Musculoskeletal exercise: Its role in promoting health and longevity

Exercise alleviates osteoporosis by regulating the secretion of the Senescent Associated Secretory Phenotype

As the elderly population grows, the number of patients with metabolic bone diseases such as osteoporosis has increased sharply, posing a significant threat to public health and social economics. Although pharmacological therapies for osteoporosis demonstrate therapeutic benefits, their prolonged use is associated with varying degrees of adverse effects. As a non-pharmacological intervention, exercise is widely recognized for its cost-effectiveness, safety, and lack of toxic side effects, making it a recommended treatment for osteoporosis prevention and management. Previous studies have demonstrated that exercise can improve metabolic bone diseases by modulating the Senescent Associated Secretory Phenotype (SASP). However, the mechanisms through which exercise influences SASP remain unclear. Therefore, this review aims to summarize the effects of exercise on SASP and elucidate the specific mechanisms by which exercise regulates SASP to alleviate osteoporosis, providing a theoretical basis for osteoporosis through exercise and developing targeted therapies.

Grip strength, metabolic syndrome, and type 2 diabetes mellitus: a prospective study

Objectives

This study examines the impact of absolute grip strength (AGS) and relative grip strength (RGS) on the risk of developing type 2 diabetes mellitus (DM), especially in relation to metabolic syndrome (MetS).

Methods

1,935 participants were adults aged 51 to 81 years with an average observation period of 6.50 years. The diagnosis of DM was based on American Diabetes Association. The JAMA 5030J1 dynamometer was used to measure the grip strength. Multivariable extended Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for DM incidence.

Results

The DM risk increased with the number of MetS risk factors. High AGS was associated with a reduced DM risk (HR = 0.66, 95% CI = 0.44-0.99), but association disappeared when adjusted for MetS. High RGS was significantly associated with a reduced risk of DM incidence (HR = 0.49, 95% CI = 0.33-0.72), even after adjusting for MetS (HR = 0.63, 95% CI = 0.42-0.94). With the presence of MetS, higher AGS was associated with a greater increase in the DM risk compared to lower AGS, while higher RGS was associated with a less increase in the DM risk compared to lower RGS.

Conclusion

This study demonstrates that RGS is a more reliable predictor of DM risks than AGS. Additionally, MetS significantly increases DM risk, particularly in individuals with obesity and hypertension. The study highlights the importance of assessing muscle quality in DM prevention and suggest that improving muscle quality may help mitigate DM risk.

Efficacy of Yijinjing for Soft Tissue Improvement in Patients with Non-specific Chronic Neck Pain: Study Protocol for a Multicenter Randomized Controlled Trial

INTRODUCTION

As a mind-body exercise, Yijinjing has shown benefits in enhancing the effects of manual therapy for the treatment of pain, disability and soft tissue status associated with non-specific chronic neck pain (NCNP). The efficacy of Yijinjing as an independent exercise regimen for the treatment of NCNP has not been established. This study is designed to assess the efficacy of Yijinjing in patients with NCNP, compared with cervical function training (CFT).

METHODS AND ANALYSIS

A total of 132 consenting NCNP participants will be randomly assigned in a 1:1 ratio to either the Yijinjing group or the CFT group (three times a week for 8 weeks). Both groups will undergo an 8-week intervention phase. Outcome variables will be assessed at baseline and at 4-week, 8-week and 12-week follow-up. The primary outcome measure is the change in visual analogue scale scores at week 8. Secondary outcomes include neck disability index, cervical range of motion and soft tissue status parameters.

ETHICS AND DISSEMINATION

This study has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki, local laws and regulations. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ITMCTR2024000323.

Meeting physical activity and resistance exercise guidelines associated with significantly reduced prevalence of diabetes in older adults

BACKGROUND

The global prevalence of diabetes is rising. Lack of physical activity is a known risk factor, and older adults with diabetes face a higher risk of complications compared to other age groups. Additionally, the risk of mortality increases with longer duration of diabetes.

OBJECTIVE

This study aimed to investigate how meeting physical activity guidelines is associated with diabetes prevalence in older adults.

METHODS

We analysed data from 5679 men and women (aged ≥65 years) who participated in the Korea National Health and Nutrition Examination Survey (2016-19). Physical activity levels were measured using the Global Physical Activity Questionnaire, including an assessment of weekly resistance exercise duration. Multivariable adjusted logistic regression analysis was conducted to examine the association between meeting leisure-time physical activity and resistance exercise guidelines with diabetes prevalence.

RESULTS

Meeting either the leisure-time physical activity guideline [odds ratio (OR): 0.72, 95% confidence interval (CI): 0.58-0.88] or the resistance exercise guideline (OR: 0.69, 95% CI: 0.59-0.80) was associated with a lower prevalence of diabetes. Notably, participants who met both guidelines had a 37% lower risk of diabetes (95% CI: 0.47-0.84) compared to those who met none.

CONCLUSIONS

Adherence to physical activity guidelines, especially leisure-time physical activity and resistance exercise, is associated with a reduced prevalence of diabetes in older adults. Meeting both sets of guidelines may significantly lower the risk of diabetes compared to not meeting any. These findings highlight the crucial role of regular physical activity in preventing diabetes amongst older individuals, with the potential for a significant public health impact.

SIRT1 and exercise-induced bone metabolism: a regulatory nexus

Regular exercise positively influences bone health, enhances bone density and strength, and reduces the risk of osteoporosis. Silent information regulator of transcription 1 (SIRT1) is a deacetylase that plays a pivotal role in the regulation of various biological processes. In this review, we explore the role of SIRT1 in modulating bone metabolism in response to exercise. SIRT1 regulates crucial cellular processes, including inflammation, aging, autophagy, and oxidative stress, in bone cells such as bone marrow mesenchymal stem cells, osteoblasts, and osteoclasts, in response to exercise-induced stimuli. Notably, exercise influences bone metabolism by modulating muscle metabolism and neurotransmitters, with SIRT1 acting as a key mediator. A comprehensive understanding of SIRT1's regulatory mechanisms will facilitate a deeper exploration of the principles underlying exercise-induced improvements in bone metabolism, ultimately providing novel insights into the treatment of bone metabolic disorders.

Beyond lifestyle, logic and empathy: subjective health, mood, emotional intelligence, and personality as keys to well-being for women and men

In a study involving 831 women and 309 men aged 18 to 64, we sought to explore the key determinants influencing various components of well-being, including happiness, life satisfaction, and vigor/vitality. The determinants examined encompassed sociodemographic variables, health indicators, sedentary behaviors, physical activity, body mass index (BMI), sleep patterns, eating habits, alcohol consumption, smoking, mood indicators, personality traits, emotional intelligence, logical thinking, non-utilitarian decision-making, and adverse childhood experiences. Our findings indicate that happiness, life satisfaction, and vigor are most significantly affected by mood indicators-especially depression-emotional intelligence (particularly the ability to manage emotions), and overall subjective health. Additionally, specific personality traits, such as extraversion in women and neuroticism in men, played a significant role in influencing well-being. Conversely, determinants such as BMI, sleep habits, regular physical activity, sedentary behavior, dietary habits, avoiding smoking and excessive alcohol consumption, as well as logical thinking, non-utilitarian decision-making, and adverse childhood experiences, showed limited or no significant impact on well-being components like happiness, life satisfaction, and vigor. These findings provide valuable insights into the complex dynamics of human well-being, highlighting the distinct determinants of happiness, life satisfaction, and vigor/vitality for men and women.

Meta-analysis of high-intensity interval training effects on cognitive function in older adults and cognitively impaired patients

Background

Cognitive enhancement treatments are limited, and while High-Intensity Interval Training (HIIT) has been suggested to improve cognitive function, high-quality evidence remains scarce. This meta-analysis evaluates the effects of HIIT on cognitive performance compared to moderate-intensity continuous training (MICT) and control groups in older adults and cognitively Impaired Patients.

Methods

A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for articles published until 10 October 2024. Eighteen studies were included, comparing cognitive outcomes across HIIT, MICT, and control groups. Cognitive tests evaluated included the Stroop test, Digit Span Test (DST), Trail Making Test (TMT), and the MOST test.

Results

HIIT significantly improved performance compared to MICT in the Stroop test (SMD = -0.8, 95% CI: -1.3 to -0.2) and DST (SMD = 0.3, 95% CI: -0.0-0.5). Compared to control groups, HIIT significantly enhanced performance in the TMT (SMD = -0.7, 95% CI: -1.3 to 0.0) and MOST test (SMD = -1.2, 95% CI: -1.8 to -0.7).

Conclusion

This meta-analysis supports the efficacy of HIIT in enhancing cognitive functions, particularly in cognitive flexibility, working memory, task switching, attention control, and inhibitory control. These findings suggest that HIIT can be an effective intervention for improving cognitive behavior in older adults and cognitively Impaired Patients.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, Identifier CRD42023413879.

Examining the moderating role of physical fitness on the relationship between ice and snow sports participation and health outcomes in China

BACKGROUND

The study examines how ice and snow sports participation, fitness, perceived social support, and access to winter sports facilities affect health outcomes in China. Understanding winter sports' health benefits is essential for improving public health in colder parts of China, where their popularity is rising.

METHODS

A sample of 875 Chinese from various regions was used to examine variable relationships using structural equation modeling (SEM) and route analysis.

RESULTS

Health outcomes, fitness, winter sports facilities, and ice and snow sports participation were positively associated. A significant correlation (β = 0.22, p < 0.001) was established between ice and snow sports participation and physical fitness, highlighting the impact of winter sports on health. Perceived social support for winter sports improves cold weather tolerance (β = 0.27, p < 0.001), emphasizing the role of social networks in resilience. The correlation between physical fitness and access to winter sports facilities (β = 0.31, p < 0.001) highlights the importance of physical talents in winter sports participation. Positive associations between physical fitness (β = 0.25, p < 0.001) and winter sports social support (β = 0.19, p < 0.001) suggest favorable health and well-being impacts. Physical fitness moderates the health benefits of ice and snow sports participation (β = 0.12, p < 0.05), whereas perceived social support for winter sports mediates the effect (β = 0.09, p < 0.05).

CONCLUSIONS

The findings emphasize the importance of supporting ice and snow activities and providing infrastructure to promote health. Physical fitness and improved health outcomes on social support can improve winter sports benefits. Public health initiatives may leverage this information to encourage active living and enhance health.

Resistance exercise training improves disuse-induced skeletal muscle atrophy in humans: a meta-analysis of randomized controlled trials

BACKGROUND

This meta-analysis aimed to determine whether resistance exercise training (RET) can attenuate the loss of muscle volume and function in anti-gravitational muscles, especially quadriceps and calf muscles, during immobilization/disuse conditions.

METHODS

A comprehensive literature search was conducted to identify randomized controlled trials comparing RET vs. no exercise during immobilization/disuse. Searches were conducted in databases including Web of Science, PubMed, EBOSCO, and Cochrane Library, without imposing a time limit until 20 March, 2023. Studies reporting outcomes related to muscle volume, MVC, peak power, concentric peak force, eccentric peak force, isometric MVC torque of knee extension, isometric MVC torque of knee flexion were included. Data were pooled using random-effects models.

RESULTS

Eleven randomized controlled trials were finally included. RET elicited substantial benefits for preserving quadriceps muscle volume (n = 5, MD = 252.56, 95% CI = 151.92, 353.21, p < 0.001). RET demonstrated a statistically significant preventive effect on the reduction of MVC in both quadriceps (n = 4, MD = 338.59, 95% CI = 247.49, 429.69, p < 0.001) and calf muscles (n = 3, MD = 478.59, 95% CI = 160.42, 796.77, p < 0.01). Peak power of quadriceps muscles (n = 4, MD = 166.08, 95% CI = 28.44, 303.73, p < 0.05) and calf muscles (n = 2, MD = 176.58, 95% CI = 102.36, 250.79, p < 0.001) were elevated after RET intervention. RET significantly ameliorated the weakening of both concentric and eccentric peak force in quadriceps (concentric: n = 2, MD = 470.95, 95% CI = 355.45, 586.44, p < 0.001; eccentric: n = 1, MD = 351.51, 95% CI = 254.43, 448.58, p < 0.001) and calf muscles (concentric: n = 2, MD = 867.52, 95% CI = 548.18, 1186.86, p < 0.001; eccentric: n = 1, MD = 899.86, 95% CI = 558.17, 1241.55, p < 0.001). Additionally, the diminishing of isometric MVC torques of knee extension (n = 6, MD = 41.85, 95% CI = 20.93, 62.77, p < 0.001) and knee flexion (n = 4, MD = 13.20, 95% CI = 8.12, 18.77, p < 0.001) were enhanced significantly after RET intervention.

CONCLUSIONS

RET effectively minimized deterioration of muscle volume and muscle function during immobilization/disuse, particularly in anti-gravitational muscles. RET should be recommended to maintain muscle and neuromuscular health for spaceflight, bed rest, immobilization/disuse conditions. Further research is needed to explore the effects of RET in more diverse populations and under various disuse conditions. More high-quality research will be required to demonstrate the aforementioned benefits conclusively.

Isotemporal substitution of sedentary time with different physical activity intensities and sleep in obesity parameters across eight latin American countries

This study aimed to examine the associations between substituting sedentary time (ST) with physical activity and sleep with obesity parameters in adults from eight Latin American countries. The sample consisted of 2173 adults aged 18-65 years. Physical activity, ST and sleep were objectively measured using accelerometers. The parameters of obesity were defined using body mass index (BMI) and waist circumference (WC). Regression analyses were conducted for isotemporal analysis of the association between substituting 30 min/day of ST with light physical activity (LPA), moderate to vigorous physical activity (MVPA) and sleep in relation to BMI and WC. Substituting light physical activity with higher intensity was also analyzed. Substituting 30 min/day of ST with MVPA was significantly associated with lower odds of a higher BMI (OR: 0.993, 95%CI 0.990-0.998) and WC (OR: 0.998, 95%CI 0.998-0.999). Conversely, substituting ST with LPA did not show a significant impact on obesity parameters. However, the substitution of 30 min/day of LPA with MVPA was also associated with lower odds of a higher BMI (OR: 0.993, 95%CI 0.989-0.997). The results highlight the importance of replacing ST and increasing the intensity of physical activity as an effective strategy for preventing and managing obesity in Latin America.

Effects of different types of Tai Chi intervention on motor function in older adults: a systematic review

BACKGROUND

Tai Chi (TC) is widely acknowledged for its positive impact on improving motor function in older adults. Nevertheless, limited research has directly compared the effects of different TC styles on older adults with functional impairments.

OBJECTIVE

This study aimed to assess the impact of different TC styles on motor function in older adults with functional impairments.

METHOD

We searched five databases-PubMed, Scopus, Chinese National Knowledge Infrastructure (CNKI), Web of Science, and Wiley Online Library-including studies published up to September 2024. The selection of literature adhered to PRISMA guidelines, with quality assessment independently carried out by two researchers.

RESULTS

Fourteen studies met the inclusion criteria for this review. The analysis revealed that TC interventions for functionally impaired older adults primarily employed Yang-style, Sun-style, Chen-style, and simplified-style TC. The populations studied included individuals with mild cognitive impairment (MCI), nonspecific low back pain (NS-LBP), preclinical disabilities, chronic diseases, poor balance, osteoarthritis (OA), Parkinson's disease (PD), sarcopenia, and those at risk of falls. The findings indicated that motor function in functionally impaired older adults were closely linked to balance, gait, mobility, strength, and fall rates. Among the various TC styles, Yang-style was the most frequently utilised intervention.

CONCLUSION

This review examined four types of TC interventions and found strong evidence supporting the effectiveness of Yang-style TC in improving motor function in older adults with functional impairments. Additionally, five assessment methods-Single-Leg Stance (SL), Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUGT), Chair Stand Test (CST), and Fall Efficacy Scale (FES)-were identified as suitable for evaluating this population. Based on the findings, it is recommended that individuals with functional impairments engage in Yang-style 24-movement TC, with an intervention duration of 12 weeks, practicing two to five times a week for 60 min each session.

Biological aging traits mediate the association between cardiovascular health levels and all-cause and cardiovascular mortality among adults in the U.S. without cardiovascular disease

The American Heart Association's (AHA) Life's Essential 8 (LE8) metrics provide a framework for assessing cardiovascular health (CVH). This study evaluates the relationship between CVH levels from LE8 and mortality risk, considering biological aging's role. Using data from the NHANES non-CVD adult population, CVH scores were categorized as low (< 50), moderate (50-79), and high (≥ 80) per AHA guidelines. Cox regression model assessed the impact of CVH levels on all-cause and cardiovascular mortality, while examining four aging indicators as mediators. RCS explored the relationships between CVH scores and mortality risk. The model's performance was evaluated using nine machine learning algorithms, with SHAP analysis on the best model to determine CVH score components' importance. Cox regression showed that all-cause mortality rates decreased by 35% for moderate and 54% for high CVH groups compared to low CVH. The high CVH group had a 59% lower cardiovascular mortality rate. Each unit increase in CVH score reduced all-cause and cardiovascular mortality to 0.98 times. RCS analysis revealed a nonlinear trend between CVH scores and mortality risk. Biological aging indicators significantly mediated the CVH-mortality relationship, with PhenoAge (21.57%) and KDM-Age (20.33%) showing the largest effects. The XGBoost model outperformed others, with SHAP analysis ranking CVH components: physical activity, nicotine, blood pressure, BMI, lipids, healthy eating index, blood glucose, and sleep. Higher CVH levels correlate with reduced all-cause and cardiovascular mortality risk, with biological aging mediating these effects. Adhering to AHA's LE8 metrics is recommended to enhance life expectancy in the non-CVD population.

Pilot study of the sequential square mat "Fisior® program": A strategy for improving mobility in older adults

OBJECTIVE

The present study aims to analyze the effectiveness of a gait re-education program using a sequential square mat (Tapiz Fisior®, in advance SSM Fisior®) in aspects related to mobility, balance, muscle strength, and gait of elderly people.

METHODS

The intervention lasted eight weeks through progressive resistance training designed specifically for older people, with an approximate duration of 30-40 min, and was carried out three times a week on non-consecutive days using the SSM Fisior®.

RESULT

The intervention improved gait, balance, physical performance, lower limb strength, and walking speed. The women improved in balance, gait, physical performance, and lower limb strength, while the men improved only in balance and gait. Better outcomes were seen in participants who were not functionally dependent at baseline. Older people who did not have functional dependence before the intervention improved in balance, gait, physical performance, and strength of the lower limbs.

CONCLUSION

In conclusion, our findings underscore that the SSM Fisior® program stands out as an effective strategy for enhancing the mobility domain of intrinsic capacity in older individuals. These results advocate for the implementation of the SSM Fisior® program as a promising approach to improve the overall well-being and functional abilities of older adults.

Single-Cell RNA Sequencing Analysis Reveals Exercise-Induced Transcriptional Dynamics in Half-Marathon Runners

Previous studies in sports science suggested that regular exercise has a positive impact on human health. However, the effects of endurance sports and their underlying mechanisms are still not completely understood. One of the main debates regards the modulation of immune dynamics in high-intensity exercise. As part of the "Run 4 Science" project in Verona, Italy, we conducted a single-cell RNA sequencing analysis on half-marathon amateur runners to investigate the transcriptional dynamics of peripheral blood mononuclear cells following endurance exercise. Blood samples were collected from four participants before and after running a half-marathon to carry out a comprehensive transcriptomic analysis of immune cells at the single-cell level. Our analysis revealed significant alterations in the transcriptional profiles following endurance physical exercise. Modulations in myeloid cells suggested the activation of stress response (6 related pathways, p < 0.04) and pathways related to viral processes (4 related pathways, p < 0.03), while in lymphoid cells they hinted to a shift towards immune activation (24 related pathways, p < 0.01). Additionally, transcriptional changes in platelets point to an activation of the coagulation process (5 related pathways, p < 0.005). Single-cell data was also analyzed following a pseudo-bulk approach (i.e., simulating a bulk RNAseq experiment) to gain further biological insights. Our findings suggest that a pseudo-bulk analysis could offer complementary findings to classical single-cell analysis methods and demonstrate that endurance physical exercise, such as running a half-marathon, induces substantial changes in the transcriptional dynamics of immune cells. These insights contribute to a better understanding of the immune modulation mediated by endurance exercise and may inform future training routines or nutritional guidelines based on individual gene expression levels.

Unraveling the Bone-Brain Axis: A New Frontier in Parkinson's Disease Research

Parkinson's disease (PD), as a widespread neurodegenerative disorder, significantly impacts patients' quality of life. Its primary symptoms include motor disturbances, tremor, muscle stiffness, and balance disorders. In recent years, with the advancement of research, the concept of the bone-brain axis has gradually become a focal point in the field of PD research. The bone-brain axis refers to the interactions and connections between the skeletal system and the central nervous system (CNS), playing a crucial role in the pathogenesis and pathological processes of PD. The purpose of this review is to comprehensively and deeply explore the bone-brain axis in PD, covering various aspects such as the complex relationship between bone metabolism and PD, the key roles of neurotransmitters and hormones in the bone-brain axis, the role of inflammation and immunity, microRNA (miRNA) functional regulation, and potential therapeutic strategies. Through a comprehensive analysis and in-depth discussion of numerous research findings, this review aims to provide a solid theoretical foundation for a deeper understanding of the pathogenesis of PD and to offer strong support for the development of new treatment methods.

Climbing the longevity pyramid: overview of evidence-driven healthcare prevention strategies for human longevity

Longevity medicine is an emerging and iterative healthcare discipline focusing on early detection, preventive measures, and personalized approaches that aim to extend healthy lifespan and promote healthy aging. This comprehensive review introduces the innovative concept of the "Longevity Pyramid." This conceptual framework delineates progressive intervention levels, providing a structured approach to understanding the diverse strategies available in longevity medicine. At the base of the Longevity Pyramid lies the level of prevention, emphasizing early detection strategies and advanced diagnostics or timely identification of potential health issues. Moving upwards, the next step involves lifestyle modifications, health-promoting behaviors, and proactive measures to delay the onset of age-related conditions. The Longevity Pyramid further explores the vast range of personalized interventions, highlighting the importance of tailoring medical approaches based on genetic predispositions, lifestyle factors, and unique health profiles, thereby optimizing interventions for maximal efficacy. These interventions aim to extend lifespan and reduce the impact and severity of age-related conditions, ensuring that additional years are characterized by vitality and wellbeing. By outlining these progressive levels of intervention, this review offers valuable insights into the evolving field of longevity medicine. This structured framework guides researchers and practitioners toward a nuanced strategic approach to advancing the science and practice of healthy aging.

Association between olive oil consumption and all-cause, cardiovascular and cancer mortality in adult subjects: a systematic review and meta-analysis

Background: The Mediterranean diet is characterized by the preferential use of olive oil (OO) and has been associated with health benefits possibly mediated by its bioactive compounds. Objectives: We aimed to analyze the association between OO consumption and changes in all-cause mortality, cardiovascular mortality and cancer mortality in the adult population. Methods: A systematic review was conducted using the Pubmed, Scopus, Web of Science and Cochrane Library databases up to October 2024. DerSimonian and Laird's random effects method was used to calculate pooled estimates of hazard ratios (HRs) and their 95% confidence intervals (95% CIs) to determine the association between OO use and changes in all-cause mortality, cardiovascular mortality, and cancer mortality. Results: Fourteen studies were included in the systematic review and seven in the meta-analysis. Our results showed an association between OO consumption and reduction in all-cause mortality (HR: 0.85; 95% CI: 0.80-0.91), cardiovascular mortality (HR: 0.84; 95% CI: 0.76-0.93) and cancer mortality (HR: 0.89; 95% CI: 0.86-0.93). Conclusions: Consumption of OO particularly reduces cardiovascular mortality (16%), followed by all-cause mortality (15%) and cancer mortality (11%) in the adult population. However, further studies are needed to clarify the underlying mechanisms.

Construction and application of the emergency resilience capability evaluation scale and model for grassroots medical workers: a cross-sectional study in Guangzhou, China

Objective

Public health emergencies pose a serious challenge to the ability of medical personnel to respond. We aimed to establish a scientific and effective resilience capability assessment scale for grassroots medical workers and explore the way to improve resilience.

Research design

Developed a resilience ability assessment scale and applied it on the medical personnel who worked in community health service centers for more than 1 year. Related indicators were identified through literature review and the Delphi method. The established scale was given weight using the attribute analytic hierarchy process, and the evaluation model was built through the grey correlation analysis.

Principal findings

A three-level indicator scale was established, which included three first-level indicators [professional quality (weight 0.346), psychological capital (weight 0.614), and emergency attitude (weight 0.040)]. The second-level indicators had 13 contents and were further subdivided into 46 three-level indicators. The overall resilience ability assessment score of 347 medical workers in Guangzhou was only 0.787. However, steady scientific-exercise habits and relative training can help improve their public health emergency resilience ability (p < 0.05).

Conclusion

The establishment of the scale can provide a strategic basis for improving the resilience strength of grass-roots medical personnel. We should encourage this group to form a good habit of exercise, strengthen their crisis awareness by actively organizing theoretical training and practical exercises on public health emergencies, and improve their psychological capital level.

Patient or public contribution

In this study, 347 medical workers from 6 basic medical institutions in Guangzhou participated in the questionnaire.

Interleukin 15: A new intermediary in the effects of exercise and training on skeletal muscle and bone function

Interleukin-15 (IL-15), a pro-inflammatory cytokine, is produced mainly by skeletal muscle cells, macrophages and epithelial cells. Recent research has demonstrated that IL-15 is closely related to the functions of bone and skeletal muscle in the locomotor system. There is growing evidence that exercise, an important means to regulate the immune and locomotor systems, influences IL-15 content in various tissues, thereby indirectly affecting the function of bones and muscles. Furthermore, the form, intensity, and duration of exercise determine the degree of change in IL-15 and downstream effects. This paper reviews the structure, synthesis and secretion of IL-15, the role of IL-15 in regulating the metabolism of bone tissue cells and myofibers through binding to the IL-15 receptor-α (IL-15Rα), and the response of IL-15 to different types of exercise. This review provides a reference for further analyses of the role and mechanism of action of IL-15 in the regulation of metabolism during exercise.

Clinical correlates of a single-item physical activity questionnaire among patients undergoing stress SPECT myocardial perfusion imaging

BACKGROUND

There has been an increasing call for employing ultrashort exercise activity questionnaires as a clinical "vital sign". To-date, this has not been applied to patients undergoing cardiac stress testing.

METHODS

We evaluated 1136 patients who completed a one-item exercise questionnaire before undergoing stress SPECT myocardial perfusion imaging (MPI). This question asked patients to grade how much they exercise during daily life on a 11-point scale (0 = none, 10 = always). Patients were divided into four exercise activity groups based on their response: no, low, moderate, and high exercise activity. The results of this questionnaire were compared with patients' clinical risk profile, mode of stress testing (exercise vs pharmacologic), and exercise treadmill duration.

RESULTS

We noted a stepwise inverse relationship between exercise activity and patients' frequency of hypertension, diabetes, and obesity (P < .001 for each). Patients with no reported exercise activity were more likely to complain of dyspnea. There was a stepwise increase in the number of patients performing treadmill exercise with increasing reported exercise activity (P < .001). The duration on treadmill exercise increased in stepwise fashion with higher patient reported exercise activity (P < .001).

CONCLUSION

Our single-item, self-reported questionnaire was correlated with patients' risk profiles, their mode of stress testing, and cardiorespiratory fitness. These correlates, along with the pragmatic nature of this ultrashort questionnaire, and its built-in identification of patients who may warrant exercise counseling, augurs for adopting ultrashort questionnaires regarding exercise activity among patients undergoing stress MPI, and other cardiac imaging tests where functional capacity is not routinely assessed.

Knee proprioception, muscle strength, and stability in Type 2 Diabetes Mellitus- A cross-sectional study

Background

The burgeoning prevalence of Type 2 Diabetes Mellitus (T2DM) has been linked to a spectrum of health complications, including those affecting the musculoskeletal system. Knee proprioception, muscle strength, and stability are essential for maintaining functional mobility and preventing falls, yet their relationship with T2DM is not fully elucidated.

Objectives

This study aimed to compare knee proprioception, muscle strength, and limits of stability (LOS) between individuals with T2DM and asymptomatic controls and to examine the moderating role of physical activity on these relationships.

Methods

In a cross-sectional design, 192 participants (96 with T2DM and 96 asymptomatic) underwent assessments for knee proprioception using a digital inclinometer, muscle strength via a handheld dynamometer, and LOS through dynamic posturography, graded as a percentage of maximum lean without losing balance.

Results

Our analysis revealed that individuals with T2DM demonstrated reduced knee muscle strength, with mean differences of 12.90 Nm (right) and 18.80 Nm (left) in 25° of flexion, and 25.78 Nm (right) and 26.36 Nm (left) in 40° of flexion, compared to asymptomatic controls. Proprioception errors were greater in the T2DM group (p < 0.001), with significant deficits noted in both knee 25° of flexion and 40° of flexion. Stability limits were also compromised, with the T2DM group displaying a decreased ability to maintain balance across all tested directions (p < 0.001). Physical activity emerged as a positive moderator, with higher activity levels correlating with improved muscle strength and stability.

Conclusion

T2DM significantly impairs musculoskeletal function, highlighting the need for integrated management strategies. The study underscores the importance of physical activity in mitigating T2DM-related musculoskeletal deterioration, suggesting that therapeutic interventions should include a focus on enhancing muscle strength and stability to improve the quality of life in this population.

Effectiveness of Telephysiotherapy in Improving Older Adults' Physical and Psychological Outcomes: A Systematic Review and Meta-Analysis

(1) Objective: to investigate the effectiveness of telephysiotherapy compared with traditional rehabilitation for elderly patients and determine the factors impacting its efficacy. (2) Method: Five online databases (PubMed, Google Scholar, Scopus, Web of Science, and Cochrane) were reviewed up to 31 July 2023. The search included the literature in English from 2014 to 2023, to capture the latest practices in telephysiotherapy for elderly patients. Data from all qualified studies were independently extracted by two authors, quantifying effect size to reflect treatment performance. (3) Results: 222 records from 19 articles were analyzed. The effect size for telephysiotherapy was 0.350 (95% C.I. = 0.283-0.416; p < 0.01). The standardized mean differences for physical and psychological outcomes were 0.406 (95% C.I. = 0.325-0.488; p < 0.01) and 0.223 (95% C.I. = 0.110-0.336; p < 0.01), respectively. (4) Conclusions: Telephysiotherapy was more effective than traditional rehabilitation, significantly improving the physical and psychological status of elderly patients. The factors influencing the effectiveness of telephysiotherapy were intervention type, intervention duration, outcome, and gender.

Causal association of basal metabolic rate on systemic sclerosis: a bidirectional mendelian randomization study

Prior evidence suggests that altered energy metabolism plays a crucial role in the development of fibrotic diseases. Recent research indicates that systemic sclerosis (SSc) patients have potentially benefited from energy management, implying that basal metabolic rate (BMR), a vital energy metabolic parameter, may be related to SSc. However, the causal effect of BMR on SSc remains unknown. Thus, we aimed to elucidate the causal links between BMR and SSc. Based on summary statistics from the genome-wide association studies (GWAS) database, two-sample Mendelian randomization (MR) was applied to explore causality between BMR and SSc. The causal relationships were assessed employing inverse variance weighted (IVW), MR-Egger, and weighted median (WM) methods. Meanwhile, several sensitivity analyses were carried out to ensure the robustness of the findings. There was an underlying genetic association of BMR on SSc (OR = 0.505, 95% CI: 0.272-0.936, P = 0.030). Moreover, no significant causal effect between SSc and BMR was observed in the reverse MR analysis (OR = 0.999, 95% CI: 0.997-1.001, P = 0.292). According to the sensitivity analysis, the presence of heterogeneity and genetic pleiotropy was not detected. Our findings, derived from a genetic perspective, provide robust evidence of a causal connection between BMR and SSc. To verify these results and clarify the potential mechanisms, further research is warranted.

Shoulder muscle weakness and proprioceptive impairments in type 2 diabetes mellitus: exploring correlations for improved clinical management

Background

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with systemic implications, potentially affecting musculoskeletal health. This study aimed to assess shoulder muscle strength and joint repositioning accuracy in individuals with T2DM, exploring potential correlations and shedding light on the musculoskeletal consequences of the condition. The objectives were two-fold: (1) to assess and compare shoulder strength and joint repositioning accuracy between individuals with T2DM and asymptomatic counterparts, and (2) to examine the correlation between shoulder strength and joint repositioning accuracy in individuals with T2DM.

Methods

A cross-sectional study enrolled 172 participants using the convenience sampling method, including 86 individuals with T2DM and an age-matched asymptomatic group (n = 86). Shoulder strength was assessed using a handheld dynamometer, while joint repositioning accuracy was evaluated with an electronic digital inclinometer.

Results

Individuals with T2DM exhibited reduced shoulder muscle strength compared to asymptomatic individuals (p < 0.001). Additionally, joint repositioning accuracy was significantly lower in the T2DM group (p < 0.001). Negative correlations were observed between shoulder strength and joint repositioning accuracy in various directions (ranging from -0.29 to -0.46, p < 0.001), indicating that higher muscle strength was associated with improved joint repositioning accuracy in individuals with T2DM.

Conclusion

This study highlights the significant impact of T2DM on shoulder muscle strength and joint repositioning accuracy. Reduced strength and impaired accuracy are evident in individuals with T2DM, emphasizing the importance of addressing musculoskeletal aspects in diabetes management. The negative correlations suggest that enhancing shoulder muscle strength may lead to improved joint repositioning accuracy, potentially contributing to enhanced physical functioning in this population.

Effects of different types of exercise intensity on improving health-related physical fitness in children and adolescents: a systematic review

A substantial body of empirical evidence reveals that physical activity is associated with a wide range of positive physical and mental health outcomes. However, an absence of comprehensive syntheses is observed concerning the varying effects of different exercise intensities on the improvement of physical health among children and adolescents. The aim of this review is to systematically investigate the effects of different exercise intensities on the physical fitness of children and adolescents, to analyses the optimal exercise intensities for improving physical fitness, and to provide a relevant theoretical basis for optimizing school physical education curricula. A systematic search strategy was used in this study in four online databases (PubMed, Scopus, EBSCO and Web of Science). Intervention studies that met the inclusion criteria underwent a thorough screening process, and their methodological quality was assessed utilizing the PEDro scale. The selected literature was systematically analyzed and evaluated through induction, summary, analysis, and evaluation. These findings indicate that high-intensity exercise training exerts significant positive effects on body composition, cardiopulmonary function and muscle fitness in children and adolescents. Therefore, we suggest that schools should focus on high-intensity sports in their physical education curriculum, which can further improve the student's PHYSICAL FITNESS.

Improving sarcopenia in older adults: a systematic review and meta-analysis of randomized controlled trials of whey protein supplementation with or without resistance training

OBJECTIVES

The aim of the study was to comprehensively analyze the effects of whey protein (WP)-enriched supplement intake with or without resistance training (RT) in older patients, either from the community or hospital, who were diagnosed with sarcopenia according to the EWGSOP or AWGS criteria.

METHODS

This meta-analysis study was registered in PROSPERO (CRD42023407885). We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for RCTs up to June 1, 2023. Standardized mean differences (SMD) with 95% confidence intervals (CI) were used to estimate the pooled results.

RESULTS

Ten RCT studies, including 1154 participants, were included and analyzed. The primary outcomes were the changes in muscle mass, strength, and physical performance. In WP group versus (vs.) Isocaloric placebo (PLA)/Routine consultation (RC) group, WP significantly increased the appendicular skeletal muscle mass index (SMD: 0.47, 95%CI: 0.23, 0.71), appendicular skeletal muscle mass (SMD: 0.28, 95%CI: 0.11, 0.45) and gait speed (SMD: 1.13, 95%CI: 0.82, 1.44) in older patients with sarcopenia. In WP with RT group vs. PLA/ RC group, there was significant increase in handgrip strength (SMD: 0.67, 95%CI: 0.29, 1.04). In addition, in the secondary outcomes, WP significantly reduced interleukin-6, significantly increased insulin-like growth factor-1 and albumin, promoted participants' intake of total energy and protein, enhanced activities of daily living scores in patients, and had no significant effect on BMI, weight, or fat mass.

CONCLUSION

This review confirms that WP can improve various aspects of older adult with sarcopenia, thereby enhancing their overall physical condition. More studies should be conducted to validate this result and further explore the effects of WP and RT in patients with sarcopenia.

Comparison of the Efficacy of Anti-Obesity Medications in Real-World Practice

Purpose

Anti-obesity medications (AOMs), along with lifestyle interventions, are effective means of inducing and maintaining weight loss in patients with obesity. Although the efficacy of AOMs has been reported, there have been no direct comparisons of these drugs. Therefore, in the present study, we aimed to compare the efficacy of all the AOMs available in Korea in a real-world setting.

Patients and Methods

The body weight and composition of 205 adults treated with phentermine, phentermine/topiramate, liraglutide, naltrexone/bupropion, lorcaserin, or orlistat for at least 6 months were analyzed at 2 month intervals. The prevalence of the achievement of a ≥5% weight loss and the changes in body composition were compared between participants using each AOM at each visit.

Results

A total of 132 (64.4%) participants achieved ≥5% weight loss within 6 months (prevalence of ≥5% weight loss after 6 months: phentermine, 87.2%; phentermine/topiramate, 67.7%; liraglutide, 58.1%; naltrexone/bupropion, 35.3%; lorcaserin, 75%; orlistat, 50%). At each visit, after adjustment for age, sex, and baseline body weight, phentermine use was associated with a significantly higher prevalence of ≥5% weight loss than the use of the other AOMs, except for liraglutide. There were significant differences in the body weight, body mass index and body fat mass among the AOM groups by visit (P for interaction <0.05), but not in their waist circumference, skeletal muscle mass, percentage body fat, or visceral fat area.

Conclusion

All the AOMs were effective at inducing and maintaining weight loss, in the absence of significant changes in muscle mass, over a 6 month period, and the short-term use of phentermine and the long-term use of phentermine/topiramate or liraglutide would be practical choices for the treatment of obesity. However, further, large-scale studies are necessary to confirm these findings.

Correlation between sarcopenia index and cognitive function in older adult women: A cross-sectional study using NHANES data

OBJECTIVES

The Sarcopenia Index (SI) has the potential as a biomarker for sarcopenia, which is characterized by muscle loss. There is a clear association between sarcopenia and cognitive impairment. However, the relationship between SI and cognitive impairment is yet to be fully understood.

METHODS

We employed data extracted from the U.S. National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2002. Our study encompassed individuals aged 65 to 80 who possessed accessible information regarding both SI and cognitive evaluations with a GFR ≥ 90. Cognitive function was assessed using the digit symbol substitution test (DSST). SI was calculated by serum creatinine (mg/dL)/cystatin C (mg/L)*100. Employing multivariate modeling, we estimated the connection between SI and cognitive performance. Furthermore, to enhance the reliability of our data analysis, we categorized SI using tertiles and subsequently calculated the P-value for trend.

RESULTS

After adjustment for potential confounders, we found SI was significantly and positively correlated with cognitive function scores both in older female in the American population [β = 0.160, 95 % confidence interval (CI) 0.050 to 0.271, P = 0.00461]. Similarly, when the total cognitive function score was treated as a categorical variable according to tertiles, higher SI was related to better total cognitive function scores in females [odds ratio (OR) = 3.968, 95 % CI 1.863 to 6.073, P = 0.00025] following adjustment for confounders.

CONCLUSIONS

Higher SI was correlated with a lower prevalence of cognitive impairment among older adult women with normal kidney function.

Global status of cardiorespiratory fitness and physical activity - Are we improving or getting worse?

Despite heightened recognition of the importance of cardiorespiratory fitness (CRF) to cardiovascular (CV) health, along with updated international consensus guidelines for physical activity (PA) and sedentary behavior (SB), significant proportions of the global adult population are physically inactive, and do not meet the threshold for CRF. Physical inactivity is considered a surrogate for low CRF given that the former is defined as not reaching the recommended minimum level of PA per week to derive a health benefit. Physical inactivity remains a major global public health problem despite decades of work by various United Nations agencies, and members of the international community to improve PA levels. Given the common coupling between physical inactivity and poor health status, it is reasonable to suggest that for a significant proportion of the global population, CRF is compromised by physical inactivity. This poses a longer-term risk to morbidity and mortality. Here we provide an indicative summary of the global status of CRF and PA and reference the implications for global health. We briefly reference opportunities moving forward, including reinforcement of the importance of engaging in movement from an early age, discouraging SB, and taking a life course approach to optimise healthy living for all.

Analysis of the Relation Between Balance Control Subsystems: A Structural Equation Modeling Approach

Balance plays a crucial role in human life and social activities. Maintaining balance is a relatively complex process that requires the participation of various balance control subsystems (BCSes). However, previous studies have primarily focused on evaluating an individual's overall balance ability or the ability of each BCS in isolation, without considering how they influence (or interact with) each other. The first study used clinical scales to evaluate the functions of the four BCSes, namely Reactive Postural Control (RPC), Anticipatory Postural Adjustment (APA), Dynamic Gait (DG), and Sensory Orientation (SO), and psychological factors such as fear of falling (FOF). A hierarchical structural equation modeling (SEM) was used to investigate the relationship between the BCSes and their association with FOF. The second study involved using posturography to measure and extract parameters from the center of pressure (COP) signal. SEM with sparsity constraint was used to analyze the relationship between vision, proprioception, and vestibular sense on balance based on the extracted COP parameters. The first study revealed that the RPC, APA, DG and SO indirectly influenced each other through their overall balance ability, and their association with FOF was not the same. APA has the strongest association with FOF, while RPC has the least association with FOF. The second study revealed that sensory inputs, such as vision, proprioception, and vestibular sensing, directly affected each other, but their associations were not identical. Among them, proprioception plays the most important role in the three sensory subsystems. This study provides the first numerical evidence that the BCSes are not independent of each other and exist in direct or indirect interplay. This approach has important implications for the diagnosis and management of balance-related disorders in clinical settings and improving our understanding of the underlying mechanisms of balance control.

Difficulties in decision making on a long standing, complicated case of osteoporosis – a real challenge for functional rehabilitation

We aim was to present a case of severe osteoporosis with concern to an adult female who was under specific medication against the condition while she experienced inexplicable weight loss in association with an incidental fracture inconsistent with DXA changes. Challenges of the case management and decision making are further on explained. Real-life-medicine poses multiple issues that require an individual decision while respecting the standard protocols. That is why a generalized decision is rather impractical. Here we introduce the clinical case of a lady in her late 60s with a known 6-year history of osteoporosis that required several difficult decisions along surveillance: at first, zoledronic acid represented an available solution, yet after one year, BMD decreased and adjustment was done by initiating a second sequence according to the teriparatide protocol. DXA-BMD, as well as the spectrum of bone turnover markers, qualified the patient as responsive and she further continued with oral bisphosphonates while being monitored via telemedicine amid COVID-19 pandemic. After 24 more months, a second decision of zoledronic acid was done, despite prior partial response, but digestive complains restricted the oral administration of anti-osteoporotic drugs. After one more year, denosumab was initiated and consecutive follow-up is essential. At this point, another challenging aspect was revealed: the discordance between DXA – based scores increase and the presence of an incidental fracture. A supplementary investigation was considered useful (Tc- whole body scintigraphy) noting the clinical presentation with local pain, dysfunctionality, and mild weight loss that also required rehabilitation management.

Increasing frequency of dyspnea among patients referred for cardiac stress testing

OBJECTIVE

To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing.

PATIENTS AND METHODS

We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question. Patients were divided into three temporal groups.

RESULTS

The overall prevalence of dyspnea in our cohort was 30.2%. However, there was a stepwise increase in the temporal prevalence of dyspnea, which was present in 25.6% of patients studied between 2002 and 2006, 30.5% of patients studied between 2007 and 2011, and 38.7% of patients studied between 2012 and 2017. There was a temporal increase in the prevalence of dyspnea in each age, symptom, and risk factor subgroup. The adjusted hazard ratio for mortality was higher among patients with dyspnea vs those without dyspnea both among all patients, and within each chest pain subgroup.

CONCLUSIONS

Dyspnea has become increasingly prevalent among patients referred for cardiac stress testing and is now present among nearly two-fifths of contemporary cohorts referred for stress-rest SPECT-MPI. Prospective study is needed to standardize the assessment of dyspnea and evaluate the reasons for its increasing prevalence.

Effect of exercise on inflammatory markers in postmenopausal women with overweight and obesity: A systematic review and meta-analysis

IMPORTANCE

Postmenopausal women affected by overweight and obesity are susceptible to a variety of diseases due to inflammation. Exercise may reduce the risk of disease by attenuating low-grade chronic inflammation.

OBJECTIVE

We conducted a systematic review and meta-analysis to investigate the effects of exercise on inflammatory markers in postmenopausal women struggling with overweight and obesity.

METHOD

Literature as of May 2023 was searched from databases such as Cochrane, Embase, Pubmed, Web of Science, and EBSCO and English-language randomized controlled trials (RCTs) that meet the inclusion criteria were selected. Studies were included based on the following criteria: (A) Written in English; (B) RCTs; (C) Postmenopausal women impacted by overweight and obesity as research objects; (D) Outcome measurements include CRP, TNF-α, IL-6, and adiponectin; (E) Duration of the exercise intervention is eight weeks.

RESULTS

A total of 34 articles and 2229 participants were included. Exercise can significantly reduce the level of C-reactive protein (CRP) (MD: -0.59, 95 % CI: -0.87 to -0.31, p < 0.00001), tumor necrosis factor-α (TNF-α) (MD: -0.65, 95 % CI: -0.94 to -0.35, p < 0.00001), interleukin-6 (IL-6) (MD: -0.48, 95 % CI: -0.75 to -0.21, p < 0.00001), and exercise can significantly increase the level of adiponectin (MD: 0.33, 95 % CI: 0.02 to 0.65, p = 0.04) in women impacted by overweight and obesity.

CONCLUSION

These results suggest that exercise may be an effective intervention for reducing pro-inflammatory markers and increasing adiponectin in postmenopausal women impacted by overweight and obesity. The findings may provide clinicians and healthcare professionals with insights into the implementation of exercise programs for postmenopausal women living with overweight and obesity.

Bone Health, Body Composition and Physiological Demands in 70-85-Year-Old Lifelong Male Football Players

The effects of lifelong football training on bone health, body composition and physiological demands were evaluated. A total of 20 veteran football players (VPG; 73.4 ± 3.7 years) and 18 untrained age-matched men (CG; 75.6 ± 4.2 years) were enrolled. Whole-body and regional dual-energy X-ray absorptiometry scans of arms, legs, proximal femur and lower spine (L1-L4) were recorded in all participants. We observerd higher bone mineral density (BMD) in the whole-body, arms and femoral regions and higher bone mineral content (BMC) in the legs and lower spine compared to the CG (p < 0.05), also higher total lean body mass (p < 0.05) and lower total body fat percentage (p < 0.05), were found. No differences in food habits were evidenced between the VPG and the CG, as evaluated using 3-day food records. Resting heart rate (RHR), blood pressure (BP) and activity profile during a football match were recorded using a global positioning system only in the VPG. The mean heart rate (HR)of theoretical maximal HR (ThHRmax), and peak of ThHRmax were 83.9 ± 8.6% and 98.6 ± 10.2%, respectively; the mean of total distance covered was 3666 ± 721 m, and the means of accelerations and decelerations were 419 ± 61 and 428 ± 65, respectively. Lifelong participation in football training improves regional BMD and BMC in legs, femur and lumbar spine compared to the CG. A high number of intense actions in term of HR and accelerations and decelerations suggests an elevated energy expenditure that in turn correlates to the healthier body composition observed in the VPG compared to the CG.

Cardiology and lifestyle medicine

Poor lifestyle habits, such as physical inactivity and poor diets, are highly prevalent within society and even more so among patients with chronic disease. The need to stem poor lifestyle habits has led to the development of a new field of Lifestyle Medicine, whose mission is to prevent, treat, and even reverse chronic diseases through lifestyle interventions. Three fields within Cardiology relate to this mission: Cardiac Rehabilitation, Preventive Cardiology, and Behavioral Cardiology. Each of these three fields have contributed substantially to the reduction of cardiovascular disease (CVD) morbidity and mortality. The historic contributions of these three cardiac fields are reviewed as well as the challenges each of these fields has faced in optimizing the application of lifestyle medicine practices. A shared agenda between Cardiology and the American College of Lifestyle Medicine could further the utilization of behavioral interventions. This review suggests seven steps that could be shared by these organizations and other medical societies. First, there is a need to develop and promulgate the assessment of lifestyle factors as "vital signs" during patient visits. Second, developing a strong partnership between the fields of Cardiology and Physiatry could improve important aspects of cardiac care, including a potential redesign of cardiac stress testing. Third, behavioral evaluations should be optimized at patients' entrée points into medical care since these may be considered "windows of opportunity". Fourth, there is a need to broaden cardiac rehabilitation into inexpensive programs and make this program eligible for patients with risk factors but no known CVD. Fifth, lifestyle medicine education should be integrated into the core competencies for relevant specialties. Sixth, there is a need for inter-societal advocacy to promote lifestyle medicine practices. Seventh, the well-being effects of healthy lifestyle behaviors, such as their impact on one's sense of vitality, should be emphasized.

The pursuit of health: A vitality based perspective

The larger number of adults who enter their senior years with a high burden of chronic diseases has led to new metrics designed to promote health pro-activity, such as the calculation of one's "healthspan". These efforts call for re-evaluation as to what is meant by "health". A large body of epidemiologic and clinical investigation identifies that good health is shaped by specific health behaviors (aerobic exercise, resistance training, sleep, and good diet quality) and four psychological determinants (positive emotions, positive mindsets, purposeful living, and social connectivity). In common, each of these determinants produce "vitality", which can be defined as having the pleasing sensation of feeling energetic. Having a strong sense of vitality produces a sense of agency, provides resilience, and serves as a leading indicator of good health. Importantly, vitality can be assessed as a single item "vital sign" in clinical practice and can be promoted by recommending simple steps to patients, such as suggesting that they initiate walking or other aerobic activities. Because health habits and psychological determinants of health are inter-related, such simple steps can initiate a "virtuous cycle" of health improvement. An emphasis on vitality can also encourage patients to become more cognizant of their level of energy and manage it through health-promoting behaviors rather than quick fix behaviors. Finally, vitality assessment and prescription can promote more successful aging. In sum, an updated and more clinically useful definition of health recognizes that it is a dynamic entity that is influenced at any time by one's engagement in physical and psychological practices that promote health. Accordingly, an updated definition of health is proposed: good health is characterized by physical and psychological well-being and is associated with vitality.

New principles, the benefits, and practices for fostering a physically active lifestyle

The modern environment has led to an increased risk and incidence of sedentary lifestyles. When physical activity (PA) becomes insufficient, pathophysiological pathways are invoked and the future risk for chronic diseases and premature mortality increases. As a consequence, since the 1970s governmental agencies and medical societies have published guidelines to promote PA. The 2018 Guidelines for Physical Activity for Americans contain important updated guidelines, but many of these guidelines are not yet sufficiently known by the public or health providers. In addition, to make use of these guidelines, they need to be integrated with optimal behavioral interventions. Accordingly, this narrative review critically assesses five tenets that stem from the 2018 Guidelines and illustrates how these tenets can be integrated with tools and techniques for motivating individuals to initiate and maintain a more physically active lifestyle. The first tenet indicates that there is no lower threshold of PA that must be obtained before health benefits begin to accrue. Second, it is no longer required that PA be obtained in bouts of 10 min or more to "count". Bouts of lesser duration also count. Pending further study, new accelerometry data suggest that vigorous intermittent PA of just 1-2 min may also benefit health, such as that acquired by stair climbing or carrying heavy groceries. This has led to a new concept of promoting "lifestyle physical activity". Third, excessive sitting is health damaging if it is not accompanied by sufficient daily life PA or accrues over long uninterrupted bouts. Fourth, it is essential to incorporate resistance exercises for optimal health and to promote successful aging. Fifth, a wealth of new evidence indicates that PA strongly protects and promotes all aspects of brain health and may improve cognition even after a single bout of exercise.

Immediate and Long-Term Effectiveness of Proprioceptive Neuromuscular Facilitation and Static Stretching on Joint Range of Motion, Flexibility, and Electromyographic Activity of Knee Muscles in Older Adults

Introduction and Objective: Previously, various stretching techniques were compared to study their effects on the different physiological parameters of hamstring muscles in the elderly population. There is no research that compares the immediate and long-term effects of proprioceptive neuromuscular facilitation-contract–relax (PNF-CR) and static stretching (SS) techniques on knee range of motion (ROM), hamstring flexibility, and knee flexor muscle EMG activity in the elderly. This study intends to compare the same. Methods: A total of 30 males aged 55–75 years were randomly assigned into the PNF-CR group (n = 10), SS group (n = 10), and control group (n = 10). The PNF-CR group received four trials of the contract–relax technique, the SS group received passive stretching of an 80 s duration by the therapist, and the control group received no intervention. A total of 12 sessions were given during the four-week period. Knee range of motion, electromyographic activity of the biceps femoris, and the sit-and-reach test were taken for the dominant side thrice: pre-intervention, immediately after stretching, and after the training period. Results: A statistically significant difference was observed in the maximum voluntary isometric contraction (MVIC) of biceps femoris between the PNF and the control groups (p = 0.01) after four weeks of intervention. The knee ROM and hamstring flexibility for the PNF group showed significant improvement immediately post-test (p = 0.01) and after four weeks of training (p = 0.07 and p = 0.001). SS showed significant results for both ROM and flexibility after four weeks of intervention (p = 0.001), and significant immediate post-test improvements were seen for ROM only (p = 0.007). Conclusions: PNF stretching has an immediate, as well as long-term, effect on knee ROM and hamstring flexibility, whereas it has only a long-term effect on muscle electromyographic activity. SS has an immediate, as well as long-term, effect on knee ROM and only a long-term effect on hamstring flexibility, without any immediate or long-term effects on muscle electromyographic activity.