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Objective: To determine the prevalence and predictors of physical activity, sedentary behaviour and fatigue five years after total knee replacement surgery. Design: A longitudinal cohort study. Setting: Community-dwelling adults who had previously undergone total knee replacement. Methods: Five-year follow-up questionnaire data were obtained from participants previously enrolled in a randomised controlled trial examining rehabilitation after total knee replacement. Main study outcomes at one year did not differ between randomisation groups, hence data were pooled for the present longitudinal analysis. Before and one and five years after surgery, participants completed questionnaires (Active Australia Survey, WOMAC, SF12 v2, demographics and fatigue). Results: 272/422 community-dwelling adults (45–74 years) completed the questionnaires at five years. Excessive sedentary behaviour was evident in 91% of the cohort, predicted by excessive sedentary behaviour and lack of energy at one year. Inadequate physical activity at five years was evident for 59% of the cohort, predicted by higher fatigue and comorbidity scores pre-surgery and inadequate physical activity at one year. Just under half (47%) of the cohort experienced clinically-important fatigue at five years, predicted by clinically-important fatigue before and one year after surgery, lack of sleep before surgery and physical activity one year after surgery. Conclusion: Documenting physical activity, sedentary behaviour and fatigue before and one year after knee replacement is important to identify those at risk of longer-term inadequate physical activity, excessive sedentary behaviour and clinically-important fatigue. Interventions to maintain activity and reduce sedentary behaviour are needed to reap the potential health benefits of total knee replacement surgery. [ABSTRACT FROM AUTHOR]

Introduction: The study purpose was to compare perceived fatigability and performance fatigability after high-velocity contractions with knee extensor muscles between people with prediabetes, people with type 2 diabetes (T2D), and controls without diabetes matched for age, body mass index, and physical activity. Methods: Twenty people with prediabetes (11 men, 9 women: 63.1 ± 6.0 yr, 26.9 ± 4.2 kg·m−2, 8030 ± 3110 steps per day), 39 with T2D (23 men, 16 women: 61.2 ± 8.5 yr, 29.4 ± 6.4 kg·m−2, 8440 ± 4220 steps per day), and 27 controls (13 men, 14 women: 58.1 ± 9.4 yr, 27.3 ± 4.3 kg·m−2, 8400 ± 3000 steps per day) completed the Fatigue Impact Scale as a measure of perceived fatigability and a fatigue protocol including 120 maximal-effort, high-velocity concentric contractions (MVCC; 1 contraction/3 s) with the knee extensors using a submaximal load (30% maximum) to quantify performance fatigability. Electrical stimulation was used to assess voluntary activation and contractile function of the knee extensor muscles before and after the fatigue protocol. Results: Fatigue Impact Scale scores were not different between people with prediabetes, people with T2D, and controls (12.5 ± 15.1, 18.3 ± 22.7, and 12.6 ± 18.6, respectively; P = 0.517). However, people with prediabetes had greater reductions in MVCC power during the fatigue protocol than did controls (31.8% ± 22.6% vs 22.1% ± 21.1%, P < 0.001), and both groups had lesser reductions than the T2D group (44.8% ± 21.9%, P < 0.001). Similarly, the prediabetes group had larger reductions in electrically evoked twitch amplitude than the control group (32.5% ± 24.9% vs 21.3% ± 33.0%, P < 0.001), but lesser reductions than those with T2D (44.0% ± 23.4%, P < 0.001). For all three groups, a greater decline in MVCC power was associated with larger reductions of twitch amplitude (r 2 = 0.350, P < 0.001). Conclusion: People with prediabetes have greater performance fatigability of the knee extensors due to contractile mechanisms compared with controls, although less performance fatigability than that of people with T2D. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the prevalence and determinants of inadequate physical activity and excessive sedentary behaviour before and after total knee replacement. Design, setting and subjects: Secondary analysis was performed on data from a cohort of 422 adults (45–74 years), drawn from 12 public or private hospitals, undergoing primary unilateral or bilateral total knee replacement surgery. Main measures: Questionnaires were used to determine the presence of inadequate physical activity and excessive sedentary behaviour before and 6  and 12 months after total knee replacement surgery. Knee pain, activity limitations, comorbidities, muscle strength, psychological well-being, fatigue, sleep and body mass index were measured/assessed as possible determinants of physical activity or sedentary behaviour. Results: Before surgery, 77% (n = 326) of the cohort participated in inadequate physical activity according to World Health Organization guidelines, and 60% (n = 253) engaged in excessive sedentary behaviour. Twelve months after surgery, 53% (n = 185) of the cohort engaged in inadequate physical activity and 45% (n = 157) in excessive sedentary behaviour. Inadequate physical activity before surgery (P = 0.02), obesity (P = 0.07) and comorbidity score >6 (P = 0.04) predicted inadequate physical activity 12 months after surgery. Excessive sedentary behaviour and activity limitations before surgery predicted excessive sedentary behaviour 12 months after surgery. Conclusion: Although there were improvements after total knee replacement, 12 months after surgery about half the cohort did not meet World Health Organization recommendations for activity. Pre-surgery assessment of physical activity, activity limitations, sedentary behaviour and body mass index is essential to identify patients at risk for long-term inactivity. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence of the anti-inflammatory effect of the anti-diabetic drug metformin and its use to reduce pain. However, we currently lack studies investigating whether metformin is associated with a reduction in chronic back pain prevalence when considering physical activity levels, body mass index (BMI), and age. Objective: To investigate whether use of metformin is associated with lower levels of reporting of chronic back pain in a large cohort with type 2 diabetes when stratified for physical activity, BMI, and age. Methods: This is a cross-sectional study of 21,889 participants with type 2 diabetes who were drawn from the UK Biobank database. We investigated whether people using metformin reported a higher prevalence of chronic low back pain than those who did not. Type 2 diabetes, chronic back pain, and metformin were self-reported. Participants were stratified according to their physical activity level (low, moderate and high), BMI (normal, overweight, and obese), and age (40 to <50; 50 to < 60; and ≥60 years). Logistic regression models were built for each physical activity level, BMI and age category to investigate the prevalence of chronic back pain amongst those using and not using metformin. Results: Participants who were using metformin and who had low levels of physical activity [OR 0.87, 95%CI 0.78 to 0.96] or who were obese [OR 0.90, 95%CI 0.86 to 0.98] or older [OR 0.85, 95%CI 0.78 to 0.93] had lower odds of reporting chronic back pain than their counterparts. Conclusion: The anti-diabetic drug metformin might reduce prevalence of chronic low back pain in people who are older, overweight, or less active. These findings should be confirmed in studies using a longitudinal design. [ABSTRACT FROM AUTHOR]

The article presents a study which investigated whether the frequency, intensity and duration of exercise influence HbA1c among people with type 2 diabetes. Topics discussed include an assessment of such relationships for aerobic exercise, resistance exercise or combined aerobic and resistance exercise, as well as the prevention and treatment of diabetes. The absolute changes in HbA1c are cited.

Introduction: The prevalence of early-onset type 2 diabetes (EOT2D; diagnosed with T2DM before 40 years old), has increased sharply in recent years. Peripheral neuropathy (DPN) is a common and debilitating complication associated with T2DM, and it is also common in EOT2D, even among adolescents. Nerve excitability studies (NES) examine nerve axonal ion channel function; and may allow early detection of axonal dysfunction. The aim of this study was to explore the differences in NES outcomes between a cohort with EOT2D and matched healthy controls. Method: Thirteen participants with EOT2D with no clinical evidence of DPN and 14 matched healthy control participants (HC) were included in the study. Nerve conduction studies (NCS) were used to assess amplitude, latency, and conduction velocity in sural (sensory) and peroneal (motor) nerves. Motor and sensory NES were conducted on the median nerve. NES parameters assessed included strength-duration time constant, threshold electrotonus (TE), current-threshold relationship and recovery cycle. HbA1c was measured. Independent sample t-tests were used to compare the group means ± standard deviations. Results: Participants with EOT2D (F:M 5:8, age 34.1±6.7yr, BMI 31.7±5.4kg∙m-2) differed from matched HC (F:M 6:8, age 32.5±5.1yr, BMI 29.6±4.4kg∙m-2) for HbA1c (EOT2D=6.8±1.0%, HC=5.2±0.3%, p<0.0001). There were no significant between-group differences in any NCS parameters, confirming the absence of clinical neuropathy. Minor changes in sensory axon NES were found in TE, which measures internodal conductances. Sensory depolarizing TE (TEd) at 10-20ms was decreased significantly in the EOT2D group (TEd 10-20ms: EOT2D = 60.1±2.9ms, HC = 62.9±3.0ms, p = 0.02). There were no significant changes in motor NES. Conclusion: Participants with EOT2D and no clinical evidence of DPN may demonstrate minor changes in sensory axonal function. Prospective studies are required to determine the clinical significance and progression of these changes. Disclosure: Y. Gu: None. A.R. Harmer: None. S.M. Dennis: None. T. Li: None. H.C. Timmins: None. P. Loh: None. N. Garg: None. T. Dharmadasa: None. J. Wong: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; AstraZeneca, Merck & Co., Inc. A. Gauld: None. P.A. Munoz: None. S.B. Park: None. Funding: Diabetes Australia; Sydney Local Health District [ABSTRACT FROM AUTHOR]

Purpose: To investigate associations between anthropometric measures (birthweight, weight gain and current BMI) and back pain; and to determine whether these associations differ between those born with low or full birthweight.Methods: The cross-sectional associations between the lifetime prevalence of back pain and anthropometric measures (birthweight, weight gain and current BMI) among 2754 adult twins were investigated in three stages: total sample; within-pair case-control for monozygotic and dizygotic twins together; and within-pair case-control analysis separated by dizygotic and monozygotic. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI).Results: Birthweight was not associated with back pain (OR 0.99; 95% CI 0.99-1.00), but a weak association was found between weight gain (OR 1.01; CI 1.00-1.01) or current BMI (OR 1.02; 95% CI 1.00-1.05) and back pain in the total sample analysis. These associations did not remain significant after adjusting for genetics. The associations did not differ between those whose were born with low or full birthweight.Conclusion: Birthweight was not associated with prevalence of back pain in adulthood. Weight gain and current BMI were weakly associated with back pain prevalence in the total sample analysis but did not differ between those born with low or full birthweight. However, the small-magnitude association only just achieved significance and appeared to be confounded by genetics and the early shared environment. Our results suggest that a direct link between these predictors and back pain in adults is unlikely. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

To evaluate the knowledge, skills and barriers to evidence-based practice and the impact of evidence-based practice training for physical therapy clinicians. Physical therapists from a health district in Sydney, Australia were invited to participate. The primary outcome was the Assessing Competency in Evidence-based Medicine scale (range 0–15; 15 is high knowledge and skill) to quantify knowledge and skills. The secondary outcomes were the four subscales of the BARRIERS scale (range 1–4; 4 is high barrier) to quantify barriers. Outcomes were collected at baseline and post an evidence-based practice training program (flipped classroom approach that addressed the core competencies for teaching evidence-based practice) of 3 months duration. Registration: Australian and New Zealand Clinical Trial Register (ACTRN12619000038190). 104 participants completed baseline data and 94 completed post-training data. The mean score for the Assessing Competency in Evidence-based Medicine scale for knowledge and skills at baseline was 9.5 (standard deviation 1.6). The mean BARRIERS subscale scores at baseline were: Healthcare Provider 1.9 (0.5); Research 2.2 (0.5); Setting 2.6 (0.5); and Presentation 2.6 (0.5). On average, training increased the Assessing Competency in Evidence-based Medicine scale score by 0.1 points (95% confidence interval −0.2 to 0.5) and reduced barriers by −0.1 (−0.2 to 0.0; Setting subscale) to −0.2 (−0.3 to −0.1; Healthcare Provider subscale). Physical therapists have knowledge and skill in evidence-based practice that is comparable to other allied health professionals, medical students and medical doctors, and encountered barriers to using high-quality clinical research to guide practice. Training did not change knowledge and skills but did reduce barriers. [ABSTRACT FROM AUTHOR]

Objective: To determine whether land-based therapeutic exercise is beneficial for people with knee osteoarthritis (OA) in terms of reduced joint pain or improved physical function and quality of life.Methods: Five electronic databases were searched, up until May 2013. Randomised clinical trials comparing some form of land-based therapeutic exercise with a non-exercise control were selected. Three teams of two review authors independently extracted data and assessed risk of bias for each study. Standardised mean differences immediately after treatment and 2-6 months after cessation of formal treatment were separately pooled using a random effects model.Results: In total, 54 studies were identified. Overall, 19 (35%) studies reported adequate random sequence generation, allocation concealment and adequately accounted for incomplete outcome data. However, research results may be vulnerable to selection, attrition and detection bias. Pooled results from 44 trials indicated that exercise significantly reduced pain (12 points/100; 95% CI 10 to 15) and improved physical function (10 points/100; 95% CI 8 to 13) to a moderate degree immediately after treatment, while evidence from 13 studies revealed that exercise significantly improved quality of life immediately after treatment with small effect (4 points/100; 95% CI 2 to 5). In addition, 12 studies provided 2-month to 6-month post-treatment sustainability data which showed significantly reduced knee pain (6 points/100; 95% CI 3 to 9) and 10 studies which showed improved physical function (3 points/100; 95% CI 1 to 5).Conclusions: Among people with knee osteoarthritis, land-based therapeutic exercise provides short-term benefit that is sustained for at least 2-6 months after cessation of formal treatment. [ABSTRACT FROM AUTHOR]

Background: During exercise, dynamic hyperinflation (DH), measured by a reduction in inspiratory capacity (IC), increases exertional dyspnea and reduces functional capacity in many patients with severe COPD. Although noninvasive ventilation (NIV) during exercise can improve exercise duration, the effect on DH is unclear.Research Questions: In people with COPD, resting hyperinflation, and evidence of DH during exercise, does bilevel NIV during exercise reduce DH and increase endurance time compared with exercise with no NIV, and does NIV with an individually titrated expiratory positive airway pressure (T-EPAP) reduce DH and increase exercise endurance time more than NIV with standardized EPAP (S-EPAP) of 5 cm H2O?Study Design and Methods: A randomized crossover trial in which investigators and participants were blinded between NIV interventions was performed. Participants (N = 19; FEV1 of 1.02 ± 0.24 L (39% ± 6% predicted) completed three constant work rate endurance cycle tests in random order-no NIV, NIV with S-EPAP, and NIV with T-EPAP-during exercise. Primary outcomes were isotime IC and exercise endurance time. Outcome measures from each intervention were compared at isotime and at end exercise by using a linear mixed-model analysis.Results: Compared with no NIV, isotime IC and endurance time were greater with both NIV with S-EPAP (mean difference: 95% CI, 0.19 L [0.10-0.28]; 95% CI, 153 s [24-280], respectively) and T-EPAP (95% CI, 0.22 L [0.13-0.32]; 95% CI, 145 s [28-259], respectively). There was no difference between NIV with S-EPAP and NIV with T-EPAP.Interpretation: In people with COPD and DH during exercise, NIV during exercise reduced DH and increased cycle endurance time. An S-EPAP of 5 cm H2O was adequate to obtain these benefits.Trial Registry: Australian New Zealand Clinical Trials Registry; No.: ACTRN12613000804785; URL: http://www.anzctr.org.au. [ABSTRACT FROM AUTHOR]

Background and objective: Approximately half of the population will experience either low back pain or neck pain, at some point in their lives. Previous studies suggest that people with diabetes are more likely to present with chronic somatic pain, including shoulder, knee and spinal pain. This study aimed to systematically review and appraise the literature to explore the magnitude as well as the nature of the association between diabetes and back, neck, or spinal (back and neck) pain. Databases and data treatment: A systematic search was performed using the Medline, CINAHL, EMBASE, and Web of Science electronic databases. Studies which assessed the association between diabetes and back or neck pain outcomes, in participants older than 18 years of age were included. Two independent reviewers extracted data on the incidence of pain and reported associations. Results: Eight studies were included in the meta-analyses. Meta-analyses showed that people with diabetes are more likely to report low back pain [5 studies; n: 131,431; odds ratio (OR): 1.35; 95% Confidence Interval (CI): 1.20 to 1.52; p<0.001] and neck pain (2 studies; n: 6,560; OR: 1.24; 95% CI: 1.05 to 1.47; p = 0.01) compared to those without diabetes. Results from one longitudinal cohort study suggested that diabetes is not associated with the risk of developing future neck, low back or spinal pain. Conclusions: Diabetes is associated with low back and neck individually, and spinal pain. The longitudinal analysis showed no association between the conditions. Our results suggest that diabetes co-exists with back pain; however, a direct causal link between diabetes and back pain was not established. Systematic review registration: PROSPERO registration . [ABSTRACT FROM AUTHOR]