Search

A study was undertaken to assess the feasibility and safety of the Tshwane Insulin Project (TIP) intervention, describe patients' and healthcare professionals' experiences with the intervention, and determine preliminary treatment effects on glycaemic control. This was a single-group feasibility study. The study was carried out in the City of Tshwane, South Africa. People with type 2 diabetes on maximum oral drugs with suboptimal glycaemic control (HbA1c: 9–12%), and healthcare professionals who were involved in the implementation of the TIP intervention were included. Implementation outcome measures included satisfaction, acceptability, appropriateness and safety; and efficacy by assessing change in HbA1c levels. Healthcare professionals and patients were satisfied with the intervention. Healthcare professionals agreed that the intervention was acceptable and appropriate. No symptomatic or severe hypoglycaemic events were reported. Improved glycaemic control was recorded with 2.2% lowering of HbA1c values (95% CI, 1.6–2.8%). The TIP intervention was feasible and can be implemented with minor amendments. Most participants recommended scaling up the intervention. Lessons learned from this study include: (1) high rates of insulin refusal should be anticipated, and insulin resistance amongst people with type 2 diabetes in primary care should be addressed; and (2) the challenges of initiating and titrating insulin in primary care can be addressed through task sharing and by involving allied healthcare workers. [ABSTRACT FROM AUTHOR]

Scientifically based social network lifestyle intervention did not reduce 10-year cardiovascular risk but improved certain NCD risk factors over 12 months. Facebook plus health professionals group reduced overweight, diabetes risk and total number of risk factors, and Facebook only group reduced inadequate fruit-and-vegetable intake and smoking compared to control. Objective: To determine if scientifically based social network (Facebook) lifestyle interventions reduce 10-year cardiovascular disease (CVD) risk. Methods: Financial sector employees (n  = 300) were equally randomly assigned: Facebook plus Health Professionals (FB+HP), Facebook (FB), or control (C). We report changes in 10-year Framingham risk score (FRS) for CVD (%) and risk factors over 12 months. Results: FRS did not change within and between groups. Overweight (−7.4% vs −5.6%, P   =  0.005) and diabetes risk (–10.7% vs 0.2%, P   =  0.011) reduced significantly in FB+HP versus FB and C, respectively. Inadequate fruit/vegetable intake (–9.4% vs 3.6%, P   =  0.011) and smoking (–0.7% vs 14.9%) reduced significantly in FB versus C. No significant changes in physical activity, central obesity, hypertension, and hypercholesterolemia between groups. Conclusions: Scientifically based social network lifestyle intervention programs could be included in workplace health promotional programmes to improve certain non-communicable disease risk factors. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: To determine if repeat annual health risk assessments (RAHRAs) with intervention reduce 10-year cardiovascular disease (CVD) risk in financial sector employees. Methods: Retrospective analysis from RAHRAs in 13,737 employees over 4 years. We report changes in 10-year FRS for CVD (%) and risk factors after 1 (GR1), 2 (GR2), and 3 (GR 3) RAHRAs. Results: Mean FRS increased with RAHRAs (GR1: +0.4%; GR2: +0.7%; GR3: +0.8%) (P  < 0.001) and was higher for GR3 versus GR1 (P  < 0.001) and GR2 (pairwise: P  < 0.0355). RAHRAs were associated with increased inadequate fruit/vegetable intake (GR1: +5.4%; GR2: +9.8%; GR3: +15.8%) (all pairwise: P  < 0.001) and overweight (GR1: +5.4% vs GR2: +9.8%) (P  < 0.001) and only hypercholesterolemia decreased (GR1: −4.4% vs GR3: −9.6%) (P  < 0.001). Conclusion: RAHRAs did not reduce 10-year CVD risk in financial sector employees. Role of RAHRAs in chronic disease management requires further study. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of non-communicable disease (NCD) risk factors, total NCD risk category and 10-year risk for cardiovascular diseases (CVD) in financial sector employees. Methods: This descriptive observational cross-sectional analysis, data from 36,074 employees was analysed. NCD risk factor data was obtained from health risk assessments that included a questionnaire and clinical measures. The 10-year risk for CVD was calculated using the Framingham non-laboratory based equation. Results: Inadequate fruit and vegetable intake (89.3%), insufficient physical activity (77.4%), and being overweight (66.8%) were the most prevalent risk factors. Women had significantly higher prevalence ratios for central obesity (2.28; P < 0.001), insufficient physical activity (1.21; P < 0.001), hypercholesterolaemia (1.15; P < 0.001), and overweight (1.08; P < 0.001) compared with men. Conclusion: A more concerted effort is required to provide employees with appropriate tools and education at the workplace to decrease and manage NCDs. [ABSTRACT FROM AUTHOR]

Introduction: Mixed gender basic military training (BMT) is adopted to integrate the female South African soldier into the military. This study aimed to assess gender differences before, during (12 weeks), and after a 20-week mixed BMT course and determine if BMT significantly reduced these differences.Methods: A total of 186 soldiers (114 male: mean age = 21.0 ± 1.1 year; 72 female: mean age = 20.5 ± 1.2 year) completed the BMT course and all anthropometric, physical fitness, explosive power, and hand grip strength measurements. Repeated-measures analysis of variance was used to model BMT data with main effects for gender comparison between males and females, and time main effect for evaluation of differences between weeks 1, 12, and 20 of BMT, as well as an interaction effect for differences in changes over time for males and females. Alpha was set at α ≤0.05.Results: Male soldiers were significantly taller (p < 0.001) and scored better in all measurements at the start of BMT, differences ranged from 1.6% to 50% between genders. Differences narrowed by up to 18.5% in aerobic, push-up, abdominal measurements, and to 4.6% in the South African National Defense Force fitness test. Differences in power output and hand grip strength remained unchanged.Conclusion: Large initial anthropometrical and physical fitness differences decreased but were still obvious at the end of BMT. BMT should bridge the physical gap between male and female soldiers to ensure they can all perform the same duties. The enforcing of equal minimum physical fitness requirements for acceptance into BMT; conditional acceptance into the military subject to the successful completion of a bridging course aimed at improving physical fitness in individuals who do not meet the minimum physical fitness requirements for acceptance; and developing a cyclic physical training program with different entry points, dependent on initial physical performance at the start of BMT, ensuring adequate progression and overload for all soldiers are possible avenues to explore to achieve this goal. [ABSTRACT FROM AUTHOR]

Our modern lifestyle often results in the importance of physical exercise being overlooked. The increasingly passive way of life has resulted in a notable increase in the prevalence of lifestyle disorders, such as hypertension and some forms of vascular pathology. This study compares the cardio-stress indices (CSIs) of active and sedentary individuals to provide insight into the impact of the significant changes that have taken place in the modernised society. The active population consisted of 217 military recruits who had completed 20 weeks of basic military training. The sedentary population (n = 126) was sourced from a traditional tertiary institution where the focus is on attending lectures. Participants from both populations wore required to attend three testing sessions, which were held during Week 1, Week 12 and Week 20. Subjects underwent a non-invasive Viport™ test to measure their CSI, heart rate and QRS duration. The results showed that although baseline readings for CSI, blood pressure (BP) and heart rate (HR) were initially higher among the active population, the commencement of the physical training programme resulted in a steady decline in respect of these three factors to approach healthier margins. However, the CSI for neither population reached the normal range, indicating that although physical activity reduces physiological stress levels, other key factors, namely lifestyle stress levels, must also be taken into account. The study supports the notion that increased physical activity has the potential to reduce the predisposition of an individual to cardiovascular disorders and contributes towards establishing the effect of training on heart health by using CSI as a means of measurement. [ABSTRACT FROM AUTHOR]

The personal health behaviours, including physical activity, of healthcare professionals influence their counselling practices as they relate to non-communicable diseases (NCDs). However, despite the importance of producing healthy, physically active graduates, there are limited data on the physical fitness of future healthcare professionals. This cross-sectional observational study determined the prevalence of below-average fitness in the four components of fitness in first-year university medical students. 152 participants (46 male, 106 female, 20.16 ± 2.69 years) completed cardiorespiratory fitness tests (submaximal step test), flexibility (sit-and-reach test), muscle strength (handgrip), and muscle endurance tests (sit-ups, push-ups). Sex differences were reported using one-way ANOVA or Chi square test and significance was set at p < 0.05. The prevalence (%) of below-average fitness was 69.54% for cardiorespiratory, 25.66% for handgrip strength, 65.79% for sit-ups, 23.03% for push-ups and 7.24% for flexibility. Physical fitness parameters (mean±standard deviation (SD)) were compared between sexes, where it was found that females were more flexible than males (40.61 ± 8.40 cm vs 36.70 ± 9.31 cm, p = 0.012). Males had better handgrip strength (88.96 ± 12.04 kg vs 59.34 ± 10.36 kg, p < 0.001), muscle endurance sit-ups (33.46 ± 9.04 vs 24.48 ± 12.18, p < 0.001) and push-ups (30.28 ± 13.95 vs 24.27 ± 12.35, p = 0.009). First-year medical students have poor physical fitness, notably cardiorespiratory fitness and muscle strength, which are important markers for NCD risk assessment. Tertiary institutions training healthcare professionals should consider developing interventions to improve students' physical fitness thereby influencing their health, wellbeing, academic performance and future counselling practices. [ABSTRACT FROM AUTHOR]

Aims: To determine factors associated with 'hypothetical willingness' to start insulin among people with Type 2 diabetes (T2DM).Methods: A quantitative cross-sectional study with insulin-naïve T2DM patients at 23 primary care facilities in the Tshwane Metropolitan Municipality. Data collected included demographic and clinical data, willingness to start insulin, attitudes and barriers to insulin therapy. Factors associated with unwillingness to start insulin therapy were explored using a multivariable logistic regression model.Results: Of 468 T2DM study patients (mean age 57.2, SD = 11.3 years), more than half (51.9%) expressed unwillingness to starting insulin therapy. Unwillingness was associated with negative attitudes (OR = 1.32, 95% CI = 1.12-1.55, p = 0.001) and reluctance (OR = 1.41, 95% CI = 1.27-1.57, p < 0.001) rather than age, sex, education or diabetes duration. The strongest reasons for patient unwillingness were injection anxieties, fear of needles, insufficient knowledge of insulin, feeling unable to cope with insulin and concerns about out-of-pocket costs.Conclusions: The prospect of insulin therapy disturbs patients' sense of self and their psychological wellbeing. The high prevalence of psychological insulin resistance among these T2DM patients needs to be addressed for effective diabetes management. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported. To (1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with a recent SARS-CoV-2 infection and (2) identify factors affecting exercise responses. Cross-sectional, experimental study. Male and female athletes (age = 24.2 ± 6.3 years) with a recent (< 28 days) SARS-CoV-2 infection (n = 72). A COVID-19 Recovery Clinic for athletes. Heart rate, SBP, and RPE were measured during submaximal exercise (modified Bruce protocol) at 10 to 28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, comorbidities, preinfection training variables, and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models. Heart rate, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (P =.0001). At stage 5 (10.1 metabolic equivalents), a higher HR and a higher SBP during exercise were associated with younger age (P =.0007) and increased body mass index (BMI; P =.009), respectively. Higher RPE during exercise was significantly associated with a greater number of whole-body (P =.006) and total number (P =.004) of symptoms during the acute phase of infection. A greater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes at 10 to 28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection, as this may indicate disease severity and be valuable for tracking progress, recovery, and return to sport. [ABSTRACT FROM AUTHOR]

Higher exercise heart rate (HR) and prolonged return-to-sport in athletes with SARS-CoV-2 infection are described, but the cardiovascular response to exercise during recovery is not understood. This prospective, cohort, experimental study with repeated measures evaluated the cardiovascular response to exercise over 16 weeks in athletes recovering from SARS-CoV-2 infection. Athletes (n = 82) completed 2–5 repeat assessments at regulated intervals over 16 weeks post-SARS-CoV-2 infection. Data from 287 assessments (submaximal exercise tests; Modified Bruce protocol) are included. HR (bpm), systolic blood pressure (SBP) (mmHg) and rating of perceived exertion (RPE) (Borg scale 6–20) were measured. Rates of change in HR, SBP and RPE over time are reported. Submaximal exercise HR, SBP and RPE decreased significantly over 16 weeks (p < 0.01). There was a steeper rate of decline for HR and RPE ≤30 days compared to >30 days after SARS-CoV-2 infection: HR at Stage 3: ≤30 days −0.53 (0.01); >30 days −0.06 (0.02) and Stage 5: ≤30 days −0.77 (0.12); >30 days −0.12 (0.02); RPE at Stage 3: ≤30 days −0.09 (0.02); >30 days −0.01 (0.0002) and Stage 5: ≤30 days −0.13 (0.02); >30 days −0.02 (0.004). The findings provide clinical recommendation for exercise prescription and monitoring RPE in response to exercise post-SARS-CoV-2 infection and contribute to the clinical understanding of recovery which can help manage athlete expectations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine factors predictive of prolonged return to training (RTT) in athletes with recent SARS-CoV-2 infection. Methods: This is a cross-sectional descriptive study. Athletes not vaccinated against COVID-19 (n = 207) with confirmed SARS-CoV-2 infection (predominantly ancestral virus and beta-variant) completed an online survey detailing the following factors: demographics (age and sex), level of sport participation, type of sport, comorbidity history and preinfection training (training hours 7 d preinfection), SARS-CoV-2 symptoms (26 in 3 categories; "nose and throat," "chest and neck," and "whole body"), and days to RTT. Main outcomes were hazard ratios (HR, 95% confidence interval) for athletes with versus without a factor, explored in univariate and multiple models. HR < 1 was predictive of prolonged RTT (reduced % chance of RTT after symptom onset). Significance was P < 0.05. Results: Age, level of sport participation, type of sport, and history of comorbidities were not predictors of prolonged RTT. Significant predictors of prolonged RTT (univariate model) were as follows (HR, 95% confidence interval): female (0.6, 0.4–0.9; P = 0.01), reduced training in the 7 d preinfection (1.03, 1.01–1.06; P = 0.003), presence of symptoms by anatomical region (any "chest and neck" [0.6, 0.4–0.8; P = 0.004] and any "whole body" [0.6, 0.4–0.9; P = 0.025]), and several specific symptoms. Multiple models show that the greater number of symptoms in each anatomical region (adjusted for training hours in the 7 d preinfection) was associated with prolonged RTT (P < 0.05). Conclusions: Reduced preinfection training hours and the number of acute infection symptoms may predict prolonged RTT in athletes with recent SARS-CoV-2. These data can assist physicians as well as athletes/coaches in planning and guiding RTT. Future studies can explore whether these variables can be used to predict time to return to full performance and classify severity of acute respiratory infection in athletes. [ABSTRACT FROM AUTHOR]

Armed service recruits are faced with many stressors, including a strenuous training regimen that may have an impact on their physiological functioning. The Cardio Stress Index (CSI) is a noninvasive marker of the stress that the heart is experiencing. The aim of the study was to test the physiological impact of 20 weeks of intense training of armed service recruits, using CSI as a noninvasive biomarker of cardiac stress. Armed service recruits are faced with many stressors, including a strenuous training regimen that may have an impact on their physiological functioning. The CSI is a noninvasive marker of the stress that the heart is experiencing. The calculation of the CSI is based on the duration of vascular excitation (QRS duration), heart rate, heart rhythm and standard deviation of the duration of time between each successive cardiac cycle (RR-interval). The aim of the present study was to test the physiological impact of 20 weeks of strenuous training of armed service recruits, using CSI as a noninvasive biomarker of cardiac stress. Experiments were conducted at three points in time (weeks 1, 12, 20) during the basic military training of armed service recruits (n = 202, males = 115, females = 87), aged between 18 and 24 years. Variables measured include: Resting CSI, heart rate and blood pressure. Data analysis was performed, using paired t-tests for pairwise comparisons of week 1 (baseline) with week 12; week 12 with week 20; and week 1 with week 20. The average CSI and heart rate remained within normal values for male participants on all three testing occasions. However, baseline readings for females were significantly higher during week 1. There was an overall decrease in the CSI in the 20 week time frame. From this study it seems as if the CSI measurement is a noninvasive method to establish the effects of training on the health of the heart. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the physical fitness, based on VO2max and exercise-induced cardiac autonomic changes, measured by heart rate variability (HRV) of 12 weeks with 20 weeks of training in the South African National Defence Force. Recruits (n = 154) participated in a medium-to-high intensity exercise intervention (daily energy expenditure: 8,485 kJ⋅d-1). The significant effect on VO2max between weeks 1 and 12 (48.57, SD = 9.25 vs. 53.36, SD = 7.21] did not continue during weeks 12-20 (53.36, SD = 7.21 vs. 53.87, SD = 7.87). No changes in the supine low frequency (LF)/high frequency (HF) (0.48, SD = 0.51 vs. 0.41, SD = 0.64) or the standing LF/HF (4.02, SD = 5.14 vs. 3.91, SD = 5.28), an indicator of autonomic balance and a possible indicator of overtraining syndrome, suggests that overtraining did not take place during weeks 12-20. This was confirmed with further decreases in supine and standing heart rate. However, the power of the vagal-induced variability continued to increase after 12 weeks. Increased vagal influence without concurrent change in autonomic balance may be interpreted as decreased sympathetic cardiac control. It is important to note that although no fitness changes were detected, positive cardiac autonomic conditioning did continue between weeks 12 and 20, as measured by increased vagal-induced HRV and decreased sympathetic influence on cardiac control. Results may be extrapolated to training in the normal population/athletes after a medium-to-high intensity exercise program, as this intervention was a closely monitored and standardized exercise program. [ABSTRACT FROM AUTHOR]

We investigated the mechanical properties of the triceps surae between professional, junior, and non-football players. Fifty-nine men participated in this study. The mechanical properties of the right legs’ triceps surae were measuredin vivousing a free oscillation technique; no significant differences existed between the groups. The mean results for musculo-articular stiffness, damping coefficient, and damping ratio were as follows: professional football players (21523 N· m−1, 330.8 N · s · m−1, and 0.201); junior football players (21063 N · m−1, 274.4 N · s · m−1, and 0.173); and non-players (19457 N · m−1, 281.5 N · s · m−1, and 0.184). When analysed according to position, the results were as follows: defender (21447 N · m−1, 308.6 N · s · m−1, and 0.189); midfielder (20762 N · m−1, 250.7 N · s · m−1, and 0.157); winger (21322 N · m−1, 335.1 N · s · m−1, and 0.212); forward (22085 N · m−1, 416.2 N · s · m−1, and 0.254); and non-players (19457 N · m−1, 281.5 N · s · m−1, and 0.184). Thus, football training, football games, and the position played had no effect on triceps surae mechanical properties. These results may be attributed to opposing adaptations between different types of training that are usually implemented in football. Alternatively, the minimum strain amplitude and/or frequency threshold of the triceps surae required to trigger adaptations of mechanical properties might not be achieved by football players with football training and matches. [ABSTRACT FROM AUTHOR]

Armed forces recruits were tested during a six month period of intense basic training. Data was collected at the start, after 12 weeks and 20 weeks. Means indicated significant decreases in cardio stress and increases in visual skills performance after 12 weeks and 20 weeks. Results indicate that cardio stress has a definite effect on visual performance. [ABSTRACT FROM AUTHOR]