Coagulation activity and thrombotic risk following high-volume endurance exercise in recreationally active cyclists

Despite the prognostic effect of physical activity, acute bouts of high-volume endurance exercise can induce cardiac stress and post-exercise hypercoagulation associated with increased thrombotic risk. The aim of this study was to explore the effect of high-volume endurance exercise on coagulation and thrombotic activity in recreational cyclists. Thirty-four recreational cyclists completed 4.8 ± 0.3 hours cycling at 45 ± 5% of maximal power output on a bicycle ergometer. Intravenous blood samples were collected pre-exercise, immediately post-exercise, 24 and 48 hours post-exercise and analysed for brain natriuretic peptide (BNP), cardiac troponin (cTn), C-reactive protein (CRP), D-dimer, thrombin-antithrombin (TAT) complex, tissue factor (TF), tissue factor pathway inhibitor (TFPI) and TF to TFPI ratio (TF:TFPI). An increase in cTn was observed post-exercise (p < 0.001). CRP concentrations were increased at 24 and 48 hours post-exercise compared to pre-exercise concentrations (p ≤ 0.001). TF was elevated at 24 hours post-exercise (p < 0.031) and TFPI was higher immediately post-exercise (p < 0.044) compared to all other time points. TF:TFPI was increased at 24 and 48 hours post-exercise compared to pre-exercise (p < 0.025). TAT complex was reduced at 48 hours post-exercise compared to pre-exercise (p = 0.015), D-dimer was higher immediately post-exercise compared to all other time points (p ≤ 0.013). No significant differences were observed in BNP (p > 0.05). High-volume endurance cycling induced markers of cardiac stress among recreational cyclists. However, plasma coagulation and fibrinolytic activity suggests no increase in thrombotic risk after high-volume endurance exercise.

Comparison of telehealth and supervised phase III cardiac rehabilitation in regional Australia: protocol for a non-inferiority trial

INTRODUCTION

Exercise-based cardiac rehabilitation programmes (ExCRP) promote recovery and secondary prevention for individuals with cardiovascular disease (CVD). Despite this, enrolment and adherence to ExCRP in rural locations is low. Telehealth programmes provide a convenient, home-based intervention, but concerns remain about compliance to exercise prescription. This paper presents the rationale and protocol design to determine if telehealth delivered ExCRP is not inferior to supervised ExCRP for improving cardiovascular function and exercise fidelity.

METHOD AND ANALYSIS

A non-inferiority, parallel (1:1), single-blinded randomised clinical trial will be conducted. Fifty patients with CVD will be recruited from a rural phase II ExCRP. Participants will be randomly assigned to telehealth or supervised ExCRP and prescribed three weekly exercise sessions for 6 weeks. Exercise sessions will include a 10 min warm up, up to 30 min of continuous aerobic exercise at a workload equivalent to the ventilatory anaerobic threshold and a 10 min cool down. The primary outcome will be change in cardiorespiratory fitness as measured by cardiopulmonary exercise test. Secondary outcome measures will include change in blood lipid profile, heart rate variability, pulse wave velocity, actigraphy measured sleep quality and training fidelity. Non-inferiority will be confirmed if intention-to-treat and per-protocol analyses conclude the same outcome following independent samples t-test with p<0.025.

ETHICS AND DISSEMINATION

Research ethics committees at La Trobe University, St John of God Health Care and Bendigo Health approved the study protocol and informed consent. Findings will be published in peer-reviewed journals and disseminated among stakeholders.

TRIAL REGISTRATION NUMBER

ACTRN12622000872730p; pre-results.

The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis

BACKGROUND

Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain.

METHODS

This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence.

RESULTS

Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m².

CONCLUSION

Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain.

TRIAL REGISTRATION

The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).

Including a Technical Factor with Physical and In-Game Movement Factors Improves Model Sensitivity When Evaluating Draft Outcome in Elite-Junior Australian Rules Football

Determining characteristics that define talent is critical for recruitment and player development. When developing predictive models, sensitivity is important, as it describes the ability of models to identify players with draft potential (true positives). In the current literature, modelling is limited to a small number of selected variables, and model sensitivity is often poor or unreported. The aim of this study was to determine how a technical factor combined with physical and in-game movement factors affects position-specific model sensitivity when evaluating draft outcome in an elite-junior National Australia Bank (NAB) League population. Physical, in-game movement, and technical involvement data were collated from draft-eligible (18th year) participants in the under 18 boys NAB League competition (n = 465). Factors identified through parallel analysis were used in binomial regression analyses. Models using factor combinations were developed to predict draft success for all-position, nomadic, fixed-position, and fixed&ruck players. Models that best characterised draft success were all-position (physical and technical: specificity = 97.2%, sensitivity = 36.6%, and accuracy = 86.3%), nomadic (physical and technical: specificity = 95.5%, sensitivity = 40.7%, and accuracy = 85.5%), fixed (physical: specificity = 96.4%, sensitivity = 41.7%, and accuracy = 86.6%), and fixed&ruck (physical and in-game movement: specificity = 96.3%, sensitivity = 41.2%, and accuracy = 86.7%). Including a technical factor improved sensitivity in the all-position and nomadic models. Physical factors and physical and in-game movement yielded the best models for fixed-position and fixed&ruck players, respectively. Models with improved sensitivity should be sought to assist practitioners to more confidently identify the players with draft potential.

Moderate continuous- and high-intensity interval training elicit comparable cardiovascular effect among middle-aged men regardless of recovery mode

To assess the effect of active and passive intra-interval recovery modes in time-efficient high-intensity interval training (HIT) on cardiorespiratory fitness, autonomic function, and endothelial function in sedentary middle-aged men.Participants (n = 62; age: 49.5 ± 5.8 y; BMI: 29.7 ± 3.7 kg·m^-2) completed the assessments of cardiorespiratory fitness, flow-mediated dilation (FMD) and heart rate variability before being randomly allocated to control (CON; n = 14), moderate intensity continuous training (MICT; n = 15), HIT with passive (P-HIT; n-15), or active recovery (A-HIT; n = 15). Participants performed thrice weekly exercise sessions for 12 weeks. MICT completed 50-60 min of continuous cycling at 60-70% heart rate (HR) maximum. HIT completed 30-s work intervals (∼85% HR) interspaced with 2.5 min of active or passive recovery.All exercise modalities increased oxygen uptake (V̇O₂) (MD: ≥ 3.1 ml·kg^-1·min^-1, 95%CI: 1.5-4.7 ml·kg^-1·min^-1; P < 0.001), power output (MD: ≥ 26 W, 95%CI: 15-37 W; P < 0.001) and cycle duration (MD: ≥ 62 s, 95%CI: 36-88 s; P < 0.001) at 85% HRM. Significant pre-to-post differences were observed among all exercise groups for FMD (MD: ≥ 3.4%, 95%CI: 0.3-6.5%; P < 0.05), while MICT and P-HIT significantly increased the standard deviation of all NN intervals (SDNN) pre-to-post intervention (MD: ≥ 7 ms, 2-13 ms; P ≤ 0.05).Time-efficient HIT elicits significant improvements in cardiorespiratory fitness, FMD and autonomic modulation following a thrice weekly 12-week exercise intervention among sedentary middle-aged men. Active recovery between successive high-intensity intervals provided no additional benefit among this deconditioned cohort.

Comparison between a targeted exercise program and a sham intervention on gluteal muscle activity in people with hip osteoarthritis: Analysis of secondary outcomes from a randomised clinical trial

BACKGROUND

People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA.

RESEARCH QUESTION

Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA?

METHODS

This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention.

RESULTS

Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population.

SIGNIFICANCE

A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention.

A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics

BACKGROUND

Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer's disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive.

OBJECTIVE

The MedWalk trial's primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment.

METHODS

MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60-90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community.

TRIAL REGISTRATION

Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au).

Effects of a targeted resistance intervention compared to a sham intervention on gluteal muscle hypertrophy, fatty infiltration and strength in people with hip osteoarthritis: analysis of secondary outcomes from a randomised clinical trial

Background

People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis.

Methods

Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time.

Results

In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm³/kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention.

Conclusion

Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles.

Trial registration

Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05907-4.

External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff

Background and study aims  N95-filtering facepiece respirators (FFR) use is associated with physiological changes and symptoms due to impaired nasal airflow and increased breathing resistance. We prospectively studied the effect of using an external nasal dilator (END) in gastroenterology laboratory (gastrointestinal lab) staff using N95FFR. Patients and methods  N95FFR qualitative saccharine fit testing was performed on study participants with and without an END. Prospective data collection and comparisons included: 1) survey of perceived symptoms and difficulty of performing one day of gastrointestinal procedures with N95FFR and 1 day of gastrointestinal procedures with END plus N95FFR in random sequence; and 2) vitals and respiratory belt plethysmography in ten gastroenterologists performing simulated colonoscopy while wearing a surgical mask (SM), N95FFR plus SM, END plus N95FFR plus SM for 20 minutes each in random sequence and rapid succession. Results  Twenty-nine of 31 participants passed the N95FFR and the END plus N95FFR fit test. Twenty-two participants (12 physicians; 11 males; mean age 44.1 years, range 31-61) performed 1 day of gastrointestinal procedures with an N95FFR and 1 day of gastrointestinal procedures with an END plus N95FFR. Significantly less difficulty with nasal breathing and severity of symptoms including breathing difficulty, headache, fatigue and frustration, occurred while using an END plus N95FFR. Respiratory plethysmography peak-to-trough measurement showed an increase during the N95FFR stage compared to the END plus N95FFR stage and the SM stage. Conclusions  N95FFR related respiratory changes and symptom development may be mitigated by END use.

Training and match demands differ between the regular season and finals in semi-professional basketball

Basketball competitions often include a scheduled regular season followed by knock-out finals. Understanding training and match demands through the season can help optimize performance and reduce injury risk. This study investigated whether training and/or match demands differed between the regular season and finals, and whether these differences were dependent on player role. Average session intensity and volume and durations of relative exercise intensities (inactive, light, moderate-vigorous, maximal, supramaximal) were quantified during training sessions and matches using accelerometry in two semi-professional basketball teams (n = 23; 10 women, 13 men). Training and match demands were compared between the regular season (training: 445 observations; matches: 387 observations) and finals (training: 113 observations, matches: 75 observations) with consideration of player role (starters, in-rotation bench, out-rotation bench). During finals matches, starters received 4.4 min more playing time (p = 0.03), performed 14% more absolute maximal activity (p < 0.01) and had 8% less relative inactive time (p = 0.02) when compared to the regular season. Out-rotation bench players received 2.1 min less playing time (p < 0.01), performed 33% less absolute maximal activity (p = 0.01) and 57% less absolute supramaximal activity (p < 0.01) in finals when compared to the regular season. During finals training sessions, average training intensity was 5% higher (p = 0.02), absolute moderate-vigorous activity was 3% higher (p = 0.04), relative maximal activity was 12% higher (p < 0.01), and relative inactive time was 5% lower (p = 0.03) when compared to the regular season. These findings suggest starters need to be physically prepared for greater match demands during finals, while out-rotation bench players should supplement their training during finals with extra supramaximal activity to maintain their conditioning levels for matches.

Factors influencing adults who participate in a physical activity coaching intervention: a theoretically informed qualitative study

OBJECTIVE

Behaviour change interventions targeting changes in physical activity (PA) can benefit by examining the underlying mechanisms that promote change. This study explored the use of the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to code and contextualise the experiences of participants who completed a PA coaching intervention underpinned by motivational interviewing and cognitive-behavioural therapy.

DESIGN

Semistructured interviews were conducted with a purposive sample of participants.

SETTING

Interviews were conducted in a tertiary hospital in regional Victoria, Australia.

PARTICIPANTS

Eighteen participants who completed a PA coaching intervention were interviewed. The participants were recruited into the coaching intervention because they were insufficiently physically active at the time of recruitment.

RESULTS

Thirteen (72%) participants were women and the average age of participants was 54 (±5) years. Four participant themes mapped directly onto five components of the COM-B model, and ten of the TDF domains. Increases in PA were influenced by changes in motivation and psychological capability. The autonomy-supportive PA coaching intervention helped to evoke participants' own reasons (and motives) for change and influenced PA behaviours. Participants reflected on their own social and/or professional strengths, and used these skills to set appropriate PA goals and action plans. The structure of the PA coaching intervention provided clarity on session determinants and a framework from which to set an appropriate agenda. Relational components (eg, non-judgemental listening, collaboration) were continually highlighted as influential for change, and should be considered in future behaviour change intervention design.

CONCLUSIONS

We demonstrate the beneficial effect of using theory-informed behaviour change techniques, and delivering them in a style that promotes autonomy and relatedness. The views of participants should be a key consideration in the design and implementation of PA coaching interventions TRIAL REGISTRATION NUMBER: ACTRN12619000036112. Post-results analysis.

Measuring change in adolescent physical activity: Responsiveness of a single item

Self-report measures are frequently used to assess change in physical activity (PA) levels. Given the limited data from adolescent populations, the primary objective of this study was to examine the responsiveness of a single item measure (SIM) of PA for adolescents to detect change in moderate-to-vigorous physical activity (MVPA) using accelerometer data as the reference measure. A secondary objective was to provide further data on the validity of the measure at one point in time. The validity of the SIM to determine the number of days ≥60 minutes of MVPA was based on data from 200 participants (62% female; age: 14.0 ± 1.6 years) and analysis of change was based on data from 177 participants (65% female; age: 14.0 ± 1.6 years). Validity of change in days ≥60 minutes of MVPA was examined through agreement in classification of change between the SIM and accelerometry as the reference measurement and Spearman’s correlation. Cohen’s d and standardised response means were used to assess the responsiveness to change of the measure. The responsiveness of the SIM and accelerometer data were comparable and modest (0.27–0.38). The correlation for change in number of days ≥60 minutes MVPA between the SIM and accelerometery was low (r = 0.11) and the accuracy of the SIM for detecting change, using accelerometry as the reference, was only marginally above chance (53%). Therefore, the adolescent version of the SIM is adequate for assessing PA at a single time point but not recommended for assessing change.

“Exercise Is My Medicine”: A Qualitative Study Exploring the Experiences of Non-admitted Patients Receiving Physical Activity Promotion From Hospital Surgeons

Background

Hospital clinicians are increasingly encouraged to use outpatient consultations as an avenue to deliver opportunistic health promotion. There is a dearth of evidence regarding the acceptance of health promotion initiatives from hospital patients themselves.

Methods

We explored the experiences of non-admitted patients who, during a routine consultation with a hospital surgeon received a recommendation to increase physical activity (PA) and a recommendation to engage in a PA telephone coaching program. Twenty-two semi-structured interviews were conducted with individuals who had received the recommendation and proceeded to enroll in a telephone coaching intervention to identify factors that influenced behavior change. Data were analyzed thematically.

Results

Participants' age ranged between 42 and 66 years, with the average age being 54 years. Of the participants, 15 (68%) were women and 7 (32%) were men. Three major themes were identified: (1) the hospital visit represented an opportunity for behavior change that is not to be missed; (2) surgeons were influential in promoting PA change contemplation; and (3) patients welcomed a communication style that promoted autonomy.

Conclusions

Almost all patients considered receiving the recommendation to engage with the telephone coaching as acceptable and helpful toward PA change. Although working in time-restricted consultations, surgeons delivered the recommendation in a patient-centered, autonomy-supportive way, which influenced behavior change. Hospitals should explore avenues to integrate health promotion into routine care, confident of the acceptability and appropriateness of health promotion practice to hospital patients.

Gastrocnemius Muscle Architecture in Elite Basketballers and Cyclists: A Cross-Sectional Cohort Study

Eccentric and concentric actions produce distinct mechanical stimuli and result in different adaptations in skeletal muscle architecture. Cycling predominantly involves concentric activity of the gastrocnemius muscles, while playing basketball requires both concentric and eccentric actions to support running, jumping, and landing. The aim of this study was to examine differences in the architecture of gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) between elite basketballers and cyclists. A trained sonographer obtained three B-mode ultrasound images from GM and GL muscles in 44 athletes (25 basketballers and 19 cyclists; 24 ± 5 years of age). The images were digitized and average fascicle length (FL), pennation angle (θ), and muscle thickness were calculated from three images per muscle. The ratio of FL to tibial length (FL/TL) and muscle thickness to tibial length (MT/TL) was also calculated to account for the potential scaling effect of stature. In males, no significant differences were identified between the athletic groups in all parameters in the GM, but a significant difference existed in muscle thickness in the GL. In basketballers, GL was 2.5 mm thicker (95% CI: 0.7-4.3 mm, p = 0.011) on the left side and 2.6 mm thicker (95% CI: 0.6-5.7 mm, p = 0.012) on the right side; however, these differences were not significant when stature was accounted for (MT/TL). In females, significant differences existed in the GM for all parameters including FL/TL and MT/TL. Female cyclists had longer FL in both limbs (MD: 11.2 and 11.3 mm), narrower θ (MD: 2.1 and 1.8°), and thicker muscles (MD: 2.1 and 2.5 mm). For the GL, female cyclists had significantly longer FL (MD: 5.2 and 5.8 mm) and narrower θ (MD: 1.7 and 2.3°) in both limbs; no differences were observed in absolute muscle thickness or MT/TL ratio. Differences in gastrocnemius muscle architecture were observed between female cyclists and basketballers, but not between males. These findings suggest that participation in sport-specific training might influence gastrocnemius muscle architecture in elite female athletes; however, it remains unclear as to whether gastrocnemius architecture is systematically influenced by the different modes of muscle activation between these respective sports.

Efficacy of Exercise-Based Rehabilitation Programs for Improving Muscle Function and Size in People with Hip Osteoarthritis: A Systematic Review with Meta-Analysis

Objective: To determine the effect of exercise-based rehabilitation programs on hip and knee muscle function and size in people with hip osteoarthritis. Methods: Seven databases were systematically searched in order to identify studies that assessed muscle function (strength or power) and size in people with hip osteoarthritis after exercise-based rehabilitation programs. Studies were screened for eligibility and assessed for quality of evidence using the GRADE approach. Data were pooled, and meta-analyses was completed on 7 of the 11 included studies. Results: Six studies reported hip and/or knee function outcomes, and two reported muscle volumes that could be included in meta-analyses. Meta-analyses were conducted for four strength measures (hip abduction, hip extension, hip flexion, and knee extension) and muscle size (quadriceps femoris volume). For hip abduction, there was a low certainty of evidence with a small important effect (effect size = 0.28, 95% CI = 0.01, 0.54) favouring high-intensity resistance interventions compared to control. There were no other comparisons or overall meta-analyses that identified benefits for hip or knee muscle function or size. Conclusion: High-intensity resistance programs may increase hip abduction strength slightly when compared with a control group. No differences were identified in muscle function or size when comparing a high versus a low intensity group. It is unclear whether strength improvements identified in this review are associated with hypertrophy or other neuromuscular factors.

Prevalence of frailty and mobility disability in older people living in retirement villages

OBJECTIVE

To determine the prevalence rates of frail, prefrail, robust and mobility disabled older adults living in retirement villages within regional Victoria, Australia.

METHODS

This cross-sectional, observational study invited residents of retirement villages to complete the self-report questionnaires Fried Frailty Phenotype and Frail Non-Disabled screening tool to classify respondents as frail, prefrail, robust and/or mobility disabled.

RESULTS

From 212 respondents, prevalence rates of frail and prefrail status were 34% and 35%, respectively. A fifth (20%) of residents were mobility disabled. The prevalence of residents classified as frail or prefrail (ie, not robust) was higher in women (74%) than in men (58%). Classification as not robust increased with increasing age.

CONCLUSIONS

This study is the first to estimate prevalence rates of frailty and mobility disability in retirement village residents in regional Australia. Findings from this study have potential to inform the development of facilities and programs to support people living in this setting.

Criterion Validity of an Automated Method of Detecting Live Play Periods in Basketball

This study aimed to develop an automated method to detect live play periods from accelerometry-derived relative exercise intensity in basketball, and to assess the criterion validity of this method. Relative exercise intensity (% oxygen uptake reserve) was quantified for two men's semi-professional basketball matches. Live play period durations were automatically determined using a moving average sample window and relative exercise intensity threshold, and manually determined using annotation of video footage. The sample window duration and intensity threshold were optimised to determine the input parameters for the automated method that would result in the most similarity to the manual method. These input parameters were used to compare the automated and manual active play period durations in another men's semi-professional match and a women's professional match to assess the criterion validity of the automated method. The optimal input parameters were a 9-s sample window and relative exercise intensity threshold of 31% oxygen uptake reserve. The automated method showed good relative (ρ = 0.95–0.96 and ICC = 0.96–0.98, p < 0.01) and absolute (median bias = 0 s) agreement with the manual method. These findings support the use of an automated method using accelerometry-derived relative exercise intensity and a moving average sample window to detect live play periods in basketball.

Reliability of ultrasonographic measurement of muscle architecture of the gastrocnemius medialis and gastrocnemius lateralis

Ultrasonography is widely used to measure gastrocnemius muscle architecture; however, it is unclear if values obtained from digitised images are sensitive enough to track architectural responses to clinical interventions. The purpose of this study was to explore the reliability and determine the minimal detectable change (MDC) of gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) muscle architecture using ultrasound in a clinical setting. A trained sonographer obtained three B-mode images from each of the GM and GL muscles in 87 volunteers (44 males, 43 females; 22±9 years of age) on two separate occasions. Three independent investigators received training, then digitised the images to determine intra-rater, inter-rater, and test-retest reliability for fascicle length (FL), pennation angle (θ) and muscle thickness. Median FL, θ, and muscle thickness for GM and GL were 53.6–55.7 mm and 65.8–69.3 mm, 18.7–19.5° and 11.9–12.5°, and 12.8–13.2 mm and 15.9–16.9 mm, respectively. Intra- and inter-rater reliability of manual digitisation was excellent for all parameters. Test-retest reliability was moderate to excellent with intraclass correlation coefficient (ICC) values ≥0.80 for FL, ≥0.61 for θ, and ≥0.81 for muscle thickness, in both GM and GL. The respective MDC for GM and GL FL, θ, and muscle thickness was ≤12.1 mm and ≤18.00 mm, ≤6.4° and ≤4.2°, and ≤3.2 mm and ≤3.1 mm. Although reliable, the relatively large MDC suggest that clinically derived ultrasound measurements of muscle architecture in GM and GL are more likely to be useful to detect differences between populations than to detect changes in muscle architecture following interventions.

Quantification of the demands of cricket bowling and the relationship to injury risk: a systematic review

BACKGROUND

Bowling in cricket is a complex sporting movement which, despite being well characterised, still produces a significant number of injuries each year. Fast bowlers are more likely to be injured than any other playing role. Frequency, duration, intensity and volume of bowling, which have been generalised as measurements of workload, are thought to be risk factors for injuries. Injury rates of fast bowlers have not reduced in recent years despite the implementation of various workload monitoring practices.

OBJECTIVE

To identify the variables used to quantify frequency, intensity, time and volume of bowling; and evaluate relationships between these variables and injury risk.

METHODS

Six online databases were systematically searched for studies on fast bowling that included terms related to workload. Population characteristics, variables relating to demand and their relationship to standardised definitions of physical activity were extracted from all included studies.

RESULTS

Bowling workload is typically quantified through measures of frequency, duration, or indirect intensity, with few studies reporting on bowling volume.

CONCLUSIONS

When reported on, volume was often described using imprecise or insufficient measures of intensity. There is a need to develop more appropriate measures of intensity during bowling and improve the quality of evidence to inform on bowling programme management practices.

Acute physiologic effects of N95 respirator use on gastroenterologists performing simulated colonoscopy

BACKGROUND AND AIMS

During the severe acute respiratory syndrome coronavirus 2 pandemic, N95 filtering facepiece respirator (FFR) use was required while performing aerosol-generating procedures. We studied the physiologic effects of N95 FFR use in a cohort of gastroenterologists performing simulated colonoscopies.

METHODS

Data collection and comparisons included (1) symptoms and change in vital signs in 12 gastroenterologists performing simulated colonoscopy for 60 minutes while wearing a surgical mask (SM) and faceshield (FS); N95 FFR, SM, and FS; and powered air-purifying respirator (PAPR) and (2) respiratory belt plethysmography and continuous electrocardiographic frequency-based heart rate (HR) variability indices including very low frequency power (measures intracardiac sympathetic tone) and low frequency to high frequency ratios (intracardiac sympathetic to vagal ratio) in 11 gastroenterologists performing simulated colonoscopy while wearing an SM (15 minutes), N95 FFR and SM (60 minutes), and SM (15 minutes) in rapid sequence.

RESULTS

Ten of 12 gastroenterologists (83%) reported symptoms with N95 FFR use, most commonly breathing difficulty, frustration, fatigue, and headache. Nine of these gastroenterologists (75%) had associated significant HR elevation. Respiratory peak to trough measurement showed a significant increase (F(2) = 7.543, P = .004) during the N95 FFR stage, which resolved after removal of the N95 FFR. Although not statistically different, all gastroenterologists showed a decrease in sympathetic to vagal ratios and an increase in intracardiac sympathetic effects in the N95 FFR stage. PAPR use was better tolerated but was associated with headache and elevated HR in 4 gastroenterologists (33%).

CONCLUSIONS

N95 FFR use by gastroenterologists is associated with development of acute physiologic changes and symptoms.

Associations Between Measures of Physical Activity and Muscle Size and Strength: A Systematic Review

Objective

To determine whether physical activity is associated with lower limb muscle size and strength within the general population.

Data Sources

Six databases were systematically searched from inception using 3 main constructs: lower extremity, muscle volume, and muscle strength.

Study Selection

Studies that measured physical activity (using either objective or subjective measurements), lower limb muscle size, and strength were included. Available discrete group data were standardized using previously published age- and sex-specific normative values prior to analysis.

Data Extraction

The final analysis included 47 studies from an initial yield of 5402 studies. Standardized scores for outcome measures were calculated for 97 discrete groups.

Data Synthesis

As anticipated, lower limb muscle size was positively correlated with lower limb muscle strength (r=0.26, P<.01; n=4812). Objectively measured physical activity (ie, accelerometry, pedometry) (n=1944) was positively correlated with both lower limb muscle size (r=0.30, P<.01; n=1626) and lower limb strength (r=0.24, P<.01; n=1869). However, subjectively measured physical activity (ie, questionnaires) (n=3949) was negatively associated with lower limb muscle size (r=–0.59, P<.01; n=3243) and lower limb muscle strength (r=–0.48, P<. 01; n=3882).

Conclusions

This review identified that objective measures of physical activity are moderately associated with lower limb muscle size and muscle strength and can, therefore, be used to predict muscle changes within the lower limbs associated with exercise-based rehabilitation programs.

Effect of Player Role and Competition Level on Player Demands in Basketball

This study compared basketball training and match demands between player roles (starters, in-rotation bench players, out-rotation bench players) and between competition levels (semi-professional, professional). Thirty-seven players from one professional women's team, one semi-professional women's team, and one semi-professional men's team wore accelerometers during training and matches throughout a competitive season. All teams were used for player role comparisons and the women's teams were used to compare competition levels. Match and training session average intensity and volume, and durations of relative exercise intensities (inactive, light, moderate-vigorous, maximal, supramaximal) were calculated. Compared to out-rotation bench players, starters experienced twice the average match intensity and volume, spent 50% less match time being inactive, and spent 1.7-4.2× more match time in all other activity categories (p < 0.01). Compared to in-rotation bench players, starters experienced 1.2× greater average match intensity and volume, spent 17% less match time being inactive, and spent 1.4-1.5× more match time performing moderate-vigorous and maximal activity (p < 0.01). No differences in match demands were found between women's competition levels, however the professional team experienced double the cumulative weekly training volume of the semi-professional team and spent 1.6-2.1× more cumulative weekly time in all activity categories (p < 0.01). To improve performance and reduce injury risk, players should prepare for the greatest match demands they could encounter during a season while considering potential changes to their role. Additionally, players might need their training volume managed when transitioning from a semi-professional to a professional season to reduce the injury risk from sharp increases in training demands.

The effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital settings: a systematic review and meta-analysis

Background

The aim of this systematic review and meta-analysis was to investigate whether behaviour change interventions promote changes in physical activity and anthropometrics (body mass, body mass index and waist circumference) in ambulatory hospital populations.

Methods

Randomised controlled trials were collected from five bibliographic databases (MEDLINE, Embase, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO). Meta-analyses were conducted using change scores from baseline to determine mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (95% CI). The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence.

Results

A total of 29 studies met the eligibility criteria and 21 were included in meta-analyses. Behaviour change interventions significantly increased physical activity (SMD: 1.30; 95% CI: 0.53 to 2.07, p < 0.01), and resulted in significant reductions in body mass (MD: -2.74; 95% CI: − 4.42 to − 1.07, p < 0.01), body mass index (MD: -0.99; 95% CI: − 1.48 to − 0.50, p < 0.01) and waist circumference (MD: -2.21; 95% CI: − 4.01 to − 0.42, p = 0.02). The GRADE assessment indicated that the evidence is very uncertain about the effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital patients.

Conclusions

Behaviour change interventions initiated in the ambulatory hospital setting significantly increased physical activity and significantly reduced body mass, body mass index and waist circumference. Increased clarity in interventions definitions and assessments of treatment fidelity are factors that need attention in future research.

PROSPERO registration number: CRD42020172140.

A physical activity coaching intervention can improve and maintain physical activity and health-related outcomes in adult ambulatory hospital patients: the Healthy4U-2 randomised controlled trial

Background

The Healthy 4 U-2 study sought to evaluate the effect of a twelve-week, physical activity (PA) coaching intervention for changes and maintenance in PA, anthropometrics and health-related outcomes in adults presenting to an ambulatory hospital clinic.

Methods

One hundred and twenty insufficiently active adults were recruited from an ambulatory hospital clinic and randomised to an intervention group that received an education session and five 20-min telephone sessions of PA coaching, or to a control group that received the education session only. ActiGraph GT3X accelerometers were used to measure moderate-to-vigorous physical activity (MVPA) at baseline, post-intervention (3-months) and follow-up (9-months). Secondary outcome measures (anthropometrics, PA self-efficacy, and health-related quality of life) were also assessed at the three time points.

Results

At baseline, the mean age and body mass index of participants were 53 ± 8 years and 31 ± 4 kg/m², respectively. Relative to control, the intervention group increased objectively measured MVPA at post-intervention (p < 0.001) and 9 months follow-up (p < 0.001). At the 9-month follow-up the intervention group completed 22 min/day of MVPA (95% CI: 20 to 25 min/day), which is sufficient to meet the recommended PA guidelines. The intervention group exhibited beneficial changes in body mass (p < 0.001), waist circumference (p < 0.001), body mass index (p < 0.001), PA self-efficacy (p < 0.001), and health-related quality of life (p < 0.001) at the 9-month follow-up.

Conclusions

This study demonstrates that a low contact PA coaching intervention results in beneficial changes in PA, anthropometrics and health-related outcomes in insufficiently active adults presenting to an ambulatory care clinic. The significant beneficial changes were measured at post-intervention and the 9-month follow-up, demonstrating a maintenance effect of the intervention.

Trial registration

Prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, Trial registration number: ACTRN12619000036112.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-020-01063-x.

Responsiveness of the single item measure to detect change in physical activity

Objective

The objective of this study was to evaluate the responsiveness of the single item measure (SIM) to detect change in PA when compared to hip-worn accelerometry. A secondary aim was to provide further data on validity of the measure at a single time point.

Methods

Validity of the SIM to determine the number of days of ≥30 minutes of accelerometer-derived moderate-to-vigorous physical activity (MVPA) was assessed in 120 participants (78% female, 19% male, 3% other; age: 46 ± 11 years). Analysis of change was based on change in the number of days that participants completed ≥30 minutes of MVPA determined by the SIM and accelerometry over two 7-day periods in 90 participants (age: 47±11 years). Accelerometer data were analysed as total minutes of MVPA per day (MVPA-total) and as sustained bouts of 10 minutes or more of MVPA (MVPA-bouts). Validity of the SIM to detect change in MVPA, using accelerometer data as the reference measurement, was examined through Spearman’s correlation and agreement in classification of change between SIM and accelerometry. Responsiveness to change was assessed by standardised response means and Cohen’s d.

Results

Standardised response means for PA change were moderate for the SIM (0.77), MVPA-total (0.57) and MVPA-bouts (0.79). The correlation for change in number of days ≥30 minutes MVPA between the SIM and accelerometry were small to moderate (MVPA-total: r = 0.36 and MVP-bouts: r = 0.40). The SIM displayed moderate accuracy (60%-63%), using accelerometer data as the reference measurement, in detecting increases in days ≥30 minutes of MVPA.

Conclusion

The SIM is a potentially useful assessment tool for evaluating change in MVPA, particularly when device-based measures or longer self-report measures are not feasible.

Physiological and biomechanical comparison between electrically assisted bicycles and motorbikes during simulated mail delivery

Electrically assisted bicycles (EABs) and motorbikes were compared in terms of energy expenditure, internal and external forces, and technique when delivering mail with different loads at different distances from the mailbox. Twenty-two postal workers performed two simulated postal tasks (foot placement [close vs. far] and delivery, and simulated mail delivery circuit) while carrying 0 and 32 kg. Independent of mail load, delivering mail with EABs was classified as moderate intensity and resulted in 33% higher energy expenditure when compared to motorbikes. Ground reaction forces were larger (7-25%) for EAB when compared to motorbike. Larger ground reaction forces were observed when both EABs and motorbikes were positioned further from the mailbox (5-23%). Using EABs during mail delivery has potential to result in numerous health benefits that are associated with moderate intensity physical activity, but can lead to larger external forces when compared to motorbikes. Practitioner summary: In order to compare electrically assisted bicycles (EAB) and motorbikes, postal workers performed simulated deliveries in the laboratory whilst measurements of energy expenditure, body loads and movement patters were undertaken. Body loads and energy expenditure were larger using EAB, which result in health benefits associated with moderate intensity exercise. Abbreviations: EAB: electrically assisted bicycles; CI: confidence interval; UHEC: University Human Ethics Committee; MB: motorbike;SH: seat height; SF: seat to floor distance; VO2: oxygen uptake; VCO2: exhaled carbon dioxide; RER: respiratory exchangeratio; TTL signal: Transistor-Transistor Logic; MET: metabolic equivalent; 3D: three-dimensional; IIR: infinite impulse response; Hz:Hertz; N: Newtons; ROM: range of motion; SD: standard deviation; p: significance level; d: Cohen effect sizes.

A web-based intervention to promote physical activity in adolescents and young adults with cystic fibrosis: protocol for a randomized controlled trial

BACKGROUND

Regular participation in physical activity by people with cystic fibrosis (CF) promotes positive clinical and health outcomes including reduced rate of decline in lung function, fewer hospitalizations and greater wellbeing. However adherence to exercise and activity programs is low, in part due to the substantial daily therapy burden for young people with CF. Strict infection control requirements limit the role of group exercise programs that are commonly used in other clinical groups. Investigation of methods to promote physical activity in this group has been limited. The Active Online Physical Activity in Cystic fibrosis Trial (ActionPACT) is an assessor-blinded, multi-centre, randomized controlled trial designed to compare the efficacy of a novel web-based program (ActivOnline) compared to usual care in promoting physical activity participation in adolescents and young adults with CF.

METHODS

Adolescents and young adults with CF will be recruited on discharge from hospital for a respiratory exacerbation. Participants randomized to the intervention group will have access to a web-based physical activity platform for the 12-week intervention period. ActivOnline allows users to track their physical activity, set goals, and self-monitor progress. All participants in both groups will be provided with standardised information regarding general physical activity recommendations for adolescents and young adults. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and at 3-months followup. Healthcare utilization will be assessed at 12 months from intervention completion. The primary outcome is change in moderate-to-vigorous physical activity participation measured objectively by accelerometry. Secondary outcomes include aerobic fitness, health-related quality of life, anxiety and depression and sleep quality.

DISCUSSION

This trial will establish whether a web-based application can improve physical activity participation more effectively than usual care in the period following hospitalization for a respiratory exacerbation. The web-based application under investigation can be made readily and widely available to all individuals with CF, to support physical activity and exercise participation at a time and location of the user's choosing, regardless of microbiological status.

TRIAL REGISTRATION

Clinical trial registered on July 13, 2017 with the Australian and New Zealand Clinical Trials Register at (ACTRN12617001009303).

Cost-effectiveness of telephone coaching for physically inactive ambulatory care hospital patients: economic evaluation alongside the Healthy4U randomised controlled trial

OBJECTIVE

To assess whether telephone coaching is a cost-effective method for increasing physical activity and health-related quality of life for insufficiently active adults presenting to an ambulatory care clinic in a public hospital.

DESIGN

An economic evaluation was performed alongside a randomised controlled trial.

SETTING

Participants were recruited from an ambulatory care clinic in a public hospital in regional Australia.

PARTICIPANTS

Seventy-two adults (aged 18-69) deemed insufficiently physically active via self-report.

INTERVENTIONS

Participants were randomised to either an intervention group that received an education session and eight sessions of telephone coaching over a 12-week period, or to a control group that received the education session only. The intervention used in the telephone coaching was integrated motivational interviewing and cognitive behavioural therapy.

OUTCOME MEASURES

The primary health outcome was change in moderate-to-vigorous physical activity (MVPA), objectively measured via accelerometry. The secondary outcome was the quality-adjusted life-year (QALY) determined by the 12-item Short Form Health Survey Questionnaire. Outcome data were measured at baseline, postintervention (3 months) and follow-up (6 months). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty.

RESULTS

The mean intervention cost was $279±$13 per person. At 6 months follow-up, relative to control, the intervention group undertook 18 more minutes of daily MVPA at an ICER of $15/min for each additional minute of MVPA. With regard to QALYs, the intervention yielded an ICER of $36 857 per QALY gained. Sensitivity analyses indicated that results were robust to varied assumptions.

CONCLUSION

Telephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently physically active ambulatory care hospital patients. Additional research could explore the potential economic impact of the intervention from a broader healthcare perspective.

TRIAL REGISTRATION NUMBER

ANZCTR: ACTRN12616001331426.

Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments

OBJECTIVE

To determine whether sex differences exist in the triage, management and outcomes associated with non-traumatic chest pain presentations in the emergency department (ED).

METHODS

All adults (≥18 years) with non-traumatic chest pain presentations to three EDs in Melbourne, Australia between 2009 and 2013 were retrospectively analysed. Data sources included routinely collected hospital databases. Triage scoring of the urgency of presentation, time to medical examination, cardiac troponin testing, admission to specialised care units, and in-ED and in-hospital mortality were each modelled using the generalised estimating equations approach.

RESULTS

Overall 54 138 patients (48.7% women) presented with chest pain, contributing to 76 216 presentations, of which 26 282 (34.5%) were cardiac. In multivariable analyses, compared with men, women were 18% less likely to be allocated an urgency of 'immediate review' or 'within 10 min review' (OR=0.82, 95% CI 0.79 to 0.85), 16% less likely to be examined within the first hour of arrival to the ED by an emergency physician (0.84, 0.81 to 0.87), 20% less likely to have a troponin test performed (0.80, 0.77 to 0.83), 36% less likely to be admitted to a specialised care unit (0.64, 0.61 to 0.68), and 35% (p=0.039) and 36% (p=0.002) more likely to die in the ED and in the hospital, respectively.

CONCLUSIONS

In the ED, systemic sex bias, to the detriment of women, exists in the early management and treatment of non-traumatic chest pain. Future studies that identify the drivers explaining why women presenting with chest pain are disadvantaged in terms of care, relative to men, are warranted.

Muscle force adaptation to changes in upper body position during seated sprint cycling

Sprint cycling performance depends upon the balance between muscle and drag forces. This study assessed the influence of upper body position on muscle forces and aerodynamics during seated sprint cycling. Thirteen competitive cyclists attended two sessions. The first session was used to determine handlebar positions to achieve pre-determined hip flexion angles (70-110° in 10° increments) using dynamic bicycle fitting. In the second session, full body kinematics and pedal forces were recorded throughout 2x6-s seated sprints at the pre-determined handlebar positions, and frontal plane images were used to determine the projected frontal area. Leg work, joint work, muscle forces and frontal area were compared at three upper body positions, being optimum (maximum leg work), optimal+10° and optimal-10° of hip flexion. Larger hip (p = 0.01-0.02) and reduced knee (p = 0.02-0.03) contribution to leg work were observed at the optimal+10° position without changes at the ankle joint (p = 0.39). No differences were observed in peak muscle forces across the three body positions (p = 0.06-0.48). Frontal area was reduced at optimum+10° of hip flexion when compared to optimum (p = 0.02) and optimum-10° (p < 0.01). These findings suggest that large changes in upper body position can influence aerodynamics and alter contributions from the knee and hip joints, without influencing peak muscle forces.

Surgeons and preventive health: a mixed methods study of current practice, beliefs and attitudes influencing health promotion activities amongst public hospital surgeons

Background

Little is known about the participation of surgeons in preventative health activities in the non-admitted hospital care setting. The aim of this study was to identify which preventive health activities surgeons practice and to explore their attitudes towards preventive health.

Methods

A mixed methods study was conducted using a sequential explanatory design. Quantitative results were obtained from a self-reported clinician survey (n = 16) and a Generalized Estimating Equation was used to assess the relationship between dependent (preventive health practice) and independent (confidence and knowledge in preventive health practice, years of practice, and attitudinal factors) variables. Using a building approach to integration, results from the quantitative analyses informed design of the interview guide. Surgeons’ beliefs and attitudes were explored using in-depth, semi structured interviews with a purposeful sample of surgeons (n = 14). Responses were collected, independently coded and analysed using a qualitative descriptive approach.

Results

In accordance with a contiguous narrative approach to integration, the quantitative and qualitative findings are reported separately. The clinician survey found that the surgeons carried out preventive health activities at low levels. Preventive health advice was predominantly verbal in nature, and few surgeons provided written material or referred patients to additional services. The GEE analyses indicated that the following factors best predicted the tendency to undertake preventive health activities: years of clinical practice (p = 0.041), and the perceived work priority placed on preventive health (p = 0.008). Interviews generated four themes that influenced the tendency of surgeons to undertake preventive health activities: perceptions of their role in preventive health, perceived motivation of patients, hospital structure, and facilitating factors. In regards to enabling factors that are likely to increase preventive health practice, surgeons unanimously advocated for referral pathways into specialist behaviour change programs that they could facilitate within their relatively brief consulting time.

Conclusions

The findings suggests that the majority of public hospital surgeons engage in routine preventive health advice at a low level. The high volume of non-admitted surgical consultations undertaken annually, coupled with medium to high self-reported knowledge and confidence in addressing behavioural risk factors, support an increased involvement of surgeons in preventive health practice.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4186-y) contains supplementary material, which is available to authorized users.

Changes in body position on the bike during seated sprint cycling: Applications to bike fitting

Dynamic bike fitting often includes the optimisation of lower limb joint kinematics while participants undertake sub-maximal intensity cycling; however, this practice might not be appropriate for sprint cycling. This study aimed to determine if trained cyclists maintain lower limb angles, defined during dynamic sub-maximal bike fitting, while completing seated sprint cycling. Fifteen competitive cyclists completed two testing sessions. Dynamic bike fitting was undertaken during the first session, where handlebar positions were identified to produce pre-determined hip flexion angles (70°-110°) during sub-maximal cycling using an inertial-based motion tracking system. In the second session, full body kinematics were determined during two 6-s sprints performed at each of the pre-determined handlebar positions. During sprinting, measured right hip angles were only different at 110°, when compared with 90° (p < 0.01, d = 0.95), and 80° (p < 0.01, d = 1.49). For the left leg, measured hip angles differed between 110° vs. 90° (p < 0.01, d = 1.52), 110° vs. 80° (p < 0.01, d = 2.09), and 100° vs. 80° (p = 0.04, d = 1.06). Even though changes in bike configuration resulted in 10° increments of hip flexion during dynamic sub-maximal bike fitting, these hip angles were not replicated during sprinting. Therefore, dynamic sub-maximal bike fitting leading to changes in handlebar positions that produce hip angles of 80°-100° might not influence cycling performance due to acute changes in the body position of cyclists on the bicycle during a sprint.

Risk of bacterial exposure to the endoscopist's face during endoscopy

BACKGROUND AND AIMS

Nonuniversal use of facial protection during endoscopy may place endoscopists at risk of exposure to blood and body fluids; however, the frequency of exposure is unknown.

METHODS

A prospective 6-month study of 4 gastroenterologists using a face shield during endoscopy was undertaken. The face shield was swabbed in a standardized fashion before and at the end of the session. Controls included pre- and post-swabs of face shields placed on the (1) endoscopy suite wall, (2) remote patient intake bay wall, and (3) after deliberate contamination with a colonoscope immediately after colonoscopy. The swabs were cultured for 48 hours, and growth was reported as no growth or by number of colony-forming units (CFUs). The groups were compared for +CFU rate and CFU number.

RESULTS

A total of 1100 procedures were performed in 239 endoscopy sessions. The +CFU rate in the pre-endoscopy groups (2%-4.8%, not significant) was significantly lower than the postendoscopist face shield (45.8%, P < .001) and endoscopy suite wall groups (21.4%, P < .001), respectively. Using a cut-off of >15 CFUs as an indicator of definite exposure, the occurrence rate was 5.6 per 100 half days of endoscopy to the endoscopist's face and 3.4 per 100 half days of endoscopy 6 feet away.

CONCLUSIONS

This is the first study to quantify the rate of unrecognized exposure to the endoscopist's face to potentially infectious biologic samples during endoscopy (5.6/100 days of endoscopy). This exposure may result in transmission of infectious diseases. As such, we recommend the use of universal facial protection during GI endoscopy.

The impact of a 21-day ultra-endurance ride on the heart in young, adult and older adult recreational cyclists

BACKGROUND

This study assessed the acute effect of 21 days of challenging exercise on heart structure and function in recreationally active people across a range of age categories.

METHODS

15 recreationally active people completed a 21-day fundraising cycling ride (MADRIDE) over a distance of 3515 km. Twenty-four hour Holter electrocardiography and blood biochemistry analyses were performed before and after the MADRIDE.

RESULTS

Incidence of cardiac arrhythmia was higher after MADRIDE (OR: 5.93; 95% CI: 5.68-6.19), with increases in both ventricular arrhythmias (OR: 9.90; 95% CI: 9.27-10.57) and supraventricular arrhythmias (OR: 3.09; 95% CI: 2.91-3.29). Adults (OR: 11.45; 95% CI: 7.41-17.69) and older adults (OR: 10.42 95% CI 9.83-11.05) were approximately 10 times more likely to experience arrhythmias after the MADRIDE. Whereas, young participants experienced 18% less cardiac arrhythmias after MADRIDE (OR: 0.82; 95% CI: 0.75-0.90). Aortic valve max velocity was reduced (MD: -0.12 m/s; 95% CI: -0.19-0.05 m/s) and mitral valve deceleration time was slower (MD: -28.91 m/s; 95% CI: -50.97-6.84 m/s) after MADRIDE. Other structural and functional characteristics along with heart rate variability were not different after MADRIDE.

CONCLUSIONS

Multi-day challenging exercise increased the incidence of both supraventricular and ventricular arrhythmias in active adults and older adults. Increases in arrhythmia rates after MADRIDE occurred without changes in cardiac structure and autonomic control. Further exploration is necessary to identify the causes of exercise-induced cardiac arrhythmia in adult and older adults.

Biomechanical and physiological responses to electrically assisted cycling during simulated mail delivery

This study quantified the biomechanical (movements and forces) and physiological (energy expenditure) demands of postal delivery performed with electrically assisted bicycles (EABs). Ten postal workers and 10 recreational athletes performed three simulated postal tasks (simulated mail delivery circuit, delivery distance [close vs. far], and 3-min stationary cycling) while carrying 0, 16 and 32 kg. Physiological (energy expenditure) and biomechanical (internal and external forces and joint angles) responses were calculated. Energy expenditure (10-20%; p < 0.05) and power output (30-44%; p < 0.05) increased with increasing mail loads. Ground reaction force increased (∼10%) for the far delivery distance, but joint reaction forces were unchanged. Lower hip flexion (p < 0.01), less hip abduction (p < 0.01) and larger spine anterior flexion (p < 0.01) were observed for the far delivery distance. Joint forces were not affected by the mail load transported (0-32 kg) or distance from the mailbox (close vs far). EABs can provide a suitable transportation method to assist mail delivery in terms of energy expenditure reduction.

Accumulated or continuous exercise for glycaemic regulation and control: a systematic review with meta-analysis

OBJECTIVE

To compare the effectiveness of accumulating exercise in multiple bouts of at least 10 min throughout a day with exercise completed in a single bout (continuous or interval), or no exercise, on glycaemic control and regulation in inactive people without diagnosed glycaemic dysfunction.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Seven electronic databases were searched: CINAHL (EBSCO), Cochrane Library, EMBASE (Ovid), MEDLINE 1948-(Ovid), SCOPUS (Elsevier), SPORTDiscus (EBSCO) and Web of Science (ISI) with no restrictions on date and included all titles indexed up to February 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles reporting insufficiently active adults (19 to 64 years) without metabolic dysfunction, measuring glycaemic control or regulation following at least 6 weeks of aerobic exercise.

RESULTS

Only one study compared accumulated exercise to single-bout exercise with no significant effect on fasting glucose (95% CI: -0.04 to 0.24 mmol·L-1) or fasting insulin (95% CI: -1.79 to 9.85 pmol·L-1) reported 48 hours after the final bout. No studies compared accumulated exercise with no-exercise. Compared with no-exercise, single-bout exercise reduces insulin resistance (mean difference (MD): -0.53 pmol·L-1; 95% CI: -0.93 to -0.13). Insulin resistance was clearly reduced with moderate-intensity (-0.68 (-1.28 to -0.09)) but not with high-intensity (-0.38 (-1.20 to 0.44)) exercise. Single-bout exercise was not statistically more beneficial than no-exercise for glycated haemoglobin (HbA1c) (MD: -0.11 %; 95% CI: -0.24 to 0.02) in metabolically healthy individuals.

SUMMARY/CONCLUSION

The glycaemic response to accumulated exercise or single-bout exercise might not be different, however exercise intensity might influence the mechanisms generating the response.

PROSPERO REGISTRATION NUMBER

CRD42015025042.

Reduced professional efficacy is associated with a blunted salivary alpha-amylase awakening response

The job demands-resources model (JD-R) has shown an ability to predict worker engagement and exhaustion, yet to our knowledge, research has not been conducted that assesses the JD-R model with physiological indicators of chronic stress and burnout. Using the JD-R model, we assessed if occupational stress and burnout were related to dysregulated cortisol and salivary alpha-amylase awakening responses (sAA-AR). Professional apprentice jockeys comprising of males (n = 14) and females (n = 18) provided morning saliva samples and completed self-report measures relating to job demands and resources, burnout, and perceived mental and physical health. Data was collected at two time points coinciding with naturally occurring 'low' and 'high' stress periods during the racing calendar. The jockeys reported good physical and mental health but had elevated levels of the burnout subtypes cynicism and exhaustion. Regression analyses suggested that those jockeys presenting with reduced professional efficacy in the high stress period produced a 'flattened' sAA-AR indicative of reduced autonomic nervous system (ANS) arousal, which has been associated with burnout. Further, decreases in professional efficacy explained the relationship between increased workplace stress and decreased ANS activity in the high stress period. Our findings suggest that assessments of psychological stress or physiology in isolation are not as useful as looking at both in combination, and extend previous findings on the sAA-AR.

Surgeons and preventative health: protocol for a mixed methods study of current practice, beliefs and attitudes influencing health promotion activities amongst public hospital surgeons

Background

The high prevalence of non-communicable diseases places significant demands on the healthcare system. As a result, hospitals are seeking to broaden their role to include more integrated health promotion. Strong leadership at different levels of the organisation is required for the successful integration of health promotion in hospital settings. The status of surgeons within healthcare affords them significant influence over clinical practice, and by extension, institutional policy and practice. The voice of this professional group is, however, absent from preventative health literature. The aim of this research is to identify which health promotion activities surgeons undertake, and to explore the attitudes of the profession towards health promotion activities.

Methods

A mixed methods study will be conducted, guided by the principles of sequential explanatory design. Quantitative results from a clinician survey will be followed by in-depth, semi structured interviews to explore findings in more depth through qualitative analysis. We will recruit from general and orthopaedic surgeons and registrars in a major tertiary hospital in a regional city in Australia (n ≈ 31). Data will be collected, independently coded and analysed using a qualitative descriptive approach. Quantitative and qualitative results will be merged during interpretation to provide complementary perspectives of interrelated contextual factors that influence health promotion activities amongst hospital surgeons.

Discussion

The depth of insight gained from these highly professionalised clinicians will offer a distinctive perspective on current practice, as well as the challenges of implementing effective health promotion into surgical practice. The findings from this research will assist in guiding strategy and policy at both clinical and institutional levels on health promotion planning and practice. Gaining insights from surgeons will strengthen the evidence base to assist the integration of health promotion into hospital practice.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3606-8) contains supplementary material, which is available to authorized users.

Integrated motivational interviewing and cognitive behaviour therapy can increase physical activity and improve health of adult ambulatory care patients in a regional hospital: the Healthy4U randomised controlled trial

BACKGROUND

The aim of this study was to determine whether a twelve-week, health coaching intervention could result in changes in physical activity, anthropometrics and health-related outcomes in adults presenting to an ambulatory hospital clinic.

METHODS

Seventy-two participants who reported being insufficiently active were recruited from an ambulatory hospital clinic and randomised to an intervention group that received an education session and eight 30-min telephone sessions of integrated motivational interviewing and cognitive behaviour therapy (MI-CBT), or to a control group that received the education session only. ActiGraph GT3X accelerometers were used to measure moderate-to-vigorous physical activity at baseline, post-intervention (3-months) and follow-up (6-months). Secondary outcome measures (anthropometrics, physical activity self-efficacy, health-related quality of life, type 2 diabetes risk) were also assessed at the three time points.

RESULTS

At baseline, the mean age and body mass index of participants (n = 72, 75% females) were 53 ± 8 years and 30.8 ± 4.1 kg/m2, respectively. Treatment group influenced the pattern of physical activity over time (p < 0.001). The intervention group increased moderate-to-vigorous physical activity from baseline to post-intervention and remained elevated at follow-up by 12.9 min/day (95%CI: 6.5 to 19.5 min/day). In contrast, at follow-up the control group decreased moderate-to-vigorous physical activity by 9.9 min/day (95%CI: -3.7 to -16.0 min/day). Relative to control, at follow-up the intervention group exhibited beneficial changes in body mass (p < 0.001), waist circumference (p < 0.001), body mass index (p < 0.001), physical activity self-efficacy (p < 0.001), type 2 diabetes risk (p < 0.001), and health-related quality of life (p < 0.001).

CONCLUSIONS

This study demonstrates that a low contact coaching intervention results in beneficial changes in physical activity, anthropometrics and health-related outcomes that were maintained at follow-up in adults who report being insufficiently active to an ambulatory care clinic.

TRIAL REGISTRATION

ANZCTR: ACTRN12616001331426 . Registered 23 September 2016.

Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: a systematic review and meta-analyses

BACKGROUND

The aim of this study was to investigate whether integrated motivational interviewing and cognitive behaviour therapy leads to changes in lifestyle mediators of overweight and obesity in community-dwelling adults.

METHOD

Six electronic databases were systematically searched up to 04 October, 2017. Analyses were restricted to randomised controlled trials that examined the effect of integrated motivational interviewing and cognitive behaviour therapy on lifestyle mediators of overweight and obesity (physical activity, diet, body composition) in community-dwelling adults. Meta-analyses were conducted using change scores from baseline in outcome measures specific to the lifestyle mediators of overweight and obesity to determine standardized mean differences (SMD) and 95% confidence intervals (95% CI). The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence.

RESULTS

Ten randomised controlled trials involving 1949 participants were included. Results revealed moderate quality evidence that integrated motivational interviewing and cognitive behaviour therapy had a significant effect in increasing physical activity levels in community-dwelling adults (SMD: 0.18, 95% CI: 0.06 to 0.31, p < 0.05). The combined intervention resulted in a small, non-significant effect in body composition changes (SMD: -0.12, 95% CI: -0.24 to 0.01, p = 0.07). Insufficient evidence existed for outcome measures relating to dietary change.

DISCUSSION

The addition of integrated motivational interviewing and cognitive behaviour therapy to usual care can lead to modest improvements in physical activity and body composition for community-dwelling adults. The available evidence demonstrates that it is feasible to integrate MI with CBT and that this combined intervention has the potential to improve health-related outcomes.

CONCLUSION

This review details recommendations for future research including the adoption of uniform objective outcome measures and well-defined interventions with sufficient follow-up durations and assessments of treatment fidelity.

Targeted gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst trial - Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial

BACKGROUND

Clinical practice guidelines recommend exercise as the first line of management for hip osteoarthritis, yet high-quality evidence from Cochrane reviews suggest only slight benefits for pain and physical function; and no benefit on quality of life (low-quality evidence). However, the scope of physical impairments identified in people with hip osteoarthritis may not have been adequately addressed with targeted rehabilitation options in previous randomised controlled trials (RCTs). Potential targeted options include gait retraining to address spatio-temporal impairments in walking; motor control training to address deep gluteal (gluteus minimus) dysfunction; and progressive, high-intensity resistance exercises to address atrophy of the gluteal muscles. The aim of this study is to investigate the effect of a targeted gluteal rehabilitation programme that incorporates gait retraining, motor control and progressive, high-intensity resistance-strength training, to address physical activity levels and self-reported physical function in people with mild to moderate disability from hip osteoarthritis.

METHODS

Ninety people diagnosed with mild to moderately disabling hip osteoarthritis will be recruited and randomised to receive one of two exercise programmes (sham or GHOst programme). Interventions will be 12 weeks in duration, with weekly, supervised physiotherapy sessions, and daily home exercises. Both groups will receive standardised education. Outcomes will be assessed at baseline, 7 weeks, 13 weeks (primary time-point) and 25 weeks. The primary outcome will be self-reported physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include physical activity measured with a tri-axial accelerometer, physical function tests, self-reported physical activity, isometric hip-muscle strength tests, hip-related patient-reported outcome measures, pain thoughts and depressive symptoms, quality of life, global rating of change, gluteal-muscle activity (electromyography (EMG)) and gluteal-muscle size and adiposity (magnetic resonance imaging (MRI)).

DISCUSSION

This will be the first study to compare a targeted gluteal rehabilitation programme to a sham exercise programme. The targeted GHOst programme includes exercises designed to address gait impairments as well as gluteal-muscle atrophy and dysfunction.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347 . Registered retrospectively on 5 July 2017. Protocol version 3.0.

The AUStralian MEDiterranean Diet Heart Trial (AUSMED Heart Trial): A randomized clinical trial in secondary prevention of coronary heart disease in a multiethnic Australian population: Study protocol

The Mediterranean diet was first characterized as a heart-protective diet in the 1960s. The significant cardioprotective effects of the Mediterranean diet in comparison to the standard-care low-fat diet have been established in the primary prevention of cardiovascular disease (CVD); however, there is insufficient evidence in secondary prevention research to influence the current standard of care. Opportunity exists to assess the Mediterranean diet as a therapeutic target for secondary CVD prevention within Australia's ethnoculturally diverse communities. The AUSMED Heart Trial is a multisite randomized controlled trial that will evaluate the efficacy of the Mediterranean diet for secondary prevention of CVD in the Australian health care setting. This trial aims to evaluate the effect of a 6-month Mediterranean diet intervention (delivered by dietitians) versus a "standard-care" low-fat diet in reducing the composite incidence of cardiovascular events at 12 months and at trial end in participants with documented evidence of a previous acute myocardial infarction at trial entry. The quality of the diet at baseline and follow-up will be assessed using comprehensive dietary questionnaires and diaries as well as relevant dietary biomarkers (such as urinary polyphenols and erythrocyte fatty acids). Cardiovascular risk markers, including novel measures of immune and inflammatory status, endothelial function, vascular compliance, platelet activity, and body composition, will be collected to explore possible mechanisms for treatment effect. Cost-effectiveness will also be estimated to support policy translation. We plan to recruit 1,032 participants (516 per arm) from cardiology clinics in major Australian hospitals in Melbourne, Adelaide, and Brisbane.

The Effect of Match Schedule on Accelerometry-Derived Exercise Dose during Training Sessions throughout a Competitive Basketball Season

Accelerometry-derived exercise dose (intensity × duration) was assessed throughout a competitive basketball season. Nine elite basketballers wore accelerometers during a Yo-Yo intermittent recovery test (Yo-Yo-IR1) and during three two-week blocks of training that represented phases of the season defined as easy, medium, and hard based on difficulty of match schedule. Exercise dose was determined using accumulated impulse (accelerometry-derived average net force × duration). Relative exercise intensity was quantified using linear relationships between average net force and oxygen consumption during the Yo-Yo-IR1. Time spent in different intensity zones was computed. Influences of match schedule difficulty and playing position were evaluated. Exercise dose reduced for recovery and pre-match tapering sessions during the medium match schedule. Exercise dose did not vary during the hard match schedule. Exercise dose was not different between playing positions. The majority of activity during training was spent performing sedentary behaviour or very light intensity activity (64.3 ± 6.1%). Front-court players performed a greater proportion of very light intensity activity (mean difference: 6.8 ± 2.8%), whereas back-court players performed more supramaximal intensity activity (mean difference: 4.5 ± 1.0%). No positional differences existed in the proportion of time in all other intensity zones. Objective evaluation of exercise dose might allow coaches to better prescribe and monitor the demands of basketball training.

Accelerometry-Derived Relative Exercise Intensities in Elite Women's Basketball

This study assessed accelerometry-derived relative exercise intensity during elite women's basketball match play. The influence of player position/role and match period on relative exercise intensities was evaluated. Ten basketballers wore accelerometers during a Yo-Yo intermittent recovery test (Yo-Yo-IR1) and 18 competitive matches. Relative exercise intensity was quantified using predicted oxygen consumption reserve determined using correlations from Yo-Yo-IR1. Total time, bout frequency and bout duration were calculated in seven intensity zones and compared between quarters, positions (back-court vs. front-court) and roles (starters vs. bench). Back-court players spent 6.0±1.9% more match time performing supramaximal activity when compared to front-court players (p<0.045). Back-court players experienced more supramaximal bouts (125±37 vs. 52±36; p=0.031) of greater average duration (2.1±0.4 vs. 1.4±0.2 s; p=0.021) and maximum duration (7±2 vs. 3±1 s; p=0.020). More sedentary to very light activity was observed in the 2^nd and 4^th quarters compared to the 1^st and 3^rd quarters (p<0.05). Despite reduced playing time, bench players performed similar amounts of maximal and supramaximal exercise when compared to starters (p≥0.279). Player position, role and match periods influence the demands of women's basketball; these factors should be considered when designing match-specific conditioning programs.

What effect does regular exercise have on oxidative stress in people with Down syndrome? A systematic review with meta-analyses

OBJECTIVE

What effect does regular exercise have on oxidative stress in people with Down syndrome?

DESIGN

Systematic review with meta-analyses.

METHODS

A systematic review with meta-analyses was conducted. Six databases were searched from inception until August 2017. Studies where included if participants with Down syndrome (any age) had completed an exercise program of at least 6 weeks duration and at least one biomarker measured the generation or removal of reactive oxidative species. Data were extracted using a customised form. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias assessment tool. Effect sizes were calculated and meta-analyses completed for clinically homogeneous data using a random effects model.

RESULTS

Seven studies (11 articles) involving 144 inactive participants investigated the effect of moderate intensity aerobic exercise. No pattern emerged for how most biomarkers responded with non-significant pooled effect sizes and high levels of heterogeneity observed. The exception was catalase which increased significantly after exercise (standardised mean difference 0.39, 95%CI 0.04-0.75; I² 15%). Available studies were at high risk of bias. Two of five studies that measured more than one biomarker reported a decrease in oxidative stress with increased antioxidant activity after exercise but the other three (including one small randomised controlled trial) reported increased oxidative stress with variable change in antioxidant activity.

CONCLUSIONS

There remains uncertainty about the effect of exercise on oxidative stress in people with Down syndrome.

REVIEW REGISTRATION

PROSPERO CRD42016048492.