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Isometric resistance training (IRT) has been shown to reduce resting and ambulatory blood pressure (BP), as well as BP variability and morning BP surge (MBPS). However, there are no data available regarding how long after cessation of IRT these effects are maintained. Therefore, the purpose of this study was to determine the effects of 8 weeks of detraining on resting BP, ambulatory BP and MBPS following 8 weeks of IRT in a population of young normotensive individuals and to further substantiate previously reported reductions in MBPS following IRT. Twenty-five apparently healthy participants with resting BP within the normal range (16 men, age = 23 ± 6 years; 9 women, age = 22 ± 4 years, resting BP: 123 ± 5/69 ± 7 mmHg) were randomly assigned to a training-detraining (TRA-DT, n = 13) or control (CON, n = 12) group. Resting BP, ambulatory BP and MBPS were measured prior to, after 8 weeks of bilateral leg IRT using an isokinetic dynamometer (4 × 2-min contractions at 20% MVC with 2-min rest periods, 3 days/week) and following an 8-week detraining period. There were significant reductions in 24-h ambulatory systolic BP (SBP) and calculated SBP average real variability (ARV) following IRT that were maintained after detraining (pre-to-post detraining, −6 ± 4 mmHg, p = 0.008, −2 ± 1.5 mmHg, p = 0.001). Similarly, the training-induced decreases in daytime SBP and daytime SBP ARV (pre-topost detraining, −5 ± 6 mmHg, p = 0.001; −2 ± 1.2 mmHg, p = 0.001, respectively), MBPS (pre-to-post detraining, −6 ± 9 mmHg, p = 0.046) and resting SBP (pre-to-post detraining, −4 ± 6 mmHg, p = 0.044) were preserved. There were no changes in night-time or night-time SBP ARV across all time points (pre-to-post detraining, −1 ± 8 mmHg, p = 1.00, −0.7 ± 2.9 mmHg, p = 1.00). These results confirm that IRT causes significant reductions in resting BP, ambulatory BP, ambulatory ARV and MBPS. Importantly, the changes remained significantly lower than baseline for 8 weeks after cessation of training, suggesting a sustained effect of IRT. hypertention, detraining effect, isometric resistance training, ambulatory, blood pressure. [ABSTRACT FROM AUTHOR]

Daniel S Baddeley-White,1 Cheri L McGowan,2 Reuben Howden,3 Benjamin DH Gordon,4 Peter Kyberd,5 Ian L Swaine1,21Department of Life & Sport Sciences, University of Greenwich, Medway Campus, London, UK; 2Department of Kinesiology, Faculty of Human Kinetics, University of Windsor, Windsor, ON, Canada; 3Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC, USA; 4Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA; 5Department of Engineering Science, University of Greenwich, Medway Campus, London, UKBackground: Hypertension is the leading risk factor for global mortality. Isometric resistance exercise training reduces blood pressure (BP). However, the protocols used are often limited by cost/immobility and the use of rigid exercise modalities. In response, a novel more versatile, isometric exercise (IE) device, the IsoBall (IB) was created.Purpose: The aim of this study was to test the BP-lowering effectiveness of this prototype.Methods: Twenty-three healthy participants (29.10±2.19 years old, 173.95±3.83 cm, 75.43±5.06 kg, SBP 127.10±10.37 mmHg, DBP 70.40±6.77 mmHg) were randomly allocated to either a control group (CON) or 2 isometric handgrip (IHG) training groups that used the Zona plus (ZON) and IB devices. The intervention groups completed 3 sessions each week of 4, 2 min IHG at 30% maximal voluntary contraction, with a 1-min rest, for 4 weeks. Resting BP, heart rate (HR) and IHG strength were measured in all groups at baseline and postintervention.Results: Postintervention systolic BP (SBP) was significantly lower in both ZON (114.5±8.2 mmHg, p = 0.000) and IB (119.9±7.0 mmHg, p = 0.000) compared to control (131.0±12.4 mmHg). Postintervention diastolic BP (DBP) was reduced in both intervention groups (ZON 66.6±7.4 mmHg, p = 0.004; IB 65.7±10.0 mmHg, p = 0.012) compared to CON (71.1±8.8 mmHg). Mean arterial pressure (MAP) was reduced in both groups (ZON 82.6±6.8 mmHg, p = 0.000; IB 84.3±9.1 mmHg, p = 0.000) compared to control (91.0±9.7 mmHg). No significant changes were seen in HR or strength (p > 0.05).Conclusion: The results of this study indicate that both the ZON and IB devices elicit significant SBP, DBP and MAP reductions. Despite the ZON group having larger reductions in BP, no significant differences were found between the two devices. Thus, this study indicates the IB device to be an effective alternative to the ZON that can also be used to perform other IE modalities.Keywords: hypertension, antihypertensive intervention, isometric exercise ball, IsoBall, Zona plus device

The purpose of this study was to determine the reproducibility of limb power outputs and cardiopulmonary responses, to incremental whole-body exercise using a novel swimming training machine. 8 swimmers with a mean age of 23.7 + 4.6 (yrs), stature 1.77 + 0.13 (m) and body mass of 74.7 ±2.8 (kg) gave informed consent and participated in repeat exercise testing on the machine. All subjects performed 2 incremental exercise tests to exhaustion using front crawl movements. From these tests peak oxygen consumption (VO2peak). Peak heart rate (HRpeak). peak power output (Wpeak) and individual limb power outputs were determined. Results showed there were no significant differences between test 1 and 2 for any variable at exhaustion, and the CV% ranged from 2.8 to 3.4%. The pooled mean values were; VO2peak 3.7±0.65L.min-1, HRpeak 178.7±6.6b.min-1 and Wpeak 349.7 ±16.5 W. The mean contributions to the total power output from the legs and arms were (37.3 ±4.1% and 62.7±5.1% respectively). These results show that it is possible to measure individual limb power outputs and cardopulmonary parameters reproducibly during whole-body exercise using this training machine, at a range of exercise intensities. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the relationship between physiological responses to dry-land testing and to water polo playing. Eight female water polo players (mean +/- s: age 26.7 +/- 5.7 years, height 169 +/- 6 cm, body mass 65.3 +/- 7.0 kg) participated in two assessments. The first involved a discontinuous incremental arm test to exhaustion on an isokinetic swim bench. Blood lactate was determined from finger-prick blood samples and heart rate was recorded at increasing exercise intensities. The highest (peak) values for blood lactate (5.1 +/- 0.2 mmol 1[sup -1]), exercise intensity (79 +/- 5.2 W) and heart rate (146 +/- 6 beats min[sup -1]) were recorded at exhaustion. Also, the exercise intensity and heart rate at a blood lactate concentration of 4 mmol 1[sup -1] were established. The second assessment involved determination of blood lactate and heart rate immediately after each quarter of a different water polo game for each subject. The mean ( s[sub x] ) blood lactate and heart rate for each quarter of the game were as follows: 3.5 +/- 0.4, 4.3 +/- 0.5, 4.3 +/- 0.7 and 4.6 +/- 0.5 mmol l[sup -1]; 138 +/- 10, 149 +/- 12, 151 +/- 9 and 154 +/- 8 beats min[sup -1], respectively. None of the peak values on the swim bench correlated with blood lactate or heart rate responses to game-playing. However, the mean exercise intensity at 4 mmol l[sup -1] lactate (64 +/- 5 W) correlated with the fourth quarter values of both blood lactate concentration (r = -0.82, P = 0.01) and heart rate (r = -0.93, P < 0.001). These results show that submaximal metabolic responses to exercise on a swim bench are closely correlated with metabolic responses to water polo game-playing. [ABSTRACT FROM AUTHOR]

Assessments of maximal intensity exercise which determine peak power output on friction-baked cycle ergometers have fallen into two categories: correction procedures which account for changes in momentum of the ergometer's flywheel and optimization procedures which attempt to satisfy muscle force-velocity relationships. The aim of this study was to compare performance in each procedure and so investigate assumptions which underpin the tests. Nineteen males aged 20.9-0.4 years and 18 females aged 22.2-0.7 years (mean - S.E.M.), who were fully accustomed to the procedures, participated in a single experimental protocol. After a 5 min warm-up, the subjects performed four bouts of all-out exercise on a Monark 814E cycle ergometer against randomly assigned loads. The loads were selected to produce peak pedalling rates in the range 100-200 rev min[sup -1] and each bout lasted 10 s. From the inverse linear relationship between applied load and peak pedalling rate, optimized peak power output (PP[sub opt]) and the accompanying pedalling rate (RPM[sub opt]) were calculated. One of the bouts used a loading equivalent to 7.5% of body weight and for this bout corrected peak power output (PP[sub corr]) and its corresponding pedalling rate (RPM[sub corr])were calculated. The PP[sub opt] was less than PP [sub corr] in the males (915-35 vs 1005-32 W) and females (673-33 vs 777-39 W) (both P< 0.001).Similarly, RPM [sub opt] was less than RPM[sub corr] (111-1 vs 128-2 rev min[sup -1] and 101-1 vs 111-2 rev min[sup -1] in the males and females, respectively; P < 0.001). The results demonstrate that optimization and correction procedures produce different values of performance. These differences are probably attributable to the mechanical principles which underpin the tests. [ABSTRACT FROM AUTHOR]

Objective: To explore relations between biochemical markers of bone turnover, indices of nutritional status, and serum oestradiol concentration in women distance runners.Methods: Thirty three women distance runners of mean age (SD) 27.2 (1.8) years participated. Eighteen were defined as eumenorrhoeic, nine as amenorrhoeic, and six as oligomenorrhoeic. Mean (SD) running distance was 47.6 (22.4) km/week. Using bivariate correlation and regression analysis, serum levels of osteocalcin and bone alkaline phosphatase (BAP) and also urine deoxypyridinoline/creatinine (Dpyr/Cr) were correlated with mean daily energy balance, body mass index (BMI; kg/m2), and serum levels of total 3,5,3'-triiodothyronine and oestradiol within each group by menstrual status.Results: All the amenorrhoeic women were in negative energy balance; they had a lower BMI, lower serum levels of oestradiol, triiodothyronine, osteocalcin and BAP and a lower urine Dpyr/Cr than any of the oligomenorrhoeic or eumenorrhoeic women. These variables were also lower in oligomenorrhoeic than in eumenorrhoeic women. Positive correlations were observed between serum levels of osteocalcin or BAP and both BMI and serum oestradiol concentration in amenorrhoeic, but not in oligomenorrhoeic or eumenorrhoeic women. Urine Dpyr/Cr did not correlate with any other variable within any group. Serum oestradiol concentration correlated positively with BMI in amenorrhoeic and oligomenorrhoeic, but not eumenorrhoeic women.Conclusions: Positive correlations between serum levels of bone formation markers, BMI and serum oestradiol concentration in our amenorrhoeic runners suggested that their reduced bone formation was linked to a low BMI and an oestrogen deficiency. Reduced bone turnover in amenorrhoeic distance runners has not previously been shown. These findings emphasise the importance of body mass and its possible link with a chronic energy deficit and hypothalamic dysfunction on bone remodelling balance in amenorrhoeic runners. [ABSTRACT FROM AUTHOR]

Objectives: There has been little research on the time course of recovery from injury in athletes. This is especially the case for recovery in arm power in injured swimmers. The purpose of this study was to compare the power output of the injured and non-injured arms of swimmers during recovery from injury by use of a maximal exercise test on a computer interfaced isokinetic swim bench.Methods: Thirteen swimmers (five men and eight women; age 18.8 (3.2) years; stature 1.76 (0.05) m; body mass 61.7 (5.9) kg; mean (SD)) gave written informed consent and were recruited to this study throughout a three year period. All subjects had experienced non-aquatic soft tissue injury to their dominant-side shoulder or upper arm in the three months before participation, but had been allowed to return to swimming training. All of the subjects had injured their dominant arm and the mean time for absence from training was 3.7 (1.1) weeks. At return to training and at four, eight, and twelve weeks thereafter, subjects performed two all-out 30 second tests on the swim bench by simulating the swimming arm action. From these tests, peak power output (PPO), mean power output (MPO), and power decay (PD) for each arm during the 30 seconds of exercise could be determined by averaging the two tests. The differences between return to training and the four, eight, and twelve week periods were analysed using repeated measures analysis of variance with Tukey b post hoc test.Results: The repeated testing showed 95% confidence intervals of +/- 11.4 W for PPO, +/- 9.5 W for MPO and +/- 0.5 for PD. When the swimmers returned to training the results showed that PPO was 179 (21.9) v 111 (18.1) W (P = 0.02), MPO was 122 (9.8) v 101 (8.8) W (P = 0.01), and PD was 2.5 (0.6) v 5.2 (1.9) (P = 0.001) for non-injured and injured arms respectively (all values mean (SEM)). There were similar differences at four weeks which disappeared after eight weeks, except for that of PPO which was still evident (187.3 (21.9) v 156.8 (18.1) W; P = 0.01). At 12 weeks there were no differences between the non-injured and injured arm on any of the indices of arm power (P > 0.05).Conclusions: These results suggest that, using the swim bench power test, differences in bilateral arm power output after injury persist for at least eight weeks after return to swimming training. These findings support the need for prolonged rehabilitation after such injury. This would best include physiotherapy and a training programme within which special consideration is given to the recuperation process. [ABSTRACT FROM AUTHOR]

Forty women took part in a study designed to investigate self-selected exercise intensity relative to ventilatory threshold during circuit weight training (CWT) and exercise-to-music (ETM) sessions. Subjects were assigned to one of two groups which were beginners (B) or habitual exercisers (HE) on the basis of their exercise habits. All subjects first underwent a laboratory cycle ergometer test involving a continuous incremental exercise protocol from which ventilatory threshold (VT) was determined using piecewise linear regression analysis. This point was expressed in terms of heart rate (VTHR) and rating of perceived exertion (VTRPE). These points were then compared with those determined during exercise training sessions (TRAHR and TRARPE respectively). The results showed that mean(s.d.) TRARPE (13.5(1.1) was not significantly different to mean(s.d.) VTRPE (12.8(0.5); P > 0.05) but that mean(s.d.) VTHR (134.8(13.5) beats min-1) and TRAHR (154.9(12.0) beats min-1) were different (P < 0.05). Beginners trained at a significantly higher percentage above VTHR than habitual exercisers (118(3.1) versus 111(2.8)% P < 0.05). During CWT the mean(s.d.) TRAHR for beginners (143.2(7.6) beats min-1) was significantly lower than that for habitual exercisers (152.5(10.1) beats min-1; P < 0.05), but not different during ETM (P < 0.05). When these TRAHR values were expressed relative to an estimated maximum heart rate (EMHR) they represented 86.5% in ETM and 80.5% in CWT which were different (P < 0.05). These results suggest that regardless of habitual exercise level and training mode, these women selected a common intensity of effort that was compatible with the described RPE. [ABSTRACT FROM AUTHOR]

Anthony W Baross,1 Jonathan D Wiles,2 Ian L Swaine21Sport and Exercise Science, University of Northampton, Northampton, UK; 2Sport and Exercise Science, Canterbury Christ Church University, Canterbury, Kent, UKAbstract: Double-leg isometric training has been demonstrated to reduce resting blood pressure in young men when using electromyographic activity (EMG) to regulate exercise intensity. This study assessed this training method in healthy older (45–60 years.) men. Initially, 35 older men performed an incremental isometric exercise test to determine the linearity of the heart rate versus percentage peak EMG (%EMGpeak) and systolic blood pressure versus %EMGpeak relationship. Thereafter, 20 participants were allocated to a training or control group. The training group performed three double-leg isometric sessions per week for 8 weeks, at 85% of peak heart rate. The training resulted in a significant reduction in resting systolic (11 ± 8 mmHg, P < 0.05) and mean arterial (5 ± 7 mmHg, P < 0.05) blood pressure. There was no significant change in resting systolic blood pressure for the control group or diastolic blood pressure in either group (all P > 0.05). These findings show that this training method, used previously in young men, is also effective in reducing resting systolic and mean arterial blood pressure in older men.Keywords: electromyography, resting blood pressure, heart rate

Surgical prehabilitation aims to optimise patients' physiological reserves to better withstand the stress of surgery, reduce the risk of postoperative complications, and promote a faster and optimal recovery. The purpose of this commentary is to outline the key aspects of prehabilitation before surgery for cancer which seem to impact its effectiveness and wider implementation. Particular attention is paid to the role and integration of resistance training programmes as a key component of multimodal prehabilitation for patients with cancer. We firstly analyse some of the barriers currently hindering the implementation of prehabilitation programmes in the National Health Service (United Kingdom). Later, we describe essential aspects of resistance training design, such as exercise modality and order execution, volume and intensity, rest periods between sets or exercises, and workout frequency. Furthermore, we propose a methodology to use the perception of effort to control patients' progression during a prehabilitation programme., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Roberto Laza-Cagigas is the Operations Lead at QuestPrehabTM (formerly Kent and Medway Prehab). Tara Rampal is the CMO of QuestPrehabTM (formerly Kent and Medway Prehab). Fernando Naclerio, Marcos Seijo, and Ian Swaine declare that they have no conflict of interest.

Background: Chronic kidney disease is common, affecting up to 13 % of the global population, and is predicted to become the fifth leading cause of 'life years lost' by 2040. Individuals with end-stage kidney disease commonly develop complications such as protein-energy wasting and cachexia which further worsens their prognosis. The syndrome of 'renal cachexia' is poorly understood, under-diagnosed and even if recognised has limited treatment options., Objective: To explore the lived experience of renal cachexia for individuals with end-stage kidney disease and the interrelated experiences of their carers., Design: This interpretive phenomenological study was designed to facilitate an in-depth exploration of how patients and carers experience of renal cachexia. To improve and document the quality, transparency, and consistency of patient and public involvement in this study the Guidance for Reporting Involvement of Patients and the Public-Short Format was followed., Setting: The study was conducted across two nephrology directorates, within two healthcare trusts in the United Kingdom., Participants: Seven participants who met the inclusion criteria were recruited for this study, four patients (three female, one male) and three carers (two male, one female)., Methods: We employed a purposive sampling strategy. Data collection was conducted between July 2022 and December 2023. Interviews were semi-structured, audio-recorded, transcribed verbatim and analysed in six steps by two researchers using interpretive phenomenological analysis. Ethical approval was approved by the Office for Research Ethics Committees Northern Ireland (Reference: 22/NI/0107)., Results: Analysis generated six group experiential themes: the lived experience of appetite loss, functional decline and temporal coping, weight loss a visual metaphor of concern, social withdrawal and vulnerability, the emotional toll of eating challenges and psychological strain amidst a lack of information about cachexia., Conclusion: This is the first qualitative study exploring the lived experience of renal cachexia for patients and carers. Our study highlights that psycho-social and educational support is urgently needed. Additionally, healthcare professionals need better information provision to help them to recognise and respond to the needs of this population. Further research is required to develop models of holistic support which could help patients and carers cope with the impact of renal cachexia and optimally manage this syndrome within the family unit., Registration: N/A., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research., (© 2024. The Author(s).)

Microcurrent is a non-invasive and safe electrotherapy applied through a series of sub-sensory electrical currents (less than 1 mA), which are of a similar magnitude to the currents generated endogenously by the human body. This review focuses on examining the physiological mechanisms mediating the effects of microcurrent when combined with different exercise modalities (e.g. endurance and strength) in healthy physically active individuals. The reviewed literature suggests the following candidate mechanisms could be involved in enhancing the effects of exercise when combined with microcurrent: (i) increased adenosine triphosphate resynthesis, (ii) maintenance of intercellular calcium homeostasis that in turn optimises exercise-induced structural and morphological adaptations, (iii) eliciting a hormone-like effect, which increases catecholamine secretion that in turn enhances exercise-induced lipolysis and (iv) enhanced muscle protein synthesis. In healthy individuals, despite a lack of standardisation on how microcurrent is combined with exercise (e.g. whether the microcurrent is pulsed or continuous), there is evidence concerning its effects in promoting body fat reduction, skeletal muscle remodelling and growth as well as attenuating delayed-onset muscle soreness. The greatest hindrance to understanding the combined effects of microcurrent and exercise is the variability of the implemented protocols, which adds further challenges to identifying the mechanisms, optimal patterns of current(s) and methodology of application. Future studies should standardise microcurrent protocols by accurately describing the used current [e.g. intensity (μA), frequency (Hz), application time (minutes) and treatment duration (e.g. weeks)] for specific exercise outcomes, e.g. strength and power, endurance, and gaining muscle mass or reducing body fat., (© 2022. The Author(s).)

Objectives: The World Health Organization emphasises the need for cost-effective alternative methods to lower blood pressure (BP). Endorsed nationally in HTN guidelines, isometric handgrip (IHG) training is an alternative method of BP control. The purpose of this study was to compare the BP, heart rate (HR) and rates of perceived exertion (RPE) responses between a bout of IHG training performed using the traditional computerized device and a more affordable, inflatable stress ball., Methods: Twenty healthy adults performed one bout (4, 2-min isometric contractions, with 1-min rests between each contraction at 30% maximal voluntary contraction) of IHG training using the traditional computerized device, and one bout with the inflatable stress ball. BP, HR, and RPE were recorded., Results: No statistically significant differences between devices were observed with HR, BP, and RPE ( p  < 0.05). However, average RPE for both devices ranged between 5 and 6 indicating that participants were rating 30% of their MVC, consistent with previous work., Discussion: The similar cardiovascular and psychophysical responses provide support for the potential use of this low individual- and provider-burden, cost-efficient IHG device, and lay the foundation for a future training study to test the hypothesis of benefit.

In this study, we aimed to develop a theoretical framework for a multimodal, integrative, exercise, anti-inflammatory and dietary counselling (MMIEAD) intervention for patients with renal cachexia with reference to how this addresses the underlying causal pathways for renal cachexia, the outcomes anticipated, and how these will be evaluated. We used a Theory of Change (ToC) approach to guide six steps. Step 1 included inputs from a workshop to obtain key stakeholder views on the potential development of a multimodal intervention for renal cachexia. Step 2 included the findings of a mixed-methods study with Health Care Practitioners (HCPs) caring for individuals with End Stage Kidney Disease (ESKD) and cachexia. Step 3 included the results from our systematic literature review on multimodal interventions for cachexia management. In step 4, we used the body of our research team's cachexia research and wider relevant research to gather evidence on the specific components of the multimodal intervention with reference to how this addresses the underlying causal pathways for renal cachexia. In steps 5 and 6 we developed and refined the ToC map in consultation with the core research team and key stakeholders which illustrates how the intervention components of MMIEAD interact to achieve the intended long-term outcomes and anticipated impact. The results of this study provide a theoretical framework for the forthcoming MMIEAD intervention for those with renal cachexia and in subsequent phases will be used to determine whether this intervention is effective. To the best of our knowledge no other multimodal intervention trials for cachexia management have reported a ToC. Therefore, this research may provide a useful framework and contribute to the ongoing development of interventions for cachexia management.

Renal cachexia is an important consideration in the person-centred care that is needed in end-stage renal disease (ESRD). However, given that clinical guidelines relating to renal cachexia are largely absent, this is an unmet care need. To inform guidelines and future renal service planning, there is an urgency to understand individuals' experiences of renal cachexia and the interrelated experiences of the carers in their lives. We report here the protocol for an interpretative phenomenological study which will explore this lived experience. A purposive sampling strategy will recruit individuals living with ESRD who have cachexia and their carers. A maximum of 30 participants (15 per group) dependent on saturation will be recruited across two nephrology directorates, within two healthcare trusts in the United Kingdom. Individuals with renal cachexia undergoing haemodialysis will be recruited via clinical gatekeepers and their carers will subsequently be invited to participate in the study. Participants will be offered the opportunity to have a face-to-face, virtual or telephone interview. Interviews will be audio-recorded, transcribed verbatim and analysed using interpretative phenomenological analysis. NVivo, will be used for data management. Ethical approval for this study was granted by the Office for Research Ethics Committees Northern Ireland (REC Reference: 22/NI/0107). Scientific evidence tends to focus on measurable psychological, social and quality of life outcomes but there is limited research providing in-depth meaning and understanding of the views of individuals with renal disease who are experiencing renal cachexia. This information is urgently needed to better prepare healthcare providers and in turn support individuals with ESRD and their carers. This study will help healthcare providers understand what challenges individuals with ESRD, and their carers face in relation to cachexia and aims to inform future clinical practice guidelines and develop supportive interventions which recognise and respond to the needs of this population., Competing Interests: The authors have declared that no competing interests exist.

The identification of the key contributing factors which predispose the foot to ulceration, increasing the risk of recurrence and slow wound healing in diabetes mellitus (DM), has led to some significant research studies over the last 30 years, providing valuable insight into the mechanism leading to diabetic foot ulceration (DFU). Although, these contributory factors are similar to those identified in pressure ulceration occurring in other parts of the body (such as "bed pressure sores') where magnitude and/or duration of mechanical stress in the presence of sensory deficits are key causal factors, research investigating pressure ulceration has also included measurement of temperature and relative humidity at the interface between the skin and supporting surface. The possible influence of these parameters (in-shoe temperature and humidity) does not appear frequently in diabetic foot ulceration research. Referred to as "microclimate", this has an important role in the pathway to tissue breakdown evidenced in pressure ulcer research and may be particularly relevant in countries with warm and humid climates. As the microclimate is influential in the ulceration pathway for other body sites, its role in the DFU causal pathway justifies further investigation.

Background: Swallowing difficulties (dysphagia) and community-acquired pneumonia are common in frail older people and maybe addressed through targeted training of the anterior neck musculature that affects the swallow. We have developed a swallowing exercise rehabilitation intervention (CTAR-SwiFt) by adapting a previously established swallowing exercise to ensure patient safety and ease of execution in the frail elderly population. The CTAR-SwiFt intervention consists of a feedback-enabled exercise ball that can be squeezed under the chin, with real-time feedback provided via a mobile application. The aim of this study is to evaluate the feasibility of assessing the effectiveness of the CTAR-SwiFt intervention in reducing dysphagia and community-acquired pneumonia, prior to a larger-scale multi-centre randomised controlled trial., Methods: We will recruit 60 medically stable patients over the age of 75 years who have been admitted with a diagnosis of pneumonia to the acute frailty wards at two participating hospitals in the UK. Study participants will be randomised into one of three groups: standard care, low intensity (once daily) CTAR-SwiFt exercise or high intensity (twice daily) CTAR-SwiFt exercises. The intervention period will last for 12 weeks, the final follow-up assessment will be conducted at 24 weeks. We will assess the feasibility outcomes, including rates of participant recruitment and retention, compliance with the exercise regime and adverse incidents. Additionally, we will assess the usability and acceptability of the intervention device and the performance of different clinical outcome measures (e.g. chin tuck strength, Functional Oral Intake Scale, SWAL-QOL, EQ-5D and swallow speed). A sub-sample of study participants will complete videofluoroscopic assessments of swallowing function before and after the intervention to evaluate the physiological changes (e.g. bolus flow rates, laryngeal elevation, base-of-tongue retraction)., Conclusions: By improving the ability to swallow, using our chin tuck exercise intervention, in frail older patients admitted to hospital with pneumonia, it is anticipated that patients' oral intake will improve. It is suggested that this will further impact clinical, patient and healthcare economic outcomes, i.e. reduce the need for supplemental feeding, improve patient satisfaction with oral intake and swallowing-related quality of life, decrease the occurrence of chest infections and reduce hospital admissions and related healthcare costs., Trial Registration: ISRCTN, ISRCTN12813363 . Registered on 20 January 2020., (© 2022. The Author(s).)

Introduction: This systematic scoping review sought to summarise and synthesise the qualitative evidence on adolescent idiopathic scoliosis (AIS) to understand the experiences of AIS, and of its diagnosis and treatment, and effective coping strategies to inform directions for future research., Method: A systematic scoping review and textual narrative synthesis was undertaken. Qualitative or mixed-methods studies with extractable qualitative data were included if participants had AIS, and patient or patient relative perspectives about AIS or its treatment were reported., Results: Fifteen papers were included. These suggested that AIS can influence self-image and perceptions of appearance and can cause those with the condition to reluctantly adjust parts of their lives and avoid some activities. The diagnosis and treatment of AIS is a major event and is often accompanied by shock, uncertainty, and anxiety. Whilst some find surgery stressful, others were relieved to have the surgery, and were generally happy with the outcome. Immediate family members may be distressed by the diagnosis and treatment of AIS., Discussion: AIS diagnosis and treatment has a substantial impact on adolescents and their families that is only addressed in part in this review. There is a pressing need for more qualitative research to understand needs, perspectives and experiences of adolescents with AIS and their families from the point of diagnosis, throughout treatment, and in the longer-term., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Aims: Although it has been widely recognized the potential of physical activity to help cancer patients' preparation for and recovery from surgery, there is little consideration of patient reflections and recovery experiences to help shape adherence to exercise programs. The aim was to explore the acceptability of our newly proposed isometric exercise program in a large general hospital trust in England providing specialist cancer care by using patient recollections of illness and therapy prior to undertaking a randomized controlled trial., Methods: Four Focus groups (FGs) were conducted with cancer survivors with an explicit focus on patient identity, functional capacity, physical strength, exercise advice, types of activities as well as the timing of our exercise program and its suitability. Thematic framework analysis was used with NVivo 11., Results: FG data was collected in January 2016. A total of 13 patients were participated, 10 were male and 3 were female with participants' ages ranging from 39 to 77. Data saturation was achieved when no new information had been generated reaching "information redundancy." Participants reflected upon their post-surgery recovery experiences on the appropriateness and suitability of the proposed intervention, what they thought about its delivery and format, and with hindsight what the psychological enablers and barriers would be to participation., Conclusion: Based upon the subjective recollections and recovery experiences of cancer survivors, isometric-resistance exercise interventions tailored to individuals with abdominal cancer has the potential to be acceptable for perioperative patients to help increase their physical activity and can also help with emotional and psychological recovery., Competing Interests: The authors declare no conflicts of interest., (© 2020 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction : With increasing age the prevalence of frailty, sarcopenia, undernutrition and dysphagia increases. These are all independent markers of outcome. This study explores the prevalence of these four and explores relationships between them. Methods : A convenience sample of 122 patients admitted to acute medical and frailty wards were recruited. Each was assessed using appropriate screening tools; Clinical Frailty Score (CFS) for frailty, SARC-F for sarcopenia, Nutritional Risk Tool (NRT) for nutritional status and 4QT for dysphagia. Results : The mean age of the participants was 80.53 years (65-99 years), and 50.37% (68) were female. Overall, 111 of the 122 (91.0%) reported the presence of at least one of the quartet. The median CFS was 5 (1-9), with 84 patients (68.9%) having a score of ≥5 (moderate or severely frail); The median SARC-F was 5 (0-10), with 64 patients (52.5%) having a score of ≥5; The median NRT was 0 (0-8) and 33 patients (27.0%) scored ≥ 1. A total of 77 patients (63.1%) reported no difficulty with swallowing/dysphagia (4QT ≥ 1) and 29 (23.7%) had only one factor. Sixteen patients (13.1%) had all four. There was a significant correlation between nutritional status and dysphagia, but not with frailty or sarcopenia. There were significant correlations between frailty and both sarcopenia and dysphagia. Conclusions : In our sample of acute medical and frailty ward patients, there was a much higher prevalence than expected (91%) of either: frailty, sarcopenia, undernutrition or dysphagia. The prevalence of all four was present in 13% of patients. We suggest that frailty, sarcopenia, nutritional risk and dysphagia comprise an "Older Adult Quartet". Further study is required to investigate the effect of the "Older Adult Quartet" on morbidity and mortality.

Background: Previous meta-analyses based on aggregate group-level data report antihypertensive effects of isometric resistance training (IRT). However, individual participant data meta-analyses provide more robust effect size estimates and permit examination of demographic and clinical variables on IRT effectiveness., Methods: We conducted a systematic search and individual participant data (IPD) analysis, using both a one-step and two-step approach, of controlled trials investigating at least 3 weeks of IRT on resting systolic, diastolic and mean arterial blood pressure., Results: Anonymized individual participant data were provided from 12 studies (14 intervention group comparisons) involving 326 participants (52.7% medicated for hypertension); 191 assigned to IRT and 135 controls, 25.2% of participants had diagnosed coronary artery disease. IRT intensity varied (8-30% MVC) and training duration ranged from 3 to 12 weeks. The IPD (one-step) meta-analysis showed a significant treatment effect for the exercise group participants experiencing a reduction in resting SBP of -6.22 mmHg (95% CI -7.75 to -4.68; P < 0.00001); DBP of -2.78 mmHg (95% CI -3.92 to -1.65; P = 0.002); and mean arterial blood pressure (MAP) of -4.12 mmHg (95% CI -5.39 to -2.85; P < 0.00001). The two-step approach yielded similar results for change in SBP -7.35 mmHg (-8.95 to -5.75; P < 0.00001), DBP MD -3.29 mmHg (95% CI -5.12 to -1.46; P = 0.0004) and MAP MD -4.63 mmHg (95% CI -6.18 to -3.09: P < 0.00001). Sub-analysis revealed that neither clinical, medication, nor demographic participant characteristics, or exercise program features, modified the IRT treatment effect., Conclusion: This individual patient analysis confirms a clinically meaningful and statistically significant effect of IRT on resting SBP, DBP and mean arterial blood pressure.

Introduction: The first widely-available dry-land training machines for swimmers were introduced about 40 years ago. They were designed so that swimmers could perform resistance exercise whilst more-closely replicating the movements of swimming, than when using other gymnasium-based resistance training machines. These machines were subsequently adapted and used as measurement tools (ergometers) in an array swimming research study. This narrative review categorizes and summarizes what has been shown by the research studies that have utilized this laboratory-based ergometry., Evidence Acquisition: A search was conducted in PubMed, Web of Science, ScienceDirect and Scopus (1970-2018) and relevant publications were included. Publications were grouped into 4 main areas of research: 1) physiological responses to exercise; 2) functional evaluation of swimmers; 3) monitoring of training; 4) muscular work output of swimmers., Evidence Synthesis: Significant differences were showed between swim bench exercise and real swimming, especially in regard to the muscles involved. The difficulties of accurate reproduction of the movements and coordinated dynamic actions of swimming have not been overcome. Nevertheless, the literature shows that the use of these devices has provided a valuable contribution to swimming physiology, while overcoming difficulties presented by attempting to make physiological measurements in the water., Conclusions: In spite of its limitations, laboratory-based ergometry has allowed a valuable contribution to the understanding of the physiology, effects of training and efficiency of swimming.

Isometric exercise training (IET)-induced reductions in resting blood pressure (RBP) have been achieved in laboratory environments, but data in support of IET outside the laboratory are scarce. The aim of this study was to compare 12 weeks of home-based (HOM) IET with laboratory-based, face-to-face (LAB) IET in hypertensive adults. Twenty-two hypertensive participants (24-60 years) were randomized to three conditions: HOM, LAB, or control (CON). IET involved isometric handgrip training (4 × 2 minutes at 30% maximum voluntary contraction, 3 days per week). RBP was measured every 6 weeks (0, 6, and 12 weeks) during training and 6 weeks after training (18 weeks). Clinically meaningful, but not statistically significant reductions in RBP were observed after 12 weeks of LAB IET (resting systolic blood pressure [SBP] -9.1 ± 4.1; resting diastolic blood pressure [DBP] -2.8 ± 2.1; P > .05), which was sustained for 6 weeks of detraining (SBP -8.2 ± 2.9; DBP -4 ± 2.9, P > .05). RBP was reduced in the HOM group after 12 weeks of training (SBP -9.7 ± 3.4; DBP -2.2 ± 2.0; P > .05), which was sustained for an additional 6 weeks of detraining (SBP -5.5 ± 3.4; DBP -4.6 ± 1.8; P > .05). Unsupervised home-based IET programs present an exciting opportunity for community-based strategies to combat hypertension, but additional work is needed if IET is to be used routinely outside the laboratory., (Copyright © 2018 American Heart Association. Published by Elsevier Inc. All rights reserved.)

Objective: To determine whether there is an association between hypermobility and sports injury., Methods: A quantitative observational approach using a cross-sectional survey was adopted. Individuals were identified as hypermobile or not. All participants were asked to complete two questionnaires: one asking demographic information and the other injury-specific. Fisher's exact test was used for statistical analysis., Results: 114 individuals participated in the study, 62 women and 52 men. 26% of the participants were hypermobile. There was no significant association between hypermobility and sports injury (p=0.66). There was a significant increase in joint and ligament sprain among the non-hypermobile (NH) group covering all sports (p=0.03). Joint dislocation was found exclusively among hypermobile individuals. The duration of injury in hypermobile individuals was higher than NH. The use of oral painkillers or anti-inflammatories in the semiprofessional group was greater than the general population., Conclusion: Hypermobility is relatively common among individuals, and there is a lot of anecdotal evidence associating it with increased rates of injuries. This project finds that NH individuals are more likely to sustain a ligament or joint sprain in sports. This is due to increased joint laxity and flexibility preventing injury. There were important limitations to this study which will be addressed in further work. These include assessing for pauciarticular hypermobility and focusing on one sport to investigate its association with sports injury in those who are hypermobile or not. It would also be important to focus on one specific joint, assessing its flexibility and association with injury., Competing Interests: Competing interests: None declared.

Body temperature is one of the fundamental measures considered in the assessment of health and well-being, with various medical conditions known to give rise to abnormal changes in temperature. In particular, abnormal variations in dynamic temperature patterns during walking or exercise may be linked to a range of foot problems, which are of particular concern in diabetic patients.A number of studies have investigated normative temperature patterns of a population by considering data from multiple participants and averaging results after an acclimatisation interval. In this work we demonstrate that the temperature patterns obtained using such an approach may not be truly representative of temperature changes in a population, and the averaging process adopted may yield skewed results.An alternative approach to determine generic reference temperature patterns based on a minimization of root mean square differences between time-shifted versions of temperature data collected from multiple participants is proposed. The results obtained indicate that this approach can yield a general trend that is more representative of actual temperature changes across a population than conventional averaging methods. The method we propose is also shown to better capture and link the effects of factors that influence dynamic temperature trends, which could in turn lead to a better understanding of underlying physiological phenomena.

Objective: To systematically review the effects of preoperative and postoperative resistance exercise training on the recovery of physical function in patients undergoing abdominal surgery for cancer., Data Sources: A systematic review of English articles using Medline, Physiotherapy Evidence Database, CINAHL and the Cochrane Library electronic databases was undertaken., Eligibility Criteria for Selecting Studies: Studies were included if they used a randomised, quasi-randomised or controlled trial study design and compared the effects of a muscle-strengthening exercise intervention (±other therapy) with a comparative non-exercise group; involved adult participants (≥18 years) who had elected to undergo abdominal surgery for cancer; and used muscle strength, physical function, self-reported functional ability, range of motion and/or a performance-based test as an outcome measure., Results: Following screening of titles and abstracts of the 588 publications retrieved from the initial search, 24 studies met the inclusion criteria and were accessed for review of the full-text version of the article, and 2 eligible studies met the inclusion criteria and were included in the review. One exercise programme was undertaken preoperatively and the other postoperatively, until discharge from hospital. The exercise interventions of the included studies were performed for five and eight sessions, respectively. There were no differences between groups in either study., Conclusion: The only two studies designed to determine whether preoperative or postoperative resistance muscle-strengthening exercise programmes improved or negatively affected physical function outcomes in patients undergoing abdominal surgery for cancer provide inconclusive results., Competing Interests: Competing interests: None declared.

The purpose of this study was to explore the relationships between mechanical power, thrust power, propelling efficiency and sprint performance in elite swimmers. Mechanical power was measured in 12 elite sprint male swimmers: (1) in the laboratory, by using a whole-body swimming ergometer (W' TOT ) and (2) in the pool, by measuring full tethered swimming force (F T ) and maximal swimming velocity (V max ): W' T  = F T  · V max . Propelling efficiency (η P ) was estimated based on the "paddle wheel model" at V max . V max was 2.17 ± 0.06 m · s -1 , η P was 0.39 ± 0.02, W' T was 374 ± 62 W and W' TOT was 941 ± 92 W. V max was better related to W' T (useful power output: R = 0.943, P < 0.001) than to W' TOT (total power output: R = 0.744, P < 0.01) and this confirms the use of the full tethered test as a valid test to assess power propulsion in sprinters and to estimate swimming performance. The ratio W' T /W' TOT (0.40 ± 0.04) represents the fraction of total mechanical power that can be utilised in water (e.g., η P ) and was indeed the same as that estimated based on the "paddle wheel model"; this supports the use of this model to estimate η P in swimming.

Considered a global health crisis by the World Health Organization, hypertension (HTN) is the leading risk factor for death and disability. The majority of treated patients do not attain evidence-based clinical targets, which increases the risk of potentially fatal complications. HTN is the most common chronic condition seen in primary care; thus, implementing therapies that lower and maintain BP to within-target ranges is of tremendous public health importance. Isometric handgrip (IHG) training is a simple intervention endorsed by the American Heart Association as a potential adjuvant BP-lowering treatment. With larger reductions noted in HTN patients, IHG training may be especially beneficial for those who (a) have difficulties continuing or increasing drug-based treatment; (b) are unable to attain BP control despite optimal treatment; (c) have pre-HTN or low-risk stage I mild HTN; and (d) wish to avoid medications or have less pill burden. IHG training is not routinely prescribed in clinical practice. To shift this paradigm, we focus on (1) the challenges of current HTN management strategies; (2) the effect of IHG training; (3) IHG prescription; (4) characterizing the population for whom it works best; (5) clinical relevance; and (6) important next steps to foster broader implementation by clinical practitioners.

Background: There has been very little published work exploring the comparative effects of isometric resistance training (IRT) on blood pressure (BP) in men and women. Most of the previously published work has involved men and used resting BP as the primary outcome variable. Early evidence suggests that IRT is particularly effective in older women and has a positive influence on ambulatory BP, a better predictor of disease risk., Objectives: With the WHO now placing global emphasis on the primary prevention of hypertension, the goals of this proof-of-concept study were to (i) examine whether sex differences exist in the ambulatory BP-lowering effects of IRT in young, normotensive men and women and (ii) determine whether these reductions can be predicted by simple laboratory stress tasks (a 2-min sustained isometric contraction and a math task involving subtracting a two-digit number from a series of numbers)., Results: There were no differences in the IRT-induced reductions in 24-h (men: Δ4 mmHg, women: Δ4 mmHg), daytime (men: Δ3 mmHg, women: Δ4 mmHg), or night-time (men: Δ4 mmHg, women: Δ3 mmHg) ambulatory BP in men (n=13) and women (n=11) (P<0.05) and these changes were not associated with systolic BP reactivity to either stress task (all P>0.05)., Conclusion: Our data suggest that lower ambulatory BP can be achieved, to a similar magnitude in young healthy women as well as men, with IRT; however, the BP-lowering effectiveness cannot be predicted by systolic BP reactivity. Taken together, this work heralds a potentially novel approach to the primary prevention of hypertension in both men and women and warrants further investigation in a larger clinical outcome trial.

To reduce resting blood pressure, a minimum isometric exercise training (IET) intensity has been suggested, but this is not known for short-term IET programmes. We therefore compared the effects of moderate- and low-intensity IET programmes on resting blood pressure. Forty normotensive participants (22.3 ± 3.4 years; 69.5 ± 15.5 kg; 170.2 ± 8.7 cm) were randomly assigned to groups of differing training intensities [20%EMGpeak (~23%MVC, maximum voluntary contraction, or 30%EMGpeak (~34%MVC)] or control group; 3 weeks of IET at 30%EMGpeak resulted in significant reductions in resting mean arterial pressure (e.g. -3.9 ± 1.0 mmHg, P < 0.001), whereas 20%EMGpeak did not (-2.3 ± 2.9 mmHg; P > 0.05). Moreover, after pooling all female versus male participants, IET induced a 6.9-mmHg reduction in systolic blood pressure in female participants, but only a 1.5-mmHg reduction in systolic blood pressure in male participants, although the difference was not significant. An IET intensity between 20%EMGpeak and 30%EMGpeak is sufficient to elicit significant resting blood pressure reductions in a short-term training period (3 weeks). In addition, sexual dimorphism may exist in the magnitude of reductions, but further work is required to confirm this possibility, which could be important in understanding the mechanisms responsible.

The purpose of this study was to establish whether an accumulated brisk walking programme, performed during the school day, is effective in changing body composition in primary school children aged 5-11 years. Altogether, 152 participants (79 boys and 73 girls) took part in this repeated-measures intervention study, divided into groups of walkers and controls. The walkers took part in the intervention during school time, which involved brisk walking around the school grounds for 15 min in the morning and afternoon, at least three times a week for 15 weeks. This represented an additional 90 min of moderate physical activity per week. The controls undertook their usual school day activities. Pre- and post-intervention anthropometric and body composition measures were taken. Body fat (-1.95 ± 2.6%) and fat mass (-0.49 ± 1.0 kg) were significantly reduced in the walkers after the intervention, whereas the controls showed no significant changes in these measures. Our results show that regular accumulated bouts of brisk walking during the school day can positively affect body composition in primary school children.

The purpose of this study was (a) to assess lactate accumulation during isometric exercise, and to quantify the shifts in accumulation following isometric training; and (b) to relate any training-induced changes in lactate accumulation to reductions in resting blood pressure. Eleven male participants undertook isometric training for a 4-week period using bilateral-leg exercise. Training caused reductions in systolic, diastolic, and mean arterial resting blood pressure (of -4.9 ± 6.3 mmHg, P = 0.01; -2.6 ± 3.0 mmHg, P = 0.01; and -2.6 ± 2.3 mmHg, P = 0.001 respectively; mean ± s). These were accompanied by changes in muscle activity, taken as electromyographic activity to reach a given lactate concentration (from 114 ± 22 to 131 ± 27 mV and from 136 ± 25 to 155 ± 34 mV for 3 and 4 mmol · L(-1) respectively. Training intensity expressed relative to peak lactate was correlated with reduced resting systolic and mean arterial blood pressure. Training caused significant shifts in lactate accumulation, and reductions in resting blood pressure are strongly related to training intensity, when expressed relative to pre-training peak lactate. This suggests that higher levels of local muscle anaerobiosis may promote the training-induced reductions in resting blood pressure.

In this study, we examined the correlations between selected markers of isometric training intensity and subsequent reductions in resting blood pressure. Thirteen participants performed a discontinuous incremental isometric exercise test to volitional exhaustion at which point mean torque for the final 2-min stage (2min-torque(peak)) and peak heart rate peak (HR(peak)) were identified. Also, during 4 weeks of training (3 sessions per week, comprising 4 × 2 min bilateral leg isometric exercise at 95% HR(peak)), heart rate (HR(train)), torque (Torque(train)), and changes in EMG amplitude (ΔEMG(amp)) and frequency (ΔEMG(freq)) were determined. The markers of training intensity were: Torque(train) relative to the 2min-torque(peak) (%2min-torque(peak)), EMG relative to EMG(peak) (%EMG(peak)), HR(train) ΔEMG(amp), ΔEMG(freq), and %MVC. Mean systolic (-4.9 mmHg) and arterial blood pressure (-2.7mmHg) reductions correlated with %2min-torque(peak) (r = -0.65, P = 0.02 and r = -0.59, P = 0.03), ΔEMG(amp) (r = 0.66, P = 0.01 and r = 0.59, P = 0.03), ΔEMG(freq) (r = -0.67, P = 0.01 and r = -0.64, P = 0.02), and %EMG(peak) (systolic blood pressure only; r = -0.63, P = 0.02). These markers best reflect the association between isometric training intensity and reduction in resting blood pressure observed after bilateral leg isometric exercise training.

There are no previous reports of energy expenditure and perceived effort during brisk-walking and running at speeds self-selected by young children. Fifty four participants (age 8-11 years old) performed 1500 m of brisk-walking and running in a marked school playground, and were given simple instructions to either 'walk quickly' or to 'jog'. During the running the children achieved higher mean speeds and a greater total energy expenditure (p < .001). However, there was no difference in the perceived effort between the two activities (p > .05). These findings suggest that under certain conditions children find it just as easy to run as they do to walk briskly, even though the speed and energy expenditure is significantly higher.

Context: Forward propulsion in freestyle swimming is predominantly achieved through arm action. Few studies have assessed the effects of arm training on arm power and swimming performance, yet there have not been any investigations on the effects of arms-only swimming training on swimming performance and physiological responses to arm exercise., Purpose: To investigate the changes in arms-only and full-stroke swimming performance, movement economy and aerobic power after an arms-only swimming training program., Methods: Fifteen male county level swimmers were assigned either to an experimental (ES, n = 8) or control group (CS, n = 7). For six weeks ES performed arms-only freestyle swimming exercises for 20% of their weekly training distance three times per week, whereas CS performed their usual swimming training. Before and after the training program, both groups performed a) two time trials, 186 m using arms-only (186ARMS) and 372 m using full-stroke (372FULL) freestyle swimming, and b) an incremental arm-pulling exercise test. The time to complete the trials was recorded. Peak oxygen uptake (VO2peak), peak exercise intensity (EIpeak) submaximal oxygen uptake at 60 W (VO2-60) and exercise intensity at ventilatory threshold (VTW) were determined from the exercise test., Results: After training, ES had improved in 186ARMS (-14.2 +/- 3.6%, P = .03), VO2-60 (-22.5 +/- 2.3%, P = .04), EIpeak (+17.8 +/- 4.2%, P = .03), and VTW (+18.9 +/- 2.3%, P = .02), but not in VO2peak (P = .09) or in 372FULL (P = .07). None of the measures changed in CS (P > .05)., Conclusion: Arms-only swimming training at 20% of the weekly training distance is an effective method to improve arm conditioning during the preparatory phase of the annual training cycle.

Although differences in daily activity levels have been assessed in cross-sectional walk-to-school studies, no one has assessed differences in body composition and dietary energy intake at the same time. In this study of 239 primary school children, there were no significant differences in daily activity levels, body composition, or estimated dietary energy intake between those who walk to school (WALK) and those who travel by car (CAR; p < .05). WALK children were more active between 8 a.m. and 9 a.m. and 3 p.m. and 4 p.m. than CAR children (p < .05). In addition, there were no significant differences in the main analysis when participants were subgrouped by gender and age.

The study aim was to consider the use of a motorised treadmill as a cycling ergometry system by assessing predicted and recorded power output values during treadmill cycling. Fourteen male cyclists completed repeated cycling trials on a motorised treadmill whilst riding their own bicycle fitted with a mobile ergometer. The speed, gradient and loading via an external pulley system were recorded during 20-s constant speed trials and used to estimate power output with an assumption about the contribution of rolling resistance. These values were then compared with mobile ergometer measurements. To assess the reliability of measured power output values, four repeated trials were conducted on each cyclist. During level cycling, the recorded power output was 257.2 +/- 99.3 W compared to the predicted power output of 258.2 +/- 99.9 W (p > 0.05). For graded cycling, there was no significant difference between measured and predicted power output, 268.8 +/- 109.8 W vs. 270.1 +/- 111.7 W, p > 0.05, SEE 1.2 %. The coefficient of variation for mobile ergometer power output measurements during repeated trials ranged from 1.5 % (95 % CI 1.2 - 2.0 %) to 1.8 % (95 % CI 1.5 - 2.4 %). These results indicate that treadmill cycling can be used as an ergometry system to assess power output in cyclists with acceptable accuracy.