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Zhao T, Yang Q, Feuerbacher JF, Yu B, Brinkmann C, Cheng S, Bloch W, Schumann M. Effects of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control: a systematic review and network meta-analysis. Br J Sports Med 2024:bjsports-2024-108127. [PMID: 39242178 DOI: 10.1136/bjsports-2024-108127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To compare the efficacy of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control. DESIGN Systematic review and network meta-analysis. DATA SOURCES Embase, Web of Science, PubMed/MEDLINE and SPORTDiscus. ELIGIBILITY CRITERIA Randomised controlled trials involving exercise, metformin or their combined treatments in individuals with prediabetes or type 2 diabetes mellitus (T2DM) were included. Outcomes included haemoglobin A1c (HbA1c), 2-hour glucose during oral glucose tolerance test, fasting glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS 407 articles with 410 randomised controlled trials (n=33 802) were included. In prediabetes, the exercise showed greater efficacy than metformin on HbA1c levels (mean difference -0.16%, 95% CI (-0.23 to -0.09) vs -0.10%, 95% CI (-0.21 to 0.02)), 2-hour glucose (-0.68 mmol/L, 95% CI (-0.97 to -0.39) vs 0.01 mmol/L, 95% CI (-0.38 to 0.41)) and HOMA-IR (-0.54, 95% CI (-0.71 to -0.36) vs -0.23, 95% CI (-0.55 to 0.10)), while the efficacy on fasting glucose was comparable (-0.26 mmol/L, 95% CI (-0.32 to -0.19) vs -0.33 mmol/L, 95% CI (-0.45 to -0.21)). In T2DM, metformin was more efficacious than exercise on HbA1c (-0.88%, 95% CI (-1.07 to -0.69) vs -0.48%, 95% CI (-0.58 to -0.38)), 2-hour glucose (-2.55 mmol/L, 95% CI (-3.24 to -1.86) vs -0.97 mmol/L, 95% CI (-1.52 to -0.42)) and fasting glucose (-1.52 mmol/L, 95% CI (-1.73 to -1.31) vs -0.85 mmol/L, 95% CI (-0.96 to -0.74)); exercise+metformin also showed greater efficacy in improving HbA1c (-1.23%, 95% CI (-2.41 to -0.05)) and fasting glucose (-2.02 mmol/L, 95% CI (-3.31 to -0.74)) than each treatment alone. However, the efficacies were modified by exercise modality and metformin dosage. CONCLUSION Exercise, metformin and their combination are efficacious in improving glucose metabolism in both prediabetes and T2DM. The efficacy of exercise appears to be superior to metformin in prediabetes, but metformin appears to be superior to exercise in patients with T2DM. PROSPERO REGISTRATION NUMBER CRD42023400622.
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Affiliation(s)
- Tong Zhao
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
- Exercise Translational Medicine Centre, Shanghai Centre for Systems Biomedicine Shanghai, Shanghai Jiao Tong University, Shanghai, Shanghai, China
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai, Shanghai, China
| | - Qize Yang
- Exercise Translational Medicine Centre, Shanghai Centre for Systems Biomedicine Shanghai, Shanghai Jiao Tong University, Shanghai, Shanghai, China
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai, Shanghai, China
| | - Joshua F Feuerbacher
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
- Department of Sports Medicine and Exercise Therapy, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Bizhu Yu
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Christian Brinkmann
- Department of Preventive and Rehabilitative Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Sulin Cheng
- Exercise Translational Medicine Centre, Shanghai Centre for Systems Biomedicine Shanghai, Shanghai Jiao Tong University, Shanghai, Shanghai, China
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai, Shanghai, China
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Moritz Schumann
- Department of Sports Medicine and Exercise Therapy, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
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Ghojazadeh M, Pourmanaf H, Fekri V, Nikoukheslat S, Nasoudi Y, Mills DE. The effects of aerobic exercise training on inflammatory markers in adult tobacco smokers: A systematic review and meta-analysis of randomized controlled trials. Respir Med 2024; 231:107732. [PMID: 38971338 DOI: 10.1016/j.rmed.2024.107732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/19/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Aerobic exercise training may reduce systemic inflammation, but the effects of this on systemic inflammatory markers in adult tobacco smokers has not been systematically reviewed. Therefore, we evaluated the effects of aerobic exercise training on C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in adult tobacco smokers using a systematic review and meta-analysis of randomized controlled trials. METHODS A comprehensive literature search was carried out using PubMed/Medline, Web of Science, EMBASE, Google Scholar, and hand search of bibliographies of the retrieved English or Persian articles up to August 2023. This review only included randomized controlled trials which investigated the effect of aerobic exercise training on CRP and TNF-α in adult smokers, based on a predefined inclusion and exclusion criteria. RESULTS A total of 1641 articles were identified. Six studies were included in the review and four evaluated CRP and two evaluated TNF-α in only males. The meta-analysis demonstrated that aerobic exercise training significantly decreased TNF-α concentrations in males (MD = -6.68, 95 % CI = -13.90 to -0.54, P = 0.05). CRP concentrations did not decrease significantly when the data from the four studies were pooled (MD = -0.17, 95 % CI = -0.37 to 0.03, P = 0.09). CONCLUSION Aerobic exercise training may reduce the concentration of TNF-α in male smokers, but it does not have a significant effect on CRP concentrations. However, these findings are based upon a small number of studies, that enrolled either exclusively male or female participants, and further investigation is necessary to increase statistical inference.
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Affiliation(s)
- Morteza Ghojazadeh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Pourmanaf
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Vahid Fekri
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Saeid Nikoukheslat
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Yasmin Nasoudi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dean E Mills
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Queensland, Australia; Respiratory and Exercise Physiology Research Group, School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Queensland, Australia; Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia.
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Bouma AJ, Nauta J, van Nassau F, Krops LA, van den Akker-Scheek I, Diercks RL, de Groot V, van der Leeden M, Leutscher H, Stevens M, van Twillert S, Zwerver H, van der Woude LHV, van Mechelen W, Verhagen EALM, van Keeken HG, van der Ploeg HP, Dekker R. Implementing Individually Tailored Prescription of Physical Activity in Routine Clinical Care: A Process Evaluation of the Physicians Implement Exercise = Medicine Project. J Phys Act Health 2024; 21:916-927. [PMID: 39084613 DOI: 10.1123/jpah.2023-0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/26/2024] [Accepted: 05/17/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Although the prescription of physical activity in clinical care has been advocated worldwide, in the Netherlands, "Exercise is Medicine" (E = M) is not yet routinely implemented in clinical care. METHODS A set of implementation strategies was pilot implemented to test its feasibility for use in routine care by clinicians in 2 departments of a university medical center. An extensive learning process evaluation was performed, using structured mixed methods methodology, in accordance with the Reach, Effect, Adoption, Implementation, and Maintenance framework. RESULTS From 5 implementation strategies employed (education, E = M tool embedded in the electronic medical records, lifestyle coach situated within the department, overviews of referral options, and project support), the presence of adequate project support was a strong facilitator of the implementation of E = M. Also, the presence of the lifestyle coach within the department seemed essential for referral rate. Although clinicians appreciated the E = M tool, barriers hampered its use in practice. CONCLUSIONS Specific implementation strategies, tailored to the setting, are effective in facilitating the implementation of E = M with specific regard to education for clinicians on E = M, deployment of a lifestyle coach within a department, and project coordination. Care providers do see a future for lifestyle coaches who are structurally embedded in the hospital, to whom they can easily refer.
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Affiliation(s)
- Adrie J Bouma
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joske Nauta
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron L Diercks
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hans Leutscher
- Knowledge Centre for Sport and Physical Activity, Ede, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sacha van Twillert
- UMC Staff Policy and Management Support, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans Zwerver
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evert A L M Verhagen
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Helco G van Keeken
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Drummond H, Middleton TRF, Shepherd AI, Davenport S. Understanding the factors that influence stroke survivors to begin or resume exercise: a qualitative exploration. Top Stroke Rehabil 2024; 31:556-563. [PMID: 38288982 DOI: 10.1080/10749357.2024.2304970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/30/2023] [Indexed: 07/25/2024]
Abstract
BACKGROUND Exercise after stroke has the potential to increase survivors' physical function and decrease disability. However, despite health professional reporting they recommend exercise to stroke survivors, the majority are physically inactive. Stroke survivors have previously expressed a lack of adequate knowledge and skills to engage in exercise. OBJECTIVES The aim of this study was to understand why active stroke survivors chose to (re)engage in exercise and how they went about doing so. A secondary aim was to understand if health professionals had a role in facilitating exercise engagement. METHODS Semi-structured interviews were conducted with stroke survivors who regularly engaged with exercise. Seven people aged between 60 and 71 years participated in the study. Time since stroke varied from 1 to 13 years. A reflexive thematic analysis approach was used to analyze interviews. RESULTS Exercise was spoken about in a positive light. For some, exercise had always been important, for others it became important after their stroke. The themes of Changing Support Over Time, Old and New Identity and Proactively Impacting the Future were developed. The participants felt that health professionals often facilitated engagement in exercise, although the type of support that was most valued differed at different points in the post-stroke journey. CONCLUSIONS Authoritative support from health professionals and family members helped participants to engage in exercise in the early stages after stroke. Collaboration and being part of a team was appreciated for ongoing exercise engagement. Exercise provided hope as participants developed their identity after stroke.
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Affiliation(s)
- Helena Drummond
- Physical Activity, Health and Rehabilitation Thematic Research Group, Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Thierry R F Middleton
- Physical Activity, Health and Rehabilitation Thematic Research Group, Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Anthony I Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Sally Davenport
- Physiotherapy Group, Great Ormond Street Institute of Child Health, University College London, London, UK
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5
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Corrigan O, Danielsen S, Doherty S, Lane P. Integrated care systems in England: the significance of collaborative community assets in promoting and sustaining health and wellbeing. FRONTIERS IN SOCIOLOGY 2024; 9:1355215. [PMID: 39165862 PMCID: PMC11334352 DOI: 10.3389/fsoc.2024.1355215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/05/2024] [Indexed: 08/22/2024]
Abstract
Until recently the healthcare system in England was based on a commissioning/provider model. However, this has been replaced with an Integrated Care Systems (ICSs) approach, aimed at improving health and wellbeing and reducing inequalities through local collaborative partnerships with public sector organizations, community groups, social enterprise organizations and other local agencies. Part of this new approach is an emphasis on the role of community assets (i.e., local resources), that are considered integral to promoting positive health and wellbeing outcomes. This paper presents research from a series of three research studies on "community assets" conducted in the East of England within a newly established ICS. Based on analysis of qualitative data highlighting the lived experience of community asset members, this paper shows the positive wellbeing impact on vulnerable community members that assets provide. Further insight on the local impact and the collaborative nature of the research is provided suggesting that new asset-based approaches recognize the social determinants of health. This presents a shift away from positivistic linear approaches to population health and wellbeing to a new non-linear collaborative approach to addressing health inequalities and promoting wellbeing. The authors suggest that exploring this through a complexity theory lens could illuminate this further. Finally, the authors warn that while community assets have an important role to play in empowering citizens and providing much needed support to vulnerable and disadvantaged communities, they are not a substitute for functioning funded public sector services that are currently being undermined by ongoing local governments funding cuts. As such, while community assets can help ameliorate some of the negative effects people experience due to economic, structural and health disadvantages, only a more fair and more equal distribution of resources can address growing health inequalities.
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Affiliation(s)
- Oonagh Corrigan
- School of Allied Health and Social Care, Faculty of Health, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Scott Danielsen
- Health, Partnerships and Wellbeing, Colchester City Council, Colchester, United Kingdom
| | | | - Pauline Lane
- School of Allied Health and Social Care, Faculty of Health, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
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McKenna C, Moyo B, Goodwin J. Barriers to using physical exercise as an intervention within inpatient mental health settings: A systematic review. Int J Ment Health Nurs 2024; 33:817-833. [PMID: 38332557 DOI: 10.1111/inm.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/05/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
Service providers find it difficult to implement Physical Exercise (PE) strategies in routine care within inpatient mental health settings even though they perceive it to be an effective therapy, with a robust evidence base. Identifying barriers that exist can assist with the development of future interventions and support PE services being introduced into mental health inpatient settings. The aim of this systematic review was to synthesise the evidence on the barriers or perceived barriers that exist amongst service users and providers when incorporating PE as an intervention within inpatient mental health settings. Using a narrative synthesis approach, four main themes were identified: (i) Barriers relating to service users' mental and physical health, (ii) Factors relating to service providers, (iii) Environmental factors and (iv) Cultural factors. Both service users and providers need more knowledge on implementing PE in inpatient mental health settings. Tailored programmes for service users are warranted, with specialist roles for staff developed.
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Affiliation(s)
- Catriona McKenna
- Eist Linn, Child and Adolescent Mental Health Unit, Bessborough, Cork, Ireland
| | - Beata Moyo
- Emergency Department, Naas General Hospital, Co. Kildare, Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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7
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Saz-Lara A, Martínez Hortelano JA, Medrano M, Luengo-González R, Miguel MG, García-Sastre M, Recio-Rodriguez JI, Lozano-Cuesta D, Cavero-Redondo I. Exercise prescription for the prevention and treatment of chronic diseases in primary care: Protocol of the RedExAP study. PLoS One 2024; 19:e0302652. [PMID: 38968237 PMCID: PMC11226089 DOI: 10.1371/journal.pone.0302652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/08/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Existing evidence supports the effectiveness of exercise in preventing and treating chronic diseases, yet its integration into clinical practice remains limited. This study protocol aims to address the evidence-practice gap by exploring barriers to exercise prescription in primary care and developing a clinical practice guideline (CPG). METHODS Employing a qualitative approach, focus groups will be conducted to investigate primary care professionals' challenges in prescribing exercise and patients' adherence to recommendations. Phenomenological analysis will facilitate data interpretation. Data triangulation, expert analysis, and quality criteria will ensure study reliability. The CPG development process is outlined, emphasizing transdisciplinary collaboration and patient involvement. CONCLUSION The RedExAP study responds to the imperative for evidence-based exercise integration in primary care. The study's combined qualitative exploration and CPG development present the potential to improve health outcomes and cost-effectiveness. By elucidating primary care professionals' and patients' perspectives, the study contributes to enhancing exercise prescription adoption. The innovative transdisciplinary approach aligns with the 2030 Agenda, promoting better population health and greater social well-being, showing promise in alleviating chronic disease burdens. This study's findings lay the groundwork for advancing evidence-based exercise interventions within primary care to transform chronic disease management.
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Affiliation(s)
- Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla‐La Mancha, Cuenca, Spain
| | - José Alberto Martínez Hortelano
- Health and Social Research Center, Universidad de Castilla‐La Mancha, Cuenca, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Alcalá de Henares, Spain
- Group for Research in Community Care and Social Determinants of Health, Madrid, Spain
| | - María Medrano
- Department of Health Sciences, Institute for Innovation & Sustainable Food Chain Development, Public University of Navarra, Pamplona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Luengo-González
- Nursing and Physiotherapy Department, University of Alcalá, Alcalá de Henares, Spain
- Group for Research in Nursing Care, Gregorio Marañón, Health Research Institute (IiSGM), Madrid, Spain
| | - Miriam Garrido Miguel
- Health and Social Research Center, Universidad de Castilla‐La Mancha, Cuenca, Spain
- Universidad de Castilla-La Mancha, Faculty of Nursing, Albacete, Spain
| | | | - José Ignacio Recio-Rodriguez
- Facultad de Enfermería y Fisioterapia (Universidad de Salamanca), Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, Spain
| | - Daniel Lozano-Cuesta
- Nursing and Physiotherapy Department, University of Alcalá, Alcalá de Henares, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla‐La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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McCartan CJ, Yap J, Best P, Breedvelt J, Breslin G, Firth J, Tully MA, Webb P, White C, Gilbody S, Churchill R, Davidson G. Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence. Cochrane Database Syst Rev 2024; 6:CD013557. [PMID: 38837220 PMCID: PMC11152184 DOI: 10.1002/14651858.cd013557.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Mental health problems contribute significantly to the overall disease burden worldwide and are major causes of disability, suicide, and ischaemic heart disease. People with bipolar disorder report lower levels of physical activity than the general population, and are at greater risk of chronic health conditions including cardiovascular disease and obesity. These contribute to poor health outcomes. Physical activity has the potential to improve quality of life and physical and mental well-being. OBJECTIVES To identify the factors that influence participation in physical activity for people diagnosed with bipolar disorder from the perspectives of service users, carers, service providers, and practitioners to help inform the design and implementation of interventions that promote physical activity. SEARCH METHODS We searched MEDLINE, PsycINFO, and eight other databases to March 2021. We also contacted experts in the field, searched the grey literature, and carried out reference checking and citation searching to identify additional studies. There were no language restrictions. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that focused on the experiences and attitudes of service users, carers, service providers, and healthcare professionals towards physical activity for bipolar disorder. DATA COLLECTION AND ANALYSIS We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined questions. We used the "best fit" framework synthesis based on a revised version of the Health Belief Model to analyse and present the evidence. We assessed methodological limitations using the CASP Qualitative Checklist. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) guidance to assess our confidence in each finding. We examined each finding to identify factors to inform the practice of health and care professionals and the design and development of physical activity interventions for people with bipolar disorder. MAIN RESULTS We included 12 studies involving a total of 592 participants (422 participants who contributed qualitative data to an online survey, 170 participants in qualitative research studies). Most studies explored the views and experiences of physical activity of people with experience of bipolar disorder. A number of studies also reported on personal experiences of physical activity components of lifestyle interventions. One study included views from family carers and clinicians. The majority of studies were from high-income countries, with only one study conducted in a middle-income country. Most participants were described as stable and had been living with a diagnosis of bipolar disorder for a number of years. We downgraded our confidence in several of the findings from high confidence to moderate or low confidence, as some findings were based on only small amounts of data, and the findings were based on studies from only a few countries, questioning the relevance of these findings to other settings. We also had very few perspectives of family members, other carers, or health professionals supporting people with bipolar disorder. The studies did not include any findings from service providers about their perspectives on supporting this aspect of care. There were a number of factors that limited people's ability to undertake physical activity. Shame and stigma about one's physical appearance and mental health diagnosis were discussed. Some people felt their sporting skills/competencies had been lost when they left school. Those who had been able to maintain exercise through the transition into adulthood appeared to be more likely to include physical activity in their regular routine. Physical health limits and comorbid health conditions limited activity. This included bipolar medication, being overweight, smoking, alcohol use, poor diet and sleep, and these barriers were linked to negative coping skills. Practical problems included affordability, accessibility, transport links, and the weather. Workplace or health schemes that offered discounts were viewed positively. The lack of opportunity for exercise within inpatient mental health settings was a problem. Facilitating factors included being psychologically stable and ready to adopt new lifestyle behaviours. There were positive benefits of being active outdoors and connecting with nature. Achieving balance, rhythm, and routine helped to support mood management. Fitting physical activity into a regular routine despite fluctuating mood or motivation appeared to be beneficial if practised at the right intensity and pace. Over- or under-exercising could be counterproductive and accelerate depressive or manic moods. Physical activity also helped to provide a structure to people's daily routines and could lead to other positive lifestyle benefits. Monitoring physical or other activities could be an effective way to identify potential triggers or early warning signs. Technology was helpful for some. People who had researched bipolar disorder and had developed a better understanding of the condition showed greater confidence in managing their care or providing care to others. Social support from friends/family or health professionals was an enabling factor, as was finding the right type of exercise, which for many people was walking. Other benefits included making social connections, weight loss, improved quality of life, and better mood regulation. Few people had been told of the benefits of physical activity. Better education and training of health professionals could support a more holistic approach to physical and mental well-being. Involving mental health professionals in the multidisciplinary delivery of physical activity interventions could be beneficial and improve care. Clear guidelines could help people to initiate and incorporate lifestyle changes. AUTHORS' CONCLUSIONS There is very little research focusing on factors that influence participation in physical activity in bipolar disorder. The studies we identified suggest that men and women with bipolar disorder face a range of obstacles and challenges to being active. The evidence also suggests that there are effective ways to promote managed physical activity. The research highlighted the important role that health and care settings, and professionals, can play in assessing individuals' physical health needs and how healthy lifestyles may be promoted. Based on these findings, we have provided a summary of key elements to consider for developing physical activity interventions for bipolar disorder.
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Affiliation(s)
- Claire J McCartan
- IMPACT Research Centre, Northern Health & Social Care Trust, Antrim, UK
| | - Jade Yap
- Mental Health Foundation, London, UK
| | - Paul Best
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - Josefien Breedvelt
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gavin Breslin
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Joseph Firth
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | | | | | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Gavin Davidson
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
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Jeong D, Park K, Lee J, Choi J, Du H, Jeong H, Li L, Sakai K, Kang S. Effects of Resistance Exercise and Essential Amino Acid Intake on Muscle Quality, Myokine, and Inflammation Factors in Young Adult Males. Nutrients 2024; 16:1688. [PMID: 38892621 PMCID: PMC11174838 DOI: 10.3390/nu16111688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Recently, many studies have been devoted to discovering nutrients for exercise-like effects. Resistance exercise and the intake of essential amino acids (EAAs) are known to be factors that can affect muscle mass and strength improvement. The purpose of this study was to investigate changes in muscle quality, myokines, and inflammation in response to resistance exercise and EAA supplementation. METHODS Thirty-four males volunteered to participate in this study. They were assigned to four groups: (1) placebo (CO), (2) resistance exercise (RE), (3) EAA supplementation, and (4) RE + EAA supplementation. Body composition, muscle quality, myokines, and inflammation were measured at baseline and four weeks after treatment. RESULTS Lean body fat had decreased in both RE and RE + EAA groups. Lean body mass had increased in only the RE + EAA group. In all groups except for CO, irisin, myostatin A, and TNF-α levels had decreased. The grip strength of the right hand and trunk flexion peak torque increased in the RE group. The grip strength of the left hand, trunk flexion peak torque, and knee flexion peak torque of the left leg were increased in RE + EAA. CONCLUSIONS RE, EAA, and RE + EAA could effectively improve the muscle quality, myokine, and inflammation factors of young adult males. This finding highlights the importance of resistance exercise and amino acid intake.
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Affiliation(s)
- Deokhwa Jeong
- Department of Smart Health Science and Technology, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (D.J.); (J.C.); (H.D.)
| | - Kyumin Park
- Center for Sports Science in Gangwon, Chuncheon 24239, Gangwon-do, Republic of Korea;
| | - Jinseok Lee
- Department of Sport Science, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (J.L.); (H.J.); (L.L.)
| | - Jiye Choi
- Department of Smart Health Science and Technology, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (D.J.); (J.C.); (H.D.)
| | - Haifeng Du
- Department of Smart Health Science and Technology, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (D.J.); (J.C.); (H.D.)
| | - Hyeongmo Jeong
- Department of Sport Science, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (J.L.); (H.J.); (L.L.)
| | - Liangliang Li
- Department of Sport Science, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (J.L.); (H.J.); (L.L.)
| | - Kenji Sakai
- Chemicals & Life Science Division, Nagase Korea Corporation, Seoul 04527, Republic of Korea;
| | - Sunghwun Kang
- Department of Smart Health Science and Technology, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (D.J.); (J.C.); (H.D.)
- Department of Sport Science, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; (J.L.); (H.J.); (L.L.)
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10
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Maricar N, Khan B, David T, Hyrich KL, Barton A. Factors facilitating and hindering South Asian immigrant adults from engaging in exercise and physical activity - a qualitative systematic review. BMC Public Health 2024; 24:1342. [PMID: 38762730 PMCID: PMC11102233 DOI: 10.1186/s12889-024-18288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/05/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Exercise and physical activity are key components of management in patients with rheumatic musculoskeletal diseases (RMD), but people of the South Asian communities have a lower level of engagement with these activities compared to their Caucasian counterparts. The aim of this qualitative systematic review was to determine the barriers and facilitators of exercise and physical activity in South Asian communities who have migrated and live in western countries, particularly in those who have RMD. METHODS Qualitative studies, published in English between 1999 and 2021 and including evaluation of barriers and/or facilitators to exercise or physical activity behaviour in people of South Asian adult communities who have migrated and/or lived in western countries were identified from Embase, MEDLINE, CINAHL, PsycINFO, Google Scholar and manual searches. The studies were appraised using the CASP checklist. Inductive thematic synthesis was used to identify common and global themes. RESULTS A total of 32 studies that discussed barriers and facilitators of physical activity in South Asian communities who have migrated and lived in western countries were used for this review but there were no studies identified that focussed specifically on those with RMD. Following appraisal of the reporting of the studies, 30 studies were included in the pooling of the results. The facilitators and barriers to physical activities were broadly categorized into 'extrinsic' and 'intrinsic' factors. Extrinsic factors such as 'opportunity' included environmental factors such as weather and safety; socioeconomic factors such as education, language and literacy, and support in the form of social, psychological and resources. Intrinsic factors included cultural factors, such as life stages and family influence, beliefs and knowledge, which impacted attitudes and skills. CONCLUSIONS This review has synthesised evidence of barriers or facilitators and identified potentially modifiable factors influencing physical activity and exercise engagement, which could form the basis of evidence-based interventions to promote participation in healthy behaviour change. Provision of a safe, comfortable and culturally acceptable environment together with culturally-aligned cognitive strategies to facilitate acquisition of exercise-efficacy skills could help engagement. REGISTRATION The systematic review was registered on PROSPERO, registration no. 289,235.
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Affiliation(s)
- Nasimah Maricar
- Northern Care Alliance NHS Foundation Trust, Salford Royal NHS Foundation Trust, Manchester, UK.
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK.
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK.
| | - Behram Khan
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Trixy David
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
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11
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Reis FJJ, Alaiti RK, Vallio CS, Hespanhol L. Artificial intelligence and Machine Learning approaches in sports: Concepts, applications, challenges, and future perspectives. Braz J Phys Ther 2024; 28:101083. [PMID: 38838418 PMCID: PMC11215955 DOI: 10.1016/j.bjpt.2024.101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The development and application of Artificial Intelligence (AI) and Machine Learning (ML) in healthcare have gained attention as a promising and powerful resource to change the landscape of healthcare. The potential of these technologies for injury prediction, performance analysis, personalized training, and treatment comes with challenges related to the complexity of sports dynamics and the multidimensional aspects of athletic performance. OBJECTIVES We aimed to present the current state of AI and ML applications in sports science, specifically in the areas of injury prediction, performance enhancement, and rehabilitation. We also examine the challenges of incorporating AI and ML into sports and suggest directions for future research. METHOD We conducted a comprehensive literature review, focusing on publications related to AI and ML applications in sports. This review encompassed studies on injury prediction, performance analysis, and personalized training, emphasizing the AI and ML models applied in sports. RESULTS The findings highlight significant advancements in injury prediction accuracy, performance analysis precision, and the customization of training programs through AI and ML. However, future studies need to address challenges such as ethical considerations, data quality, interpretability of ML models, and the integration of complex data. CONCLUSION AI and ML may be useful for the prevention, detection, diagnosis, and treatment of health conditions. In this Masterclass paper, we introduce AI and ML concepts, outline recent breakthroughs in AI technologies and their applications, identify the challenges for further progress of AI systems, and discuss ethical issues, clinical and research opportunities, and future perspectives.
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Affiliation(s)
- Felipe J J Reis
- Department of Physical Therapy, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil; Pain in Motion Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
| | - Rafael Krasic Alaiti
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de Sao Paulo (USP), Sao Paulo, Brazil; Research, Technology, and Data Science Office, Grupo Superador, Sao Paulo, Brazil
| | - Caio Sain Vallio
- Health Innovation, Data Science, and MLOps Semantics, São Paulo, Brazil
| | - Luiz Hespanhol
- Department of Physical Therapy, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil; Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers (UMC) location VU University Medical Center Amsterdam (VUmc), Amsterdam, the Netherlands
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12
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Pikula A, Gulati M, Bonnet JP, Ibrahim S, Chamoun S, Freeman AM, Reddy K. Promise of Lifestyle Medicine for Heart Disease, Diabetes Mellitus, and Cerebrovascular Diseases. Mayo Clin Proc Innov Qual Outcomes 2024; 8:151-165. [PMID: 38434935 PMCID: PMC10907160 DOI: 10.1016/j.mayocpiqo.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
The burden of noncommunicable chronic diseases has relevant and negative consequences to persons, health care systems, and economies worldwide. Chronic diseases are the leading cause of disability and mortality and are responsible for 90% of health care expenditure. The most common chronic diseases are diabetes mellitus (DM), cardiovascular disease, and cerebrovascular disease (stroke and vascular cognitive impairment). Modifiable risk factors (MRFs) for these conditions include hypertension, hyperlipidemia, smoking, poor diet, and low-physical activity; with hypertension being the most prevalent MRF. Most MRFs can be successfully targeted through lifestyle medicine (LSM), which is a medical specialty that addresses the root causes of chronic diseases through its primary, secondary, and tertiary preventative approaches. Lifestyle medicine comprises 6 pillars (nutrition, physical activity, sleep health, stress reduction, social connections, and substance use) which through various behavioral approaches, focus on regular physical activity, healthy eating, good quality and quantity sleep, and meaningful social connections coupled with the reduction of stress and substance use. This paper will briefly review the evidence and promise of individual LSM pillars in addressing the underlying MRFs of DM, cardiovascular and cerebrovascular disease (specifically stroke and vascular cognitive impairment). Lifestyle medicine holds a great promise for comprehensive and much improved population health. However, the adoption of LSM at the societal scale requires a multifaceted approach and widespread integration would galvanize a paradigm shift to prevent, treat or reverse chronic diseases from the root causes and achieve health equity.
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Affiliation(s)
- Aleksandra Pikula
- Department of Medicine, Division of Neurology, University of Toronto, Ontario, Canada
- Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health, Univeristy Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mahima Gulati
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Jonathan P. Bonnet
- Palo Alto Veteran’s Affairs, Palo Alto, California
- Stanford University School of Medicine, Palo Alto, California
| | - Sarah Ibrahim
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Ontario, Canada
- SickKids Research Institute, Toronto, Ontario, Canada
- Centre for Advancing Collaborative Healthcare & Education (CACHE), University of Toronto, Ontario, Canada
| | | | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
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Brown CEB, Richardson K, Halil-Pizzirani B, Atkins L, Yücel M, Segrave RA. Key influences on university students' physical activity: a systematic review using the Theoretical Domains Framework and the COM-B model of human behaviour. BMC Public Health 2024; 24:418. [PMID: 38336748 PMCID: PMC10854129 DOI: 10.1186/s12889-023-17621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/30/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Physical activity is important for all aspects of health, yet most university students are not active enough to reap these benefits. Understanding the factors that influence physical activity in the context of behaviour change theory is valuable to inform the development of effective evidence-based interventions to increase university students' physical activity. The current systematic review a) identified barriers and facilitators to university students' physical activity, b) mapped these factors to the Theoretical Domains Framework (TDF) and COM-B model, and c) ranked the relative importance of TDF domains. METHODS Data synthesis included qualitative, quantitative, and mixed-methods research published between 01.01.2010-15.03.2023. Four databases (MEDLINE, PsycINFO, SPORTDiscus, and Scopus) were searched to identify publications on the barriers/facilitators to university students' physical activity. Data regarding study design and key findings (i.e., participant quotes, qualitative theme descriptions, and survey results) were extracted. Framework analysis was used to code barriers/facilitators to the TDF and COM-B model. Within each TDF domain, thematic analysis was used to group similar barriers/facilitators into descriptive theme labels. TDF domains were ranked by relative importance based on frequency, elaboration, and evidence of mixed barriers/facilitators. RESULTS Thirty-nine studies involving 17,771 participants met the inclusion criteria. Fifty-six barriers and facilitators mapping to twelve TDF domains and the COM-B model were identified as relevant to students' physical activity. Three TDF domains, environmental context and resources (e.g., time constraints), social influences (e.g., exercising with others), and goals (e.g., prioritisation of physical activity) were judged to be of greatest relative importance (identified in > 50% of studies). TDF domains of lower relative importance were intentions, reinforcement, emotion, beliefs about consequences, knowledge, physical skills, beliefs about capabilities, cognitive and interpersonal skills, social/professional role and identity, and behavioural regulation. No barriers/facilitators relating to the TDF domains of memory, attention and decision process, or optimism were identified. CONCLUSIONS The current findings provide a foundation to enhance the development of theory and evidence informed interventions to support university students' engagement in physical activity. Interventions that include a focus on the TDF domains 'environmental context and resources,' 'social influences,' and 'goals,' hold particular promise for promoting active student lifestyles. TRIAL REGISTRATION Prospero ID-CRD42021242170.
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Affiliation(s)
- Catherine E B Brown
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
| | - Karyn Richardson
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | | | - Lou Atkins
- Centre for Behaviour Change, University College London, London, UK
| | - Murat Yücel
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, Australia
| | - Rebecca A Segrave
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Subías-Perié J, Navarrete-Villanueva D, Fernández-García ÁI, Moradell A, Lozano-Berges G, Gesteiro E, Pérez-Gómez J, Ara I, Gómez-Cabello A, Vicente-Rodríguez G, Casajús JA. Effects of a multicomponent training followed by a detraining period on metabolic syndrome profile of older adults. Exp Gerontol 2024; 186:112363. [PMID: 38244708 DOI: 10.1016/j.exger.2024.112363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
AIMS The present study sought to analyze the effects of 6-month multicomponent training (MCT) combined with a 4-month detraining on metabolic syndrome (MetS) profile among older adults with decreased functional capacity. METHODS This quasi-experimental study included a total of 104 older adults (80.5 ± 6.0 years) and the sample was divided into a training (TRAIN, n = 55) or control group (CON). Harmonized definition was used to diagnose the MetS. Functional capacity, blood biochemical parameters, blood pressure, body composition and anthropometric measurements were assessed 3 times. Analysis of variance for repeated measures and Wilcoxon signed-rank test were used to check the differences within groups. RESULTS TRAIN decreased diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDLC) and total fat mass during training period, whereas CON did not show any significant changes. During detraining, TRAIN increased HDLC, systolic blood pressure (SBP), waist circumference (WC) and total fat mass; and decreased glucose and fat free mass, whereas CON increased the concentration of glucose and HDLC. From baseline to post-detraining assessment, CON increased the concentration of triglycerides and the WC, while TRAIN only increased the WC (all p < 0.05). CONCLUSIONS Exercise can be a key component in the treatment of the MetS, since MCT seems to be effective to decrease DBP and total fat mass. Nevertheless, 4-months of detraining could cause a drop of total fat mass, but no in DBP. To avoid reversibility of the benefits obtained, it could be beneficial to promote continuing exercise programs. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT03831841.
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Affiliation(s)
- Jorge Subías-Perié
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain.
| | - David Navarrete-Villanueva
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain.
| | - Ángel Iván Fernández-García
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain.
| | - Ana Moradell
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain.
| | - Gabriel Lozano-Berges
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Eva Gesteiro
- Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; ImFine Research Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain.
| | - Jorge Pérez-Gómez
- Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; HEME (Health, Economy, Motricity and Education) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Ignacio Ara
- Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; GENUD-Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain; Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludables (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Alba Gómez-Cabello
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain; Centro Universitario de la Defensa, 50090 Zaragoza, Spain.
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - José Antonio Casajús
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), University of Zaragoza, 50013 Zaragoza, Spain; Department of Physiatry and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; Red Española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, 50009 Zaragoza, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
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Rijal A, Adhikari TB, Dhakal S, Maagaard M, Piri R, Nielsen EE, Neupane D, Jakobsen JC, Olsen MH. Effects of adding exercise to usual care on blood pressure in patients with hypertension, type 2 diabetes, or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. J Hypertens 2024; 42:10-22. [PMID: 37796224 DOI: 10.1097/hjh.0000000000003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Exercise is the most recommended lifestyle intervention in managing hypertension, type 2 diabetes, and/or cardiovascular disease; however, evidence in lowering blood pressure is still inconsistent and often underpowered. METHOD We conducted a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials adding any form of trialist defined exercise to usual care versus usual care and its effect on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in participants with hypertension, type 2 diabetes, or cardiovascular disease searched in different databases from inception to July 2020. Our methodology was based on PRISMA and Cochrane Risk of Bias-version1. Five independent reviewers extracted data and assessed risk of bias in pairs. RESULTS Two hundred sixty-nine trials randomizing 15 023 participants reported our predefined outcomes. The majority of exercise reported in the review was dynamic aerobic exercise (61%), dynamic resistance (11%), and combined aerobic and resistance exercise (15%). The trials included participants with hypertension (33%), type 2 diabetes (28%), or cardiovascular disease (37%). Meta-analyses and trial sequential analyses reported that adding exercise to usual care reduced SBP [mean difference (MD) MD: -4.1 mmHg; 95% confidence interval (95% CI) -4.99 to -3.14; P < 0.01; I2 = 95.3%] and DBP (MD: -2.6 mmHg; 95% CI -3.22 to -2.07, P < 0.01; I2 = 94%). Test of interaction showed that the reduction of SBP and DBP was almost two times higher among trials from low-and middle-income countries (LMICs) as compared to high-income countries (HICs). The exercise induced SBP reduction was also higher among participants with hypertension and type 2 diabetes compared to participants with cardiovascular disease. The very low certainty of evidence warrants a cautious interpretation of the present results. CONCLUSION Adding any type of exercise to usual care may be a potential complementary strategy for optimal management of blood pressure for patients with hypertension, type 2 diabetes, or cardiovascular disease, especially, in LMICs.PROSPERO registration number CRD42019142313.
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Affiliation(s)
- Anupa Rijal
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark
| | - Tara Ballav Adhikari
- Department of Public Health, Research Unit for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | - Sarmila Dhakal
- Center for Research on Environment, Health and Population Activities (CREPHA), Kusunti, Lalitpur, Nepal
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koge
| | - Reza Piri
- Department of Clinical Research, University of Southern Denmark
- Department of Nuclear Medicine, Odense University Hospital
- Department of Cardiology, Odense University Hospital, Odense Denmark
| | - Emil Eik Nielsen
- Department of Regional Health Research, University of Southern Denmark
- Department of Cardiology, Odense University Hospital, Odense Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University Baltimore, Mayland, USA
| | - Janus Christian Jakobsen
- Department of Regional Health Research, University of Southern Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark
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Ambros-Antemate JF, Beristain-Colorado MDP, Vargas-Treviño M, Gutiérrez-Gutiérrez J, Hernández-Cruz PA, Gallegos-Velasco IB, Moreno-Rodríguez A. Improving Adherence to Physical Therapy in the Development of Serious Games: Conceptual Framework Design Study. JMIR Form Res 2023; 7:e39838. [PMID: 37948110 PMCID: PMC10674146 DOI: 10.2196/39838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 04/25/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Insufficient levels of treatment adherence can have adverse effects on the outcomes of physical rehabilitation. To address this issue, alternative approaches to traditional therapies, such as serious games, have been designed to enhance adherence. Nevertheless, there remain gaps in the development of serious games concerning the effective implementation of motivation, engagement, and the enhancement of treatment adherence. OBJECTIVE This study aims to design a conceptual framework for the development of serious games that incorporate essential adherence factors to enhance patient compliance with physical rehabilitation programs. METHODS We formulated a conceptual framework using iterative techniques inspired by a conceptual framework analysis. Initially, we conducted a comprehensive literature review, concentrating on the critical adherence factors in physical rehabilitation. Subsequently, we identified, categorized, integrated, and synthesized the concepts derived from the literature review to construct the conceptual framework. RESULTS The framework resembles a road map, comprising 3 distinct phases. In the initial phase, the patient's characteristics are identified through an initial exploration. The second phase involves the development of a serious game, with a focus on enhancing treatment adherence by integrating the key adherence factors identified. The third phase revolves around the evaluation of the serious game. These phases are underpinned by 2 overarching themes, namely, a user-centered design and the GameFlow model. CONCLUSIONS The conceptual framework offers a detailed, step-by-step guide for creating serious games that incorporate essential adherence factors, thereby contributing to improved adherence in the physical rehabilitation process. To establish its validity, further evaluations of this framework across various physical rehabilitation programs and user groups are necessary.
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Affiliation(s)
| | | | - Marciano Vargas-Treviño
- Facultad de Sistemas Biológicos e Innovación Tecnológica, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Jaime Gutiérrez-Gutiérrez
- Facultad de Sistemas Biológicos e Innovación Tecnológica, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Pedro Antonio Hernández-Cruz
- Laboratorio de genómica y proteómica, Centro de investigación Universidad Nacional Autónoma de México-Universidad Autónoma "Benito Juárez" de Oaxaca, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Itandehui Belem Gallegos-Velasco
- Laboratorio de genómica y proteómica, Centro de investigación Universidad Nacional Autónoma de México-Universidad Autónoma "Benito Juárez" de Oaxaca, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
| | - Adriana Moreno-Rodríguez
- Facultad de Ciencias Químicas, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca de Juárez, Mexico
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Suri RS, Moist L, Lok C, Clase CM, Harris J, Reid RD, Ramsay T, Zimmerman D. A Simple Exercise Program for Patients With End-Stage Kidney Disease to Improve Strength and Quality of Life: Clinical Research Protocol. Can J Kidney Health Dis 2023; 10:20543581231205160. [PMID: 37901358 PMCID: PMC10605660 DOI: 10.1177/20543581231205160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Abstract
Background Most patients with end-stage kidney disease (ESKD) appreciate the importance of exercise and would like to increase their physical activity; however, they report a few key barriers, including (1) lack of physician advice to do so, (2) lack of safe and convenient programs (ie, appropriate for home or neighborhood), and (3) cost. Importantly, patients indicated in a previous survey that they would prefer an exercise program that improves muscle strength and symptoms, and are less interested in cardiovascular disease prevention. Objective To test the feasibility of a simple, prescribed exercise program using Nordic walking poles in patients with ESKD treated with dialysis. Design Randomized multicenter pilot trial of an exercise intervention that includes Nordic walking poles, personalized physician exercise prescriptions, pedometers, and access to exercise videos, compared with standard of care, in patients being treated with maintenance dialysis. Setting Multicenter tertiary care centers in Canada. Patients Ambulatory adult patients with ESKD treated with peritoneal dialysis or hemodialysis (HD) for at least 6 months at participating sites are potentially eligible. Inclusion criteria include ability to use Nordic walking poles (either de novo or in place of mobility aid) and to provide informed consent in English or in French. Exclusion criteria include (1) any absolute contraindication to exercise, (2) baseline step count >8000 steps/day, (3) planned living donor kidney transplant, and (4) participation in another interventional trial that may affect the results of this study. Methods This is a randomized multicenter pilot trial of an exercise intervention that consists of a prescription to exercise using Nordic walking poles, a pedometer to track activity, and access to exercise videos, with the comparator of standard of care (dialysis unit staff encouragement to exercise) in patients being treated with maintenance dialysis. Randomization is concealed and uses a 1:1 ratio for group assignment. Our specific aims are to determine the feasibility of patient recruitment, adherence to the exercise program (verified by step counts), and efficacy of the intervention on patient-important outcomes that were assessed as a priority by patients in a prior survey-specifically strength, fatigue, and sleep. We record days spent in hospital and loss of independent living to inform sample size calculations for a definitive trial of exercise in patient with ESKD treated with dialysis. Adverse events are closely monitored. Outcomes Primary: Our recruitment goal is 90 to 150 patients over 27 months; adherence success will be defined if >75% of randomized patients, excluding those who are transplanted or deceased, achieve >80% of their prescribed steps at 6 and 12 months. Secondary Efficacy Outcomes: (1) strength-hand grip strength and 5 times sit to stand, (2) energy-Short Form (SF)-36 vitality subscale, and (3) sleep-Pittsburg Sleep Quality Index will be assessed at baseline, 6, and 12 months. Results Trial recruitment started before the COVID-19 pandemic and the pandemic led to many interruptions and delays. Online exercise Web sites and a tailored video were added to the protocol to encourage activity when participants were unable or reluctant to walk in public places. Limitations This trial was designed to include ambulatory patients with ESKD and does not address the burden of disease in patients with very restricted mobility. Trial Registration NCT03787589.
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Affiliation(s)
- Rita S. Suri
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Louise Moist
- Department of Medicine, London Health Science Centre, Western University, London, ON, Canada
| | - Charmaine Lok
- Department of Medicine, University Health Network, University of Toronto, ON, Canada
| | - Catherine M. Clase
- Department of Medicine, Hamilton Centre for Kidney Research, McMaster University, Hamilton, ON, Canada
| | - Jennifer Harris
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, ON, Canada
| | - Robert D. Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, ON, Canada
| | - Tim Ramsay
- School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Deborah Zimmerman
- Department of Medicine, Ottawa Hospital, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
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18
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Singh V, Pollard K, Okasheh R, Percival J, Cramp F. Understanding the role of allied health professional support workers with exercise qualifications in the delivery of the NHS Long Term Plan within allied health professional services in England. BMJ Open Sport Exerc Med 2023; 9:e001625. [PMID: 37654513 PMCID: PMC10465888 DOI: 10.1136/bmjsem-2023-001625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
Demand modelling for the allied health professionals (AHPs) workforce showed that significant expansion would be needed to successfully deliver on the National Health Service (NHS) Long Term Plan. The aim was to explore the use of AHP support workers with exercise qualifications in AHP services and to understand their current and potential role in NHS commissioned AHP services in England. The project had two phases and took place between October 2020 and January 2021. In phase one, an electronic survey was carried out to identify the scope and variation of exercise professionals working in AHP support roles in NHS commissioned services. Semi-structured interviews were conducted in phase two to gain further understanding about the experiences of those involved in AHP commissioned services. Survey data were analysed using descriptive statistics and interview data were qualitatively analysed using thematic analysis. Recorded interviews were transcribed and initially coded. Coding was then refined and themes were identified. Support workers with exercise qualifications made a valued contribution to AHP services and were considered cost-effective in delivering a specialised exercise intervention. AHP support workers contributed to a range of tasks relating to clinical exercise prescription. Collated data highlighted inconsistency in the way AHP support workers with exercise qualifications identified themselves, despite similar roles. Variation existed in the level of autonomy for AHP support workers with exercise qualifications, even within the same NHS Agenda for Change band. Attempts to manage this disparity involved numerous governance processes to ensure safe, high-quality healthcare in the context of delegation to support workers. Limited training and development opportunities and the lack of career progression for support workers were consistently acknowledged as a source of frustration and hindrance to individuals fulfilling their potential. AHP support workers with exercise qualifications have potential to positively impact service delivery providing added value to the NHS workforce.
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Affiliation(s)
- Vincent Singh
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Katherine Pollard
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rasha Okasheh
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - John Percival
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Fiona Cramp
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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19
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Jiang H, Mei Y, Lin B, Wang W, Wang X, Zhao Z, Zhang ZX. Perspectives of cardiac rehabilitation in patients who had a stroke: a protocol for a qualitative study review. BMJ Open 2023; 13:e071964. [PMID: 37536962 PMCID: PMC10401236 DOI: 10.1136/bmjopen-2023-071964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Stroke has a high incidence and disability rate, and its recurrence and readmission rates are rising, making it the second-leading cause of mortality in the globe. Cardiac rehabilitation is a well-known, evidence-based strategy that might serve as an additional preventative programme. Prior quantitative research has proven the positive results and high practicability of cardiac rehabilitation for patients who had a stroke, however, cardiac rehabilitation is not yet a routine component of stroke rehabilitation worldwide. It might be useful to conduct meta-integration of previous qualitative studies to understand if existing cardiac rehabilitation programme meets the needs of patients who had a stroke. Therefore, the purpose of this study is to combine systematically the perspectives on benefits, barriers and facilitating factors of cardiac rehabilitation in patients who had a stroke. METHODS AND ANALYSIS There will be a search of PubMed, Web of Science, Embase, Scopus, CINAHL and PsycINFO databases. In addition, grey literature from Google Scholar, OpenGrey, PyARXiv, bioRxiv and medRxiv will also be searched. Included studies will be qualitative studies or findings from mixed-method research involving patients who engage in CR after a stroke. Regardless of the publishing date and context, English-language articles will be reviewed. Two impartial reviewers will screen studies and extract data from the included studies. According to the Joanna Briggs Institute Centre for Evidence-Based Health Care Quality Evaluation Criteria for qualitative research, the methodology of the included literature will be examined. For data synthesis, the pooling meta-integration approach and Noblit and Hare's seven steps of meta-ethnography will be used. ETHICS AND DISSEMINATION Because there will be no collection of primary data, this systematic review is exempt from the need that gets ethical approval. The findings of the review will be made public by publishing them in scholarly journals and presenting them at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42023387534.
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Affiliation(s)
- Hu Jiang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
- The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Beilei Lin
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wenna Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoxuan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhixin Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhen-Xiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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20
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Musa S, Dergaa I, Al Shekh Yasin R, Singh R. The Impact of Training on Electronic Health Records Related Knowledge, Practical Competencies, and Staff Satisfaction: A Pre-Post Intervention Study Among Wellness Center Providers in a Primary Health-Care Facility. J Multidiscip Healthc 2023; 16:1551-1563. [PMID: 37287690 PMCID: PMC10243608 DOI: 10.2147/jmdh.s414200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
Background The transition to electronic health records (EHR) has improved the quality of health-care delivery and patient safety. However, poor usability and incongruent workflow may impose a significant burden on documentation and time management, resulting in staff burnout. We aimed to (i) evaluate the effectiveness of personalized EHR training on wellness providers' knowledge and practical competencies, and (ii) assess staff satisfaction regarding the EHR usage post-training. Methodology An interventional study was conducted between July 15, 2021, and March 1, 2022, among 14 wellness staff (age: 38 ± 3.9 years; 7 males, 7 females) in the Wellness Center-Rawdat Al-Khail Health Center. Six months of blended training was delivered. The impact of training was assessed using a pre-post survey on the knowledge and practical competencies related to EHR usage. Staff satisfaction was assessed post-training. Results Majority of respondents had improvement in identifying the advantages of EHR: improve confidentiality of care (pre = 35.7% vs post = 100%, p = 0.001), reduce medical errors (pre = 35.7% vs post = 85.7%, p = 0.02), improve quality of health care (pre = 35.7% vs post = 100%, p = 0.001), and reduce wait time (pre = 42.9% vs post = 85.7%, p = 0.03). Time performing these tasks by massage therapists/receptionists was reduced: viewing/editing ambulatory organizer (pre = 20±0 s vs post = 10±0 s), access PM office (pre = 155±136 s vs post = 10±0 s), selection/access patient chart (pre = 75±30 s vs post = 30±20 s), check-in/out (pre = 120±0 s vs post = 60±0 s), and view/edit massage form (pre = 135±75.5 s vs post = 60±0 s). For gym instructors, time to access ambulatory organizer (pre = 30±0 s vs post = 10±0 s), view/edit the gym form (pre = 101±57 s vs post = 71±36 s), view patients' clinical data (pre = 60±70 s vs post = 10±3 s), and place referral orders (pre = 197±144 vs post = 82±23 s) was reduced. A mean percentage score of 65.4±38.7 indicated very good staff satisfaction. Conclusion This tailored, hands-on training has been well received and effectively improved wellness staff knowledge, competencies, and satisfaction relative to EHR functionalities.
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Affiliation(s)
- Sarah Musa
- Department of Preventative Health, Primary Health Care Corporation (PHCC), Doha, Qatar
| | - Ismail Dergaa
- Department of Preventative Health, Primary Health Care Corporation (PHCC), Doha, Qatar
| | - Rawia Al Shekh Yasin
- Department of Quality & Patient Safety, Primary Health Care Corporation (PHCC), Doha, Qatar
| | - Rajvir Singh
- Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
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21
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Vishnubala D, Iqbal A, Marino K, Pandya T, Salman D, Pringle A, Nykjaer C, Bazira P, Eastwood D, Finn G. Creating a sport and exercise medicine undergraduate syllabus: a delphi study. BMC MEDICAL EDUCATION 2023; 23:179. [PMID: 36959591 PMCID: PMC10035170 DOI: 10.1186/s12909-023-04139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sport and Exercise Medicine (SEM) is a growing speciality in the United Kingdom (UK). This growth has not been replicated in SEM teaching at an undergraduate level and SEM-related topics in schools of medicine in the UK are under-represented. As SEM continues to develop as a specialty it is important to consider how it is embedded at all levels of training. The aim of this project was to establish a consensus on SEM-related skills and knowledge relevant for undergraduate medical students in the UK, ultimately creating a curriculum of learning objectives (LOs). METHODS A modified Delphi survey was utilised to seek consensus on LOs suitable for incorporation into UK medical school curricula. An expert panel with adequate knowledge in the field was recruited. The initial curriculum was created by the research team using already established postgraduate SEM curricula. All learning objectives were sent to the expert panel for opinions in phases. Levels of agreement and comments made by the expert panel were reviewed after each phase until a consensus on each learning objective was made. RESULTS The expert panel was made up of 45 individuals, with 35 also completing phase 2 (78% retention rate). The initial curriculum contained 58 learning objectives separated into 9 themes. In phase 1 31% (18/58) were accepted outright, 48% (28/58) were altered and 19% (11/58) were rejected. Two additional learning objectives were added. Of the 49 LOs included in phase 2, 98% (48/49) were accepted. The final curriculum was made up of 9 sub-themes and 48 LOs. CONCLUSION Sport and Exercise Medicine is a broad ranging and rapidly growing speciality. It is important to establish SEM education in all levels of medical education, including undergraduate level. This is the first published version of a Delphi SEM curriculum for undergraduate medical teaching.
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Affiliation(s)
- Dane Vishnubala
- Hull York Medical School, York, UK.
- University of Leeds, Leeds, UK.
- School of Public Health/MSK lab, Imperial College London, London, UK.
- University of York, Heslington, York, YO105DD, UK.
| | | | | | - Tej Pandya
- Royal Bolton Hospital, Minerva Road, Farnworth, BL4OJR, UK
| | - David Salman
- School of Public Health/MSK lab, Imperial College London, London, UK
| | - Andy Pringle
- Sport Outdoor and Exercise Science, University of Derby, Derby, UK
| | - Camilla Nykjaer
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
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22
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Goh J, Wong E, Soh J, Maier AB, Kennedy BK. Targeting the molecular & cellular pillars of human aging with exercise. FEBS J 2023; 290:649-668. [PMID: 34968001 DOI: 10.1111/febs.16337] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/29/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023]
Abstract
Biological aging is the main driver of age-associated chronic diseases. In 2014, the United States National Institute of Aging (NIA) sponsored a meeting between several investigators in the field of aging biology, who identified seven biological pillars of aging and a consensus review, "Geroscience: Linking Aging to Chronic Disease," was published. The pillars of aging demonstrated the conservation of aging pathways in diverse model organisms and thus represent a useful framework with which to study human aging. In this present review, we revisit the seven pillars of aging from the perspective of exercise and discuss how regular physical exercise can modulate these pillars to stave off age-related chronic diseases and maintain functional capacity.
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Affiliation(s)
- Jorming Goh
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Centre for Healthy Longevity, National University Health System (NUHS), Singapore
| | - Esther Wong
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Centre for Healthy Longevity, National University Health System (NUHS), Singapore
| | - Janjira Soh
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Andrea Britta Maier
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Centre for Healthy Longevity, National University Health System (NUHS), Singapore.,Department of Medicine, National University of Singapore, Singapore.,Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Brian Keith Kennedy
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Centre for Healthy Longevity, National University Health System (NUHS), Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
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23
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Franklin BA, Wedig IJ, Sallis RE, Lavie CJ, Elmer SJ. Physical Activity and Cardiorespiratory Fitness as Modulators of Health Outcomes: A Compelling Research-Based Case Presented to the Medical Community. Mayo Clin Proc 2023; 98:316-331. [PMID: 36737120 DOI: 10.1016/j.mayocp.2022.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
The beneficial health effects and prognostic significance of regular moderate-to-vigorous physical activity (PA), increased cardiorespiratory fitness (CRF), or both are often underappreciated by the medical community and the patients they serve. Individuals with low CRF have higher annual health care costs, higher rates of surgical complications, and are two to three times more likely to die prematurely than their fitter counterparts when matched for risk factor profile or coronary calcium score. Increased levels of habitual PA before hospitalization for acute coronary syndromes are also associated with better short-term cardiovascular outcomes. Accordingly, this review examines these relations and the potential underlying mechanisms of benefit (eg, exercise preconditioning), with specific reference to the incidence of cardiovascular, cancer, and coronavirus diseases, and the prescriptive implications and exercise thresholds for optimizing health outcomes. To assess the evidence supporting or refuting the benefits of PA and CRF, we performed a literature search (PubMed) and critically reviewed the evidence to date. In aggregate, these data are presented in the context of clarifying the impact that regular PA and/or increased CRF have on preventing and treating chronic and infectious diseases, with reference to evidence-based exercise thresholds that the medical community can embrace and promote.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation Department, Beaumont Health, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Isaac J Wedig
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA
| | - Robert E Sallis
- Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA.
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Lapointe T, Houle J, Sia YT, Payette M, Trudeau F. Addition of high-intensity interval training to a moderate intensity continuous training cardiovascular rehabilitation program after ischemic cerebrovascular disease: A randomized controlled trial. Front Neurol 2023; 13:963950. [PMID: 36686521 PMCID: PMC9846748 DOI: 10.3389/fneur.2022.963950] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/01/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Moderate intensity continuous training (MICT) is usually recommended for stroke or transient ischemic attack (TIA) patients. High intensity interval training (HIIT) has emerged as a potentially effective method for increasing cardiorespiratory fitness (CRF) among clinical populations. Its effectiveness remains to be demonstrated after stroke. A combined program of HIIT and MICT was designed to create a realistic exercise program implemented for a clinical setting to help patients become more active. Purpose This study aimed to compare the effects of a 6-month exercise program with either MICT only or a combination of HIIT and MICT and a control group in terms of CRF, cardiovascular risk factors, functionality, cognitive function (Montreal Cognitive Assessment) and depression markers (Hospital Anxiety and Depression Scale). Methods This randomized controlled trial started with 52 participants (33 men and 19 women, mean age: 69.2 ± 10.7) divided into three groups: HIIT + MICT combined, MICT, and control. Both exercise groups consisted of 4 weekly sessions including supervised and at-home exercise. Outcomes were assessed at T0 (baseline measure), T6 (end of exercise protocols), and T12 (follow-up), 40 participants having completed the 12-month follow-up. Results At T6, both HIIT+MICT and MICT programs provided a similar increase of CRF (3 ml·min-1·kg-1) from baseline (p < 0.01), while the control group showed a global slight decrease. Despite some decrease of CRF at T12 compared to T6, improvement persisted 6 months post-intervention (HIIT + MICT: p < 0.01 and MICT: p < 0.05). The control group decreased compared with baseline (p < 0.05). The two exercise programs induced a comparable increase in self-reported physical activity and a decrease in anxiety and depression markers. Participants in HIIT + MICT and MICT programs declared a good degree of acceptability assessed by the Acceptability and Preferences Questionnaire. Conclusion A 6-month HIIT + MICT combined program and a standard MICT program induced similar improvements in CRF, self-reported physical activity and anxiety and depression markers among patients with prior ischemic stroke or TIA compared with a control group. These effects appear to persist over time. Addition of HIIT was safe and considered acceptable by participants. Our results do not support any superiority of the combination HIIT + MICT nor disadvantage vs. MICT in this population.
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Affiliation(s)
- Thalia Lapointe
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Ying-Tung Sia
- Integrated University Center for Health and Social Services Mauricie- and Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Marika Payette
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - François Trudeau
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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25
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Sarvilina IV, Danilov AB, Tkacheva ON, Gromova OA, Solovieva EY, Dudinskaya EN, Rozanov AV, Kartashova EA. [Influence of chronic pain in osteoarthritis on the risk of cardiovascular diseases and modern methods of drug prevention]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-30. [PMID: 37315238 DOI: 10.17116/jnevro202312305120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The purpose of the review of scientific medical literature was to evaluate the data of the epidemiology of osteoarthritis (OA) and cardiovascular diseases (CVD) with the analysis of risk factors, pathophysiological and pathobiochemical mechanisms of the relationship between OA and the risk of developing CVD in the presence of chronic pain, modern strategies for screening and management of this cohort of patients, the mechanism of action and pharmacological effects of chondroitin sulfate (CS). Conclusions were drawn about the need for additional clinical and observational studies of the efficacy and safety of the parenteral form of CS (Chondroguard) in patients with chronic pain in OA and CVD, improvement of clinical recommendations for the treatment of chronic pain in patients with OA and cardiovascular risk, with special attention to interventions that eliminate mobility restrictions in patients and the inclusion of basic and adjuvant therapy with DMOADs to achieve the goals of multipurpose monotherapy in patients with contraindications to standard therapy drugs.
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Affiliation(s)
- I V Sarvilina
- Medical Center «Novomedicina» LLC, Rostov-on-Don, Russia
| | - Al B Danilov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O N Tkacheva
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - O A Gromova
- Federal Research Center «Computer Science and Control», Moscow, Russia
| | - E Yu Solovieva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E N Dudinskaya
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Rozanov
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
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Pellegrino JK, Anthony TG, Gillies P, Arent SM. The exercise metabolome: acute aerobic and anaerobic signatures. J Int Soc Sports Nutr 2022; 19:603-622. [PMID: 36250148 PMCID: PMC9559054 DOI: 10.1080/15502783.2022.2115858] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Exercise modality differentially alters body composition and physical performance. Metabolic changes underlying these outcomes can be tracked through assessment of circulating metabolites. Here, global responses to an acute bout of aerobic or anaerobic exercise were compared in the serum of male and female subjects using a discovery-based metabolomics platform. Methods On separate days, 40 healthy, active participants completed 45 min of aerobic cycling or resistance exercise, and blood samples were collected at rest, immediately after (T1) and 1 hour post-exercise (T2) to examine the serum metabolomic landscape. Results The two exercise metabolomes appeared more similar than different in this healthy cohort. Overall, metabolomic signatures of both exercise modalities were markedly altered from rest at T1, and returned toward baseline by T2. Metabolomic perturbations at T1 and the T1-T2 rate of recovery post-exercise were greater following aerobic cycling than resistance exercise. Shared signatures included elevations in purine metabolism, substrate catabolism and mobilization, and inflammatory signaling. Aerobic exercise resulted in greater substrate diversity and use of fatty acids, whereas resistance exercise displayed higher purine turnover and glycolytic flux. Discussion Individual metabolite differences between conditions were seen in magnitude but not direction. Metabolomic signatures of the exercise responses appeared fairly robust across exercise modalities. An initial perturbation and subsequent shift toward recovery by an hour post-exercise defined the signature in our healthy cohort. The expedited recovery following aerobic cycling may be explained by globally elevated lipid metabolism.
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Affiliation(s)
- Joseph K. Pellegrino
- Department of Health and Human Performance, University of Scranton, Scranton, PA, USA
| | - Tracy G Anthony
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Peter Gillies
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Shawn M. Arent
- Department of Exercise Sciences, University of South Carolina, Columbia, SC, USA
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Gollie JM, Sen S. Circulating Endothelial Progenitor and Mesenchymal Stromal Cells as Biomarkers for Monitoring Disease Status and Responses to Exercise. Rev Cardiovasc Med 2022; 23:396. [PMID: 37680455 PMCID: PMC10483375 DOI: 10.31083/j.rcm2312396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Noncommunicable chronic diseases, such as obesity, cardiovascular disease (CVD), and type 2 diabetes (T2D), pose significant health challenges globally. Important advances have been made in the understanding of the pathophysiologal mechanisms and treatment of noncommunicable diseases in recent years. Lack of physical activity is a primary contributor to many noncommunicable diseases including metabolic syndrome, T2D, CVD, and obesity. Certain diabetes medications and non-pharmaceutical interventions, such as physical activity and exercise, are shown to be effective in decreasing the CVD risks associated with heart disease, stroke, obesity, prediabetes, and T2D. The ability to measure and analyze circulating adult stem cells (ASCs) has gained particular interest due to their potential to identify at-risk individuals and implications in various therapeutics. Therefore, the purpose of this narrative review is to (1) provide an overview of ASCs; specifically endothelial progenitor cells (EPCs) and mesenchymal stromal cells (MSCs), (2) describe the responses of these cells to acute and chronic exercise, and (3) highlight the potential effect of exercise on EPCs and MSCs in aging and disease. EPCs are circulating cells, abundantly available in peripheral blood, bone marrow, and umbilical cord, and are defined by cell surface markers such as CD34+. EPCs are expected to play an important role in angiogenesis and neovascularization and have been implicated in the treatment of CVD. MSCs are essential for maintaining tissue and organ homeostasis. MSCs are defined as multipotent heterogeneous cells that can proliferate in vitro as plastic-adherent cells, have fibroblast-like morphology, form colonies in vitro, and can differentiate into ostyeoblasts, adipocytes, chondroblasts, and myoblasts. In the presence of aging and disease, EPCs and MSCs decrease in quantity and functional capacity. Importantly, exercise facilitates EPC differentiation and production from bone marrow and also helps to promote migration and homing to the hypoxic and damaged tissue which in turn improve angiogenesis and vasculogenesis. Similarly, exercise stimulates increases in proliferation and migratory activity of MSCs. Despite the reported benefits of exercise on EPC and MSC number and function, little is known regarding the optimal exercise prescription for aging and clinical populations. Moreover, the interactions between medications and exercise on EPCs and MSCs is currently unclear. Use of ASCs as a biomarker have the potential to revolutionize the management of patients with a variety of metabolic and obesity related disorders and also pro-inflammatory diseases. Further investigation of clinical entities are urgently needed to understand the implications of interventions such as exercise, diet, and various medications on EPC and MSC quantity and function in aging and clinical populations.
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Affiliation(s)
- Jared M. Gollie
- Research & Development, VA Medical Center, Washington, DC 20422, USA
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, DC 20037, USA
| | - Sabyasachi Sen
- Department of Medicine, VA Medical Center, Washington, DC 20422, USA
- Department of Medicine, The George Washington University, Washington, DC 20037, USA
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Jackson C, Finikarides L, Freeman ALJ. The adverse effects of trastuzumab-containing regimes as a therapy in breast cancer: A piggy-back systematic review and meta-analysis. PLoS One 2022; 17:e0275321. [PMID: 36454979 PMCID: PMC9714930 DOI: 10.1371/journal.pone.0275321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Trastuzumab is a valuable therapy option for women with ERBB2(HER2)+ breast cancer tumours, often used in combination with chemotherapy and alongside other therapies. It is known to have adverse effects, but these have proved difficult to separate from the effects of other concurrent therapies patients are usually taking. This study aims to assess the adverse effects specifically attributable to trastuzumab, and whether they vary by patient subgroup or concurrent therapies. METHODS As registered on PROSPERO (CRD42019146541), we used previous systematic reviews as well as the clinicaltrials.gov registry to identify randomised controlled trials in breast cancer which compared treatment regimes with and without trastuzumab. Neoadjuvant, adjuvant and metastatic settings were examined. Data was extracted from those which had, as of July 2022, reported adverse events. Risk of bias was assessed using ROB2. Primary outcomes were adverse events of any type or severity (excluding death). A standard random-effects meta-analysis was performed for each outcome independently. In order to ascertain whether adverse effects differed by individual factors such as age or tumour characteristics, or by use of trastuzumab concurrently with hormone therapy, we examined individual-level patient data for one large trial, HERA. RESULTS 79 relevant trials were found, of which 20 contained comparable arms of trastuzumab-containing therapy and corresponding matched therapy without trastuzumab. This allowed a comparison of 8669 patients receiving trastuzumab versus 9556 receiving no trastuzumab, which gave a list of 25 statistically and clinically significant adverse effects related to trastuzumab alone: unspecified pain, asthenia, nasopharyngitis, skin disorders (mainly rash), dyspepsia, paraesthesia, infections (often respiratory), increased lacrimation, diarrhoea, myalgia, oedema (limb/peripheral), fever, nose bleeds, cardiac events, insomnia, cough, back pain, dyspnoea, chills, dizziness or vertigo, hypertension, congestive heart failure, increased levels of aspartate aminotransferase, gastrointestinal issues and dehydration. Analysis of individual patient-level data from 5102 patients suggested that nausea is slightly more likely for women taking trastuzumab who are ER+ /also taking hormone therapy than for those who are ER-/not taking hormone therapy; no other potential treatment-subgroup interactions were detected. We found no evidence for significantly increased rates of neutropenia, anaemia or lymphopenia in patients on trastuzumab-containing regimes compared to those on comparable regimes without trastuzumab. CONCLUSIONS This meta-analysis should allow clinicians and patients to better identify and quantify the potential adverse effects of adding trastuzumab to their treatment regime for breast cancer, and hence inform their decision-making. However, limitations include serious risk of bias due to heterogeneity in reporting of the outcomes and the open-label nature of the trials.
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Affiliation(s)
| | - Leila Finikarides
- Winton Centre for Risk & Evidence Communication, Department of Pure Mathematics & Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | - Alexandra L. J. Freeman
- Winton Centre for Risk & Evidence Communication, Department of Pure Mathematics & Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
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29
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de Santana GN, Dibai-Filho AV, da Silva Júnior JEF, da Silva ACB, de Jesus SFC, dos Santos PG, Fidelis-de-Paula-Gomes CA. Association between adherence to a home exercise program and central sensitization, pain intensity, and functionality in individuals with knee osteoarthritis. BMC Musculoskelet Disord 2022; 23:989. [DOI: 10.1186/s12891-022-05959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Objective
To analyze the association between adherence to a home exercise program and central sensitization, pain intensity, and functionality in individuals with knee osteoarthritis (KOA).
Methods
A cross-sectional study was conducted involving 57 individuals with KOA. Evaluations were performed using the Exercise Adherence Rating Scale (EARS), the numerical rating scale (NRPS), the International Knee Documentation Committee (IKDC), The Central Sensitization Inventory (CSI), and the 30 sec sit and stand test (30SSST). Histograms were created to determine the normality of the data. The Kolmogorov-Smirnov test was used to determine the normality of the data. Thus, Pearson’s (r) and determination (R2) correlation coefficients were calculated to determine the strength of associations between variables.
Results
No significant association was found between adherence behavior or reasons for adherence and central sensitization symptoms, the intensity of pain on rest and movement, knee disability symptoms, and functionality.
Conclusion
No significant association was identified between adherence to a home exercise program and central sensitization, pain intensity, and functionality in individuals with KOA.
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Munroe D, Moore MA, Bonnet JP, Rastorguieva K, Mascaro JS, Craighead LW, Haack CI, Quave CL, Bergquist SH. Development of Culinary and Self-Care Programs in Diverse Settings: Theoretical Considerations and Available Evidence. Am J Lifestyle Med 2022; 16:672-683. [PMID: 36389039 PMCID: PMC9644137 DOI: 10.1177/15598276211031493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/20/2021] [Accepted: 06/23/2021] [Indexed: 09/15/2024] Open
Abstract
Culinary-based self-care programs are innovative and increasingly utilized models for catalyzing behavior change and improving health and well-being. The content, duration, and delivery of existing programs vary considerably. Between January and August 2019, we developed a teaching kitchen and self-care curriculum, which was administered as part of a year-long worksite well-being program to employees at an academic healthcare system. The curriculum domains included culinary skills, nutrition, physical activity, yoga, stress management, mindful eating, and ethnobotany. An informal systematic literature search was performed to assemble and evaluate key principles and practices related to self-care domains, learning methodologies, and programmatic design considerations. Here, we provide a qualitative summary of the evidence-informed development of the curriculum intervention.
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Affiliation(s)
- Dominique Munroe
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Miranda A. Moore
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Jonathan P. Bonnet
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Krystyna Rastorguieva
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Jennifer S. Mascaro
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Linda W. Craighead
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Carla I. Haack
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Cassandra L. Quave
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
| | - Sharon H. Bergquist
- American University of Integrated
Sciences, St. Michael, Barbado (DM); Department of Family and Preventive
Medicine; Emory University, Atlanta, GA, USA (MAM, JPB, JSM); Emory Healthcare, Atlanta, GA, USA (KR); Department of Psychology (LWC); Department of
Surgery, Emory University, Atlanta, GA, USA (CIH); Department of Dermatology, Emory University (CLQ); and Department of Medicine, Emory University, Atlanta, GA, USA (SHB)
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Hafsteinsson Östenberg A, Enberg A, Pojskic H, Gilic B, Sekulic D, Alricsson M. Association between Physical Fitness, Physical Activity Level and Sense of Coherence in Swedish Adolescents; An Analysis of Age and Sex Differences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12841. [PMID: 36232140 PMCID: PMC9565133 DOI: 10.3390/ijerph191912841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the association between physical fitness, physical activity, and sense of coherence (SOC) in Swedish adolescents (n = 2028 males, n = 1287 females) aged 14 to 18 using a cross-sectional design. METHODS Using the Swedish Physical power Mental harmony and Social capacity (FMS) student profile, participants performed physical tests measuring their cardiovascular ability (CV) and muscular strength. Questionnaires were used to measure physical activity levels (PA), the participation in organized physical training, sedentary behavior (SB), screen time, and SOC value. Multiple linear regression analyses were used to analyze the association between SOC and independent variables. RESULTS The regression analyses explained a small, shared variance between SOC and the independent variables in boys (4.3%) and girls (3.3%). SB showed a positive association with SOC both in girls (β = 0.114, p = 0.002) and boys (β = 0.109, p = 0.013). Abdominal strength was positively associated, while VO2max was inversely associated, with SOC (β = 0.113, p = 0.022; β = -0.109, p = 0.026, respectively) in boys. Girls had poorer fitness than boys did across all age groups except at age 18. PA levels decreased from age 14 to 18 in girls and boys, but without differences between sexes. Abdominal strength decreased from age 14 to 18 in girls and boys. In general, girls had lower SOC than boys across all age groups. CONCLUSIONS Poor sedentary behavior was significantly associated with weaker SOC for both genders, indicating overall physical activity as the most important factor for stronger SOC. However, emotional support in vulnerable environments may have a bigger impact than physical activity or sedentary behavior on the SOC value for adolescents.
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Affiliation(s)
| | - Anton Enberg
- Department of Sport Science, Linnaeus University, 352 95 Kalmar/Växjö, Sweden
| | - Haris Pojskic
- Department of Sport Science, Linnaeus University, 352 95 Kalmar/Växjö, Sweden
| | - Barbara Gilic
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
| | - Marie Alricsson
- Department of Sport Science, Linnaeus University, 352 95 Kalmar/Växjö, Sweden
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Gustavsson E, Björk J. The Ethical Relevance of "Alternatives" in Health Care Priority Setting - The Case of Preexposure Prophylaxis (PrEP) of HIV. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:359-365. [PMID: 36187410 PMCID: PMC9511950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preexposure prophylaxis for HIV is a drug that reduces the risk for an HIV-negative person to acquire HIV if taken prior to sex. It has been suggested that it is important for resource allocation decisions that there are alternatives (such as abstinence, masturbation, etc.) for individuals potentially benefitted by this prophylaxis. In this paper we explore this idea from an ethical perspective in relation to three notions often discussed in priority setting ethics, namely responsibility, outcomes, and severity of disease. While the relevance of alternatives may be explained in terms by responsibility-sensitive priority setting, such a view comes with several challenges. We then discuss two other ways in which this intuition could be better explained: (a) in terms of total outcome of health, and (b) in terms of severity of the condition.
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Affiliation(s)
- Erik Gustavsson
- Division of Philosophy and Applied Ethics, Department
of Culture and Society, Linköping University, Linköping, Sweden,The National Centre for Priorities in Health,
Department of Health, Medicine and Caring Sciences, Linköping University,
Linköping, Sweden,To whom all correspondence should be addressed:
Erik Gustavsson, Division of Philosophy and Applied Ethics, Department of
Culture and Society, Linköping University, Linköping, Sweden;
| | - Joar Björk
- Stockholm Centre for Healthcare Ethics (CHE), LIME,
Karolinska Institutet, Stockholm, Sweden,Department of Research and Development, Region
Kronoberg, Växjö, Sweden
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Patoulias D, Katsimardou A, Imprialos K, Doumas M. Exercise, Erectile Dysfunction and Co-Morbidities: "The Good, the Bad and the Ugly". Rev Cardiovasc Med 2022; 23:304. [PMID: 39077699 PMCID: PMC11262406 DOI: 10.31083/j.rcm2309304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 07/31/2024] Open
Abstract
Erectile dysfunction (ED), defined as the inability to attain or maintain sufficient penile erection for sexual intercourse, is a growing health problem, which unfortunately remains underreported, underdiagnosed and undertreated. Growing evidence suggests that ED is a promising cardiovascular risk marker, as it is associated with major co-morbidities increasing cardiovascular disease burden, while it is an independent predictor of cardiovascular morbidity and mortality. The role of exercise as a non-pharmacological therapeutic intervention in ED has been widely investigated during the last two decades, both in observational studies and in randomized controlled trials, enrolling different patients' populations. In the present narrative review, we summarize relevant evidence concerning the effect of exercise on vascular ED and the pathophysiologic background, underscoring the importance of enhanced physical activity as a recommendation in all subjects with vascular ED.
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Affiliation(s)
- Dimitris Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Alexandra Katsimardou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Konstantinos Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
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Velluzzi F, Cossu G, Fosci M, Montisci R, Zaccheddu R, Minerba L, Musu M, Pintus E, Fortin D, Romano F, Aviles Gonzalez CI, Melis P, Deledda A, Loviselli A, Carta MG. Effect of a Low-Moderate Exercise Program on Dysmetabolism in Older Adults: Results of a Randomized Controlled Trial. Nutrients 2022; 14:3337. [PMID: 36014843 PMCID: PMC9413492 DOI: 10.3390/nu14163337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/11/2022] Open
Abstract
Physical exercise has been shown to improve dysmetabolism in older adults, reducing cardiovascular risk, while its role in preventing dysmetabolism is less known. Moreover, most of the trials use exercise programs that are difficult to put into daily practice. The purpose of this Randomized Controlled Trial (RCT) was to evaluate the effectiveness of a 3-month moderate exercise program in improving or preventing dysmetabolism in 120 older adults, randomly selected for the exercise program (experimental group) or cultural activities (control group). None of the subjects were following a hypocaloric diet, and all of them reported healthy eating habits. Anthropometric (Body Mass Index (BMI) and Waist Circumference (WC)) and metabolic variables (fasting plasma glucose (FPG), High-Density Lipoprotein Cholesterol (HDL-C), and triglycerides (TG)) were assessed at baseline (T0) and at the end of the trial (T1). Dysmetabolism was defined by the presence of an increased WC plus at least two metabolic alterations. At T0, the two groups did not differ by sex, age, education, BMI, WC, FPG, HDL-C levels, and prevalence of dysmetabolism. The mean BMI value indicated overweight, and WC values were higher than the cut-off. At T1, a slight reduction in the number of people with dysmetabolism was found only in the experimental group. However, none of the individuals without dysmetabolism at T0 in the experimental group developed it at T1, while 11.4% developed it in the control group (p = 0.032). This study highlights that a moderate exercise program, accessible in daily practice, can prevent dysmetabolism in older adults, even while being overweight, while if dysmetabolism is already present, more prolonged combined nutritional and exercise interventions will be needed.
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Affiliation(s)
- Fernanda Velluzzi
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Michele Fosci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Mario Musu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Elisa Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Dario Fortin
- Department of Psychology and Cognitive Science, University of Trento, 38123 Trento, Italy
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Unitelma Sapienza University, 00185 Rome, Italy
| | - Cesar Ivan Aviles Gonzalez
- Departamento de Facultad de Ciencias de la Salud, Universidad Popular del Cesar, Valledupar 200002, Colombia
| | - Paola Melis
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Andrea Deledda
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Andrea Loviselli
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Pellerine LP, O’Brien MW, Shields CA, Crowell SJ, Strang R, Fowles JR. Health Care Providers’ Perspectives on Promoting Physical Activity and Exercise in Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159466. [PMID: 35954823 PMCID: PMC9368367 DOI: 10.3390/ijerph19159466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022]
Abstract
Health care providers (HCPs) are entrusted with providing credible health-related information to their patients/clients. Patients/clients who receive physical activity and exercise (PAE) advice from an HCP typically increase their PAE level. However, most HCPs infrequently discuss PAE or prescribe PAE, due to the many challenges (e.g., time, low confidence) they face during regular patient care. The purpose of this study was to ascertain HCPs’ perspectives of what could be done to promote PAE in health care. HCPs (n = 341) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices and ideas to promote PAE. The sample consisted of 114 physicians, 114 exercise professionals, 65 dietitians, and 48 nurses. Quantitative textual analysis (frequency of theme ÷ number of respondents) was performed to identify common themes to promote PAE in health care. In the pooled sample, the primary theme cited was to increase the availability of community programs (24.1% of respondents), followed by more educational opportunities for providers (22.5%), greater promotion of PAE from HCPs (17.1%), reducing financial barriers experienced by patients/clients (16.3%), and increasing availability of qualified exercise professionals (15.0%). Altogether, increased PAE education and greater availability of affordable community PAE programs incorporating qualified exercise professionals, would reduce barriers preventing routine PAE promotion and support the promotion of PAE in Nova Scotia.
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Affiliation(s)
- Liam P. Pellerine
- Division of Kinesiology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.P.P.); (M.W.O.)
| | - Myles W. O’Brien
- Division of Kinesiology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.P.P.); (M.W.O.)
| | - Chris A. Shields
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS B4P 2K5, Canada;
| | | | - Robert Strang
- Department of Health and Wellness, Government of Nova Scotia, Halifax, NS B3J 1V9, Canada;
| | - Jonathon R. Fowles
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS B4P 2K5, Canada;
- Nova Scotia Health Authority, Halifax, NS B3H 1V8, Canada;
- Correspondence:
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Mankowski RT, Justice JN. Translational Research on Aging and Adaptations to Exercise. Exp Gerontol 2022; 166:111872. [DOI: 10.1016/j.exger.2022.111872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hohberg V, Kreppke JN, Kohl J, Seelig E, Zahner L, Streckmann F, Gerber M, König D, Faude O. Effectiveness of a personal health coaching intervention (diabetescoach) in patients with type 2 diabetes: protocol for an open-label, pragmatic randomised controlled trial. BMJ Open 2022; 12:e057948. [PMID: 35649615 PMCID: PMC9161069 DOI: 10.1136/bmjopen-2021-057948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/28/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The widespread prevalence of type 2 diabetes (T2D) not only influences patients' daily lives but also has an economic impact on society. Increasing physical activity and a healthy diet can delay the progression of T2D. Although there are evidence-based recommendations on diet and physical activity, patients with T2D have difficulties implementing them. An appropriate lifestyle intervention can address this problem. METHODS AND ANALYSIS This study is based on the need to develop an intervention that helps patients to establish behavioural changes in order to achieve glycaemic control. The intervention will be evaluated in a monocentric, open-label, pragmatic, two-arm randomised controlled trial with a sample ratio of 1:1 and a parallel design. This superiority study will be conducted in Switzerland. All enrolled patients (n=90) will receive the standard medical treatment for T2D. The intervention group will receive personal health coaching by telephone and access to a smartphone and web application for 1 year. The control group will receive access to the application for 1 year and a one-time written diet and exercise recommendation. The primary outcomes are objectively measured physical activity and glycated haemoglobin. Secondary outcomes are self-reported physical activity, nutrition, cognitive mediators of changes in sport-related behaviour, blood values, medication and nutritional supplements, anthropometric data, quality of life, neuropathy and cost-effectiveness. All outcomes will be measured at baseline, at 27 weeks after inclusion and at 54 weeks after inclusion. The recruitment of participants and the measurements will be completed after 2 years. Linear mixed-effects models will be applied for each outcome variable to analyse the intervention effects. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee North-western and Central Switzerland in February 2021 (ref: 2020-02755). All participants will be required to provide written informed consent. The results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN79457541.
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Affiliation(s)
- Vivien Hohberg
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jan-Niklas Kreppke
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jan Kohl
- Institute of Sports and Sport Science, University of Freiburg, Freiburg im Breisgau, Germany
| | - Eleonora Seelig
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Endocrinology and Diabetology, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Lukas Zahner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Fiona Streckmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Onkology, University Hospital Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Daniel König
- Institute of Sports and Sport Science, University of Freiburg, Freiburg im Breisgau, Germany
- Institute for Nutrition, Exercise and Health, University of Vienna, Wien, Austria
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Prevalence of Metabolic Syndrome and Association with Physical Activity and Frailty Status in Spanish Older Adults with Decreased Functional Capacity: A Cross-Sectional Study. Nutrients 2022; 14:nu14112302. [PMID: 35684102 PMCID: PMC9182809 DOI: 10.3390/nu14112302] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome (MetS) is a cluster of medical conditions associated with several health disorders. MetS and frailty can be related to prolonged physical deconditioning. There is a need to know whether there is concordance between the different ways of diagnosing it and to know their prevalence in Spanish older adults. Thus, the aims of this study were to describe the prevalence of MetS; to analyse the concordance between different definitions to diagnose MetS; and to study the associations between MetS, frailty status, and physical activity (PA) in older adults with decreased functional capacity. This report is a cross-sectional study involving 110 Spanish older adults of ages ≥65 years with decreased functional capacity. Clinical criteria to diagnose MetS was defined by different expert groups. Anthropometric measurements, blood biochemical analysis, frailty status, functional capacity, and PA were assessed. The Kappa statistic was used to determine the agreement between the five MetS definitions used. Student’s t-test and the Pearson chi-square test were used to examine differences between sex, frailty, and PA groups. The sex-adjusted prevalence of MetS assessed by the National Cholesterol Education Program—Third Adult Treatment Panel was 39.4% in men and 32.5% in women. The International Diabetes Federation and the Harmonized definitions had the best agreement (k = 1.000). The highest odds ratios (ORs) of cardiometabolic risk factors to develop MetS were elevated triglycerides (37.5) and reduced high-density lipoprotein cholesterol (27.3). Central obesity and hypertension prevalence were significantly higher in the non-active group (70.7% and 26.8%, respectively), compared to the active group (50.0% and 7.7%, respectively). Moreover, the active group (OR = 0.85, 95% CI = 0.35, 2.04) and active women group (OR = 0.77, 95% CI = 0.27, 2.20) appeared to show a lower risk of developing this syndrome. MetS is highly prevalent in this sample and changes according to the definition used. It seems that sex and frailty do not influence the development of MetS. However, PA appears to decrease central obesity, hypertension, and the risk of developing MetS.
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Ennezat PV, Alavi Z, Le Jemtel TH, Hansen MR. Consideration Regarding the Analysis of Randomized Controlled Trials in the Era of Evidence-based Medicine. J Cardiovasc Pharmacol 2022; 79:605-619. [PMID: 34983917 DOI: 10.1097/fjc.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/19/2021] [Indexed: 01/09/2023]
Abstract
ABSTRACT Analysis of randomized controlled trials (RCTs) is the cornerstone of evidence-based medicine, therapeutic guidelines and ultimately daily practice. However, 2 issues contribute to cloud the analysis of RCTs. Industry-sponsored RCTs aim at capturing as large indications as possible and clinicians rely excessively on P value statistical significance for the evaluation of the findings. To be most valuable to practitioners, analysis of RCTs needs to provide absolute risk reduction, number of patients needed to treat, fragility index along with the estimation of lost to follow-up patients, and outcome postponement (gain in survival time). We analyzed few major cardiovascular RCTs and assessed the robustness of their findings. Our suggested analytic parameters may be further used in future systematic reviews and meta-analyses.
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Affiliation(s)
- Pierre V Ennezat
- Department of Cardiology, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Zarrin Alavi
- INSERM, CIC 1412, Centre Hospitalier Universitaire de Brest, Brest, France
| | | | - Morten R Hansen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark; and
- Department of Clinical Biochemistry and Pharmacology Odense University Hospital, Odense, Denmark
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Long DE, Kosmac K, Dungan CM, Bamman MM, Peterson CA, Kern PA. Potential Benefits of Combined Statin and Metformin Therapy on Resistance Training Response in Older Individuals. Front Physiol 2022; 13:872745. [PMID: 35492586 PMCID: PMC9047873 DOI: 10.3389/fphys.2022.872745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022] Open
Abstract
Metformin and statins are currently the focus of large clinical trials testing their ability to counter age-associated declines in health, but recent reports suggest that both may negatively affect skeletal muscle response to exercise. However, it has also been suggested that metformin may act as a possible protectant of statin-related muscle symptoms. The potential impact of combined drug use on the hypertrophic response to resistance exercise in healthy older adults has not been described. We present secondary statin analyses of data from the MASTERS trial where metformin blunted the hypertrophy response in healthy participants (>65 years) following 14 weeks of progressive resistance training (PRT) when compared to identical placebo treatment (n = 94). Approximately one-third of MASTERS participants were taking prescribed statins. Combined metformin and statin resulted in rescue of the metformin-mediated impaired growth response to PRT but did not significantly affect strength. Improved muscle fiber growth may be associated with medication-induced increased abundance of CD11b+/CD206+ M2-like macrophages. Sarcopenia is a significant problem with aging and this study identifies a potential interaction between these commonly used drugs which may help prevent metformin-related blunting of the beneficial effects of PRT.Trial Registration: ClinicalTrials.gov, NCT02308228, Registered on 25 November 2014.
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Affiliation(s)
- Douglas E. Long
- Department of Physical Therapy and Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Kate Kosmac
- Department of Physical Therapy and Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Cory M. Dungan
- Department of Physical Therapy and Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Marcas M. Bamman
- Florida Institute for Human and Machine Cognition, Pensacola, FL, United States
- Center for Exercise Medicine and Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Charlotte A. Peterson
- Department of Physical Therapy and Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Philip A. Kern
- Department of Internal Medicine, Division of Endocrinology, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, KY, United States
- *Correspondence: Philip A. Kern,
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Lavin KM, Coen PM, Baptista LC, Bell MB, Drummer D, Harper SA, Lixandrão ME, McAdam JS, O’Bryan SM, Ramos S, Roberts LM, Vega RB, Goodpaster BH, Bamman MM, Buford TW. State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions. Compr Physiol 2022; 12:3193-3279. [PMID: 35578962 PMCID: PMC9186317 DOI: 10.1002/cphy.c200033] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For centuries, regular exercise has been acknowledged as a potent stimulus to promote, maintain, and restore healthy functioning of nearly every physiological system of the human body. With advancing understanding of the complexity of human physiology, continually evolving methodological possibilities, and an increasingly dire public health situation, the study of exercise as a preventative or therapeutic treatment has never been more interdisciplinary, or more impactful. During the early stages of the NIH Common Fund Molecular Transducers of Physical Activity Consortium (MoTrPAC) Initiative, the field is well-positioned to build substantially upon the existing understanding of the mechanisms underlying benefits associated with exercise. Thus, we present a comprehensive body of the knowledge detailing the current literature basis surrounding the molecular adaptations to exercise in humans to provide a view of the state of the field at this critical juncture, as well as a resource for scientists bringing external expertise to the field of exercise physiology. In reviewing current literature related to molecular and cellular processes underlying exercise-induced benefits and adaptations, we also draw attention to existing knowledge gaps warranting continued research effort. © 2021 American Physiological Society. Compr Physiol 12:3193-3279, 2022.
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Affiliation(s)
- Kaleen M. Lavin
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Human Health, Resilience, and Performance, Institute for Human and Machine Cognition, Pensacola, Florida, USA
| | - Paul M. Coen
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Liliana C. Baptista
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Margaret B. Bell
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Devin Drummer
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara A. Harper
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Manoel E. Lixandrão
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeremy S. McAdam
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Samia M. O’Bryan
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sofhia Ramos
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Lisa M. Roberts
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick B. Vega
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Bret H. Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
- Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida, USA
| | - Marcas M. Bamman
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Human Health, Resilience, and Performance, Institute for Human and Machine Cognition, Pensacola, Florida, USA
| | - Thomas W. Buford
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Yeh TC, Liang CS, Tsai CK, Solmi M, Lafer B, Tseng PT, Hsu CW, Lin PY, Firth J, Stubbs B, Hassan L, Fornaro M, Vieta E, Thompson T, Shin J, Carvalho AF. Neurological, Psychiatric, and Psychological Implications of the COVID-19 Pandemic: Protocol for a Large-Scale Umbrella Review of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1681. [PMID: 35162704 PMCID: PMC8835005 DOI: 10.3390/ijerph19031681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 01/08/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 disease (SARS-CoV-2) is the most severe manifestation of the coronavirus disease 2019 (COVID-19) pandemic. Accruing evidence indicates that the COVID-19 pandemic may have profound deleterious neurological, psychiatric, and psychological outcomes. The number of systematic reviews (SRs) and meta-analyses (MAs) on this topic has grown exponentially. This protocol aims to synthesize all evidence from SRs and MAs on the associations between the COVID-19 pandemic and neuropsychiatric outcomes. The following electronic databases will be systematically searched from inception up to 15 January 2022: PubMed, Embase, APA PsycINFO, and Cochrane Reviews. An umbrella review (UR) of SRs and MAs of observational studies will be conducted. SRs and/or MAs of observational studies examining any direct or indirect association of COVID-19 with the neuropsychiatric outcomes will be deemed eligible for potential inclusion in this UR. The direct associations include the impact on the (1) prognosis of COVID-19 and (2) neuropsychiatric sequelae after COVID-19 infection. The indirect associations include the influence of the COVID-19 pandemic on the (1) treatments and (2) outcomes of neurological and psychiatric conditions associated with the COVID-19 pandemic.
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Affiliation(s)
- Ta-Chuan Yeh
- National Defense Medical Center, Department of Psychiatry, Tri-Service General Hospital, Taipei 114, Taiwan;
- Department of Psychiatry, Penghu Branch, Tri-Service General Hospital, Penghu 880, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 112, Taiwan
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON K1Z 7K4, Canada;
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON K1Z 7K4, Canada
- Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON K1Z 7K4, Canada
| | - Beny Lafer
- Bipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo 05403-903, Brazil;
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung 811, Taiwan;
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-W.H.); (P.-Y.L.)
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-W.H.); (P.-Y.L.)
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Joseph Firth
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, UK; (J.F.); (L.H.)
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London SE13 6QJ, UK;
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK
| | - Lamiece Hassan
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, UK; (J.F.); (L.H.)
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Dentistry, Federico II University of Naples, 80138 Naples, Italy;
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, 08035 Barcelona, Spain;
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London SE10 9LS, UK;
| | - Jaeil Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Andre F. Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia;
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Handlery R, Regan E, Lewis AF, Larsen C, Handlery K, Flach A, Fritz S. Active Participation of Care Partners in a Physical Activity Intervention Alongside People with Stroke: A Feasibility Study. Physiother Can 2022; 74:97-110. [PMID: 35185254 PMCID: PMC8816353 DOI: 10.3138/ptc-2020-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
Purpose: This study investigated the feasibility of a physical activity intervention for people with stroke and their care partners and the role social support plays in physical activity adherence. Method: The study used a single-group, pretest-posttest design with follow-up. Participants were adults with chronic stroke and their care partners. The intervention consisted of 8 weeks of structured, group-based physical activity classes, followed by 19 weeks of self-directed physical activity. Recruitment, adherence, safety, and retention were assessed. Familial social support was assessed before and after the 8-week structured portion and again 19 weeks later. Results: A total of 21 participants (15 people with stroke, 6 care partners), mean age 67.6 (SD 11.6) years, were recruited; 19 (90.5%) completed the 19-week assessment. No adverse events were experienced during the programme. Attendance during the 8-week portion was better than during the 19-week portion (mean difference 0.95; p < 0.001; 95% CI: 0.71, 1.19 visits/wk). No relationship was found between social support and physical activity adherence (p > 0.05). Conclusions: Involvement of care partners in a physical activity intervention is feasible and safe. Both people with stroke and their care partners may require ongoing support to participate in long-term physical activity. The relationship between social support and physical activity adherence requires further study.
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Affiliation(s)
- Reed Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Elizabeth Regan
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Allison Foster Lewis
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Chelsea Larsen
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Kaci Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Alicia Flach
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Stacy Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
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The effect of a rehabilitation program after mesenchymal stromal cell transplantation for advanced osteonecrosis of the femoral head: a 10-year follow-up study. Arch Rehabil Res Clin Transl 2022; 4:100179. [PMID: 35282152 PMCID: PMC8904865 DOI: 10.1016/j.arrct.2022.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the status of 10 patients with advanced osteonecrosis of the femoral head who underwent mesenchymal stromal cell transplants and a 12-week rehabilitation program 10 years earlier. Design Retrospective study. Setting University clinical research laboratory. Participants Patients (N=10) who had undergone mesenchymal stromal cell transplantation and rehabilitation for a single hip osteonecrosis of the femoral head 10 years prior to the current study were recruited by telephone. The average age was 31.7 years and all participants were men; radiographic stages were 3A in 6 patients and 3B in 4 patients before treatment. Intervention A 12-week rehabilitation program with follow-up once every 1 to 2 years was performed after mesenchymal stromal cell transplantation. Main Outcome Measures Radiographic analysis, clinical score, timed Up and Go test, hip function (range of motion, muscle strength), and Short Form-36 scores were assessed before treatment and 1 and 10 years after treatment. Results Upon imaging, 5 hips were found to be stable (stable group) and 5 had progressed (progressed group); 2 of the latter group required a total hip arthroplasty. The pretreatment radiographic stage of the progressed group was more advanced than that of the stable group. Body mass index was higher in the progressed group than in the stable group. Hip function and clinical score at 1 and 10 years after treatment improved in the hips of 8 patients without total hip arthroplasty. There were no severe adverse events during the rehabilitation. Conclusions The 12-week rehabilitation program and annual follow-up after mesenchymal stromal cell transplantation for osteonecrosis of the femoral head was associated with pain reduction, maintaining hip muscle strength, widening range of motion, and improving quality of life. The level and timing of weight-bearing and social activity should be planned according to the individual's lifestyle and body composition.
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Saini RK, Chaudhury S, Singh N, Chadha DS, Kapoor R. Depression, anxiety, and quality of life after percuataneous coronary interventions. Ind Psychiatry J 2022; 31:6-18. [PMID: 35800859 PMCID: PMC9255611 DOI: 10.4103/ipj.ipj_126_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/25/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world. However, some fascinating advances in the field of cardiology have not only added years to people's life but life to years as well. Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a nonsurgical procedure used to treat stenotic coronary arteries. In recent years, PCI has become the preferred modality of treatment for occluded coronary arteries. However, there has been growing interest in the quality of life (QOL) issues for those who undergo such procedures. Depression, anxiety, vital exhaustion, hostility, anger, and acute mental stress have been evaluated as risk factors for the development and progression of CAD. Further, they also have strong bearing toward recovery from an acute coronary event. The current article discusses the role of depression, anxiety, and QOL of patients undergoing PCI.
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Affiliation(s)
- Rajiv Kumar Saini
- Department of Psychiatry, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - Navreet Singh
- Department of Cardiology, CH (WC) Chandimandir, Panchkula, India
| | - D S Chadha
- Department of Cardiology, CH (IAF), Bengaluru, Karnataka, India
| | - Rajneesh Kapoor
- Department of Interventional Cardiology, Medanta Medicity, Gurgaon, Haryana, India
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Marzolini S, Wu C, Hussein R, Xiong LY, Kangatharan S, Peni A, Cooper CR, Lau KS, Nzodjou Makhdoom G, Pakosh M, Zaban SA, Nguyen MM, Banihashemi MA, Swardfager W. Associations Between Time After Stroke and Exercise Training Outcomes: A Meta-Regression Analysis. J Am Heart Assoc 2021; 10:e022588. [PMID: 34913357 PMCID: PMC9075264 DOI: 10.1161/jaha.121.022588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6-minute walk distance, 10-meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post-stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta-regression analyses adjusted for study baseline mean values (pre-post comparisons) or baseline mean values and baseline control-intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre-post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6-minute walk distance (36.3 meters; 95% CI, 14.2-58.5), comfortable 10-meter walk time (0.13 m/s; 95% CI, 0.06-0.19) and fast 10-meter walk time (0.16 m/s; 95% CI, 0.03-0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41-5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6-minute walk distance (baseline-adjusted 27.3 meters; 95% CI, 6.1-48.5; fully adjusted, 24.9 meters; 95% CI, 0.82-49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6-50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
- Healthy Living for Pandemic Event Protection (HL–PIVOT) NetworkTorontoONCanada
- Rehabilitation Sciences InstituteUniversity of TorontoONCanada
- Faculty of Kinesiology and Physical EducationUniversity of TorontoONCanada
| | - Che‐Yuan Wu
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | | | - Lisa Y. Xiong
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | - Suban Kangatharan
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
| | - Ardit Peni
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
| | | | - Kylie S.K. Lau
- Department of Human BiologyUniversity of TorontoONCanada
| | | | - Maureen Pakosh
- Library & Information ServicesUniversity Health NetworkToronto Rehabilitation InstituteTorontoONCanada
| | - Stephanie A. Zaban
- Faculty of Kinesiology and Physical EducationUniversity of TorontoONCanada
| | - Michelle M. Nguyen
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | - Mohammad Amin Banihashemi
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
| | - Walter Swardfager
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
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Effectiveness of Fixed-Dose Combination Therapy (Polypill) Versus Exercise to Improve the Blood-Lipid Profile: A Network Meta-analysis. Sports Med 2021; 52:1161-1173. [PMID: 34878638 DOI: 10.1007/s40279-021-01607-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Both exercise and polypills are recommended treatments to improve the blood-lipid profile. OBJECTIVE The aim of this study was to compare head-to-head the effectiveness of polypill and exercise strategies in improving the blood-lipid profile in high-risk cardiovascular patients. METHODS We performed an electronic search in Web of Science, EMBASE, Cochrane Database of Systematic Reviews, MEDLINE and SPORTDiscus, from inception to August 2021. Randomized controlled trials (RCTs) testing the effectiveness of exercise interventions or treatment with fixed-dose combination therapy (polypill) in improving the blood-lipid profile in adults with atherosclerotic cardiovascular disease or presenting at least one well recognized cardiovascular risk factor were included. RESULTS A total of 131 RCTs were included: 15 and 116 studies analyzing the effects of polypills and exercise, respectively, on blood-lipid levels. Both exercise and polypill strategies were effective in reducing low-density lipoprotein cholesterol (LDL-c) and total cholesterol (TC), but only exercise interventions improved high-density lipoprotein cholesterol (HDL-c) and triglyceride levels compared with the control group. The results of the network meta-analyses showed that the polypill without antiplatelet therapy was the most effective pharmacological treatment for improving the lipid profile, while aerobic interval exercise was the most effective exercise intervention. CONCLUSIONS Considering that both polypills and exercise are effective in reducing LDL-c and TC but only exercise improves HDL-c and triglycerides, and that exercise provides further health benefits (e.g., increases in physical fitness and decreases in adiposity), it seems reasonable to recommend exercise as the first treatment option in dyslipidemia when the patient's general condition and symptoms allow it. PROSPERO REGISTRATION NUMBER CRD42019122794.
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Donneyong MM, Fischer MA, Langston MA, Joseph JJ, Juarez PD, Zhang P, Kline DM. Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312702. [PMID: 34886429 PMCID: PMC8657217 DOI: 10.3390/ijerph182312702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014-2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)-the ratio of the prevalence among BAAs to that among nHWs-as an index of BAA-nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains-health behaviors, clinical care, social and economic and physical environment-as contributors to BAA-nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = -0.21, p < 0.001) and social and economic (β = -0.11, p < 0.01) domains were significantly inversely associated with the observed BAA-nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA-nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke.
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Affiliation(s)
- Macarius M. Donneyong
- College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA
- Correspondence: ; Tel.: +614-292-0075
| | - Michael A. Fischer
- General Internal Medicine at Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA;
| | - Joshua J. Joseph
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA;
| | - Ping Zhang
- Division of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
| | - David M. Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
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Takeda H, Takatori K. Effect of buddy-style intervention on exercise adherence in community-dwelling disabled older adults: A pilot randomized controlled trial. Clin Rehabil 2021; 36:379-387. [PMID: 34825590 DOI: 10.1177/02692155211041104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the preliminary effects of a buddy-style intervention to improve exercise adherence. DESIGN A parallel-group, open-label, pilot randomized controlled trial. SETTING Adult day-care centers. PARTICIPANTS Sixty-five disabled older adults. INTERVENTIONS All participants underwent a 12-week home exercise program, and the intervention group received a 5-10 min buddy-style intervention between older adults in the intervention group once weekly at an adult day-care center. MAIN MEASURES Based on the exercise log calendar, the number of days of exercise was assessed for each of the three phases: 1-4 weeks, 5-8 weeks, and 9-12 weeks. Short physical performance battery was measured at baseline and after 12 weeks. RESULTS Of the 590 screened older adults, 65 were recruited and 33 were assigned to the intervention group. One participant in each group withdrew before the program began, and four and five patients in the intervention and control groups, respectively, dropped out by the 12-week assessment. Analysis of covariance of the 28 and 26 patients in the intervention and control groups, respectively, for whom exercise log calendars could be retrieved, showed that the intervention group (24.4/28 days) exercised significantly more days than the control group (20.6/28 days) at 9-12 weeks (P = 0.009). In the between-group effect of the intention-to-treat analysis of short physical performance battery, walking and standing test (P = 0.790, P = 0.829) were not significantly different, and balance test (P = 0.049) was significantly better in the control group. CONCLUSIONS There was a preliminary effect of the buddy-style intervention to improve exercise adherence.
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Affiliation(s)
- Hiromichi Takeda
- Rehastage Co. Ltd, Japan.,Graduate School of Health Science, Kio University, Japan
| | - Katsuhiko Takatori
- Graduate School of Health Science, Kio University, Japan.,Health Promotion Center, Kio University, Japan
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Chen Z, Zhou Z, Peng X, Sun C, Yang D, Li C, Zhu R, Zhang P, Zheng L, Tang C. Cardioprotective responses to aerobic exercise-induced physiological hypertrophy in zebrafish heart. J Physiol Sci 2021; 71:33. [PMID: 34749643 PMCID: PMC10717721 DOI: 10.1186/s12576-021-00818-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/21/2021] [Indexed: 01/01/2023]
Abstract
Herein, we aimed to establish an aerobic exercise-induced physiological myocardial hypertrophy zebrafish (Danio rerio) model and to explore the underlying molecular mechanism. After 4 weeks of aerobic exercise, the AMR and Ucrit of the zebrafish increased and the hearts were enlarged, with thickened myocardium, an increased number of myofilament attachment points in the Z-line, and increased compaction of mitochondrial cristae. We also found that the mTOR signaling pathway, angiogenesis, mitochondrial fusion, and fission event, and mitochondrial autophagy were associated with the adaptive changes in the heart during training. In addition, the increased mRNA expression of genes related to fatty acid oxidation and antioxidation suggested that the switch of energy metabolism and the maintenance of mitochondrial homeostasis induced cardiac physiological changes. Therefore, the zebrafish heart physiological hypertrophy model constructed in this study can be helpful in investigating the cardioprotective mechanisms in response to aerobic exercise.
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Affiliation(s)
- Zhanglin Chen
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China
| | - Zuoqiong Zhou
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China
| | - Xiyang Peng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China.
| | - Chenchen Sun
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China
| | - Dong Yang
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China
| | - Chengli Li
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China
| | - Runkang Zhu
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China
| | - Ping Zhang
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China
| | - Lan Zheng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China.
| | - Changfa Tang
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of the Hunan Province, College of Physical Education, Hunan Normal University, No. 529 Lushan South Road, Yuelu District, Changsha, 410012, Hunan, China.
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