Nonpharmacological Interventions for Chronic Pain in Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Nonpharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different nonpharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis.

RESEARCH DESIGN AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions.

RESULTS

Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences -0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity.

DISCUSSION AND IMPLICATIONS

Nonpharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults.

Effects of physical exercise on muscle function of the knee, pain and quality of life in postmenopausal women with knee osteoarthritis: A systematic review with meta-analysis

Objective of this study was to investigate the effects of physical exercise on muscle function of the knee, pain and quality of life in postmenopausal women with knee osteoarthritis (OA). An electronic search was conducted of the PubMed, Embase, Web of Science, Cochrane Library, LILACS and PEDro databases for relevant articles published up to September 2023. Only randomized clinical trials with interventions involving physical exercise of any modality in postmenopausal women with knee OA were included. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Recommendations. Methodological quality of the studies selected was assessed using the PEDro scale and the evidence was synthesized using the Grading of Recommendations, Assessment, Development and Evaluation scale. Among the 169 articles identified, five were included in the present systematic review and enabled meta-analysis of the outcomes physical function, pain and stiffness. The findings demonstrated the effectiveness of physical exercise in improving physical function, assessed through the Six-Minute Walk Test and the WOMAC scale's physical function domain, compared to the control group. However, no significant differences were observed in pain or stiffness outcomes between the treatment and control groups. Unfortunately, insufficient data precluded a meta-analysis for knee muscle function and quality of life outcomes. Despite the potential of physical exercise to enhance physical function in postmenopausal women with knee OA, the study highlights a lack of standardization in assessment tools and tests, limiting the feasibility of meta-analysis. PROSPERO REGISTRATION: CRD42022316476.

Alzheimer's disease prevention: Apolipoprotein e4 moderates the effect of physical activity on brain beta-amyloid deposition in healthy older adults

OBJECTIVES

To investigate if higher baseline physical activity levels are associated with less β-amyloid burden and whether the ApoE4 genotype moderates this association cross-sectionally and longitudinally.

DESIGN

Prospective cohort study.

METHODS

204 cognitively normal older adults (74.5 ± 6.6 years; 26 % ApoE4-carrier) were analyzed. Baseline physical activity was measured using the Minnesota Physical Activity Questionnaire. Brain β-amyloid burden was measured with positron emission tomography using 11C-labeled Pittsburgh compound. A subsample of 128 participants underwent longitudinal positron emission tomography (2.0 ± 0.9 scans over 5 ± 3 years). Statistical analysis was run according to physical activity (high/low group) and the ApoE4 genotype (carrier/noncarrier).

RESULTS

The ApoE4 genotype moderated the relationship between physical activity and β-amyloid, such that low physical activity had a greater impact on β-amyloid deposition in ApoE4-carriers than noncarriers. This ApoE4 × physical activity effect on brain β-amyloid deposition was also observed when all available β-amyloid scan timepoints were included in the model. β-amyloid deposition increased over time (p < 0.001), and ApoE4-carriers had disproportionately greater β-amyloid accumulation than ApoE4-noncarriers. The lower physical activity group had marginally greater β-amyloid accumulation than the higher physical activity group (p = 0.099), but there was no significant ApoE4 effect on β-amyloid accumulation.

CONCLUSIONS

Low physical activity in combination with the ApoE4-carrier genotype is associated with increased β-amyloid burden, suggesting that ApoE4 moderates the effect of physical activity on β-amyloid load. However, this effect was insufficient for baseline physical activity to modulate the change in β-amyloid accumulation over time.

Physical activity trajectories and all-cause mortality in type 1 diabetes: A nationwide longitudinal study

AIMS

To identify physical activity trajectories, explore the factors associated with them and assess their relationship with all-cause mortality.

METHODS

This was a population-based longitudinal cohort study, with data from all specialist care units for type 1 diabetes in Sweden. A total of 48.921 adult patients were included, each with at least 3 registrations of physical activity, and a maximum follow-up of 14 years. The main outcomes were the longitudinal physical activity trajectories and all-cause mortality.

RESULTS

Of 48.921 patients, 55.9% were males and mean (SD) age was 39.7(16.7). Four physical activity trajectories were identified: Steady Low (10.8%), Decreaser (12.7%), Increaser (20.7%) and Steady High (55.8%). Female sex, higher education, higher income, normal BMI, fewer comorbidities and foot free from diabetic disease were significantly associated with sustained high physical activity. Compared to the steady low group, the decreaser, increaser, and steady high physical activity groups exhibited lower adjusted risk of all-cause mortality (53-73% reduction).

CONCLUSIONS

Consistently low physical activity is associated with higher all-cause mortality. This study underscores the importance of identifying patients at risk of low physical activity and tailoring personalized approaches to promote sustained physical activity in type 1 diabetes, ultimately improving outcomes.

Exercise for knee osteoarthritis pain: Association or causation?

Exercise is universally recommended as a primary strategy for the management of knee osteoarthritis (OA) pain. The recommendations are based on results from more than 100 randomized controlled trials (RCTs) that compare exercise to no-attention control groups. However, due to the inherent difficulties with adequate placebo control, participant blinding and the use of patient-reported outcomes, the existing RCT evidence is imperfect. To better understand the evidence used to support a causal relationship between exercise and knee OA pain relief, we examined the existing evidence through the Bradford Hill considerations for causation. The Bradford Hill considerations, first proposed in 1965 by Sir Austin Bradford Hill, provide a framework for assessment of possible causal relationships. There are 9 considerations by which the evidence is reviewed: Strength of association, Consistency, Specificity, Temporality, Biological Gradient (Dose-Response), Plausibility, Coherence, Experiment, and Analogy. Viewing the evidence from these 9 viewpoints did neither bring forward indisputable evidence for nor against the causal relationship between exercise and improved knee OA pain. Rather, we conclude that the current evidence is not sufficient to support claims about (lack of) causality. With our review, we hope to advance the continued global conversation about how to improve the evidence-based management of patients with knee OA.

Effect of branched-chain amino acid supplementation and exercise on quadriceps muscle quantity and quality in patients with cirrhosis as assessed by ultrasonography: A randomized controlled trial

BACKGROUND/AIM

Sarcopenia and myosteatosis are common in patients with cirrhosis. The study aimed to evaluate efficacy of ultrasound to monitor muscle status during branched-chain amino acid (BCAA) supplementation and/or muscle exercise interventional approaches.

PATIENTS AND METHODS

A randomized controlled study, included 220 liver cirrhosis patients with Child- Pugh B and C, randomized into a control group (55 patients) received only the standard care, and interventional groups (165 patients) equally distributed into three subgroups, in addition to standard care, they received BCAA, programmed exercise, or BCAA and programmed exercise. At baseline and after 28 days, all participants were subjected to ultrasound-measured quadriceps muscle thickness and echo-intensity, muscle strength using handgrip, performance using short physical performance battery (SPPB), Model for End-Stage Liver Disease (MELD) score and nutritional assessment using 7- point Subjective Global Assessment Score (SGA) and laboratory assessment.

RESULTS

All interventional groups showed a significant improvement in the ultrasound detected quadriceps muscle thickness (p = 0.001) and echo intensity, in addition to muscle strength, muscle performance, and SGA. Hematological parameters (hemoglobin and platelet count), biochemical parameters (ALT, AST, bilirubin, creatinine, urea and INR) and MELD score were also improved in the interventional groups. In Child-Pugh B patients BCAA combined with exercise showed an add-on effect.

CONCLUSION

BCAA supplements, programed muscle exercise and both are useful interventional methods in improving muscle quality and quantity in cirrhosis patients, which can be monitored by ultrasound. The best results can be achieved by combined intervention in Child-Pugh B, while in Child-Pugh C single intervention may lead to an acceptable improvement. The trial was registered retrospectively in the Clinical Trials Registry (registration number NCT06088550).

The Impacts of New York State's Paid Family Leave Policy on Parents' Sleep and Exercise

OBJECTIVES

To assess changes in young parents' health behaviors following implementation of New York State's Paid Family Leave Program (NYSPFL).

METHODS

We used synthetic control (N = 117,552) and difference-in-differences (N = 18,973) models with data from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2019 to provide individual-level estimates of the effects of NYSPFL on self-reported exercise in the past month and average daily sleep of adults aged 21-30 years living with one or more children under 18 years of age in New York and comparison states.

RESULTS

Synthetic control model results indicate that the NYSPFL increased the likelihood of exercise in the past month among mothers, single parents, and low-income parents by 6.3-10.3% points (pp), whereas fathers showed a decrease in exercise (7.8 pp). Fathers, single parents, and those with two or more children showed increases in daily sleep between 14 and 21 min per day.

CONCLUSIONS FOR PRACTICE

State paid family and medical leave laws may provide benefits for health behaviors among young parents with children under 18, particularly those in low-income and single-parent households.

Nurse-led physical activity interventions for people with dementia in nursing homes: A systematic review on intervention characteristics and implementation facilitators/barriers

BACKGROUND

Physical activities are important to maintain and promote physical functioning and activities of daily living in people with dementia. Nurses are in a key position to deliver physical activity interventions in nursing homes. However, synthesized strategies for sustainable implementation of physical activity interventions in nursing homes for people with dementia are lacking.

OBJECTIVE

We aimed at synthesizing the evidence on nurse-led physical activity interventions and at identifying facilitators and barriers to sustainable implementation of physical activity interventions for people with dementia.

DESIGN

Systematic review.

REVIEW METHODS

We performed a comprehensive literature search combining database searches (MEDLINE, CINAHL, CENTRAL, Web of Science Core Collection; last search: September 27, 2023) and supplementary search methods (citation tracking, web searching, clinical guideline database searching). We considered studies on nurse-led physical activity interventions for people with dementia living in nursing homes for eligibility; published as journal articles and related material in English, French, German language, without restrictions on primary study design and publication year. Independently and in duplicate, we assessed the references' eligibility and the quality of the included studies. We used the Mixed Methods Appraisal Tool to appraise quality of included studies. We piloted and double-checked data extractions, and summarized the results narratively and graphically (harvest plot). We prospectively registered our review (PROSPERO CRD42021271833).

RESULTS

We identified 24 studies (of which eleven were randomized trials) assessing various interventions that we categorized into physical exercise (n = 8), care-integrated physical activity (n = 6), outdoor or walking activity (n = 5), technology-supported physical exercise (n = 3), and dancing (n = 2). Types of outcomes and length of follow-up varied widely. Effects were inconclusive, except for outdoor or walking activities showing an overall positive impact on physical outcomes. For eight interventions, we identified evidence on implementation barriers (b) and facilitators (f), including staff shortage (b), staff time resources (b), or ease of implementation for staff (f) and adaptability of interventions (f) or refusal to participate of people with dementia (b).

CONCLUSIONS

The results of our review provide a comprehensive overview on types, characteristics and effects of nurse-led physical activity interventions for people with dementia in nursing homes. Based on evidence from a range of study designs and sources, we came to the conclusion that all stakeholders involved considered physical activity interventions for people with dementia as useful and relevant. Outcome measures varied widely and a clear conclusion on effectiveness remains open.

Metabolic plasticity and obesity-associated changes in diurnal postexercise metabolism in mice

BACKGROUND

Circadian disruption is widespread and increases the risk of obesity. Timing of therapeutic interventions may promote coherent and efficient gating of metabolic processes and restore energy homeostasis.

AIM

To characterize the diurnal postexercise metabolic state in mice and to identify the influence of diet-induced obesity on identified outcomes.

METHODS

C57BL6/NTac male mice (6 wks of age) were fed a standard chow or high-fat diet for 5 weeks. At week 5, mice were subjected to a 60-min (16 m/min, 5 % incline) running bout (or sham) during the early rest (day) or early active (night) phase. Tissue and serum samples were collected immediately post-exercise (n = 6/group). In vivo glucose oxidation was measured after oral administration of 13C-glucose via 13CO2 exhalation analysis in metabolic cages. Basal and isoproterenol-stimulated adipose tissue lipolysis was assessed ex vivo for 1 h following exercise.

RESULTS

Lean mice displayed exercise-timing-specific plasticity in metabolic outcomes, including phase-specificity in systemic glucose metabolism and adipose-tissue-autonomous lipolytic activity depending on time of day. Conversely, obesity impaired temporal postexercise differences in whole-body glucose oxidation, as well as the phase- and exercise-mediated induction of lipolysis in isolated adipose tissue. This obesity-induced alteration in diurnal metabolism, as well as the indistinct response to exercise, was observed concomitant with disruption of core clock gene expression in peripheral tissues.

CONCLUSIONS

Overall, high-fat fed obese mice exhibit metabolic inflexibility, which is also evident in the diurnal exercise response. Our study provides physiological insight into exercise timing-dependent aspects in the dynamic regulation of metabolism and the influence of obesity on this biology.

The effect of psychologically informed practice with behavioural graded activity in cancer survivors: systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to determine the effectiveness of psychologically informed practice (PIP) with behavioural graded activity (BGA) compared to (1) waitlist controls (WLC), (2) other interventions (OI), (3) PIP alone or (4) BGA alone in cancer patients and survivors (CPaS).

METHODS

PubMed, Web of Science and Embase were screened for randomised controlled trials encompassing BGA + PIP in CPaS. Effect sizes were inventoried for outcomes regarding physical activity (PA), quality of life (QoL) and debilitating symptoms (DS), which were assessed at four time points: post-intervention (PI), follow-up F1 (1 to 3 months), F2 (4 to 6 months) and F3 (> 6 months). The quality of the evidence was classified by the GRADE approach.

RESULTS

Thirty-three studies were found eligible, comprising 4330 participants. Significant effects with low heterogeneity of PIP + BGA comparing to WLC were found for anxiety (SMD - 1.29 [-1.71; - 0.86]), depression (SMD - 0.79 [- 1.10; - 0.48]), functional impairment (SMD - 0.72 [- 0.95; - 0.50]), PA (self-reported: (SMD - 0.58 [- 0.84; - 0.32]) and objectively measured: (SMD - 0.51 [- 0.90; - 0.13])) and social impairment (SMD - 0.33 [- 0.58; - 0.08]). When comparing PIP + BGA to OI, fatigue (SMD - 0.35 [- 0.51; - 0.20]) and PA (SMD - 0.26 [- 0.41; - 0.11]) at PI, and fatigue (SMD - 0.34 [- 0.58; - 0.10]) at F1 were found significant with low heterogeneity. No significant effects were observed in the meta-analyses of studies comparing PIP + BGA to BGA or PIP alone.

CONCLUSIONS

PIP with BGA has a favourable effect on DS, PA and QoL in CPaS when compared to non-behavioural interventions such as WLC, usual care and education. However, further research is needed on 'how' and 'when' PIP + BGA should be provided in cancer rehabilitation.

IMPLICATIONS FOR CANCER SURVIVORS

PIP + BGA has the potential to facilitate CPaS to reach the recommended amount of PA and reduce DS.

Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis

OBJECTIVE

To examine the benefits and harms of structured outdoor physical activity (PA) for people living with one or more somatic or mental diseases.

METHODS

We identified articles from inception until Marts 2023 in MEDLINE, EMBASE, CINAHL and CENTRAL and citation tracking in Web of Science. We included randomized controlled trials (RCTs) and observational studies examining structured outdoor PA reporting physical function, health-related quality of life (HRQOL), pain or mental outcomes. We used random-effect meta-analyses and investigated heterogeneity in subgroups, sensitivity and meta-regression analyses. Observational studies and studies with insufficient data were summarized narratively. Certainty of evidence was assessed with GRADE.

RESULTS

From 4098 hits, 20 studies (19 RCTs and 1 cohort) were included (n: 1759 participants). Studies varied in type of disease and intervention. End of intervention results suggested a small effect on HRQOL (k = 10, SMD = 0.45, 95%CI: 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95%CI: 0.13 to 0.64), while effects were moderate on mental outcomes (k = 13, SMD = -0.52, 95%CI: -0.82 to -0.23) favoring the outdoor intervention over comparators (no intervention, usual care, indoor PA or outdoor intervention without exercise). We were not able to conclude on outdoor interventions' effect on pain. Four studies reported adverse events including non-serious (pain, falls, fatigue) and serious (hospitalization, pneumonia). Certainty of evidence was overall very low.

CONCLUSION

Structured outdoor PA may improve HRQOL and physical function, as well as mental health outcomes. The very low certainty of evidence calls for high quality RCTs to determine benefits and harms of structured outdoor PA.

Time dedicated to physical activity among medical residents: are there differences based on gender or specialty type?

INTRODUCTION

Physical activity (PA) is associated with positive health outcomes such as prevention of chronic diseases, psychological well-being and improved work performance. Medical residents are subjected to sleep deprivation, extended work schedule and high burnout prevalence. These conditions may lead to the neglect of personal health and the restriction of time dedicated to PA. The objective of the present study was to analyze the time dedicated to PA of medical residents, comparing women vs men residents and surgical vs clinical residents.

METHODS

It is a cross-sectional study performed in a Spanish third-level university hospital. All medical residents from our institution were invited to voluntarily participate in the study answering a web-based questionnaire on June 2022. Data regarding demographics, residency and PA practice was recorded.

RESULTS

The response rate was 20.73% (114/550). The 32.5% of the residents considered themselves to be physically inactive and mean time dedicated to PA in a regular week was 3.62 ± 2.22 h. Men residents dedicated more time to PA than women residents (4.23 ± 2.42 h vs 3.14 ± 1.95 h, p = 0.012) and surgical residents dedicated more time than clinical residents (4.33 ± 2.36 h vs 3.23 ± 2.05 h, p = 0.01).

CONCLUSIONS

One third of the medical residents consider themself physically inactive. Women and clinical residents practice PA less time than men and surgical residents. Efforts should be made to encourage PA among residents, especially in women and non-surgeons.

Electrocardiographic characteristics of pediatric and adolescent football players

Electrocardiographic characteristics of children and adolescents present differences compared to adults. The aim of our work was to study electrocardiograms (ECGs) of football male players from childhood to late adolescence and examine if the ECG parameters are influenced by systematic exercise. One thousand fifty-four football players participated and formed four groups. Group A included 89 players aged 5-7 years, group B 353 players aged 8-11 years, group C consisted of 355 football players 12-15 yearsold and group D of 257 players with 16-18 years of age. All participants underwent preparticipation screening, including 12-lead surface ECG. Heart rate (HR), PR, RR, QRS, QT, QTc intervals, QT dispersion (QTdisp) and QRS axis were calculated. All ECGs were evaluated according to the current preparticipation cardiac screening guidelines, that refer to athletes aged 12-35 years and do not include pediatric players. Eleven percent of the participants presented an ECG finding. Group D obtained the lowest values of HR, QTc and the highest of PR, RR, QRS, QT intervals and QTdisp, whereas no differences in QRS axis were reported. Incomplete Right Bandle Branch Block (RBBB) was the most frequent ECG peculiarity, detected in 7.3% of the participants. Years of training were statistically significantly correlated to HR, PR, RR, QRS and QT intervals. In conclusion, guidelines for ECG interpretation of athletes in childhood, early and late adolescence are needed.

Estimation of Heat Production Rate using Thermal Data During Exercise in Indoor Environments: A Study of Heat Storage Rate in Male Athletes

The increasing preference for indoor exercise spaces highlights the relationship between indoor thermal environments and physiological responses, particularly concerning thermal comfort during physical activity. Determining the metabolic heat production rate during exercise is essential for optimizing the thermal comfort, well-being, and performance of individuals engaged in physical activities. This value can be determined during the activity using several methods, including direct calorimetry measurement, indirect calorimetry that uses analysis of respiratory gases, or approximations using collected data such as speed, body mass, and heart rate. The study aimed to calculate the metabolic heat production rate by infrared thermal evaluation (ITE) based on the body's thermal balance approach and compare it with the values determined by indirect calorimetry (IC). Fourteen participants volunteered for the study, using a cycling ergometer in a controlled climatic chamber. After the familiarization sessions, maximal O2 intake levels (VO2max) were determined through maximal graded exercise tests. Subsequently, constant work rate exercise tests were performed at 60% of VO2max for 20 min. The metabolic heat production rates were calculated by IC and ITE for each athlete individually. Respiratory gases were used to determine IC, while body skin and core temperatures, along with physical environmental data, were applied to calculate ITE using the human body thermal balance approximation of ASHRAE. According to the results, heat storage rates were misleading among the body's heat transfer modes, particularly during the first 8 min of the exercise. ITE showed a moderate level of correlation with IC (r: 0.03-0.86) with a higher level of dispersion relative to the mean (CV%: 12-84%). Therefore, a new equation (ITEnew) for the heat storage rates was proposed using the experimental data from this study. The results showed that ITEnew provided more precise estimations for the entire exercise period (p > 0.05). Correlations between ITEnew and IC values were consistently strong throughout the exercise period (r: 0.62-0.85). It can be suggested that ITEnew values can predict IC during the constant work rate steady-state exercise.

Nonsurgical Interventions to Prevent Disease Progression in Prostate Cancer Patients on Active Surveillance: A Systematic Review and Meta-analysis

CONTEXT

Active surveillance (AS) is a standard of care for patients with low-risk and selected intermediate-risk prostate cancer (PCa). Nevertheless, there is a lack of summary evidence on how to impact disease trajectory during AS.

OBJECTIVE

To assess which interventions prevent PCa progression effectively during AS.

EVIDENCE ACQUISITION

We queried PubMed, Scopus, and Web of Science databases to identify studies examining the impact of interventions aimed at slowing disease progression during AS. The primary endpoint was PCa progression, the definition of which must have included pathological upgrading. The secondary endpoint included treatment toxicities.

EVIDENCE SYNTHESIS

We identified 22 studies, six randomized controlled trials and 16 observational studies, which analyzed the association between different interventions and PCa progression during AS. The interventions considered in the studies included 5-alpha reductase inhibitors (5-ARIs), statins, diet, exercise, chlormadinone, fexapotide triflutate (FT), enzalutamide, coffee, vitamin D3, and PROSTVAC. We found that administration of 5-ARIs was associated with improved progression-free survival (PFS; hazard ratio: 0.59; 95% confidence interval 0.48-0.72), with no increased toxicity signals. Therapies such as vitamin D3, chlormadinone, FT, and enzalutamide have shown some efficacy. However, these anticancer drugs have been associated with treatment-related adverse events in up to 88% of patients.

CONCLUSIONS

The use of 5-ARIs in PCa patients on AS is associated with longer PFS. However, for the other interventions, it is difficult to draw clear conclusions based on the weak available evidence.

PATIENT SUMMARY

Patients with prostate cancer managed with active surveillance (AS) who are treated with 5-alpha reductase inhibitors have a lower risk of disease progression, with minimal adverse events. Other interventions require more studies to determine their efficacy and safety profile in men on AS.

Locally applied heat stress during exercise training may promote adaptations to mitochondrial enzyme activities in skeletal muscle

There is some evidence for temperature-dependent stimulation of mitochondrial biogenesis; however, the role of elevated muscle temperature during exercise in mitochondrial adaptation to training has not been studied in humans in vivo. The purpose of this study was to determine the role of elevating muscle temperature during exercise in temperate conditions through the application of mild, local heat stress on mitochondrial adaptations to endurance training. Eight endurance-trained males undertook 3 weeks of supervised cycling training, during which mild (~ 40 °C) heat stress was applied locally to the upper-leg musculature of one leg during all training sessions (HEAT), with the contralateral leg serving as the non-heated, exercising control (CON). Vastus lateralis microbiopsies were obtained from both legs before and after the training period. Training-induced increases in complex I (fold-change, 1.24 ± 0.33 vs. 1.01 ± 0.49, P = 0.029) and II (fold-change, 1.24 ± 0.33 vs. 1.01 ± 0.49, P = 0.029) activities were significantly larger in HEAT than CON. No significant effects of training, or interactions between local heat stress application and training, were observed for complex I-V or HSP70 protein expressions. Our data provides partial evidence to support the hypothesis that elevating local muscle temperature during exercise augments training-induced adaptations to mitochondrial enzyme activity.

Cardiac rehabilitation for participants with implantable cardiac devices: A systematic review and meta-analysis

Aim

The aim is to discuss efficacy and safety of exercise-based cardiac rehabilitation (CR) programmes in participants with implantable cardiac devices compared with usual care.

Methods

MEDLINE, EMBASE and Cochrane databases were searched from inspection till July 15, 2022. Randomized controlled trials were included if they enrolled adult participants with implantable cardiac devices and tested exercise-based CR interventions in comparison with any control. Risk of bias was assessed, and endpoints data were pooled using random-effects model.

Results

Sixteen randomized trials enrolling 2053 participants were included. Study interventions differed between studies in terms of programme components, setting, exercise intensity, and follow-up. All studies included physical exercise component. In both implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) groups, exercise training in CR programmes improved peak oxygen uptake (VO2) [(mean difference (MD) 2.08 ml/kg/min; 95 % CI: 1.44-2.728, p < 0.0001; I2 = 99 %) and (MD 2.24 ml/kg/min; 95 % CI: 1.43-3.04, p < 0.0001; I2 = 96 %), respectively] and 6-min walk test in ICD group (MD 41.51 m; 95 % CI: 15.19-67.82 m, p = 0.002; I2 = 95 %) compared with usual care. In CRT group, there was no statistically significant improvement in left ventricular ejection fraction change between comparison groups. The results were consistent in subgroup analysis according to high or low-to-moderate exercise intensity for change in peak VO2 and ejection fraction in CRT group. There was no difference in number of ICD shocks between the comparators.

Conclusion

Exercise-based CR programmes appear to be safe when enrolling participants with implantable cardiac devices and leading to favourable functional outcomes.

Implementing good life with osteoArthritis from Denmark (GLA:D®) in australian public hospitals. Part 1: Feasibility

BACKGROUND

Literature reporting positive outcomes from the Good Life with osteoArthritis in Denmark (GLA:D®) program in Australia mainly involves patients attending private physiotherapy services.

OBJECTIVE

Evaluate the feasibility of implementing GLA:D® in Australian public hospitals.

DESIGN

Implementation study in three metropolitan tertiary public hospitals over six months.

METHOD

Patients aged ≥18 years with knee or hip joint-related problems deemed appropriate for non-surgical care were invited to participate in GLA:D®. Feasibility was evaluated using RE-AIM framework components (Implementation, Effectiveness, Maintenance) using service-level metrics, patient-level data, and program fidelity assessment. Findings of qualitative interviews with service providers are presented in Part 2.

RESULTS

Implementation: 70 patients (69 with knee osteoarthritis) participated (13 cohorts). 55 (79%) patients attended both education sessions, and 49 patients (70%) attended 10-12 exercises sessions. Fidelity was met based on environmental, therapist, participant- and program-related criteria.

EFFECTIVENESS

At 3 months, patients reported lower average pain (visual analogue scale [0-100 mm]: effect size -0.56, 95% CI -0.88 to -0.23) and disability (HOOS/KOOS-12 [100-0]: 0.67, 0.28 to 1.05), and improved quality of life (EQ-5D overall score: 0.46, 0.11 to 0.80). No adverse events were reported. All patients who completed 3-month assessment (n = 52) would recommend GLA:D®. Maintenance: All participating services elected to continue delivering GLA:D® beyond the study.

CONCLUSIONS

Implementing GLA:D® in Australian public hospitals is feasible, safe, and acceptable to patients with knee osteoarthritis. Public hospital patients with knee osteoarthritis reported improvements in pain, disability, and quality of life similar to previous GLA:D® cohorts.

The bidirectional relationship between brain structure and physical activity: A longitudinal analysis in the UK Biobank

Physical activity is a protective factor against brain atrophy, while loss of brain volume could also be a determinant of physical activity. Therefore, we aimed to explore the bidirectional association of physical activity with brain structures in middle-aged and older adults from the UK Biobank. Overall, 3027 participants (62.45 ± 7.27 years old, 51.3% females) had data at two time points. Hippocampal volume was associated with total (β=0.048, pFDR=0.016) and household (β=0.075, pFDR<0.001) physical activity. Global fractional anisotropy (β=0.042, pFDR=0.028) was also associated with household physical activity. In the opposite direction, walking was negatively associated with white matter volume (β=-0.026, pFDR=0.008). All these associations were confirmed by the linear mixed models. Interestingly, sports at baseline were linked to hippocampal and frontal cortex volumes at follow-up but these associations disappeared after adjusting for multiple comparisons (pall>0.104). In conclusion, we found more consistent evidence that a healthier brain structure predicted higher physical activity levels than for the inverse, more established relationship.

Quantifying the dose-response relationship between exercise and health-related quality of life in patients undergoing haemodialysis: A meta-analysis

Objective

This meta-analysis aims to explore the dose-response relationship of aerobic exercise or aerobic combined resistance exercise on cardiopulmonary function in maintenance hemodialysis（MHD）, with the goal of aiding in the formulation of precise exercise prescriptions.

Methods

A literature search up to August 18, 2023, was conducted in databases including Web of Science, among others, focusing on the effects of exercise interventions on cardiopulmonary function in hemodialysis patients.Two researchers independently conducted literature screening, data extraction, and an assessment of study methodology quality. A dose-response meta-analysis was carried out using a one-stage cubic spline mixed-effects model, followed by stratified analyses based on intervention period, intervention method, and exercise environment.

Results

A nonlinear dose-response relationship was observed between exercise and 6-minute walk test (6WMT) as well as peak oxygen uptake (VO2Peak) in hemodialysis patients. The optimal exercise dose for the 6WMT across the full exposure range was 922 METs-min/week, with VO2Peak increasing with the dose. The effects were influenced by the type of exercise, intervention period, and exercise environment. An exercise dose of 500 METs-min/week and 619 METs-min/week was found sufficient to achieve the minimal clinically important differences (MCID) for 6WMT and VO2Peak, respectively.

Conclusion

There is a significant association between the dose of exercise and its effects. With appropriate adjustment of variables, even low-dose exercise can lead to clinically significant improvements in cardiopulmonary function.

Voluntary wheel running as a promising strategy to promote autonomic resilience to social stress in females: Vagal tone lies at the heart of the matter

Social stress is a major risk factor for comorbid conditions including cardiovascular disease and depression. While women exhibit 2-3× the risk for these stress-related disorders compared to men, the mechanisms underlying heightened stress susceptibility among females remain largely unknown. Due to a lack in understanding of the pathophysiology underlying stress-induced comorbidities among women, there has been a significant challenge in developing effective therapeutics. Recently, a causal role for inflammation has been established in the onset and progression of comorbid cardiovascular disease/depression, with women exhibiting increased sensitivity to stress-induced immune signaling. Importantly, reduced vagal tone is also implicated in stress susceptibility, through a reduction in the vagus nerve's well-recognized anti-inflammatory properties. Thus, examining therapeutic strategies that stabilize vagal tone during stress may shed light on novel targets for promoting stress resilience among women. Recently, accumulating evidence has demonstrated that physical activity exerts cardio- and neuro-protective effects by enhancing vagal tone. Based on this evidence, this mini review provides an overview of comorbid cardiovascular and behavioral dysfunction in females, the role of inflammation in these disorders, how stress may impart its negative effects on the vagus nerve, and how exercise may act as a preventative. Further, we highlight a critical gap in the literature with regard to the study of females in this field. This review also presents novel data that are the first to demonstrate a protective role for voluntary wheel running over vagal tone and biomarkers of cardiac dysfunction in the face of social stress exposure in female rats.

The safety, feasibility, and efficacy of an 18-week exercise intervention for adults with primary brain cancer - the BRACE study

PURPOSE

To determine the safety, feasibility, and potential effect of an 18-week exercise intervention for adults with primary brain cancer.

MATERIALS AND METHODS

Eligible patients were 12-26-weeks post-radiotherapy for brain cancer. The individually-prescribed weekly exercise was ≥150-minutes of moderate-intensity exercise, including two resistance-training sessions. The intervention was deemed "safe" if exercise-related, serious adverse events (SAE) were experienced by <10% of participants, and feasible if recruitment, retention, and adherence rates were ≥75%, and ≥75% compliance rates were achieved in ≥75% of weeks. Patient-reported and objectively-measured outcomes were assessed at baseline, mid-intervention, end-intervention, and 6-month follow-up, using generalized estimating equations.

RESULTS

Twelve participants enrolled (51 ± 19.5 years, 5 females). There were no exercise-related SAEs. The intervention was feasible (recruitment:80%, retention:92%, adherence:83%). Participants completed a median of 172.8 (min:77.5, max:560.8) minutes of physical activity per week. 17% met the compliance outcome threshold for ≥75% of the intervention. Improvements in quality of life (mean change (95% CI): 7.9 units (1.9, 13.8)), functional well-being (4.3 units (1.4, 7.2)), depression (-2.0 units (-3.8, -0.2)), activity (112.8 min (42.1, 183.4)), fitness (56.4 meters (20.4, 92.5)), balance (4.9 s (0.9, 9.0)), and lower-body strength (15.2 kg (9.3, 21.1)) were observed end-intervention.

CONCLUSION

Preliminary evidence support that exercise is safe and beneficial to the quality of life and functional outcomes for people with brain cancer.Registration: ACTRN12617001577303.

Social Cognitive Theory Variables as Correlates of Physical Activity Behavior Among Hispanics With Multiple Sclerosis

OBJECTIVE

To examine the association between social cognitive theory (SCT) variables and physical activity (PA) behavior in Hispanic adults with multiple sclerosis (MS).

DESIGN

Observational, survey study.

SETTING

General community.

PARTICIPANTS

Inclusion criteria: (a) age 18 years or older, (b) self-identify as Hispanic or Latino, (c) diagnosis of MS, and (d) English or Spanish as primary language. Two hundred forty-three individuals opened the survey, 24 individuals did not meet inclusion criteria, and 66 individuals were excluded due to not completing any of the SCT variable measures (N=153).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

PA was measured using the Godin Leisure Time Exercise Questionnaire (GLTEQ) total and Health Contribution Scores (HCS). SCT variables included standard measures of exercise self-efficacy, planning, goal setting, outcome expectations, social support, and functional impairment.

RESULTS

The final sample included 153 participants with a mean (SD) age of 43 (11) years, 78% identified as women, 57% were employed, and 63% had a college degree or higher. The mean (SD) MS disease duration was 11 (9) years, 74% of participants reported relapsing remitting MS, and median (interquartile range) Patient Determined Disease Steps (PDDS) score was 3.0 (3.0). Significant correlations were observed between all SCT variables and both GLTEQ total and GLTEQ HCS scores (P<.001). Forward stepwise regression with Akaike's Information Criterion (AICC) identified PDDS, age, exercise planning, exercise self-efficacy, and exercise goal setting as the most appropriate covariates and SCT variables to include in a multivariable model examining independent contributions on GLTEQ HCS scores. The multivariable, linear regression analysis indicated that PDDS (Standardized B=-.280, P<.001), exercise planning (Standardized B=.214, P<.05), and exercise self-efficacy (Standardized B=.183, P<.05) explained 42.4% of variance in GLTEQ HCS scores.

CONCLUSIONS

This study provides a contribution to the literature by identifying SCT variables that correlate with PA behavior among Hispanics with MS that may guide the creation of culturally appropriate PA programs.

Move your feet and sleep: A longitudinal dynamic analysis of self-reported exercise, sedentary behavior, and insomnia symptoms

INTRODUCTION

Insomnia symptoms are associated with poor physical and mental health. Exercise is associated with good sleep while sedentary behavior is associated with poor sleep. This study investigated the longitudinal, dynamic associations among exercise, sedentary behavior, and insomnia symptoms.

METHODS

Seven hundred and fifty-six adults (Mage=47.2years, 54.9% female) took part in an online longitudinal study investigating sleep and health across the lifespan. Participants reported duration of moderate-to-strenuous exercise, percentage of day spent sitting, and insomnia symptoms (Insomnia Severity Index [ISI]). The ISI was scored as a total score and two-factor scores: (1) Sleep Disturbance (items 1, 2, 3) and (2) Daytime Dysfunction (items 4, 5, 6, 7). Multilevel modeling was used to examine the typical (i.e., between-persons) and individual (i.e., within-persons) associations among sedentary behavior, exercise, and insomnia symptoms.

RESULTS

Sedentary behavior was significantly associated with total ISI scores at both the between-person and within-person levels (β = 0.036, t = 3.23, p = .001; β = 0.014, t = 1.99, p = .048). Both between-persons and within-person levels of sedentary behavior were associated with Daytime Dysfunction (β = 0.028, t = 3.79, p < .001; β = 0.009, t = 2.08, p = .039). Exercise was associated with total ISI and Daytime Dysfunction scores at the between-persons level but not at the within-persons level (β = 0.028, t = 2.57, p = .01; β = -0.002, t = -3.02, p = .003).

CONCLUSIONS

Sedentary behavior was a more consistent and robust predictor of insomnia symptoms than exercise. The association between sedentary behavior and insomnia symptoms was dynamic in that when an individual reported being more sedentary than their norm, they also reported more insomnia symptoms. Future analyses should examine potential moderator variables and comorbid conditions.

Effective fall prevention exercise in residential aged care: an intervention component analysis from an updated systematic review

OBJECTIVE

The effect of fall prevention exercise programmes in residential aged care (RAC) is uncertain. This paper reports on an intervention component analysis (ICA) of randomised controlled trials (RCTs), from an update of a Cochrane review, to develop a theory of features of successful fall prevention exercise in RAC.

METHODS

Trial characteristics were extracted from RCTs testing exercise interventions in RAC identified from an update of a Cochrane review to December 2022 (n=32). Eligible trials included RCTs or cluster RCTs in RAC, focusing on participants aged 65 or older, assessing fall outcomes with stand-alone exercise interventions. ICA was conducted on trials with >30 participants per treatment arm compared with control (n=17). Two authors coded trialists' perceptions on intervention features that may have contributed to the observed effect on falls. Inductive thematic analysis was used to identify the key differences between the trials which might account for positive and negative outcomes.

RESULTS

32 RCTs involving 3960 residents including people with cognitive (57%) and mobility (41%) impairments were included. ICA on the 17 eligible RCTs informed the development of a theory that (1) effective fall prevention exercise delivers the right exercise by specifically targeting balance and strength, tailored to the individual and delivered simply at a moderate intensity and (2) successful implementation needs to be sufficiently resourced to deliver structured and supervised exercise at an adequate dose.

CONCLUSIONS

This analysis suggests that delivering the right exercise, sufficiently resourced, is important for preventing falls in RAC. This clinical guidance requires confirmation in larger trials.