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Maintaining euhydration is important for optimal health, performance and recovery, but can be challenging for alpine skiers when training in a relatively cold but dry environment. This study aimed to evaluate hydration status, fluid loss and fluid intake in adolescent alpine skiers during a training camp. Twelve athletes aged 14.3 ± 0.9 years volunteered to participate in the study. Athletes resided at an altitude of 1600 m and trained between 1614 and 2164 m. During eight consecutive days, urine specific gravity was measured before each morning training session using a refractometer. Changes in body weight representing fluid loss and ad libitum fluid intake during each morning training session were assessed using a precision scale. Mean pre-training urine specific gravity remained stable throughout the training camp. Individual values ranged between 1.010 and 1.028 g/cm3with 50 to 83% of athletes in a hypohydrated state (urine specific gravity ≥ 1.020 g/cm3). Mean training induced fluid loss remained stable throughout the training camp (range -420 to -587 g) with individual losses up to 1197 g (-3.5%). Fluid intake was significantly lower than fluid loss during each training session. To conclude, urine specific gravity values before training indicated insufficient daily fluid intake in more than half of the athletes. Furthermore, fluid intake during training in adolescent alpine skiers was suboptimal even when drinks were provided ad libitum. Coaches and athletes should be encouraged to carefully monitor hydration status and to ensure that alpine skiers drink sufficiently during and in between training sessions.

IntroductionMalnutrition, suboptimal hydration, and inadequate body composition can have negative consequences on soldiers’ performance and health. A recent consensus statement concerning “soldiers’ physical performance” points to the scarcity of data in specific military populations. Therefore, the aim of the present study was to assess and compare dietary intake, hydration status, and body composition of three military groups during their specific military training.Materials and MethodsEighty-five soldiers (ie, 21 in a qualification course to join the Special Forces [SF], 22 Infantrymen [Chasseurs Ardennais, CA], and 42 Recruits [REs]) participated in this 3- to 4-day study. Body mass was assessed before and after each study period. All soldiers self-reported their dietary intakes, from which energy and macronutrient intakes were calculated. In addition, their morning urine samples were collected daily to assess urine specific gravity (USG) as a measure of hydration status. Fat mass was estimated at the end of the study using bioelectrical impedance analysis.ResultsAll groups lost significant amounts of body mass (ie, mean losses ranging between 1.3 and 1.7 kg). Macronutrient intakes were not fully met in respect to the recommendations. Most notably, REs’ fat intake was high (ie, 42.3 [±1.6] energy percent [E%]), while their carbohydrate intake was low (ie, 44.5 [±2.1] E%). Furthermore, saturated fat intakes were high among all groups (ie, group means ranging between 13.6 and 21.4 E%). USG values indicated suboptimal hydration status was prevalent in all groups. Most noteworthy, for SF, only 5.4% of the USG values indicated optimal hydration. The average fat mass (%) for SF, CA, and RE was 11.2 (±3.1), 18.8 (±5.1), and 19.4 (±5.0), respectively.ConclusionThe present study showed that military men are not always adequately fed nor hydrated. These issues should be resolved by creating nutritional packages, and individual dietary and hydration strategies, all in function of military planning and weather conditions.

Evidence for the relationship between chronic pain and nutrition is mounting, and chronic pain following cancer is gaining recognition as a significant area for improving health care in the cancer survivorship population. This review explains why nutrition should be considered to be an important component in chronic pain management in cancer survivors by exploring relevant evidence from the literature and how to translate this knowledge into clinical practice. This review was built on relevant evidence from both human and pre-clinical studies identified in PubMed, Web of Science and Embase databases. Given the relationship between chronic pain, inflammation, and metabolism found in the literature, it is advised to look for a strategic dietary intervention in cancer survivors. Dietary interventions may result in weight loss, a healthy body weight, good diet quality, systemic inflammation, and immune system regulations, and a healthy gut microbiota environment, all of which may alter the pain-related pathways and mechanisms. In addition to being a cancer recurrence or prevention strategy, nutrition may become a chronic pain management modality for cancer survivors. Although additional research is needed before implementing nutrition as an evidence-based management modality for chronic pain in cancer survivors, it is already critical to counsel and inform this patient population about the importance of a healthy diet based on the data available so far. ispartof: JOURNAL OF CLINICAL MEDICINE vol:11 issue:3 ispartof: location:Switzerland status: published

The relationship between lean mass and functional asymmetry in terms of their magnitude and direction was examined in 22 high-level female tennis players (20.9 ± 3.6 years). Lean mass of both upper and lower extremities was examined using Dual X-ray Absorptiometry. Functional asymmetry was assessed using a battery of field tests (handgrip strength, seated shot-put throw, plate tapping, single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, and 505 change of direction (time and deficit)). Paired sample t-tests compared the dominant (overall highest/best (performance) value) against the non-dominant value (highest/best (performance) value of the opposing extremity). Linear regressions were used to explore the relationship between lean mass and functional asymmetry magnitudes. Kappa coefficients were used to examine the consistency in direction between the extremity displaying the highest lean mass value and the extremity performing dominantly across tests. Significant asymmetry magnitudes (p &lt, 0.05) were found for all upper and lower extremity lean mass and functional values. No relationship was apparent between lean mass and functional asymmetry magnitudes (p-value range = 0.131–0.889). Despite finding perfect consistency in asymmetry direction (k-value = 1.00) for the upper extremity, poor to fair consistency (k-value range = −0.00–0.21) was found for the lower extremity. In conclusion, lean mass and functional asymmetries should be examined independently.

Introduction: Low grip work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When grip work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow to identify pre-frailty earlier. Therefore, this study aimed to investigate whether the combination of grip work and self-perceived fatigue is related to pre-frailty in well-functioning older adults aged 80 and over. Methods: Four-hundred and five community-dwelling older adults aged 80 and over (214 robust and 191 pre-frail) were assessed for muscle endurance (grip Work corrected for body weight (GW_bw)), self-perceived fatigue (MFI-20) and frailty state (Fried Frailty Index, FFI). A Capacity to Perceived Vitality ratio (CPV) was calculated by dividing GW_bw by the MFI-20 scores. ANCOVA analysis (corrected for age and gender) was used to compare robust and pre-frail older adults, and binary logistic regressions were applied to analyze the relationship between CPV and pre-frailty status. Results: Pre-frail older adults who scored negative on the exhaustion item of the FFI still showed significantly lower GW (p < 0.001), CPV ratios (p < 0.001) and higher self-perceived fatigue (p < 0.05) compared to the robust ones. The likelihood for pre-frailty related significantly to higher age, being men and lower CPV ratios. In women, every unit increase in CPV ratio decreased the likelihood for pre-frailty by 78% (OR 0.22; 95% CI: 0.11–0.44), for men this effect was less strong (34%, OR 0.66; 95% CI: 0.47–0.93). Conclusions: Pre-frail community-dwelling persons aged 80 years and over without clinical signs of exhaustion on the FFI still experience significantly higher fatigue levels (lower Grip Work, higher self-perceived fatigue and lower CPV levels) compared to robust ones. CPV ratio could therefore be a good tool to identify subclinical fatigue in the context of physical (pre-)frailty.

This randomized controlled trial examined the effects of cold-water immersion (CWI), partial-body cryotherapy (PBC), or a passive control (CON) on physiological and recovery variables following exercise-induced muscle damage (EIMD, 5 × 20 drop jumps) in females. Twenty-eight females were allocated to PBC (30 seconds at -60°C, 2 minutes at -135°C), CWI (10 minutes at 10°C), or CON (10 minutes resting). Muscle oxygen saturation (SmO2 ), cutaneous vascular conductance (CVC), mean arterial pressure (MAP), and local skin temperature were assessed at baseline and through 60 minutes (10-minute intervals), while delayed onset of muscle soreness (DOMS), muscle swelling, maximum voluntary isometric contraction (MVIC), and vertical jump performance (VJP) were assessed up to 72 hours (24-hour intervals) following treatments. SmO2 was lower in PBC (Δ-2.77 ± 13.08%) and CWI (Δ-5.91 ± 11.80%) compared with CON (Δ18.96 ± 1.46%) throughout the 60-minute follow-up period (P < .001). CVC was lower from PBC (92.7 ± 25.0%, 90.5 ± 23.4%) and CWI (90.3 ± 23.5%, 88.1 ± 22.9%) compared with CON (119.0 ± 5.1 and 116.1 ± 6.6%, respectively) between 20 and 30 minutes (P < .05). Mean skin temperature was lower from CWI vs PBC (between 10 and 40 minutes, P < .05). Mean skin temperature was higher in CON compared with CWI up to 60 minutes and compared with PBC up to 30 minutes (P < .05). DOMS was lower following both PBC and CWI compared with CON through 72-hour (P < .05), with no difference between groups. No main group differences for swelling, MVIC, and VJP were observed. In conclusion, CWI elicited generally greater physiological effects compared with PBC while both interventions were more effective than CON in reducing DOMS in females, but had no effect on functional measures or swelling.

Pre-exercise hypohydration can impair soccer performance and has been extensively studied in different soccer populations. Therefore, the aim of this systematic review was to report hypohydration prevalence, measured by blood or urine samples, in different soccer populations based on sex (males and females), performance level (professional and recreational players) and context (training sessions and games). The Pubmed, Web of Science and SPORTDiscus databases were systematically searched until November 2018. Data were pooled to compare hypohydration prevalence between the different subgroups. Following the systematic search selection process, 24 studies were included. The results indicated that overall pre-exercise hypohydration prevalence was 63.3%, 37.4% and 58.8% for urine specific gravity (USG), urine osmolality (U Osm) and urine colour, respectively. Furthermore, no study implemented blood samples to examine hypohydration prevalence in soccer players. The subgroup analyses using USG data indicated that pre-exercise hypohydration prevalence was significantly higher amongst males (66.0%; p = 0.001), professional soccer players (66.2%; p = 0.020) and before a training session (79.6%; p < 0.001). Pre-exercise hypohydration prevalence was 46.8% among female soccer players, 55.6% in recreational soccer players and 41,3% before a game. The subgroup analyses using U Osm data indicated that hypohydration prevalence was significantly higher before a training session (52.6%; p = 0.023). Based on these results, it can be concluded that hypohydration prevalence in soccer players is of major concern. Future research should explore how pre-exercise hydration status can be improved in a sustainable way.

BACKGROUND: Investigations of the perfusion of the skin's microcirculation with laser speckle contrast imaging (LSCI) after cold treatments are rare. Therefore, the aim of this study was to compare the effects between cold-water immersion (CWI) conduction and partial-body cryotherapy (PBC) convection on perfusion of the microcirculation and skin temperature on the thigh. MATERIALS AND METHODS: Twenty healthy males were randomly allocated to CWI (10°C for 10 minutes) or PBC (-60°C for 30 seconds, -135°C for 2 minutes). Perfusion and skin temperature measurements were conducted on the anterior thigh region up to 60 minutes post-treatment. RESULTS: Cold-water immersion decreased perfusion of the microcirculation significantly compared to baseline values between 10 minutes (P = 0.003) and 30 minutes (P = 0.01) post-treatment. PBC increased perfusion of the microcirculation and decreased skin temperature only at the first measurement interval (0 minute, both P = 0.01) post-treatment. Additionally, local skin temperature was significantly decreased compared to baseline values only after CWI up to 30 minutes (P = 0.04) post-treatment. CONCLUSION: Cold-water immersion reduced local skin microcirculation and skin temperature while PBC only slightly increased the perfusion of the microcirculation immediately after the treatment. For cooling purposes, the conduction method seems superior compared to the convection method, assessed with a LSCI device.

This study aimed to examine side-to-side differences in phase angle (PhA) in both upper and lower limbs of youth elite tennis players. Among other outcomes, PhA was directly determined using segmental multifrequency bioelectrical impedance analysis (BIA) in 26 tennis players (11.6 ± 1.1 years, 54% boys) and compared against a sex- and age-matched reference population. Significant upper limb asymmetry in PhA (p < 0.001), with a higher value on the dominant side of the body, was observed in the tennis players. At lower limb level, the tennis players showed a tendency towards a significantly higher PhA in the contralateral compared to the ipsilateral limb (p = 0.089). Using vector analysis (BIVA), a significant degree of PhA asymmetry (p = 0.002) was only reflected in the tennis players' upper limb. Additional segmental outcomes also demonstrated a significant degree of upper limb asymmetry in terms of tennis players' lean mass (p < 0.001), total segmental water (p < 0.001), fat mass (p < 0.001), extracellular water (p < 0.001) and extracellular water ratio (p < 0.001), whereas lower limb asymmetry was only observed in tennis players' fat mass (p = 0.037) and extracellular water (p = 0.001). This is the first study to report significantly more pronounced BIA-based side-to-side differences in youth elite tennis players compared to a non-athletic reference population at the upper limb level, whereas no significant between-group differences in the lower limbs were found. This explorative study should trigger future research to further scrutinize the role of BI(V)A as a promising field-method in monitoring bodily asymmetries in youth elite tennis players in view of sport performance and athletic health. HighlightsBioelectrical Impedance Analysis is a promising field-method to monitor side-to-side asymmetry in youth elite tennis players.Youth elite tennis players displayed a more pronounced degree of BIA-based side-to-side differences compared to a non-athletic reference population at the upper limb level, whereas whilst between-group differences appeared to be less evident in the lower limbs.Future research is warranted to scrutinize whether and to what extent these degrees of segmental bodily asymmetry may be related to injury risk (prevention) and athletic development of (pre)adolescent tennis players.

BACKGROUND: Healthy eating behavior throughout pregnancy and postpartum is important. This study aimed to investigate the perceived sex-specific importance of determinants of changes in eating behavior during pregnancy and postpartum. METHODS: Fifty-four determinants were rated by first-time parents (n = 179) on their impact. Experts (n = 31) rated the determinants in terms of their modifiability, relationship strength, and population-level effect from which a "priority for research"-score was calculated. RESULTS: During pregnancy, the three highest rated determinants by women were "health concerns", "physiological changes", and "fatigue". Men perceived "health concerns", "health consciousness", and "influence of the pregnant partner" as important. Postpartum, the three highest rated determinants by women were "adaptation to rhythm of baby", "baby becomes priority", and "practical constraints because of the baby". Men perceived "adaptation to rhythm of baby", "fatigue". and "(lack of) anticipation" as important. According to the experts, "professional influence", "food knowledge", and "home food availability" received high priority scores for both sexes and during both periods. CONCLUSIONS: Priority for research and interventions should go towards tailored family-based approaches focusing on food education in a broad sense taking into account aspects such as health consciousness, self-efficacy skills, and the social and home food environment while being supported by healthcare professionals. ispartof: NUTRIENTS vol:13 issue:7 ispartof: location:Switzerland status: published

Background Although diet is an essential aspect of human health, the link between diet and pain is still not well understood. Preclinical animal research provides information to understand underlying mechanisms that allow identifying the needs for human research. Objectives This study aims to give a systematic overview of the current evidence from preclinical studies regarding the analgesic and pronociceptive effects of various diets in non-neuropathic, non-cancer, or non-visceral acute and chronic pain models. Study design A systematic Review. Setting This study examined studies that investigate the analgesic and pronociceptive effects of various diets in non-neuropathic, non-cancer, or non-visceral acute and chronic pain models. Methods This review was conducted following the PRISMA guidelines and was registered in PROSPERO with the registration number CRD42019133473. The certainty of evidence was examined by a modified GRADE approach. Results After the screening process twenty-four eligible papers were included in this review. Nineteen studies examined acute pain, nine studies chronic inflammatory pain, and four studies assessed both acute and chronic pain models. Limitations Due to the heterogeneity of the included studies, a meta-analysis was not included in this study. Conclusions In animal models, excessive saturated, monounsaturated or omega-6 polyunsaturated fat ingestion and diets rich in fats and carbohydrates can decrease pain sensitivity in acute nociceptive pain, whereas it can induce mechanical allodynia and heat hyperalgesia in chronic inflammatory pain. Additionally, diets rich in anti-inflammatory ingredients, as well as a calorie-restricted diet can promote recovery from primary mechanical allodynia and heat hyperalgesia in chronic inflammatory pain.

Background:\ud Asymmetries have been reported to negatively impact sport performance. This study examined the magnitude and direction of whole-body functional asymmetry in international versus national female tennis players.\ud Methods:\ud Ten internationally and twelve nationally ranked tennis players participated. Upper extremity functional asymmetries (or side-to-side performance differences) were evaluated using handgrip strength, seated shot-put throw and plate tapping. Lower extremity functional asymmetries were determined using the single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, 505 changes of direction (time and deficit), and Y-balance test (anterior, posteromedial, posterolateral). ANOVAs were used to compare the dominant (overall best or fastest result of a specific test) versus non-dominant performance values (best or fastest result of the corresponding extremity) within the internationally versus nationally ranked players. Functional asymmetry magnitudes differences (expressed as a %) were examined using Mann-Whitney U tests. Kappa coefficients examined the consistency as to which extremity performed dominantly across tests.\ud Results:\ud Significant asymmetries for every upper and lower extremity test were found. The functional asymmetry magnitude was significantly (p=0.020) higher on the single leg forward hop test for the nationally (6.3%) versus internationally ranked players (2.9%). Kappa coefficients showed perfect levels of consistency regarding all upper extremity tests (k=1.00), indicating true limb dominance whereas more variance was found as to which lower extremity performed dominantly across tests (k range=-0.067-0.174).\ud Conclusions:\ud The included female tennis players displayed significant whole-body functional asymmetries. Poor consistency as to which lower extremity performed dominantly across tests warrants individual asymmetry monitoring.

Amongst adults with chronic pain, overweight and obesity are highly prevalent. The association between chronic pain and overweight is driven by several explanations, including increased biomechanical load, changes in the gut microbiome, and low-grade (neuro)inflammation. Moreover, the link between overweight, obesity and chronic pain can best be considered from a lifestyle perspective. Since conservative treatment for chronic pain is often limited to short-term and small effects, addressing important comorbidities within a lifestyle approach could be the next step towards precision medicine for these patients. Indeed, evidence shows that combining weight reduction with conservative pain management is more effective to reduce pain and disability, compared to either intervention alone. This perspective article aims to update the reader with the current understanding of the possible explanatory mechanisms behind the interaction between overweight/obesity and chronic pain in an adult population. Second, this paper applies this knowledge to clinical practice, including assessment and conservative treatment of overweight/obesity in adults with chronic pain. Henceforth, clinical recommendations and guidelines are provided based on available scientific evidence and the authors’ clinical expertise. Impact This paper will guide clinicians in the implementation of weight reduction programs within pain management.

Numerous studies have reported that athletes’ pre-training/-game hydration status is of concern. Up to now, only two cohort studies have examined the effect of an intervention aimed at improving pretraining/-game hydration status; however, without including a control group. Therefore, the aim of this quasi-experimental study was to examine whether and to what extent an individually tailored intervention focused on the benefits of being optimally hydrated before training or game would alter the hydration status of female soccer players. Two teams of young adult female soccer players were allocated to an intervention (n = 22; 19.8 ± 3.0 years) or a control group (n = 15; 22.8 ± 4.0 years). Players in the intervention group received an individually tailored intervention, based on Urine Specific Gravity (USG) measurements, which took place in between two training weeks. Before each training and match play, a urine sample was collected to determine players’ hydration status. Mixed modelling was applied to assess within and between differences in hydration status over time. The pre-training/-game hydration status of the intervention group improved significantly, with players’ mean USG-value decreasing from 1.013 ± 0.001 g/mL to 1.008 ± 0.002 g/mL (p = 0.005). In contrast, the mean USG-value in the control group increased significantly from 1.012 ± 0.002 g/mL to 1.016 ± 0.002 g/mL (p = 0.023), indicating a deterioration of their pre-training/-game hydration status. The individually tailored intervention did show a positive effect even though female soccer players in the present study were already reasonably well hydrated before the start of the intervention.

Introduction: Few treatment programs for chronic pain nowadays take a dietary pattern or adipose status into account. Areas covered: An important role of neuroinflammation in chronic pain is now well established, at least in part due to increased central nervous system glial activation. Based on preclinical studies, it is postulated that the interaction between nutrition and central sensitization is mediated via bidirectional gut–brain interactions. This model of diet-induced neuroinflammation and consequent central sensitization generates a rationale for developing innovative treatments for patients with chronic pain. Methods: An umbrella approach to cover the authors’ expert opinion within an evidence-based viewpoint. Expert opinion: A low-saturated fat and low-added sugar dietary pattern potentially decreases oxidative stress, preventing Toll-like receptor activation and subsequent glial activation. A low-saturated fat and low-added sugar diet might also prevent afferent vagal nerve fibers sensing the pro-inflammatory mediators that come along with a high-(saturated) fat or energy-dense dietary pattern, thereby preventing them to signal peripheral inflammatory status to the brain. In addition, the gut microbiota produces polyamines, which hold the capacity to excite N-methyl-D-aspartate receptors, an essential component of the central nervous system sensitization. Hence, a diet reducing polyamine production by the gut microbiota requires exploration as a therapeutic target for cancer-related and non-cancer chronic pain.

Objective To evaluate the cost-effectiveness of an influenza vaccination program (IVP) among employees. Methods This health economic evaluation was embedded in a prospective cohort study of a voluntary IVP. Data on incidence, direct, and indirect costs were collected via questionnaires. Bootstrapping and modeling techniques were used to assess uncertainty of the results. Results In the base-scenario, the IVP was less effective, more expensive and thus, neither cost-effective nor cost-beneficial. When applying a sensitivity analysis using published estimates of IVP effectiveness on the data, the IVP became cost-effective and cost-beneficial. Conclusions Like in many evaluations of real-world settings, lack of randomization may have caused selection bias which may explain the surprising results of the main analysis. This indicates the importance of sensitivity analyses and modeling approaches for future studies assessing the cost-effectiveness of IVP in a real-world setting.

Background The aim of this study was to assess the evidence regarding economic evaluations of worksite health promotion programs in Europe. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search, study selection, data extraction and quality appraisal were performed independently by two researchers. Full economic evaluations of worksite health promotion programs carried out in a European workplace were included. Results From 1728 search results, 39 articles describing 37 studies were included. Regarding methodological quality, 9 studies were rated as strong, 15 as moderate and 15 as weak. Six of the studies fulfilled the minimum standard for health economic evaluations. Worksite health promotion was applied in many different forms for a wide range of settings. Cost-effectiveness, cost-benefit and cost-utility analyses were performed from different perspectives. Effects on health outcomes tended to be small and uncertain. Only 9 out of 21 cost-benefit analyses reported a financial benefit and 10 out of 23 cost-effectiveness analyses concluded that the intervention was cost-effective. Two out of eight cost-utility analyses were found to be cost-effective. Productivity loss accounted for more than 85% of the total costs and thus, was the main cost driver in the analyses. Conclusions Due to considerable heterogeneity, no specific type of intervention could be identified to be particularly effective and the economic value of worksite health promotion remains uncertain. Further studies, investigating comprehensive worksite health promotion programs are needed to provide evidence on their efficiency. Guidelines to perform economic evaluations in the field of worksite health promotion, especially for valuation of productivity loss, are required.

Objectives: The aim of this systematic review and meta-analysis was to evaluate the effectiveness of local heat applications (LHAs) in individuals with acute or chronic musculoskeletal disorders.Data sources: An electronic search was conducted on MEDLINE, Cochrane Controlled Register of Trials, Current Nursing and Allied Health Literature, and the Physiotherapy Evidence databases up to December 2019.Study selection: Studies incorporating adults with any kind of musculoskeletal issues treated by LHA compared with any treatment other than heat were included.Data extraction: Two authors independently performed the methodological quality assessment using the Cochrane Risk of Bias tool.Data synthesis: LHA showed beneficial immediate effects to reduce pain vs no treatment (P

Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain. This review was conducted following the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines and was registered in PROSPERO with the registration number CRD42018110782. PubMed, Web of Science, and Embase online databases were searched. After screening titles and abstracts of 20,316 articles and full texts of 347 articles, 12 eligible articles were included in this review, consisting of nine experimental and three observational studies. Seven out of nine experimental studies reported a pain-relieving effect of dietary changes. Additionally, protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold. In conclusion, plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.

Purpose: Military personnel are exposed to variable and sometimes very high noise in their professional environment. The aim of this study is to evaluate through a longitudinal study if our hearing conservation program has to be adapted to consider specific interventions for subgroups of our military population still subject to a higher risk of hearing loss. Methods: We conducted a retrospective longitudinal study in 2015–2016 to describe the evolution of hearing threshold levels of military personnel as measured during periodic audiometric screening over a period of 6 years (2009–2014) after the implementation of our hearing conservation program. A linear mixed model explored the relationship of pure-tone average (PTA) on 3, 4 and 6 KHz with probability of noise exposure, gender, age at baseline, time since baseline, hearing loss at baseline and ear. Results: For 18,672 military individuals, our results show a small but statistically significant increase of 0.08 dB per year in PTA on 3, 4 and 6 KHz over the 6-year period that is consistently decelerating as a function of time. An additional annual increase of hearing thresholds due to higher age and moderate and high probability of exposure to noise was also found. Conclusions: No major adaptation of our hearing conservation program is required but efforts should be strengthened to better evaluate and counsel older individuals and subjects exposed to noise regarding avoidance of noise and correct use of personal hearing protection.

Acute Effects on TH4 Thoracic Spine Mobilisation Techniques on the Sympathetic Nervous System - a Cross-Over Feasibility Study Abstract. Up to date, empiric evidence about effects of thoracic spine mobilisation (TH4) on the sympathetic nervous system is lacking. The primary goal of this feasibility study was to determine adherence rate, side effects and the protocol as well as the implementation of the study design. The secondary goal was to analyse and interpret acute effects on the sympathetic nervous system after thoracic mobilisation in anterior thrust and posterior thrust on six healthy participants on two following days. The feasibility of this study was adequate. The spine mobilisations did not produce any adverse effects. The anterior thrust spine mobilisations showed a tendency in reducing the heart rate activity.

The promotion of sustainable and healthy mobility among older adults (≥ 65 years) is an important challenge. E-bikes may be part of the solution, but research about e-bike use among older adults is scarce. The current study aims to examine e-bikes’ purchase reasons, benefits and disadvantages, purposes and amount of use, substitution effects and crash characteristics among older e-bike users. Additionally, it examines differences between men and women. In Flanders (Belgium), 357 older e-bike users completed an online- or interview-version of the same questionnaire. Among men and women, the most prevalent reason for e-bike purchase was to bike with less effort (24.1%). The most important benefit of e-bike use was to be able to bike longer distances (35.0%). E-bikes’ heavy weight was the most frequently reported disadvantage (33.3%). Men more frequently reported battery issues, but also that they do not experience any disadvantage. Women more frequently reported fear of falling/injuries. Participants used their e-bikes for various purposes. Men more frequently reported to cycle for recreation alone while women used the e-bike more for social reasons. E-bikes predominantly replaced trips by conventional bike (72.0%) and car (50.7%). About one quarter (27.5%) had experienced an e-bike crash, most frequently caused by an uneven or slippery surface (26.5%). To promote active ageing, policy initiatives could include strategies aimed at stimulating e-bike use. These strategies should focus on emphasizing the identified benefits, reducing the disadvantages and increasing e-bike safety. Research in countries with less favorable cycling cultures is necessary to confirm current findings.

In order to be able to tailor environmental interventions to adolescents at risk for low levels of physical activity, the aim of the present study is to identify subgroups of adolescents with different physical and social environmental preferences towards cycling for transport and to determine differences in individual characteristics between these subgroups. In this experimental study, 882 adolescents (12–16 years) completed 15 choice tasks with manipulated photographs. Participants chose between two possible routes to cycle to a friend's house which differed in seven physical micro-environmental factors, cycling distance and co-participation in cycling (i.e. cycling alone or with a friend). Latent class analysis was performed. Data were collected from March till October 2016 across Flanders (Belgium). Three subgroups could be identified. Subgroup 1 attached most importance to separation of the cycle path and safety-related aspects. Subgroup 2 attached most importance to being able to cycle together with a friend and had the highest percentage of regular cyclists. In subgroup 3, the importance of cycling distance clearly stood out. This subgroup included the lowest percentage of regular cyclists. Results showed that in order to stimulate the least regular cyclists, and thus also the subgroup most at risk for low levels of active transport, cycling distances should be as short as possible. In general, results showed that providing well-separated cycle paths which enable adolescents to cycle side by side and introducing shortcuts for cyclists may encourage different subgroups of adolescents to cycle for transport without discouraging other subgroups.

When relating glycaemic index (GI) and glycaemic load (GL) to health outcomes, many prospective cohort studies assess the nutritional exposure only once in time, that is, at the start of the study, presuming a stability in nutritional consumption during the course of the study. The aim of this study is to investigate the reproducibility of GI and GL. This is a prospective cohort study in which 562 middle-aged Belgian adults noted all foods and drinks consumed during 3 d in 2002 and 2012. GI and GL were calculated after reference tables. The Pearson correlation coefficients between 2002 and 2012 were 0·27 for GI and 0·41 for GL. For GI, 33 % of the participants remained in the same quintile between 2002 and 2012, whereas 31 % moved to a non-adjacent quintile. For GL, this was 34 and 28 %, respectively. The lowest and the highest quintiles of GI were the most stable, with 40 and 44 % of the participants staying in the same quintile. This was only 22 % for the fourth quintile. The same tendency was present for GL – that is, the most extreme quintiles were the most stable. This study shows 10-year correlation coefficients for GI and GL below 0·50. Multiple nutritional assessments and limiting the analysis to the extreme quintiles of GI and GL will limit a possible misclassification in the prospective cohort studies owing to the low reproducibility.

Evaluating and testing hydration status is increasingly requested by rehabilitation, sport, military and performance-related activities. Besides commonly used biochemical hydration assessment markers within blood and urine, which have their advantages and limitations in collection and evaluating hydration status, there are other potential markers present within saliva, sweat or tear. This literature review focuses on body fluids saliva, sweat and tear compared to blood and urine regarding practicality and hydration status influenced by fluid restriction and/or physical activity. The selected articles included healthy subjects, biochemical hydration assessment markers and a well-described (de)hydration procedure. The included studies (n=16) revealed that the setting and the method of collecting respectively accessing body fluids are particularly important aspects to choose the optimal hydration marker. To obtain a sample of saliva is one of the simplest ways to collect body fluids. During exercise and heat exposures, saliva composition might be an effective index but seems to be highly variable. The collection of sweat is a more extensive and time-consuming technique making it more difficult to evaluate dehydration and to make a statement about the hydration status at a particular time. The collection procedure of tear fluid is easy to access and causes very little discomfort to the subject. Tear osmolarity increases with dehydration in parallel to alterations in plasma osmolality and urine-specific gravity. But at the individual level, its sensitivity has to be further determined.

The central- and peripheral mechanisms by which heat strain limits physical performance are not fully elucidated. Nevertheless, pre-cooling is often used in an attempt to improve subsequent performance. This study compared the effects of pre-cooling vs. a pre-thermoneutral application on central- and peripheral fatigue during 60% of isometric maximum voluntary contraction (MVC) of the right quadriceps femoris muscle. Furthermore, the effects between a pre-cooling and a pre-thermoneutral application on isometric MVC of the right quadriceps femoris muscle and subjective ratings of perceived exertion (RPE) were investigated. In this randomized controlled trial, 18 healthy adults voluntarily participated. The participants received either a cold (experimental) application (+8 °C) or a thermoneutral (control) application (+32 °C) for 20 min on their right thigh (one cuff). After the application, central (fractal dimension – FD) and peripheral (muscle fiber conduction velocity – CV) fatigue was estimated using sEMG parameters during 60% of isometric MVC. Surface EMG signals were detected from the vastus medialis and lateralis using bidimensional arrays. Immediately after the submaximal contraction, isometric MVC and RPE were assessed. Participants receiving the cold application were able to maintain a 60% isometric MVC significantly longer when compared to the thermoneutral group (mean time: 78 vs. 46 s; p=0.04). The thermoneutral application had no significant impact on central fatigue (p>0.05) compared to the cold application (p=0.03). However, signs of peripheral fatigue were significantly higher in the cold group compared to the thermoneutral group (p=0.008). Pre-cooling had no effect on isometric MVC of the right quadriceps muscle and ratings of perceived exertion. Pre-cooling attenuated central fatigue and led to significantly longer submaximal contraction times compared to the pre-thermoneutral application. These findings support the use of pre-cooling procedures prior to submaximal exercises of the quadriceps muscle compared to pre-thermoneutral applications.

Objective The workplace is an ideal setting to implement public health strategies, but economic justification for such interventions is needed. Therefore, we performed a critical appraisal and synthesis of health economic evaluations (HEE) of workplace interventions aiming to increase physical activity (PA) and/or decrease sedentary behavior (SB). Methods A comprehensive search filter was developed using appropriate guidelines, such as the Peer Review of Electronic Search Strategies (PRESS) checklist, and published search algorithms. Six databases and hand searches were used to identify eligible studies. Full HEE of workplace interventions targeting PA/SB were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC) list. Two researchers independently performed all procedures. Hedges' g was calculated to compare intervention effects. Outcomes from HEE were recalculated in 2017 euros and benefit-standardized. Results Eighteen HEE were identified that fulfilled on average 68% of the CHEC list criteria. Most studies showed improvements in PA/SB, but effects were small and thus, their relevance is questionable. Interventions were heterogeneous, no particular intervention type was found to be more effective. HEE were heterogeneous regarding methodological approaches and the selection of cost categories was inconsistent. Indirect costs were the main cost driver. In all studies, effects on costs were subject to substantial uncertainty. Conclusions Due to small effects and uncertain impact on costs, the economic evidence of worksite PA/SB-interventions remains unclear. Future studies are needed to determine effective strategies. The HEE of such interventions should be developed using guidelines and validated measures for productivity costs. Additionally, studies should model the long-term costs and effects because of the long pay-back time of PA/SB interventions. ispartof: SCANDINAVIAN JOURNAL OF WORK ENVIRONMENT & HEALTH vol:46 issue:2 pages:127-142 ispartof: location:Finland status: published

Background Physiotherapists often use thoracic spine mobilization (TSM) to reduce pain in patients with back disorders via a reduction of sympathetic activity. There is a “trade-off” in the activity of the sympathetic and parasympathetic nervous system activity. A sympathetic/parasympathetic balance (SPB) is needed to guarantee body homeostasis. However, body homeostasis is seldom considered as an aim of the treatment from the perspective of most physiotherapists. Strong empirical evidence for the effects of TSM on the SPB is still lacking. Some studies showed that spinal manipulation may yield beneficial effects on SPB. Therefore, it could be hypothesized that TSM is feasible and could influence SPB reactions. The primary aim was to describe the participants’ adherence to the intervention and to the measurement protocol, to identify unexpected adverse events (UAE) after TSM, to evaluate the best method to measure SPB parameters (heart rate variability (HRV), blood pressure (BP), heart rate (HR), skin perfusion and erythema) and to estimate the investigation procedure. The secondary aim was to assess the effects of TSM on SPB parameters in a small sample of healthy participants. Methods This crossover pilot study investigated TSM using posterior-anterior mobilization (PAM) and anterior-posterior mobilization (APM) on segments T6 to T12 in twelve healthy participants during two consecutive days. To evaluate feasibility, the following outcomes were assessed: adherence, UAE, data collection and data analysis. To evaluate the effect of TSM on SPB, HRV, BP, HR, skin perfusion and erythema were measured. Results The adherence was 100%. No UAE were reported. PAM showed larger effect sizes compared to APM in many secondary variables. Conclusions Although 100% maximal adherence was reached and no UAE were observed, data recording in future studies should be done during a second time interval while the data transfer from device to the computer software should occur immediately after completion of each participant’s measurement. The results of this pilot study suggest that PAM can reduce HRV HF and HRV ratio LF/HF and increase HR. Trial registration ClinicalTrail.gov (NCT02832141).

Summary Background To date, the accuracy of bio-impedance (BIA) to assess body composition & sarcopenia in persons aged 80 and over remains unclear. Objective We aimed to evaluate the agreement between dual energy X-ray absorptiometry (DXA) and BIA equations to determine lean mass, as well as their suitability to identify sarcopenia. Design 174 community dwelling well-functioning persons (83 women, 91 men) aged 80 and over were included. Appendicular lean mass (ALM) was predicted using BIA-based equations available in literature, and compared to DXA outcomes. Through cross-validation and stepwise multiple linear regression, a new ALM-formula was generated suitable for this population. Results Literature-based BIA equations systematically overestimated ALM. The new prediction formula that we propose for the 80+ is: ALM = 0,827+(0,19*Impedance Index)+(2,101*Sex)+(0,079*Weight); R2 = 0,888; SEE = 1,450 kg. Sarcopenia classification based on our new BIA equation for ALM showed better agreement with DXA (k ≥ 0,454) compared to literature-based BIA equations (k Conclusions Despite the high correlation between both methods, literature-based BIA equations consistently overestimate ALM compared to DXA in persons aged 80 and over. We proposed a new equation for ALM, reaching higher agreement with DXA and thus improving the accuracy of BIA for this specific age group.

No abstract available

The aim of this study was to examine the magnitude of upper extremity bone mineral content (BMC) asymmetries in tennis players. Furthermore, the influence of sex (male versus female versus mixed), chronological age (juniors: < 18 years; adults: 18–39 years and seniors: ≥ 40 years) and starting age (early starters: < 14 years and late starters: > 18 years) on these asymmetries were examined. Two databases were searched for scientific articles that examined upper extremity BMC in tennis players. Pooling of the individual study effect sizes was conducted using the random-effects model. Three subgroup analyses were performed based on sex, chronological age and starting age. Out of the 15 included studies 24 effect sizes were extracted resulting in a significant difference in BMC value between the dominant and nondominant upper extremity of the tennis players (Standardised Mean Difference: 0.85 [95% CI: 0.67–1.03]). The three subgroup analyses all showed medium to strong effect sizes and significant intergroup differences. To conclude, BMC was significantly higher in the dominant upper extremity compared to the nondominant upper extremity in tennis players. Nevertheless, the influence of training volume and playing experience on these asymmetries are yet to be examined.

Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually-tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV. ispartof: PM&R vol:12 issue:4 pages:410-419 ispartof: location:United States status: published

Background:Longitudinal evidence concerning the association between cardiorespiratory fitness (CRF) and blood lipids and between anthropometric parameters (ANTP) and blood lipids is limited. This study aimed to investigate the association between changes in CRF and ANTP and changes in blood lipids.Methods:In 2002–2004 and 2012–2014, 652 participants were tested. CRF was measured as VO2peak using a maximal ergometer test. Waist circumference (WC) and Body Mass Index (BMI) were used as ANTP. Blood samples were analyzed for total cholesterol (TC), HDL cholesterol, LDL cholesterol and triglycerides. A linear regression analysis was performed to investigate associations between changes in CRF and ANTP and changes in blood lipids.Results:After adjustment a decrease in CRF was associated with an increase in triglycerides and a decrease in HDL cholesterol in men. An increase in WC was associated with an increase in TC, LDL cholesterol and ratio total/HDL cholesterol and a decrease in HDL cholesterol, while an increase in BMI was associated with an increase in ratio total/HDL cholesterol and a decrease in HDL cholesterol.Conclusions:WC and BMI were more longitudinally associated with blood lipids compared with CRF. Improving ANTP can enhance the blood lipid profile, while CRF had only limited influence.

Introduction Cycling is a non-polluting and healthy transportation mode for older adults. However, there is limited knowledge about the infrastructural changes necessary to stimulate cycling among older adults (≥65 years). This is particularly true for electric cycling (e-biking), an increasingly popular form of cycling. The current experiment with manipulated photographs examined the environmental preferences for transportation cycling among older adults. Additionally, it examined whether subgroups with different environmental preferences exist and whether these subgroups differ on socio-demographics, health characteristics, transport behaviour, e-bike use and cycling levels. Methods A structured questionnaire and choice-based conjoint exercise was completed by 895 Flemish older adults. The conjoint exercise included 13 choice tasks each presenting two street situations, which were manipulated on nine environmental attributes. Hierarchical Bayes and latent class analyses were applied to obtain environmental preferences and identify subgroups. Results In the total sample, type of cycle path was the most important environmental attribute (importance = 40.0, 95% CI = 39.0–41.0) determining older adults’ preference for transportation cycling. The second most important attribute was traffic density (16.7, 95% CI = 15.9–17.4), followed by cycle path evenness (11.8, 95% CI = 11.4–12.1) and distance (10.6, 95% CI = 10.1–11.0). Six subgroups with different environmental preferences were identified. These subgroups could be characterized based on differences in cycling limitations, driving status, e-bike use and cycling levels. Conclusions The provision of well-separated cycle paths should be considered a priority in urban planning initiatives aiming to stimulate transportation cycling among older adults. Such initiatives should be evaluated to validate the current findings and optimize future initiatives.

Objectives The transition from high school to college or university has been shown to be a critical period for weight and fat gain. To date, no European data on weight and fat gain over the full trajectory of college or university are available. Therefore, the purpose of the present study was to investigate weight and fat gain among Belgian university students from freshman through senior year of university. Methods In this prospective observational study, a total of 340 university students were measured six times, i.e. at baseline (start of the first academic year) and at the start of the second semester of the first, second, third, fourth and fifth academic year. Objective measurements included body weight, height, body mass index (BMI), fat%, fat mass, fat free mass and waist circumference. Multilevel modelling was used to assess anthropometric changes over time according to sex. Results From freshman through senior year of university, individual weight changes ranged from -5.2 to +15.7kg, and respectively 77.4% and 69.3% of students showed increases in BMI and fat%. Stronger increases in weight and BMI were found for males (5.7kg; 1.6kg/m2; both p

BackgroundThe transition to parenthood is a cornerstone event for both parents, potentially leading to relevant changes in lifestyle and behaviour. In women, the metabolic changes during and after pregnancy and the deleterious effects of excessive gestational weight gain and postpartum weight retention have been extensively described. However, there is no full understanding about which specific energy balance related behaviours (EBRB) contribute to unfavourable weight gain and weight retention. Furthermore, information on how transition to parenthood affects men is lacking. Therefore, this study aims to investigate changes in body weight, body composition and EBRB in couples transitioning to parenthood.MethodsTRANSPARENTS is a multi-centre observational follow-up study that focuses on body weight, body composition and EBRB during the transition to parenthood. Couples (women and men) will be recruited during the first trimester of their first pregnancy. Study visits will occur at four occasions (12weeks of pregnancy, 6weeks postpartum, 6months postpartum and 12months postpartum). Anthropometrics of the parents and new-borns will be assessed including body weight, height/length, body composition (using bio-electrical impedance analysis and measurement of four skinfold thicknesses (biceps, triceps, subscapular and supraspinal/suprailiac)) and waist and hip circumference. Dietary intake, physical activity, sedentary behaviour, smoking habits, sleeping pattern, fatigue, diet and exercise related partner support, mental health, breastfeeding, contraception use, and socio-demographics will be assessed using a questionnaire. In addition, accelerometry will be used to assess physical activity and sedentary behaviour objectively. Also data from women's medical record, such as pre-pregnancy weight and pregnancy outcomes, will be included. Multilevel modelling will be used to evaluate maternal and paternal changes in body weight, body composition and EBRB during and after pregnancy (primary outcomes). Multiple linear regression analyses will be performed to identify predictors of changes in body weight, body composition and EBRB. All analyses will be adjusted for possible confounders.DiscussionTRANSPARENTS is a unique project identifying vulnerable parents and (un)favourable changes in EBRB throughout this potentially critical life period. Provided insights will facilitate the development of effective intervention strategies to help couples towards a healthy transition to parenthood.Trial registrationClinicaltrials.gov Identifier: NCT03454958. Registered March 2018. This study is funded by the Research Foundation -Flanders ('Fonds voor Wetenschappelijk Onderzoek' (FWO)). The project was evaluated by the FWO Health Sciences expert panel. Project number FWO: G033418 N. R.D. is holder of a Fundamental Clinical Investigatorship 1803311 N. Contact information: Egmontstraat 5, 1000 Brussel. Telephone: + 32 2 512 91 10. Email: post@fwo.be.The funder had no role in the study design, data collection, management, analysis, and interpretation of data, writing the report and decision to submit the report for publication, and will not have ultimate authority over any of these activities.

BackgroundMobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels. ObjectiveThe objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app “Active Coach” on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults. MethodsWe recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied. ResultsNo significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P