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Brites-Lagos C, Maranhão C, Szumilewicz A, Santos-Rocha R. Development and validation of the physical exercise program "Active Mums" for postpartum recovery: application of the CReDECI-2 guidelines. BMC Pregnancy Childbirth 2024; 24:378. [PMID: 38769520 PMCID: PMC11103992 DOI: 10.1186/s12884-024-06387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/02/2024] [Indexed: 05/22/2024] Open
Abstract
Postpartum physical activity is a public health issue. Reporting on the quality of exercise interventions designs must be ensured in view of the reproducibility and successful implementation of such studies. The objective was to develop and preliminary validate a physical exercise program for postpartum recovery, aiming to promote physical fitness and health of the new mothers. The study was carried out through the three stages of development, piloting, and evaluation. The Consensus on Exercise Reporting Template (CERT) was used to describe the postpartum exercise program. The Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare (CReDECI2) was followed to develop and preliminary validate the program. A tailored postpartum exercise program was developed based on evidence-based international recommendations to be implemented by qualified exercise professionals. A pilot intervention of 16 weeks was carried out, engaging a group of postpartum women. The viability of the program was subsequently evaluated by all participants. The present work provided guidance to develop a study protocol with a larger sample in order to prove the effectiveness of a supervised postpartum exercise program on selected parameters of health.
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Affiliation(s)
- Carla Brites-Lagos
- ESDRM Sport Sciences School of Rio Maior - Santarem Polytechnic University, Rio Maior, Portugal
| | - Cristiana Maranhão
- ESDRM Sport Sciences School of Rio Maior - Santarem Polytechnic University, Rio Maior, Portugal
| | - Anna Szumilewicz
- Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Rita Santos-Rocha
- ESDRM Sport Sciences School of Rio Maior - Santarem Polytechnic University, Rio Maior, Portugal.
- SPRINT - Sport Physical Activity and Health Research and Innovation Center - Santarem Polytechnic University, Rio Maior, Portugal.
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Sousa ASP, Guedes DC, Félix J, Pereira S, Santos R. Physical Activity, Readiness, and Cardiovascular Risk Stratification in the Polytechnics Communities of the Northern Region of Portugal Integrated in Mobility as a Service Concept. Healthcare (Basel) 2023; 11:3145. [PMID: 38132035 PMCID: PMC10742940 DOI: 10.3390/healthcare11243145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of the study is to characterize physical activity (PA) levels and PA readiness as well as stratify cardiovascular risk among the population of polytechnics community members in the north region of Portugal, including students, academic teachers, and non-teacher staff. An online questionnaire about general sample characterization, PA level, and readiness was applied. Of the 717 respondents, 237 were academic teachers, 143 were non-teacher staff, and 337 were students. Most of the participants had a level of moderate PA, including students, academic teachers, and non-teacher staff (82%). The sedentary behavior was higher in the academic teachers and non-teacher staff groups. A total of 56% of the participants had low cardiovascular risk; the group of students were the population with higher risk. Approximately half of the participants need to consult a qualified professional before increasing their PA. Overall, the participants presented moderate levels of PA, although there is still a considerable number of sedentary people that must be considered.
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Affiliation(s)
- Andreia S. P. Sousa
- Centre for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal; (D.C.G.); (J.F.); (S.P.); (R.S.)
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Song J, Wu Z, Fang Y, Li R, Chuang Y, Wang W, Niu S, Hong J, Su L, Sun Y, Song X, Zhuo L. Effects of Multimodal Exercise on Health-related Physical Fitness and Quality of Life in Patients with Nasopharyngeal Carcinoma during Radiotherapy. Pain Manag Nurs 2023; 24:650-658. [PMID: 37198043 DOI: 10.1016/j.pmn.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 04/08/2023] [Accepted: 04/08/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND The health-related physical fitness of patients with nasopharyngeal carcinoma can decrease significantly during radiotherapy, which can adversely affect their quality of life. AIM This study was designed to evaluate the potential influence of a multimodal exercise program on the health-related physical fitness and quality of life of patients with nasopharyngeal carcinoma during radiotherapy. METHODS Forty patients with nasopharyngeal carcinoma undergoing radiotherapy in the First Affiliated Hospital of Fujian Medical University from May to November 2019 were included. The participants in the control group (N=20) received routine nursing, while those in the intervention group (N=20) were also subjected to the multimodal exercise program during radiotherapy. RESULTS The multimodal exercise program had a positive effect on participants. The step test index in the intervention group was significantly higher as compared to the control group (p < .05). The participants were subjected to 5 times slow speed (60°/s) and 10 times fast (180°/s) speed, and function of some extensor and flexor muscles of the elbow, shoulder, and knee joints in the intervention group was markedly improved (p < .05). In the intervention group, the grip strength of the right hand was observed to be significantly improved (p < .01). Furthermore, the upper limb scratch dorsal test of intervention group was significantly better than that of the control group (p < .05). The scores of physical, emotional, and social functions in the intervention group were found to be significantly higher as compared to the control group (p < .05). CONCLUSIONS The multimodal exercise program significantly improved the health-related physical fitness and life quality of the patients with nasopharyngeal carcinoma during radiotherapy, though its long-term effects remain to be further analyzed.
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Affiliation(s)
- Jihong Song
- The Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Zilan Wu
- The Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yan Fang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Rong Li
- The Fujian Medical University, Fuzhou, Fujian Province, China
| | | | - Wenzong Wang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Sitian Niu
- The Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jinsheng Hong
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Li Su
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Xiurong Song
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Litao Zhuo
- The Fujian Medical University, Fuzhou, Fujian Province, China
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Marins EF, Caputo EL, Krüger VL, Junior DM, Scaglioni FG, Del Vecchio FB, Primo TT, Alberton CL. Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK). Trials 2023; 24:780. [PMID: 38041180 PMCID: PMC10693081 DOI: 10.1186/s13063-023-07833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of years lived with disability worldwide. Public safety workers are highly exposed to physically demanding activities and inappropriate postures, increasing the risk of experiencing LBP. Smartphone app-based self-managed interventions may be an alternative for chronic non-specific LBP (CNSLBP) treatment. This study aims to evaluate the effectiveness of a smartphone app-based self-managed exercise program plus health education, compared to a health education program alone, on neuromuscular and perceptual outcomes in police officers and firefighters with CNSLBP. METHODS This is a parallel, two-armed, blinded evaluator randomized clinical trial. Police officers and firefighters (from public safety institutions in the Rio Grande do Sul state, Brazil) will be randomly assigned to a m-health self-managed exercise program (twice a week) plus health education or health education alone. Self-management exercise program components are mobility and core resistance exercises, available on the app. Follow-ups will be conducted post-treatment (8 weeks) and 16 weeks after randomization. The co-primary outcomes will be pain intensity and disability post-treatment (8 weeks). Secondary outcomes will be biopsychosocial factors related to CNSLBP. DISCUSSION We hypothesize that the effects of a smartphone app-based self-managed exercise program on co-primary and secondary outcomes will be superior, compared to the health education only in public safety workers with CNSLBP. TRIAL REGISTRATION The study was prospectively registered at ClinicalTrials.gov (NCT05481996. Registered on August 01, 2022).
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Affiliation(s)
- Eduardo F Marins
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil.
| | - Eduardo L Caputo
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
| | - Vitor L Krüger
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
| | - Dirceu M Junior
- Postgraduate Program in Computing, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, Rio Grande Do Sul, 96010-610, Brazil
| | - Fabrício G Scaglioni
- Postgraduate Program in Computing, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, Rio Grande Do Sul, 96010-610, Brazil
| | - Fabricio B Del Vecchio
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
| | - Tiago T Primo
- Postgraduate Program in Computing, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, Rio Grande Do Sul, 96010-610, Brazil
| | - Cristine L Alberton
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
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Brites-Lagos C, Ramos L, Szumilewicz A, Santos-Rocha R. Feasibility of a Supervised Postpartum Exercise Program and Effects on Maternal Health and Fitness Parameters-Pilot Study. Healthcare (Basel) 2023; 11:2801. [PMID: 37893875 PMCID: PMC10606677 DOI: 10.3390/healthcare11202801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
The postpartum period is marked by profound changes in women at physical, psychological, and physiological levels. Many of these changes persist after four to six weeks postpartum, and most women do not resume their levels of physical activity, which increases the risk of remaining inactive for many years. It is crucial to implement effective programs that promote exercise during the postpartum period. The objective of this study was to test the feasibility and analyze the effects of a structured and supervised postpartum exercise program on maternal health and fitness parameters. To analyze the potential effects of the intervention, the level of physical activity, quality of life, pelvic girdle and low back pain, fatigue, depression, and the level of functional and physical fitness were assessed at baseline, after 8 weeks, and after 16 weeks of intervention. Feedback on the exercise program was collected after the final assessment. The results showed that a structured and supervised postpartum exercise program was feasible and safe and produced positive effects on selected maternal health and fitness parameters. These results will encourage a study protocol with a larger sample in order to prove its effectiveness, improve the guidelines for postpartum exercise, and incorporate this program into a routine healthcare setting.
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Affiliation(s)
- Carla Brites-Lagos
- ESDRM, Department of Physical Activity and Health, Sport Sciences School of Rio Maior, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal; (C.B.-L.); (L.R.)
| | - Liliana Ramos
- ESDRM, Department of Physical Activity and Health, Sport Sciences School of Rio Maior, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal; (C.B.-L.); (L.R.)
- CIEQV, Life Quality Research Center, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal
| | - Anna Szumilewicz
- Department of Fitness, Faculty of Physical Culture, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Rita Santos-Rocha
- ESDRM, Department of Physical Activity and Health, Sport Sciences School of Rio Maior, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal; (C.B.-L.); (L.R.)
- CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, 1499-002 Cruz Quebrada, Portugal
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Amateur Female Athletes Perform the Running Split of a Triathlon Race at Higher Relative Intensity than the Male Athletes: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11030418. [PMID: 36766993 PMCID: PMC9914054 DOI: 10.3390/healthcare11030418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Maximal oxygen uptake (V˙O2max), ventilatory threshold (VT) and respiratory compensation point (RCP) can be used to monitor the training intensity and the race strategy, and the elucidation of the specificities existing between the sexes can be interesting for coaches and athletes. The aim of the study was to compare ventilatory threshold (VT), respiratory compensation point (RCP), and the percentage of the maximal aerobic speed (MAS) that can be maintained in a triathlon race between sexes. Forty-one triathletes (22 men and 19 women), 42.1 ± 8.4 (26 to 60) years old, that raced the same Olympic triathlon underwent a cardiorespiratory maximal treadmill test to assess their VT, RPC, and MAS, and race speed. The maximal oxygen uptake (V˙O2max) (54.0 ± 5.1 vs. 49.8 ± 7.7 mL/kg/min, p < 0.001) and MAS (17 ± 2 vs. 15 ± 2 km/h, p = 0.001) were significantly higher in male than in female athletes. Conversely, there were no sex differences according to the percentage of V˙O2max reached at VT (74.4 ± 4.9 vs. 76.1 ± 5.4%, p = 0.298) and RCP (89.9 ± 3.6 vs. 90.6 ± 4.0%, p = 0.560). The mean speed during the race did not differ between sexes (12.1 ± 1.7 km/h and 11.7 ± 1.8 km/h, p = 0.506, respectively). Finally, men performed the running split at a lower percentage of speed at RCP than women (84.0 ± 8.7 vs. 91.2 ± 7.0%, respectively, p = 0.005). Therefore, male and female athletes accomplished the running split in an Olympic triathlon distance at distinct relative intensities, as female athletes run at a higher RCP percentage.
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Dos Anjos Souza VR, Seffrin A, da Cunha RA, Vivan L, de Lira CAB, Vancini RL, Weiss K, Knechtle B, Andrade MS. Running economy in long-distance runners is positively affected by running experience and negatively by aging. Physiol Behav 2023; 258:114032. [PMID: 36384169 DOI: 10.1016/j.physbeh.2022.114032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The maximum oxygen uptake (V˙O2max), the maximum rate of oxygen that can be sustained before the onset of blood lactate accumulation, and the metabolic cost of locomotion are the main physiological factors associated with long-distance running performance. The latter is known as the running economy. Generally, runners reach peak performance in long races between 25 and 30 years of age, with a progressive decline occurring thereafter. However, it is not known whether the running economy is affected or how it is affected by aging. AIM To investigate the effect of age and years of running experience on the running economy of amateur long-distance runners aged 20-80 years. METHODS Sixty-nine recreational long-distance runners, divided into five age groups according to decade of life, participated in this study: Group 1 (n= 9) 27.2 ± 1.3 years, Group 2 (n= 18) 35.9 ± 2.2 years, Group 3 (n= 17) 43.4 ± 2.8 years, Group 4 (n= 17) 53.0 ± 2.3 years, and Group 5 (n= 8) 65.5 ± 2.9 years. For running economy assessment, oxygen cost (OC) and energy cost (EC) were measured. Furthermore, the participants were interviewed on their running experience. RESULTS For EC, the two independent variables composing the regression model were age (ß = 0.703, t= 5.443, p < 0.001) and running experience (ß = -0.230, t = -1.785, p= 0.07), and 34% of the energy cost variation can be explained by these two factors. EC and OC were compared among the groups. There were no significant differences between Groups 1 and 2 (p= 0.999), Groups 1 and 3 (p= 1.000), and Groups 1 and 4 (p= 0.528). However, Group 5 had a significantly higher energy cost than Group 1 (p < 0.001), Group 2 (p < 0.001), Group 3 (p < 0.001) and Group 4 (p < 0.001). CONCLUSION The number of years of running experience has a positive effect on running economy, but it is insufficient to overcome the negative effect of the aging process. Furthermore, running economy was significantly worse in participants aged ≥60 years compared with that in younger athletes.
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Affiliation(s)
| | - Aldo Seffrin
- Postgraduate program in Translation Medicine, Federal University of São Paulo, Brazil
| | | | - Lavínia Vivan
- Postgraduate program in Translation Medicine, Federal University of São Paulo, Brazil
| | - Claudio Andre Barbosa de Lira
- Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Brazil
| | - Rodrigo Luiz Vancini
- Center for Physical Education and Sports, Federal University of Espírito Santo, Brazil
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
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Development of the Brazilian Version of a Pan-Canadian Behavior Change Program and Its Health and Fitness Outcomes. J Clin Med 2022; 11:jcm11195926. [PMID: 36233793 PMCID: PMC9573575 DOI: 10.3390/jcm11195926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic diseases are a major health problem worldwide, especially in lower-income jurisdictions. Considering this scenario, the World Health Organization has recently established, as a research priority, preventive interventions for populations from lower-income countries, such as the middle-income country of Brazil. The purpose of this article is to describe the components of a pan-Canadian lifestyle program adapted to Brazilians and to report its health and fitness outcomes. A 12-week program called ACCELERATION was translated and culturally adapted to Brazilians. A quasi-randomized controlled trial was designed, consisting of weekly emails and educational videos addressing risk factors for chronic disease. Health and fitness measures included body composition, cardiovascular variables, aerobic fitness, and muscular strength. The Brazilian experimental group showed maintenance in heart rate, blood pressure, and VO2max values while presenting an improvement of 3.3% in body fat percentage (p = 0.040, d = −0.325) and 5.1% in muscular strength (p = 0.039, d = 0.328). Overall, these results were similar to the Canadian intervention. Based on these findings, the Brazilian version of the program has the potential to contribute to the fight against chronic diseases in Brazil.
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Schwartz J, Oh P, Perotto MB, Rhodes RE, Firth W, Bredin SSD, Gaytán-González A, Warburton DER. A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security. Front Cardiovasc Med 2021; 8:730373. [PMID: 34527714 PMCID: PMC8435680 DOI: 10.3389/fcvm.2021.730373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/10/2021] [Indexed: 01/12/2023] Open
Abstract
In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.
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Affiliation(s)
- Juliano Schwartz
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Maira B. Perotto
- West Toronto Diabetes Education Program, LAMP Community Health Centre, Toronto, ON, Canada
| | - Ryan E. Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Wanda Firth
- Hearts & Health in Motion Program, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS, Canada
| | - Shannon S. D. Bredin
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Alejandro Gaytán-González
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
- Institute of Applied Sciences for Physical Activity and Sport, University of Guadalajara, Guadalajara, Mexico
| | - Darren E. R. Warburton
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
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