness and health during the period of the intervention. Therefore, this methodology showed a great potential to be a valuable tool for healthcare professionals in detecting and monitoring metabolic stress, as well as other associated disorders.

The way in which a person walks, known as human gait, is a significant indicator of overall health and well-being. Abnormalities in gait can indicate the presence of metabolic disorders, such as diabetes or obesity. However, detecting these disorders can be challenging using traditional methods, which often involve subjective assessments or invasive procedures. In this study, a novel methodology known as Criticality Analysis (CA) was proposed for the detection and monitoring of human gait in people with metabolic disorders taking part in an intervention to increase activity and reduce weight. The CA approach utilised inertial measurement unit gait data, alongside clinical health measures. This allows for the control of nonlinear growth in the system, resulting in lower dimensional, nonlinear, free-scale, stable, controlled, and organised trajectories. These trajectories were then analysed using a Support Vector Machine (SVM) algorithm, which is well-suited for this task due to its ability to handle nonlinear and dynamic data. The combination of the CA approach and the SVM algorithm demonstrated high accuracy and non-invasiveness in detecting metabolic disorders, yielding an average accuracy within the range of 78.2% to 90%. Additionally, the classification technique accuracy, at a group level was observed to reduce during period of the intervention (e.g., from week 2 to week 3) alongside changes in fitness and health, which indicates the potential of using the approach to measure and monitor biological systems. As such, this novel methodology has the potential to be a valuable tool for healthcare professionals in detecting and monitoring metabolic disorders, as well as other unknown diseases associated with the human biological system.

Purpose : Using systematic review methodology, we set out to describe the evidence for physical activity and nutrition interventions for children and adolescents with cerebral palsy (CP) as compared with no intervention or exposure that reports physical health and cognitive outcomes. Method : Quantitative, primary studies that explored the effectiveness of these interventions, replicable in school and home contexts, in comparison to any other or no intervention or exposure in children and adolescents between the ages of 6–18 years old with a diagnosis of cerebral palsy were included (PROSPERO CRD42022322143). Risk of bias was assessed by Joanna Briggs Institute and QualSyst. Results : A total of 16 international heterogeneous studies (13 physical activity and 3 nutrition) with interventions ranging from a single exposure to 8 months, with quality 58% to 89% and effectiveness, D = 0.03 to 0.97, were included. Outcome measures were varied. Conclusion : The review brings together a number of high-quality studies on physical activity and nutrition interventions and promising findings of impact on cardiovascular, musculoskeletal, and cognitive outcomes. Evidence supports implementation of these interventions in community contexts. Future research would benefit from agreement on the use of core outcome measures for meta-synthesis.