Medicine and Health Sciences Commons^™

The Current State Of Subjective Training Load Monitoring—A Practical Perspective And Call To Action, Joseph O. C. Coyne, G. Gregory Haff, Aaron J Coutts, Robert U. Newton, Sophia Nimphius

Research outputs 2014 to 2021

This commentary delivers a practical perspective on the current state of subjective training load (TL) monitoring, and in particular sessional ratings of perceived exertion, for performance enhancement and injury prevention. Subjective measures may be able to reflect mental fatigue, effort, stress, and motivation. These factors appear to be important moderators of the relationship TL has with performance and injury, and they also seem to differ between open and closed skill sports. As such, mental factors may affect the interaction between TL, performance, and injury in different sports. Further, modeling these interactions may be limited due to the assumption that an …

Aerobic Exercise And Fatigue In Rheumatoid Arthritis Participants: A Meta-Analysis Using The Minimal Important Difference Approach, George A. Kelley, Kristi S. Kelley, Leigh F. Callahan

Clinical and Translational Science Institute

Objective To use the minimal important difference (MID) versus the standardized mean difference (SMD) approach in order to provide more robust and clinically relevant information regarding the association between land‐based aerobic exercise and changes in self‐reported fatigue among adults with rheumatoid arthritis (RA). Methods Data from a previous meta‐analysis of 5 randomized controlled trials that represented up to 298 participants per study were utilized to calculate 9 effect sizes, using the MID approach. Data used to obtain the MID were derived from previously reported anchor‐based values specific to each fatigue instrument in adults with RA. Results were pooled using a …

Understanding And Improving Older Male Participation And Older Adult Adherence In Evidence-Based Health Promotion Programs, Chelsie L. Anderson

FIU Electronic Theses and Dissertations

The aging population and burden of chronic conditions have led researchers and practitioners to develop, implement, and evaluate evidence-based programs (EBPs) for older adults. The Healthy Aging Regional Collaborative (HARC) was established to make EBPs including Diabetes Self-Management Program, Chronic Disease Self-Management Program, Matter of Balance, and EnhanceFitness (EF) accessible in south Florida. According to the REAIM model, reach, effectiveness, adoption, implementation, and maintenance determine the impact of EBPs. Evaluation of HARC demonstrated widespread adoption of EBPs by community organizations that reached diverse participants and effectiveness among participants attending the recommended number of sessions, but only 19% of EBP participants …

Moderate Exercise Enhances Endothelial Progenitor Cell Exosomes Release And Function, Chunlian Ma, Jinju Wang, Hua Liu, Yanyu Chen, Xiaotang Ma, Shuzhen Chen, Yanfang Chen, Ji Chen Bihl, Yi Yang

Pharmacology and Toxicology Faculty Publications

Purpose: Exercise has cardiovascular benefits which might be related to endothelial progenitor cells (EPC). Meanwhile, there is evidence suggesting that EPC-derived exosomes (EPC-EX) promote vascular repair and angiogenesis through their carried microRNA (miR)-126. In this study, we investigated whether exercise could increase the levels of circulating EPC-EX and their miR-126 cargo, and by which promote the protective function of EPC-EX on endothelial cells (EC). Methods: Plasma EPC-EX from sedentary, low, or moderate exercise mice, respectively, denoted as EPC-EXS, EPC-EXL, and EPC-EXM, were isolated using microbead-based sorting techniques and characterized by nanoparticle tracking analysis, Western blot, and quantitative real-time polymerase chain …

Dietary Intake And Physical Activity Assessment: Current Tools, Techniques, And Technologies For Use In Adult Populations., Holly L. Mcclung, Lauren T. Ptomey, Robin P. Shook, Anju Aggarwal, Anna M. Gorczyca, Edward S. Sazonov, Katie Becofsky, Rick Weiss, Sai Krupa Das

Manuscripts, Articles, Book Chapters and Other Papers

Accurate assessment of dietary intake and physical activity is a vital component for quality research in public health, nutrition, and exercise science. However, accurate and consistent methodology for the assessment of these components remains a major challenge. Classic methods use self-report to capture dietary intake and physical activity in healthy adult populations. However, these tools, such as questionnaires or food and activity records and recalls, have been shown to underestimate energy intake and expenditure as compared with direct measures like doubly labeled water. This paper summarizes recent technological advancements, such as remote sensing devices, digital photography, and multisensor devices, which …

Oxytocin And Cancer: An Emerging Link, Ben Lerman, Trisheena Harricharran, Olorunseun O. Ogunwobi

Publications and Research

The neuropeptide hormone oxytocin, which is released from the posterior pituitary gland, is involved in a number of physiological processes. Understanding of its effects is gradually increasing due to new research in this area. While mostly recognized as a reproductive system hormone, oxytocin also regulates other organ systems such as the brain and cardiovascular system. Recently, research has focused on unraveling its involvement in cancer, and emerging evidence suggests a potential role for oxytocin as a cancer biomarker. This review summarizes observations linking oxytocin and cancer, with a special emphasis on prostate cancer, where it may promote cell proliferation. Research …

Association Between Bone-Specific Physical Activity Scores And Pqct-Derived Measures Of Bone Strength And Geometry In Healthy Young And Middle-Aged Premenopausal Women., Sojung Kim, Breanne S Baker, Pragya Sharma-Ghimire, Debra A Bemben, Michael G Bemben

Faculty Scholarship for the College of Science & Mathematics

The aim of this study was to determine if bone-specific physical activity questionnaire (BPAQ) scores were positively related to bone health in healthy young and middle-aged premenopausal women. The total BPAQ was a stronger predictor of bone strength and bone mineral density of hip in young women as compared to middle-aged premenopausal women.

PURPOSE: The purpose of this study was to determine whether the BPAQ scores were predictive indices of volumetric BMD (vBMD), bone strength, and bone geometry in young and middle-aged premenopausal women.

METHODS: Healthy young (n = 60) and middle-aged premenopausal women (n = 54) between the ages …

Effects Of Bingocize® On Quality Of Life, Fall Risk, And Health Knowledge In Community-Dwelling Older Adults, Alyssa Kathryn Dispennette

Masters Theses & Specialist Projects

Quality of life (QOL) is an important aspects of overall well-being in older adults. QOL is associated with functional, physical, and psychological health; all of which can be improved with increased physical activity. A high fall risk is associated with low physical function and QOL. One in four older adults experiences a fall each year, making it necessary to focus public health interventions towards decreasing fall risk and improving QOL in older adults. Bingocize® is a health promotion program designed to promote health, health knowledge, physical activity, and social engagement among older adults. The purpose of this study was to …

A Model For The Association Between Attention-Deficit/ Hyperactivity Disorder And Obesity: Effects Of Physical Activity, Sedentary Behavior, Gender, And Medication, Danielle Quesada

FIU Electronic Theses and Dissertations

Attention-deficit hyperactivity disorder (ADHD) and obesity both present a significant burden to the health of children and adolescents. Research suggests a possible association between ADHD and obesity. This dissertation focused on examining the association between ADHD and obesity, and the roles physical activity, sedentary behavior, gender, and medication might play in this relationship.

The first manuscript is a review of the literature examining research on the association between ADHD and obesity in children and adolescents. The search included studies that reported on the prevalence of obesity among those with ADHD, the prevalence of ADHD among those who are obese, clinical …

Maternal Obesity And Fetal Macrosomia: An Integrative Review Of The Literature Regarding Interventions, Charity Stalcup

Senior Honors Theses

Research suggests pre-pregnancy obesity is associated with an increased risk of macrosomia in the newborn. Since women are expected to gain weight during pregnancy, the standard recommendation of weight loss for obesity is not ideal for this population. In this systematic review of the literature regarding interventions for maternal obesity to reduce fetal macrosomia, 149 articles were screened using three different databases to identify recent randomized controlled trials related to this topic. A total of 11 full text articles were analyzed and included in the review. The articles addressed nutritional, lifestyle, and pharmacological interventions. The results indicated there is currently …

Cognitive Changes Following Multiple-Modality Exercise And Mind-Motor Training In Older Adults With Subjective Cognitive Complaints: The M4 Study, Narlon Cassio Boa Sorte Silva, Dawn P. Gill, Adrian M. Owen, Teresa Liu-Ambrose, Vladimir Hachinski, Ryosuke Shigematsu, Robert Petrella

Lifestyle Research Team

Background

We investigated the effects of multiple-modality exercise with additional mind-motor training on cognition in community-dwelling older adults with subjective cognitive complaints.

Methods

Participants (n = 127, mean age 67.5 [7.3] years, 71% women) were randomized to receive 45 minutes of multiple-modality exercise with additional 15 minutes of either mind-motor training (M4, n = 63) or control (balance, range of motion and breathing exercises [M2, n = 64]). In total, both groups exercised 60 minutes/day, 3 days/week, for 24 weeks. Standardized global cognitive functioning (GCF), concentration, reasoning, planning, and memory were assessed at 24 weeks and after a 28-week no-contact …

Cognitive Changes Following Multiple-Modality Exercise And Mind-Motor Training In Older Adults With Subjective Cognitive Complaints: The M4 Study, Narlon Cassio Boa Sorte Silva, Dawn P. Gill, Adrian M. Owen, Teresa Liu-Ambrose, Vladimir Hachinski, Ryosuke Shigematsu, Robert Petrella

Lifestyle Research Team

Background

We investigated the effects of multiple-modality exercise with additional mind-motor training on cognition in community-dwelling older adults with subjective cognitive complaints.

Methods

Participants (n = 127, mean age 67.5 [7.3] years, 71% women) were randomized to receive 45 minutes of multiple-modality exercise with additional 15 minutes of either mind-motor training (M4, n = 63) or control (balance, range of motion and breathing exercises [M2, n = 64]). In total, both groups exercised 60 minutes/day, 3 days/week, for 24 weeks. Standardized global cognitive functioning (GCF), concentration, reasoning, planning, and memory were assessed at 24 weeks and after a 28-week no-contact …

A 6-Week Hip Muscle Strengthening And Lumbopelvic-Hip Core Stabilization Program To Improve Pain, Function, And Quality Of Life In Persons With Patellofemoral Osteoarthritis: A Feasibility Pilot Study., Lisa T. Hoglund, Laura Pontiggia, John D. Kelly

Department of Physical Therapy Faculty Papers

Background: Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA.

Methods: Ten females with PFJ …

The Impact Of Blood Pressure Dipping Status On Cognition, Mobility And Cardiovascular Health In Older Adults Following An Exercise Program, Narlon Cassio Boa Sorte Silva, Michael A. Greagory, Dawn P. Gill, Cheri L. Mcgowan, Robert Petrella

Lifestyle Research Team

Objectives: To determine whether a dual-task gait and aerobic exercise intervention differentially impacted older adults with normal blood pressure (BP) dipping status (dippers) compared to those with nondipping status (nondippers).

Methods: This study was a secondary analysis involving participants (mean age = 70.3 years, 61% women) who attended a laboratory-based exercise intervention over a 6-month period (40 min/day and 3 days/week). Participants were assessed in measures of cognition, mobility, and cardiovascular health at baseline, 3, 6, and 12 months (after a 6-month no-contact follow-up).

Results: We observed improvements in cognition in both groups at 6 and 12 months, although no …

Synergic Trial (Synchronizing Exercises, Remedies In Gait And Cognition) A Multi-Centre Randomized Controlled Double Blind Trial To Improve Gait And Cognition In Mild Cognitive Impairment, Manuel Montero-Odasso, Quincy J. Almeida, Amer M. Burhan, Richard Camicioli, Julien Doyon, Sarah Fraser, Karen Li, Teresa Liu-Ambrose, Laura Middleton, Susan Muir-Hunter, William Mcilroy, José A. Morais, Frederico Pieruccini-Faria, Kevin Shoemaker, Mark Speechley, Akshya Vasudev, G. Y. Zou, Nicolas Berryman, Maxime Lussier, Leanne Vanderhaeghe, Louis Bherer

Bone and Joint Institute

© 2018 The Author(s). Background: Physical exercise, cognitive training, and vitamin D are low cost interventions that have the potential to enhance cognitive function and mobility in older adults, especially in pre-dementia states such as Mild Cognitive Impairment (MCI). Aerobic and progressive resistance exercises have benefits to cognitive performance, though evidence is somewhat inconsistent. We postulate that combined aerobic exercise (AE) and progressive resistance training (RT) (combined exercise) will have a better effect on cognition than a balance and toning control (BAT) intervention in older adults with MCI. We also expect that adding cognitive training and vitamin D supplementation to …

Systemic Exercise-Induced Hypoalgesia Following Isometric Exercise Reduces Conditioned Pain Modulation, Ali Alsouhibani, Henrik Bjarke Vaegter, Marie K. Hoeger Bement

Physical Therapy Faculty Research and Publications

Objective

Physically active individuals show greater conditioned pain modulation (CPM) compared with less active individuals. Understanding the effects of acute exercise on CPM may allow for a more targeted use of exercise in the management of pain. This study investigated the effects of acute isometric exercise on CPM. In addition, the between-session and within-session reliability of CPM was investigated.

Design

Experimental, randomized crossover study.

Setting

Laboratory at Marquette University.

Subjects

Thirty healthy adults (19.3±1.5 years, 15 males).

Methods

Subjects underwent CPM testing before and after isometric exercise (knee extension, 30% maximum voluntary contraction for three minutes) and quiet rest in …

Wellness And Multiple Sclerosis: The National Ms Society Establishes A Wellness Research Working Group And Research Priorities, Robert W. Motl, Ellen M. Mowry, Dawn M. Ehde, Nicholas G. Larocca, Kathy E. Smith, Kathleen Costello, Lynne Shinto, Alexander V. Ng, Amy B. Sullivan, Barbara Giesser, Kevin K. Mccully, Bo Fernhall, Malachy Bishop, Matthew Plow, Patrizia Casaccia, Nancy D. Chiaravalloti

Early Childhood, Special Education, and Counselor Education Faculty Publications

Background: People with multiple sclerosis (MS) have identified “wellness” and associated behaviors as a high priority based on “social media listening” undertaken by the National MS Society (i.e. the Society).

Objective: The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda.

Method: The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness.

Results: That process informed a …

Effects Of Exercise On Appetite-Regulating Hormones, Perceived Hunger, And Energy Intake: A Narrative Overview, Marsa Gleason, Basil H. Aboul-Enein, Josh Bernstein, Joanna Kruk

Health & Wellness Department Faculty Publications and Research

Controlling appetite, perceived hunger, and energy intake are important factors in weight management. This narrative review examines the effect of different forms, intensities and duration of exercise on the appetite-regulating hormones leptin, acylated ghrelin, glucagon like peptide-1 (GLP-1) and peptide tyrosine tyrosine3-36 (PYY3-36), perceptions of hunger, and energy intake in overweight/obese, and normal weight populations. The studies reviewed compared exercise intensities- low, moderate, and high intensity, and modes of exercise- aerobic and resistance training. The studies selected in this narrative review included participants that ranged in age from 13-57 years old, male and female, previously sedentary and physically active, and …

Feasibility And Preliminary Outcomes Of A Standardized Exercise Program In Adults With Down Syndrome: A Pilot Study, Megan Flores, Kristen Barta, Martha Sneary, Germaine Ferreira, Elizabeth Ardolino

Physical Therapy Collection

Purpose/ Hypothesis: Youth with Down Syndrome (DS) have limited participation in physical activity. When compared to their typically developing peers, adults with DS display decreased functional mobility and strength. Exercise has shown to improve the physical fitness, overall health, and quality of life in people with DS. The Lee Silverman Voice Treatment (LSVT® BIG) is an effective treatment approach designed for patients with Parkinson’s disease. The core components of LSVT® BIG include large amplitude movements, sensory calibration, high intensity, and maximum effort while performing the daily exercises. Due to hypotonicity associated with DS, these individuals typically display kyphotic posture, shortened …

Community-Deliverable Exercise And Depression In Adults With Arthritis: Confirmatory Evidence Of A Meta-Analysis Using The Ivhet Model, George A. Kelley, Kristi S. Kelley

Clinical and Translational Science Institute

Objective—Using the traditional random-effects model, a recently reported standardized effect size (g) reduction of −0.42 (95% CI, −0.58 to −0.27) was observed as a result of communitydeliverable exercise in adults with arthritis and other rheumatic diseases (AORD). However, a recently proposed alternative model (IVhet) has been shown to have superior coverage probability to the random-effects model. The purpose of this brief report was to compare these previous random-effects results with the IVhet model. Methods—Based on a previous meta-analysis of 35 g’s representing 2,449 participants, results were pooled using the IVhet model. Influence analysis, number needed-to-treat (NNT), percentile improvement, and gross …

Incorporation Of A Health Literacy Exercise Into First Year Pharmacy Students’ Introductory Pharmacy Practice Experiences, Aleda Chen, Stephanie M. Cailor, Thad Franz, Nicole Harper

Pharmacy Practice Faculty Publications

No abstract provided.

Knowledge, Attitudes, And Practice Of Oncologists And Oncology Health Care Providers In Promoting Physical Activity To Cancer Survivors: An International Survey, Sarah Hardcastle, Robert Kane, Paola Chivers, Dana A. Hince, Andrew Dean, Dominic Higgs, Paul A. Cohen

Health Sciences Papers and Journal Articles

Objective: To investigate knowledge, attitudes and practices of oncologists towards physical 2 activity (PA) in cancer survivors, and the association between oncologists’ own PA behavior 3 and PA promotion. Methods: Oncologists (n=123) completed a survey based on the Theory of 4 Planned Behavior (TPB). Participants reported PA promotion behavior, PA involvement, 5 attitudes, intentions, social norm, Perceived Behavioral Control (PBC), confidence and 6 knowledge of exercise prescription. Structural equation modelling (SEM) evaluated these 7 associations. Results: Less than half of oncologists reported regularly promoting PA to 8 patients (46%), with 20% providing written information and 23% referrals. Only 26% were …

Time For Change: Fitness And Strength Can Be Improved And Sustained In Adolescents With Low Motor Competence, Beth Hands, Paola Chivers, Tegan Grace, Fleur Mcintyre

Health Sciences Papers and Journal Articles

Background: There are few exercise interventions focused on adolescents with low motor competence and most interventions are short with little follow up and engagement over time.

Methods and procedures: Fifty-eight adolescents with low motor competence (39 males, Mean Age=13.6, SD=1.4 years) attended an exercise clinic twice a week for each 13 week program. Two programs ran each year, and participants attended for as long as they felt progress was made or they turned 18 years of age. Performance on the Multistage Fitness Test (MSFT), Curl-ups, Grip Strength, 1RM Leg press and Chest Press, Vertical Jump and Standing Broad Jump (SBJ) …

Can Foot Exercises And Going Barefoot Improve Function, Muscle Size, Foot Pressure During Walking And Qualitative Reports Of Function In People With Flat Foot?, Marcey Keefer Hutchison, Robin Dorociak, Alison Modafferi, Shanna Howland, Angela Foster, Jean Jarbath, Brenden Thompson, Tyler Whited, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Specific exercises to train foot muscles for barefoot running (i.e. doming seated[DS] and standing[DSt]) and post foot and ankle injury (i.e. seated plantar flexion and inversion[SPFI]) are common. Exercise programs specifically for the foot claim improvement in foot posture (foot posture index [FPI]) and foot strength. However, rigorous assessment of foot function as a result of exercise is lacking (i.e. foot posture, strength, and plantar pressure). Further, no studies specifically address patients with flat foot. The purpose of this case series study was to assess the immediate effects of an 8-week foot exercise and barefoot weight bearing program on …

Patient Experiences Of A Physiotherapy-Led Multidisciplinary Rehabilitative Intervention After Successful Treatment For Oesophago-Gastric Cancer, Annemarie Bennett, L. O'Neill, D. Connolly, E. M. Guinan, L. Boland, Suzanne Doyle, J. O'Sullivan, J. V. Reynolds, J. Hussey

Articles

Purpose To qualitatively explore the perceived impact of a 12-week rehabilitative intervention for oesophago-gastric cancer survivors on their physical, mental and social wellbeing. Methods Of the 21 participants who completed the intervention, 19 took part in a semi-structured focus group interview. Four audio-taped focus groups were held, ranging in size from two to eight participants. Focus groups were transcribed and analysed using a descriptive qualitative approach. Results At recruitment, participants were 23.5 ± 15.2 months post-surgery and all had suboptimal fitness levels. Participants reported improvements in their physical capacity and ability to carry out activities of daily living during the …

Clinical Perspectives On Incorporating Cardiorespiratory Fitness In Clinical Practice, Mary T. Imboden, Lynn A. Witty, Mitchell H. Whaley, Matthew P. Harber, Bradley S. Fleenor, Leonard A. Kaminsky

Faculty Publications - Department of Kinesiology

Cardiorespiratory fitness (CRF) has been documented as a strong, independent predictor of non-communicable disease and mortality in both clinical and apparently healthy populations. This well-established relationship has impelled organizations, including the American Heart Association, to release scientific statements highlighting the importance of accurate quantification of CRF. Current knowledge of the relationship between CRF and mortality is predominantly based on estimated CRF obtained from varying indirect methods. Cardiopulmonary exercise testing (CPX), the gold standard method of CRF measurement, provides a more accurate and reliable quantification of CRF compared to estimated methods. This review provides support for the diagnostic and prognostic use …

Overwhelming Research And Clinical Evidence Of Exercise Medicine Efficacy In Cancer Management—Translation Into Practice Is The Challenge Before Us, Robert Newton

Research outputs 2014 to 2021

The paper “Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement”1 is very timely. As the authors have convincingly demonstrated, rigorous clinical and research evidence support something of which most medical and allied health professionals are cognizant: the benefit of physical activity and exercise for people with cancer.

Proficiency In Pole Handling During Nordic Walking Influences Exercise Effectiveness In Middle-Aged And Older Adults, Eiji Fujita, Karen Yakushi, Masaki Takeda, Mohammod Monirul Islam, Masaki Nakagaichi, Dennis Taaffe, Nobuo Takeshima

Research outputs 2014 to 2021

Nordic walking (NW) is a total body version of walking increasingly used as a health-promoting activity by middle-aged and older adults. The present study examined the relationship between force exerted through the pole and physiological response during NW. In this non-randomized exercise trial, 17 participants comprising 8 middle-aged and older recreationally trained Nordic walkers (NWrec: 63.7 ± 8.1 years) and 9 experienced NW instructors (NWinstr: 57.5 ± 7.8 years) underwent outdoor ordinary walking (OW) and NW bouts as fast as possible for 12 minutes. Walking distance, speed, heart rate (HR), energy expenditure (METs and J/kg/m) and upper and lower limb …

What Maximum Ankle Torque Is Appropriate For Training Patients With Non-Insertional Achilles Tendinopathy?, Tyler Cuddeford, Jeff Houck, Derek Palmer, Jason Beilstein, Jordan Visser

Faculty Publications - College of Physical Therapy

Background and Purpose: The capacity of the Achilles tendon during a 1-repetition eccentric maximum contraction is largely unknown. This study examined the maximum ankle torque during a concentric/ eccentric heel raise/lowering task and while running in healthy individuals and participants with chronic Achilles tendinopathy. These findings were applied to a 10-week training program for a patient with chronic Achilles tendinopathy.

Methods: A total of 13 subjects (9 healthy and 4 with Achilles tendinopathy) participated in this study. Subjects were asked to perform a maximum eccentric contraction wearing a weighted vest while collecting 3-dimensional biomechanical variables. Subjects also ran along an …

Youth Leisure-Time Physical Activity From The Perspectives Of Young Adults With Visual Impairments, Justin A. Haegele

Human Movement Sciences & Special Education Faculty Publications

The purpose of this study was to examine the meaning that young adults with visual impairments ascribe to their youth leisure-time physical activity experiences. This study adopted an interpretative phenomenological analysis (IPA) research approach. Ten participants (aged 21-34 years; eight women, two men) with visual impairments were included in this study. Semi-structured, audio-taped telephone interviews acted as the primary source of data for this study. Data were analyzed thematically using a four-step process informed by IPA and three interrelated themes were constructed: (a) "I just always felt normal when I was doing them": Preferences for unstructured activities, (b) "They didn't …