Search

Background: Patients with multiple sclerosis (MS) face a wide range of symptoms, including physical disability, imbalance, motor disorders, and acute and chronic pain. The psychosocial consequences of these symptoms may limit social well-being and quality of life in these patients. Purpose: The aim of the study was to assess self-perceived social isolation among patients with MS and its relationship with pain intensity and disability status. Methods: This cross-sectional study was conducted on 200 patients with MS referred to neurology wards and clinics, the MS Association, and rehabilitation centers. Data collection tools used included a demographic information form, Numeric Pain Rating Scale, Expanded Disability Status Scale, and Social Isolation Questionnaire. Results: The mean scores of 4.66 (SD = 1.15) for disability and 4.18 (SD = 2.22) for pain intensity both indicated moderate levels of both. Of the sample, 21.5% (43 patients) reported no pain, 22.5% (n = 45) reported mild pain, 35% (n = 70) reported moderate pain, and 21% (n = 42) reported intense pain. The average social isolation score was 63.52 (SD = 3.32), which is higher than the theoretical average. Of the sample, 44.5% reported low social isolation, whereas 55.5% indicated high social isolation. Gender, duration of MS, economic status, disability status, and pain intensity were all found to be significantly associated with social isolation in patients with MS (all ps < .05). Conclusions: Based on the findings, comprehensive support plans are necessary to improve psychosocial well-being, social life, and quality of life in patients with MS. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the second most common cancer in humans. Its therapy procedures such as breast biopsy can cause anxiety and persistent pain in patients. Virtual reality (VR) has been applied to promote comfort in various populations. However, the effectiveness of VR in relieving pain and anxiety in patients undergoing breast cancer treatment is unclear. Purpose: This study was designed to examine the effect of VR on anxiety and pain in people undergoing treatment for breast cancer. Methods: PubMed, Cochrane, Embase, Scopus, Web of Science, and MEDLINE databases were searched for studies involving VR, pain, and anxiety in patients with breast cancer published up to March 2022. The Cochrane Handbook for Systems quality evaluation standard 6.3.0 was followed to assess risk of bias in the identified studies, with the results reported in line with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses statement. Subsequently, a meta-analysis of the included data was conducted using RevMan 5.3 software. Results: Six randomized controlled trials and one quasi-experimental study were included. The strength of the evidence ranged from moderate to high. Although VR was found to ameliorate anxiety in patients with breast cancer, only three studies showed statistically significant changes. All of the included studies reported statistically significant improvement in pain levels. In addition, two of the studies reported cybersickness symptoms as a common side effect of VR. Conclusions: VR has an important role to play in alleviating pain in patients with breast cancer. However, evidence demonstrating VR's importance in alleviating anxiety symptoms in this population is insufficient. Studies conducted with larger sample sizes and high-quality research methodologies will be necessary to clarify this issue. Clinical nurses should address the potential side effects of VR. [ABSTRACT FROM AUTHOR]

Background: Fatigue, a major health concern among patients receiving hemodialysis, is associatedwith poor quality of life, negative emotions, and cognitive dysfunction. Acupressure is a lowcost and noninvasive traditional Chinese therapy that has been widely used in community and clinic settings. However, the beneficial effects of acupressure on various aspects of fatigue among these patients have not been systematically investigated. Purpose: This study was designed to determine the effects of acupressure on fatigue in patients receiving hemodialysis. The moderating influences of bio-sociodemographic characteristics and methodology on the association between acupressure and posthemodialysis fatigue were also examined. Methods: Four electronic databases were searched for qualified articles published between database inception and November 2, 2022. Only randomized controlled trials designed to investigate the effects of acupressure on fatigue in patients receiving hemodialysis were qualified for consideration. A random-effects model was used for data analysis. Results: Eight randomized controlled trials with 11 effect sizes and 725 participants were included in this study. In these studies, acupressure was found to have a significantly higher alleviation effect on general fatigue (g = -0.78; 95% confidence interval [-1.09, -0.48]) and the behavioral, emotional, sensory, and cognitive domains of fatigue (g = -0.51, -0.51, -0.72, and -0.41, respectively) among patients receiving hemodialysis than those in the control groups. Furthermore, the stimulation of the Shenmen acupoint was found to increase the effects ( p < .01) of acupressure on fatigue reduction significantly. Notably, the use of special equipment to perform the acupressure was not found to significantly improve outcomes ( p = .99). Conclusions/Implications for Practice: Acupressure is effective in alleviating fatigue in patients receiving hemodialysis, particularly when the Shenmen acupoint is used together with other acupoints, and is effective without the application of special equipment. Acupressuremay be adopted as a complementary therapy for fatigue alleviation in patients receiving hemodialysis. Based on the findings, healthcare providers should coach patients receiving hemodialysis with fatigue on how to use acupressure therapy appropriately to alleviate this health concern. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia, prevalent in patients with cancer, negatively affects quality of life. However, generic tools are unable to capture theminor effects of sarcopenia on quality of life. The short-form version of the Sarcopenia Quality of Life (SFSarQoL) questionnaire was developed as an efficient tool to assess the impact of sarcopenia on quality of life in older adults. However, its clinimetric properties in patients with cancer remain unknown. Purpose: This study was designed to examine the clinimetric properties of the Chinese SF-SarQoL in patients with colorectal cancer, particularlywith regard to its ability to detect changes in quality of life. Methods: A longitudinal survey was conducted using the SFSarQoL and other questionnaires on 408 patients with colorectal cancer planning to undergo surgery. Follow-up was subsequently conducted on 341 of these patients 1 month after surgery. The clinimetric properties of the SF-SarQoL were examined, including reliability (internal consistency), validity (construct validity, concurrent validity), sensitivity (ability to detect changes, discriminative ability), and floor and ceiling effects. Results: The internal consistency of the SF-SarQoL was found to be acceptable (Cronbach's alpha = .94 and McDonald's omega = .94). Strong scalability of the total score and each item was confirmed usingMokken analysis. Concurrent validity analyses indicate the SF-SarQoL is significantly correlated with muscle-related and health-related questionnaire scores. The SF-SarQoL showed adequate sensitivity due to its good ability to detect changes in quality of life with a moderate effect size (Cohen's d = 0.56) and discriminate between sarcopenic and nonsarcopenic patients (area under the curve = 0.73, 95% CI [0.66, 0.79]) using receiver operating characteristic curve analyses. No floor or ceiling effects were observed. [ABSTRACT FROM AUTHOR]

Background: Early detection of dysphagia is important for preventing aspiration pneumonia. Although videofluoroscopy is currently the primary diagnostic tool for dysphagia, access to this tool may be limited because of radiation exposure risk, high cost, and other factors. Purpose: In this study, a meta-analysis was used to determine the strength of the correlation between dysphagia detection outcomes obtained using subjective questionnaires and videofluoroscopy. Methods: The PubMed and Embase databases were searched for original articles up to December 2022. Studies published in English that used cross-sectional designs to assess the correlation between subjective questionnaires and videofluoroscopywere considered eligible for inclusion. The search terms used included “dysphagia,” “questionnaire,” and “videofluoroscopy.” Two reviewers critically appraised and extracted the correlation coefficient r values. In addition, a random-effects meta-analysis was conducted. The Q statistic was used to assess the heterogeneity among the included studies. Publication bias was checked using the funnel plot and Egger's tests. Multilevel analysis was used to determine sensitivity to consider within-study correlations. In addition, subgroup analyses were conducted based on type of questionnaire, head and neck cancer, and English-speaking regions. Results: The meta-analysis included five studies and 856 patients using the Eating Assessment Tool-10 and one study and 27 patients using the Sydney Swallow Questionnaire. The results of the random-effects meta-analysis showed a moderate relationship between the subjective questionnaires and videofluoroscopy (r = .35, 95% CI [0.20, 0.48]). Similar results were also obtained using multilevel analysis (r = .34, 95% CI [0.25, 0.42]). No publication bias was found for any of the studies (p = .88). In the subgroup analyses, a moderate relationship between Eating Assessment Tool-10 and videofluoroscopy (r = .31, 95% CI [0.19, 0.42]) and an ultrahigh relationship between Sydney Swallow Questionnaire and video-fluoroscopy (r = .74, 95% CI [0.50, 0.87]) were found. Furthermore, moderate associations were observed within each head and neck cancer and English-speaking regions subgroup. However, no significant differences were found between these two subgroups. Conclusions: These results indicate the subjective questionnaires considered in this study share a moderate relationship with videofluoroscopy. Subjective questionnaires may be used as an auxiliary tool by nurses and homecare givers for the early assessment of dysphagia risk in patients. [ABSTRACT FROM AUTHOR]

Prehospital rapid sequence intubation (RSD, like inpatient RSI, is not without risk of adverse effects to the patient. The most notable of these adverse effects is postintubation hemodynamic instability. Air medical providers choose induction agents for critically ill patients who require emergent airway management, some of whom may already be hemodynamically unstable prior to RSI. Ketamine is often selected as the induction agent of choice for patients who are either unstable before RSI or have a high index of suspicion of becoming unstable in the postintubation period. Although widely considered to have a good safety profile for induction, ketamine administration has been correlated with episodes of postintubation hypotension. In this retrospective literature review, the effect of using half-dose ketamine for induction in patients who show pre-RSI instability (systolic blood pressure <90 mm Hg or body mass index >30) on postintubation hemodynamics is examined. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis is the most common therapy for managing patients with end-stage renal disease. Depression is one of the most common psychological problems faced by dialysis patients, and there is limited research on the influences of religion and spirituality on dialysis patients. Purpose: This study was designed to compare religion and spiritual health status between hemodialysis patients with and without depressive symptoms. Methods: A cross-sectional survey was conducted on 137 hemodialysis patients living in Taiwan. The self-report instruments used included the Religious Beliefs Scale, Spiritual Health Scale-Short Form, and Beck Depression Inventory-II. Data were analyzed using t test, chi-square test, point-biserial correlation of variance, and logistic regression. Results: Most (63.5%) of the participants were classified with depression, of which most were male (70.1%), older (mean = 62.56 years), and unemployed (73.6%) and had less formal education. Fifty-two of the participants with depression had a 1- to 5-year duration of hemodialysis, whereas the nondepressed group had a higher mean score for number of religious activities, positive religious beliefs, and total score for spiritual health. Logistic regression showed an increased odds ratio (OR) of depression for participants with a duration of hemodialysis of 1–5 years (OR = 3.64, 95% CI [1.01, 13.15]). Participants with higher scores for spiritual health had a lower risk of depression (OR = 0.82, 95% CI [0.75, 0.90]), indicating a positive association between spiritual health and lower depression risk. Conclusions/Implications for Practice: The prevalence rate of depression in hemodialysis patients is higher than that in the general population. Providing screenings for spiritual health and depression as part of routine medical care for hemodialysis patients is recommended to detect spiritual distress and depression early. [ABSTRACT FROM AUTHOR]

Background: Poor functional status relating to heart failure (HF) negatively affects health-related quality of life (HRQOL). Patients with HF, especially those with New York Heart Association (NYHA) Class III or IV HF, often exhibit poor HRQOL because of physical limitations and HF-related symptoms. Although sense of coherence (SOC) has been reported to be a determinant of HRQOL, its role as a mediator between functional status and HRQOL remains unclear, and few studies have explored the prevalence of HF in patients in NYHA Classes I and II. Purpose: This study was designed to investigate SOC as a mediator between different functional status classes and HRQOL in patients with HF. Methods: A cross-sectional study was conducted on patients with HF recruited from a hospital in northern Taiwan from April 2020 to September 2020. The Minnesota Living with Heart Failure Questionnaire and a questionnaire on sociodemographic characteristics; functional classification in terms of NYHA Classes I, II, and III; and SOC were administered. The PROCESS v3.5 (by Andrew F. Hayes) macro was applied to analyze the effects, and Model 4 was used to examine the mediating role of SOC on the relationship between NYHA functional class and HRQOL. Results: Of the 295 participants, SOC was found to mediate the effects of functional status on HRQOL more significantly in patients in Class II than those in Class III but not more significantly in patients in Class I than those in Class III. A weaker mediating effect of SOC was noted on the relationship between functional status and HRQOL in patients with HF in NYHA Class II than those in Class III. Conclusions: In patients with HF, poor functional status often reduces HRQOL significantly. SOC mediates the relationship between functional status and HRQOL more significantly in those in NYHA Class II than those in Class III. Nursing staff should work to increase patients' SOC by strengthening their coping capacity and improving their functional status to improve their HRQOL. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) refers to permanent damage to the kidneys that occurs gradually over time. Further progression may be preventable depending on its stage. Purpose: This study was developed to evaluate the effect of a health literacy education program (HLEP) on mental health and renal functioning in patients with CKD. Methods: A single-blind, randomized controlled trial study was conducted. Data were collected from March 25 to December 18, 2021. Participants were randomly assigned to either the experimental group (n = 42), which received multidisciplinary care and HLEP, or the control group (n = 42), which received multidisciplinary care only. Data were collected at baseline (T1), Month 3 (T2), and Month 6 (T3), and the data included patient characteristics, estimated glomerular filtration rate, and responses to the Mandarin Multidimensional Health Literacy Questionnaire and Beck Depression Inventory. Results: After 6 months of the HLEP intervention, the results of generalized estimating equations analysis showed that, compared with the control group, the experimental group had significantly higher health literacy at Month 3 (β = −3.37, 95% CI [−5.68, −1.06]), significantly improved depression at Month 3 (β = −2.24, 95% CI [−4.11, −0.37]) and Month 6 (β = −4.36, 95% CI [−6.60, −2.12]), and a significantly higher estimated glomerular filtration rate at Month 6 (β = 5.87, 95% CI [1.35, 10.38]). Conclusions/Implications for Practice: The findings of this study may provide a reference for healthcare providers to educate patients with Stage 3–4 CKD using the HLEP. Positive effects on health literacy, depression, and renal function in patients with Stage 3–4 CKD were observed in the short term. Findings from this study may facilitate the implementation of multidisciplinary and nurse-led strategies in primary care to reinforce patients' health literacy, self-care ability, and adjustment to CKD as well as delay disease progression. [ABSTRACT FROM AUTHOR]

Background: Genitourinary syndrome is commonly reported in postmenopausal women. Kegel's exercise is a noninvasive therapy that improves pelvic floor muscle parameters. However, the effect of Kegel's exercise on health-related quality of life (HRQoL) in postmenopausal women with genitourinary syndrome has not been synthesized or shown. Purpose: This study was designed to systematically review and analyze the previous literature to determine whether Kegel's exercise enhances HRQoL in postmenopausal women with genitourinary syndrome of menopause. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, and six databases were searched, including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and Scopus, from their dates of inception to November 2021. Eligible studies evaluated the effects of Kegel's exercise on HRQoL in postmenopausal women with urinary, sexual, or genital symptoms. Review Manager software was used to perform the meta-analysis using a random-effects model. Chi-square and I² tests were used to evaluate heterogeneity among the studies. Meta-analysis was performed based on the symptoms (i.e., urinary, sexual, and genital) identified in the quality-of-life questionnaires. Results: This systematic review covered five studies with 268 participants. The research appraisal found most of these studies had a low risk of bias. The intervention periods ranged from 4 to 12 weeks. Compared with non-Kegel's exercise or regular activity, Kegel's exercise was found to significantly improve HRQoL-related urinary symptoms (three studies, standardized mean difference = −0.95, 95% CI [−1.35, −0.54], I² = 0%). However, the effect of this exercise on HRQoL-related sexual symptoms did not differ from non-Kegel's exercise or regular activity (two studies, standardized mean difference = 1.11, 95% CI [−0.25, 2.47], I²= 94%). None of the covered studies examined the effect of Kegel's exercise on HRQoL-related genital symptoms. Conclusions/Implications for Practice: Kegel's exercise is an effective intervention for improving HRQoL-related urinary symptoms in postmenopausal women. However, there remains insufficient evidence to assess the effectiveness of Kegel's exercise on HRQoL-related genital symptoms in this population. The results support using Kegel's exercise as a useful intervention to manage urinary symptoms in postmenopausal women. [ABSTRACT FROM AUTHOR]

Background: Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management. Purpose: This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes. Methods: A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 (N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples. Results: Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (β = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (β = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management. Conclusion/Implications for Practice: This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Multiple role theory has proven effective in predicting variations in health, and a growing body of research has shown the importance of taking women's roles into account when analyzing physical activity levels. Nonetheless, researchers have yet to characterize the interaction between the various roles played by women and their physical activity. Purpose: The objectives of this study were to elucidate the relationship between multiple roles and leisure-time physical activities (LTPAs) and to determine whether LTPA varies among women across different roles. Methods: Data were derived from the 2013 National Health Interview Survey database provided by the Health Promotion Administration of Taiwan's Ministry of Health and Welfare, which includes 5,147 working-age women. The current study focused on women aged 20–50 years. The roles considered in this study included living with a partner, living with children, and employment status. LTPA levels were categorized as regular, inactive, or insufficient based on the LTPA metabolic equivalent in the previous week. The associations among level of LTPA, multiple roles, and demographic characteristics were analyzed using multiple regression analysis. Results: We found single mothers with children to be more inactive than partnered mothers, and women living with a partner and those living with children were more likely to be inactive, whereas women working full-time were not at risk of inactivity. Women who assumed a larger number of roles were at a greater risk of inactivity. These findings are consistent with role strain theory. Conclusions: Single mothers with children are more inactive than partnered mothers, and appropriate social support programs are necessary to reduce further disparities. Second, multiple demands on working-age women limit the time available for LTPAs, particularly among women living with a partner and children and engaged in full-time work. A physical activity intervention is a program or initiative designed to promote physical activity and improve health outcomes. We should develop and provide sustainable physical activity resources through the help of partners' housework to better promote physical activity intervention for working-age women. [ABSTRACT FROM AUTHOR]

Background: Many family caregivers of people with dementia (PwDs) have sleep problems and poor sleep quality. Sleep may be negatively affected by caring for a family member with dementia, especially a spouse. Purpose: This study was designed to assess sleep quality in spouse caregivers of PwDs and determine the impact of care provision on their sleep quality. Methods: A secondary analysis of 58,050 participants in the 2018 Korea Community Health Survey was conducted. To prevent selection bias, a propensity score matching analysis was performed. Multiple logistic regression analysis was conducted to investigate the predictors of sleep quality. Results: After obtaining a propensity score matching threshold of 3:1, the percentage of poor sleepers was 24.2% in the control group and 33.3% in the spouse-caregiver group, which indicates a significant difference (χ² = 11.79, p = .001). After adjusting for depressive symptoms in the multiple logistic analyses, no intergroup difference was found in terms of risk of poor sleep quality (odds ratio = 1.12, 95% CI [0.90, 1.61]). Conclusions/Implications for Practice: The findings of this study support that spouse caregivers of PwDs have poorer sleep quality than their nonspouse peers and that management of depressive symptoms is important to improving the sleep quality of spouses providing care to PwDs. Nursing interventions such as light therapy and exposure to sunlight during daytime hours to both improve sleep quality and reduce depressive symptoms can improve sleep quality in this vulnerable caregiver group. [ABSTRACT FROM AUTHOR]

Background: Salary impacts nurse retention rates and thus is a factor affecting the nursing shortage both in Taiwan and around the world. Nurses in Taiwan earn a low salary compared with other health professionals and may be undervalued compared with their international counterparts. Purpose: This study was designed to analyze the factors associated with nurse salary (NS) in Organisation for Economic Co-operation and Development (OECD) countries and to compare NS in Taiwan with those in OECD member states. Methods: Data were extracted from the OECD statistics database and official statistics for Taiwan. For the 28 OECD member countries considered in this study and Taiwan, 21 indicators characterizing healthcare systems, including demographics, socioeconomic status, health behaviors and risks, healthcare resources, health financing, healthcare utilization, health outcomes, and economic inequality, were examined for the period of 2009-2018. A random-effects model (REM) and a fixed-effects model (FEM) were used to investigate the associations between these indicators and annual NS levels. The expected annual NS for Taiwan was estimated and compared with the actual NS for Taiwan using the REM. Results: In the REM, higher NS in OECD countries was shown to be positively associated with gross domestic product per capita (0.49, 95% confidence interval [CI] [0.41, 0.56]), proportion of population aged 65 years and over (2.72, 95% CI [2.17, 3.26]), crude birth rate (1.02, 95% CI [0.56, 1.49]), number of computerized tomography scanners per million population (0.26, 95% CI [0.17, 0.35]), alcohol consumption per person (0.94, 95% CI [0.26, 1.61]), and prevalence of obesity (0.64, 95% CI [0.40, 0.89]) and to be in inversely associated with infant mortality rate (-3.13, 95% CI [-3.94, -2.32]), bed density (-0.99, 95% CI [-1.72, -0.25]), number of hospital discharges (-0.08, 95% CI [-0.11, -0.05]), household out-of-pocket expenditure as a percentage of health expenditure (-0.34, 95% CI [-0.56, -0.11]), and the Gini coefficient (-0.25, 95% CI [-0.50, -0.01]). The FEM results were similar to those of the REM. The predicted annual NS for Taiwan based on the REM rose from 29,390 U.S. dollars (corrected for purchasing power parity; 95% CI [22,532, 36,247]) in 2009 to 49,891 U.S. dollars (95% CI [42,344, 57,438]) in 2018. The actual annual NS in Taiwan in 2018 was approximately 12% lower than the model-predicted value. Conclusions/Implications for Practice: Taiwan has a lower NS compared with its OECD counterparts. These findings may help policymakers, healthcare managers, and nurse organizations develop effective strategies to improve the remuneration system for nurses in Taiwan. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review and meta-analysis assessed the effectiveness of high-intensity interval training (HIIT) alone and combined HIIT programs compared with usual care on cancer-related fatigue (CRF) and pain related to cancer or cancer-related treatments. Methods: Articles published prior to January 2023 were searched in the following digital databases: PubMed, Cochrane Database of Systematic Reviews and Cochrane Controlled Clinical Trials (CENTRAL), Web of Science, Scopus and ScienceDirect. Randomized controlled trials were included that met the following criteria: (i) adult cancer patients and survivors (>18 yr old); (ii) HIIT or combined HIIT programs versus usual care; (iii) assessment of fatigue and pain. Cochrane tool was used for assessing Risk ofBias(RoB) and Review Manager (RevMan 5.2) was used for data analysis. Results: Based on limited number (12) of studies included, we found HIIT and combined HIIT interventions have significant effect sizes on reducing both CRF (standardized mean difference, 0.63; 95% confidence interval, 0.42-0.84; P < 0.001) and cancer-associated pain (standardized mean difference, 0.44; 95% confidence interval, 0.25-0.63; P < 0.001). Conclusions: This systematic review and meta-analysis indicate that HIIT and combined HIIT programs can reduce CRF and pain. [ABSTRACT FROM AUTHOR]

Purpose: To investigate associations between 4-yr change in step cadence and markers of cardiometabolic health in people with a history of prediabetes and to explore whether these associations are modified by demographic factors. Methods: In this prospective cohort study, adults, with a history of prediabetes, were assessed for markers of cardiometabolic health (body mass index, waist circumference, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], triglycerides, and glycated hemoglobin A1c [HbA1c]), and free-living stepping activity (activPAL3™) at baseline, 1 yr, and 4 yr. Brisk steps per day were defined as the number of steps accumulated at ≥100 steps per minute and slow steps per day as those accumulated at <100 steps per minute; the mean peak stepping cadence during the most active 10 minutes of the day was also derived. Generalized estimating equations examined associations between 4-yr change in step cadence and change in cardiometabolic risk factors, with interactions by sex and ethnicity. Results: Seven hundred ninety-four participants were included (age, 59.8 ± 8.9 yr; 48.7% women; 27.1% ethnic minority; total steps per day, 8445 ± 3364; brisk steps per day, 4794 ± 2865; peak 10-min step cadence, 128 ± 10 steps per minute). Beneficial associations were observed between change in brisk steps per day and change in body mass index, waist circumference, HDL-C, and HbA1c. Similar associations were found between peak 10-min step cadence and HDL-C and waist circumference. Interactions by ethnicity revealed change in brisk steps per day and change in peak 10-min step cadence had a stronger association with HbA1c in White Europeans, whereas associations between change in 10-min peak step cadence with measures of adiposity were stronger in South Asians. Conclusions: Change in the number of daily steps accumulated at a brisk pace was associated with beneficial change in adiposity, HDL-C, and HbA1c; however, potential benefits may be dependent on ethnicity for outcomes related to HbA1c and adiposity. [ABSTRACT FROM AUTHOR]

Purpose: Dog walking is a popular daily activity, yet information regarding its injury burden is limited. This study describes the epidemiology of injuries related to leash-dependent dog walking among adults presenting to US emergency departments from 2001 to 2020. Methods: A retrospective analysis was performed using the National Electronic Injury Surveillance System database to identify adults (≥18 yr) presenting to US emergency departments with leash-dependent dog walking-related injuries between 2001 and 2020. Outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for sustaining a fracture or traumatic brain injury (TBI). Weighted estimates and 95% confidence intervals (CI) were generated using National Electronic Injury Surveillance System sample weights. Results: Between 2001 and 2020, an estimated 422,659 adults presented to US emergency departments with injuries related to leash-dependent dog walking. The annual incidence increased more than fourfold during this period (n = 7282 vs n = 32,306, P < 0.001). Most patients were women (75%) and adults age 40 to 64 yr (47%), with a mean age of 53 ± 0.5 yr. Patients commonly injured their upper extremity (51%) and were injured while falling when pulled or tripped by the leash (55%). The three most common injuries were linger fracture (6.9%), TBI (5.6%), and shoulder sprain/strain (5.1%). On multivariate analysis, fracture risk among dog walkers was higher in adults age ≥65 yr (odds ratio [OR], 2.1; 95% CI, 1.8-2.5) and women (OR, 1.5; 95% CI, 1.3-1.7). Risk of TBI was also elevated among older dog walkers (OR, 1.6; 95% CI, 1.3-2.0). Conclusions: Dog walking is associated with a considerable and rising injury burden. Dog owners should be informed of this injury potential and advised on risk-reduction strategies. [ABSTRACT FROM AUTHOR]

The extent to which the 8-wk U.S. Army Basic Combat Training (BCT) course elicits or exacerbates menstrual dysfunction (MD) and mechanisms behind this dysfunction is not clear. Purpose: To determine whether changes in menstruation develop in female trainees during BCT and whether changes in body mass, body composition and/or physical activity are associated with menstrual interruption during BCT. Methods: Female trainees grouped according to self-reported menstrual status in the 12 months before BCT as having regular cycles (RC; n = 352) or MD (n = 97) completed height, body mass, and body composition assessments and questionnaires before and after BCT. Fisher's exact test and Mann-Whitney U test were used to compare between-group differences in categorical and continuous variables, respectively. Among RC trainees, odds ratios were calculated to examine the influence of changes in body mass, lean mass, and fat mass on a trainee's likelihood to miss a period during BCT. Results: There were no differences in race, height, body mass, body mass index, or physical activity history at pre-BCT between RC and MD (P >0.05). Overall, 86% of trainees experienced changes to menstruation during BCT. RC were more likely than MD to have at least one period during BCT (81% vs 69%, respectively, P = 0.01). Among RC, gaining more body mass and lean mass and losing less fat mass were associated with increased odds of missing a period during BCT. Conclusions: These findings demonstrate that most female trainees experience menstrual changes during BCT. Menstrual cycle interruptions do not appear to align with loss of body or fat mass. [ABSTRACT FROM AUTHOR]

Purpose: In postmenopausal women, optimizing muscular strength and physical performance through proper resistance training (RT) is crucial in achieving optimal functional reserve later in life. This study aimed to compare if a higher-load-tolower-load (HL-to-LL) scheme is more effective than a lower-load-to-higher-load (LL-to-HL) scheme on muscular strength and physical performance in postmenopausal women after 12 and 24 wk of RT. Methods: Twenty-four postmenopausal women were randomized into two groups: LL-to-HL (n = 12, 27-31 repetitions maximum (RM) in the first 12 wk, and 8-12RM in the last 12 wk) or HL-to-LL (n = 12, 8-12RM during the first 12 wk, and 27-31RM in the last 12 wk). Muscular dynamic (1RM test) and isometric strength (MIVC) and functional tests (sit-to-stand power, 400-m walking, and 6-min walking) were analyzed at baseline, after 12 and 24 wk. Results: Different load intensity transition schemes resulted in enhancements (P < 0.05) in dynamic (45° leg press: LL-to-HL = 21.98% vs HL-to-LL = 16.07%; leg extension: LL-to-HL = 23.25% vs HL-to-LL = 16.28%; leg curl: LL-to-HL = 23.89% vs HL-to-LL = 13.34%) and isometric strength (LLto-HL = 14.63% vs HL-to-LL = 19.42%), sit-to-stand power (LL-to-HL = 7.32% vs HL-to-LL = 0%), and walking speed (400-m test: LL-to-HL = 3.30%vsHL-to-LL = 5.52%; 6-min test: LL-to-HL = 4.44%vs HL-to-LL = 5.55%) after 24wk of RT, without differences between groups (P > 0.05). However, only the HL increased the dynamic strength in 45° leg press and leg extension and sit-to-stand power. Moreover, walking speed changes were more strongly correlated with the changes in MIVC (P < 0.05). Conclusions: Our results indicate that both load intensity transition schemes produce similar improvements in muscular strength and physical performance in postmenopausal women after 24 wk of RT. However, the HL was more effective in increasing 45° leg press and leg extension strength, as well as power (mainly when performed after the LL), whereas having little effect on leg curl strength, isometric strength, and walking speed. Our findings suggest that although an HL makes a muscle isotonically stronger, it may have limited impact on isometric strength and walking speed in postmenopausal women. [ABSTRACT FROM AUTHOR]

Introduction: Interrupting sedentary time during the day reduces postprandial glycemia (a risk factor for cardiometabolic disease). However, it is not known if benefits exist for postprandial glucose, insulin and triglyceride responses in the evening, and if these benefits differ by body mass index (BMI) category. Methods: In a randomized crossover study, 30 participants (25.4 ± 5.4 yr old; BMI 18.5-24.9: n = 10, BMI 25-29.9: n = 10, BMI≥30: n = 10) completed two intervention arms, beginning at ~1700 h: prolonged sitting for 4 h, and sitting with regular activity breaks of 3 min of resistance exercises every 30 min. Plasma glucose, insulin, and triglyceride concentrations were measured in response to twomeals fed at baseline and 120 min. Four-hour incremental area under the curve was compared between interventions. Moderation by BMI status was explored. Results: Overall, when compared with prolonged sitting, regular activity breaks lowered plasma glucose and insulin incremental area under the curve by 31.5% (95% confidence interval = -49.3% to -13.8%) and 26.6% (-39.6% to -9.9%), respectively. No significant differences were found for plasma triglyceride area under the curve. Interactions between BMI status and intervention was not statistically significant. Conclusions: Interventions that interrupt sedentary time in the evening may improve cardiometabolic health by some magnitude in all participants regardless of bodyweight. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate within-cycle differences in nocturnal heart rate (HR) and heart rate variability (HRV) in naturally menstruating women (NM) and women using combined hormonal contraceptives (CU) or progestin-only hormonal contraceptives (PU). Methods: Physically active participants were recruited into three groups: NM (n = 19), CU (n = 11), and PU (n = 12). Participants' HR and HRV (with Bodyguard 2 HRV monitor) and blood hormones were monitored during one menstrual cycle (MC) (NM group) or for 4 wk (CU and PU groups). Estradiol, progesterone, and luteinizing hormone were analyzed from fasting blood samples collected four times in the NM (M1 = bleeding, M2 = follicular phase, M3 = ovulation, and M4 = luteal phase) and PU groups (M1 = lowest E2, M2 = M1 + 7 d, M3 = M1 + 14 d, and M4 = M1 + 21 d) and twice in the CU group (active and inactive pill phases). After every blood sample, nightly HR and HRV were recorded and examined as an average from two nights. Results: Hormonal concentrations differed (P < 0.05) between MC phases in the NM and PU groups, but not (P ≥ 0.116) between the active and the inactive phases in the CU group. In the NM and PU groups, some of the HRV values were higher, whereas in the NM group, HR was lower during M2 compared with M3 (P < 0.049) and M4 (P < 0.035). In the CU group, HRV values (P = 0.014–0.038) were higher, and HR was lower (P = 0.038) in the inactive phase compared with the first week of the active phase. Conclusions: The MC and the hormonal cycle phases influence autonomic nervous system balance, which is reflected in measurements of nocturnal HR and HRV. This should be considered when monitoring recovery in physically active individuals. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate associations between menstrual function, eating disorders, and risk of low energy availability with musculoskeletal injuries in British servicewomen. Methods: All women younger than 45 yr in the UK Armed Forces were invited to complete a survey about menstrual function, eating behaviors, exercise behaviors, and injury history. Results: A total of 3022 women participated; 2% had a bone stress injury in the last 12 months, 20% had ever had a bone stress injury, 40% had a time-loss musculoskeletal injury in the last 12 months, and 11% were medically downgraded for a musculoskeletal injury. Menstrual disturbances (oligomenorrhea/amenorrhea, history of amenorrhea, and delayed menarche) were not associated with injury. Women at high risk of disordered eating (Female Athlete Screening Tool score >94) were at higher risk of history of a bone stress injury (odds ratio (OR; 95% confidence interval (CI)), 2.29 (1.67–3.14); P < 0.001) and time-loss injury in the last 12 months (OR (95% CI), 1.56 (1.21–2.03); P < 0.001) than women at low risk of disordered eating. Women at high risk of low energy availability (Low Energy Availability in Females Questionnaire score ≥8) were at higher risk of bone stress injury in the last 12 months (OR (95% CI), 3.62 (2.07–6.49); P < 0.001), history of a bone stress injury (OR (95% CI), 2.08 (1.66–2.59); P < 0.001), a time-loss injury in the last 12 months (OR (95% CI), 9.69 (7.90–11.9); P < 0.001), and being medically downgraded with an injury (OR (95% CI), 3.78 (2.84–5.04); P < 0.001) than women at low risk of low energy availability. Conclusions: Eating disorders and risk of low energy availability provide targets for protecting against musculoskeletal injuries in servicewomen. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hypertension is greater in postmenopausal females compared with males of similar age. Previous meta-analyses of normotensive and hypertensive adults have shown that aerobic exercise training reduces systolic blood pressure (SBP) and/or diastolic blood pressure (DBP). However, the effect of aerobic exercise training on blood pressure specifically within healthy postmenopausal females remains unclear. This systematic review with meta-analysis quantified the effect of aerobic exercise training on resting SBP and DBP in healthy postmenopausal females. Methods: The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines and was registered in PROSPERO (CRD42020198171). The literature search was done in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL Plus, and SPORTDiscus. Randomized controlled trials involving healthy postmenopausal females with normal or high normal blood pressure and undergoing ≥4 wk of aerobic exercise training were included. The total weighted mean change in SBP and DBP was compared between the exercise and the control interventions. A random-effects model was used to calculate the overall effect sizes of the weighted mean differences and the 95% confidence interval (CI). Results: Twelve studies were included in the meta-analysis (exercise interventions: n = 357, age = 60 ± 4 yr, baseline SBP/DBP = 128 ± 13/79 ± 8 mm Hg; control interventions: n = 330, age = 60 ± 4 yr, baseline SBP/DBP = 126 ± 11/77 ± 6 mm Hg). Compared with the change observed in response to the control interventions, exercise training significantly reduced SBP (−0.43 mm Hg, 95% CI = −0.78 to −0.09, P = 0.02) and DBP (−0.39 mm Hg, 95% CI = −0.73 to −0.05, P = 0.05). Conclusions: Aerobic exercise training significantly reduces resting SBP and DBP in healthy postmenopausal females with normal or high normal blood pressure. However, this reduction is small and of uncertain clinical significance. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the time course of health, fitness, and occupational performance changes in firefighter recruits across a fire academy. Methods: Nineteen recruits (24.9 ± 4.3 yr; 26.7 ± 3.1 kg·m−2) had their body composition, balance, vertical jump (VJ) performance, cardiorespiratory fitness (CRF), upper and lower body strength, hamstrings-to-quadriceps (H/Q) ratio, lower back endurance, and weighted stair climb (SC) performance assessed at the beginning (week 1 [W1]), midpoint (week 15 [W15]), and end (week 30 [W30]) of a fire academy. Results: The fire academy improved body composition, balance, CRF, leg extension strength, and SC performance from W1 to W15 (P ≤ 0.042) which then plateaued at W30 (P ≥ 0.314). Leg flexion strength and the H/Q ratio decreased from W1 to W15 (P ≤ 0.035) and plateaued at W30 (P ≥ 0.947). Upper body strength was similar at W1 and W15 (P ≥ 0.999), but decreased at W30 (P ≤ 0.033). However, no significant changes occurred across the academy for VJ performance or lower back endurance (P ≥ 0.090). Conclusions: These findings highlight the positive effect of the academy on body composition, CRF, balance, SC performance, and leg extension strength. However, the decreases in upper body and leg flexion strength, the H/Q ratio, and lack of changes in VJ performance and low back endurance may highlight key areas of need to maximize injury prevention and performance enhancement efforts in the academy. Further, the varied time course of changes may help fire departments identify opportunities to modify exercise programming across their academies. [ABSTRACT FROM AUTHOR]

The verification phase is becoming the norm for confirming V̇O2max during a graded exercise test (GXT), but the use of such testing in untrained participants in the heat remains unknown. Purpose: This study aimed to assess the V̇O2 uptake obtained during a GXT and subsequent verification phase in untrained participants in a hot environment. Methods: Twelve sedentary males completed a GXT followed by a biphasic supramaximal-load verification phase in a hot environment (39°C, 32% relative humidity). Rest between tests occurred in a temperate chamber and lasted until gastrointestinal temperature returned to baseline. Results: Mean verification phase V̇O2max (37.8 ± 4.3 mL·kg−1·min−1) was lower than GXT (39.8 ± 4.1 mL·kg−1·min−1; P = 0.03) and not statistically equivalent. Using an individualized analysis approach, only 17% (2/12) of participants achieved a V̇O2 plateau during the GXT. Verification phase confirmed GXT V̇O2max in 100% of participants, whereas the traditional and the new age-dependent secondary V̇O2max criteria indicated GXT V̇O2max achievement at much lower rates (8/12 [67%] vs 7/12 [58%], respectively). Correlational indices between GXT and verification phase V̇O2max were strong (intraclass correlation coefficient = 0.95, r = 0.86), and Bland–Altman analysis revealed a low mean bias of −2.1 ± 1.9 mL·kg−1·min−1 and 95% limits of agreement (−5.8 to 1.7 mL·kg−1·min−1). Conclusions: Very few untrained males achieved a V̇O2 plateau during GXT in the heat. When conducting GXT in a hot condition, the verification phase remains a valuable addition to confirm V̇O2max in untrained males. [ABSTRACT FROM AUTHOR]

Purpose: Whether the association between objectively assessed physical activity and mortality differs between adults with versus those without frailty is unclear. We investigated this association in community-dwelling older adults. Methods: This prospective study used the data of 4165 older adults 65 yr or older from the Kyoto–Kameoka study in Japan who wore a triaxial accelerometer (EW-NK52). The number of steps was classified by quartiles using the average daily value of data obtained from the accelerometer across four or more days. Frailty was evaluated using the validated Kihon Checklist. We evaluated the association between mortality and daily steps using a multivariable Cox proportional hazards analysis and restricted spline model. Results: The average daily steps for the first, second, third, and fourth quartiles were 1786, 3030, 4452, and 7502, respectively. In total, 113 deaths were recorded during a median follow-up of 3.38 yr (14,061 person-years). After adjusting for confounders, the top quartile was associated with a lower hazard ratio (HR) for mortality than the bottom quartile (HR = 0.39, 95% confidence interval = 0.18–0.85). In a stratified model by frailty status, the daily step count dose–response curve at which the HR for mortality plateaued among nonfrail individuals was approximately 5000–7000 steps per day. By contrast, the daily step count showed an inverse relationship with mortality at approximately 5000 steps or more per day in frail individuals. Conclusions: The relationship between daily steps and mortality is different between those with and those without frailty, and people with frailty may require more daily steps than those with nonfrailty to achieve the inverse relationship with mortality. These findings may be useful for informing future physical activity guidelines. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the criterion validity of Activities Completed over Time (ACT24), an automated previous-day recall tool designed for mobile devices for 1) estimating sedentary versus active time compared with an activPAL, and 2) estimating time spent in activity domains (e.g., work, household, leisure) compared with direct observation (DO). Methods: Over a 7-d study period, 53 participants were sent invitations to complete three automated ACT24 recalls and to wear an activPAL device. A subset (N = 24) consented to two, 3-h video-recorded DO sessions. activPAL and ACT24 data were matched by date, and agreement for sedentary versus active time was compared between methods using paired t -tests for mean differences and spearman correlations. We compared DO and ACT24 results by domain for overall time use and separately for sedentary and active time using κ statistics and tested mean differences with linear mixed models. Results: Compared with the activPAL, the mean difference in ACT24 sedentary time was 1.9% (mean (95% confidence interval), −0.17 (−0.75 to 0.40) h·d−1), and the mean difference for ACT24 active time was 2.2% (0.14 (−0.32 to 0.60) h·d−1). Correlations were R = 0.61 (95% confidence interval, 0.39 to 0.76) and R = 0.65 (0.44 to0.78) for sedentary and active time, respectively. Domain-specific agreement was substantial for leisure-time, work, and shopping/errands (κ range, 0.63–0.79), moderate for transportation (κ = 0.49), and fair for personal care and household activities (κ = 0.24 and 0.33). ACT24 estimates of average time within each domain were not significantly different from DO. Conclusions: The present study confirms that ACT24 is accurate for group-level estimation of active and sedentary time. Domain-specific agreement tended to be higher for more commonly reported activities and those that were of longer duration. [ABSTRACT FROM AUTHOR]

Peak cardiac output (Q˙ peak) can be measured noninvasively using inert gas rebreathing (IGR). There is no consensus on the optimal protocol to measure Q˙ peak using IGR, which requires a rebreathing period of ~10 s as close to "maximal" exercise as possible. Purpose: This study aimed to compare Q˙ peak elicited by a constant load protocol (Q˙ CL) and an incremental step protocol (Q˙ step). Methods: A noninferiority randomized crossover trial was used to compare Q˙ peak between protocols using a noninferiority margin of 0.5 L·min−1. Participants (n = 34 (19 female, 15 male); 25 ± 5 yr) performed two baseline V̇O2peak tests to determine peak heart rate (HRpeak) and peak work rate (W peak). Participants then performed the Q˙ CL and Q˙ step protocols each on two separate occasions with the order of the four visits randomized. Q˙ peak was measured using IGR (Innocor; COSMED, Rome, Italy). The Q˙ CL protocol involved a V̇O2peak test followed 10 min later by cycling at 90% W peak, with IGR initiated after 2 min. Q˙ step involved an incremental step test with IGR initiated when the participant's HR reached 5 bpm below their HRpeak. The first Q˙ CL and Q˙ step tests were compared for noninferiority, and the second series of tests was used to measure repeatability (typical error (TE)). Results: The Q˙ CL protocol was noninferior to Q˙ step (Q˙ CL = 17.1 ± 3.2, Q˙ step = 16.8 ± 3.1 L·min−1; 95% confidence intervals, −0.16 to 0.72 L·min−1). The baseline V̇O2peak (3.13 ± 0.83 L·min−1) was achieved during Q˙ CL (3.12 ± 0.72, P = 0.87) and Q˙ step (3.12 ± 0.80, P = 0.82). The TE values for Q˙ peak were 6.6% and 8.3% for Q˙ CL and Q˙ step, respectively. Conclusions: The Q˙ CL protocol was noninferior to Q˙ step and may be more convenient because of the reduced time commitment to perform the measurement. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to apply multifractal detrended fluctuation analysis (MFDFA) to surface EMG to detect neuromuscular changes after realistic warm-up procedures that was followed by various stretching exercises. Methods: Sixteen volunteers conducted two experimental sessions. Testing included two maximal voluntary contractions before, after a standardized warm-up, and after a stretching exercise (static or neurodynamic nerve gliding technique). EMG was registered on biceps femoris and semitendinosus muscles. EMG was analyzed using different parameters obtained from the singularity Hurst exponent function and multifractal power spectrum (both obtained from the multifractal detrended fluctuation analysis). Results: The Hurst exponent, α maximum, and peak value of the multifractal spectrum significantly decreased after warm-up as compared with baseline for both biceps femoris (P = 0.003, P = 0.006, and P = 0.003, respectively) and semitendinosus (P = 0.006, P = 0.013 and P = 0.01, respectively) muscles. No further alteration was obtained after static or neurodynamic nerve gliding stretching as compared with post-warm-up (P = 1.0). No significant difference was obtained for Hurst exponent range, width, and asymmetry of the multifractal spectrum (P > 0.05). Conclusions: From the present results, EMG depicted multifractal features sensitive to detect neuromuscular changes after a warm-up procedure. An increase in multiscale complexity is revealed after warm-up without any further alteration after stretching. The multifractal spectrum depicted dominant small fluctuations that shifted toward slightly larger fluctuations that could be attributed to motor unit recruitment. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity levels (PAL) are associated with mortality risk and were instrumental in estimating national energy requirements, but we are unaware of population-based estimates of PAL in US adults. Thus, we conducted a nationwide survey using a validated previous-day recall method to estimate PAL and the behavioral determinants of low and higher PAL. Methods: Participants from the AmeriSpeak panel 20–75 yr of age (N = 2640) completed Activities Completed over Time in 24-hours previous-day recalls. PAL values were estimated as the average metabolic equivalent value over 24 h. Recalls were conducted on randomly selected days in October and November 2019. Survey sample design weights were applied to reflect the US population. Results: Mean age was 45.3 yr, 51% were female, 67% were non-Hispanic White, and 37% had a body mass index of ≥30 kg·m−2. US adults reported a mean PAL of 1.63 (95% confidence interval, 1.60–1.65), and 39% (37%–42%) of adults reported PAL ≥1.6 on a given day. Men reported higher PAL than women (1.67 vs 1.59), and older adults reported lower PAL. Adults with PAL <1.4 spent 81% (12.1 h·d−1) of their waking day sedentary and 19% (2.7 h·d−1) in total physical activity. Adults with PAL considered to be "active"(1.6–1.89) spent only 49% (8.0 h·d−1) of their waking day sedentary, and 51% (8.3 h·d−1) physically active. Conclusions: Our study provides novel estimates of PAL in a nationwide sample of US adults and a description of the type and intensity of sedentary and physically active behaviors contributing to low and higher PAL. These findings may inform public health messages aimed at increasing physical activity in adults and potentially contribute to obesity prevention efforts. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study are, first, to investigate the probability of runners successfully transitioning from running in a traditional shoe to barefoot. Second, to identify prognostic indicators of failure of transition to barefoot running. Methods: Over 20 wk, 76 healthy runners (female, 40; age, 35.04 yr [SD, 8.9 yr]; body weight, 69.9 kg [SD 13.4 kg]) attempted to transition from running in traditional shoes to running barefoot. A minimalist shoe was used as an intermediary. Participants ran for 4 wk exclusively in provided traditional shoes followed by 4 wk of transitioning to minimalist shoes. This process was repeated to transition to barefoot running. Participants were followed up until they withdrew from the study or successfully transitioned to running barefoot. A survival analysis examined the weeks of successful transition. Along with sex and age, baseline measures of traditional shoe overall comfort, footstrike pattern, midfoot width mobility and plantar foot pressure pain threshold were examined as prognostic variables for failure to transition using Cox regression. Results: The cumulative probability of successful transition to running barefoot was 70.8% (95% confidence interval [CI], 61%–83%). The primary footwear-related reason for withdrawal was pain, primarily in the foot (n = 7), two runners had confirmed injuries. Runners exhibiting a rearfoot strike pattern and higher midfoot width mobility were more likely to fail to transition (hazard ratios [HR], 4.02; 95% CI, 1.33–12.16 and HR, 1.22; 95% CI, 1.05–1.42). Conclusions: Most runners who wish to run barefoot will be able to transition. Our study indicates that there may be biomechanical and anatomical characteristics that are prognostic of failing to transition when using a 20-wk transition period and an intermediary minimalist shoe. Whether a different transition process increases the probability of a success remains to be seen. [ABSTRACT FROM AUTHOR]

Introduction: Substantial increases in joint range of motion (ROM) have been reported after eccentric resistance training; however, between-study variability and sample size issues complicate the interpretation of the magnitude of effect. Methods: PubMed, Medline, and SPORTDiscus databases were searched for studies examining the effects of eccentric training on lower-limb passive joint ROM in healthy human participants. Meta-analysis used an inverse-variance random-effects model to calculate the pooled standardized difference (Hedge's g) with 95% confidence intervals. Results: Meta-analysis of 22 ROM outcomes (17 studies, 376 participants) revealed a large increase in lower-limb passive joint ROM (g = 0.86 (95% confidence intervals, 0.65–1.08)). Subgroup analyses revealed a moderate increase after 4–5 wk (g = 0.63 (0.27–0.98)), large increase after 6–8 wk (g = 0.98 (0.73–1.24)), and moderate increase after 9–14 wk (g = 0.75 (0.03, 1.46)) of training. Large increases were found in dorsiflexion (g = 1.12 (0.78–1.47)) and knee extension (g = 0.82 (0.48–1.17)), but a small increase in knee flexion was observed (g = 0.41 (0.05–0.77)). A large increase was found after isokinetic (g = 1.07 (0.59–1.54)) and moderate increase after isotonic (g = 0.77 (0.56–0.99)) training. Conclusions: These findings demonstrate the potential of eccentric training as an effective flexibility training intervention and provide evidence for "best practice" guidelines. The larger effect after isokinetic training despite <50% training sessions being performed is suggestive of a more effective exercise mode, although further research is needed to determine the influence of contraction intensity and to confirm the efficacy of eccentric training in clinical populations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the effect of walking cadence on knee flexion angular impulse and peak external flexion moment in patients with patellofemoral osteoarthritis (OA). Methods: Forty-eight patients with patellofemoral OA underwent repeated quantitative gait analyses on an instrumented treadmill using a randomized crossover design. Walking trials were conducted at a fixed gait speed, under three cadence conditions: (i) preferred cadence, (ii) +10% increased cadence, and (iii) −10% decreased cadence, completed in random order. Using a linear mixed model, we tested the association of cadence conditions with surrogate measures of patellofemoral load (primary outcome measure: knee flexion angular impulse) while controlling for body mass. We then repeated the analyses while sequentially replacing the dependent variable with secondary outcome measures. Results: Walking with increased cadence decreased (adjusted mean difference [95% confidence interval]) the knee flexion angular impulse (−0.85 N·m·s−1 [−1.52 to −0.18], d = 0.20) and peak knee flexion moment (−4.11 N·m [−7.35 to −0.86], d = 0.24), whereas walking with decreased cadence increased the knee flexion angular impulse (1.83 N·m·s−1 [1.15 to 2.49], d = 0.42) and peak knee flexion moment (3.55 N·m [0.30 to 6.78], d = 0.21). Similar decreases and increases were observed for secondary outcome measures. Conclusions: Walking with increased cadence, while maintaining a fixed gait speed, reduces knee flexion angular impulse as well as other surrogate measures of knee loading in patients with patellofemoral OA. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare and rank gluteal muscle forces in eight hip-focused exercises performed with and without external resistance and describe the underlying fiber lengths, velocities, and muscle activations. Methods: Motion capture, ground reaction forces, and electromyography (EMG) were used as input to an EMG-informed neuromusculoskeletal model to estimate gluteus maximus, medius, and minimus muscle forces. Participants were 14 female footballers (18–32 yr old) with at least 3 months of lower limb strength training experience. Each participant performed eight hip-focused exercises (single-leg squat, split squat, single-leg Romanian deadlift [RDL], single-leg hip thrust, banded side step, hip hike, side plank, and side-lying leg raise) with and without 12 repetition maximum (RM) resistance. For each muscle, exercises were ranked by peak muscle force, and k-means clustering separated exercises into four tiers. Results: The tier 1 exercises for gluteus maximus were loaded split squat (95% confidence interval [CI] = 495–688 N), loaded single-leg RDL (95% CI = 500–655 N), and loaded single-leg hip thrust (95% CI = 505–640 N). The tier 1 exercises for gluteus medius were body weight side plank (95% CI = 338–483 N), loaded single-leg squat (95% CI = 278–422 N), and loaded single-leg RDL (95% CI = 283–405 N). The tier 1 exercises for gluteus minimus were loaded single-leg RDL (95% CI = 267–389 N) and body weight side plank (95% CI = 272–382 N). Peak gluteal muscle forces increased by 28–150 N when exercises were performed with 12RM external resistance compared with body weight only. Peak muscle force coincided with maximum fiber length for most exercises. Conclusions: Gluteal muscle forces were exercise specific, and peak muscle forces increased by varying amounts when adding a 12RM external resistance. These findings may inform exercise selection by facilitating the targeting of individual gluteal muscles and optimization of mechanical loads to match performance, injury prevention, or rehabilitation training goals. [ABSTRACT FROM AUTHOR]

Electrolytes imbalances are highly prevalent and have shown a high impact on mortality in patients with acute myocardial infarction. These electrolytes imbalance have prognostic value in predicting mortality in patients with acute myocardial infarction. The purpose of this study was to assess the prognostic value of electrolyte imbalances in predicting 1-month mortality among patients with myocardial infarction with and with no ST-elevation. This cohort study was conducted in a referral hospital in the West Bank, Palestine. All patients with confirmed medical diagnosis of acute myocardial infarction and admitted to the medical coronary care unit in the hospital were eligible participants. A convenience sample of 186 participants was obtained. These participants were followed up for 1 month to assess their survival (alive or dead). Demographic and clinical data were recorded by reviewing their health records. The derived data were analyzed using SPSS version 19. About 36% of all patients were found to be hyponatremic, 15% of them have hypokalemia, and 9% of patients had hypocalcemia. There was a significant difference between STEMI and non-STEMI in sodium (t = 4.7, P <.001). A multivariate logistic regression analysis was performed to predict 1-month mortality for patients with myocardial infarction with and with no ST-elevation. The predictors that were found to be significant are sodium (odds ratio [OR] = 0.789, P =.010), calcium (OR = 0.221, P =.014), diastolic blood pressure (OR = 0.933, P =.047), and blood urea nitrogen (OR = 0.821, P =.005). Electrolyte imbalance was highly prevalent among patients with acute myocardial infarction. Hyponatremia and hypocalcemia were present and associated significantly with predicting 1-month mortality. Health care providers should take into consideration the electrolytes of patients with acute myocardial infarction from the first moment of admission and correct them early to maximize the clinical outcomes and survival for patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare cortical motor planning activity during response selection and motor execution processes between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a reaction time and response selection task. Methods: Individuals with ACLR (n = 20) and controls (n = 20) performed a lateralized choice reaction time (e.g., Go/NoGo) task. Electrocortical activity and reaction time were recorded concurrently using electroencephalography and inertial measurement units. Separate stimulus locked and response-locked event-related potentials were computed for each limb. The lateralized readiness potential (LRP) was computed as the interhemispheric differences between waveforms and the mean LRP area and onset latency were recorded. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) and the associations between LRP characteristics and response performance (number of errors) were assessed. Results: Participants with ACLR have had smaller LRP area during periods of response selection (P = 0.043, d = 0.4) and motor execution (P = 0.015, d = 0.5) and committed more errors in both Go (P < 0.001, d = 0.8) and NoGo (P = 0.032, d = 0.5) response conditions. There were no differences in latency of response selection or motor execution. Participants with ACLR had higher active motor thresholds (P < 0.001, d = 1.3) than controls, which was weakly associated with smaller LRP areas (r = 0.32–0.42, P < 0.05). Conclusions: The ACLR group demonstrated greater motor planning and response inhibition during a choice reaction time task. More errant performance also suggests poorer decision making in the presence of a "speed-accuracy" trade-off. Key features of the sample, including lower corticospinal excitability, lend support to an interpretation of widespread cortical inhibition contributing to impairments in response selection and motor execution. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine changes in neurocognitive, psychosocial, and balance functioning in collegiate male and female soccer players across three consecutive years of baseline testing compared with a control group of noncontact athletes. Methods: Generalized estimating equations were used to compare changes in annual, preseason baseline measures of neurocognitive function, neurobehavioral and psychological symptoms, and postural stability between collegiate soccer players (n = 75; 51 [68%] female soccer players) and noncontact athletes (n = 210; 133 [63%] female noncontact athletes) across three consecutive years. Results: Among all participants, the group–time interaction was not significant for any outcome measures. Overall, soccer players reported lower (better) Brief Symptom Inventory 18 Depression (P = 0.004, Exp(B) = 0.36, 95% confidence interval [CI] = 0.18–0.73), Global Severity Index (P = 0.006, Exp(B) = 0.53, 95% CI = 0.33–0.84), and Post-Concussion Symptom Scale Symptom Severity (P < 0.001, Exp(B) = 0.45, 95% CI = 0.22–0.95) scores than noncontact athletes. No other outcome measures were different between soccer players and noncontact athletes. Conclusions: Among collegiate athletes, soccer players report similar or better psychosocial functioning and symptom scores than noncontact athletes. Importantly, neurocognitive functioning, neurobehavioral and psychological symptoms, and postural stability do not worsen over time in collegiate soccer players relative to their noncontact counterparts. Our findings suggest that despite possible exposure to repetitive head impacts, collegiate soccer players do not exhibit changes in observable function and symptoms across multiple seasons. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate whether a reduction in daily sedentary behavior (SB) improves insulin sensitivity in adults with metabolic syndrome in 6 months, without adding intentional exercise training. Methods: Sixty-four sedentary inactive middle-age adults with overweight and metabolic syndrome (mean (SD) age, 58 (7) yr; mean (SD) body mass index, 31.6 (4.3) kg·m−2; 27 men) were randomized into intervention and control groups. The 6-month individualized behavioral intervention supported by an interactive accelerometer and a mobile application aimed at reducing daily SB by 1 h compared with baseline. Insulin sensitivity by hyperinsulinemic euglycemic clamp, body composition by air displacement plethysmography, and fasting blood samples were analyzed before and after the intervention. SB and physical activity were measured with hip-worn accelerometers throughout the intervention. Results: SB decreased by 40 (95% confidence interval, 17–65) min·d−1, and moderate-to-vigorous physical activity increased by 20 (95% confidence interval, 11–28) min·d−1 on average in the intervention group with no significant changes in these outcomes in the control group. After 6 months, fasting plasma insulin decreased (~1 mU·L−1) in the intervention group compared with the control group (time–group, P = 0.0081), but insulin sensitivity did not change in either group. The changes in body mass or adiposity did not differ between groups. Among all participants, the changes in SB and body mass correlated inversely with the change in insulin sensitivity (r = −0.31, −0.44; P = 0.025, 0.0005, respectively). Conclusions: An intervention aimed at reducing daily SB resulted in slightly decreased fasting insulin, but had no effects on insulin sensitivity or body adiposity. However, as the change in insulin sensitivity associated with the changes in SB and body mass, multifaceted interventions targeting to weight loss are likely to be beneficial in improving whole-body insulin sensitivity. [ABSTRACT FROM AUTHOR]

Purpose: Several studies have shown a lower risk of developing frailty with long-term higher levels of physical activity. However, most these studies lacked repeated measurement over the follow-up period. Therefore, we examined the association between different types of physical activity and in frailty development using repeated measurements. Methods: A total of 69,642 nonfrail women 60 yr and older from the Nurses' Health Study were followed from 1992 to 2016. Leisure time physical activity was assessed biennially. Frailty was defined as having 3+ of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses, and ≥5% weight loss. Cox models adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence interval (CI) for the association between total, moderate-intensity physical activity, vigorous-intensity physical activity, walking, and incident frailty. Results: During 24 yr of follow-up, we documented 16,479 incident frailty cases. Comparing top to bottom quintiles of MET-hours per week of physical activity, the HR was 0.48 (95% CI = 0.45–0.50) for total physical activity, 0.51 (0.48–0.54) for moderate, and 0.75 (0.71–0.79) for vigorous activity (P trend <0.001 for all activities). For each hour per week increase, HR was 0.56 (0.53–0.58), 0.51 (0.48–0.54), and 0.63 (0.58–0.68) for total, moderate, and vigorous activity, respectively. Walking was the most common activity, and each hour per day increase in walking was associated with an HR of 0.41 (0.38–0.44) for frailty incidence; this was evident even among those older than 70 yr and those with preexisting frailty characteristics. Conclusions: Both moderate and vigorous physical activities were associated with a lower risk of frailty. In particular, walking, a broadly accessible activity, was also associated with lower risk. [ABSTRACT FROM AUTHOR]

Purpose: Physical inactivity and obesity increase risk for breast cancer recurrence and cardiovascular death; inflammation is hypothesized to mediate these associations. Methods: In a four-arm randomized controlled trial, 318 breast cancer survivors with overweight or obesity were randomized to exercise alone, weight loss alone, exercise plus weight loss, or control for 12 months. Inflammation outcomes included C-reactive protein (CRP), serum amyloid A (SAA), intracellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1). Results: Compared with control, exercise alone increased ICAM-1 (9.3%; 95% confidence interval [CI] = 1.6–16.9) and VCAM-1 (8.6%; 95% CI = 2.6–14.5) but did not change CRP or SAA. Compared with control, weight loss alone reduced CRP (−35.2%; 95% CI = −49.9 to −20.7), and SAA (−25.6%; 95% CI = −39.8 to −11.9) but did not change ICAM-1 or VCAM-1. Compared with control, exercise plus weight loss reduced CRP (−44.1%; 95% CI = −57.1 to −31.1) and SAA (−26.6%; 95% CI = −40.5 to −12.6) but did not change ICAM-1 or VCAM-1. Among 194 participants with elevated CRP at baseline (e.g., >3 mg·L−1), compared with control, weight loss alone (0.17; 95% CI = 0.04–0.30) and exercise plus weight loss (0.31; 95% CI = 0.16–0.46) increased the probability of achieving normal CRP at month 12. In analyses that consolidated randomized groups, body weight and adiposity reductions, but not change in fitness level, correlated with decreased CRP, SAA, and ICAM-1 levels. Conclusions: In breast cancer survivors with overweight or obesity, weight loss or exercise plus weight loss reduced measures of inflammation that are associated with breast cancer recurrence and cardiovascular death. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the burden of knee, hip, and lumbar spine disorders occurring in the year after an ankle sprain and the influence therapeutic exercise (TE) has on this burden. Methods: A total of 33,361 individuals diagnosed with ankle sprain in the Military Health System between 2010 and 2011 were followed for 1 yr. The prevalence of knee, hip, and lumbar care-seeking injuries sustained after sprain was identified. Relationships between demographic groups, ankle sprain type, and use of TE with rate of proximal injuries were evaluated using Cox proportional hazard models to determine hazard rate effect modification by attribute. The observed effect of TE for ankle sprain on rate of injury to proximal joints was evaluated using Kaplan–Meier survival analyses. Results: Of the total cohort, 20.5% (n = 6848) of patients sustained a proximal injury. Specifically, 10.1% of the cohort sustained a knee (n = 3356), 2.9% a hip (n = 973), and 10.3% a lumbar injury (n = 3452). Less than half of the cohort received TE after initial sprain. Patients that did were less likely to have subsequent knee (HR = 0.87, 95% confidence interval [CI] = 0.80–0.94), hip (HR = 0.68, 95% CI = 0.58–0.79), or lumbar (HR = 0.82, 95% CI = 0.76–0.89) injuries. Conclusions: One in five individuals that sought care for an ankle sprain experienced a proximal joint injury in the following year. TE for the management of the initial ankle sprain reduced the likelihood of proximal injury diagnosis and should be considered in treatment plans for return to work and sport protocols after ankle sprains. [ABSTRACT FROM AUTHOR]

Introduction: Lifestyle modification through incorporation of exercise training could improve metabolic syndrome (MetS) clinical components (hypertension, dyslipidemia, hyperglycemia, and visceral abdominal obesity). We aimed to assess if long-term exercise training could restrain the increased pharmacological cost of the clinical management of the MetS. Methods: Medicine cost during a 5-yr-long randomized controlled exercise intervention trial was analyzed. After a per-protocol analysis, a group of 64 individuals 53 ± 2 yr old, with overweight (body mass index, 33.4 ± 0.9 kg·m−2) and MetS (3.6 ± 0.2 factors) were randomized to a training (4 months·yr−1 for 5 yr; EXERCISE, n = 25) or to a control group (CONTROL, n = 26). Subjects were studied on three occasions during the 5-yr follow-up. Participants continued their routine medication managed by their general practitioner. The main outcome is the 5-yr evolution of medication cost to treat MetS (hyperglycemia, hypertension, and hyperlipidemia). A secondary outcome is the benefit–cost ratio of the exercise intervention. Results: In CONTROL, medicine cost increased 160% from baseline (P < 0.001), whereas in EXERCISE, it remained unchanged (33%; P = 0.25). After the 5-yr follow-up, medicine use was 60% and medicine cost 74% higher in CONTROL than EXERCISE (P < 0.05 in both cases). However, MetS z score was similarly reduced over time in both groups (P = 0.244 for group–time interaction). The number of prescribed medications increased after 5 yr in CONTROL (89%; P < 0.001), whereas it remained stable with yearly training (17%; P = 0.72 in EXERCISE). Ten-year atherosclerotic cardiovascular disease risk estimation increased only in CONTROL (15%; P = 0.05 for group–time interaction). The benefit in medicine savings (€153 per year and patient) triplicated the estimated cost (€50.8 per year and patient) of the exercise intervention. Conclusions: A 5-yr-long supervised exercise training program in middle-age individuals with MetS prevents the need for increasing medicine use. The savings in pharmacological therapy outweighs the estimated costs of implementing the exercise program. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the effects of four resistance exercise orders on muscular strength, body composition, functional fitness, cardiovascular risk factors, and mental health parameters in trained older women. Methods: The intervention lasted 63 wk. Sixty-one physically independent women (>60 yr) after completing a 12-wk resistance training (RT) preconditioning phase were randomized into four different exercise orders groups to perform 12 wk of RT: multijoint to single-joint and upper- to lower-body, single-joint to multijoint and upper- to lower-body, multijoint to single-joint and lower- to upper-body, and single-joint to multijoint and lower- to upper-body. This was followed by a 12-wk detraining period and another 12-wk RT in which exercise orders were crossed over between MJ-SJ and SJ-MJ conditions. Body composition (dual-energy x-ray absorptiometry), muscular strength (one-repetition maximum tests), functional fitness (gait speed, walking agility, 30-s chair stand, and 6-min walk tests), cardiovascular risk factors (glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, C-reactive protein, advanced oxidation protein product, total radical-trapping antioxidant parameter, and nitric oxide), depressive (Geriatric Depression Scale) and anxiety symptoms (Beck Anxiety Inventory), and cognitive performance (Montreal Cognitive Assessment, Trail Making, verbal fluency, and Stroop test) were analyzed. Results: After the final training period, all groups presented significant improvements (P < 0.05) in almost all analyzed variables (muscular strength, body composition, functional tests, blood biomarkers, and mental health parameters), without significant difference among exercise orders. Conclusions: Our results suggest that RT exercise orders in which MJ, SJ, upper, or lower-body exercises are performed first have similar effects on health parameters in trained older women. [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]

Purpose: Muscle anatomical cross-sectional area (ACSA) can be assessed using ultrasound and images are usually evaluated manually. Here, we present DeepACSA, a deep learning approach to automatically segment ACSA in panoramic ultrasound images of the human rectus femoris (RF), vastus lateralis (VL), gastrocnemius medialis (GM) and lateralis (GL) muscles. Methods: We trained three muscle-specific convolutional neural networks (CNN) using 1772 ultrasound images from 153 participants (age = 38.2 yr, range = 13–78). Images were acquired in 10% increments from 30% to 70% of femur length for RF and VL and at 30% and 50% of muscle length for GM and GL. During training, CNN performance was evaluated using intersection-over-union scores. We compared the performance of DeepACSA to manual analysis and a semiautomated algorithm using an unseen test set. Results: Comparing DeepACSA analysis of the RF to manual analysis with erroneous predictions removed (3.3%) resulted in intraclass correlation (ICC) of 0.989 (95% confidence interval = 0.983–0.992), mean difference of 0.20 cm2 (0.10–0.30), and SEM of 0.33 cm2 (0.26–0.41). For the VL, ICC was 0.97 (0.96–0.968), mean difference was 0.85 cm2 (−0.4 to 1.31), and SEM was 0.92 cm2 (0.73–1.09) after removal of erroneous predictions (7.7%). After removal of erroneous predictions (12.3%), GM/GL muscles demonstrated an ICC of 0.98 (0.96–0.99), a mean difference of 0.43 cm2 (0.21–0.65), and an SEM of 0.41 cm2 (0.29–0.51). Analysis duration was 4.0 ± 0.43 s (mean ± SD) for analysis of one image in our test set using DeepACSA. Conclusions: DeepACSA provides fast and objective segmentation of lower limb panoramic ultrasound images comparable with manual segmentation. Inaccurate model predictions occurred predominantly on low-quality images, highlighting the importance of high-quality image for accurate prediction. [ABSTRACT FROM AUTHOR]

Purpose: There is limited understanding of factors affecting concussion diagnosis status using large sample sizes. The study objective was to identify factors that can accurately classify previous concussion diagnosis status among collegiate student-athletes and service academy cadets with concussion history. Methods: This retrospective study used support vector machine, Gaussian Naïve Bayes, and decision tree machine learning techniques to identify individual (e.g., sex) and institutional (e.g., academic caliber) factors that accurately classify previous concussion diagnosis status (all diagnosed vs 1+ undiagnosed) among Concussion Assessment, Research, and Education Consortium participants with concussion histories (n = 7714). Results: Across all classifiers, the factors examined enable >50% classification between previous diagnosed and undiagnosed concussion histories. However, across 20-fold cross validation, ROC-AUC accuracy averaged between 56% and 65% using all factors. Similar performance is achieved considering individual risk factors alone. By contrast, classifications with institutional risk factors typically did not distinguish between those with all concussions diagnosed versus 1+ undiagnosed; average performances using only institutional risk factors were almost always <58%, including confidence intervals for many groups <50%. Participants with more extensive concussion histories were more commonly classified as having one or more of those previous concussions undiagnosed. Conclusions: Although the current study provides preliminary evidence about factors to help classify concussion diagnosis status, more work is needed given the tested models' accuracy. Future work should include a broader set of theoretically indicated factors, at levels ranging from individual behavioral determinants to features of the setting in which the individual was injured. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine if percent fat-free mass loss (% FFML) after diet alone, diet plus aerobic, or diet plus resistance exercise is a predictor of weight regain in women with overweight. Methods: One hundred and forty-one premenopausal women with overweight (body mass index, 28 ± 1 kg·m−2; age, 35 ± 6 yr) enrolled in a weight loss program to achieve a body mass index <25 kg·m−2 (diet alone, diet plus resistance, or diet plus aerobic exercise) and were followed for 1 yr. Body weight and composition (with dual-energy x-ray absorptiometry) were measured at baseline, after weight loss, and at 1 yr. Results: Participants lost 12.1 ± 2.6 kg of body weight, 11.3 ± 2.5 kg of fat mass, and 0.5 ± 1.6 kg of fat-free mass during the weight loss intervention, followed by weight regain at 1 yr (6.0 ± 4.4 kg, 51.3% ± 37.8%; P < 0.001 for all). % FFML was −3.6 ± 12.4, and a greater % FFML was associated with more weight regain (r = −0.216, P = 0.01, n = 141), even after adjusting for the intervention group (β = −0.07; 95% confidence interval, −0.13 to −0.01; P = 0.017). Conclusions: % FFML is a significant predictor of weight regain in premenopausal women with overweight. These results support strategies for conserving fat-free mass during weight loss, such as resistance training. Future research should try to identify the mechanisms, at the level of both appetite and energy expenditure, responsible for this association. [ABSTRACT FROM AUTHOR]

Purpose: Although cardiorespiratory fitness (CRF) is inversely associated with all-cause mortality in women, less is known regarding the gradient of mortality risk in women, particularly at the lower end of the CRF continuum. Methods: A total of 17,901 healthy women (mean age, 45.9 yr) completed a baseline clinical examination, including a maximal treadmill exercise test at the Cooper Clinic in Dallas, TX, between 1971 and 2016. Participants were placed into CRF quintiles based on age and treadmill time. Results: After a mean follow-up period of 17.9 yr, 1198 all-cause deaths occurred. More favorable cardiometabolic risk factors, smoking status, and physical activity levels were observed across ordered CRF quintiles (P < 0.001 for all). Adjusted all-cause mortality hazard ratios with 95% confidence intervals were 1.71 (1.40–2.09), 1.55 (1.29–1.87), 1.25 (1.03–1.51), 1.16 (0.97–1.38), and 1.0 (referent), respectively, across CRF quintiles (P trend ≤ 0.001). When utilizing CRF as a continuous variable in a spline analysis and using 4.5 METs as the referent, we estimate a 10% reduction in mortality risk per 1-MET increment in CRF (P < 0.001) until a threshold of approximately 11 METs. Mortality risk was approximately 50% lower at the 11-MET threshold when compared with the referent. No further significant reduction in mortality risk was observed beyond the 11-MET threshold. In addition, age-adjusted hemodynamic variables including resting and maximal double product, heart rate reserve, double-product reserve, and 1-min recovery heart rate were more favorable across CRF quintiles (P < 0.001 for all). Conclusions: Beginning at a referent value of 4.5 METs, a significant decreasing gradient of all-cause mortality exists across the CRF continuum, until a threshold of approximately 11 METs is reached. Although all women should be encouraged to work toward meeting public health guidelines for physical activity, it is especially important to target those at the low end of the CRF continuum. [ABSTRACT FROM AUTHOR]

Purpose: Hand grip strength (HGS) is a widely used indicator of overall muscle strength and general health. We computed a polygenic risk score (PRS) for HGS and examined whether it predicted muscle strength, functional capacity, and disability outcomes. Methods: Genomewide association study summary statistics for HGS from the Pan-UK Biobank was used. PRS were calculated in the Finnish Twin Study on Aging (N = 429 women, 63–76 yr). Strength tests included HGS, isometric knee extension, and ankle plantarflexion strength. Functional capacity was examined with the Timed Up and Go, 6-min and 10-m walk tests, and dual-task tests. Disabilities in the basic activities of daily living (ADL) and instrumental ADL (IADL) were investigated with questionnaires. The proportion of variation in outcomes accounted for by PRS HGS was examined using linear mixed models and extended logistic regression. Results: The measured HGS increased linearly over increasing PRS (β = 4.8, SE = 0.93, P < 0.001). PRS HGS independently accounted for 6.1% of the variation in the measured HGS (β = 14.2, SE = 3.1, P < 0.001), 5.4% of the variation in knee extension strength (β = 19.6, SE = 4.7, P < 0.001), 1.2% of the variation in ankle plantarflexion strength (β = 9.4, SE = 4.2, P = 0.027), and 0.1%–1.5% of the variation in functional capacity tests (P = 0.016–0.133). Further, participants with higher PRS HGS were less likely to have ADL/IADL disabilities (odds ratio = 0.74–0.76). Conclusions: Older women with genetic risk for low muscle strength were significantly weaker than those with genetic susceptibility for high muscle strength. PRS HGS was also systematically associated with overall muscle strength and proximal and distal functional outcomes that require muscle strength. [ABSTRACT FROM AUTHOR]

Purpose: Young people spend a substantial proportion of their time at school sedentary; therefore, this setting represents an important target for interventions aimed at displacing sedentary time with physical activity. This study aimed to examine the postprandial metabolic effects of breaking sedentary time by accumulating walking and repeated bouts of nonambulatory standing during simulated school days in inactive adolescent girls. Methods: Seventeen girls (mean ± SD = 12.8 ± 0.4 yr) completed two 3-d experimental conditions. On days 1 and 2 of the standing + walking (STD-WLK) experimental trial, participants interrupted sedentary time by completing 4 × 10 min bouts of self-paced walking and accumulated 18 × 5 min standing bouts during each simulated school day. On day 3 of STD-WLK, participants attended school as normal with no additional physical activity or standing prescribed. On all 3 d of the control condition (CON), participants attended school as normal with no physical activity intervention. On days 2 and 3 of both STD-WLK and CON, a baseline capillary blood sample was provided to determine fasting [TAG] and [glucose]. Participants then consumed a standardized breakfast (0 h) and lunch (4.7 h), and blood samples were provided postprandially at 2.7, 5.3, and 7.3 h for [TAG] and [glucose]. Results: Energy expenditure was 28% (95% confidence interval = 8% to 52%) higher during school hours on day 1 and day 2 during STD-WLK compared with CON (2171 vs 1693 kJ; effect size = 0.89, P = 0.008). However, no reduction of fasting or postprandial [TAG] or [glucose] was observed on day 2 or day 3 (P ≥ 0.245). Conclusions: Two consecutive days of breaking prolonged sitting with self-paced walking and intermittent standing had no meaningful effect on postprandial metabolism in adolescent girls. [ABSTRACT FROM AUTHOR]