Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review

'Excellent for mind,body and spirit': Participant, facilitator, and community stakeholder experiences of Music and Movement for Health

BACKGROUND AND PURPOSE

Arts-based interventions are an emerging area of interest in health research for older adults. Music and Movement for Health (MMH) is one such systematically developed interdisciplinary arts-based intervention designed to enhance health and wellbeing of older adults. The objective of this qualitative study was to explore the opinions and experiences of participants, facilitators, and community stakeholders of the MMH intervention.

MATERIALS AND METHODS

This embedded qualitative study was completed as part of a wider evaluation of the MMH intervention. A purposive sample of older adults who had completed MMH (n = 71), facilitators (n = 8) and community stakeholders (n = 4) participated in this study. Data were collected through a combination of focus groups and telephone/virtual interviews. Data were analysed using inductive thematic analysis.

RESULTS

Data analysis led to the generation of the overarching theme 'Positive ageing in place', which encompassed two themes: (1) 'Intersection of exercise and arts' and (2) 'Fostering a sense of belonging', and five subthemes. MMH was viewed as a unique arts-based intervention that combined participants' interest in music and dance and had many perceived physical and psychological benefits. Additionally, MMH provided routine and social opportunities to older adults, which were particularly valued in the aftermath of the COVID-19 pandemic.

CONCLUSION

The provision of exercise through the arts was enjoyable and, resultantly, desirable to many older adults, with perceived positive physical and psychosocial outcomes. Consequently, the use of arts-based interventions for health promotion and social opportunities among older adults warrants further investigation.

TRIAL REGISTRATION

ISRCTN35313497.

Adherence and Retention Rates to Home-Based Video Exercise Programs in Older Adults-Systematic Review and Meta-Analysis

Introduction: This systematic review and meta-analysis aimed to investigate adherence and retention rates to home-based video exercise programs and identify key factors associated with these rates in older adults to understand the effectiveness of home-based video exercise interventions. Methods: We searched PubMed, Web of Science, and Scopus for articles addressing adherence to and retention of home-based video exercise programs. The study was conducted following PRISMA recommendations. Results: A total of 26 articles, including 1,292 participants older than 65, were included in the final qualitative and quantitative syntheses. The weighted mean of the retention rate was 91.1, and of the attendance rate was 85.0, with low I2 = 3.5, not significant p = 0.409 heterogeneity. The generalized regression models showed a positive effect of session duration on the attendance rate (%), where the possible change from <20 min to >60 min duration could decrease the attendance rate (%) B = -24.390 (p <0.001). The delivery method had a significant effect, where the absence of live contact with the coach in web-based or DVD-delivered interventions could decrease the attendance rate (%) compared to the online sessions B = -11.482 (p = 0.010). The lockdown during the COVID-19 pandemic had a positive effect on both the attendance rate (%) B = 10.321 (p = 0.019) and retention rate (%) B = 9.577 (p = 0.032). Conclusions: This systematic review and meta-analysis indicate that supervised home-based video exercise programs lasting less than 60 min might be a suitable and sustainable exercise mode to keep older adults active, especially in times resembling feelings of confinement.

'I'm a failure again, I can't do it': Attitudes towards, and experiences of, exercise participation in adults with class III obesity

OBJECTIVES

Living within a larger body brings unique challenges to exercise participation, which are poorly understood. This qualitative study explored the attitudes towards, and experiences of, exercise participation in adults with class III obesity.

DESIGN

Individual semi-structured qualitative interviews.

METHODS

We recruited 30 adults with class III obesity (body mass index: 45.8 ± 8.6 kg/m2) from a specialist multidisciplinary weight management service. Participants took part in semi-structured interviews while participating in a 6-month home-based aerobic and resistance exercise intervention. Open-ended questions were used flexibly to explore their views and experiences of exercise, encompassing barriers, motives and perceived benefits. Transcripts were analysed using reflexive thematic analysis.

RESULTS

Three themes were developed: (1) a web of barriers; (2) tailored exercise facilitates positive experiences; and (3) a desire to live a normal life. People with class III obesity perceived that they were unable to do exercise; a view that was attributed to perceived judgement, low physical function, pain during everyday activities and failed weight loss attempts. These complex physical and psychosocial barriers to exercise were described as contributing to exercise avoidance. High value was placed on tailored exercise that accommodates the unique needs of moving in a larger body. A desire to carry out everyday tasks underpinned motivations for exercise.

CONCLUSIONS

Our findings suggest that multi-component obesity interventions should move away from generic exercise prescriptions designed to maximize energy expenditure, and instead move towards addressing the unique physical and psychosocial needs of people who have class III obesity with tailored person-centred and weight-neutral exercise prescriptions.

The impact of exercise interventions on sleep in adult populations with depression, anxiety, or posttraumatic stress: review of the current evidence and future directions

Consistent evidence suggests that exercise leads to improvements in subjective sleep quality and also objective sleep metrics in non-psychiatric adult populations. However, the degree to which exercise provides sleep benefits for adults with psychiatric disorders is less known, despite the potential benefits given that sleep disturbance is prevalent in these populations. In this narrative review, we synthesize results of randomized controlled trials examining the influence of aerobic and/or resistance exercise interventions on sleep outcomes in adult psychiatric populations. We specifically focus on populations with elevated symptoms or diagnoses of depression, anxiety, or posttraumatic stress disorder. A systematic search through June 2024 yielded 26 relevant trials. Overall, most trials reported improvement of subjective sleep quality after aerobic and/or resistance exercise programs in samples with depression. Similar effects were observed for posttraumatic stress; however, larger trials are needed. Further research is needed to examine the impact of exercise on sleep in anxiety populations as only one trial with mixed results was identified. Results were more equivocal for the subpopulation of adult women with perinatal or postpartum depression, demonstrating the importance of understanding exercise effects on sleep in specific subpopulations. Few studies examined objective sleep outcomes, impact of acute exercise on next day sleep, or the interplay between exercise, sleep, and psychiatric symptom changes, all important areas of future research. Other implications and future directions are discussed, including potential moderators and mechanisms of action that warrant further study to better understand how exercise interventions may optimally target sleep in psychiatric populations.

The Level and Limitations of Physical Activity in Elderly Patients with Diabetes

Background/Objectives: Old age and illnesses can limit physical activity (PA). We have assessed the level of PA and its limitations in older people with diabetes (DM). Methods: Cross-sectional study, period: January and June 2024, place: Diabetes Center, subjects: patients (N = 207) > 64 years with DM), Surveying using: IPAQ, Accompanying Survey (AS). The significance was assessed by: Student's t-test, Mann-Whitney U test, Pearson's test. The relationships between the IPAQ and the AS results were analyzed based on a meta-analysis model for variable effects, OR with a 95% CI. ROC curve was used to determine the threshold values for age, BMI. Correlations between selected key variables were evaluated using the PCA. Results: The median age: 72 years (65-87), BMI: 28.70 (18.61-49.69). The median PA level: 1837 MET-min/week (0-9.891). The individuals who obtained insufficient (n = 28), sufficient (n = 75), and high levels of PA (n = 53) were 17.95%, 48.08%, and 33.97%, respectively. Diseases were the main factor limiting PA (53.54%) in patient's opinion, followed by the lack of a companion or motivation. The meta-analysis found no diseases linked to insufficient PA, but those with BMI > 33.3 and over 75 years old more often had insufficient PA. PCA revealed several characteristics that predispose individuals to insufficient PA. Conclusions: People over 75 years of age tend to avoid PA more than younger seniors, leading to its insufficient level, similarly like higher BMI. The individual with DM who has an insufficient level of PA is typically a single, woman, over 75, BMI > 33.

Relationship between big five personality and health literacy in elderly patients with chronic diseases: the mediating roles of family communication and self-efficacy

The significance of health literacy for elderly individuals with chronic illnesses lies in managing and delaying disease development, which is affected by personal and environmental factors. Family communication can provide an emotional support environment; self-efficacy is an important factor of subjective initiative and personality. A relatively persistent thinking and behavior pattern can affect the environment, subjective initiative, and individual health outcomes. This study aims to explore the effects of the Big Five personality traits on the health literacy of elderly individuals with chronic illnesses and to hypothesize that family communication and self-efficacy mediate the Big Five personalities and health literacy. A cross-sectional study of 2251 elderly individuals with chronic diseases was conducted through nationwide random quota sampling. The structural equation model was used to explore the mediating role of family communication and self-efficacy between the Big Five personality and health literacy. Family communication played a simple mediating role in the influence of extraversion, agreeableness, conscientiousness, and neuroticism on health literacy. Self-efficacy played a simple mediating role in the influence of the Big Five personalities on health literacy. Self-efficacy and family communication played a chain mediating role between extraversion, agreeableness, conscientiousness, neuroticism, and health literacy. Nurses can enhance the health literacy of elderly individuals with chronic illnesses with extraversion, agreeableness, conscientiousness, and neuroticism through family communication and self-efficacy while promoting the health literacy of those with openness through self-efficacy.

The Influence of Mental Fatigue on Physical Performance and Its Relationship with Rating Perceived Effort and Enjoyment in Older Adults

The study investigated the influence of mental fatigue on older people's enjoyment during a series of physical exercises. Using a randomized cross-over design, participants (n = 35) completed a 6-minute walking test - 6MWT, a Timed Up and Go-TUG test and three sets of knee extension exercise (first set: KE1, second set: KE2, third set: KE3) under two experimental conditions (control or mental fatigue). The Nonparametric Analysis of Longitudinal Data in Factorial Experiments was used to compare the number of repetitions performed during three sets of resistance exercise between conditions. The same analysis method was applied to compare the perception of effort and enjoyment across five moments (Post-6MWT, Post-TUG, Post-KE1, Post-KE2, Post-KE3) and two conditions and the Visual Analogue Scales (VAS) across four moments (baseline, Pre-6MWT, Pre-TUG, Pre-KE) and two conditions. Mental fatigue did not affect the physical function, perception of effort and enjoyment of exercise in older people. Participants, however, reported higher enjoyment for walking and dynamic balance compared to strength exercise. Mental fatigue had no effect on the physical function, perception of effort and enjoyment of exercise of older people. Participants presented a higher enjoyment for walking and dynamic balance compared to strength exercise. Given the importance of resistance exercises for health, clinicians should prioritize resources to education programs emphasizing the benefits of resistance exercise in both short- and long-term health. Including social interaction opportunities in physical exercise programs and prescribing activities appropriate to participants' ability levels could enhance engagement and adherence.

Adherence to Exercise in People with Lung or Head and Neck Cancer: Self-Reported Symptoms and Motivation During Cancer Treatment Need to Be Considered

Objectives: Symptoms and motivation may impact adherence to home-based exercise training programs (HETP) during cancer treatment (CT) for lung or head and neck cancer. This study aimed to identify self-reported symptoms and their frequency, as well as motivation towards an HETP during CT for primary lung or head and neck cancer. Associations between symptoms and motivation with HETP adherence were also investigated. Methods: Participants underwent CT combined with an HETP that included aerobic (walk-based) and resistance training (Theraband®). Weekly assessment was conducted using a questionnaire developed by the researchers, evaluating the presence of symptoms. A scale (0 to 10) was used to assess motivation towards the HETP. Adherence was defined as the ratio between HETP sessions completed vs. the number prescribed. Symptom frequency was recorded as the number of weeks a symptom was experienced. Linear regression was used to explore associations. Results: Twenty-four participants were included (61 ± 7 yr; 21 males; head and neck cancer n = 18; median treatment duration: 9 [7 to 11] weeks). The most commonly reported symptoms were fatigue (33%), malaise (24%) and dysphagia (23%). Average score for motivation to exercise was 6.4 ± 2.0. Adherence to the HETP was 47%. Malaise was associated with reduced adherence to HETP (p = 0.002), explaining 35% of the variance. Motivation was associated with increased adherence (p = 0.008), explaining 28% of the variance. Conclusions: Fatigue, malaise and dysphagia were among the most frequently reported symptoms during treatment. Malaise and self-motivation to exercise can significantly influence adherence to HETPs. Symptom and motivational support might be necessary when implementing HETPs during CT.

Effect of a Physical Exercise Intervention on Physical Function Parameters and Blood Analytical Changes in Lung Cancer Survivors: A Feasibility Study

Background: Lung cancer carries a high burden of systemic symptoms, including in survivors, leading to a reduced quality of life (QoL). We assessed whether a 12-week multicomponent supervised exercise programme, including muscular strength and aerobic training, was beneficial in patients who had undergone surgery for early non-small cell lung cancer (NSCLC) in terms of physical performance, QoL, and metabolic and nutritional analytical parameters. Methods: Physical performance was measured by gait speed, handgrip strength, 30 s sit-to-stand (30s-STS) test repetitions, distance covered in the 6 min walk test (6MWT), and the Short Physical Performance Battery (SPPB) score. QoL was assessed with the EORTC-QLQ-C30 questionnaire. Blood glucose, cholesterol, triglycerides, total proteins, albumin, pre-albumin, creatinine, c-reactive protein, insulin-growth factor 1 (IGF-1), and the haemoglobin and hematocrit percentages were measured before and after the intervention in order to observe any beneficial effects related to metabolic markers. Results: After the intervention, the mean scores for the 6MWT (p < 0.001), STS (p < 0.001), 6MWT (p < 0.01), and SPPB (p < 0.01) had significantly improved. However, handgrip strength and nutritional analytical were unchanged. The EORTC-QLQ-C30 functions and symptoms significantly improved after the intervention (p < 0.05 and p < 0.01, respectively). A significant decrease in cholesterol, triglycerides, and IGF-1 and a significant increase in pre-albumin in blood was also observed post-intervention (p < 0.05). Conclusions: This supervised, community-based 12-week multicomponent was feasible (adherence rate 70.35%) and provided benefits not only to physical performance but also to the quality of life of patients with NSCLC.

Effects of the WHO analgesic ladder on pain severity, pain interference, and blood pressure control in hypertensive patients with chronic musculoskeletal pain: a cross-sectional study

AIM

This study aimed to investigate the effects of pain management according to the World Health Organization (WHO) analgesic ladder on pain severity, pain interference, and blood pressure (BP) in treated hypertensive patients with chronic musculoskeletal pain.

BACKGROUND

Pain management can affect BP control owing to the proposed mechanism by which persistent pain contributes to increased BP. However, there are inadequate studies investigating the benefit of pain management in controlling both pain and BP in hypertensive patients who have chronic pain.

METHODS

In this cross-sectional study, demographic data and pain characteristics (resting pain score on the numerical pain rating scale, pain severity, and pain interference subscale of the Brief Pain Inventory) were collected via face-to-face interviews. BP was measured thrice on the same day. Data on pain medications taken in the previous 1 month were retrieved from the medical records. Participants were categorized into three groups following pain management patterns according to the WHO analgesic ladder: no, partial, and complete treatment. Multivariate logistic regression analysis (MLRA) was used to analyse the association between the variables and uncontrolled BP.

FINDINGS

Among 210 participants, the mean (standard deviation) age was 68 (15.5) years, and 60.47% had uncontrolled BP. The resting pain score, pain severity, and pain interference subscale scores of the complete treatment group were significantly lower than that of the partial treatment group (P = 0.036, 0.026, and 0.044, respectively). The MLRA revealed that pain management patterns were associated with uncontrolled BP (adjusted odds ratio [AOR]: 6.75; 95% confidence interval [CI]: 2.71-16.78; P < 0.001) and resting pain scores (AOR: 1.17; 95% CI: 1.04-1.38; P = 0.048). Our findings suggest that pain management patterns adhering to the WHO analgesic ladder can reduce pain severity and pain interference and also control BP in hypertensive patients with chronic musculoskeletal pain.

Resistance physical exercise modulates metabolic adipokines, decreases body weight, and improves glomerular filtration in patients with chronic kidney disease in hemodialysis

Chronic kidney disease (CKD) is a condition characterized by abnormalities in kidney structure and function that persist for more than 3 months. It is estimated that more than 800 million people in the world have a diagnosis of CKD. To remove the harmful metabolic substances from the body, people with CKD need to perform hemodialysis. Due to their beneficial effects against a wide range of clinical conditions, physical exercise is considered a non-pharmacological therapy. This study aimed to evaluate the beneficial effects of resistance exercise during hemodialysis on metabolic adipokines, myokines, body weight, and glomerular filtration rate in patients living with CKD. Briefly, the blood samples were collected in two moments: immediately before the start of the resistance exercise protocol and 1 week after the end of the protocol. Resistance exercise protocol was performed thrice a week for 12 weeks and applied during hemodialysis sessions. Here, resistance exercise increases the circulating irisin (14.56%; p = 0.0112), handgrip strength (5.70%; p = 0.0036), glomerular filtration rate (25.9%; p = 0.022) and significantly decreases adiponectin (- 55.7%; p = 0.0044), body weight (- 3.7%; p = 0.0001), glucose (- 22%; p = 0.009), and albumin levels (- 9.55%; p = 0.0001). Conversely, leptin levels (- 10.9%; p = 0.38), iron (3.05%; p = 0.705), ferritin (3.24%; p = 0.880), hemoglobin (- 0.52%; p = 0.75), total cholesterol (7.9%; p = 0.19), LDL (- 9.99%; p = 0.15) and HDL (- 4.8%; p = 0.45), did not change after resistance exercise. Interestingly, 1,25 hydroxyvitamin D levels were significantly increased (14.5%; p = 0.01) following resistance exercise. Considering the effect of sex (males vs. females), we found that irisin levels increased in females but not in males after the resistance exercise protocol. Furthermore, handgrip strength and body weight were different, indicating that males had the highest strength and weight. We demonstrated that both males and females had lower albumin levels after the resistance exercise protocol. In conclusion, we suggest that resistance exercise has beneficial effects in the CKD population by modulating adipokines and metabolic myokines and therefore can be used as a non-pharmacological adjunctive therapy in CKD patients undergoing HD.

Considering the 24-Hour Activity Cycle in Older Adults

Older adults are often advised to engage in more moderate-to-vigorous physical activity (MVPA). Although MVPA offers significant health benefits, focusing solely on MVPA may be difficult for many in this population due to their typically higher levels of sedentary behavior (SB). Increasing light-intensity physical activity (LIPA) can offer similar health benefits and be a more achievable starting point for inactive older adults. The 24-hour activity cycle provides a conceptual model that can assist healthcare providers in promoting physical activity. This model emphasizes the interaction between four key behaviors (i.e., sleep, sedentary behavior, LIPA, and MVPA) and presents a holistic approach to optimizing the balance of these activity behaviors. This article outlines strategies to help older adults increase their physical activity and reduce sedentary time within the 24-hour activity cycle, promoting sustainable, long-term behavior change in this population.

Obesity and cardiovascular disease: an ESC clinical consensus statement

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence

ABSTRACT

Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.

An exploration of self-perceived competence in providing nutrition care among physiotherapists in Ireland: a cross-sectional study

BACKGROUND

Integrating nutrition care into physiotherapy can address modifiable risk factors contributing to chronic diseases, providing comprehensive and effective patient care, and supporting a wellness-oriented approach to healthcare.

OBJECTIVE

To investigate physiotherapists' self-perceived confidence in their competence in nutrition care in Ireland.

METHODS

Cross-sectional study using data from a validated online survey tool. Four constructs of competence in nutrition care were assessed: knowledge, skill, communication and counseling, and attitude. Open-ended responses were collected to gather opinions on nutrition knowledge requirements. Participants were chartered physiotherapists representing public and private workplaces across geographical settings in Ireland.

RESULTS

447 physiotherapists completed the survey. Most were female (n = 364, 81%), in private practice (n = 136, 31%), and located in a city (n = 215, 48%) with a mean 17 years post-qualification experience. Participants' self-perceived confidence in nutrition care competence was positive (mean score of 107.2/175). However, knowledge (mean score of 18.5/35) and skills (mean score of 27.2/55) related to nutrition care received lower ratings. Age and years of practice were positively associated with higher confidence in providing nutrition care. Most participants (n = 314, 71%) agreed that additional nutrition education is needed. Three overarching themes were identified regarding nutrition knowledge requirements: importance of providing nutrition advice, stated knowledge needs for nutrition education and training, and feasibility of nutrition care within physiotherapy practice.

CONCLUSIONS

Physiotherapists in Ireland have confidence in provision of nutrition care but rated their knowledge and skills in nutrition as relatively low. Nutrition knowledge and skill are essential for physiotherapist practice as they can significantly impact patients' outcomes.

The role of patient-related factors in the implementation of a multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): a qualitative process evaluation

BACKGROUND

Structured aftercare programs are implemented to facilitate the transition from rehabilitation centers to patients' home environments. Taking the program GeRas as an example, this paper aims to evaluate the influence of patient-related factors on the implementation of the geriatric aftercare program GeRas from patients' and providers' perspectives.

METHODS

To capture patients' and providers' perspectives, qualitative interviews were conducted using a semi-structured interview guide. The analysis was inductive-deductive and based on the thematic analysis by Braun and Clarke and guided by Domain IV of the CFIR.

RESULTS

16 participants (10 patients, 4 providers, 2 family members) were interviewed from May 2023 to November 2023. Patient-related factors were perceived as an important aspect during the implementation of the GeRas program. The results were allocated to the four Constructs of Domain IV of the CFIR (Motivation, Opportunity, Capability, Needs). Especially patients' intrinsic motivation, social environment, and physical capabilities seemed to be crucial for successful implementation. While extrinsic motivation can mitigate missing personal capabilities, it cannot replace the presence of intrinsic motivation and capabilities. The results showed that patient-related factors are interlinked.

DISCUSSION/CONCLUSION

The relevance of patient-related factors during the implementation of the GeRas program shows that such programs must consider these factors during intervention planning.

Home care program and exercise prescription for improving quality of life in geriatric population with knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

Knee Osteoarthritis (OA) is a degenerative bone disease commonly affecting the elderly. Exercise has emerged as a primary treatment strategy for individuals with knee OA. Various exercise regimes are now recognized as key approaches in managing OA.

OBJECTIVE

To evaluate the impact of a Home Care program combined with Exercise prescriptions on the quality of life in the geriatric population with knee OA.

METHODS AND MATERIALS

This review was conducted following a systematic approach to search for relevant articles in electronic databases. Studies published between 2011 and 2021 were included, following the PRISMA Guidelines. The databases screened included PubMed, Scopus, Cochrane, PEDro, MEDLINE, and EMBASE, using medical subject headings (MeSH) and Health Science Description (DeSC) terms.

RESULTS

A total of 12 studies involving participants undergoing home care programs and exercise prescriptions for OA were identified. The review findings indicated significant improvements in pain management and quality of life for individuals adhering to a structured home care program and therapist-guided exercise prescription.

CONCLUSION

The review suggests that implementing a home care program alongside an appropriate exercise regimen can enhance the quality of life in geriatric patients with knee OA, improving adherence to physical activity and overall patient outcomes.

Increased physical activity promotes skin clearance, improves cardiovascular and psychological health, and increases functional capacity in patients with psoriasis

Background

Patients with psoriasis are less physically active compared to age-matched controls, due to psoriasis-specific barriers, which significantly limits their ability to benefit from health-promoting levels of physical activity (PA). In addition, long-term health outcomes for people with psoriasis are poor and include depression, metabolic syndrome and cardiovascular disease (CVD); presenting a significant challenge to healthcare services.

Objectives

We designed a PA intervention in partnership with patients with psoriasis hypothesising this may have therapeutic utility in the management of psoriasis.

Methods

Participants with chronic plaque psoriasis were recruited to a single-centre, 20-week, prospective cohort study. A wrist-worn accelerometer (GENEActiv Original; Activinsights Ltd) and a hip-worn pedometer (Onwalk 900; Decathlon Group) were used objectively measure levels of PA. Our 10-week PA intervention comprised twice weekly 60-min walks within three different greenspaces in Greater Manchester, each led by a Sports and Exercise Scientist to deliver a pre-specified volume/dose of activity. During weeks-11-20 of the study, participants followed independent activities. Clinical evaluation, including assessment of psoriasis severity, cardiometabolic parameters, psychological wellbeing and functional capacity was made at baseline, week-10 and -20.

Results

Sixteen patients with psoriasis completed the study. We observed significantly reduced Psoriasis Area and Severity Index at week-10 (p = 0.01) and -20 (p = 0.001) compared to baseline, with 50% of participants achieving PASI-50 at week-20. Dermatology Life Quality Index (DLQI) was significantly reduced at week-20 (p = 0.04), compared to baseline. Significant reduction in blood pressure at week-10 (systolic: -7.4 mmHg, p = 0.002; diastolic: -4.2 mmHg, p = 0.03) and -20 (systolic: -8.8 mmHg, p = 0.001; diastolic: 4.1 mmHg, p = 0.008) was observed and pulse wave velocity was significantly reduced by week-20 (p = 0.02), suggesting improvement in cardiovascular health. Despite high prevalence of anxiety and depression at baseline, we documented a significant improvement in wellbeing and psychological health. Functional capacity was significantly enhanced following completion of the study.

Conclusion

Increasing PA constitutes a promising therapeutic intervention in the management of psoriasis. Evaluation of our intervention in a clinical trial would help determine clinical utility and establish PA guidelines for patients with psoriasis.

Feasibility of Whole-Body Resistance Training With Social Support Reinforcement for Older Adults Living Alone: A Mixed-Methods Pilot Study

PURPOSE

To examine the feasibility and acceptability of progressive whole-body resistance training with social support reinforcement for older adults living alone.

METHOD

This mixed methods single-group pilot study examined an intervention provided over 3 nonconsecutive days per week for 12 weeks. We evaluated quantitative data on recruitment, uptake, retention, and adherence, and measured pretest and posttest outcome scores on body composition, physical function, and psychosocial health. We conducted a focus group interview to collect qualitative data on participants' perspectives.

RESULTS

Seven participants (five women and two men) completed the program (attendance rate = 88.9%). Physical function and psychosocial health improved, but soft lean and skeletal muscle mass decreased. Five themes emerged from the qualitative data.

CONCLUSION

Results support the feasibility and benefits of this intervention program for older adults living alone despite challenges with recruitment and uptake. [Journal of Gerontological Nursing, 50(10), 34-41.].

Physical activity promotion through digital technology among older adults with type 2 diabetes mellitus: A scoping review

Objectives

Digital technologies in healthcare are rapidly advancing, and have the potential to enhance delivery across outpatient, inpatient, and community settings, thus ultimately improving healthcare practices. These technologies have been demonstrated to be among the safest alternatives to in-person visits for vulnerable or homebound people, thereby avoiding travel and facilitating healthcare-provider communication. This review was aimed at understanding the application of digital technology to promote physical activity and exercise in older adults with type 2 diabetes mellitus.

Methods

A comprehensive scoping review method was followed, according to the six-step framework developed by Arksey and O'Malley. A search was performed in six databases: Scopus, Embase, PubMed, ProQuest, Web of Science, and the Cumulated Index to Nursing and Allied Health Literature (CINAHL). Seven studies were retrieved.

Results

The search in the six databases returned 3252 records, only seven of which met the final selection criteria and were included in the review. All seven studies were conducted in high-income countries. Only one of the seven studies reported using a detailed exercise protocol.

Conclusion

Digital technology using smartphones provides an effective and a feasible solution to deliver physical activity promotion programs to older adults with type 2 diabetes mellitus, and can improve heath related outcomes.

Effects of conventional versus virtual reality-simulated treadmill exercise on fatigue, cognitive function, and participant satisfaction in post-COVID-19 subjects. A randomized trial

Background/objective

Post-COVID-19 subjects typically experience symptoms of fatigue, cognitive impairment, and sleep difficulty, which can be relieved by conventional aerobic exercise. Virtual Reality (VR) technology to support conventional exercise has recently gained much attention. Therefore, this study aimed to assess the effects of traditional treadmill exercise compared to virtual reality-simulated treadmill exercise on fatigue, cognitive function, sleep quality, and participant satisfaction with the exercise program in post-COVID-19 subjects.

Methods

This single-centered, randomized, parallel-group intervention study was conducted between December 2021 and March 2022. Sixteen of twenty post-COVID-19 subjects completed this study (n1 = 8, n2 = 8). Inclusion criteria were persistent dyspnea/fatigue, mild cognitive problems, and age from 30-60 years. Exclusion criteria were previous severe COVID-19 infection and ICU admission, concomitant respiratory or cardiovascular disease, and musculoskeletal or neurological disease. Eligible subjects were assigned randomly to two groups: a non-VR group that received traditional treadmill aerobic exercise only and a VR group that received treadmill exercise with non-immersive VR. Both groups received moderate-intensity exercise on a treadmill at [50-60 % (peak HR－resting HR) + resting HR] for 30-45 min, three times per week, and for four weeks. The outcome measures were the Chalder Fatigue Scale, Montreal Cognitive Assessment (MoCA) questionnaire, Pittsburgh Sleep Quality Index (PSQI), and participant satisfaction with the exercise program rated on a 5-point Likert scale.

Results

Both groups showed significant improvements in the Chalder Fatigue Scale, the MoCA questionnaire, and the PSQI scores after training compared to baseline (p < 0.05), without significant differences between them (p > 0.05). However, participant satisfaction with the exercise program was significantly higher in the VR group than in the non-VR group (p = 0.037).

Conclusion

A moderate-intensity 4-week treadmill exercise program with and without non-immersive VR may improve fatigue, cognitive function, and sleep quality to the same extent in COVID-19 survivors. However, participant satisfaction with the exercise program could be greater after conventional treadmill training assisted by non-immersive VR than after conventional treadmill training alone in this cohort.

Trial registration

Pan African Clinical Trials Registry, PACTR202311561948428, retrospectively registered.

The effect of six-week regular stretching exercises on regional and distant pain sensitivity: an experimental longitudinal study on healthy adults

BACKGROUND

Stretching exercises are widely used for pain relief and show positive effects on musculoskeletal, nociplastic and neuropathic pain; the magnitude of altered pain sensitivity responses following regular stretching is currently unknown. This study aimed to investigate the effect of six weeks of regular stretching exercise on regional and widespread pain sensitivity and range of motion and the effect of stretching cessation on regional and widespread pain sensitivity and range of motion.

METHODS

An experimental single-blind longitudinal repeated measures study. Twenty-six healthy adults were recruited. Regional and distant pressure pain thresholds and passive knee extension range of motion were measured at three points: before (baseline) and after six weeks (post-stretch) of daily bilateral hamstring stretching exercises and following four weeks of cessation (post-cessation) from stretching exercises.

RESULTS

Participants had a mean ± standard deviation (range) age of 23.8 ± 2.1 (21-30) years. There was a 36.7% increase in regional (p = 0.003), an 18.7% increase in distant pressure pain thresholds (p = 0.042) and a 3.6% increase in range of motion (p = 0.002) between baseline and post-stretch measures. No statistically significant differences were found for regional (p = 1.000) or distant pressure pain thresholds (p = 1.000), or range of motion (p = 1.000) between post-stretch and post-cessation. A 41.2% increase in distant pressure pain thresholds (p = 0.001), a 15.4% increase in regional pressure pain thresholds from baseline to post-cessation (p = 0.127) and a 3.6% increase in passive knee extension range of motion (p = 0.005) were found from baseline to post-cessation.

CONCLUSIONS

Six weeks of regular stretching exercises significantly decreased regional and widespread pain sensitivity. Moreover, the results showed that the hypoalgesic effect of stretching on regional and widespread pain sensitivity persisted following four weeks of cessation. The results further support the rationale of adding stretching exercises to rehabilitation efforts for patients experiencing nociceptive, nociplastic, and neuropathic pain. However, further research is needed to investigate how the long-term effects of stretching exercises compare with no treatment in clinical populations.

TRIAL REGISTRATION

The trial was registered June 1st, 2021 at ClinicalTrials.gov (Trial registration number NCT04919681).

Development Trends and Prospects of Technology-Based Solutions for Health Challenges in Aging Over the Past 25 Years: Bibliometric Analysis

BACKGROUND

As the global population ages, we witness a broad scientific and technological revolution tailored to meet the health challenges of older adults. Over the past 25 years, technological innovations, ranging from advanced medical devices to user-friendly mobile apps, are transforming the way we address these challenges, offering new avenues to enhance the quality of life and well-being of the aging demographic.

OBJECTIVE

This study aimed to systematically review the development trends in technology for managing and caring for the health of older adults over the past 25 years and to project future development prospects.

METHODS

We conducted a comprehensive bibliometric analysis of literatures related to technology-based solutions for health challenges in aging, published up to March 18, 2024. The search was performed using the Web of Science Core Collection, covering a span from 1999 to 2024. Our search strategy was designed to capture a broad spectrum of terms associated with aging, health challenges specific to older adults, and technological interventions.

RESULTS

A total of 1133 publications were found in the Web of Science Core Collection. The publication trend over these 25 years showed a gradual but fluctuating increase. The United States was the most productive country and participated in international collaboration most frequently. The predominant keywords identified through this analysis included "dementia," "telemedicine," "older-adults," "telehealth," and "care." The keywords with citation bursts included "telemedicine" and "digital health."

CONCLUSIONS

The scientific and technological revolution has significantly improved older adult health management, particularly in chronic disease monitoring, mobility, and social connectivity. The momentum for innovation continues to build, with future research likely to focus on predictive analytics and personalized health care solutions, further enhancing older adults' independence and quality of life.

Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study

BACKGROUND

Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy.

OBJECTIVE

This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS.

METHODS

Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics.

RESULTS

A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is -26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=-0.21, P<.001).

CONCLUSIONS

The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy.

The ESCAPE Trial for Older People With Chronic Low Back Pain: A Feasibility Study of a Clinical Trial of Group-Based Exercise in Primary Health Care

Low back pain is a highly disabling health condition that generates high costs for patients and healthcare systems. For this reason, it is considered a serious public health problem worldwide. This pilot study aimed to assess the feasibility of a future randomized controlled trial (RCT) by evaluating adherence to treatment, contamination between groups, satisfaction with treatment, and understanding of the exercise instructions provided by the physiotherapist. Additionally, we sought to identify and implement necessary modifications to the exercise protocol for better suitability in older people. We conducted a prospective, registered pilot RCT comparing an 8-week group-based exercise program with a waiting list in older people (≥60 years old) with chronic low back pain. Sixty participants were recruited through social media, pamphlets, and invitations at community referral centers. The study demonstrated the feasibility of a full RCT. Participants reported high satisfaction with the treatment (i.e., 100% indicated willingness to return for future services) and a high understanding of the exercise instructions (i.e., 81.8% reported "very easy" comprehension). Adherence to the exercise program exceeded the average reported for group exercise interventions in older adults (i.e., 82.58%). Dropout was associated solely with preexisting physical activity levels. The exercise protocol was successfully adapted to better suit the needs of the older adult population. This pilot RCT demonstrates the feasibility of a full-scale RCT to evaluate the effectiveness of group exercise in improving pain intensity and disability in older adults with chronic low back pain. The implemented adjustments to the exercise protocol and overall study approach strengthen the methodological foundation and expected accuracy of the future RCT.

Intersecting planetary health: Exploring the impacts of environmental stressors on wildlife and human health

This comprehensive review articulates critical insights into the nexus of environmental stressors and their health impacts across diverse species, underscoring significant findings that reveal profound effects on both wildlife and human health systems. Central to our examination is the role of pollutants, climate variables, and pathogens in contributing to complex disease dynamics and physiological disruptions, with particular emphasis on immune and endocrine functions. This research brings to light emerging evidence on the severe implications of environmental pressures on a variety of taxa, including predatory mammals, raptorial birds, seabirds, fish, and humans, which are pivotal as indicators of broader ecosystem health and stability. We delve into the nuanced interplay between environmental degradation and zoonotic diseases, highlighting novel intersections that pose significant risks to biodiversity and human populations. The review critically evaluates current methodologies and advances in understanding the morphological, histopathological, and biochemical responses of these organisms to environmental stressors. We discuss the implications of our findings for conservation strategies, advocating for a more integrated approach that incorporates the dynamics of zoonoses and pollution control. This synthesis not only contributes to the academic discourse but also aims to influence policy by aligning with the Global Goals for Sustainable Development. It underscores the urgent need for sustainable interactions between humans and their environments, which are critical for preserving biodiversity and ensuring global health security. By presenting a detailed analysis of the interdependencies between environmental stressors and biological health, this review highlights significant gaps in current research and provides a foundation for future studies aimed at mitigating these pressing issues. Our study is significant as it proposes integrative and actionable strategies to address the challenges at the intersection of environmental change and public health, marking a crucial step forward in planetary health science.

Evaluation of an integration community project for asylum seekers in Sweden: physical activity adherence and changes in character traits and life satisfaction

Asylum seekers' traumatic experiences in combination with discrimination, social isolation, and exclusion in the host country leads to low adherence from health and integration initiatives. Along with their inability to seek health care and physical inactivity, this situation increases their mental illness and, most importantly, decreases their well-being. In fact, the lack of well-being (e.g., life satisfaction) is a better marker of mortality and morbidity than the presence of mental illness. In this context, one of the major single determinants of well-being is character, a dimension of personality that stands for self-regulation, adaptation, and intentional conscious behavior (i.e., goals and values). Host countries often implement integration initiatives including activities aiming to attenuate mental illness, but only a handful are evaluated and reported, with even fewer addressing character development, increases in life satisfaction, or adherence. Our aim was to evaluate the integration initiative "Health for Everyone-Sport, Culture, and Integration", a 10-week physical activity community project. Specifically, we investigated changes in life satisfaction and character traits (i.e., Self-Directedness, Cooperativeness, and Self-Transcendence) and if these variables, at baseline, predicted adherence and changes in physiological health (i.e., cardiorespiratory fitness, skeletal muscle mass, body fat mass, and visceral fat). Participants (n = 269) answered (pre and post measurements) the Satisfaction with Life Scale, the Short Character Inventory, and undertook physiological tests. In addition, their attendance to the physical activity sessions was registered throughout the project (i.e., adherence). Participants showed no significant increases in Self-Directedness, Cooperativeness, or life satisfaction, but significant decreases in Self-Transcendence. Moreover, higher life satisfaction and lower Self-Transcendence at baseline predicted higher adherence to the activity. However, neither character traits nor life satisfaction predicted changes in physiological health. We argue that low frequency physical activity initiatives may improve this population's physical health because participants probably have a sedentary life and low levels of physical health due to their asylum conditions (e.g., unemployment, low income, poor housing and social network). Furthermore, physical activity per se may not improve the well-being of asylum seekers. Hence, promoting well-being and character development might require person-centered initiatives focusing on the whole individual in order to fit programmes to the needs and life situation of this population.

Resistance Training and Nutritional Supplementation in Older Adults with Sarcopenia after Acute Disease: A Feasibility Study

Resistance exercise and protein supplementation are recognized as effective treatment strategies for age-related sarcopenia; however, there are limited data on their feasibility, tolerability, and safety. The primary outcome of this study was feasibility, evaluated through the 15-item TELOS (Technological, Economics, Legal, Operational, and Scheduling) feasibility components and by recruitment, retention, and consent rates. Tolerability was measured by examining permanent treatment discontinuation, treatment interruption, exercise dose modification, early termination, rescheduling of missed sessions, losses to follow-up, attendance, and nutritional compliance. Safety was evaluated using the parameters provided by the European Medicines Agency, adapted for exercise interventions. Thirty-two subjects were recruited (average age 81.6 [SD 9.3] years). The TELOS components were assessed before the intervention; out of 15 questions relevant for successful implementation, 4 operational needs answers required specific actions to prevent potential barriers. The recruitment rate was 74%. Eleven patients (34.4%) had permanent treatment interruption (retention rate = 65.6%). Patients attended a mean of 23 (SD 12.0) exercise sessions, with a mean of 56 (SD 32.6) nutritional compliances. A total of 21 patients (65.6%) experienced adverse events unrelated to the intervention, while 7 patients (21.9%) presented adverse reactions to strength exercise. The main barriers to feasibility were operational components and recruitment challenges. Although the intervention was generally safe, the high rate of probable adverse effects, unrelated to the intervention but associated with the individual's baseline health condition, may affect adherence to treatment programs of this kind.

Beyond validation: getting wearable activity trackers into cardiovascular care-a discussion paper

This paper addresses the challenge of integrating wearable activity trackers (WATs) into cardiovascular disease care. Despite evidence supporting the use of trackers for monitoring and promoting physical activity, implementation challenges persist in clinical settings. The paper emphasizes the lack of systematic, evidence-based implementation approaches for integrating trackers. It underscores the urgent need for stakeholder collaboration between clinicians, patients, implementation scientists, researchers, health and technology partners, and the use of proven implementation science methodologies. This is crucial for bridging the gap and ensuring effective translation of WATs into cardiovascular care, meeting the increasing demand from patients and clinicians.

Tailored exercise with telehealth monitoring improves adherence and global health in kidney transplant recipients

Introduction

Tailored exercise prescription is a crucial intervention for kidney transplant recipients (KTRs). This longitudinal study investigates the impact on long-term effectiveness of exercise prescriptions over one year follow-up, implementing telehealth tools for exercise administration and adherence monitoring.

Materials and methods

KTRs were evaluated with clinical assessments including body composition, blood and urinary parameters, physical performance and quality of life at baseline (T0), after six (T6) and twelve (T12) months. The adherence to prescribed exercise training was monitored via video call interviews until T6 when the sample was divided into a group monitored via wearables (WG) and a group continuing video calls (VG) until T12.

Results

Twenty-six KTRs completed the study. No changes in body composition and kidney function were reported. KTRs showed an improvement in lipid profile, systolic blood pressure, cardiorespiratory fitness and quality of life. WG showed no clinical differences compared to VG except for reported higher quality of life.

Discussion

A good adherence to the exercise prescription was obtained with both monitoring methods (232 vs 253 min/week). This study reinforces the inclusion exercise training for KTRs to enhance physical fitness and reduce cardiovascular risk factors. These results emphasize the role of telehealth monitoring methods as motivators for adherence to long-term exercise prescriptions.

Cognitive functional therapy for lower back pain: A meta-analytical assessment of pain and disability outcomes in randomized controlled trials

BACKGROUND

Cognitive functional therapy (CFT) aims to address low back pain (LBP) comprehensively by considering physical, psychological, and social factors.

OBJECTIVE

The objective was to evaluate the effectiveness of CFT in reducing pain and disability in individuals with LBP over various time intervals.

METHOD

A comprehensive literature search was conducted to identify relevant randomized controlled trials (RCTs) assessing the effects of CFT on LBP.

RESULTS

In this study, 1510 records were initially identified, and 7 studies were included in the analysis. Disability scores were significantly reduced after CFT had been applied for 6 to 8 weeks (SMD =-0.46, 95% CI [-0.74, -0.19]), 12 weeks to 3 months (SMD =-0.54, 95% CI [-0.72, -0.36]), 6 months (MD =-5.82, 95% CI [-9.82, -1.82]), and 12 months (SMD =-0.4, 95% CI [-0.55, -0.26]). There were also significant reductions in pain scores observed after 12 weeks to 3 months (SMD =-0.49, 95% CI [-0.68, -0.3]), 6 months (MD =-0.75, 95% CI [-1.5, -0.0001]), and 12 months (SMD =-0.27, 95% CI [-0.42, -0.12]).

CONCLUSION

CFT showed potential for improving disability scores for individuals with LBP across various time intervals. However, its impacts on pain scores varied.

Prehabilitation to Enhance Vascular Surgery Outcomes: A Narrative Review

Prehabilitation, an emerging strategy, prepares patients for elective surgery by encouraging healthy behaviors, including physical exercise and healthy nutrition, while providing psychological support, to improve postoperative outcomes and foster healthier lifestyles. Despite growing interest, there is little research on prehabilitation. Specifically, studies involving prehabilitation in vascular surgery are heterogeneous with small sample sizes. This review aimed to investigate the reported positive impact of prehabilitation on vascular surgery patients, discuss prehabilitation models, highlight prehabilitation program-associated challenges, and suggest appropriate interventions. Prehabilitation improves physical fitness, reduces postoperative complications, and enhances overall recovery. Multimodal prehabilitation programs can positively impact vascular surgery patients, with benefits including improved cardiovascular fitness, reduced postoperative complications, shorter postoperative hospital stays, enhanced overall recovery, and improved quality of life. The currently reported prehabilitation programs are heterogeneous, with limitations regarding patient adherence and lack of long-term outcomes, posing challenges to their widespread adoption. Overall, prehabilitation shows promise for improving vascular surgery outcomes and fostering long-term healthy behaviors. The systematic implementation of prehabilitation in vascular surgery care pathways, overcoming reported limitations, and integrating multimodal prehabilitation into routine preoperative care hold potential benefits. This review underscores the need for high-quality research to establish best practices in prehabilitation and integrate them into the standard of care for vascular surgery patients.

Benefits of Individualized Training in Fatigued Patients with Multiple Sclerosis

INTRODUCTION

Chronic fatigue is the most common and debilitating symptom in people with multiple sclerosis (PwMS). Recently, exercise has been proven to alleviate chronic fatigue and improve physical functions. Tailoring the training intervention to the potential fatigue causes could optimize the beneficial effects of training on fatigue. The objective of this study was to compare the effectiveness of an individualized (IND) versus a traditional (TRAD) exercise intervention in reducing chronic fatigue.

METHODS

Twenty-nine PwMS with high chronic fatigue were randomly assigned to 12 wk of either a TRAD or IND exercise intervention. TRAD comprised aerobic and resistance exercises according to the guidelines for PwMS. IND specifically addressed identified individual weaknesses. Participants visited the laboratory before and after training for the following assessments: patient-reported outcomes (fatigue, quality of life, depression questionnaires), incremental cycling test (peak oxygen uptake (V̇O 2peak )), and cycling fatigue test (maximal voluntary contraction, rating of perceived exertion).

RESULTS

Similar improvements in fatigue, depression, and quality of life were observed between groups ( P > 0.05). Compared with TRAD, IND induced a significant greater increase in V̇O 2peak (+21.0% ± 13.9% vs 6.8% ± 11.5%, P < 0.05) and a greater reduction in rating of perceived exertion at a given submaximal intensity (-30.3% ± 18.9% vs -12.1% ± 20.4%, P < 0.001), whereas maximal voluntary contraction increased similarly in both groups ( P > 0.05).

CONCLUSIONS

Although tailored exercise improved similarly fatigue and other subjective parameters (depression, quality of life, sleep quality) compared with than traditional exercise intervention, prescribing an individualized intervention led to greater improvement in V̇O 2peak (but not maximal strength) and perception of effort. This may have positive functional consequences for patients.

Systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults: Reimagining future interventions

BACKGROUND

Prevention programs, and specifically exercise, can reduce falls among community-dwelling older adults, but low adherence limits the benefits of effective interventions. Technology may overcome some barriers to improve uptake and engagement in prevention programs, although less is known on adherence for providing them via this delivery mode. We aimed to synthesize evidence for adherence to technology-based falls prevention programs in community-dwelling older adults 60 years and older. We conducted a systematic review following standard guidelines to identify randomized controlled trials for remote delivered (i.e., no or limited in-person sessions) technology-based falls prevention programs for community-dwelling older adults. We searched nine sources using Medical Subject Headings (MeSH) terms and keywords (2007-present). The initial search was conducted in June 2023 and updated in December 2023. We also conducted a forward and backward citation search of included studies. Two reviewers independently conducted screening and study assessment; one author extracted data and a second author confirmed findings. We conducted a random effects meta-analysis for adherence, operationalized as participants' completion of program components, and aimed to conduct meta-regressions to examine factors related to program adherence and the association between adherence and functional mobility. We included 11 studies with 569 intervention participants (average mean age 74.5 years). Studies used a variety of technology, such as apps, exergames, or virtual synchronous classes. Risk of bias was low for eight studies. Five interventions automatically collected data for monitoring and completion of exercise sessions, two studies collected participants' online attendance, and four studies used self-reported diaries or attendance sheets. Studies included some behavior change techniques or strategies alongside the technology. There was substantial variability in the way adherence data were reported. The mean (range) percent of participants who did not complete planned sessions (i.e., dropped out or lost to follow-up) was 14% (0-32%). The pooled estimate of the proportion of participants who were adherent to a technology-based falls prevention program was 0.82 (95% CI 0.68, 0.93) for studies that reported the mean number of completed exercise sessions. Many studies needed to provide access to the internet, training, and/or resources (e.g., tablets) to support participants to take part in the intervention. We were unable to conduct the meta-regression for adherence and functional mobility due to an insufficient number of studies. There were no serious adverse events for studies reporting this information (n = 8). The use of technology may confer some benefits for program delivery and data collection. But better reporting of adherence data is needed, as well as routine integration and measurement of training and skill development to use technology, and behavior change strategies within interventions. There may be an opportunity to rethink or reimagine how technology can be used to support people's adoption and integration of physical activity into daily life routines.

The Benchmarking Exercise Programme for Older People (BEPOP): Design, Results and Recommendations from The First Wave of Data Collection

Objectives

The Benchmarking Exercise Programme for Older People (BEPOP) service improvement project seeks to determine and promote the exercise training characteristics associated with positive outcomes for resistance exercise for older people living with, or at risk of, sarcopenia or physical frailty.

Methods

Mixed-methods service improvement project. Ten UK National Health Service physiotherapist-led therapy services delivering exercise interventions for older people submitted anonymized data for up to 20 consecutive patients. A multidisciplinary expert panel generated a report and recommendations with site-specific benchmarking data and feedback. In parallel, participating physiotherapy team members were interviewed to elicit feedback on BEPOP rationale, processes and perceived value.

Results

Data from 188 patients were included, mean age 80 years (range 60-101). 115 (61%) received objective assessment of strength-based physical performance. Bodyweight exercises (173 [92%]) and resistance bands (49 [26%]) were the commonest exercise modalities. Exercises progressed predominantly through increased repetitions (163 [87%]) rather than increased load. 50 (30%) had no reassessment of outcomes; only 68 (41%) were signposted to follow-on exercise services. Staff interviews identified themes around knowledge, diagnosis, data collection and practice reflection.

Conclusion

BEPOP was feasible to deliver and generated actionable insights for service improvement via improved diagnosis, measurement and progression of resistance exercise.

Determinants of exercise adherence in sedentary middle-aged and older adults

Regular exercise positively impacts neurocognitive health, particularly in aging individuals. However, low adherence, particularly among older adults, hinders the adoption of exercise routines. While brain plasticity mechanisms largely support the cognitive benefits of exercise, the link between physiological and behavioral factors influencing exercise adherence remains unclear. This study aimed to explore this association in sedentary middle-aged and older adults. Thirty-one participants underwent an evaluation of cortico-motor plasticity using transcranial magnetic stimulation (TMS) to measure changes in motor-evoked potentials following intermittent theta-burst stimulation (iTBS). Health history, cardiorespiratory fitness, and exercise-related behavioral factors were also assessed. The participants engaged in a 2-month supervised aerobic exercise program, attending sessions three times a week for 60 min each, totaling 24 sessions at a moderate-to-vigorous intensity. They were divided into Completers (n = 19), who attended all sessions, and Dropouts (n = 12), who withdrew early. Completers exhibited lower smoking rates, exercise barriers, and resting heart rates compared to Dropouts. For Completers, TMS/iTBS cortico-motor plasticity was associated with better exercise adherence (r = -.53, corrected p = .019). Exploratory hypothesis-generating regression analysis suggested that post-iTBS changes (β = -7.78, p = .013) and self-efficacy (β = -.51, p = .019) may predict exercise adherence (adjusted-R2 = .44). In conclusion, this study highlights the significance of TMS/iTBS cortico-motor plasticity, self-efficacy, and cardiovascular health in exercise adherence. Given the well-established cognitive benefits of exercise, addressing sedentary behavior and enhancing self-efficacy are crucial for promoting adherence and optimizing brain health. Clinicians and researchers should prioritize assessing these variables to improve the effectiveness of exercise programs.

Implementation of a multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): an early qualitative process evaluation

BACKGROUND

Geriatric rehabilitation aims at increasing physical and social activity and maintaining the functional reserve of older people. However, the continuity of geriatric rehabilitation in the outpatient setting is limited due to a lack of structured aftercare programs. In order to overcome this, a three-month multimodal home-based intervention program (GeRas) was implemented. The aim of this early qualitative process evaluation was to assess GeRas in terms of perceived reach, effectiveness/efficacy, adoption/uptake, implementation, and maintenance/sustainability (Domains within the RE-AIM Framework) from the perspective of patients who received the intervention and healthcare providers who were involved in the delivery of the intervention.

METHODS

In a qualitative process evaluation, 13 healthcare providers and 10 patients were interviewed throughout the beginning of the implementation period of GeRas to capture early experiences using a semi-structured interview guide. The interview guide and qualitative content analysis was guided by the RE-AIM Framework.

RESULTS

The GeRas program was perceived to be largely well implemented and beneficial by healthcare providers and patients. According to healthcare providers, GeRas showed more advantages compared to usual care. Additionally, outcome expectations were mainly met (Domain 1: Effectiveness). However, the implementation of the intervention delivered via the eHealth system was perceived as challenging (Domain 2: Adoption). Nevertheless, the outpatient physical exercise, the outpatient counselling, and the continuous care after discharge improved perceived well-being regardless of the intervention type (Domain 3: Implementation). To facilitate the continued use of GeRas, technical requirements should be created to increase user-friendliness and to motivate patients to continue the training in the long term (Domain 4: Maintenance).

CONCLUSION

Although initial experiences with the implementation and effectiveness of GeRas were positive in general, organisational and technical issues need to be resolved to enhance sustainable and successful implementation of the GeRas program.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00029559). Registered 5/10/2022.

Robot-assisted gait training in patients with various neurological diseases: A mixed methods feasibility study

BACKGROUND

Walking impairment represents a relevant symptom in patients with neurological diseases often compromising social participation. Currently, mixed methods studies on robot-assisted gait training (RAGT) in patients with rare neurological diseases are lacking. This study aimed to explore the feasibility, acceptability, goal attainment and preliminary effects of RAGT in patients with common and rare neurological diseases and understand the intervention context and process.

METHODS

A mixed-methods feasibility study was conducted at an Austrian rehabilitation centre. Twenty-eight inpatients after stroke in the subacute and chronic phases, with multiple sclerosis, Parkinson's disease, spinal cord injury, spinocerebellar ataxia, acute/chronic inflammatory demyelinating polyneuropathy and motor neuron disease were included. Patients received RAGT for 45 minutes, 4x/week, for 4 weeks. Baseline and post-intervention assessments included gait parameters, walking and balance, and questionnaires. Semi-structured observations were conducted twice during the intervention period and analysed using thematic analysis. Descriptive statistics within the respective disease groups and calculation of effect sizes for the total sample were performed. Triangulation was employed to develop a deeper understanding of the research topic.

RESULTS

Data from 26 patients (mean age 61.6 years [standard deviation 13.2]) were analysed. RAGT was highly accepted by patients and feasible, indicated by recruitment, retention, and adherence rates of 84.8% (95% confidence interval, CI 0.7-0.9), 92.2% (95% CI 0.7-1.0) and 94.0% (95% CI 91.4-96.2), respectively. Goal attainment was high, and only mild adverse events occurred. Improvements in walking speed (10-Metre Walk Test, effect size r = 0.876), walking distance (6-Minute Walk Test, r = 0.877), functional mobility (Timed Up and Go, r = 0.875), gait distance (r = 0.829) and number of steps (r = 0.834) were observed. Four themes were identified: familiarising with RAGT; enjoyment and acceptance through a trusting therapeutic relationship; actively interacting; and minimising dissatisfaction.

DISCUSSION

Sufficiently powered randomised controlled trials are needed to validate our results.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00027887.

Limited Evidence for the Benefits of Exercise in Older Adults with Hematological Malignancies: A Systematic Review and Meta-Analysis

Older patients receiving antineoplastic treatment face challenges such as frailty and reduced physical capacity and function. This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on physical function outcomes, health-related quality of life (QoL), and symptom burden in older patients above 65 years with hematological malignancies undergoing antineoplastic treatment. This review adheres to Cochrane guidelines, with the literature searches last updated on 27 March 2024, including studies with patients above 18 years. Screening of identified studies, data extraction, risk of bias, and GRADE assessments were performed independently by two authors. Meta-analyses evaluated the impact of exercise, considering advancing age. Forty-nine studies contributed data to the meta-analyses. Five studies included patients with a mean age above 60 years, and none included only patients above 60. Exercise interventions had moderate to small positive effects on QoL global (SMD 0.34, 95% CI [0.04-0.64]) and physical function (SMD 0.29, 95% CI [0.12-0.45]). Age did not explain the variability in exercise effects, except for physical function (slope 0.0401, 95% CI [0.0118-0.0683]) and pain (slope 0.0472, 95% CI [0.01-0.09]), which favored younger patients. Exercise interventions improve physical function and QoL and reduce symptoms in adults with hematological malignancies undergoing antineoplastic treatment; however, the influence of age remains inconclusive.

The effects of green exercise on the mental and physical health of people with chronic conditions: a systematic review

Green exercise, defined as physical activity in natural settings, shows promise for enhancing exercise participation and improving health. This systematic review aimed to assess the effectiveness of green exercise in people with chronic conditions. Seven electronic databases were searched and of the 7801 screened articles, 14 trials met the inclusion criteria. Green exercise was a safe and well-tolerated intervention, with low drop-out levels. It was found to positively affect participants' quality of life in three studies and mental health in four studies. Compared to non-exercise groups, green exercise significantly improved physical and mental health in patients with breast cancer, COPD, cardiovascular disease risk, chronic low back pain, obesity, and diabetes. However, it had no impact on the physical health of stroke patients or the cognitive performance of those with ADHD. Green exercise appears to be a safe intervention that can improve various chronic health issues.

MoveONParkinson: developing a personalized motivational solution for Parkinson's disease management

Introduction

Despite the effectiveness of exercise-based interventions on symptom management and disease progression, many people with Parkinson's Disease (PwPD) do not exercise regularly. In line with the ubiquitous use of digital health technology, the MoveONParkinson digital solution was developed, comprising a Web Platform and a Mobile App with a Conversational Agent (CA). The interface features were designed based on the principles of Social Cognitive Theory with the goal of fostering behavior change in PwPD for sustained exercise participation and improved disease management.

Methods

Using a mixed methods approach, this study aimed to collect feedback, assess the acceptability of the Mobile App and the Web Platform, and evaluate the usability of the latter. Quantitative data, which included questionnaire responses and the System Usability Scale (SUS) scores, were analyzed using descriptive statistics, heatmaps, and correlation matrices. Qualitative data, comprising semi-structured and thinking-aloud interview transcripts, were subjected to an inductive thematic analysis. A total of 28 participants were involved in the study, comprising 20 physiotherapists (average age: 34.50 ± 10.4), and eight PwPD (average age: 65.75 ± 8.63; mean Hoehn & Yahr: 2.0 (± 0.76)).

Results

Three main themes emerged from the thematic analysis of the interviews, namely: Self-management (Theme 1), User Engagement (Theme 2), and Recommendations (Theme 3). The assessment of the Mobile App and the CA (mean score: 4.42/5.0 ± 0.79) suggests that PwPD were able to navigate this interface without notable difficulties. The mean SUS score of 79.50 (± 12.40%) with a 95% confidence interval ranging from 73.70 to 85.30, reveal good usability.

Discussion

These findings indicate a high level of acceptability of the MoveONParkinson digital solution, serving as a foundation for assessing its impact on exercise engagement and, subsequently, its influence on symptom management and quality of life of PwPD.

Discontinuation of HIIT restores diabesity while retraining increases gut microbiota diversity

Investigations involving high-intensity interval training (HIIT) have proven to be efficient in controlling diabesity. This study aimed to assess the impact of discontinuing HIIT and retraining within the context of diabesity. 75 C57BL6 mice went through 5 stages: baseline, induction of diabesity with Western diet, training, detraining, and retraining (6 weeks each period). Detraining led to elevated adiposity, exacerbated metabolic parameters and intestinal health, and altered gut microbiota composition. Retraining restored blood glucose regulation and enhanced intestinal health yet did not induce fat reduction. While both training and retraining exerted an effect on the composition of the gut microbiota, the impact of diet demonstrates a more substantial potency compared to that of exercise concerning intestinal health and microbiome. These findings may contribute to a broader understanding of diabesity management and introduce perspectives for the use of specific physical training to enhance patient outcomes and intestine health.

Assessment of Park Paths and Trails for Physical Activity Promotion among Older Adults in Saudi Arabia: Feasibility and Future Directions

Chronic diseases affect more than 80% of older adults. One modifiable risk factor for secondary prevention is physical activity. Public parks are an essential resource for physical activity, but environmental features may limit participation. Our aims were (1) to assess the feasibility and utility of the Path Environment Audit Tool (PEAT) for use in a larger-scale study focused on older adults and (2) to examine the physical activity-promoting features of five public parks.

METHODS

A descriptive study design was used to assess five public parks in Riyadh, Saudi Arabia, from April to June 2022. Additionally, process, resource, and management assessments were also conducted.

RESULTS

The PEAT was easy to use, but additions are recommended to increase relevance to older adults with chronic disease. Descriptive analyses revealed positive features, such as adequate lighting, but other features such as path slope were more variable.

CONCLUSIONS

Study findings can guide the future use of the PEAT for older adult participants and inform environmental modifications.

Factors impeding physical activity in older hospitalised patients: A qualitative meta-synthesis

BACKGROUND

Older hospitalised patients have low levels of physical activity and multiple impairing factors.

AIMS

To systematically evaluate the perceived barriers to physical activity among older patients during hospitalisation, and provide reference for future intervention programs.

DESIGN

Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations.

METHODS

An exhaustive exploration was conducted across the CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science from their inception until August, 2023 to identify qualitative research on obstacles to physical activity among older hospital patients. The quality of the literature was evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative research. Meta-synthesis method was used to integrate the results.

RESULTS

In total, 8 literatures were included, 43 themes were extracted, and analogous research results were amalgamated to generate 10 categories and 3 syntheses: individual level, interpersonal influencing factors and hospital environment and resources level.

CONCLUSION

Older inpatients are faced with multiple barriers to physical activity. Medical staff should pay attention to changes in physical activity during hospitalisation, identify barriers to physical activity in older inpatients and provide references for promoting physical activity programs for the older.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a meta-synthesis and does not require relevant contributions from patients or the public.

WHAT IS ALREADY KNOWN

Older patients are at low physical activity levels during hospitalisation. Older inpatients are faced with multiple barriers to physical activity.

WHAT THIS PAPER ADDS

Factors of physical activity impairment in hospitalised older patients should be considered in the context of health status, psychological factors, motivation and social support. Disease-induced psychological fallout has a greater impact on physical activity in the older.

Effect of a pragmatic lifestyle modification intervention on physical activity levels and body mass index among obese and overweight adolescents in Udupi, India: a cluster randomized trial

Background

Determine the effects of a multifactorial lifestyle intervention on physical activity (PA), BMI and health-related quality of life (QoL) in obese and overweight adolescents.

Methods

Nine schools in India were clustered randomly in a 12-month study with students allocated to a multifactorial intervention (MFI), or exercise only (EX) or control (CON) group. Participants were adolescents aged 11-16 years (n=671). In the MFI group, adolescents and their parents received lifestyle education using a validated booklet combined with a PA intervention for school students. The EX group received school-based PA only; the CON group continued regular activities. Primary outcomes were PA levels measured with the PAQ-A, and BMI; the secondary outcome was health-related QoL. A linear regression statistical model was used to analyse time, group effects and interactions, with Bonferroni correction for within-group differences at baseline (T0) and at 12-weeks (T1) (post-intervention), 6-month (T2) and 12-month (T3) follow-ups.

Results

Significant time and group effects observed for all groups with PA scores (p<0.001), with MFI group having largest increase in PA; with BMI (p<0.001) and MFI showing the least gain in BMI; and HRQOL (p<0.001), with MFI group showing greatest improvement in scores. There were significant increases in PA at T1 and T3 time-points with the EX group, and at T3 time-point only for MFI and CON, with MFI group showing largest increase in HRQOL scores. BMI increased significantly for all groups at T2 (MFI p=0.001, EX p<0.001) and T3 (p<0.001), while HRQOL increased significantly for both MFI and EX at both follow-ups (p<0.001).

Conclusions

School-based lifestyle MFI was more effective for improving PA, lifestyle behaviours and HRQOL than exercise alone for adolescents, although BMI was not reduced. MFI with PA could be an effective school-based approach for behaviour modification but BMI has limitations for measuring body composition changes.

Registration

CTRI/2019/04/018834 (30/04/2019).

The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions

A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.

Interactions between Stress Levels and Hormonal Responses Related to Sports Performance in Pro Women's Basketball Team

The testosterone to cortisol ratio (T:C ratio) is a measure of whether elite athletes are recovering from their training. This study described this hormone balance stress in elite women's basketball. (1) Objectives: to analyse the fluctuation of T:C ratio over a 16-week period and explore itis relation to their athletic performance. The participants characteristics were: (height: 177.6 ± 6.4 cm; body mass: 77.808 ± 12.396 kg age: 26.0 ± 5.9 years; and a playing experience of 14.7 ± 2.9 years with 5.0 ± 1.2 years at the elite level. The T:C ratio at Time 1 is: 4.0 ± 2.4 (n = 12); and at Time 2 is: 5.1 ± 4.3 (n = 12). (2) Methods: during 16 weeks of competition, participants underwent analysis of blood samples to assess various biochemical parameters including hormone levels. In addition, their athletic performance was assessed with the following tests: jumping (SJ, CMJ, ABK, DJ); throwing test with a medicine ball (3 kg); Illinois COD agility test; sprint repeatability with change of direction; 20-m speed test without change of direction; and Yo-yo intermittent endurance test IET (II). (3) Results: The main alterations observed were an increase in T levels (1.687%) and a decrease in C levels (-7.634%) between moments, with an improvement (26.366%) in the T:C ratio. Improvements were also observed in some of the tests developed, such as jumping (SJ: 11.5%, p = 0.029; CMJ: 10.5%, p = 0.03; DJ: 13.0%, p = 0.01), upper body strength (MBT: 5.4%, p = 0.03), translation ability (20 m: -1.7%), repeated sprint ability (RSA: -2.2%), as well as intermittent endurance test (Yy (IET): 63.5%, p = 0.01), with significant changes in some of the performance tests. (4) Conclusions: T:C ratio may differ in a manner unrelated to training volume, showing some variation. These results may be attributed to the accumulation of psychophysiological stress during the season.

How to Promote Walking in Women with Fibromyalgia: A Look at Catastrophizing, Goal Conflict, and Avoidance from a Self-Emotional Regulatory Perspective

The aim of this study was twofold: to explore the concordance between two measures of physical activity (accelerometer and IPAQ) among female fibromyalgia (FM) patients, as well as to examine the impact of psychosocial variables (catastrophism, activity avoidance) on walking among these patients. Helplessness, activity avoidance, and commitment to physical activity were evaluated in 132 FM women. After the first assessment, an accelerometer was placed by a psychologist on each participant for seven consecutive days. Eight days later, accelerometers were collected, and participants were evaluated again using the IPAQ. Two models were tested to analyze mediation and a moderated mediation effect. The mediating role of activity avoidance between helplessness and minutes walked was corroborated regarding the objective measure of walking. The effect of helplessness on minutes walked during a week was mediated by activity avoidance and assessed by accelerometers. Cognitive variables played a contextual role when trying to promote exercise. Activity avoidance must be understood as a key variable in physical activity promotion, specifically in the promotion of walking with the aim to do exercise in individuals with FM.