Exercise Snacks: A Novel Strategy to Improve Cardiometabolic Health

Frail Older Adults' Needs and Preferences for Mobile Health Exercise Interventions Guided by Nudge Theory: AQualitative Analysis

AIM

To explore frail older adults' preferences and needs regarding mobile health (mHealth) exercise interventions in China. Additionally, it sought to identify the nudge strategies necessary for initiating and sustaining exercise behaviours among frail older adults.

DESIGN

A qualitative study.

METHOD

The semi-structured interviews were conducted between April and May 2024 from two communities in Changsha, China. The data were analysed using a deductive framework analysis aligned to nudge theory, and an inductive thematic analysis to gather relevant needs and preferences.

RESULTS

This study involved 14 participants with pre-frailty or frailty, aged 60-82 years (median age of 64 years). While participants were generally receptive to new technologies, lower levels of health literacy and competing priorities often hindered their participation. Three primary functionality requirements were as follows. (1) Profession engagement: tailored exercise prescription, professional and timely feedback and guidance; (2) personalised knowledge encompassing pain management, successful cases and inspiration; (3) beneficial, tailored, dynamic, fragmented, challenging exercise courses. Participants showed positive attitudes towards simplification nudges, gamification nudges, social nudges, trustworthy nudges, reminder nudges, economic nudges, feedback nudges and pre-commitment nudges. Addressing privacy concerns was essential to build trust and acceptance among older adults.

CONCLUSION

These findings emphasised the importance of designing mHealth interventions that address frail older adults' specific needs and preferences while incorporating effective nudge strategies to promote engagement and adherence. Future researchers should explore wearables, ChatGPT language models, virtual coaching assistants, exercise snack to further optimise the experience and analyse the effects of nudges in mHealth exercise interventions among older adults.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Exercise systems or app development for frail older adults should meet three basic functionality and essential nudge strategies.

REPORTING METHOD

The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting.

PATIENT OR PUBLIC CONTRIBUTION

Older adults' engagement and interview data contribute a lot.

Associations of exercise snacks with cognitive function among older adults in NHANES 2011-2014

BACKGROUND

With an aging global population, dementia incidence is rapidly increasing, affecting 50 million people worldwide. While physical activity has been linked to cognitive enhancement, the specific effects of intermittent short bouts of exercise, termed 'exercise snacks' (ES), on cognitive function (CF) in older adults are not well understood.

METHODS

We analyzed data from 2549 adults aged ≥60 years from the 2011-2014 National Health and Nutrition Examination Survey cycles. CF was assessed using standardized tests, and physical activity data were obtained from accelerometer measurements. ES was defined as 2-5 min of moderate-to-vigorous physical activity. Regression analyses, smoothed curve fitting, and threshold effect analyses were conducted, adjusting for relevant covariates.

RESULTS

Significant positive associations were found between CF and daily average Monitor-Independent Movement Summary specific to ES (MIMS-ES: β = 0.0001, 95 % CI: 0.0001-0.0001) and total time spent on ES (Time-ES: β = 0.0021, 95 % CI: 0.0014-0.0029). Each additional unit of MIMS-ES and each minute of ES daily increased CF scores by 0.0001 and 0.0021 points, respectively, suggesting benefits for cognitive health in aging populations. An inverted U-shaped relationship was observed, with inflection points at 2522.82 units/day for MIMS-ES and 91.57 min/day for Time-ES, indicating diminishing cognitive benefits beyond these thresholds.

CONCLUSION

ES was associated with higher CF. This practical form of physical activity offers an effective strategy for cognitive health and mitigating age-related decline, presenting a more accessible alternative to traditional continuous exercise.

A systematic review and meta-analysis of the effectiveness of high-intensity interval training for physical fitness in university students

BACKGROUND

Extensive research has demonstrated the effectiveness of high-intensity interval training (HIIT) in children and adults; however, evidence specific to university students remains limited. This study aimed to evaluate the effects of HIIT on promoting physical health in university students and to identify potential factors influencing intervention outcomes.

METHOD

A systematic search was conducted across five electronic databases (Web of Science, Scopus, PubMed, SportDiscus, and MEDLINE) up to December 2024 using Boolean operators and keywords related to HIIT and university students.

INCLUSION CRITERIA

(1) Experimental studies; (2) Physical-related outcomes; (3) Intervention duration of at least 3 weeks; (4) Meets the definition of high-intensity activity; (5) Participants are general university students. A meta-analysis was conducted using RevMan 5.4 software, comparing intervention and control groups. Effect sizes were calculated using Cohen's d, and heterogeneity was assessed with the I² statistic. Subgroup analyses were performed based on intervention duration and rest interval duration.

RESULTS

Results showed that HIIT significantly reduced BMI, body fat percentage, waist-to-hip ratio, and heart rate, while significantly improving VO2max and muscle strength in university students. Interventions lasting longer than eight weeks demonstrated greater improvements in muscle strength compared to those lasting eight weeks or less. However, there are no significant differences in rest interval across any of the groups. Notably, HIIT also has positive effects on agility and speed with varying effect sizes.

CONCLUSION

The unique characteristics of university students make HIIT a time-efficient and effective intervention strategy for this population. Future studies should consider the specific needs of the university environment, incorporating the latest technological advancements and developing tailored intervention strategies that align with students' preferences.

Castro FA, Costa EC, Boullosa D, Astorino TA. Affective valence predictors from real-world based short sprint interval training

Affective valence is typically positive at exercise intensities below the lactate threshold, yet more aversive responses occur at supra-threshold intensities. Nevertheless, the physiological and psychological predictors of affective valence during supramaximal intensities including short sprint interval training (sSIT) have not yet been elucidated. Seventeen (7 women/10 men) moderately active young adults (age ​= ​[28.2 ​± ​5.6] years;V ˙ O2max [maximum oxygen consumption] ​= ​[52.9 ​± ​8.1] mL·kg- 1·min- 1; BMI [body mass index] ​= ​[24 ​± ​2] kg·m- 2) completed four low-volume running sSIT sessions (10 ​× ​4 ​s efforts with 30 ​s of passive recovery). We recorded participants' heart rate (HR), root mean square of successive differences of normal RR intervals (RMSSD), heart rate recovery (HRR), ratings of perceived exertion (RPE), feeling scale (FS), intention and self-efficacy during, and after each session. Overall, no significant correlation (p ​> ​0.05) was found between FS and baseline clinical outcomes. No significant correlation (p ​> ​0.05) was detected between FS and any training parameter. No significant correlations were noted between FS and exercise task self-efficacy and intentions (p ​> ​0.05). The regression model was significant (F 3,61  ​= ​5.57; p ​= ​0.002) and only three variables significantly entered the generated model: ΔHRRend-120s end (p ​= ​0.002; VIF ​= ​2.58; 40.8%), time ≥ 90% HRpeak (p ​= ​0.001; VIF ​= ​1.26; 31.6%), and RMSSDend (p ​= ​0.025; VIF ​= ​2.23; 27.6%). These findings suggest that HR-based measures, particularly those related to in-task stress (time ≥ 90% HRpeak) and acute recovery (ΔHRRend-120s end, and RMSSDend), may predict affective valence during real-world sSIT.

Customizing intense interval exercise training prescription using the "frequency, intensity, time, and type of exercise" (FITT) principle

Intense interval exercise training induces various physiological and metabolic adaptations related to performance and health. For designing a program, the F.I.T.T. principle, referring to frequency, intensity, time, and type of exercise, can be used to manipulate the level of physiological stress in the body, leading to various adaptations. Modifying these four parameters results in a wide range of interval protocols that are safe and effective for different populations including athletes and individuals with chronic diseases. In this review, we present how the manipulation of the F.I.T.T. components can alter the acute and chronic cardiorespiratory, metabolic, perceptual, and affective responses and adaptations to intense interval exercise training. From this evidence, it appears that the duration of the exercise bout and recovery interval are critical parameters for the manipulation of almost all acute responses, enabling periodization of intense interval exercise training, and promoting optimal adaptations and exercise adherence. In addition, a considerable level of adaptations may be achieved with training frequencies as low as once or twice per week and with lower than maximal intensities, adding to the feasibility of this exercise mode. Overall, by varying these parameters, the design of an intense interval exercise training program can be tailored according to the needs and abilities of each individual, and an optimized training prescription may be achieved.

Opportunities for Physical Activity Behavior Change Among Emergency Medical Services Clinicians: Qualitative Investigation

OBJECTIVES

Emergency medical services (EMS) clinicians often do not achieve sufficient levels of physical activity. We investigate behavioral determinants that influence participation in physical activity among EMS clinicians.

METHODS

We enrolled EMS clinicians from a North Carolina third-service EMS agency in 2023. A trained qualitative investigator conducted twenty virtual, 30-minute, individual, semi-structured interviews using an interview guide developed by experts in physical activity behaviors, EMS, and qualitative research. Interviews were guided by the Theoretical Domains Framework and Capability Opportunity Motivation Behavior Change Model. Structured interviews were digitally recorded and transcribed verbatim by a professional transcription service. Transcriptions were verified against audio for accuracy and de-identified. A codebook was established using a hybrid inductive/deductive approach, and thematic analysis was performed.

RESULTS

The 20 participants had a median age of 31 years (IQR 27-34), of which 65% (13/20) were female. Several key themes emerged that represent opportunities for behavioral intervention. First, physical activity is often viewed as a process requiring high inhibitory self-regulation and is often paired with highly restrictive behaviors, which likely leads to existing poor behavioral habits. Existing confidence in being physically active was often tied to goal setting and mastery experiences, suggesting an opportunity to leverage specific and achievable goal setting, self-monitoring, and feedback. Further, EMS clinicians often struggle with incorporating physical activity amid work and life demands in a practical, sustainable way. They also identified a lack of available time, resources, and organizational support. High-quality social networks are foundational behavior change components and were often lacking among participants.

CONCLUSIONS

Behavioral determinants of physical inactivity included a theme of negative implicit associations around physical activity among some participants and need for achievable goal setting, self-monitoring, and building positive social support networks. Further investigation is needed to develop and test toolsets to improve physical activity behaviors among EMS clinicians.

Application of Exercise Snacks across Youth, Adult and Clinical Populations: A Scoping Review

BACKGROUND

Interest in 'exercise snacks' has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on 'exercise snacks', across youth, adult and clinical populations through a scoping review.

METHODS

A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of 'snacks', in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form.

RESULTS

The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as 'exercise snacks', with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. 'Exercise snack' intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity.

CONCLUSION

The 'exercise snack' concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend 'exercise snacks' terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their 'exercise snacks' model, through exercise and adverse event reporting checklists.

Physical Activity in Lower-Extremity Sarcoma Survivors: Specific Recommendations and Program Design

Survivors of lower-extremity sarcoma are at high risk of developing physical performance dysfunctions and impaired quality of life resulting from the sarcoma disease itself and the adverse side effects of the treatments. Therefore, the implementation of safe and effective exercise programs addressing survivors' functionality and life quality is an essential and complementary nonpharmacological intervention in the cancer continuum. The viability and success of physical activity and exercise in lower-extremity sarcoma survivors remains largely unknown, likely due to the heterogeneity of clinical presentation and development of this type of cancer regarding diagnosis, treatment, and prognosis. This study provides specific recommendations for designing an appropriate training program that will help maintain sarcoma survivors' physical activity and improve their quality of life. The main conclusions reported here result from scientific studies and analyses of clinical data both selected from a systematic search in PubMed database. Sarcoma survivors should be advised as soon as the disease is diagnosed to perform a simple program of low-intensity and short-duration exercise prior to surgery (prehabilitation). Later, during clinical treatments and taking into account their psychobiological status, an adapted exercise program may be developed within the hospital environment. Finally, building healthy habits is recommended so as to improve disease-free survival, including regular physical activity, always under the supervision of professionals in this field. Hopefully, these suggestions will contribute to a better professional performance by specialists in the implementation of safe, reliable, and exercise programs in lower-extremity sarcoma survivors.

Diabetes, obesity, and cardiovascular disease-what is the impact of lifestyle modification?

Diabetes, obesity, and cardiovascular disease (CVD) represent an escalating global health challenge, contributing significantly to morbidity, mortality, and healthcare costs. Evidence from large cohort studies and clinical trials underscores the impact of diabetes and obesity as major risk factors for CVD, causing systemic inflammation, insulin resistance, and neurohormonal activation. Frequently, a sedentary lifestyle and unbalanced dietary habits are associated with these risk factors. Physical activity and exercise training interventions, a Mediterranean and plant-based diet, smoking cessation, and reduction of alcohol have shown promise in mitigating these risks. The implementation of lifestyle and pharmacotherapy have emerged as new pillars of preventive medicine. This review discusses the evidence of lifestyle interventions to reduce the burden of diabetes, obesity, and CVD. It is highlighted that only a multifaceted, sustained approach integrating lifestyle interventions and pharmacological strategies can reduce the burden of disease and improve long-term outcomes.

Contextual and affective precursors of physical activity intention and enactment examined through ecological momentary assessment

BACKGROUND

Regular physical activity (PA) provides numerous health benefits, which is why many people intend to lead an active lifestyle. Yet, internal and external states and barriers can hinder the translation of such intentions into actual behavior. This study prospectively studied such barriers, namely, the temporal relationship between the independent variables momentary affect (stress, emotions), and the dependent variables PA intentions and subsequent PA behavior. The variables were measured using Ecological Momentary Assessment (EMA) at the within-person level.

METHODS

A total of 41 healthy participants (aged 19-67) completed 4 daily EMA prompts over three weeks on their smartphones, capturing data on momentary affective states (happy, active, irritated, tired, concerned, nervous, relaxed, energetic), anticipated contextual barriers (i.e., PA-incompatible external circumstances), prospective PA intentions, and PA behavior (retrospective, since the last prompt). We applied generalized linear mixed effect models to examine the influence of momentary affect and contextual barriers onto a) PA intentions, b) their consecutive enactment, and c) directly onto PA behavior.

RESULTS

Individuals were more likely to form PA intentions when feeling happy, active, or energetic, but less likely when external/contextual barriers were high or when they felt tired. Furthermore, only PA intentions were significant precursors of subsequent PA behavior, while neither contextual barriers, nor momentary affect directly affected PA behavior.

CONCLUSIONS

Interventions for fostering PA, such as Just-in-Time Adaptive Interventions, should address and 'stabilize' intentions through addressing external barriers and positive affects (happy, active, energetic). The present results call for more temporally sensitive and dynamic health behavior theories of PA.

Perceptions and Experiences of Exercise Snacks Among Middle-Aged and Older Adults: A Systematic Review and Meta-Synthesis

BACKGROUND

Physical inactivity in middle-aged and older adults is a major health problem. Exercise snacks are an emerging form of physical activity characterized by shorter single bouts of high-intensity exercise spread out repeatedly throughout the day which can provide more exercise opportunities for middle-aged and older adults.

PURPOSE

To summarize perceptions and experiences of exercise snacks among middle-aged and older adults, and explore the barriers and facilitators of promoting exercise snacks.

METHODS

We followed the PRISMA and systematically searched five databases from the earliest to May 2024. The Critical Appraisal Skills Program tool is used to quality assess and the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) is used to guide thematic synthesis.

RESULTS

Fourteen categories from nine studies were summarized, and 277 findings were identified. Three synthesized findings were: capability of middle-aged and older adults (including health-related exercise disorders, learning and mastery skills, and health literacy), opportunities for exercise snacks (including flexible and free, easy and quick, integration into life, social and family support, and application of mobile health technology), and motivation of exercise snacks (including pleasurable experiences, gaining physical and mental benefits, effective reminders, incentives and feedback, personalized needs, and self-efficacy).

CONCLUSION

Exercise snacks are a promising approach， however, they need to be continuously optimized. Our results can provide evidence for designing and optimizing exercise snack programs. Medical workers should assist middle-aged and older adults in developing appropriate exercise snack strategies.

TRIAL REGISTRATION

PROSPERO (CRD42024544089).

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.

Tailoring Exercise Prescription for Effective Diabetes Glucose Management

CONTEXT

Physical activity, exercise, or both are a staple of lifestyle management approaches both for type 1 diabetes mellitus (T1DM) and type 2 diabetes (T2DM). While the current literature supports both physical activity and exercise for improving glycemic control, reducing cardiovascular risk, maintaining proper weight, and enhancing overall well-being, the optimal prescription regimen remains debated.

EVIDENCE ACQUISITION

We searched PubMed and Google Scholar databases for relevant studies on exercise, insulin sensitivity, and glycemic control in people with T1DM and T2DM.

EVIDENCE SYNTHESIS

In patients with T1DM, exercise generally improves cardiovascular fitness, muscle strength, and glucose levels. However, limited work has evaluated the effect of aerobic plus resistance exercise compared to either exercise type alone on glycemic outcomes. Moreover, less research has evaluated breaks in sedentary behavior with physical activity. When considering the factors that may cause hypoglycemic effects during exercise in T1DM, we found that insulin therapy, meal timing, and neuroendocrine regulation of glucose homeostasis are all important. In T2DM, physical activity is a recommended therapy independent of weight loss. Contemporary consideration of timing of exercise relative to meals and time of day, potential medication interactions, and breaks in sedentary behavior have gained recognition as potentially novel approaches that enhance glucose management.

CONCLUSION

Physical activity or exercise is, overall, an effective treatment for glycemia in people with diabetes independent of weight loss. However, additional research surrounding exercise is needed to maximize the health benefit, particularly in "free-living" settings.

Acute effects of different "exercise snacking'' modalities on glycemic control in patients with type 2 diabetes mellitus (T2DM): study protocol for a randomized controlled trial

BACKGROUND

Impaired glycemic control, a sedentary lifestyle and diabetes related consequences are common challenges faced by experts and individuals with type 2 diabetes mellitus (T2DM). Although regular exercise has been shown to improve glycemic control in individuals with T2DM, conventional exercise recommendations are not always feasible for patients due to time constraints. Therefore, "exercise snacking'', which involves short bouts of exercise interspersed throughout the day, has emerged as a potential alternative to traditional exercise regimes. However, optimal intensity, amount, frequency and/or type of "exercise snacking'' for individuals with T2DM remains unclear. The purpose of this three-arm randomized crossover study is to examine the acute effects of different "exercise snacking" modalities on cardiometabolic factors and mental health.

METHODS

Ten sedentary patients (five males and five females, age range: 18-45 years; body mass index (BMI) range: 25-35 kg/m2) diagnosed with T2DM without additional diseases will be recruited. In this crossover study, participants will receive all of the following interventions in a random order: (1) three short sessions of 6 × 1 min of cycling at 90% of maximal heart rate (HRmax) (2) three short sessions of 1 × 20 s of "all out'' sprints at cycle ergometer and (3) no intervention. Glycemic parameters, blood pressure, rate of perceived extraction (RPE), adverse events, enjoyment and affect will be evaluated before and directly after each intervention.

DISCUSSION

The results of this acute study have great potential to inform future public health efforts designed to improve glycemic control, increase exercise rates and affect overall health in individuals with T2DM.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (NCT06146036) registred on 18 December, 2023.

Effect of brief intense stair climbing on cardiorespiratory fitness and metabolic risk factors in inactive young men with obesity: A randomized controlled trial

BACKGROUND AND AIM

We investigated the effects of brief, intense stair climbing on cardiorespiratory fitness (CRF) and cardiometabolic risk factors in young Korean men with obesity.

METHODS AND RESULTS

Twenty-four healthy men (age: 25.8 ± 2.4 years, BMI: 27.1 ± 2.5 kg/m2) were randomized into either the stair climbing exercise group (n = 12) or the control group (no exercise intervention, n = 12). The stair climbing exercise (5 days per week for 4 weeks) included a 3-min warm-up, followed by three 20-s bouts of vigorous stair climbing [≥80 % of age-predicted maximal heart rate (MHR)], with 2-min of recovery in between. Peak oxygen uptake (VO2peak) and body composition were measured by maximal treadmill test and bioelectrical impedance analysis, respectively. A fasting blood sample was obtained after a 10-h overnight fast to measure cardiometabolic markers. All participants completed the study and attended 97.1 % of all scheduled exercise sessions. There was significant group x time effect on CRF, such that the stair climbing exercise group had significant improvements in VO2peak (pre: 38.7 ± 5.2 versus post: 41.6 ± 5.7 ml/kg/min, P < 0.01) and exercise duration (pre: 10.4 ± 1.8 versus post: 12.1 ± 1.9 min, P < 0.01) during a maximal treadmill test, but with decreases in VO2peak and no change in the exercise duration the control group. Body weight, body fat and metabolic variables were unchanged after stair climbing exercise.

CONCLUSION

Brief, intense stair climbing with a total time commitment of 10 min per day is effective for improving VO2peak in young men with obesity.

CLINICAL TRIAL REGISTRATION

KCT0008139.

Effects of breaking up prolonged sitting via exercise snacks intervention on the body composition and plasma metabolomics of sedentary obese adults: a randomized controlled trial

Obesity resulting from long-term sedentary a significant threat to human health. This study explores the effects of exercise snack intervention on body composition and plasma metabolomics in sedentary obese adults. Participants in the snack group were subjected to 4 days of sprint exercises by stair-climbing per week for 12 weeks. Systemic and regional fat mass, epicardial adipose tissue (EAT), abdominal visceral (AVFA) and subcutaneous (ASFA) fat area and plasma metabolomics data were measured before and after intervention. A higher improvement of EAT, AVFA and ASFA in the snack group compared to that in the control group, with a significant interaction effect (p < 0.05). The key differential metabolites between the two groups include isoleucine, glycine and serine. The proposed exercise snack effectively reduced the amount of AVFA and EAT. The change in body composition may be associated with the altered pathways of isoleucine, glycine, and serine metabolism.

Physical activity interventions: an update on advancing sedentary time, technology, and dissemination and implementation research

Approximately 28% of American adults meet both the physical activity (PA) and strength training guidelines despite the numerous health benefits associated with a physically active lifestyle. The purpose of this paper is to provide an update of the 2017 Society of Behavioral Medicine PA Special Interest Group article that outlined future directions in sedentary time reduction interventions, technology-based PA interventions, and the dissemination and implementation of PA interventions. Since the prior review, there has been significant progress on effective interventions for reducing sedentary time. However, there has been less progress for improving the specificity of sedentary time guidelines. There has been a dramatic increase in the number of studies examining PA mHealth interventions and support for mHealth intervention has generally been positive, though sustaining engagement in mHealth interventions remains a challenge. Promising newer technologies that have been explored more extensively since the prior review including artificial intelligence (AI). Knowledge of how to implement and scale-up effective PA interventions has also increased. Several current trends in PA intervention research that continue to advance the field include examining the moderating effect of the built environment on the effectiveness of behavioral interventions, cultural tailoring of interventions, Just in Time Adaptive Interventions (JITAIs), and exercise snacks (vigorous intensity PA sessions that are less than one minute). Overall, there has been significant progress in the PA intervention field but significant work remains for creating effective interventions that can be readily implemented into real world settings.

Effects of blood flow restriction training on cardiometabolic health and body composition in adults with overweight and obesity: a meta-analysis

Objective

This meta-analysis aims to evaluate the effects of blood flow restriction (BFR) training on cardiometabolic health and body composition in adults with overweight and obesity.

Method

Following PRISMA guidelines, a systematic search of PubMed (MEDLINE), EMBASE, Web of Science, Cochrane, and Scopus databases was conducted on 15 March 2024. Pooled effects for each outcome were summarized using Hedge's g (g) through meta-analysis-based random effects models, and subgroup analyses were used to explore moderators.

Results

A total of 11 studies with 242 participants (Age:32.6 ± 3.6, BMI:27.2 ± 3.5) were included. Regarding cardiometabolic health, BFR training significantly reduced systolic blood pressure (g = 0.62 [0.08, 1.16], p = 0.02), while no significant differences were observed in maximal oxygen uptake (g = 0.48 [-0.21, 1.17], p = 0.17) or diastolic blood pressure (g = 0.31 [-0.22, 0.84], p = 0.25). Regarding body composition, BFR training significantly reduced body fat percentage (g = 0.30 [0.01, 0.58]; p = 0.04), while no significant differences (p > 0.05) were observed in body weight (g = 0.14 [-0.14, 0.42]), body mass index (g = 0.08 [-0.21, 0.38]), waist circumference (g = 0.13 [-0.28, 0.53]), or waist-to-hip ratio (g = 0.48 [-0.19, 1.15]). Subgroup analysis revealed no significant difference in improving systolic blood pressure (g = 0.57 [-0.10, 1.24] vs. g = 0.70 [-0.18, 1.59]) and body fat percentage (g = 0.20 [-0.20, 0.61] vs. g = 0.45 [-0.05, 0.95]) between BFR resistance training and BFR aerobic training. In all selected studies, the overall risk of bias was categorized as "some concern". The certainty of evidence for the BFR outcomes was low.

Conclusion

BFR training shows promise in improving cardiometabolic health and body composition, indicating that it may serve as a beneficial, individualized exercise prescription for improving cardiovascular disease risk and fat loss in adults with excess body weight and obesity.

Systematic Review Registration

https://archive.org/details/osf-registrations-uv6jx-v1.

Tabata training in perspective

Originally developed as a specific form of exhaustive intermittent training involving 6-8 × 20 s of supramaximal-intensity cycling exercises with 10 s of recovery for athletes, Tabata training has become universally recognized around the world. The purpose of this review article is to provide a perspective on Tabata training and discuss how this popular style of intermittent training has evolved and been applied over the last ∼30 years. The article will review the original motivation behind Tabata training with relevance to concepts such as maximal accumulated oxygen deficit and maximal oxygen uptake (V̇o2max) and discuss how Tabata training has been adapted to involve sport-specific training and cross training. Studies of Tabata training on physiological responses and adaptations in muscle, blood vessels, bone, and brain across different populations will be reviewed. Finally, research on how Tabata-style training was applied to counteract inactivity during the COVID19 pandemic will be discussed. Evolving from the study of athletes, Tabata training represents an example of how high-intensity intermittent/interval training can be adapted and applied in various settings to enhance performance and health.

Effects of Physical Exercise Breaks on Executive Function in a Simulated Classroom Setting: Uncovering a Window into the Brain

Acknowledging the detrimental effects of prolonged sitting, this study examined the effects of an acute exercise break during prolonged sitting on executive function, cortical hemodynamics, and microvascular status. In this randomized crossover study, 71 college students completed three conditions: (i) uninterrupted sitting (SIT); (ii) SIT with a 15 min moderate-intensity cycling break (MIC); and (iii) SIT with a 15 min vigorous-intensity cycling break (VIC). Behavioral outcomes, retinal vessel diameters (central retinal artery equivalents [CRAE], retinal vein equivalents [CRVE], arteriovenous ratio [AVR]), cortical activation, and effective connectivity were evaluated. Linear mixed models identified significant positive effects of exercise conditions on behavioral reaction time (RT), error rate, and inverse efficiency score (β = -2.62, -0.19, -3.04: ps < 0.05). MIC and VIC conditions produced pre-to-post-intervention increases in CRAE and CRVE (β = 4.46, 6.34), frontal activation, and resting-state and task-state causal density (β = 0.37, 0.06) (ps < 0.05) compared to SIT; VIC was more beneficial for executive function and neurobiological parameters. The effect of AVR on average RT was mediated through task-based causal density (indirect effect: -0.82). Acutely interrupting prolonged sitting improves executive function, microvascular status, and cortical activation and connectivity, with causal density mediating the microvascular-executive function link.

An Exploration of Adults Transitioning Into Retirements' Perspectives on Vigorous Intermittent Lifestyle Physical Activity

ISSUE ADDRESSED

Australian adults transitioning into retirement aged 55-75 years (> 50%) do not meet the World Health Organization recommendation of physical activity (PA). One potential strategy to promote PA is through vigorous intermittent lifestyle physical activity (VILPA). This study aimed to investigate barriers and facilitators from adults transitioning to retirement about participation in VILPA and to identify strategies to promote and implement VILPA.

METHODS

Thirty adults transitioning to retirement (mean age = 64 years) were recruited to participate in focus groups to provide their perceptions on VILPA. All participants' PAs were measured by accelerometers. A set of semi-structured questions developed from the findings of a previous scoping review was used to guide focus groups with participants. To increase awareness of PA bouts and intensity, the focus group discussions were prompted by participants' individualised accelerometer-measured PA reports. The identified barriers and facilitators were mapped to the Theoretical Domains Framework. Intervention strategies were derived from the framework domains.

RESULTS

Three focus groups were conducted. Participants perceived barriers to participation in VILPA stem from health constraints, insufficient awareness about VILPA, and adverse weather conditions. To promote VILPA, adults transitioning to retirement require a better understanding of PA intensities, knowledge of identifying VILPA opportunities, and monitoring and feedback for engagement. Intervention to promote VILPA should include elements of education, persuasion, incentivisation and enablement.

CONCLUSIONS

Adults transitioning to retirement perceived VILPA as feasible and convenient for increasing their overall PA. SO WHAT?: The study findings will directly inform the development of a targeted VILPA intervention with key stakeholders and an implementation plan to promote PA in adults transitioning to retirement.

History and perspectives on interval training in sport, health, and disease

Exercise can be conducted as low-intensity continuous training (LICT) or a variety of higher intensity work/rest formats, collectively called interval training. Interval training was developed for athletes in the early 20th century. It was systemized in Sweden as Fartlek, and in Germany as die interval Method, in the 1930s. Most contemporary forms of interval training evolved from these progenitors. In essence, interval training allows a large volume of high-intensity or race specific training to be performed while controlling the development of fatigue. Adding interval training to LICT done by athletes adds about 2%-4% to performance achievable with LICT, which represents a competitively meaningful difference in performance (e.g., 4:25 vs. 4:00 over 1 mile). More recently, interval training has been applied to health- fitness participants and even to patients with health conditions. Studies indicate that a comparatively low volume of interval training can produce substantial improvement in physiologic capacity, in as little as 20% of training time versus LICT. There are data indicating that interval training can be reasonably pleasant, have good adherence, and is safe, even in patients. Although interval training was originally designed for athletics, the fundamental patterns of work versus recovery are remarkably similar in healthy adults and patients. Although the total volume of training and both absolute and relative intensity and magnitude of homeostatic disturbance are larger in athletes, the overall pattern of effort is the same in fitness participants and patients. Interval training can thus be characterized as an important step in the evolution of exercise training.

Exercise snacks and physical fitness in sedentary populations

Physical inactivity remains a pressing global public health concern. Prolonged periods of sedentary behavior have been linked to heightened risks of non-communicable diseases such as cardiovascular diseases and type 2 diabetes, while engaging in any form of physical activity can elicit favorable effects on health. Nevertheless, epidemiological research indicates that people often struggle to meet recommended physical activity guidelines, citing time constraints, lack of exercise equipment, and environmental limitations as common barriers. Exercise snacks represents a time-efficient approach with the potential to improve physical activity levels in sedentary populations, cultivate exercise routines, and enhance the perception of the health benefits associated with physical activity. We review the existing literature on exercise snacks, and examine the effects of exercise snacks on physical function and exercise capacity, while also delving into the potential underlying mechanisms. The objective is to establish a solid theoretical foundation for the application of exercise snacks as a viable strategy for promoting physical activity and enhancing overall health, particularly in vulnerable populations who are unable to exercise routinely.

Mexican Clinical Practice Guidelines for Adult Overweight and Obesity Management

PURPOSE

To develop Mexico's first methodologically rigorous clinical practice guideline for the management of adult overweight and obesity. The target audiences are interdisciplinary healthcare professionals across healthcare systems who are the first point of contact for patients with obesity in Mexico, patients, and health system decision makers.

RECENT FINDINGS

A review of recent international obesity clinical practice guidelines and an expert consensus process identified: i) common recommendations appropriate for implementation in Mexico and ii) knowledge gaps requiring the formulation of new recommendations. In all, 20 new recommendations and 20 good practice statements were developed using the GRADE Evidence-to-Decision Framework and expert consensus. Overweight and obesity negatively impact the health and well-being of individuals and populations in Mexico. This guideline aims to establish a new evidence-based, patient-centered, non-stigmatizing, and practical treatment and management framework, based on the fundamental principles of chronic disease prevention and management.

Effects of Integrating Stair Climbing-Based Exercise Snacks Into the Campus on Feasibility, Perceived Efficacy, and Participation Perspectives in Inactive Young Adults: A Randomized Mixed-Methods Pilot Study

This 6-week pilot study aimed to investigate the feasibility, perceived efficacy, and participation perspectives of a university campus stair climbing-based exercise snack (ES) intervention and to compare it to moderate-intensity continuous training (MICT). Healthy, young, inactive adults (age: 21.6 ± 2.3 years, BMI: 22.5 ± 3.6 kg/m2) were randomly assigned to three groups (ES, MICT, and Control [CON]). ES (n = 14, 6 females) and MICT (n = 13, 9 females) groups performed three sessions per week over 6 weeks, while the control group (n = 15, 9 females) maintained their habitual lifestyle. ES involved 3 × ~30 s 'all-out' stair-climbing (6 flights, total 126 steps and 18.9 m elevation) bouts separated by > 1 h rest, and MICT involved 40 min stationary cycling at 60%-70% HRmax. Mixed linear effect models were used to explore within and between-group differences, and the change in magnitude was determined using mean difference (MD), 95% confidence interval (CI), and Cohen's d effect size. Fourteen participants also completed post-intervention semi-structured interviews. Retention rates of 93% (ES, 14/15), 93% (MICT, 13/14), and 100% (CON, 15/15) were achieved from baseline to post-assessments, with compliance (participants' attendance to scheduled ES sessions) of 97% (733/756 sessions) and 93% (217/234 sessions) in ES and MICT, respectively. No significant differences were found between ES and MICT for future intentions (4.8 ± 1.4 and 5.0 ± 0.9), enjoyment (PACES, 89.0 ± 16.4 and 94.5 ± 11.9), and satisfaction. A significant group × time interaction was found in the quality of life and perceived stress. ES and MICT significantly increased the quality of life by 8% (MD = 5.5 [95% CI = 0.3, 10.7], Cohen's d = 0.64) and 6% (MD = 4.6 [95% CI = 0.9, 8.2], Cohen's d = 0.88) compared to baseline, whereas CON experienced a significant decrease (MD = -7.9 [95% CI = -14.4, -1.6], Cohen's d = 0.56). ES significantly decreased perceived stress by 7% (MD = -4.6 [95% CI = -8.9, -0.3], Cohen's d = 0.58), while MICT (MD = 2.0 [95% CI = -0.1, 4.1], Cohen's d = 0.28) and CON (MD = -2.4 [95% CI = -6.1, 1.3], Cohen's d = 0.22) had no significant effects. The majority (12/14) of participants generally demonstrated positive attitudes toward participation in ES and found it easier than expected while highlighting enablers, barriers, and future recommendations. Stair climbing-based ES could be integrated into the campus setting, appeared feasible, and was similar to MICT regarding future intentions, enjoyment, and satisfaction. Both ES and MICT might induce relevant positive effects on the quality of life, and ES demonstrated greater benefits compared to MICT or CON for reducing perceived stress. Interviews provided positive insights into fostering adherence to ES among university students.

Optimal Frequency of Interrupting Prolonged Sitting for Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Crossover Trials

Increasing evidence highlights the efficacy of interruptions in prolonged sitting (i.e., activity/sedentary breaks) for improving cardiometabolic health, but precise conclusions and recommendations regarding the optimal interruption frequency remain poorly defined. This systematic review and meta-analysis aimed to directly compare the effect of different frequencies of interrupting prolonged sitting on cardiometabolic health and to determine potential moderators. Randomized crossover trials with at least two frequency interruptions compared to a prolonged sitting condition were identified via systematic review. We compared the acute effects of high-frequency (≤ 30 min per bout, HF) versus low-frequency (> 30 min per bout, LF) interruption protocols on various cardiometabolic health outcomes via three-level meta-analysis with pooled effects evaluated within a random-effects model and exploration of potential sources of heterogeneity through subgroup analyses. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Thirteen studies with 211 participants (24-66 years, 41% female) were included. When comparing HF to LF condition, the HF had a significantly greater reduction in glucose (9 studies [n = 740]; Hedge's g = -0.30, 95% CI [-0.57, -0.03], p = 0.03; I2-level 3 = 42%, PI [-1.01, 0.41]). However, there was no difference in insulin (4 studies [n = 304]; Hedge's g = -0.22, 95% CI [-0.73, 0.29], p = 0.35; I2-level 3 = 52%, PI [-1.18, 0.74]), triglyceride (3 studies [n = 484]; Hedge's g = 0.11, 95% CI [-0.10, 0.30], p = 0.29; I2-level 3 = 0%, PI [-0.10, 0.30]), blood pressure (5 studies [n = 352]; Hedge's g = -0.06, 95% CI [-0.41, 0.28], p = 0.69; I2-level 3 = 35%, PI [-0.81, 0.62]), and superficial femoral flow-mediated dilation (3 studies [n = 98]; Hedge's g = -0.42, 95% CI [-2.43, 1.60], p = 0.47; I2-level 3 = 78%, PI [-4.09, 3.25]) between the two conditions. The quality of evidence was low GRADE for all outcomes. The present study suggests that a higher sedentary interruption frequency might be more efficacious than a lower frequency/higher duration protocol for reducing glucose levels. Based on these findings, interrupting sedentary time at least, every 30 min may be an ideal strategy to improve glucose control.

Environmental Affordance for Physical Activity, Neurosustainability, and Brain Health: Quantifying the Built Environment's Ability to Sustain BDNF Release by Reaching Metabolic Equivalents (METs)

Background/Objectives: Unlike enriched environments for rodents, human-built environments often hinder neuroplasticity through sedentary lifestyles, to which exercise can merely overcome its adverse effects. This paper introduces "environmental affordance for physical activity" to quantify the potential of spatial layout designs to stimulate activity and sustain neuroplasticity, mainly hippocampal neurogenesis. Methods: A novel framework links metabolic equivalents (METs) that can be afforded by the spatial layout of the built environment to its role in increasing the brain-derived neurotrophic factor (BDNF)-a biomarker that promotes and sustains adult hippocampal neurogenesis and synaptic plasticity. Equations are developed to assess the built environment's affordance for physical activity through BDNF changes measurable after brief exposure to the built environment for 20-35 min. Results: The developed equations are evidenced to be feasible to cause BDNF release through low- to moderate-intensity physical activity. This model provides a feasible assessment tool to test the built environment's effectiveness towards neurosustainability. Conclusions: By sustaining neurogenesis, the environmental affordance for physical activity holds promise for improving mental health and preventing cognitive decline.

Validity of Four Consumer-Grade Optical Heart Rate Sensors for Assessing Volume and Intensity Distribution of Physical Activity

Consumer-grade optical heart rate (HR) sensors emerged as promising tools to monitor volume and intensity of physical activity (PA). However, no validation study of optical HR sensors included recent comprehensive validation recommendations, required for facilitating usage for medical purposes. Validity of HR data measured with four consumer-grade optical sensors, the wrist-worn Garmin Venu 2S and Polar Vantage M2, and the upper arm-worn Polar Verity Sense and Scosche Rhythm24 were assessed in 32 participants over 24 h including various laboratory-based and free-living activities. Furthermore, validity of time at moderate or vigorous PA intensity zones was analyzed. A medical-grade ECG served as a reference. Reliability was assessed by analyzing data of laboratory-based activities during two visits. Across activities, the mean absolute percentage error ranged from 2.2% to 4.7% and intraclass correlation coefficients ranged from 0.91 to 0.98, indicating high validity for all optical sensors. All sensors validly detected time spent at moderate or vigorous intensities (mean error < 10%), except Polar M2 for moderate PA (mean error 12.8%) and Garmin V2 for vigorous PA (mean error -15.9%). Sensor day-to-day reliability was high, indicated by a mean absolute error of < 5 beats/min. Upper arm-worn sensors consistently outperformed wrist-worn sensors, particularly in activities involving increased arm movement and at higher intensities. Our findings identified an overall high validity of these four consumer-grade optical HR sensors, also for assessing time spent at higher PA intensities. However, differences were observed between sensors regarding activity subtypes and intensity levels. These data support informed decisions when selecting optical sensors for PA monitoring and intervention. Trial Registration: The study was performed in compliance with the Declaration of Helsinki and its current amendments and was prospectively registered at ClinicalTrials.gov (ID NCT05525000).

Move less, spend more: the metabolic demands of short walking bouts

The metabolic cost of steady-state walking is well known; however, across legged animals, most walking bouts are too short to reach steady state. Here, we investigate how bout duration affects the metabolic cost of human walking with varying mechanical power, metabolic intensity and duration. Ten participants walked for 10- to 240-s bouts on a stair climber at 0.20, 0.25 and 0.36 m s-1 and on a treadmill at 1.39 m s-1. Oxygen uptake was time-integrated and divided by bout duration to get bout average uptake (V̇O2(b)). Fitting of oxygen uptake kinetics allowed calculating non-metabolic oxygen exchange during phase-I transient and, hence, non-steady-state metabolic cost (C met(b)) and efficiency. For 240-s bouts, such variables were also calculated at steady state. Across all conditions, shorter bouts had higher V̇O2(b) and C met(b), with proportionally greater non-metabolic oxygen exchange. As the bout duration increased, V̇O2(b), C met(b) and efficiency approached steady-state values. Our findings show that the time-averaged oxygen uptake and metabolic cost are greater for shorter than longer bouts: 30-s bouts consume 20-60% more oxygen than steady-state extrapolations. This is partially explained by the proportionally greater non-metabolic oxygen uptake and leads to lower efficiency for shorter bouts. Inferring metabolic cost from steady state substantially underestimates energy expenditure for short bouts.

The link between childhood physical activity enjoyment and adult kinesiophobia in individuals with chronic low back pain

BACKGROUND

This study aimed to investigate the relationship between childhood physical activity enjoyment and current kinesiophobia among individuals with chronic low back pain (CLBP), considering the mediating influence of adult physical activity.

METHODS

We recruited 648 adults (474 males, 174 females) with CLBP through an online platform. Of these, 99.1% (n = 642) were aged 18-60 years, and 0.9% (n = 6) were older than 60 years. Childhood physical activity enjoyment was retrospectively assessed using a single-item question to gauge participants' enjoyment during primary school. Kinesiophobia was measured with the 11-item Tampa Scale for Kinesiophobia (TSK-11), and physical activity was assessed focusing on walking, moderate, and vigorous physical activities. Age, sex, education, and income served as control variables in the analysis.

RESULTS

A significant negative association was found between childhood physical activity enjoyment and adult kinesiophobia. Additionally, childhood physical activity enjoyment was positively associated with adult physical activity across the three types of physical activities. In the adjusted mediation model, walking was identified as the only statistically significant partial mediator.

CONCLUSION

The findings highlight the long-term protective role of childhood physical activity enjoyment against the development of kinesiophobia in adulthood. Walking, in particular, holds unique therapeutic potential, emphasizing the importance of fostering physical activity enjoyment early in life for sustained physical activity and reduced risk of kinesiophobia among CLBP patients.

High-intensity interval versus moderate-intensity continuous cycling training in Parkinson's disease: a randomized trial

Exercise training is recommended to improve the quality of life in those living with Parkinson's disease (PD); however, the optimal prescription to improve cardiorespiratory fitness and disease-related motor symptoms remains unknown. Twenty-nine participants with PD were randomly allocated to either 10 wk of high-intensity interval training (HIIT) (n = 15; 6 female) or moderate-intensity continuous training (MICT) (n = 14; 5 female). The primary outcome was the change in maximal oxygen consumption (V̇o2peak). Secondary outcomes included changes in the Unified Parkinson's Disease Rating Scale (UPDRS) Part III motor score, Parkinson's Fatigue Scale (PFS)-16, resting and exercise cardiovascular measures, gait, balance, and knee extensor strength and fatigability. Exercise training increased V̇o2peak (main effect of time, P < 0.01), with a clinically meaningful difference in the change following HIIT versus MICT (Δ3.7 ± 3.7 vs. 1.7 ± 3.2 mL·kg-1·min-1, P = 0.099). The UPDRS motor score improved over time (P < 0.001) but without any differences between HIIT versus MICT (Δ-9.7 ± 1.3 vs. -8.4 ± 1.4, P = 0.51). Self-reported subjective fatigue (PFS-16) decreased over time (P < 0.01) but was similar between HIIT and MICT groups (P = 0.6). Gait, balance, blood pressure (BP), and heart rate (HR) were unchanged with training (all P > 0.09). Knee extensor strength increased over time (P = 0.03) but did not differ between HIIT versus MICT (Δ8.2 ± 5.9 vs. 11.7 ± 6.2 Nm, P = 0.69). HIIT alone increased the muscular endurance of the knee extensors during an isotonic fatigue task to failure (P = 0.04). In participants with PD, HIIT and MICT both increased V̇o2peak and led to improvements in motor symptoms and perceived fatigue; HIIT may offer the potential for larger changes in V̇o2peak and reduced knee extensor fatigability.NEW & NOTEWORTHY The optimal exercise prescription to improve cardiorespiratory fitness and disease-related motor symptoms in adults with Parkinson's disease remains unknown. In a single-center randomized trial consisting of either 10 wk of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT), we found that both training modes increased V̇o2peak, with a larger clinically meaningful difference following HIIT. Both exercise modes improved motor symptoms and subjective fatigue, whereas HIIT increased the muscular endurance of the knee extensors.

Accumulated HIIT inhibits anxiety and depression, improves cognitive function, and memory-related proteins in the hippocampus of aged rats

This study aimed to compare the effects of High-Intensity Interval Training (HIIT) performed in a single session(1xHIIT) versus three daily sessions (3xHIIT) on fitness level and behavior of aged rats. Eighteen-month-old Wistar rats were assigned to Untrained (UN), 1xHIIT, or 3xHIIT (n = 12/group). Both groups, 1xHIIT and 3xHIIT, performed 15 min of a treadmill running HIIT protocol during 8 weeks. 1xHIIT protocol consisted of a single daily session of 15 min, while the 3xHIIT performed three daily sessions of 5 min with a 4 h interval between the sessions. Morris Water Maze (MWM) task was used to evaluate spatial learning and memory. Splash test, Forced Swim test, and Elevated Plus Maze task (EPM) were used to evaluate anhedonic, depressive-like, and anxious behaviors, respectively. Rats were euthanized, and the hippocampus was harvested for western blot analyses (CaMKII and BDNF). Both HIIT protocols improved VO2max and spatial memory. Notably, only the 3xHIIT protocol attenuated anxious and depressive-like behaviors. Western blot analyses of the hippocampus revealed that both HIIT protocols increased BDNF levels. BDNF levels were higher in the 3xHIIT when compared with 1xHIIT group, and we observed increasement of the CamKII levels just in the 3x HIIT group. Therefore, this study provides evidence indicating that accumulated HIIT sessions is more effective than traditional daily HIIT sessions in improving fitness level, cognitive function, memory, inhibiting the development of mood disorders, and enhancing BDNF and CaMKII levels in the hippocampus of aged rats.

Relation between frailty and hypertension is partially mediated by physical activity among males and females in the Canadian Longitudinal Study on Aging

Frailty reflects the heterogeneity in aging and may lead to the development of hypertension and heart disease, but the frailty-cardiovascular relationship and whether physical activity modifies this relationship in males and females are unclear. We tested whether higher frailty was positively associated with hypertension and heart disease in males and females and whether habitual movement mediated this relationship. The relationship between baseline frailty with follow-up hypertension and heart disease was investigated using the Canadian Longitudinal Study on Aging at 3-year follow-up data (males: n = 13,095; females: n = 13,601). Frailty at baseline was determined via a 73-item deficit-based index, activity at follow-up was determined via the Physical Activity Scale for the Elderly, and cardiovascular function was self-reported. Higher baseline frailty level was associated with a greater likelihood of hypertension and heart disease at follow-up, with covariate-adjusted odds ratios of 1.08-1.09 (all, P < 0.001) for a 0.01 increase in frailty index score. Among males and females, sitting time and strenuous physical activity were independently associated with hypertension, with these activity behaviors being partial mediators (except male-sitting time) for the frailty-hypertension relationship (explained 5-10% of relationship). The strength of this relationship was stronger among females. Only light-moderate activity partially mediated the relationship (∼6%) between frailty and heart disease in females, but no activity measure was a mediator for males. Higher frailty levels were associated with a greater incidence of hypertension and heart disease, and strategies that target increases in physical activity and reducing sitting may partially uncouple this relationship with hypertension, particularly among females.NEW & NOTEWORTHY Longitudinally, our study demonstrates that higher baseline frailty levels are associated with an increased risk of hypertension and heart disease in a large sample of Canadian males and females. Movement partially mediated this relationship, particularly among females.

Exercise snacks are a time-efficient alternative to moderate-intensity continuous training for improving cardiorespiratory fitness but not maximal fat oxidation in inactive adults: a randomized controlled trial

The aims of this study were (1) to determine how stair-climbing-based exercise snacks (ES) compared to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness (CRF), and (2) to explore whether ES could improve maximal fat oxidation rate (MFO) in inactive adults. Healthy, young, inactive adults (n: 42, age: 21.6 ± 2.3 years, BMI: 22.5 ± 3.6 kg·m-2, peak oxygen uptake (VO2peak): 33.6 ± 6.3 mL·kg-1·min-1) were randomly assigned to ES, MICT, or Control. ES (n = 14) and MICT (n = 13) groups performed three sessions per week over 6 weeks, while the control group (n = 15) maintained their habitual lifestyle. ES involved 3 × 30 s "all-out" stair-climbing (6 flight, 126 steps, and 18.9 m total height) bouts separated by >1 h rest, and MICT involved 40 min × 60%-70% HRmax stationary cycling. A significant group × time interaction was found for relative VO2peak (p < 0.05) with ES significantly increasing by 7% compared to baseline (MD = 2.5 mL·kg-1·min-1 (95% CI = 1.2, 3.7), Cohen's d = 0.44), while MICT had no significant effects (MD = 1.0 mL·kg-1·min-1 (-1.1, 3.2), Cohen's d = 0.17), and Control experienced a significant decrease (MD = -1.7 mL·kg-1·min-1 (-2.9, -0.4), Cohen's d = 0.26). MFO was unchanged among the three groups (group × time interaction, p > 0.05 for all). Stair climbing-based ES are a time-efficient alternative to MICT for improving CRF among inactive adults, but the tested ES intervention appears to have limited potential to increase MFO.

A Comparative Analysis of Acute Physiological and Perceptual Responses in Whole-Body and Ergometer-Based High-Intensity Interval Training Protocols

The primary aim of the present investigation was to compare the acute physiological and perceptual responses between two modes of interval training using a randomized crossover design. More specifically, eleven young adult participants (23 ± 4 years, 77 ± 13 kg, 178 ± 7 cm) performed two protocols: one composed of whole-body calisthenics exercises and another on a cycle ergometer. Both protocols encompassed eight 20 s bouts at intensities equivalent to all-out (HIIT-WB) and 170% of the maximal power output (HIIT-C), respectively, interspersed with 10 s of passive rest. The peak and average heart rate, the rating of perceived effort, and blood lactate, creatine kinase, and lactate dehydrogenase concentrations were measured. Aside from blood lactate (HIIT-WB = 9.4 ± 1.8 mmo/L; HIIT-C = 12.5 ± 2.5 mmol/L, p < 0.05) and the rating of perceived exertion (HIIT-WB = 8.8 ± 0.9; HIIT-C = 9.6 ± 0.5, p < 0.05), physiological responses did not significantly differ between protocols (all p > 0.05), with high average heart rate values (HIIT-WB = 86 ± 6% HRmax; HIIT-C = 87 ± 4% HRmax) and a low magnitude of muscle damage, as inferred by CK and LDH concentrations (HIIT-WB = 205.9 ± 56.3 and 203.5 ± 72.4 U/L; HIIT-C = 234.5 ± 77.1 and 155.1 ± 65.3 U/L), respectively. It can be concluded that both protocols elicit vigorous heart rate responses and a low magnitude of muscle damage and, therefore, appear as viable alternatives to improve aerobic fitness. The inclusion of a whole-body HIIT protocol may be an interesting alternative for training prescription in relation to more common interval training protocols.

Health-Related Benefits and Adherence for Multiple Short Bouts of Aerobic Physical Activity Among Adults

Most adults do not adhere to established aerobic physical activity (PA) guidelines due in part to various barriers. PA snacks, or periodic short bouts of activity (<10 minutes) offer a potential strategy to overcoming such barriers and increasing PA. Previous efforts have been focused on eliciting the health benefits of PA and exercise snacks, yet adherence to this concept has not been examined. The purpose of this review is to summarize the current literature assessing adherence to PA snacks and health-related outcomes associated with PA snacks. PubMed, CINAHL, and SPORTDiscus were searched for literature published between January 2018-September 2023. Studies investigating adherence and/or the health-related outcomes of PA snacks were included. Of 4201 articles identified, 12 studies were included in the review. Most of the studies were randomized (n = 10), focused on adults with a chronic disease/life-long condition or exhibited a sedentary lifestyle (n = 8), and reported positive health outcomes (n = 12; e.g., improvements in cardiometabolic markers and body composition). Five studies reported adherence to supervised and unsupervised PA snack interventions, with high rates ≥92%. This review supports and extends the previously reported health-related benefits of PA snacks. It also shows promise for increasing overall PA and adherence to the PA guidelines.

Resistance Exercise Minimal Dose Strategies for Increasing Muscle Strength in the General Population: an Overview

Many individuals do not participate in resistance exercise, with perceived lack of time being a key barrier. Minimal dose strategies, which generally reduce weekly exercise volumes to less than recommended guidelines, might improve muscle strength with minimal time investment. However, minimal dose strategies and their effects on muscle strength are still unclear. Here our aims are to define and characterize minimal dose resistance exercise strategies and summarize their effects on muscle strength in individuals who are not currently engaged in resistance exercise. The minimal dose strategies overviewed were: "Weekend Warrior," single-set resistance exercise, resistance exercise "snacking," practicing the strength test, and eccentric minimal doses. "Weekend Warrior," which minimizes training frequency, is resistance exercise performed in one weekly session. Single-set resistance exercise, which minimizes set number and session duration, is one set of multiple exercises performed multiple times per week. "Snacks," which minimize exercise number and session duration, are brief bouts (few minutes) of resistance exercise performed once or more daily. Practicing the strength test, which minimizes repetition number and session duration, is one maximal repetition performed in one or more sets, multiple days per week. Eccentric minimal doses, which eliminate or minimize concentric phase muscle actions, are low weekly volumes of submaximal or maximal eccentric-only repetitions. All approaches increase muscle strength, and some approaches improve other outcomes of health and fitness. "Weekend Warrior" and single-set resistance exercise are the approaches most strongly supported by current research, while snacking and eccentric minimal doses are emerging concepts with promising results. Public health programs can promote small volumes of resistance exercise as being better for muscle strength than no resistance exercise at all.

Exercise Snacks and Other Forms of Intermittent Physical Activity for Improving Health in Adults and Older Adults: A Scoping Review of Epidemiological, Experimental and Qualitative Studies

Exercise snacks, including other variants of brief intermittent bouts, are an emerging approach for increasing physical activity, although their operationalisation is unstandardised and their health benefits remain unclear. This scoping review aimed to explore characterisations of exercise snacks and summarise their effects on health in adults and older adults. Clinical trial registers (clinicaltrials.gov and ANZCTR) and electronic databases (PubMed, CINAHL, CENTRAL, PsycINFO) were searched from inception to 1 June 2023, for ongoing and published studies of exercise snacks. Backwards and forwards citation tracking was also conducted to identify additional eligible studies. Studies were included if they investigated exercise snacks-brief intermittent bouts of physical activity spread across the day-in adults or older adults. We included epidemiological, experimental, quasi-experimental and qualitative studies that examined the effect of exercise snacks on any health outcomes or described barriers to and enablers of these approaches. Thirty-two studies were included (7 trial registers, 1 published protocol, 3 epidemiological studies and 20 trials reported across 21 studies). Three main terms were used to describe exercise snacks: exercise snack(ing), snacktivity and vigorous intermittent lifestyle physical activity (VILPA). Participants were predominantly physically inactive but otherwise healthy adults or older adults. Exercise snacks were feasible and appeared safe. Epidemiological studies showed steep, near-linear associations of VILPA with reduced all-cause, cardiovascular and cancer mortality as well as reduced incidence of major adverse cardiovascular events and cancer. The limited trial evidence showed exercise snacks had modest effects on improving cardiorespiratory fitness, whereas effects on physical function, mood, quality of life and other health outcomes were equivocal. In conclusion, exercise snacks appear feasible and safe for adults and older adults and may have promising health benefits, but this is mostly based on findings from a limited number of small quasi-experimental studies, small randomised trials or qualitative studies. More studies are needed in individuals with chronic disease. This emerging physical activity approach may have appeal for individuals who find structured exercise unfeasible.Registration https://osf.io/qhu24/.

Physical inactivity causes exercise resistance of fat metabolism: harbinger or culprit of disease?

Physical inactivity is the fourth leading cause of death in the world. It is associated with myriad diseases and premature death. Two possible contributing factors are postprandial lipidaemia (PPL), which accelerates atherosclerosis, and impaired whole-body fat oxidation, which contributes to obesity. Acute exercise in physically active people is effective for increasing whole body fat oxidation and lowering PPL the next morning. However, in people who have low physical activity (<8000 steps/day), an acute bout of exercise (1 h at 62% maximal oxygen consumption) has no effect on increasing fat oxidation or reducing PPL ('exercise resistance'). The acute harms of inactivity are not due to the lack of exercise and are more powerful than the benefits of exercise, at least regarding fat metabolism. The increase in mortality with reduced daily steps is remarkably steep. Low background steps/day also impair the metabolic adaptations to short-term endurance training, suggesting that the ills of inactivity extend beyond fat metabolism. 'Exercise resistance' with inactivity could be a culprit, causing atherosclerosis, or maybe also a harbinger (impaired fat oxidation) of more widespread diseases. Recommendations regarding the amount of moderate to vigorous exercise needed for health should factor in the amount of background activity (i.e. ∼8000 steps/day) necessary to avoid 'exercise resistance'.

Don't Just Stand There. Rethinking the Ideal Body Posture for Otorhinolaryngologists

Surgeons have a high rate of work-related musculoskeletal injuries; an area that has received little attention. These injuries result in surgeons performing less efficiently, needing to take time off work, suffering higher rates of burnout, and may ultimately lead surgeons to retire earlier than planned. Otorhinolaryngologists are at particular risk for work-related musculoskeletal injuries. Beyond the clinician, sustaining such injuries can negatively impact patient safety. Ergonomic interventions have been used effectively to reduce work-related musculoskeletal injuries in other professions, yet not in surgery. With traditional teachings of ideal body postures to avoid injury and manual handling training being re-evaluated, it is important to explore evidence based interventions for reducing work-related musculoskeletal injuries in otorhinolaryngologists. New research encourages us to shift the focus away from the traditional one-size-fits-all approach to ergonomics and toward postural recommendations and education that promote a dynamic, individualized approach to avoiding sustained, static and awkward postures.

Is low-volume high-intensity interval training a time-efficient strategy to improve cardiometabolic health and body composition? A meta-analysis

The present meta-analysis aimed to assess the effects of low-volume high-intensity interval training (LV-HIIT; i.e., ≤5 min high-intensity exercise within a ≤15 min session) on cardiometabolic health and body composition. A systematic search was performed in accordance with PRISMA guidelines to assess the effect of LV-HIIT on cardiometabolic health and body composition. Twenty-one studies (moderate to high quality) with a total of 849 participants were included in this meta-analysis. LV-HIIT increased cardiorespiratory fitness (CRF, SMD = 1.19 [0.87, 1.50]) while lowering systolic blood pressure (SMD = -1.44 [-1.68, -1.20]), diastolic blood pressure (SMD = -1.51 [-1.75, -1.27]), mean arterial pressure (SMD = -1.55 [-1.80, -1.30]), MetS z-score (SMD = -0.76 [-1.02, -0.49]), fat mass (kg) (SMD = -0.22 [-0.44, 0.00]), fat mass (%) (SMD = -0.22 [-0.41, -0.02]), and waist circumference (SMD = -0.53 [-0.75, -0.31]) compared to untrained control (CONTROL). Despite a total time-commitment of LV-HIIT of only 14%-47% and 45%-94% compared to moderate-intensity continuous training and HV-HIIT, respectively, there were no statistically significant differences observed for any outcomes in comparisons between LV-HIIT and moderate-intensity continuous training (MICT) or high-volume HIIT. Significant inverse dose-responses were observed between the change in CRF with LV-HIIT and sprint repetitions (β = -0.52 [-0.76, -0.28]), high-intensity duration (β = -0.21 [-0.39, -0.02]), and total duration (β = -0.19 [-0.36, -0.02]), while higher intensity significantly improved CRF gains. LV-HIIT can improve cardiometabolic health and body composition and represent a time-efficient alternative to MICT and HV-HIIT. Performing LV-HIIT at a higher intensity drives higher CRF gains. More repetitions, longer time at high intensity, and total session duration did not augment gains in CRF.

Exercise in the workplace: examining the receptivity of practical and time-efficient stair-climbing "exercise snacks"

In the workplace, people are often sedentary for prolonged time and do not regularly engage in physical activity-two factors independently linked to premature morbidity and mortality. This study aimed to determine the receptivity of incorporating practical stair-climbing "exercise snacks" (Snacks; three isolated bouts of ascending 53-60 stairs performed sporadically throughout the day) into workplace settings compared to more traditional high-intensity interval training (HIIT; performed as three bouts of 53-60 stairs within a structured HIIT workout) and to explore if these exercise strategies could influence sedentary and physical activity behaviour. Fourteen participants (12 women; Mage = 38.9 ± 10.2 years) completed two supervised exercise trials (Snacks and HIIT) followed by 1 week participating in either form of exercise in their workplace. Ratings of perceived exertion (RPE), affective valence, enjoyment, and self-efficacy were measured at the supervised exercise sessions. During the follow-up period, sedentary behaviour and physical activity were measured with an accelerometer. Affective valence was more positive (p = 0.03; η2 p = 0.21) and there was a lower rise in RPE (p = 0.01; η2 p = 0.29) during Snacks than HIIT. Post-exercise enjoyment of, and self-efficacy towards, Snacks and HIIT were high and similar (ps > 0.05). After the supervised trials, 10/14 of the participants preferred Snacks and 4/14 preferred HIIT (p = 0.18). On days when participants chose to perform either exercise modality, the average number of sit-to-stands in a 24 h period was increased (48.3 ± 8.7 to 52.8 ± 7.8; p = 0.03; Hedge's g = 0.73) and moderate-to-vigorous physical activity tended to increase (21.9 ± 18.2 to 38.1 ± 22.1 min; p = 0.06; Hedge's g = 0.60) compared to days when they chose not to exercise. Stair-climbing exercise snacks may be an attractive approach to implement in the workplace setting and has potential to positively impact sedentary behaviour and physical activity metrics.

A Perspective on High-Intensity Interval Training for Performance and Health

Interval training is a simple concept that refers to repeated bouts of relatively hard work interspersed with recovery periods of easier work or rest. The method has been used by high-level athletes for over a century to improve performance in endurance-type sports and events such as middle- and long-distance running. The concept of interval training to improve health, including in a rehabilitative context or when practiced by individuals who are relatively inactive or deconditioned, has also been advanced for decades. An important issue that affects the interpretation and application of interval training is the lack of standardized terminology. This particularly relates to the classification of intensity. There is no common definition of the term "high-intensity interval training" (HIIT) despite its widespread use. We contend that in a performance context, HIIT can be characterized as intermittent exercise bouts performed above the heavy-intensity domain. This categorization of HIIT is primarily encompassed by the severe-intensity domain. It is demarcated by indicators that principally include the critical power or critical speed, or other indices, including the second lactate threshold, maximal lactate steady state, or lactate turnpoint. In a health context, we contend that HIIT can be characterized as intermittent exercise bouts performed above moderate intensity. This categorization of HIIT is primarily encompassed by the classification of vigorous intensity. It is demarcated by various indicators related to perceived exertion, oxygen uptake, or heart rate as defined in authoritative public health and exercise prescription guidelines. A particularly intense variant of HIIT commonly termed "sprint interval training" can be distinguished as repeated bouts performed with near-maximal to "all out" effort. This characterization coincides with the highest intensity classification identified in training zone models or exercise prescription guidelines, including the extreme-intensity domain, anaerobic speed reserve, or near-maximal to maximal intensity classification. HIIT is considered an essential training component for the enhancement of athletic performance, but the optimal intensity distribution and specific HIIT prescription for endurance athletes is unclear. HIIT is also a viable method to improve cardiorespiratory fitness and other health-related indices in people who are insufficiently active, including those with cardiometabolic diseases. Research is needed to clarify responses to different HIIT strategies using robust study designs that employ best practices. We offer a perspective on the topic of HIIT for performance and health, including a conceptual framework that builds on the work of others and outlines how the method can be defined and operationalized within each context.

Middle cerebral artery blood velocity and cognitive function after high- and moderate-intensity aerobic exercise sessions

This crossover study explored the acute effect of a session of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) on middle cerebral artery (MCA) variables such as cerebral blood velocity, pulsatility index (PI) and resistivity index (RI) through transcranial Doppler (TCD), and cognitive function (CF - verbal fluency and Digit Span) in healthy young adults. Participants (26 healthy young adults, 13 women, 24 ± 3 years) underwent two different randomized exercise sessions: (1) MICT (60 % heart rate reserve, HRR) and (2) HIIT (80 % HRR). MCA velocity, PI, RI, CF, and serum lactate were measured immediately before and after the sessions. HIIT demonstrated improved executive function/semantic fluency (20 %, p = 0.019), while both MICT and HIIT increased lactate (625 %, HIIT, p < 0.001, and 238 %, MICT, p < 0.001). Other assessments remained stable, except for reduced PI (p = 0.029) and RI (p = 0.023) after MICT, with no significant difference (pre-post for HIIT-MICT). Notably, cognition improvement correlated with lactate increase in HIIT (ρ = 0.436; p < 0.001). Executive function/semantic fluency increased after HIIT relative to MICT. The findings show that there are no systematic out-of-normal changes in the cerebrovascular circulation of clinically healthy adults undergoing HIIT and MICT.

Psychosocial and environmental risk factors of obesity and hypertension in children and adolescents-a literature overview

Childhood obesity has become a worldwide epidemic in the 21st century. Its treatment is challenging and often ineffective, among others due to complex, often not obvious causes. Awareness of the existence and meaning of psychosocial and environmental risk factors seems to be an essential element in the prevention and treatment of obesity and its complications, especially arterial hypertension. In this review, we will discuss the role of that risk factors linking obesity and increased cardiovascular disorders including the role of nutritional factors (including the role of unhealthy diet, inadequate hydration), unhealthy behaviors (e.g. smoking, alcohol and drugs, sedentary behavior, low physical activity, disrupted circadian rhythms, sleep disorders, screen exposure), unfavorable social factors (such as dysfunctional family, bullying, chronic stress, mood disorders, depression, urbanization, noise, and environmental pollution), and finally differences in cardiovascular risk in girls and boys.

Functional Neuromyofascial Activity: Interprofessional Assessment to Inform Person-Centered Participative Care-An Osteopathic Perspective

Introduction: Health professionals and bodyworkers may be pivotal in promoting prevention programs, providing tailored advice and guidance to patients' adherence to self-care strategies, such as physical activity. Contemporary evidence encourages manual therapists to involve patients in decision-making and treatment procedures integrating passive and active approaches in treatment planning. This manuscript provides a definition and applications of neuromyofascial movement patterns, discusses the significance of functional assessment, and gives an example of clinical applications in the osteopathic field to highlight how this assessment can promote interdisciplinarity. Methods: The reporting framework used in the current manuscript followed guidelines for writing a commentary. Results: The manuscript highlights the crucial role that the neuromyofascial system plays in human movement and overall well-being and the importance of a functional neuromyofascial activity assessment in the context of person-centered participative care. Conclusions: Understanding individual neuromyofascial patterns could help healthcare practitioners, movement specialists, and bodyworkers in tailoring treatment plans, meeting patients' unique needs, and promoting a more effective personalized approach to care. The current perspective could spark debates within the professional community and provide a research roadmap for developing an evidence-informed interprofessional framework.

Benefits beyond cardiometabolic health: the potential of frequent high intensity 'exercise snacks' to improve outcomes for those living with and beyond cancer

High intensity interval training (HIIT) has been shown to consistently elicit rapid and significant adaptations in a number of physiological systems, across many different healthy and clinical populations. In addition, there is increasing interest in how some acute, yet transient responses to high intensity exercise potentially reduce the risks of particular diseases. Recent work has shown that discrete, brief bouts of high intensity exercise (termed 'exercise snacks') can improve glucose control and vascular health and thus counter the negative cardiometabolic consequences of prolonged, uninterrupted periods of inactivity. In this brief review, we advance the case, using evidence available from pre-clinical studies in the exercise oncology literature, that brief, frequently completed bouts of high intensity exercise embedded within an individual's overall daily and weekly physical activity schedule, may transiently impact the tumour microenvironment and improve the health outcomes for those who have been diagnosed and treated for cancer.