ROBot-assisted physical training of older patients during acUte hospitaliSaTion-study protocol for a randomised controlled trial (ROBUST)

BACKGROUND

During hospitalisation, older patients spend most of their time passive in bed, which increases the risk of functional decline and negative adverse outcomes. Our aim is to examine the impact of robot-assisted physical training on functional status in older geriatric patients during acute hospitalisation.

METHODS

This is a single-centre investigator-blinded placebo-controlled randomised controlled trial including geriatric patients aged ≥ 65 years, able to ambulate before hospitalisation, and with expected length of stay ≥ 2 days. In addition to standard physiotherapy treatment, the intervention group receive active robot-assisted resistance training and the control group passive robot-assisted sham training. Exclusion criteria are as follows: ambulation without assistance at the time of inclusion, known severe dementia, delirium, patients who have received less than three training sessions at discharge, terminal illness, recent major surgery/lower extremity fracture, conditions contradicting the use of training robot, lower extremity metastases, deemed unsuitable for robot-assisted training by a healthcare professional, or weight > 165 kg. The primary outcome is functional status assessed by change in Barthel Index-100 and 30-s chair stand test between inclusion and day of discharge. Secondary outcomes include functional status at 1- and 3-month follow-up, quality of life, depression, concern about falling, falls, cognition, qualitative interviews, need of homecare, discharge destination, readmissions, healthcare costs, sarcopenia, muscle quantity (bioimpedance), and mortality. Clinical meaningful change of the Barthel Index is 5 points. A recent study in geriatric patients reported a 6.9-point change following exercise. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 244 participants per group (n = 488) are needed to detect the same mean difference. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 74 participants per group (n = 148) are needed to detect a minimum clinical change of 2.6 repetitions for 30-s chair stand test. Recruitment started in January 2023 and is expected to continue for 19 months including follow-up.

DISCUSSION

If our study shows that in-hospital robot-assisted training prevents functional decline in older patients, this may have a major impact on the individual patient due to increased wellbeing and a higher level of independency. In addition, society will benefit due to potential decrease in the need of municipality-delivered homecare following discharge.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05782855. Registration date: March 24, 2023.

Reliability of Ultrasound Shear Wave Elastography for Evaluating Psoas Major and Quadratus Lumborum Stiffness: Gender and Physical Activity Effects

OBJECTIVE

We aimed to assess the reliability of quantifying psoas major (PM) and quadratus lumborum (QL) stiffness with ultrasound shear wave elastography (SWE), and to explore the effects of gender and physical activity on muscle stiffness.

METHODS

Fifty-two healthy participants (18-32 y) were recruited. To determine reliability, 29 of them underwent repeated SWE measurements of PM and QL stiffness by an operator on the same day. The intra-class correlation coefficients (ICC3,1), standard error of measurement (SEM) and minimal detectable change with 95% confidence interval (MDC95) were calculated. The rest participants underwent a single measurement. Two-way MANCOVA was conducted for the effects of gender and physical activity on muscle stiffness.

RESULTS

The observed reliability for PM (ICC3,1 = 0.89-0.92) and QL (ICC3,1 = 0.79-0.82) were good-to-excellent and good, respectively. The SEM (kPa) was 0.79-1.03 and 1.23-1.28, and the MDC95 (kPa) was 2.20-2.85 and 3.41-3.56 for PM and QL, respectively. After BMI adjustment, both gender (PM: F = 10.15, p = 0.003; QL: F = 18.07, p < 0.001) and activity level (PM: F = 5.90, p = 0.005; QL: F = 6.33, p = 0.004) influenced muscle stiffness. The female and inactive groups exhibited higher stiffness in both muscles.

CONCLUSION

SWE is reliable for quantifying the stiffness of PM and QL. Female and physical inactivity may elevate PM and QL stiffness, underscoring the importance of accounting for these factors in muscle stiffness investigations. Larger prospective studies are needed to further elucidate their effects.

Physical activity and exercise programs for kidney patients: an Italian survey of nephrology centres

BACKGROUND

Data on exercise activities in place, and on the interest for developing them in Nephrology Services in Italy is limited. To address this gap, we carried out this cross-sectional study to investigate the status of physical activity and exercise programs available in Italian Nephrology Centres. Additionally, research priorities on this topic were examined.

METHODS

We developed a 14-item electronic survey, which consisted of multiple-choice questions covering exercise training programs, physical assessment, barriers to exercise practice and to exercise programs, exercise and physical activity counselling practices, perceived exercise benefits, literature evidence, and research priorities. Data on the characteristics of the centres were also collected.

RESULTS

Sixty-two responses from Italian nephrology centres were collected. Ninety-three percent of the respondents were aware of the scientific evidence supporting the benefits of regular exercise programs for chronic kidney disease (CKD) patients. Additionally, in 75% of centres the nephrologists believed that physical activity counselling should be performed by the nephrologists. However, only 26% of centres provided exercise programs, mainly for dialysis patients, and 63% never or infrequently assessed physical activity in the context of patient management. Eighty-nine percent of centres reported barriers to implementing exercise programs, including lack of funding, institutional disinterest, patient refusal, and negative attitudes of the healthcare personnel. Forty-six research priorities related to exercise in CKD patients were suggested, with the majority focusing on impact of exercise programs and physical activity on cardiovascular, nutritional, and psychosocial outcomes.

CONCLUSION

This survey highlights the limited availability of exercise programs and physical activity evaluation in clinical practice in Italian Nephrology Centres. However, the survey also revealed a strong interest for counselling CKD patients on physical activity and implementing exercise prescriptions and interventions.

The cross-sectional and prospective associations of parental practices and environmental factors with 24-hour movement behaviours among school-aged Asian children

BACKGROUND

Parental practices and neighbourhood environmental factors may influence children's movement behaviours. We aimed to investigate the cross-sectional and prospective associations of parental practices and neighbourhood environmental factors with accelerometer-measured 24-hour movement behaviours (24 h-MBs) among school-aged children in Singapore.

METHODS

The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study collected information on dimensions of parental practices and neighbourhood environment at age 5.5 years. Confirmatory factor analyses were performed to generate latent variables and used to compute overall parental practices [involvement in PA + support for PA + control of screen viewing context] and environmental scores [facilities for active play + active mobility facilitators + barriers*-1]. Children wore an accelerometer on their non-dominant wrist for seven consecutive days at ages 5.5 and 8 years. The R-package GGIR 2.6 was used to derive moderate-to-vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA), inactivity, and total-sleep (napping+night sleep) minutes per day. Associations were determined using compositional data analysis with multivariate linear regression models, taking into account potential confounders.

RESULTS

Among 425 children (48% girls, 59% Chinese), higher parental involvement in PA, parental support for PA and overall parental practices were associated with 24 h-MBs at ages 5.5 and 8 years, specifically with greater time spent in MVPA and less time being inactive relative to the remaining movement behaviours. The corresponding mean changes in the overall 24 h-MB for increasing parental practices from lowest to highest scores (- 2 to + 2 z-scores) indicated potential increases of up to 15-minutes in MVPA, 20-minutes in LPA, 5-minutes in sleep duration, and a reduction of 40-minutes in inactivity at age 5.5 years. At age 8 years, this could translate to approximately 15-minutes more of MVPA, 20-minutes more of LPA, a 20-minute reduction in sleep duration, and a 20-minute reduction in inactivity. Parental control of screen viewing contexts and neighbourhood environmental factors were not associated with 24 h-MBs.

CONCLUSIONS

Parental practices but not environmental factors were associated with higher MVPA and lower inactivity among Singaporean children, even at a later age. Further research may provide insights that support development of targeted public health strategies to promote healthier movement behaviours among children.

STUDY REGISTRATION

This study was registered on 4th August 2010 and is available online at ClinicalTrials.gov: NCT01174875.

Two-week step-reduction has limited negative effects on physical function and metabolic health in older adults

PURPOSE

This study determined the effects of a 2-week step-reduction period followed by 4-week exercise rehabilitation on physical function, body composition, and metabolic health in 70-80-year-olds asymptomatic for injury/illness.

METHODS

A parallel-group randomized controlled trial (ENDURE-study, NCT04997447) was used, where 66 older adults (79% female) were randomized to either intervention or control group. The intervention group reduced daily steps to < 2000, monitored by accelerometer, for two weeks (Period I) and then step-reduction requirement was removed with an additional exercise rehabilitation 4 times per week for 4 weeks (Period II). The control group continued their habitual physical activity throughout with no additional exercise intervention. Laboratory tests were performed at baseline, after Period I and Period II. The primary outcome measure was leg lean mass (LLM). Secondary outcomes included total lean and fat mass, blood glucose and insulin concentration, LDL cholesterol and HDL cholesterol concentration, maximal isometric leg press force (MVC), and chair rise and stair climb performance.

RESULTS

LLM remained unchanged in both groups and no changes occurred in physical function nor body composition in the intervention group in Period I. HDL cholesterol concentration reduced after Period I (from 1.62 ± 0.37 to 1.55 ± 0.36 mmol·L-1, P = 0.017) and returned to baseline after Period II (1.66 ± 0.38 mmol·L-1) in the intervention group (Time × Group interaction: P = 0.065). MVC improved after Period II only (Time × Group interaction: P = 0.009, Δ% = 15%, P < 0.001).

CONCLUSION

Short-term step-reduction in healthy older adults may not be as detrimental to health or physical function as currently thought.

Cross-sectional and prospective associations between children's 24-h time use and their health-related quality of life: a compositional isotemporal substitution approach

Background

Promoting active, balanced lifestyles among children may be an important approach to optimising their health-related quality of life (HRQoL). However, the relationships between children's movement behaviours and HRQoL remain unclear.

Methods

We examined the associations between movement behaviours (sleep, inactivity, light and moderate-to-vigorous intensity physical activity) assessed using accelerometers at ages 8 and 10 years and self-reported HRQoL scores (overall, and physical and emotional well-being, self-esteem, relationship with family and friends, and school functioning domains) at age 10 years among 370 children in a local birth cohort using compositional isotemporal substitution techniques.

Findings

Cross-sectionally, light and moderate-to-vigorous intensity physical activities were associated with better self-esteem (β = 15.94 [2.71, 29.18]) and relationship with friends (β = 10.28 [3.81, 16.74]) scores respectively. Prospectively, inactivity was associated with lower overall HRQoL (β = -10.00 [-19.13, -0.87]), relationship with friends (β = -16.41 [-31.60, -1.23]) and school functioning (β = -15.30 [-29.16, -1.44]) scores, while sleep showed a positive trend with overall HRQoL (β = 10.76 [-1.09, 22.61]) and school functioning (β = 17.12 [-0.87, 35.10]) scores. Children's movement behaviours were not associated with their physical and emotional well-being, or relationship with family scores. The isotemporal substitution analyses suggest that increasing time spent in physical activity and/or sleep at the expense of inactivity may benefit children's HRQoL.

Interpretation

Our findings suggest that sleep and physical activity may be associated with better HRQoL, with the inverse for inactivity. However, the relationship between children's movement behaviours and HRQoL is complex and warrants further research.

Funding

Singapore National Research Foundation, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research.

Arterial stiffness and the reallocation of time between device-measured 24-hour movement behaviours: A compositional data analysis

BACKGROUND AND AIMS

Arterial stiffness predicts cardiovascular morbidity and mortality. We aimed to quantify the differences in arterial stiffness associated with reallocating time between 24-h movement behaviours.

METHODS

This observational cross-sectional study included Luxembourg residents aged 25-79y who each provided ≥4 valid days of triaxial accelerometry (n = 1001). Covariable adjusted compositional isotemporal substitution models were used to examine if theoretical reallocations of time between device-measured sedentariness, the sleep period, light physical activity (PA), and moderate-to-vigorous PA (MVPA) were associated with the percentage difference in carotid-femoral pulse wave velocity (cfPWV). We further investigated if replacing sedentary time accumulated in prolonged (≥30 min) with non-prolonged (<30 min) bouts was associated with arterial stiffness. The results are presented as 30 min time exchanges (β (95% confidence interval)).

RESULTS

Beneficial associations with lower cfPWV were observed when reallocating time to MVPA from the sleep period (-1.38 (-2.63 to -0.12) %), sedentary time (-1.70 (-2.76 to -0.62) %), and light PA (-2.51 (-4.55 to -0.43) %), respectively. Larger associations in the opposite direction were observed when reallocating MVPA to the same behaviours (for example, replacing MVPA with sedentary time: 2.50 (0.85-4.18) %). Replacing prolonged with non-prolonged sedentary time was not associated with cfPWV (-0.27 (-0.86 to 0.32) %). In short sleepers, reallocating sedentary time to the sleep period was favourable (-1.96 (-3.74 to -0.15) %).

CONCLUSIONS

Increasing or at least maintaining MVPA appears to be important for arterial health in adults. Extending sleep in habitually short sleepers, specifically by redistributing sedentary time, may also be important.

Exploring the peripheral mechanisms of lower limb immobilisation on muscle function using novel electrophysiological methods

OBJECTIVE

To explore the effects of short-term immobilisation and subsequent retraining on peripheral nervous system (PNS) measures using two novel electrophysiological methods, muscle velocity recovery cycles (MVRC) and MScanFit motor unit number estimation (MUNE) alongside lower limb muscle strength, muscle imaging and walking capacity.

METHODS

Twelve healthy participants underwent 1-week of ankle immobilisation and 2-weeks of retraining. Assessments before and after immobilisation, and after retraining, included MVRC [muscle membrane properties; muscle relative refractory period (MRRP), early and late supernormality], MScanFit, MRI-scans [muscle contractile cross-sectional area (cCSA)], isokinetic dynamometry [dorsal and plantar flexor muscle strength], and 2-minute maximal walk test [physical function].

RESULTS

After immobilisation, compound muscle action potential (CMAP) amplitude reduced (-1.35[-2.00;-0.69]mV); mean change [95%CI]) alongside reductions in plantar (but not dorsal) flexor muscle cCSA (-124[-246;3]mm2), dorsal flexor muscle strength (isometric -0.06[-0.10;-0.02]Nm/kg, dynamicslow -0.08[-0.11;-0.04]Nm/kg, dynamicfast no changes), plantar flexor muscle strength (isometric -0.20[-0.30;-0.10]Nm/kg, dynamicslow -0.19[-0.28;-0.09]Nm/kg, dynamicfast -0.12[-0.19;-0.05]Nm/kg) and walking capacity (-31[-39;-23]m). After retraining, all immobilisation-affected parameters returned to baseline levels. In contrast, neither MScanFit nor MVRC were affected apart from slightly prolonged MRRP in gastrocnemius.

CONCLUSIONS

PNS do not contribute to the changes observed in muscle strength and walking capacity.

SIGNIFICANCE

Further studies should include both corticospinal and peripheral mechanisms.

Menopausal symptoms and cardiometabolic risk factors in middle-aged women: A cross-sectional and longitudinal study with 4-year follow-up

OBJECTIVE

To study associations of menopausal symptoms with cardiometabolic risk factors.

STUDY DESIGN

A cross-sectional and longitudinal study of a representative population sample of 1393 women aged 47-55 years with a sub-sample of 298 followed for four years. The numbers of vasomotor, psychological, somatic or pain, and urogenital menopausal symptoms were ascertained at baseline through self-report. Their associations with cardiometabolic risk factors were studied using linear regression and linear mixed-effect models. Models were adjusted for age, menopausal status, body mass index, the use of hormonal preparations, education, smoking, and alcohol consumption.

MAIN OUTCOME MEASURES

Cardiometabolic risk factors included total cholesterol, low-density and high-density lipoprotein cholesterol, blood pressure, glucose, triglycerides, total and android fat mass, and physical activity.

RESULTS

All cholesterol and fat mass measures had modest positive associations with menopausal symptoms. The number of vasomotor symptoms, in particular, was associated with total cholesterol (B = 0.13 mmol/l, 95 % CI [0.07, 0.20]; 0.15 mmol/l [0.02, 0.28]) and low-density lipoprotein cholesterol (0.08 mmol/l [0.03, 0.14]; 0.12 mmol/l [0.01, 0.09]) in cross-sectional and longitudinal analyses, respectively. However, these associations disappeared after adjusting for confounders. The number of symptoms was not associated with blood pressure, glucose, triglycerides, and physical activity. Menopausal symptoms at baseline did not predict the changes in the risk factors during the follow-up.

CONCLUSIONS

Menopausal symptoms may not be independently associated with cardiometabolic risk, and they do not seem to predict the changes in risk factors during the menopausal transition.

The association between sport type and eating/body image concerns in high school students: a cross-sectional observational study

PURPOSE

Disordered eating and body image concerns are increasingly common among adolescents, possibly representing the underpinning of eating disorders (EDs). This cross-sectional observational study aimed at investigating the relationship between various patterns of sports involvement or inactivity, and the abovementioned psychopathological dimensions.

METHODS

All adolescents attending their 3rd-5th Italian grade in a single high school reported their sociodemographic and anthropometric data, their weekly sports involvement, and filled the Eating Disorders Examination Questionnaire 6.0 (EDE-Q), the Body Uneasiness Test, and the Muscle Dysmorphia Disorder Inventory (for boys). Comparisons were performed considering sex, weekly hours of activity, and different sports type (none, individual, or team sports).

RESULTS

Of 744 enrolled students, 522 (70.2%) completed the survey. Girls showed higher underweight rates, preference for inactivity or individual sports, and higher psychometric scores compared to boys. Among girls, no differences were found based on time spent exercising or sports type. Inactive boys displayed worse weight- and shape-based psychopathology, higher body uneasiness, and higher appearance intolerance compared to those who devoted more time to exercise. Among boys, individual and team sports were associated with lower EDE-Q scores compared to inactivity, whereas body uneasiness and appearance intolerance were lower only in team sports.

CONCLUSIONS

The study confirms the presence of remarkable sex differences in eating and body concerns of adolescents. Among boys, sports involvement is tied to lower ED psychopathology, and preference for team sports may be associated with reduced concerns. Wider longitudinal studies on will clarify the direction and specificity of these findings.

LEVEL OF EVIDENCE

Level V-Cross-sectional observational study.

Impact of risk for severe COVID-19 illness on physical activity during the pandemic

BACKGROUND

Precautions to mitigate spread of COVID-19 such as the closing of exercise facilities impacted physical activity behaviors. Varied risks for severe COVID-19 may have influenced participation in regular physical activity to maintain precautions.

OBJECTIVE

Describe differences in the amount and intensity of physical activity between adults at high versus low risk for severe COVID-19 illness during the pandemic. We hypothesized that over 13 months, 1) high-risk adults would have greater odds of inactivity than low-risk adults, and 2) when active, high-risk adults would have lower metabolic equivalent of task minutes (MET-min) than low-risk adults.

METHODS

This longitudinal observational cohort study surveyed U.S. adults' demographics, health history, and physical activity beginning March 2020 using REDCap. Using self-report, health history was assessed with a modified Charlson Comorbidity Index and physical activity with the International Physical Activity Questionnaire. Repeated physical activity measurements were conducted in June, July, October, and December of 2020, and in April of 2021. Two models, a logistic model evaluating physical inactivity (hypothesis 1) and a gamma model evaluating total MET-min for physically active individuals (hypothesis 2), were used. Models were controlled for age, gender, and race.

RESULTS

The final sample consisted of 640 participants (mean age 42.7 ± 15.7, 78% women, 90% white), with n = 175 categorized as high-risk and n = 465 as low-risk. The odds of inactivity for the high-risk adults were 2.8 to 4.1 times as high than for low-risk adults at baseline and 13 months. Active high-risk adults had lower MET-min levels than low-risk adults in March (28%, p = 0.001), June (29%, p = 0.002), and July of 2020 (30%, p = 0.005) only.

CONCLUSIONS

Adults at high risk of severe COVID-19 illness were disproportionately more likely to be physically inactive and exhibit lower MET-min levels than adults at low risk during the early months of the COVID-19 pandemic.

Subjective and objective sleep and circadian parameters as predictors of depression-related outcomes: A machine learning approach in UK Biobank

BACKGROUND

Sleep and circadian disruption are associated with depression onset and severity, but it is unclear which features (e.g., sleep duration, chronotype) are important and whether they can identify individuals showing poorer outcomes.

METHODS

Within a subset of the UK Biobank with actigraphy and mental health data (n = 64,353), penalised regression identified the most useful of 51 sleep/rest-activity predictors of depression-related outcomes; including case-control (Major Depression (MD) vs. controls; postnatal depression vs. controls) and within-case comparisons (severe vs. moderate MD; early vs. later onset, atypical vs. typical symptoms; comorbid anxiety; suicidality). Best models (of lasso, ridge, and elastic net) were selected based on Area Under the Curve (AUC).

RESULTS

For MD vs. controls (n_(MD) = 24,229; n_(control) = 40,124), lasso AUC was 0.68, 95 % confidence interval (CI) 0.67-0.69. Discrimination was reasonable for atypical vs. typical symptoms (n_(atypical) = 958; n_(typical) = 18,722; ridge: AUC 0.74, 95 % CI 0.71-0.77) but poor for remaining models (AUCs 0.59-0.67). Key predictors across most models included: difficulty getting up, insomnia symptoms, snoring, actigraphy-measured daytime inactivity and lower morning activity (~8 am). In a distinct subset (n = 310,718), the number of these factors shown was associated with all depression outcomes.

LIMITATIONS

Analyses were cross-sectional and in middle-/older aged adults: comparison with longitudinal investigations and younger cohorts is necessary.

DISCUSSION

Sleep and circadian measures alone provided poor to moderate discrimination of depression outcomes, but several characteristics were identified that may be clinically useful. Future work should assess these features alongside broader sociodemographic, lifestyle and genetic features.

Substituting device-measured sedentary time with alternative 24-hour movement behaviours: compositional associations with adiposity and cardiometabolic risk in the ORISCAV-LUX 2 study

BACKGROUND

There is a considerable burden of sedentary time in European adults. We aimed to quantify the differences in adiposity and cardiometabolic health associated with theoretically exchanging sedentary time for alternative 24 h movement behaviours.

METHODS

This observational cross-sectional study included Luxembourg residents aged 18-79 years who each provided  ≥ 4 valid days of triaxial accelerometry (n = 1046). Covariable adjusted compositional isotemporal substitution models were used to examine if statistically replacing device-measured sedentary time with more time in the sleep period, light physical activity (PA), or moderate-to-vigorous PA (MVPA) was associated with adiposity and cardiometabolic health markers. We further investigated the cardiometabolic properties of replacing sedentary time which was accumulated in prolonged (≥ 30 min) with non-prolonged (< 30 min) bouts.

RESULTS

Replacing sedentary time with MVPA was favourably associated with adiposity, high-density lipoprotein cholesterol, fasting glucose, insulin, and clustered cardiometabolic risk. Substituting sedentary time with light PA was associated with lower total body fat, fasting insulin, and was the only time-exchange to predict lower triglycerides and a lower apolipoprotein B/A1 ratio. Exchanging sedentary time with more time in the sleep period was associated with lower fasting insulin, and with lower adiposity in short sleepers. There was no significant evidence that replacing prolonged with non-prolonged sedentary time was related to outcomes.

CONCLUSIONS

Artificial time-use substitutions indicate that replacing sedentary time with MVPA is beneficially associated with the widest range of cardiometabolic risk factors. Light PA confers some additional and unique metabolic benefit. Extending sleep, by substituting sedentary time with more time in the sleep period, may lower obesity risk in short sleepers.

Loss of cardiorespiratory fitness and its recovery following two weeks of head-down bed rest and the protective effects of exercise in 55-65-year-old adults

Cardiorespiratory fitness declines with age and this decline can be accelerated by inactivity and bed rest. Recovery of fitness is possible, but the timeline in 55-65-year-old adults is unknown. Furthermore, the effectiveness of exercise to prevent deconditioning during bed rest is unexplored in this age group. Twenty-two adults (11 women, 59 ± 3 years) completed two weeks of strict 6° head-down bed rest (HDBR). Half of the participants performed approximately 1 hour of daily exercises, including high-intensity interval cycling, aerobic cycling, and upper- and lower-body resistance training, while control participants were inactive. Step-incremental cycling tests to exhaustion were conducted pre-HDBR and at 3 times during the recovery phase (day-1 or 2, day-6, and 4 weeks) to assess peak oxygen uptake (V̇O₂). Peak V̇O₂ was reduced in the control group throughout the first 6 days of recovery, but did return to pre-HDBR levels by the 4-week recovery time point (interaction: p=0.002). In the exercise group, peak V̇O₂ was not different at any time point during recovery from pre-HDBR. Ventilatory threshold V̇O₂ (interaction: p=0.002) and heart rate at 15 W (interaction: p=0.055) mirrored the changes in peak V̇O₂ in each respective group. Overall, this study showed that approximately 1 hour of daily exercise effectively protected 55-65-year-old adults' cardiorespiratory fitness during two weeks of HDBR. HDBR without exercise countermeasures caused substantial reductions in cardiorespiratory fitness, but fitness recovered within 4 weeks of resuming daily activities. These findings highlight the importance of physical activity in late middle-age adults.

Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study

Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.

Motivation, stress, recovery, and physical activity of teachers: discoveries with the Reiss Motivation Profile® and the Firstbeat® measurement

Aim

Teaching is known as a high-stress occupation. Managing fatigue and promoting work engagement, teachers' expectations and perceptions can impact work-related stress-recovery-balance and physical activity levels. The main objective of the current study was to investigate the relationship between intrinsic motivational factors and the autonomic nervous system, such as heart rate and heart rate variability regulation, sleep, and physical activity levels.

Methods

The research included 66 primary and high school teachers in Tampere, Finland, in 2020-2021. The Reiss Motivation Profile® (RMP) was selected as an instrument to provide a practical approach to understanding people's intrinsic motivators and the effects of those on the Firstbeat®-measured heart rate and heart rate variability, and accelerometry. Stepwise multiple linear regression models were used to assess whether the RMP motives reflected Firstbeat®-measured outcomes.

Results

Motives such as Acceptance, Eating, Family, Physical Activity, Power, Tranquillity, and Vengeance were found to have a relationship with Firstbeat®-measured outcomes. An increase in the Physical Activity motive was related to lower stress and less light physical activity. Furthermore, an increase in the Physical Activity motive showed a relationship with better recovery and a higher amount of vigorous physical activity. However, the statistical analysis of heart rate and heart rate variability showed only low explanatory power (R2 = 0.111-0.140) for stress, recovery, and sleep. On the contrary, the explanatory power of measurements related to physical activity and sedentary behavior was higher (R2 = 0.171-0.298). In addition, the need for Acceptance as an important intrinsic motive that may prevent people from vigorous physical activity deserves further research.

Conclusion

The results indicated that there are several factors affecting the autonomous nervous system but also behavior. The basic desires explained sedentary and physical activity behavior better than the functioning of the autonomic nervous system. The 16 life motives can serve as a valuable theory for understanding better how to encourage people to have healthier habits.

Device-measured physical activity and sedentary time in a national sample of Luxembourg residents: the ORISCAV-LUX 2 study

BACKGROUND

Existing information about population physical activity (PA) levels and sedentary time in Luxembourg are based on self-reported data.

METHODS

This observational study included Luxembourg residents aged 18-79y who each provided ≥4 valid days of triaxial accelerometry in 2016-18 (n=1122). Compliance with the current international PA guideline (≥150 min moderate-to-vigorous PA (MVPA) per week, irrespective of bout length) was quantified and variability in average 24h acceleration (indicative of PA volume), awake-time PA levels, sedentary time and accumulation pattern were analysed by linear regression. Data were weighted to be nationally representative.

RESULTS

Participants spent 51% of daily time sedentary (mean (95% confidence interval (CI)): 12.1 (12.0 to 12.2) h/day), 11% in light PA (2.7 (2.6 to 2.8) h/day), 6% in MVPA (1.5 (1.4 to 1.5) h/day), and remaining time asleep (7.7 (7.6 to 7.7) h/day). Adherence to the PA guideline was high (98.1%). Average 24h acceleration and light PA were higher in women than men, but men achieved higher average accelerations across the most active periods of the day. Women performed less sedentary time and shorter sedentary bouts. Older participants (aged ≥55y) registered a lower average 24h acceleration and engaged in less MVPA, more sedentary time and longer sedentary bouts. Average 24h acceleration was higher in participants of lower educational attainment, who also performed less sedentary time, shorter bouts, and fewer bouts of prolonged sedentariness. Average 24h acceleration and levels of PA were higher in participants with standing and manual occupations than a sedentary work type, but manual workers registered lower average accelerations across the most active periods of the day. Standing and manual workers accumulated less sedentary time and fewer bouts of prolonged sedentariness than sedentary workers. Active commuting to work was associated with higher average 24h acceleration and MVPA, both of which were lower in participants of poorer self-rated health and higher weight status. Obesity was associated with less light PA, more sedentary time and longer sedentary bouts.

CONCLUSIONS

Adherence to recommended PA is high in Luxembourg, but half of daily time is spent sedentary. Specific population subgroups will benefit from targeted efforts to replace sedentary time with PA.

The time course of disuse muscle atrophy of the lower limb in health and disease

Short, intermittent episodes of disuse muscle atrophy (DMA) may have negative impact on age related muscle loss. There is evidence of variability in rate of DMA between muscles and over the duration of immobilization. As yet, this is poorly characterized. This review aims to establish and compare the time-course of DMA in immobilized human lower limb muscles in both healthy and critically ill individuals, exploring evidence for an acute phase of DMA and differential rates of atrophy between and muscle groups. MEDLINE, Embase, CINHAL and CENTRAL databases were searched from inception to April 2021 for any study of human lower limb immobilization reporting muscle volume, cross-sectional area (CSA), architecture or lean leg mass over multiple post-immobilization timepoints. Risk of bias was assessed using ROBINS-I. Where possible meta-analysis was performed using a DerSimonian and Laird random effects model with effect sizes reported as mean differences (MD) with 95% confidence intervals (95% CI) at various time-points and a narrative review when meta-analysis was not possible. Twenty-nine studies were included, 12 in healthy volunteers (total n = 140), 18 in patients on an Intensive Therapy Unit (ITU) (total n = 516) and 3 in patients with ankle fracture (total n = 39). The majority of included studies are at moderate risk of bias. Rate of quadriceps atrophy over the first 14 days was significantly greater in the ITU patients (MD -1.01 95% CI -1.32, -0.69), than healthy cohorts (MD -0.12 95% CI -0.49, 0.24) (P < 0.001). Rates of atrophy appeared to vary between muscle groups (greatest in triceps surae (-11.2% day 28), followed by quadriceps (-9.2% day 28), then hamstrings (-6.5% day 28), then foot dorsiflexors (-3.2% day 28)). Rates of atrophy appear to decrease over time in healthy quadriceps (-6.5% day 14 vs. -9.1% day 28) and triceps surae (-7.8% day 14 vs. -11.2% day 28), and ITU quadriceps (-13.2% day 7 vs. -28.2% day 14). There appears to be variability in the rate of DMA between muscle groups, and more rapid atrophy during the earliest period of immobilization, indicating different mechanisms being dominant at different timepoints. Rates of atrophy are greater amongst critically unwell patients. Overall evidence is limited, and existing data has wide variability in the measures reported. Further work is required to fully characterize the time course of DMA in both health and disease.

Physical Activity During Lockdowns Associated with the COVID-19 Pandemic: A Systematic Review and Multilevel Meta-analysis of 173 Studies with 320,636 Participants

Background

Many countries have restricted public life in order to contain the spread of the novel coronavirus (SARS-CoV2). As a side effect of related measures, physical activity (PA) levels may have decreased.

Objective

We aimed (1) to quantify changes in PA and (2) to identify variables potentially predicting PA reductions.

Methods

A systematic review with random-effects multilevel meta-analysis was performed, pooling the standardized mean differences in PA measures before and during public life restrictions.

Results

A total of 173 trials with moderate methodological quality (modified Downs and Black checklist) were identified. Compared to pre-pandemic, total PA (SMD − 0.65, 95% CI − 1.10 to − 0.21) and walking (SMD − 0.52, 95% CI − 0.29 to − 0.76) decreased while sedentary behavior increased (SMD 0.91, 95% CI: 0.17 to 1.65). Reductions in PA affected all intensities (light: SMD − 0.35, 95% CI − 0.09 to − 0.61, p = .013; moderate: SMD − 0.33, 95% CI − 0.02 to − 0.6; vigorous: SMD − 0.33, − 0.08 to − 0.58, 95% CI − 0.08 to − 0.58) to a similar degree. Moderator analyses revealed no influence of variables such as sex, age, body mass index, or health status. However, the only continent without a PA reduction was Australia and cross-sectional trials yielded higher effect sizes (p < .05).

Conclusion

Public life restrictions associated with the COVID-19 pandemic resulted in moderate reductions in PA levels and large increases in sedentary behavior. Health professionals and policy makers should therefore join forces to develop strategies counteracting the adverse effects of inactivity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-022-00515-x.

Association of developmental coordination disorder and low motor competence with impaired bone health: A systematic review

AIMS

Individuals with developmental coordination disorder (DCD) and low motor competence (LMC) may be at increased risk of low bone health due to their lifetime physical activity patterns. Impaired bone health increases an individual's risk of osteoporosis and fracture; therefore, it is necessary to determine whether a bone health detriment is present in this group. Accordingly, this systematic review explores the association between DCD/LMC and bone health.

METHODS AND PROCEDURES

Studies were included with assessment of bone health in a DCD/LMC population. Study bias was assessed using the JBI critical appraisal checklist. Due to heterogeneity, meta-analysis was not possible and narrative synthesis was performed with effect size and direction assessed via harvest plots.

OUTCOMES AND RESULTS

A total of 16 (15 paediatric/adolescent) studies were included. Deficits in bone measures were reported for the DCD/LMC group and were more frequent in weight-bearing sites. Critical appraisal indicated very low confidence in the results, with issues relating to indirectness and imprecision relating to comorbidities.

CONCLUSIONS AND IMPLICATIONS

Individuals with DCD or LMC are at increased risk of bone health deficits. Bone impairment locations indicate insufficient loading via physical activity as a potential cause of bone deficits. Results indicate a potential for earlier osteoporosis onset.

Day-level associations of physical activity and sedentary time in mother-child dyads across three years: a multi-wave longitudinal study using accelerometers

Understanding associations between mothers' and children's physical activity and sedentary behavior on more fine-grained timescales can provide insights into real-time intervention opportunities. This study examined the extent to which mothers' and their children's device-measured moderate-to-vigorous physical activity (MVPA) and sedentary time (SDT) were associated at the day level during non-school time. Mother-child dyads (N = 193; baseline Mean ages = 40.69 ± 6.11 [mother] and 9.57 ± 0.89 [child] years) provided 3,135 paired days of accelerometry data from six bi-annual waves across three years. Controlling for covariates, multilevel models revealed that mothers' and their children's MVPA and SDT were positively associated at the day level during non-school time, both on weekdays and weekends. During weekdays, the day-level association for SDT was stronger for older than younger children, and the day-level association for MVPA was stronger for boys than girls. Designing family-based interventions targeting school-age children and their mothers during non-school time across the week may be useful for promoting active lifestyles.

Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participants

BACKGROUND

This study examined the joint associations of sleep patterns and physical activity (PA) with all-cause, cardiovascular disease (CVD), and cancer mortality.

METHODS

A total of 341,248 adults (mean age = 39.7 years; men: 48.3%) were included in the study, with a 15-year follow-up. Participants reported sleep duration and disturbances (difficulty falling asleep, easily awakened, or use of sleeping medication). PA was classified into 4 levels: <7.5, 7.5-14.9, 15.0-29.9, and ≥30.0 metabolic equivalent hours per week (MET-h/week). To understand the joint associations of sleep patterns and PA with mortality, Cox proportional hazard models were conducted, with exposure variables combining sleep duration/disturbances and PA.

RESULTS

Compared with the reference group (sleeping 6-8 h/day), individuals who slept >8 h/day had higher risk for all-cause mortality (hazard ratio (HR) = 1.307, 95% confidence interval (95%CI): 1.248-1.369), CVD mortality (HR = 1.298, 95%CI: 1.165-1.445), and cancer mortality (HR = 1.128, 95%CI: 1.042-1.220). Short sleep duration was not associated with mortality risk. Increased risk of all-cause and CVD mortality was found in participants who had difficulty falling asleep (HR = 1.120, 95%CI: 1.068-1.175; HR = 1.163, 95%CI: 1.038-1.304, respectively), and used sleeping medication (HR = 1.261, 95%CI: 1.159-1.372; HR = 1.335, 95%CI: 1.102-1.618, respectively) compared with those who slept well. Long sleep duration and sleep disturbances were not associated with risk of all-cause and CVD mortality among individuals achieving a PA level of ≥15 MET-h/week, and in particular among those achieving ≥30 MET-h/week.

CONCLUSION

Long sleep duration, difficulty falling asleep, and use of sleeping medication were related to a higher risk of death. Being physically active at a moderate intensity for 25-65 min/day eliminated these detrimental associations.

[Estimación del aumento global del tiempo de sedentarismo durante los confinamientos de la COVID-19: una revisión sistemática y un metanálisis.]

OBJECTIVE

Las estrategias restrictivas de movilidad derivadas de la pandemia por COVID-19 podrían afectar negativamente al estado de salud de la población debido a la disminución de los niveles de actividad física. El objetivo de este estudio es estimar el aumento del tiempo de sedentarismo durante los confinamientos en comparación con la situación anterior al brote de COVID-19 en muestras de población adulta de diferentes países del mundo.

METHODS

Se realizó una búsqueda sistemática en tres bases de datos electrónicas, hasta el 27 de febrero de 2021, de estudios que informaran sobre el tiempo total de sedentarismo antes y durante los confinamientos por COVID-19 utilizando una herramienta validada. Se realizó un metanálisis utilizando modelos de efectos aleatorios para calcular las diferencias de medias ponderadas en el tiempo sedentario diario total antes y durante los confinamientos. El análisis se repitió estratificado y comparando por sexo.

RESULTS

Se incluyeron 20 estudios, con una calidad metodológica buena (n=15) y regular (n=5). Para el metanálisis se agruparon los datos de 18 estudios, con 47.245 participantes. Los confinamientos por COVID-19 en todo el mundo condujeron a un aumento medio ponderado de 2,40 horas diarias en el tiempo total de comportamiento sedentario (intervalo de confianza del 95%: 1,95; 2,85). El análisis estratificado y comparativo por sexo en 8 estudios indicó un aumento similar para mujeres (n=20.455) y hombres (n=11.825).

CONCLUSIONS

El tiempo total de sedentarismo diario aumentó en 2,40 horas en todo el mundo durante los confinamientos en comparación con la situación anterior al brote de COVID-19, sin diferencias significativas entre sexos.

Interactive effect of socio-eco-demographic characteristics and perceived physical activity barriers on physical activity level among older adults

Background

Studies examining associations of socio-eco-demographic characteristics with physical activity (PA) participation of older adults have produced inconsistent results. Perceived PA barriers may be a possible explanation for the mixed findings. Therefore, the purpose of this study was to examine the correlation of socio-eco-demographic (SED) characteristics with PA of older adults and the moderation effects of perceived barriers of PA.

Methods

Three hundred eighty-four older adults (≥ 60 years old) were recruited from public places in six different cities. Questions regarding socio-eco-demographic characteristics, PA, and perceived PA barriers were asked, in-person, by two examiners. Ordinal logistic regression models examined the association of socio-eco-demographic characteristics with subjectively measured PA, and the interactive effects of subscales of perceived PA barriers and socio-eco-demographic variables for PA outcomes.

Results

Significant main effects for PA outcomes were found for education and living status (P < 0.01) and college-educated individuals and those were living in their private houses reported higher PA. Also, 24 significant interactive effects of perceived PA barriers by socio-eco-demographic factors were found (P < 0.05). Significant moderation effects by all subscales of perceived PA barriers were observed for education and living status. The effect of age for the PA outcomes was moderated by “lack of time”, “fear of injury”, and “lack of skill”. Only “fear of injury” and “lack of time” moderated the effect of gender and marriage for outcome variable, respectively. The effect of employment was moderated by “lack of willpower”, “fear of injury”, “lack of skill” and “lack of resources”.

Conclusions

Novel evidence revealed that there are moderations by perceived PA barriers for the effect of almost all socio-eco-demographic characteristics. These findings highlight a need to consider older adults’ perspectives and perceptions, when it comes to establish policies for PA participation.

Physical activity and COVID-19. The basis for an efficient intervention in times of COVID-19 pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic has shocked world health authorities generating a global health crisis. The present study aimed to analyze the different factors associated with physical activity that could have an impact in the COVID-19, providing a practical recommendation based on actual scientific knowledge. We conducted a consensus critical review using primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages. The method was a narrative literature review of the available literature regarding physical activity and physical activity related factors during the COVID-19 pandemic. The main online database used in the present research were PubMed, SciELO, and Google Scholar. COVID-19 has negatively influenced motor behavior, levels of regular exercise practice, eating and nutritional patterns, and the psychological status of citizens. These factors feed into each other, worsening COVID-19 symptoms, the risk of death from SARS-CoV-2, and the symptoms and effectiveness of the vaccine. The characteristics and symptoms related with the actual COVID-19 pandemic made the physical activity interventions a valuable prevention and treatment factor. Physical activity improves body composition, the cardiorespiratory, metabolic, and mental health of patients and enhancing antibody responses in vaccination.

Potential value of home square-stepping exercises for inactive older adults: an exploratory case study

Background

Most older adults do not engage in regular physical activity. However, more research on options to partake in regular exercise in this population by reducing barriers and enhancing enablers while still reaching benefits is needed.

Methods

Using embedded mixed methods, 10 inactive older adults over the age of 65 completed a 3-week square-stepping exercise intervention to help overcome the initial barriers and activate initial enablers to perform regular exercise. Physical activity level was tracked at home with a pedometer using median steps/day over seven days for pre-post measure. Aerobic intensity while doing square-stepping exercises was quantified via a heart rate monitor in a supervised session. Each participant had an interview asking about barriers and enablers to regular exercise and if the intervention could modify any. Based on initial physical activity a framework matrix was used to pull potential barriers to compare, contrast, and search for patterns between participants with lower and higher initial physical activity levels.

Results

The 3-week square-stepping exercise intervention helped participants overcome barriers such as being uncomfortable in a fitness facility and body image and activate enablers such as the use of home equipment and convenience. The median total steps/day increased by 12% (p = 0.02), and a moderate-intensity level was reached by 80% of the sample participants when performing the square stepping exercise during a supervised session. Common barriers such as having a suitable program, hard to keep the intensity were reported by participants regardless of the initial physical activity level.

Conclusion

Regardless of initial physical activity level, inactive older adults can increase physical activity level at the recommended intensity and overcome common barriers to exercise when performing square-stepping exercises, especially for those intimidated by a fitness facility setting and those concerned with their body image. A longer intervention including more participants using the square-stepping exercises is required to understand if square-stepping exercises can increase the proportion of older adults exercising regularly.

Supplementary information

The online version contains supplementary material available at 10.1186/s12877-021-02712-x.

24-hour movement behaviour profiles and their transition in children aged 5.5 and 8 years - findings from a prospective cohort study

BACKGROUND

Time spent in movement behaviours, including physical activity (PA), sedentary behaviour (SB) and sleep, across the 24-h day may have distinct health consequences. We aimed to describe 24-h movement behaviour (24 h-MB) profiles in children and how profile membership changed from age 5.5 to 8 years.

METHODS

Children in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort were asked to wear an accelerometer (ActiGraph-GT3X+) on their wrist for seven consecutive days at ages 5.5 and 8 years to measure 24 h-MB patterns. Time spent in night sleep, inactivity (proxy for SB), light PA, moderate PA (MPA), and vigorous PA (VPA) per day were calculated using the R-package GGIR 2.0. Using latent profile analyses (n = 442) we identified 24 h-MB profiles, which were given animal names to convey key characteristics. Latent transition analyses were used to describe the profile membership transition from ages 5.5 to 8 years. Associations with sex and ethnicity were examined.

RESULTS

We identified four profiles, "Rabbits" (very high-MPA/VPA, low-inactivity and average-night-sleep), "Chimpanzees" (high-MPA, low-inactivity and average-night-sleep), "Pandas" (low-PA, high-inactivity and high-night-sleep) and "Owls" (low-PA, high-inactivity and low-night-sleep), among children at both time points. At ages 5.5 and 8 years, the majority of children were classified into profiles of "Chimpanzees" (51 and 39%, respectively) and "Pandas" (24 and 37%). Half of the sample (49%), particularly "Rabbits", remained in the same profile at ages 5.5 and 8 years: among children who changed profile the predominant transitions occurred from "Chimpanzees" (27%) and "Owls" (56%) profiles to "Pandas". Sex, but not ethnicity, was associated with profile membership: compared to girls, boys were more likely to be in the "Rabbits" profile (adjusted OR [95% CI]: 3.6 [1.4, 9.7] and 4.5 [1.8, 10.9] at ages 5.5 and 8 years, respectively) and less likely to be in the "Pandas" profile (0.5 [0.3, 0.9] and 0.4 [0.2, 0.6]) at both ages.

CONCLUSIONS

With increasing age about half the children stayed in the same of four 24 h-MB profiles, while the predominant transition for the remaining children was towards lower PA, higher inactivity and longer sleep duration. These findings can aid development and implementation of public health strategies to promote better health.

STUDY REGISTRATION

This study was registered on 4th August 2010 and is available online at ClinicalTrials.gov: NCT01174875 .

Can remotely supervised exercise positively affect self-reported depressive symptoms and physical activity levels during social distancing?

The main objective of this cross-sectional study was to compare the self-reported depressive symptoms and physical activity (PA) levels among participants who performed self- nonexercising (NE), guided exercise (SGE), remotely supervised exercise (RSE), and face-to-face supervised exercise (FFE) during social distancing. Three hundred and forty-four individuals (≥18 years and 67% women) answered a self-reported online survey that included questions related to the physical exercise practice (e.g., supervised and remote) during social distancing and questions about perceptions of depressive symptoms (Montgomery-Åsberg Depression Rating Scale-Self Rated [MADRS-S] scores) and metabolic equivalent task minutes per week (METs min•wk^-1) of moderate- and vigorous-intensity PA, and total PA scores (International Physical Activity Questionnaire-Short Form) before and during social distancing. The RSE group (n=45) showed higher METs of vigorous-intensity PA than the SGE (n=146) and NE (n=109) groups. The RSE and FFE (n=44) groups showed higher METs of the total PA scores than the SGE and NE groups. The NE group showed higher MADRS-S scores than the other groups. Lower MADRS-S scores depend on the exercise practice and higher METs of vigorous-intensity PA depend on the supervised exercise practice. Thus, telehealth interventions can be implemented during the pandemic to enhance vigorous PA.

Associations between previous sport and exercise experience and physical literacy elements among physically inactive Danes

Background

Physical inactivity is recognized as a leading global public health threat. Physical Literacy, a concept describing an individual’s prerequisites to participate in and adhere to physical activities, has been suggested to be a key concept in understanding physical activity in various populations. The aim of this study was to describe the prerequisites for physical activity among inactive adults in terms of their physical literacy and previous experience with sport and exercise and how these are interrelated.

Methods

Sample: 1033 physical inactive Danes. Measures: BREQ-3, ESES, the Levels of knowledge questionnaire and the physical self-confidence scale.

Results

Inactive Danish adult’s physical literacy scores are generally low compared to samples in other studies. Inactive adults with no or little previous experience with sport and exercise had lower levels of competences, self-efficacy and autonomous motivation for exercise and sport than the inactive with more experience. Previous sport and exercise experience was positively associated to the physical and affective domain of PL.

Conclusion

Previous experience with sport and exercise is very important to consider when developing sport and exercise activities for currently inactive adults as individuals with low previous experience have lower competences and autonomous motivation and therefore need lower challenges and other important attention to the motivational climate in order to ensure that the activities are motivating enough to secure continued engagement.

"I am going out!" - lifestyle sports and physical activity in adolescents

Background

Lifestyle sport activities (e.g. parkour or skateboarding) are considered attractive and beneficial for a long-term commitment to physical activity (PA) and might be a great opportunity for adolescents who do not feel comfortable in an organized or competitive atmosphere. The purpose of the study was to assess whether participation in lifestyle activities is associated with moderate-to-vigorous physical activity (MVPA), out-of-school vigorous physical activity (VPA), and sedentary behaviour in adolescents aged 10–15 years, with major demographic variables (sex, age, socioeconomic status) being taken into account.

Methods

Data from a research project linked to the Health Behaviour in School-aged Children (HBSC) survey collected in 2017 in the Czech Republic was used. The sample consisted of 679 participants (303 of them girls) and was selected by quota sampling. Chi-square tests were used to assess differences in involvement in lifestyle activities according to sex, grade, and socioeconomic status. Ordinal and linear regression models were used to analyse the associations of participation in lifestyle activities and selected energy balance-related behaviours.

Results

Participation in lifestyle sport activities was significantly associated with a higher level of physical activity (MVPA and out-of-school VPA) after adjustment for sociodemographic factors, as was participation in organized sport. No significant associations were shown for sedentary behaviour.

Conclusions

Adolescents participating in lifestyle sport activities report being more physically active and, in case of doing multiple such activities concurrently, also spending less time sitting than their peers not involved in lifestyle sport activities. As such, lifestyle sport activities seem to represent a feasible way of increasing overall PA level in adolescent population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11066-3.

Negative impact of disuse and unloading on tendon enthesis structure and function

Exposure to chronic skeletal muscle disuse and unloading that astronauts experience results in muscle deconditioning and bone remodeling. Tendons involved in the transmission of force from muscles to skeleton are also affected. Understanding the changes that occur in muscle, tendon, and bone is an essential step toward limiting or preventing the deleterious effects of chronic reduction in mechanical load. Numerous reviews have reported the effects of this reduction on both muscle and bone, and to a lesser extent on the tendon. However, none focused on the tendon enthesis, the tendon-to-bone attachment site. While the enthesis structure appears to be determined by mechanical stress, little is known about enthesis plasticity. Our review first looks at the relationship between entheses and mechanical stress, exploring how tensile and compressive loads determine and influence enthesis structure and composition. The second part of this review addresses the deleterious effects of skeletal muscle disuse and unloading on enthesis structure, composition, and function. We discuss the possibility that spaceflight-induced enthesis remodeling could impact both the capacity of the enthesis to withstand compressive stress and its potential weakness. Finally, we point out how altered compressive strength at entheses could expose astronauts to the risk of developing enthesopathies.

Validity and reliability of the motivation for physical activity (RM4-FM) questionnaire

There is a lack of validated instruments measuring motivation for physical activity (RM4-FM) in the Finnish language. The study examined the translated RM4-FM instrument's psychometric properties in a sample of healthy, older Finnish adults. RM4-FM was translated and linguistically validated adhering to published guidelines. 65-75-year olds (n=102), completed the RM4-FM, the physical activity acceptance questionnaire (PAAQ) and sociodemographic characteristics questionnaires electronically. The RM4-FM was readministered one month after the initial assessment. RM4-FM translated well into Finnish. Motivation dimension scores were skewed towards high internal and low external motivation. A floor effect was confirmed in the external regulation dimension and a ceiling effect was confirmed in the identified regulation dimension. Confirmatory factor analysis indicated inadequacy of the four-dimension model. Separate assessment of each of the four motivation dimensions with Exploratory factor analysis showed unidimensionality for all dimensions. Exploratory factor analysis provided a best-fit model of three factors (influence of other people, intention of well-being and emotional aspect of motivation). Readministration of the instruments showed good test-retest reliability in all motivation dimensions. Female gender, higher education, and higher PAAQ score were associated with higher internal motivation and lower external motivation scores. The Finnish version of the RM4-FM instrument provides valid and reliable scores in assessing motivation for physical activity in healthy, older Finnish adults. The score distributions suggested shortages in the scale when evaluating internal motivation. The three-factor model of the RM4-FM provided more favorable structural validity compared to the original version.

Effects of two months of bed rest and antioxidant supplementation on attentional processing

Physical inactivity across the lifespan is a growing public health concern affecting the cardiovascular, musculoskeletal, and central nervous system. Data on the effects of dietary antioxidants as neuroprotective treatments when physical activity levels are impaired are lacking. In this randomized controlled study, twenty young healthy men underwent 60 days of bed rest. Participants were randomly assigned to a treatment group (n = 10) receiving a daily antioxidant supplement comprising polyphenols, omega-3 fatty acids, vitamin E, and selenium or a control group (n = 10). Event-related potentials (ERPs) and behavioral data from a three-stimulus oddball paradigm were collected eight days before bed rest, after 60 days of immobilization, and after eight days of recovery. After two months of bed rest, we found a significant decrease in task efficiency irrespective of the treatment that was corroborated by lower ERPs in fronto-central and parietal brain regions. Neither behavioral nor electrocortical data returned to baseline values after eight days of recovery. Our results provide support for the adverse and persistent neurobehavioral effects of prolonged bed rest, which could not be mitigated by antioxidant supplementation. These findings raise important implications for situations in which physical activity levels become severely restricted such as medical conditions or sedentary lifestyles.

COVID-19 nationwide lockdown and physical activity profiles among North-western Italian population using the International Physical Activity Questionnaire (IPAQ)

Background

The role of physical activity in enhancing health is well recognized. However, in the more industrialized countries, physical activity rates are declining, and the emerging COVID-19 pandemic may amplify this scenario. Thus, this study aimed to report the Italian population’s physical activity profile living in the North-western regions during the national lockdown.

Methods

Physical activity was assessed using the official Italian short form of IPAQ, intended for Social Networking Services (SNS). Participation was voluntary, and people could fill the questionnaire simply by clicking on a specific link.

Results

The final sample size was 612 Italians, male and female, equally distributed (49.1% male and 50.9% female). Data showed a percentage of 15.4% of inactive subjects (MET < 700), 61.8% of moderate-active (MET 700–2500), and 22.9% of active people (MET > 2500). Women were more inactive than men (p < 0.01; 57.4% vs 42.6%). Furthermore, participants were classified into four classes of age: 18–29; 30–44; 45–59; and 60–79. Class 18–29 was prevalent (p < 0.01, 68.3%) and showed higher levels of physical activity (p < 0.05).

Conclusions

Italians living in North-western regions maintained a moderate amount of physical activity during the quarantine. This behavior should be encouraged, particularly among women that usually appear to be less active than men.

Ceramide Biomarkers Predictive of Cardiovascular Disease Risk Increase in Healthy Older Adults After Bed Rest

Acute bed rest places older adults at risk for health complications by disrupting homeostasis in many organ systems, including the cardiovascular system. Circulating ceramides are emerging biomarkers predictive of cardiovascular and metabolic health and have recently been shown to be sensitive indices of cardiovascular (CV) risk. Therefore, the purpose of this study was to characterize the time course of changes in circulating ceramides in healthy younger and older adults after 5 days of bed rest and to determine whether short-term bed rest alters CV-related circulating ceramides. We hypothesized that circulating ceramides predictive of poor cardiometabolic outcomes would increase following 5 days of bed rest. Thirty-five healthy younger and older men and women (young: n = 13, old: n = 22) underwent 5 days of controlled bed rest. Fasting blood samples collected daily during the course of bed rest were used to measure circulating ceramides, lipoproteins, adiponectin, and fibroblast growth factor 21 (FGF21) levels. The primary findings were that circulating ceramides decreased while ceramide ratios and the cardiac event risk test 1 score were increased primarily in older adults, and these findings were independent of changes in circulating lipoprotein levels. Additionally, we found that changes in circulating adiponectin, FGF21 and the 6-minute walk test (6MW) inversely correlated with CV-related circulating ceramides after bed rest. The results of this study highlight the sensitivity of circulating ceramides to detect potential CV dysfunction that may occur with acute physical disuse in aging.

Teleprehabilitation during COVID-19 pandemic: the essentials of "what" and "how"

In view of the COVID-19 pandemic and recent global events, the healthcare system and its services have been negatively affected, contributing towards extensive surgical backlogs. Oncological surgical candidates have been the most impacted by these changes and recommended self-isolation practices, which could result in emotional distress, sedentary behavior, and poor lifestyle habits. Preoperative supportive intervention, prehabilitation, has been proven to improve patients' functional status and clinical trajectories. Presently, there is a critical need for prehabilitation to optimize patient health, as they experience extended wait times. However, in-hospital delivery may not be an ideal approach due to public health and safety measures. Telehealth is a field of research and practice, which has grown and evolved significantly in the last two decades, allowing for the remote delivery of health services. Therefore, the current commentary addresses the different modalities of telehealth delivery in perspective of their known feasibility and potential application in prehabilitation.

The physiological benefits of sitting less and moving more: Opportunities for future research

Sedentary behavior (SB) and physical activity (PA) are important risk factors of cardiovascular disease morbidity and mortality. In addition to increasing the amount of moderate-to-vigorous PA (MVPA), the current PA guidelines recommend that adults should reduce SB, or any waking activity performed while sitting, reclining, or lying, with low energy expenditure. While mounting evidence has emphasized the benefits of increasing MVPA, little has focused on the effect of SB on health. Therefore, this review discusses the pathophysiological effects of SB and the potential physiological benefits of reducing/breaking up SB at the levels below the current guidelines for PA. Such knowledge is important, given that the majority of the United States population performs insufficient or no MVPA and is at high risk of being negatively impacted by SB. Interventions targeting sedentary time, such as breaking up SB by standing and moving, may be safe, feasible, and applicable to execute daily for a wide range of the population. This review also discusses the importance of monitoring SB in the era of the coronavirus disease 2019 (COVID-19) pandemic and the clinical implications of sitting less and moving more.

Inequality in physical activity, global trends by income inequality and gender in adults

Background

Physical inactivity is a global pandemic associated with a high burden of disease and premature mortality. There is also a trend in growing economic inequalities which impacts population health. There is no global analysis of the relationship between income inequality and population levels of physical inactivity.

Methods

Two thousand sixteen World Health Organisation’s country level data about compliance with the 2010 global physical activity guidelines were analysed against country level income interquantile ratio data obtained from the World Bank, OECD and World Income Inequality Database. The analysis was stratified by country income (Low, Middle and High) according to the World Bank classification and gender. Multiple regression was used to quantify the association between physical activity and income inequality. Models were adjusted for GDP and percentage of GDP spent on health care for each country and out of pocket health care spent.

Results

Significantly higher levels of inactivity and a wider gap between the percentage of women and men meeting global physical activity guidelines were found in countries with higher income inequality in high and middle income countries irrespective of a country wealth and spend on health care. For example, in higher income countries, for each point increase in the interquantile ratio data, levels of inactivity in women were 3.73% (CI 0.89 6.57) higher, levels of inactivity in men were 2.04% (CI 0.08 4.15) higher and the gap in inactivity levels between women and men was 1.50% larger (CI 0.16 2.83). Similar relationships were found in middle income countries with lower effect sizes. These relationships were, however, not demonstrated in the low-income countries.

Conclusions

Economic inequalities, particularly in high- and middle- income countries might contribute to physical inactivity and might be an important factor to consider and address in order to combat the global inactivity pandemic and to achieve the World Health Organisation target for inactivity reduction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-020-01039-x.

The current global state of movement and physical activity - the health and economic costs of the inactive phenotype

Physical inactivity is one of the major contributing factors to the global pandemic of non-communicable diseases. Unfortunately, low levels of habitual movement and physical activity (PA) are seen in an increasing proportion of populations across low- and middle-income countries and high-income countries alike. This new normal - the inactive phenotype - is a significant contributor to multiple health and economic costs. Here we provide a brief historical overview of societal declines in PA, roughly consistent with major transitions in PA and nutrition in recent decades. This is followed by a synthesis of research evidence linking inactivity with poor health outcomes and prevention approaches needed to impact a perpetuation of poor lifestyle behaviors. A major focus of the paper is on the economic/health costs and the reduction of the inactive phenotype. In summary, we demonstrate that the consequences of insufficient PA are manifold, and if sustained, impact short and long-term health and quality of life, along with substantial economic costs.

Egocentric social network correlates of physical activity

BACKGROUND

The social environment might play an important role in explaining people's physical activity (PA) behavior. However, little is known regarding whether personal networks differ between physically active and physically inactive people. This study aimed to examine the relationship between personal network characteristics and adults' physical (in)activity.

METHODS

An egocentric social network study was conducted in a random sample in Switzerland (n = 529, mean age of 53 years, 54% females). Individual and personal network measures were compared between regular exercisers and non-exercisers. The extent of these factors' association with PA levels was also examined.

RESULTS

Non-exercisers (n = 183) had 70% non-exercising individuals in their personal networks, indicating homogeneity, whereas regular exercisers (n = 346) had 57% regularly exercising individuals in their networks, meaning more heterogeneous personal networks. Additionally, having more regular exercisers in personal networks was associated with higher PA levels, over and above individual factors. Respondents with an entirely active personal network reported, on average, 1 day of PA more per week than respondents who had a completely inactive personal network. Other personal network characteristics, such as network size or gender composition, were not associated with PA.

CONCLUSION

Non-exercisers seem to be clustered in inactive networks that provide fewer opportunities and resources, as well as less social support, for PA. To effectively promote PA, both individuals and personal networks need to be addressed, particularly the networks of inactive people (e.g., by promoting group activities).

Laryngeal suspension, combined with rehabilitation and nutritional support, improved the clinical course of a patient with sarcopenic dysphasia

•

Sarcopenic dysphasia results from a generalized loss of skeletal muscle mass.

•

We used laryngeal suspension to compensate for a decrease in swallowing function.

•

Laryngeal suspension supported an earlier recovery to eating normal meals.

•

Laryngeal suspension could improve outcomes of sarcopenic dysphagia.

Introduction

Sarcopenic dysphasia is a relatively new disease concept describing impairments in swallowing resulting from a generalized loss of skeletal muscle mass.

Presentation of case

In this case report, we describe the clinical history and presentation of a 76-year-old man who developed mild sarcopenic dysphasia following a period of physical inactivity after spinal stenosis surgery, which resulted in a loss of 10 kg of body weight in the 10-month period after surgery. The patient’s dysphasia was managed with laryngeal suspension, performed via a minimally invasive thyromandibulopexy, in combination with rehabilitation and nutritional support. After a brief period of postoperative rehabilitation, the patient was able to eat soft meals on postoperative day 14, and a regular meal on postoperative day 18, without aspiration. We include a brief description of our surgical technique in the case report.

Discussion

Laryngeal suspension compensated for a decreased functional capacity of the swallowing muscles, with postoperative rehabilitation improving the strength of the swallowing muscles. Fixation of the thyroid cartilage to the mandible compensated for insufficient opening of the esophageal orifice, decreasing the pyriform sinus residue. Drawing of the thyroid cartilage in an anterosuperior position improved the anterosuperior position of the epiglottis, shortening the distance between the epiglottis and the base of the tongue, which narrowed the vallecula space and decreased vallecular residue.

Conclusion

Based on our experience, laryngeal suspension, via minimally invasive thyromandibulopexy, could be considered to improve the outcomes of sarcopenic dysphagia, with an earlier return to eating normal meals.

The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables

Background

To elucidate the populations and conditions where screen-based sedentary behaviors (SB) and internalizing symptoms are coupled, this review synthesized the evidence for factors that may moderate the associations between screen-based SB, depressive symptoms, and anxiety symptoms among youth.

Methods

Two independent researchers conducted a systematic literature search of the Medline, psycINFO, and Scopus electronic databases in late 2018 for observational studies assessing moderators of the association between screen-based SB and depressive and anxiety symptoms. Studies among children and adolescents were eligible if moderation was assessed by statistical test (interaction) or stratification; and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines.

Results

Seventy empirical studies (46 cross-sectional, 19 longitudinal, and 5 both) of 13 different moderating variables of screen-based SB-internalizing symptom associations met the eligibility criteria. Of these, 40 studies were of depressive symptoms, 2 were of anxiety symptoms, and 28 studies assessed symptoms of both. The most consistent evidence of moderation was for screen-type, such that TV viewing was not as strongly associated with internalizing symptoms compared to other forms of screen-based SB. There was also inconsistent evidence for physical activity buffering screen-based SB-internalizing symptom associations and for female sex amplifying screen-based SB-internalizing symptom associations. In general, the body of evidence for anxiety symptoms was more limited than that for depressive symptoms, and were therefore more inconsistent.

Conclusions

Screen-type, physical activity, and sex may influence the magnitude of screen-based SB-internalizing symptom coupling; highlighting potential sources of heterogeneity of screen-based SB-internalizing symptom associations. Additional studies aimed at understanding potential mechanistic explanations for the above moderators are needed prior to the development of tailored intervention strategies designed to decouple screen-based SB and internalizing symptoms among youth.

Use of actigraphy to characterize inactivity and activity in patients in a medical ICU

BACKGROUND

In the intensive care unit (ICU), inactivity is common, contributing to ICU-acquired weakness and poor outcomes. Actigraphy may be useful for measuring activity in the ICU.

OBJECTIVES

To use actigraphy to characterize inactivity and activity in critically ill patients.

METHODS

This prospective observational study involved 48-h wrist actigraphy in medical ICU (MICU) patients, with activity data captured across 30-s epochs. Inactivity (zero-activity epochs) and activity (levels of non-zero activity) were summarized across key patient (e.g., age) and clinical (e.g., mechanical ventilation status) variables, and compared using multivariable regression.

RESULTS

Overall, 189,595 30-s epochs were collected in 34 MICU patients. Zero-activity (inactivity) comprised 122,865 (65%) of epochs; these epochs were 24% and 13% more prevalent, respectively, in patients receiving mechanical ventilation (versus none, p < 0.001) and in the highest (versus lowest) organ failure score tertile (p = 0.03). Ambulatory (versus non-ambulatory) patients exhibited more non-zero activity (35 more movements per epoch, p < 0.001), while those in the highest (versus lowest) organ failure score tertile exhibited less activity (22 fewer movements per epoch, p = 0.03). Significant inactivity/activity differences were not observed when evaluated based on age, sedation, or restraint status.

CONCLUSIONS

Actigraphy demonstrated that MICU patients are profoundly inactive, including those who are young, non-sedated and non-restrained. Hence, ICU-specific, non-patient-related factors may contribute to inactivity, an issue requiring further investigation.

RNA-seq data of soleus muscle tissue after spinal cord injury under conditions of inactivity and applied exercise

Reduced muscle mass and increased fatiguability are major complications after spinal cord injury (SCI), and often hinder the rehabilitation efforts of patients. Such detriments to the musculoskeletal system, and the concomitant reduction in level of activity, contribute to secondary complications such as cardiovascular disease, diabetes, bladder dysfunction and liver damage. As a result of decreased weight-bearing capacity after SCI, muscles undergo morphological, metabolic, and contractile changes. Recent studies have shown that exercise after SCI decreases muscle wasting and reduces the burden of secondary complications. Here, we describe RNA sequencing data for detecting chronic transcriptomic changes in the rat soleus after SCI at two levels of injury severity, under conditions of restricted in-cage activity and two methods of applied exercise, swimming or shallow water walking. We demonstrate that the sequenced data are of good quality and show a high alignment rate to the Rattus norvegicus reference assembly (Rn6). The raw data, along with UCSC Genome Browser tracks created to facilitate exploration of gene expression, are available in the NCBI Gene Expression Omnibus (GEO; GSE129694).

Immediate post-breakfast physical activity improves interstitial postprandial glycemia: a comparison of different activity-meal timings

The optimal timing between meal ingestion and simple physical activity for improving blood glucose control is unknown. This study compared the effects of physical activity on postprandial interstitial glucose responses when the activity was conducted either immediately before, immediately after, or 30 min after breakfast. Forty-eight adults were randomized to three separate physical activity interventions: standing still (for 30 min), walking (for 30 min), and bodyweight exercises (3 sets of 10 squats, 10 push-ups, 10 lunges, 10 sit-ups). In each intervention, 16 participants completed four trials (A to D) during which a 500 kcal mixed nutrient liquid breakfast meal was consumed. Interstitial glucose responses were recorded using continuous glucose monitoring for 2 h after the meal. The activity was completed either after the glucose monitoring period (trial A; control) or immediately before (trial B), immediately after (trial C), or 30 min after (trial D) the breakfast. Mean, coefficient of variance (CV), and area under the curve (AUC) for glucose were calculated and compared between the four trials. Walking and bodyweight exercises immediately after the meal improved mean, CV, and AUC glucose (P ≤ 0.05 vs. control), while standing immediately after the meal only improved AUC glucose (P ≤ 0.05 vs. control) and nearly improved mean glucose (P = 0.06). Mean, CV, and AUC glucose were not affected by standing, walking, or bodyweight exercise conducted immediately before, or 30 min after the meal (all P > 0.05 vs. control). Energy intake (diet records) and energy expenditure (Actigraph) were consistent throughout the studies and did not influence the findings. Low- to moderate-intensity activity should be implemented soon after eating to improve glucose control following breakfast. The type of activity appears less important than the timing. These findings will help optimize exercise-meal timing in general health guidelines. ClinicalTrials.gov Identifier: NCT03730727

Physical Activity Attenuates Total and Cardiovascular Mortality Associated With Physical Disability: A National Cohort of Older Adults

Background

Regular physical activity (PA) has been shown to protect against disability onset but, once the disability is present, it is unclear if PA might attenuate its harmful health consequences. Thus, we examined if mortality risk associated with physical disability can be offset by PA among older adults.

Methods

We used data from a cohort of 3,752 individuals representative of the noninstitutionalized population aged 60 years and older in Spain. In 2000-2001, participants self-reported both PA levels (inactive, occasionally, monthly, weekly) and five physical disabilities (agility, mobility, global daily activities, instrumental activities of daily living, and self-care). Individuals were prospectively followed through 2014 to assess incident deaths.

Results

The mean follow-up was 10.8 years, with a total of 1,727 deaths, 638 of them due to cardiovascular disease (CVD). All disability types were associated with higher total and CVD mortality. Being physically active (ie, doing any PA) was associated with a statistically significant 26%-37% and 35%-50% lower risk of total and CVD death, respectively, across types of disability. As compared with those being physically active and without disability, those who were inactive and had a disability showed the highest mortality risk from total (hazard ratios from 1.52 to 1.90 across disabilities, all p < .05) and from CVD (hazard ratios from 1.99 to 2.24 across disabilities, all p < .05). Total and CVD mortality risk was similar in physically active participants with disabilities and in inactive individuals without disability.

Conclusions

In older adults, PA could attenuate the increased risk of mortality associated with physical disability.

Patterns and Correlates of Self-Reported Physical Activity in a Cohort of Racially Diverse Pregnant Adolescents

STUDY OBJECTIVE

Regular physical activity (PA) during pregnancy decreases the risk of gestational hypertension and preeclampsia. Currently, little is known about the PA of pregnant adolescents. Our intent was to characterize the PA behaviors of a group of racially diverse, low-income pregnant teens and to identify potential determinants of PA.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS

A cohort of 157 racially diverse pregnant adolescents (13-18 years of age) completed up to 3 previous day PA recalls as part of a larger prospective longitudinal study on determinants of maternal and fetal bone health. Subjects self-reported activities from 7 AM to 11:30 PM, choosing from a list of 37 activities including a category for "other." Subjects recorded activities in 30-minute intervals.

MAIN OUTCOME MEASURES

Estimated metabolic equivalent task (MET) values were assigned to each activity and summed for a measure of total daily PA in MET min/d. Determinants of PA were evaluated using a stepwise linear mixed effect model.

RESULTS

The average calculated MET min/d was 1478 ± 130. Significant determinants of MET min/d included race (P = .007), maternal age at conception (P = .042), gestational age (P = .002), and attending school (P < .001). Black teens were less physically active than white teens, and older teens were more active than younger teens; activity decreased throughout gestation, and teens currently attending school were more active.

CONCLUSION

PA is low across gestation and pregnant teens spent more than half of their monitored time in sedentary activities. Targeted interventions are needed to achieve current PA goals in this pediatric obstetric population.

Predictors of and barriers to adherence in a 16-week randomised controlled trial of Bikram yoga in stressed and sedentary adults

BACKGROUND

Bikram yoga may enhance health outcomes in healthy adults and those at risk for chronic disease, however, challenges remain in achieving optimal adherence to this practice. This study investigated factors influencing adherence to a 16-week Bikram yoga intervention in stressed and sedentary adults.

METHODS

Experimental group participants (n = 29) were instructed to attend 3-5 Bikram yoga classes weekly for 16 weeks. Baseline demographics, behaviours and health measures were investigated as predictors of adherence. Barriers were assessed via documentation of adverse events, and exit survey responses.

RESULTS

Participants (38.2 ± 10.1 years) were predominantly overweight-obese (83%), female (79%), and attended 27 ± 18 classes. Higher adherence was associated with older age (p = 0.094), less pain (p = 0.011), fewer physical limitations (p = 0.011), poorer blood lipid profile, and higher heart rate variability (HRV; total power, (p = 0.097)). In multi-variable analysis, three variables: age (β = 0.492, p = 0.006), HRV (β = 0.413, p = 0.021) and pain (β = 0.329, p = 0.048) remained predictors of adherence. Difficulty committing to the trial, lack of enjoyment and adverse events were barriers to adherence.

CONCLUSIONS

These findings should be considered in the development of future Bikram yoga trials to facilitate higher levels of adherence, which may enhance health outcomes and inform community practice. Future trials should investigate and address additional barriers and facilitators of Bikram yoga practice.

Three-Year Hospitalization and Mortality in Elderly Smokers with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure

BACKGROUND

In elderly smokers, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) usually present with dyspnoea. COPD and CHF are associated -almost invariably with concomitant chronic diseases, which contribute to severity and prognosis.

OBJECTIVES

We investigated similarities and differences in the clinical presentation, concomitant chronic diseases and risk factors for -mortality and hospitalization at 3-year follow-up in elderly smokers/ex-smokers with a primary diagnosis of COPD or CHF recruited and followed in specialized centers.

METHODS

We examined 144 patients with COPD and 96 with CHF, ≥65 years, ≥20 pack/years, and measured COPD Assessment Test (CAT) score, modified Medical Research Council, NYHA, and Charlson Index, routine blood test, estimated glomerular filtration rate, HRCT scan, 6-min walk test. In addition, in each patient we actively searched for CHF, COPD, peripheral vascular disease, and metabolic syndrome.

RESULTS

COPD and CHF patients had mild to moderate disease, but the majority was symptomatic. Comorbidities were highly prevalent and often unrecognized in both groups. COPD and CHF patients had a similar risk of hospitalization and death at 3 years. Lower glomerular filtration rate, shorter 6MWT, and ascending aorta calcification score ≥2 were independent predictors of mortality in COPD, whereas previous 12 months hospitalizations, renal disease, and heart diameter were in CHF patients. Lower glomerular filtration rate value, higher CAT score, and lower FEV1/FVC ratio were associated with hospitalization in COPD, while age, lower FEV1% predicted, and peripheral vascular disease were in CHF.

CONCLUSIONS

There are relevant similarities and differences between patients with COPD and CHF even when admitted to specialized outpatient centers, suggesting that these patients should be manage in multidisciplinary units.