Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases

International Delphi study of clinical and exercise professionals' opinion of physical activity prescreening and contraindications for participating in postpartum physical activity

OBJECTIVE

To establish expert consensus on prescreening and contraindications to moderate-to-vigorous intensity physical activity (MVPA) during the first year postpartum.

METHODS

A Delphi survey of clinical and exercise professionals working with postpartum women and people was conducted until consensus was reached (≥75% agreement). Round I consisted of questions about relative and absolute contraindications to MVPA. Rounds II and III included additional questions based on the thematic coding of open-ended responses from the previous rounds. The results were used to develop a postpartum MVPA preparticipation screening tool.

RESULTS

120 participants completed round I, 105 completed round II and 95 completed round III. Consensus was reached in 46/49 (94%) statements. Twenty-four relative contraindications to MVPA were identified: (loss of consciousness; neurological symptoms; kidney disease; calf pain or swelling suggestive of deep vein thrombosis; severe abdominal pain; vaginal bleeding not associated with menses; postpartum cardiomyopathy; caesarean section with symptoms that worsen with MVPA; unstable hypertension; eating disorder; malnutrition; anaemia; excessive fatigue; fractures or other significant musculoskeletal injuries; haemodynamic instability; breathing difficulties; acute systemic infection accompanied by fever, body aches, or swollen lymph glands; the new onset of chest pain, discomfort, and other angina-like symptoms with exertion; dizziness or lightheadedness during MVPA; new symptoms of heart disease, stroke; and other medical or physical conditions that may affect the ability to be physically active. Key biopsychosocial barriers to MVPA were identified.

CONCLUSION

This Delphi study recommends relative contraindications to MVPA for the first year postpartum that were incorporated into a postpartum MVPA pre-participation screening tool the Get Active Questionnaire for Postpartum.

Benefits of Pilates on Depression, Anxiety, and Stress: An Observational Study Comparing People Practicing Pilates to Non-Active Controls

Background: The positive effects of Pilates on balance, resistance, strength, and flexibility have been described several times. Additionally, positive effects on psychological symptoms, such as anxiety and depression, were documented. However, the change in behaviors at risk for stress-related physical disorders has not yet been validated in a group of people practicing Pilates. In light of these assumptions, changes in risk behaviors for stress-related physical disorders were assessed along with psychological symptoms, comparing a group of people practicing Pilates with non-active controls. Methods: The study was observational. Data from an experimental group of twenty-five people practicing Pilates (five males and 20 females between 50 and 64 years old) were compared to those of a control group of 24 people (seven males and 17 females between 54 and 65 years). Psychological symptoms were assessed through the Symptom Questionnaire (SQ) while the P Stress Questionnaire (PSQ) investigated risk behaviors for stress-related physical disorders. Results: The analyses attested a significant decrease in anxiety (time × group effect: F = 17.38; p < 0.001), depression (time × group effect: F = 5.44; p < 0.05), and somatization (time × group effect: F = 11.25; p < 0.01), as well as an improvement in stress-risk behaviors, especially in the ability to benefit from spare time by "taking one's mind away" from commitments (time × group effect: F = 8.56; p < 0.01). Conclusions: Although the literature describes benefits for anxiety and depression following moderate-intensity sporting activities, our study also noted positive effects from Pilates on stress and psychological symptoms. Our findings suggest that Pilates may be appropriate for people who can perform light to moderate exercise.

Analysis of chronic disease comorbidity patterns in middle-aged and elderly smokers in China: The China Health and Retirement Longitudinal Study

BACKGROUND

China has the largest tobacco consumer population in the world, and with the increasing severity of aging, the health issues caused by smoking continue to draw attention. This study aims to explore the current state of chronic disease comorbidity under different smoking patterns, providing a foundation for the formulation of public health policies.

METHODS

A total of 10771 participants older than 45 were included from CHARLS collected in 2020 after screening. The research variables were extracted and processed using Stata 18.0 software, followed by data filtering and organization in Excel. Through chi-square tests and multinomial logistic regression analysis, the study explored the influencing factors of comorbidity patterns under different smoking statuses.

RESULTS

The results indicate that within the framework of multiple chronic conditions, 2,254 individuals (20.9%) were relatively healthy, while 79.1% had one or more chronic conditions: 3,656 in the simple chronic disease group (33.9%), 3,998 in the minor complex chronic disease group (37.1%), and 863 in the major complex chronic disease group (8.0%). The severity of comorbidity patterns was significantly associated with age, alcohol consumption, hospitalization in the past year, outpatient visits in the past month, insufficient sleep, and poor cognitive function across different smoking statuses. Additionally, living in urban areas and having depression were linked to higher comorbidity severity among non-smokers. Among smokers, being female and having low life satisfaction were independent risk factors for comorbidity patterns. In the group of former smokers, intense physical activity was associated with an increased risk of severe comorbidity patterns.

CONCLUSION

In response, it is recommended to strengthen public health strategies and interventions related to chronic disease comorbidity among smokers.

The association between glycated hemoglobin, physical activity and infertility: a multiple logistic regression and mediation analysis based on the NHANES database

Objective

To determine the relationship between physical activity (PA) patterns and infertility among women in the United States and to ascertain whether glycated hemoglobin (HbA1c) influences this association.

Design

A cross-sectional study of PA patterns and infertility was conducted. The PA classification was based on two categories: recreational PA and work-related PA. The subgroups were classified as inactive, less active, or active. We conducted data analysis via both multiple logistic regression analysis and mediation analysis.

Setting

National Health and Nutrition Examination Survey (NHANES, 2013-2018).

Participants

Women aged 18-49 years (n, 3,948).

Results

There was no statistically significant link demonstrated between infertility and work-related PA patterns. The recreational PA group may decrease the prevalence of infertility, with its occurrence being merely 0.79 times that of inactive group. (95% CI: 0.62, 1.0; p = 0.045). The consistency of this discrepancy was not preserved in Model III after the mixed effect was incorporated into the recreational PA group. The stratified research findings revealed that the association between recreational PA patterns and infertility was influenced by variables such as age, BMI, and history of diabetes. Furthermore, the mediation analysis revealed that recreational PA did not have a statistically significant direct effect on infertility (p = 0.098). HbA1c serves as a mediator in this interaction (95% CI: -0.06, -0.02).

Conclusion

Recreational PA patterns were associated with infertility among women aged 18-49 years in the United States, which was likely due to the effects of HbA1c.

The best exercises from top 20 by health-related indicators

Background

The study aimed to determine whether participation in professional sports, exercise in a sports/health center, or independent exercise (dependent variables) is associated with 11 health behavior-related indicators (independent variables) compared to having no exercise.

Methods

The survey involved 293 professional Lithuanian athletes, 2,120 who exercise independently or in a sports/health centre and perform at least one of the 20 most popular exercise types in Lithuania (hereafter referred to as "E-20"), and 3,400 who do not exercise. The participants were aged 18-74 years.

Results

The study uniquely examines a comprehensive range of 11 health-related indicators: body mass index, subjective health, depressed mood, stress, sedentary behavior, physical activity, sleep, alcohol consumption, smoking, overeating, and breakfast consumption. We examined whether these indicators differ between the three populations studied, whether they are associated with specific types of the E-20 exercises, and whether these patterns differ between men and women.

Conclusion

Our study indicates that participants who engaged in physical activity generally scored higher on various health-related scales compared to those who were inactive. These benefits include reductions in depressed mood, stress, body mass index, and binge eating, as well as improvements in the regularity of breakfast consumption, vigorous physical activity, moderate to vigorous physical activity, and sleep duration (notably in men).

The Role of Exercise on Glial Cell Activity in Neuropathic Pain Management

Chronic pain is a widespread global health problem with profound socioeconomic implications, affecting millions of people of all ages. Glial cells (GCs) in pain pathways play essential roles in the processing of pain signals. Dysregulation of GC activity contributes to chronic pain states, making them targets for therapeutic interventions. Non-pharmacological approaches, such as exercise, are strongly recommended for effective pain management. This review examines the link between exercise, regular physical activity (PA), and glial cell-mediated pain processing, highlighting its potential as a strategy for managing chronic pain. Exercise not only improves overall health and quality of life but also influences the function of GCs. Recent research highlights the ability of exercise to mitigate neuroinflammatory responses and modulate the activity of GCs by reducing the activation of microglia and astrocytes, as well as modulating the expression biomarkers, thereby attenuating pain hypersensitivity. Here, we summarize new insights into the role of exercise as a non-pharmacological intervention for the relief of chronic pain.

Personalized Predictions for Changes in Knee Pain Among Patients With Osteoarthritis Participating in Supervised Exercise and Education: Prognostic Model Study

Background

Knee osteoarthritis (OA) is a common chronic condition that impairs mobility and diminishes quality of life. Despite the proven benefits of exercise therapy and patient education in managing OA pain and functional limitations, these strategies are often underused. To motivate and enhance patient engagement, personalized outcome prediction models can be used. However, the accuracy of existing models in predicting changes in knee pain outcomes remains insufficiently examined.

Objective

This study aims to validate existing models and introduce a concise personalized model predicting changes in knee pain from before to after participating in a supervised patient education and exercise therapy program (GLA:D) among patients with knee OA.

Methods

Our prediction models leverage self-reported patient information and functional measures. To refine the number of variables, we evaluated the variable importance and applied clinical reasoning. We trained random forest regression models and compared the rate of true predictions of our models with those using average values. In supplementary analyses, we additionally considered recently added variables to the GLA:D registry.

Results

We evaluated the performance of a full, continuous, and concise model including all 34 variables, all 11 continuous variables, and the 6 most predictive variables, respectively. All three models performed similarly and were comparable to the existing model, with R2 values of 0.31-0.32 and root-mean-squared errors of 18.65-18.85-despite our increased sample size. Allowing a deviation of 15 (visual analog scale) points from the true change in pain, our concise model correctly estimated the change in pain in 58% of cases, while using average values that resulted in 51% accuracy. Our supplementary analysis led to similar outcomes.

Conclusions

Our concise personalized prediction model provides more often accurate predictions for changes in knee pain after the GLA:D program than using average pain improvement values. Neither the increase in sample size nor the inclusion of additional variables improved previous models. Based on current knowledge and available data, no better predictions are possible. Guidance is needed on when a model's performance is good enough for clinical practice use.

Exercise and tissue fibrosis: recent advances in therapeutic potential and molecular mechanisms

Tissue fibrosis represents an aberrant repair process, occurring because of prolonged injury, sustained inflammatory response, or metabolic disorders. It is characterized by an excessive accumulation of extracellular matrix (ECM), resulting in tissue hardening, structural remodeling, and loss of function. This pathological phenomenon is a common feature in the end stage of numerous chronic diseases. Despite the advent of novel therapeutic modalities, including antifibrotic agents, these have only modest efficacy in reversing established fibrosis and are associated with adverse effects. In recent years, a growing body of research has demonstrated that exercise has significant benefits and potential in the treatment of tissue fibrosis. The anti-fibrotic effects of exercise are mediated by multiple mechanisms, including direct inhibition of fibroblast activation, reduction in the expression of pro-fibrotic factors such as transforming growth factor-β (TGF-β) and slowing of collagen deposition. Furthermore, exercise has been demonstrated to assist in maintaining the dynamic equilibrium of tissue repair, thereby indirectly reducing tissue damage and fibrosis. It can also help maintain the dynamic balance of tissue repair by improving metabolic disorders, exerting anti-inflammatory and antioxidant effects, regulating cellular autophagy, restoring mitochondrial function, activating stem cell activity, and reducing cell apoptosis, thereby indirectly alleviating tissue. This paper presents a review of the therapeutic potential of exercise and its underlying mechanisms for the treatment of a range of tissue fibrosis, including cardiac, pulmonary, renal, hepatic, and skeletal muscle. It offers a valuable reference point for non-pharmacological intervention strategies for the comprehensive treatment of fibrotic diseases.

How Do Peripheral Neurons and Glial Cells Participate in Pain Alleviation by Physical Activity?

Chronic pain is a global health problem with major socioeconomic implications. Drug therapy for chronic pain is limited, prompting search for non-pharmacological treatments. One such approach is physical exercise, which has been found to be beneficial for numerous health issues. Research in recent years has yielded considerable evidence for the analgesic actions of exercise in humans and experimental animals, but the underlying mechanisms are far from clear. It was proposed that exercise influences the pain pathways by interacting with the immune system, mainly by reducing inflammatory responses, but the release of endogenous analgesic mediators is another possibility. Exercise acts on neurons and glial cells in both the central and peripheral nervous systems. This review focuses on the periphery, with emphasis on possible glia-neuron interactions. Key topics include interactions of Schwann cells with axons (myelinated and unmyelinated), satellite glial cells in sensory ganglia, enteric glial cells, and the sympathetic nervous system. An attempt is made to highlight several neurological diseases that are associated with pain and the roles that glial cells may play in exercise-induced pain alleviation. Among the diseases are fibromyalgia and Charcot-Marie-Tooth disease. The hypothesis that active skeletal muscles exert their effects on the nervous system by releasing myokines is discussed.

Physical activity reverses the aging induced decline in angiogenic potential in the fast locomotory muscles of mice

Fast locomotory muscles, which are responsible for generating the highest power outputs, are more vulnerable to aging than slow muscles. In this study, we aimed to evaluate the impact of middle age and voluntary physical activity on capillarization and angiogenic potential in fast locomotory muscles. Middle-aged (M-group) and young (Y-group) wild-type FVB female mice were randomly assigned to either the sedentary or trained group undergoing 8-week spontaneous wheel running (8-sWR). Capillary density (assessed via immunohistochemical capillary staining and Western immunoblotting) of the fast locomotory muscles in the M-group (15-months old) was not significantly different compared to the Y-group (4-months old). Nevertheless, the expression of key pro-angiogenic genes in the fast muscle of the M-group was lower than that in the fast muscle of Y-group. 8-sWR had no impact on muscle capillarization; however, it increased fast muscle Vegfa expression in both the M and Y groups. We concluded that although fast muscle capillarization is still preserved in middle age, nevertheless the angiogenic potential (at least at the level of gene expression) is significantly reduced at this stage of aging. Moderate-intensity voluntary physical activity had no effect on capillary density, but it increased the angiogenic potential of the fast muscle.

Effects of Exercise on Physical Fitness in Older Adults with and Without Severe Cognitive Impairment

Physical fitness is defined as the ability to perform daily activities efficiently and without excessive fatigue, involving anthropometric variables and physical capacities. This study evaluates the effects of an adapted physical exercise program in older adults with and without severe cognitive impairment (SCI), aiming to compare its effects on blood pressure, anthropometric parameters, and physical fitness. The study included 78 older adults (24 with SCI) who participated in an individualized exercise program for one year, attending at least twice a week. Variables such as body mass index (BMI), body fat percentage (%BF), handgrip strength (HGS), aerobic endurance (6MiWa), balance, coordination, and agility were assessed. The results show significant improvements (p < 0.05) in most variables after the intervention, especially in flexibility, walking speed, and coordination. Although adults with SCI started with lower baseline levels, the magnitude of the improvements was similar to that of adults without SCI. However, greater deterioration was observed in handgrip strength and lower limb strength in adults with SCI, highlighting the need for specific interventions for this population. The study concludes that adapted physical exercise improves physical fitness and anthropometric parameters in older adults with and without SCI. It emphasizes the importance of using playful and communicative strategies to ensure the active participation of adults with SCI, promoting their functionality and physical independence.

The Role of Inflammatory Markers in Linking Metabolic Syndrome to Cognitive Decline in Middle-Aged Women: A Focus on TNF-α and IL-6

Background: Metabolic syndrome (MetS) and related disorders, such as insulin resistance, pose significant health risks in middle-aged women, including cognitive decline. Chronic inflammation, characterized by elevated levels of interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), has been identified as a key mechanism linking metabolic disturbances to neurodegenerative processes. Methods: This study aimed to examine the associations between metabolic disorders, inflammatory markers, and cognitive function among middle-aged women. A cross-sectional study was conducted on 179 non-smoking perimenopausal and postmenopausal women aged 43-73 years. Anthropometric, metabolic, and cognitive parameters were assessed, including body mass index (BMI), waist-to-height ratio (WHtR), fasting glucose (GLU), triglycerides (TG), IL-6, TNF-α, and Mini-Mental State Examination (MMSE) scores. Logistic regression models were applied to evaluate the relationships between inflammation, MetS components, and cognitive impairments. Results: Women with insulin resistance showed significantly worse metabolic profiles and lower MMSE scores (23.98 vs. 24.91, p = 0.032). IL-6 levels were strongly associated with hypertriglyceridemia (OR = 1.096, 95% CI: 1.044-1.151, p < 0.001) and insulin resistance (OR = 1.068, 95% CI: 1.030-1.107, p < 0.001), while TNF-α correlated with abdominal obesity (WHtR OR = 1.429, 95% CI: 1.005-2.031, p = 0.047). Moreover, TNF-α was a significant predictor of cognitive impairments (OR = 1.362, 95% CI: 1.153-1.610, p < 0.001), whereas IL-6 showed no significant association. Conclusions: These findings highlight that TNF-α may be a key inflammatory marker associated with metabolic disturbances and cognitive decline in middle-aged women. IL-6 appears to be more specifically linked to lipid abnormalities and insulin resistance. Targeted interventions to reduce inflammation may moderate metabolic and cognitive risks in this population.

Role of exercise on the reduction of cancer development: a mechanistic review from the lncRNA point of view

More research has been done on the correlation between exercise and cancer, which has revealed several ways that physical activity decreases the risk of developing the disease. The developing function of lncRNAs as an important molecular link between exercise and cancer suppression is the main topic of this review. According to recent research, regular physical exercise also alters the expression levels of several lncRNAs, which are generally elevated in cancer. A complex network of interactions that may provide protective effects against carcinogenesis is suggested by the contribution of these lncRNAs in various cellular processes, such as epigenetic alterations, proliferation, and apoptosis regulation. We offer a comprehensive summary of the existing information regarding specific lncRNAs that are influenced by physical activity and could potentially impact cancer-related processes. We also go over the difficulties in interpreting these alterations, taking into account the fact that several lncRNAs have a dual function in promoting and preventing cancer in various physiological settings. To understand the complex impacts of exercise-induced lncRNA regulation in cancer biology, more study is required. The critique strongly highlights the possibility of lncRNAs serving as both indicators and treatment prospects for cancer-preventive strategies.

The effects of exercise interventions on fatigue, body composition, physical fitness, and biomarkers in breast cancer patients during and after treatment: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Breast cancer is the leading cancer type among women, accounting for 24.5% of female cancer cases worldwide.

OBJECTIVE

The purpose of this study is to systematically review and conduct a meta-analysis to evaluate the effects of exercise interventions on breast cancer patients at different stages of treatment.

METHODS

Databases including PubMed, Cochrane Library, and Embase were searched for English-language randomized controlled trials (RCTs) published since 2000. The study included data from women aged 18 and above with breast cancer, either undergoing treatment or after treatment. Effect sizes were calculated using the standardized mean difference.

RESULTS

Out of 2845 studies, 40 met the inclusion criteria, with 17 studies focusing on patients undergoing treatment and 23 on after treatment patients. Exercise significantly reduced fatigue both undergoing (d =  - 0.20) and after treatment (d =  - 1.11). After treatment exercise interventions resulted in improvements in lean mass (d = 1.27), fat mass (d =  - 1.33), percentage body fat (d =  - 1.22), and waist circumference (d =  - 0.69). Additionally, biomarkers such as IL-6, HDL, LDL, glucose, systolic blood pressure (SBP), and diastolic blood pressure (DBP) showed improvements after treatment.

CONCLUSIONS

Exercise interventions are effective in reducing fatigue and enhancing fitness while undergoing treatment and have positive effects on body composition and biomarkers after treatment. Low-to-moderate intensity exercise is recommended undergoing treatment, while moderate-to-high intensity exercise is beneficial after treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Personalized exercise programs should be incorporated as a standard part of care in clinical settings to alleviate fatigue undergoing treatment and improve body composition and biomarkers following treatment.

Exercise combined with metformin ameliorates diabetic kidney disease by increasing renal autophagy and reducing oxidative stress in rats with high-fat diet and streptozotocin induced diabetes

Diabetic kidney disease (DKD) is one of the common and serious complications of type 2 diabetes mellitus (T2DM). Metformin is commonly prescribed for the treatment of T2DM, while exercise is frequently recommended as adjunctive therapy. However, the therapeutic efficacy and molecular etiology of combined therapy with exercise and metformin in DKD remain to be elucidated. The present study therefore aimed to investigate the therapeutic effects and mechanisms underlying the combined effects of exercise and metformin on DKD. A rat model of T2DM was constructed by administering a high-fat diet and intraperitoneal injections of streptozotocin (30 mg/kg) for 6 weeks. The rats with T2DM exhibited reduced autophagic flux, increased oxidative stress, and morphological and structural lesions in the kidneys, compared to those of normal rats in the control group. The combination of exercise and metformin alleviated DKD, indicated by the elevation of renal autophagic flux, and a reduction in oxidative stress, renal fibrosis, and histopathological damage to the kidneys. Our findings suggested that exercise combined with metformin has a therapeutic role in DKD, and the study serves as a valuable reference for future research on the treatment of DKD.

A dose-response meta-analysis of physical activity and the risk of alzheimer's disease in prospective studies

BACKGROUND

Alzheimer's disease (AD) has become an increasing global health challenge, particularly with the accelerated aging of the population. Therefore, preventive research targeting AD has become especially important. In recent years, physical activity (PA), as a potential non-pharmacological intervention, has garnered increasing attention from researchers. The aim of this study was to evaluate the effect of PA on AD risk through systematic review and meta-analysis and to further explore its potential preventive benefits.

METHODS

The literature search for this study encompassed PubMed, Embase, Web of Science, and the Cochrane Library databases, covering publications from their inception until November 1, 2024. Only English-language publications were included. Stratified analyses were conducted to explore the relationship between PA and AD risk by combining multivariate-adjusted effect estimates using random-effects models, along with subgroup analyses, sensitivity analyses, multifactorial meta-regression, and dose-response analyses to comprehensively assess the association between PA and the risk of AD.

RESULTS

Ultimately, 29 studies were included in the primary analysis, along with 3 additional studies for supplemental analyses, involving 1,453,561 participants, of whom 68,497 were diagnosed with AD. The results indicated that high-intensity PA significantly reduced the risk of AD by 26% (Hazard ratio [HR] = 0.74, 95% CI 0.67-0.83). Additionally, dose-response analyses revealed both linear and nonlinear associations, with linear dose-response results indicating a 15% reduction in AD risk for every 10 MET-h/wk increase in PA. Subgroup analyses indicated that the protective effect of PA was more pronounced in the non-obese population (BMI < 25) (HR = 0.65, 95% CI, 0.52-0.82), in individuals aged 75 years or older (HR = 0.57, 95% CI 0.48-0.67), and in non-APOE ε4 gene carriers (HR = 0.72, 95% CI 0.55-0.93), who exhibited greater protection. To explore the sources of heterogeneity among the included studies, a multifactorial meta-regression analysis was performed, which did not significantly explain the heterogeneity of the primary outcomes. Moreover, the robustness of the pooled results was confirmed through supplemental meta-analysis, subgroup analysis, and sensitivity analysis.

CONCLUSIONS

The results of this study support the potential of PA in reducing the risk of AD, particularly in non-obese populations, older age groups, and non-APOE ε4 gene carriers. PA holds significant potential in public health as a feasible and low-cost non-pharmacological intervention strategy.

Twelve-week interval training alters cytokines, adipokines and bone markers in women with obesity

This study aimed to investigate the effects of a 12-week high-intensity interval training on inflammatory cytokines, adipokines, and markers of bone turnover and examine whether high-intensity interval training-induced changes in inflammatory cytokines and adipokines were associated with changes in markers of bone turnover. Twenty-four women with obesity (mean [standard deviation]: age: 36.1 [3.38] years, height: 158.9 [11.9] cm, and body mass index: 31.9 [1.5] kg/m2) were randomly assigned to either control (n=10) or high-intensity interval training (n=14) groups. Body mass (- 2.7%), fat mass (- 15%), and percent body fat (- 6.2%) significantly decreased (p<0.05), while the predicted V̇O2max increased (29.6%; p<0.001) following the high-intensity interval training program. The training program resulted in increased adiponectin (7.6%) and osteocalcin (11.3%; p<0.05) and reduced tumor necrosis factor alpha (66.1%), interleukin-1α (18.6%), C-reactive protein (24.0%), leptin (21.5%), and carboxy-terminal telopeptide cross-linking type one collagen (14%; p<0.05). When high-intensity interval training and control groups were analyzed separately, training-induced changes in inflammatory cytokines and adipokines were not associated with changes in bone turnover markers (p>0.05), whereas significant associations were found when the data of the groups were analyzed together (p<0.05). In conclusion, a 12-week high-intensity interval exercise program improves the inflammatory state, adipokines, markers of bone turnover, cardiorespiratory fitness, and body composition in women with obesity.

The effectiveness of exercise interventions in the improvement of sleep in older adult people: a meta-analysis

Background

Sleep problems are prevalent among the older adult population, with a significant impact on their health and overall well-being. Several randomized controlled trials (RCTs) have yielded controversial results regarding the efficacy of exercise interventions in the improvement of sleep among older adult people. This systematic review and meta-analysis aim to assess the influence of exercise interventions on sleep quality within this demographic.

Methods

A search was conducted across four databases, namely Web of Science, PubMed, Embase, and SportDiscus, in order to identify randomized controlled trials investigating exercise interventions and sleep in the older adult. The quality of the studies included was evaluated by two researchers according to the PEDro scale. Meta-analysis and sensitivity analysis were performed utilizing RevMan 5.4 and Stata 17 software.

Result

A total of fifty studies encompassing 3,937 participants were included in the analysis. Regarding patient-reported sleep parameters, exercise interventions exhibited enhancements in sleep quality (WMD = -2.18, 95%CI: -2.83 to -1.53, p < 0.01) and reductions in insomnia severity (SMD = -0.52, 95%CI: -0.79 to -0.25, p < 0.01), albeit without significant improvements in daytime sleepiness (SMD = -0.66, 95%CI: -1.41 to 0.09, p = 0.09). In terms of clinician-reported sleep parameters, exercise interventions resulted in increased total sleep time (WMD = 8.98, 95%CI: 1.19 to 16.78, p < 0.05) and sleep efficiency (WMD = 3.66, 95%CI: 2.46 to 4.85, p < 0.01), and reduced wake time after sleep onset (WMD = -11.85, 95%CI: -15.58 to -8.11, p < 0.01), but did not decrease sleep onset latency (WMD = -3.05, 95%CI: -6.23 to 0.13, p = 0.06) or the number of awakenings during sleep (WMD = -0.73, 95%CI: -1.98 to 0.52, p = 0.25).

Conclusion

Exercise interventions have demonstrated positive effects on enhancing sleep quality among the older adult population. This study lends support to the utilization of exercise interventions as a safe, feasible, and effective non-pharmacological treatment approach for enhancing sleep among older individuals.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024530227, Identifier CRD42024530227.

Identifying Exercise Interventions That May Slow the Progression of Cognitive Decline in Older Adults With Mild Cognitive Impairment: A Scoping Review

Mild cognitive impairment (MCI) is defined as the stage between normal cognitive changes that may occur with age and more serious symptoms that indicate dementia. Symptoms of MCI can include problems with thinking, judgment, memory, and language, but the loss does not significantly interfere with the ability to handle everyday activities. A wide range of evidence demonstrates that aerobic, strength training, and combined exercises can slow the progression of cognitive impairment. However, few research studies in the United States exist, possibly due to an over-reliance on pharmacological intervention. To answer our research question, we performed a scoping review analysis of randomized controlled trials (RCTs) to locate published studies showing the types of exercise interventions using cognitive measures that benefit communities of older adults. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension Scoping Reviews guidelines, the authors searched five databases, namely, PubMed, GALE, Wiley Online Library, EBSCOHost, and OVID, for exercise intervention programs and slowing the progression of cognitive decline in older adults with MCI. All searches were performed between September 2022 and February 2023. In summary, we analyzed 10 international RCTs with 1,075 participants (mean age of over 50 years), but only 668 people were included in the control or experimental group. Combining exercise modalities in the intervention groups versus control groups prompted more beneficial results, improving global cognitive functioning. Resistance training shows promise as an exercise modality suitable for older adults to slow the progression of cognitive impairment.

Effect of Mediterranean diet and physical activity on healthcare professional depression, burnout and professional fulfillment during COVID-19

Objectives. The mental health of healthcare professionals, especially during the COVID-19 pandemic, is a critical concern. This study investigates the prevalence of burnout and professional fulfillment, depression and the relationship between physical activity and adherence to the Mediterranean diet with depression, burnout and professional fulfillment among healthcare professionals. Methods. Data were collected through a web-based survey of 567 healthcare professionals. Logistic regression analysis with age and sex adjustment was employed to analyze the results. Results. The prevalence of depression was 44%, burnout stood at 66% and professional fulfillment was reported at 28%. Adherence to the Mediterranean diet was linked to a reduced risk of depression (odds ratio [OR] 0.63, 95% confidence interval [CI] [0.41, 0.96], p = 0.033) and physical activity was also associated with a lower risk of depression (OR 0.49, 95% CI [0.32, 0.75], p = 0.001). Furthermore, adherence to the Mediterranean diet was associated with a reduced risk of burnout (OR 0.49, 95% CI [0.25, 0.98], p = 0.045). Conclusion. This study highlights the positive impact of physical activity and the Mediterranean diet as lifestyle factors on depression and burnout. These findings have implications for screening, follow-up and timely interventions to support the mental well-being of healthcare professionals.

Effects of exergames on rehabilitation outcomes in patients with osteoarthritis. A systematic review

PURPOSE

To analyze the effects of exergames on rehabilitation outcomes in osteoarthritis (OA) patients.

MATERIALS AND METHODS

A systematic review was reported according to the PRISMA statement. Randomized controlled trials (RCTs) were searched in Pubmed, Scopus, WoS, CINAHL, and PEDro (inception to November 2023). Studies that applied non-immersive exergames and assessed physical, functional, cognitive, pain, and psychosocial outcomes were included. Comparisons were other exercise modalities and non-intervention. Methodological quality was assessed with PEDro scale, and risk of bias (RoB) was assessed with Cochrane RoB-2 tool.

RESULTS

Eight studies were included (total of participants = 401). The mean PEDro score was 6.1, and seven studies had high RoB. Seven studies involved knee OA and one cervical OA. The most frequent duration for interventions was four weeks. Exergames were more effective than controls in at least one outcome in all studies. The outcomes for which exergames were most effective were functional disability, postural balance, muscle strength, proprioception, gait, range of motion, pain, quality of life, depression, and kinesiophobia.

CONCLUSION

Non-immersive exergames constitute an effective strategy for optimizing several relevant outcomes in rehabilitation. However, more RCTs with high methodological quality are required to deepen the knowledge about the multidimensional effects of exergames in OA patients.

Charting the Molecular Terrain of Exercise: Energetics, Exerkines, and the Future of Multiomic Mapping

Physical activity plays a fundamental role in human health and disease. Exercise has been shown to improve a wide variety of disease states, and the scientific community is committed to understanding the precise molecular mechanisms that underlie the exquisite benefits. This review provides an overview of molecular responses to acute exercise and chronic training, particularly energy mobilization and generation, structural adaptation, inflammation, and immune regulation. Furthermore, it offers a detailed discussion of known molecular signals and systemic regulators activated during various forms of exercise and their role in orchestrating health benefits. Critically, the increasing use of multiomic technologies is explored with an emphasis on how multiomic and multitissue studies contribute to a more profound understanding of exercise biology. These data inform anticipated future advancement in the field and highlight the prospect of integrating exercise with pharmacology for personalized disease prevention and treatment.

Does multimodal exercise reduce C-reactive protein levels in major depressive disorder? Preliminary results from a randomized controlled trial

This randomized controlled trial aimed to evaluate the adjunctive effects of an affect-based, supervised, multimodal, online, and home-based exercise intervention on C-reactive protein (CRP) levels and depressive symptoms by comparing it to pharmacotherapy alone (antidepressants) over a 12-week period. The study specifically focused on CRP levels and their association with depression outcomes. Depressive symptoms and blood samples were assessed before (baseline - t0), during (Week 5 - t1), and at end of treatment (Week 12 - t2). The exercise intervention was designed to optimize positive affect during and after exercise, and considered each participant's preferred exercise intensity to enhance perceived effort, pleasure, and enjoyment. The study enrolled 59 adults and randomly allocated them into two groups: exercise group (EG; n = 26,76.9% females, mean age 28.5 years) and control group (CG, n = 33, 78.7% females, mean age 25.9 years). CRP levels reduced in the EG at t2 compared with t0 [p = .019; d = .64 (CI 95% -.04,1.24)], while the CRP did not change during treatment in the CG [p = .116; d = -.35 (CI 95% -.93,.16)]. At t2, EG showed clinically meaningful reductions in CRP compared to CG: [p = .043; d = .50 (CI 95% .14,1.30)]. For EG, the anti-inflammatory response predicted reductions in self-reported depressive symptoms (t = 2.066, β = .438, p = .030). Given the significant role inflammation plays in modulating depression symptoms, our findings indicate that structured multimodal exercise programs, which can be delivered online, are effective in the management of depression and potentially have anti-inflammatory. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (ReBEC: RBR-4pgd3ct); Date of registration: 10/19/2023.

The role of skeletal muscle respiratory capacity in exercise performance

The connection between the respiratory capacity of skeletal muscle mitochondria and athletic performance is widely acknowledged in contemporary research. Building on a solid foundation of prior studies, current research has fostered an environment where scientists can effectively demonstrate how a tailored regimen of exercise intensity, duration, and frequency significantly boosts mitochondrial function within skeletal muscles. The range of exercise modalities is broad, spanning from endurance and high-intensity interval training to resistance-based exercises, allowing for an in-depth exploration of effective strategies to enhance mitochondrial respiratory capacity-a key factor in improving exercise performance, in other words offering a better skeletal muscle capacity to cope with exercise demands. By identifying optimal training strategies, individuals can significantly improve their performance, leading to better outcomes in their fitness and athletic endeavours. This review provides the prevailing insights on skeletal muscle mitochondrial respiratory capacity and its role in exercise performance, covering essential instrumental and methodological aspects, findings from animal studies, potential sex differences, a review of existing human studies, and considerations for future research directions.

Tailored Exercise Intervention in Metabolic Syndrome: Cardiometabolic Improvements Beyond Weight Loss and Diet-A Prospective Observational Study

Background: Metabolic syndrome (MS) is a cluster of cardiovascular and metabolic risk factors that increase the likelihood of both acute events and chronic conditions. While exercise has been shown to improve individual risk factors associated with MS; research on its effects on MS as an integrated condition remains limited. This study aims to evaluate the effectiveness of a 6-month Adapted Personalized Motor Activity (AMPA) program for improving the health outcomes of individuals with MS. Methods: Seventy-one sedentary participants with MS (mean age: 63 ± 9.4 years, 46.5% female) completed a 6-month intervention, incorporating moderate-intensity aerobic and resistance training. Each participant received a personalized exercise plan prescribed by a sports medicine physician. The training was monitored via telemetry to ensure safety. No dietary recommendations were provided during the intervention. Baseline and post-intervention assessments included Cardiopulmonary Exercise Testing (CPET), anthropometric measurements, blood pressure, heart rate, lipid profile (total cholesterol, HDL, LDL, and triglycerides), fasting glucose, and HbA1c. Results: Significant improvements were observed in fasting glucose (-10.6%, p < 0.001), HbA1c (-3.88%, p < 0.001), HDL cholesterol (+20.8%, p < 0.001), LDL cholesterol (-25.1%, p < 0.001), and VO2max (+8.6%, p < 0.001). Systolic and diastolic blood pressure also decreased significantly, with reductions of -12% (p < 0.001) and -5.9% (p < 0.001), respectively. Reductions in weight and waist circumference were statistically significant but modest and clinically irrelevant, showing no correlation with improvements in cardio-metabolic parameters. Logistic regression and correlation matrix analyses were performed to identify key predictors of changes in individual risk factors. Conclusions: While personalized exercise alone may not fully control individual risk factors of metabolic syndrome, its overall effect is comparable to low-intensity pharmacological polytherapy with minimal adverse effects. These benefits appear to be independent of dietary habits, gender, and both baseline and post-intervention physical performance and anthropometric measures.

Physical therapist characteristics and therapeutic relationship process construct factors that improve patient health outcomes in physical therapy: a systematic review

BACKGROUND

It appears that the therapeutic relationship in physiotherapy practice facilitates the success of patient health outcomes, although the process by which it is carried out has been poorly studied.

OBJECTIVE

To explore the influence of the therapeutic relationship on any patient health outcomes in physical therapy settings.

METHODS

PubMed, Web of Science, Scopus, CINAHL, LILACS and Dialnet databases were systematically searched following PRISMA guidelines. The searches were completed in August 2024. Qualitative and quantitative studies measuring the therapeutic relationship and assessing its influence on health outcomes of patients treated with physical therapy were included.

RESULTS

The search yielded a total of 769 results. 13 studies ultimately retained for analysis. A total of 1555 individuals were studied who had suffered injuries such as low back pain; osteoarthritis; underwent cardiac surgery; hip fracture and elite athletes recovering from injuries. The results obtained were classified into three main themes: characteristics and skills of physical therapists (interpersonal, organizational, leadership and communication skills), therapeutic relationship factors (shared decision making, trusting relationships, motivating the patient and individualization of care) and patient health outcomes influenced by therapeutic relationship (functional outcomes, disability, pain intensity, outcome expectations, perceived global effect, adherence, self-efficacy, sports performance and lung function).

CONCLUSIONS

Through physical therapist's soft skills, therapeutic relationship factors are built under the paradigm of person-centered care and shared decision making, having a positive influence on certain patient health outcomes. Therefore, evidence support that therapeutic relationship contributes to improved patient health outcomes.

Role of strategies used by young people for dealing with emotional distress: a qualitative study in deprived urban neighborhoods in Latin America

BACKGROUND

Many young people achieve recovery from mental health problems by using strategies to manage emotional distress and enhance well-being. Given that little is known about the functions of these strategies, especially in Latin American countries, this study aims to describe the usefulness of the resources used by youth from deprived urban neighborhoods in Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Perú) in managing emotional distress.

METHODS

112 in-depth interviews about strategies for dealing with emotional distress and their perceived function were conducted with young people from three Latin American cities. The sample included young adults and adolescents in a longitudinal cohort study. A thematic content analysis was carried out.

RESULTS

Participants identify different functions linked to their strategies to cope with emotional distress or increase their well-being. However, "coping with distress," "perceived support," and "distraction" are the three main functions of the strategies used by them in situations of emotional distress. Each of these functions comprises several aspects, some of which overlap between functions, such as motivation, emotional expression, companionship, and regulation.

CONCLUSION

The variety of functions linked to the strategies used by young people to cope with emotional distress or enhance their well-being could guide the facilitation of a favorable social and interpersonal context through public policies and a community approach that promotes young people's access to strategies to cope with emotional distress.

Exploring barriers, motivators and facilitators for physical activity and exercise in a UK South Asian community: a qualitative study

OBJECTIVES

This study aimed to elucidate motivators, barriers and facilitators of physical activity (PA) and exercise in a UK adult South Asian (SA) population. In addition, we sought to understand the sources of information regarding PA and the awareness of UK PA guidelines. Finally, the study aimed to explore public understanding of the utility of exercise for health outcomes and the role in disease prevention.

DESIGN

Explorative study using qualitative research methods including interviews and self-determination theory.

SETTING

Birmingham, UK.

PARTICIPANTS

The study included 15 UK SA adults (8 male, 7 female) with a mean age of 53.1 years (SA defined as Indian, Pakistani, Bangladeshi or Sri Lankan).

RESULTS

We here found three key themes: (1) Engagement in PA and exercise, (2) Factors influencing PA and exercise (both barriers and facilitators) and (3) Accessibility to information. Participants showed a thorough understanding of PA; however, they lacked knowledge of strength-building exercise (ie, resistance exercise). This was particularly evident in SA women. Barriers to exercise typically focused around concepts of time, while facilitators centred on sufficient support. Knowledge of PA and exercise was typically obtained via social media, with only 2/15 aware of UK guidelines.

CONCLUSIONS

While SA adults were aware of the importance of PA and its utility in health prevention, there was an evident lack of knowledge of guidelines and in particular the need for resistance exercise or other strength-building activities. We highlight a need to develop new routes to disseminate information within the SA population to increase knowledge and understanding of PA and resistance exercise for overall health.

Associations of total, domain-specific, and intensity-specific physical activity with all-cause and cause-specific mortality in China: A population-based cohort study

BACKGROUND

Evidence of an association between physical activity (PA) and mortality has mainly focused on leisure-time physical activity (LTPA) and moderate-to-vigorous-intensity physical activity (MVPA). We aimed to assess the associations of total, domain-specific, and intensity-specific PA with all-cause and cause-specific mortality.

METHODS

We used baseline PA data from the China Kadoorie Biobank, including 482,067 participants aged 30-79 years from 10 areas in China. PA via self-report was quantified as a metabolic equivalent of task hours per day. Total PA was calculated by summing occupational, commuting, household, and leisure-time PA, and domain- and intensity-specific PAs were also calculated. Cox regression was used to estimate the associations of quintiles of different types of PA with all-cause and cause-specific mortality and adjust for potential confounders. Cause-specific mortalities were also examined in a competing risk analysis.

RESULTS

During a median follow-up of 12.1 years, 47,281 deaths occurred. Total PA was inversely associated with the risk of all-cause mortality, with a hazard ratio (HR) (95% confidence interval [95% CI]) of 0.69 (0.67-0.71) in the highest quintile as compared with the lowest quintile. Similar associations were observed for disease-specific mortality risks from cardiovascular disease, cancer, respiratory disease, diabetes, and nervous system disease, with HR (95% CI) for top vs. bottom quintile of PA of 0.68 (0.64-0.71), 0.80 (0.76-0.83), 0.39 (0.35-0.44), 0.44 (0.35-0.55), and 0.52 (0.38-0.73), respectively. In addition, the risk of all-cause mortality was lowered by 34%, 13%, 17%, and 30% for occupational PA, non-occupational PA, low-intensity PA, and MVPA, respectively, when comparing the highest quintile with the lowest quintile.

CONCLUSIONS

PA was inversely associated with the risk of all-cause and cause-specific mortality, regardless of domain and intensity. Any PA can bring long-term beneficial health effects.

Diagnosis and Treatment of Adolescent Polycystic Ovary syndrome:A Review

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age. Diagnosing adolescent PCOS is challenging due to the overlap between adult PCOS diagnostic criteria and normal physiological changes in adolescence. This review examines the diagnosis and treatment strategies for adolescent PCOS. The diagnosis of adolescent PCOS should meet two primary criteria-ovulatory dysfunction and biochemical or clinical hyperandrogenism-after excluding other causes. Defining these criteria accurately aids in early diagnosis and management of adolescent PCOS. However, due to limited research, age-specific diagnostic standards remain lacking. Once diagnosed, timely interventions-such as lifestyle, exercise, and dietary changes, along with targeted treatments like metformin and antiandrogens-should be initiated. In addition, the management of adolescent PCOS presents several challenges, including the absence of standardized medication guidelines, adolescent psychological factors that may impede adherence to dietary and exercise recommendations, and parental concerns about the long-term effects of medication on bone health and metabolism. Therefore, additional research is required to establish optimal management protocols to enhance patients' quality of life and prevent complications.

Substituting Carbohydrate at Lunch for Added Protein Increases Fat Oxidation During Subsequent Exercise in Healthy Males

CONTEXT

How pre-exercise meal composition influences metabolic and health responses to exercise later in the day is currently unclear.

OBJECTIVE

Examine the effects of substituting carbohydrate for protein at lunch on subsequent exercise metabolism, appetite, and energy intake.

METHODS

Twelve healthy males completed 3 trials in randomized, counterbalanced order. Following a standardized breakfast (779 ± 66 kcal; ∼08:15), participants consumed a lunch (1186 ± 140 kcal; ∼13:15) containing either 0.2 g·kg-1 carbohydrate and ∼2 g·kg-1 protein (LO-CARB), or 2 g·kg-1 carbohydrate and ∼0.4 g·kg-1 protein (HI-CARB), or they fasted (FAST). Participants later cycled at ∼60% V̇O2peak for 1 hour (∼16:15) and post-exercise ad libitum energy intake was measured (∼18:30). Substrate oxidation, subjective appetite, and plasma concentrations of glucose, insulin, nonesterified fatty acids (NEFA), peptide YY (PYY), glucagon-like peptide 1 (GLP-1), and acylated ghrelin were measured for 5 hours post-lunch.

RESULTS

Fat oxidation was greater during FAST (+11.66 ± 6.63 g) and LO-CARB (+8.00 ± 3.83 g) than HI-CARB (P < .001), with FAST greater than LO-CARB (+3.67 ± 5.07 g; P < .05). NEFA were lowest in HI-CARB and highest in FAST, with insulin demonstrating the inverse response (all P < .01). PYY and GLP-1 demonstrated a stepwise pattern, with LO-CARB greatest and FAST lowest (all P < .01). Acylated ghrelin was lower during HI-CARB and LO-CARB vs FAST (P < .01). Energy intake in LO-CARB was lower than FAST (-383 ± 233 kcal; P < .001) and HI-CARB (-313 ± 284 kcal; P < .001).

CONCLUSION

Substituting carbohydrate for protein in a pre-exercise lunch increased fat oxidation, suppressed subjective and hormonal appetite, and reduced post-exercise energy intake.

Daily physical activity and trajectories of care service use among older adults: the HUNT4 Trondheim 70+ study

Introduction

Understanding factors that influence care service use is crucial for developing preventive strategies to maintain independence among older adults. In this study, we aimed to identify distinct trajectory groups of municipal care service use among community-dwelling older adults to determine whether daily physical activity is associated with future care service use.

Methods

This prospective cohort study included 981 community-dwelling older adults from the HUNT4 Trondheim 70+ study. At baseline, physical activity was assessed over seven consecutive days using two accelerometers attached to the thigh and lower back. An activity type machine learning model was used to classify the physical activity types: walking, standing, cycling, running, sitting, and lying. Municipal care service use was retrieved monthly from medical records for 3 years. Using group-based trajectory modeling, we identified distinct trajectories of care service use. Multinomial regression models adjusted for age, sex, education level, dementia, and physical performance were used to evaluate the associations between daily physical activity at baseline and care service group belonging.

Results

We identified four distinct trajectory groups of municipal care service use, labeled steady low (72.7%), low increasing (9.0%), medium increasing (12.0%), and high increasing (6.3%). Daily time spent in total physical activity was not associated with trajectory group belonging when adjusted for age, sex, education level, dementia, and physical performance. However, more time spent walking, in bouts lasting longer than a minute, was associated with a reduced relative risk of belonging to the high increasing compared to the steady low group. Furthermore, age, physical performance, and dementia were all significantly associated with trajectory group belonging, and sex differences were observed. Compared to women, men had a reduced relative risk of belonging to the low increasing, medium increasing, or high increasing trajectory groups.

Conclusion

This study identified four distinct trajectories of municipal care service use among older adults over 3 years. Total daily physical activity was not associated with trajectories of care service use, but more time spent walking in longer bouts was independently associated with lower care service use, even when adjusted for the strong predictors of physical performance, dementia diagnosis, and age.

Exercise, the Gut Microbiome and Gastrointestinal Diseases: Therapeutic Impact and Molecular Mechanisms

The benefits of regular physical activity (PA) on disease prevention and treatment outcomes have been recognized for centuries. However, only recently has interorgan communication triggered by the release of "myokines" from contracting skeletal muscles emerged as a putative mechanism by which exercise confers protection against numerous disease states. Cross-talk between active skeletal muscles and the gut microbiota reveal how regular PA boosts host immunity, facilitates a more diverse gut microbiome and functional metabolome, and plays a positive role in energy homeostasis and metabolic regulation. In contrast, and despite the large interindividual variation in the human gut microbiome, reduced microbial diversity has been implicated in several diseases of the gastrointestinal (GI) tract, systemic immune diseases, and cancers. Although prolonged, intense, weight-bearing exercise conducted in extreme conditions can increase intestinal permeability, compromising gut-barrier function and resulting in both upper and lower GI symptoms, these are transient and benign. Accordingly, the gut microbiome has become an attractive target for modulating many of the positive effects of regular PA on GI health and disease, although the precise dose of exercise required to induce favourable changes in the microbiome and enhance host immunity is currently unknown. Future efforts should concentrate on gaining a deeper understanding of the factors involved in exercise-gut interactions through the generation of functional 'omics readouts (ie, metatranscriptomics, metaproteomics, and metabolomics) that have the potential to identify functional traits of the microbiome that are linked to host health and disease states, and validating these interactions in experimental and preclinical systems. A greater understanding of how PA interacts with the GI tract and the microbiome may enable targeted therapeutic strategies to be developed for individuals and populations at risk for a variety of GI diseases.

ActiLup: is it feasible? High-intensity interval training in systemic lupus erythematosus patients with fatigue: protocol for a prospective, monocentric proof-of-concept study

The symptoms of active systemic lupus erythematosus (SLE) potentially lead to inactivity, muscle loss and social isolation. In addition to medical treatment, the current EULAR recommendations describe the relevance of physical activity, exercise and training as a non-pharmacological management option in patients with SLE. A positive interaction between fatigue and the basic health-promoting effects of exercise is well established. Still unclear is what kind of training, setting, and intensity show optimal objective and subjective outcomes. The study will include 40 adult SLE patients with moderate to severe fatigue. The study lasts 28 weeks and is divided into a 12-week "real-world" monitoring phase before rehabilitation, a 4-week inpatient rehabilitation phase, and a 12-week maintenance activity and training phase after the rehabilitation. The parameters consisted of physical performance parameters, laboratory parameters, physician and patient-related questionnaires and activity data based on a fitness watch. During rehabilitation, patients receive individual high-intensity interval training (HIIT), basic endurance training and functional interval training. This proof-of-concept trial aims to investigate if high-intensity interval training is feasible and how VO2peak is increased. Additionally, the effect of the severity of fatigue measured by patient-related outcomes and the number of anti-NR2 antibodies is focussed. This study was approved by the Ethics Committee of the Medical Association of Rhineland-Palatinate and complies with the standards of the Declaration of Helsinki. All participants will sign a written informed consent. Trial registration number: DRKS00022933.

Navigating exercise attitudes and emotional positivity in adulthood during the COVID-19 pandemic: evidence from Shandong Province

Introduction

During the onset of the COVID-19 pandemic, understanding public attitudes and emotional responses towards physical exercise became crucial. This study aimed to explore the relationship between positive emotions and attitudes towards physical exercise among adults in Shandong Province, China, and to identify the influence of demographic factors such as gender, age, and education levels on these attitudes and emotions.

Methods

A cross-sectional study was conducted among 404 adults in Shandong Province, China. Data were collected through surveys that assessed participants' attitudes towards physical exercise and their emotional positivity. Quantitative analysis was performed to examine the correlations and differences based on demographic variables, including gender, age, and education levels.

Results

A robust positive correlation was found between positive emotions and attitudes towards physical exercise, with an emotional positivity ratio of 2.01±1.38% among respondents. Significant differences in attitudes and emotional positivity were observed based on demographic factors. Specifically, male participants had a higher mean score in behavioral intention and control compared to females. Older adults (>41 years) demonstrated more positive exercise attitudes, with a higher total score of 4.05 ± 0.54 compared to younger age groups. Additionally, respondents with a graduate degree and above reported the highest emotional positivity rate, outpacing those with lower educational levels.

Discussion

The findings indicate that demographic factors, including gender, age, and education levels, play a crucial role in shaping attitudes and emotional responses towards exercise, especially during a global health crisis. These insights highlight the importance of considering demographic differences when promoting physical exercise and designing public health interventions. Future research should further explore the underlying mechanisms and potential interventions to enhance positive attitudes and emotional responses towards physical exercise across diverse populations.

Application of the hierarchical model of intrinsic and extrinsic motivation in the context of exercise: a systematic review

Given the increase in sedentary lifestyles and physical inactivity, various psychosocial approaches have been used to combat this epidemic. Several studies have used Self-Determination Theory (SDT) as a theoretical framework for studying behavioral change, as well as the Hierarchical Model of Intrinsic and Extrinsic Motivation (HMIEM) which, based on SDT, aims to explain how different levels of generality can be responsible for behavioral consequences. The aim was to investigate the associations between the variables that make up the HMIEM model applied to the context of physical exercise (gym exercisers). Following the PRISMA protocol and the PECOS strategy, the Web of Science, PubMed, Scopus, and SPORTDiscus databases were used to search for experimental and non-experimental studies written in English. Seven studies were considered for analysis and subjected to a methodological quality assessment The results showed that the variables that make up the social factors (e.g., supportive/thwarting behaviors) tend to be associated with satisfaction of basic psychological needs (BPN) (r = 0.51, p < 0.01; r = -0.73, p < 0.01) and with frustration of BPN (r = -0.39, p < 0.01; r = 0.78, p < 0. 01), BPN satisfaction and frustration tend to be associated with autonomous forms of motivation (r = 0.57, p < 0.01; r = -0.63, p < 0.01) and controlled forms of motivation (r = -0.76, p < 0.01; r = 0.46, p < 0.01) and autonomous and controlled forms of motivation are associated with behavioral consequences (e.g., intention) (r = 0.19, p < 0.01; r = -0.17, p < 0.01). This systematic review covers interpersonal behaviors and the bright and dark sides of SDT, showing that the positive alignment between the psychosocial determinants that make up the horizontal axis of the HMIEM is fundamental for adherence to and maintenance of sustainable physical exercise practices, and future studies should now address these issues in a longitudinal manner and perhaps move on to study the vertical axis of the HMIEM.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and cardiometabolic multimorbidity among middle-aged and older adults in China

BACKGROUND

The ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) (NHHR) served as a novel comprehensive lipid indicator. This study aimed to explore the association between NHHR and the incidence of cardiometabolic multimorbidity (CMM).

METHODS

This study included 8191 individuals from the China Health and Retirement Longitudinal Study (CHARLS) database. We used multivariable cox proportional hazards regression, logistic regression, and restricted cubic splines (RCS) analysis to evaluate the association between NHHR and CMM. Subgroup analyses and interaction tests were also performed.

RESULTS

The incidences of CMM among participants in quartiles (Q) 1-4 of NHHR were 7.03%, 8.3%, 10.06%, and 16.55%, respectively. The NHHR was significantly higher in individuals with CMM compared to those without CMM (P < 0.001). When assessed as a continuous variable, NHHR was independently associated with the risk of CMM, as demonstrated by both multivariable cox proportional hazards regression analysis (HR = 1.05, 95% CI = 1.02-1.07, P < 0.001) and logistic regression analysis (OR = 1.09, 95% CI = 1.04-1.15, P < 0.001). Compared to individuals in the lowest quartiles of the NHHR (Q1), the risk of CMM in the highest quartiles (Q4) was increased by 1.25-fold according to multivariable cox proportional hazards regression analysis (HR = 2.25, 95% CI = 1.73-2.93, P < 0.001) and by 1.48-fold according to logistic regression analysis (OR = 2.48, 95% CI = 1.86-3.31, P < 0.001). This association was consistent across nearly all subgroups. RCS analysis revealed a significant nonlinear association between NHHR and CMM. Additionally, the predictive ability of NHHR for CMM was 0.613, which was superior to that of both HDL-C and non-HDL-C (P < 0.05). Furthermore, the composite variable comprising NHHR and other traditional risk factors exhibited the highest predictive value (C statistic = 0.679).

CONCLUSION

A higher NHHR was closely associated with an increased risk of CMM. Further studies on NHHR could be beneficial for preventing and treating CMM.

Physical activity and motivational readiness for physical activity behavior change in adults with non-communicable diseases in Germany: a trend analysis of two cross-sectional health surveys from the German GEDA study 2014/2015 and 2019/2020

BACKGROUND

Physical activity (PA) is a cornerstone in maintaining a healthy lifestyle as well as in the prevention and rehabilitation of non-communicable diseases (NCD). First analysis of PA showed lower activity rates in adults with NCD compared to the general population. To improve health monitoring and to address World Health Organization (WHO) recommendations to systematically identify and track efforts to reduce inequalities in PA participation, trend analysis of PA in adults with NCD was performed for the period 2014/15 to 2019/20 for Germany. Furthermore, motivational readiness for PA behavior change was analysed based on the transtheoretical model (TTM).

METHODS

Based on two population-based cross-sectional health surveys (GEDA 2014/15-EHIS and GEDA 2019/20-EHIS) for Germany (N = 46,724), the prevalence of meeting WHO PA guidelines was analysed for adults with certain NCD compared to the general population. PA was assessed by self-report via the European Health Interview Survey- Physical Activity Questionnaire (EHIS-PAQ). Trend analyses and logistic regression models were performed to calculate disease specific Odds Ratios (OR) for fulfilment of PA recommendations. Motivational readiness for PA was assessed with the stages of change according to the TTM with data of GEDA 2014/15-EHIS.

RESULTS

Reporting any NCD is associated with lower fulfilment of health-enhancing aerobic PA in both surveys for almost all NCD, with lowest levels among adults reporting stroke, type 2 diabetes mellitus, chronic obstructive pulmonary disease, obesity and coronary heart disease. Sufficient muscle-strengthening was higher in adults with musculoskeletal diseases like osteoarthritis, lower back pain and neck pain compared to adults without these diseases. The prevalence of meeting WHO PA recommendations among adults with NCD remains at a low level. Sufficient health-enhancing aerobic PA tend to decrease in adults with NCD from 2014/15 to 2019/20, while sufficient muscle-strengthening increased in the same period. Motivational readiness for PA is lower for most adults with NCD, compared to the general adult population.

CONCLUSION

Lower rates of WHO PA recommendation fulfilment is recognized for most NCD groups compared to the population without NCD for both surveys, but the proportion of adults with NCD who meet the WHO PA recommendations differ widely between NCD groups. A positive trend from 2014/15 to 2019/20 can only be seen for adults with osteoarthritis. Based on our findings the implementation of PA promotion particular with regards to motivational readiness and disease specific PA measures is strongly recommended to improve prevention and ambulatory health care for adults with NCD.

Improvements in Exercise for Alzheimer's Disease: Highlighting FGF21-Induced Cerebrovascular Protection

Alzheimer's disease (AD) is the most common neurodegenerative disease. Currently, it has shown a trend of earlier onset, with most patients experiencing a progressive decline in cognitive function following the disease's onset, which places a heavy burden on society and family. Since no drug cure for AD exists, exploring new ways for its treatment and prevention has become critical. Early vascular damage is an initial trigger for neuronal injury in AD, underscoring the importance of vascular health in the early stages of the disease. Patients with early AD experience abnormal blood-brain barrier transport of amyloid-β (Aβ) peptides, with excess Aβ being deposited in the cerebral vasculature. The toxic effects of Aβ lead to abnormalities in cerebrovascular structure and function. Fibroblast growth factor21 (FGF21) is an endocrine factor that positively regulates energy homeostasis and glucose-lipid metabolism. Notably, it is one of the effective targets for metabolic disease prevention and treatment. Recent studies have found that FGF21 has anti-aging and vasoprotective effects, with receptors for FGF21 present in the brain. Exercise stimulates the liver to produce large amounts of FGF21, which enters the blood-brain barrier with the blood to exert neurovascular protection. Therefore, we review the biological properties of FGF21, its role in the cerebrovascular structure and function in AD, and the mechanism of exercise-regulated FGF21 action on AD-related cerebrovascular changes, aiming to provide a new theoretical basis for using exercise to ameliorate degenerative neurological diseases.

Physiological mechanisms of neuromuscular impairment in diabetes-related complications: Can physical exercise help prevent it?

Diabetes mellitus is a chronic disorder that progressively induces complications, compromising daily independence. Among these, diabetic neuropathy is particularly prevalent and contributes to substantial neuromuscular impairments in both types 1 and 2 diabetes. This condition leads to structural damage affecting both the central and peripheral nervous systems, resulting in a significant decline in sensorimotor functions. Alongside neuropathy, diabetic myopathy also contributes to muscle impairment and reduced motor performance, intensifying the neuromuscular decline. Diabetic neuropathy typically implicates neurogenic muscle atrophy, motoneuron loss and clustering of muscle fibres as a result of aberrant denervation-reinervation processes. These complications are associated with compromised neuromuscular junctions, where alterations occur in pre-synaptic vesicles, mitochondrial content and post-synaptic signalling. Neural damage is intensified by chronic hyperglycaemia and oxidative stress, exacerbating vascular dysfunction and reducing oxygen delivery. These complications imply a severe decline in neuromuscular performance, evidenced by reductions in maximal force and power output, rate of force development and muscle endurance. Furthermore, diabetes-related complications are compounded by age-related degenerative changes in long-term patients. Aerobic and resistance training offer promising approaches for managing blood glucose levels and neuromuscular function. Aerobic exercise promotes mitochondrial biogenesis and angiogenesis, supporting metabolic and cardiovascular health. Resistance training primarily enhances neural plasticity, muscle strength and hypertrophy, which are crucial factors for mitigating sarcopenia and preserving functional independence. This topical review examines current evidence on the physiological mechanisms underlying diabetic neuropathy and the potential impact of physical activity in counteracting this decline.

Aerobic Exercise Prescription for Pain Reduction in Fibromyalgia: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVE

Fibromyalgia is a condition characterised by disabling levels of pain of varying intensity. Aerobic exercise may play a role in reducing pain in these patients. The aim of this review is to assess the dose of aerobic exercise needed, based on the frequency, intensity, type, time, volume and progression (FITT-VP) model, to obtain clinically relevant reductions in pain.

DATABASES AND DATA TREATMENT

A systematic review and meta-analysis of randomised clinical trials was conducted in the Web of Science (WoS), PEDro, PubMed and Scopus databases, the search having been conducted between July and October of 2023. Risk of bias was assessed with the Cochrane Risk of Bias assessment tool 2.

RESULTS

Seventeen studies were included. The risk of bias varied, with six studies showing low risk; five, some concerns; and six, high risk. Aerobic exercise interventions were analysed using the FITT-VP model. Frequency ranged from 1 to 10 times per week, intensity varied from light to vigorous, and the types of exercise included music-based exercise, interval training, pool-based exercise, stationary cycling, swimming and walking. The intervention durations ranged from 3 to 24 weeks, with session lengths ranging from 10 to 45 min. Most of the studies presented significant differences, favouring aerobic exercise (MD -0.49; CI [-0.90, -0.08; p = 0.02]), with moderate to low heterogeneity in subgroup analyses.

CONCLUSIONS

The study findings underscore the efficacy of aerobic exercise in alleviating pain among fibromyalgia patients, advocating for tailored exercise dosing to optimise adherence and outcomes.

SIGNIFICANCE STATEMENT

Individuals with fibromyalgia should engage in aerobic exercises two to three times weekly, for twenty-five to forty minutes in each session, aiming for more than a hundred minutes per week. They should start at low intensity, gradually increasing to higher intensities over six to twelve weeks, for optimal pain management. Exercise types should be selected in collaboration with the patient and based on personal preferences and accessibility, such as walking, and swimming, to ensure long-term adherence to the regimen.

Effect of Aerobic Exercise on Symptom Burden and Quality of Life in Adults With Persisting Post-concussive Symptoms: The ACTBI Randomized Controlled Trial

OBJECTIVE

To evaluate a 6-week sub-symptom threshold aerobic exercise protocol (AEP) versus a stretching protocol (SP) on symptom burden and quality of life (QoL) in adults with persisting post-concussive symptoms (PPCS).

DESIGN

The Aerobic exercise for treatment of Chronic symptoms following mild Traumatic Brain Injury (ACTBI) Trial was a randomized controlled trial with 2 groups.

SETTING

Outpatient brain injury, pain, and physiotherapy clinics.

PARTICIPANTS

A total of 210 participants were screened. A consecutive sample of 52 adults with PPCS and exercise intolerance after mild traumatic brain injury were enrolled. No participants withdrew because of the adverse effects of the intervention.

INTERVENTIONS

Participants were randomized to a 6-week AEP (n=27) or 6-week SP (n=25).

MAIN OUTCOME AND MEASURES

The Rivermead Post Concussion Symptoms Questionnaire was the primary outcome. Secondary outcomes included QoL using the QoL After Brain Injury Questionnaire, in addition to measures of mood, anxiety, functional impact of headache, fatigue, dizziness, exercise tolerance, and sleep.

RESULTS

Participants were a mean (SD) of 43.0 (10.9) years old (75% female) and 24.7 (14.0) months post-injury. In per-protocol analysis, between-group difference (AEP vs SP) was not significant for the Rivermead Post Concussion Symptoms Questionnaire, but QoL After Brain Injury Questionnaire between-group difference was significant (mean change=5.024; 95% Cl, 0.057-9.992; P=.047) from baseline to 6 weeks. In the intention-to-treat analysis, between-group changes in primary and secondary outcomes were not significant.

CONCLUSIONS

This trial provides preliminary data to support the prescription of aerobic exercise for adults with PPCS. Despite presenting with exercise intolerance, participants were able to engage in subsymptom threshold exercise with QoL benefits.

Development and Implementation of the "Exercise is Medicine" Elective at an Osteopathic Medical School

Introduction

Lifestyle changes are a powerful way to combat many chronic illnesses. However, education on appropriate instruction of physical activity appears to be insufficient among medical students. This manuscript highlights development, incorporation, and feedback of the Exercise is Medicine elective at the West Virginia School of Osteopathic Medicine.

Materials and Methods

Twenty-four medical students attended ten weekly sessions, each of which lasted 2 h and covered a different topic. Participants were selected based on previous experience with exercise-based medicine and their personal beliefs on incorporating it into clinical encounters. Outcomes were gathered using surveys consisting of the Likert Scale, rating, yes/no/maybe, and free text questions.

Results

Confidence in prescribing lifestyle changes increased (p < 0.0001) from pre- to post-elective. Feelings of incorporating course material into practice increased (p < 0.05) after the elective. Feelings that physicians could impact their patients' physical activity did not change.

Conclusion

Implementation of the Exercise is Medicine elective was well received among students and increased student knowledge and confidence in prescribing lifestyle changes to a variety of patient populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02172-z.

Sportizumab - Multimodal progressive exercise over 10 weeks decreases Th17 frequency and CD49d expression on CD8+ T cells in relapsing-remitting multiple sclerosis: A randomized controlled trial

BACKGROUND

Multiple Sclerosis (MS) represents a neuroinflammatory autoimmune disease characterized by the predominance of circulating T cell subsets with proinflammatory characteristics and increased central nervous system (CNS)-homing potential. Substantial evidence confirms various beneficial effects of chronic exercise interventions in MS, but it is unknown how long-term multi-modal intense exercise affects MS-associated lymphocytes that are commonly targeted by medication in persons with relapsing remitting MS (pwRRMS).

METHODS

A total of 45 participants with defined RRMS were randomized to either the exercise (n = 22) or passive waitlist-control group (n = 23). A 10-week intervention consisting of progressive resistance and strength-endurance exercises was applied (3x/week à 60 min). Blood was drawn before (T1) and after (T2) the intervention period. Flow cytometry was used for phenotyping lymphocyte subsets.

RESULTS

Relative protein expression of CD49d within CD8+ T cells, quantified via mean fluorescence intensity (MFI), is significantly associated with the Expanded Disability Status Scale (p = 0.007, r = 0.440), decreased in the exercise group (p = 0.001) only, and was significantly lower in the exercise compared to the control group at T2 (p < 0.001). T helper (Th) 17 cell frequency decreased only in the exercise group (p < 0.001). CD8+CD20+ T cell frequency was significantly lower in the exercise compared to the control group at T2 (p = 0.003), without showing significant time effects.

CONCLUSION

The 10-week multimodal exercise intervention mainly affected circulating T cells harboring a pathophysiological phenotype in MS. The findings of a decreased frequency of pathogenic Th17 cells and the reduced CNS-homing potential of CD8+ T cells, indicated by reduced CD49d MFI, substantiate the positive effects of exercise on cellular biomarkers involved in disease activity and progression in MS. To confirm exercise-mediated beneficial effects on both disease domains, clinical endpoints (i.e., relapse rate, lesion formation, EDSS score) should be assessed together with these cellular and molecular markers in studies with a larger sample size and a duration of six to twelve months or longer.

[How does an intervention work?-German Version. : Development of an effect model for a complex intervention to prevent recurring or persistent pain using the example of PAIN 2.0]

In addition to the usual evaluation approach (usually a clinical randomized trial in the sense of the question: does an intervention work), complex interventions require further systematic investigations to prove their effectiveness. The role of the context in which the intervention is delivered is essential here, as is consideration of the question of why an intervention works (or does not work). Detailed recommendations exist for the planning and implementation of effectiveness studies on complex interventions, to which interdisciplinary multimodal pain therapy undoubtedly belongs. In an effectiveness model, concrete, verifiable assumptions are formulated as to how an intervention produces changes that are reflected in the endpoint. This article provides a brief introduction to methodological approaches to effectiveness research on complex interventions and uses the PAIN 2.0 project (01NVF20023) to describe in concrete terms what an effectiveness model for interdisciplinary multimodal pain therapy for the prevention of chronic pain in an outpatient setting might look like.

Profiling the patient with inflammatory bowel disease in the relationship between physical activity and partner/social network status: A post hoc patient-tailored analysis of the "BE-FIT-IBD" study

INTRODUCTION

Normal quality of life is an ultimate target in the therapeutic approach to inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC) in the context of which regular physical activity (PA) is often a chimeric parameter that is not standardized in terms of quality/quantity. The study aimed to profile a sample of IBD patients about the relationship between PA-partner status and social network support.

PATIENTS AND METHODS

A post hoc analysis of the "BE-FIT-IBD" study was set up by stratifying the data of PA with that of partner status and the support that the patient's social network (i.e., relatives, friends) provided in inciting the patient to practice regular PA.

RESULTS

In the 219 patients included, there was a greater tendency for patients with stable partners to view the risk of reactivation/worsening of IBD as a barrier to conducting regular PA (p<0.0001). Single patients considered PA more as a protective factor (p=0.045). Patients without a PA-supporting social network retained IBD-related treatment as a PA barrier (p=0.016) and PA as a risk for IBD complications (p=0.01), with less confidence that PA could improve the course of IBD (p<0.001). Rectal syndrome was an IBD-related barrier more represented in patients with PA-deterring social network (p<0.0001).

CONCLUSIONS

These factors are potential targets for recovering the IBD patient's adherence to regular PA.

Cost-Effectiveness of Telerehabilitation Compared to Traditional In-Person Rehabilitation: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the cost-effectiveness of telerehabilitation compared to traditional in-person rehabilitation. A comprehensive search of PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid databases identified 14 eligible studies. The analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, assessing economic outcomes using incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). Findings indicate that telerehabilitation was cost-effective in three out of 14 studies included in the cost-effectiveness analysis. The mean ICER for telerehabilitation compared to traditional rehabilitation varied, with a probability of cost-effectiveness reaching 90% at a willingness-to-pay (WTP) threshold of $30,000 per QALY. However, at a WTP threshold of $0, the probability of cost-effectiveness remained low, suggesting that telerehabilitation does not always dominate in cost-effectiveness analyses. The study highlights the potential of telerehabilitation to provide similar or improved health outcomes compared to traditional rehabilitation while reducing travel costs and enhancing patient access. Increased patient satisfaction, reduced hospital readmissions, and improved adherence to rehabilitation protocols contributed to the economic benefits observed. However, methodological heterogeneity across studies remains a limitation. Given the growing adoption of digital health technologies, telerehabilitation presents a viable and economically efficient alternative to in-person rehabilitation. Policymakers should consider integrating telerehabilitation into routine healthcare services, particularly in resource-constrained settings, to optimize cost-effectiveness and enhance accessibility. Further research should focus on standardizing cost-effectiveness evaluation methods to strengthen evidence for large-scale implementation.

Is Physical Exercise Beneficial for People with Primary Sjögren’s Syndrome? Findings from a Systematic Review

Background: The aim of the study was to identify and critically evaluate the best available evidence on the impact of physical exercise on patients with primary Sjögren’s syndrome. Methods: Studies were searched in four electronic databases (PubMed, Web of Science, Scopus, and SportDiscus) from their inception up to September 2024. The methodological quality of the included studies was assessed using the 10-point Physiotherapy Evidence Database (PEDro) scale and the Methodological Index for Non-Randomized Studies (MINORS). Results: A total of four randomized controlled trials and one comparative study were analyzed. The training programs evaluated varied in duration, ranging from 12 to 28 weeks. Exercise was found to have a positive intra-group impact on fatigue, quality of life, and functional capacity. However, exercise does not demonstrate superior effects compared to standard treatment for improving quality of life and disease impact. Conclusions: It is essential to increase the number of studies involving individuals with primary Sjögren’s syndrome across various exercise conditions to more comprehensively evaluate the potential benefits.

Community-Dwelling Filipino Older Adults' Experiences with Virtual Coach for Health-Enhancing Physical Activity (HEPA): A Phenomenology

Background: Physical inactivity among older adults persists as one of the global burdens. Older adults' physical activity (PA) levels decline simultaneously with age, causing health problems and poor outcomes. Immersive interventions, such as mixed reality virtual coaches, are gaining the potential to provide innovative solutions to prevent physical inactivity among older adults. However, an in-depth understanding of older adults' experience in using virtual-coach-driven physical exercise programs remains unexplored. Purpose: This study explored the experiences of community-dwelling older adults in using a virtual-coach-driven physical exercise program. Design: This study applied a phenomenological design using the qualitative approach to determine the lived experiences of community-dwelling older adults about the mother project, the "Move and Groove for Older Adults Program" (Hataw at Sigla para kay Lolo at Lola), a virtual-coach-driven physical exercise program using MR. A semi-structured interview guide was crafted consisting of three domains (acceptability, barriers, and facilitators), each with two open-ended questions. MAXQDA was used to thematically analyze the qualitative data. Results: Nine key informants shared their experiences with the virtual coach-driven physical exercise program using mixed reality. Four themes were identified describing their experiences with the program: (1) "Looking around": Exploring MR technology, (2) "Looking after": Engaging with MR exercise peers, (3) "Looking at": Examining issues with MR technology devices, and (4) "Looking Ahead": Envisioning the future of MR exercises. Conclusions: The findings of this study introduced new concepts and challenged old notions regarding older adults' technological engagement. The virtual-coach-driven physical exercise program enabled the participants to explore the novel methodology, enhance peer relationships, examine potential issues, and envision a future of possibilities using the technology. These outcomes are pertinent for progressing studies, scholars, and technology developers in incorporating MR into gerontechnology for wellness and fullness of life in the aging population. The mother project of this study was retrospectively registered [ID NCT06136468].

Open-source code for analysis of the lifetime total physical activity questionnaire (LTPAQ)

Advancing research to understand the impact of lifetime physical activity patterns on health is essential. While some progress on the topic has been made, further research is nevertheless warranted. Openly accessible operational resources for processing and analysing longitudinal physical activity data would help advance the field. The Lifetime Total Physical Activity Questionnaire (LTPAQ) provides an in-depth and detailed record of occupational/volunteer, household and recreational physical activities conducted across the lifespan. Despite the authors describing a specific code for physical activity data processing, its lack of comprehensiveness hinders its implementation by researchers or health professionals with limited programming or software expertise. For this purpose, we aimed to develop an open-source MATLAB code to simplify data handling and enhance comparability between studies using the LTPAQ. The source code of the LTPAQ analysis is accessible on our Git repository (https://github.com/coralsanchezmartin/LTPAQ_MATLAB_code). This code automates data handling, ensuring efficiency and facilitating adaptability. Moreover, it interacts seamlessly with Microsoft Excel sheets, providing a user-friendly interface for data input, storage, and organisation. This approach, combined with ongoing efforts to refine the code, seeks to overcome LTPAQ's scoring complexities, and promote a standardised methodology. By facilitating the processing of physical activity data from this questionnaire, our tool is expected to encourage its application in epidemiological studies and foster new insights into the impact of lifestyle from a life course perspective, ultimately playing a crucial role in shaping public health policies and enhancing clinical practice.