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Background: Cardiorespiratory fitness (CRF) is inversely associated with mortality in apparently healthy subjects and in some clinical populations, but evidence for the association between CRF and all-cause and/or cardiovascular disease (CVD) mortality in patients with established CVD is lacking. This study aimed to quantify this association. Methods: We searched for prospective cohort studies that measured CRF with cardiopulmonary exercise testing in patients with CVD and that examined all-cause and CVD mortality with at least 6 months of follow-up. Pooled hazard ratios (HRs) were calculated using random-effect inverse-variance analyses. Results: Data were obtained from 21 studies and included 159,352 patients diagnosed with CVD (38.1% female). Pooled HRs for all-cause and CVD mortality comparing the highest vs. lowest category of CRF were 0.42 (95% confidence interval (95%CI): 0.28-0.61) and 0.27 (95%CI: 0.16-0.48), respectively. Pooled HRs per 1 metabolic equivalent (1-MET) increment were significant for all-cause mortality (HR = 0.81; 95%CI: 0.74-0.88) but not for CVD mortality (HR = 0.75; 95%CI: 0.48-1.18). Coronary artery disease patients with high CRF had a lower risk of all-cause mortality (HR = 0.32; 95%CI: 0.26-0.41) than did their unfit counterparts. Each 1-MET increase was associated with lower all-cause mortality risk among coronary artery disease patients (HR = 0.83; 95%CI: 0.76-0.91) but not lower among those with heart failure (HR = 0.69; 95%CI: 0.36-1.32). Conclusion: A better CRF was associated with lower risk of all-cause mortality and CVD. This study supports the use of CRF as a powerful predictor of mortality in this population.

The frailty syndrome increases the morbidity/mortality in older adults, and several studies have shown a higher prevalence of this syndrome in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to identify the characteristics of frail patients with COPD to define a new phenotype called "COPD-frail." We conducted a cross-sectional study in a cohort of patients with stable COPD, classified as either frail, pre-frail, or non-frail. Sociodemographic, clinical, and biochemical variables were compared between the three groups of patients. The study included 127 patients, of which 31 were frail, 64 were pre-frail, and 32 non-frail. All subjects had FEV1/FVC below the lower limit of normal (range Z-score: -1.66 and -5.32). Patients in the frail group showed significantly higher scores in the mMRC (modified Medical Research Council) scale, the CAT (COPD Assessment Test), and the BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index. They also showed differences in symptoms according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), as well as more COPD exacerbations, less physical activity, more anxiety and depression symptoms based on HADS (Hospital Anxiety and Depression Scale), and lower hemoglobin, hematocrit, and 25-hydroxycholecalciferol levels. Variables with independent association with frailty included the mMRC score, the HAD index for depression and age. In summary, differential characteristics of frail patients with COPD encourage the definition of a "COPD-frail" phenotype that-if identified early-would allow performing interventions to prevent a negative impact on the morbidity/mortality of these patients.

Strength training is recommended for people with hemophilia; however, published data are anecdotal and have methodological limitations. The purpose of this study was to evaluate the safety and effectiveness of progressive moderate-to-vigorous intensity elastic resistance training on physical function and pain in this patient population.

Ankles and knees are commonly affected in people with hemophilia and thus are targets for prevention or rehabilitation. However, to our knowledge, no studies have evaluated muscle activity and safety during exercises targeting the lower limbs in people with hemophilia; this lack of information hinders clinical decision-making.

Eccentric training has been associated with several specific physiological adaptations. The flywheel machine is one of the easiest ways of performing eccentric overload training. However, no studies evaluated its feasibility, safety and muscle activity in patients with haemophilia (PWH).

To evaluate the use of the absorbed depth-dose as a surrogate of the half-value layer in the calibration of a high-dose-rate electronic brachytherapy (eBT) equipment. The effect of the manufacturing tolerances and the absorbed depth-dose measurement uncertainties in the calibration process are also addressed.

Introduction People with haemophilic arthropathy (PWHA) have impairments in postural control. However, little is known about the effects of demanding conditions, including the unipedal stance and dual tasks, on postural control in PWHA. Aim Determine the effects of performing dual tasks while in the one-leg stance on postural sway and postural control complexity in PWHA vs. healthy active (HAG) and non-active (HNAG) groups of individuals. Methods Fifteen PWHA and 34 healthy subjects (18 active and 16 non-active) were recruited. Vertical (V), mediolateral (ML) and anteroposterior (AP) centre of mass signals were acquired using a 3-axis accelerometer placed at the L3/L4 vertebrae of subjects as they performed the one-leg stance under single and dual-task conditions. Sway balance and the complexity of postural control were studied via root mean square (RMS) acceleration and sample entropy, respectively. Increased complexity of postural sway was attributed to increased automatism of postural control. Results RMS values for PWHA were higher than HAG under both conditions for the V and ML axes, and higher than HNAG under the dual-task condition for the ML axis. Sample entropy was lower in PWHA than healthy individuals under the dual-task condition for V and ML axes, and the single-task condition for the ML axis (P < .05). Conclusion PWHA had poorer postural sway and decreased postural control complexity when performing a one-leg stance than healthy people, especially when the dual-task condition was applied. These results may help to design new approaches to assess and improve postural control in PWHA.

Low back pain (LBP) is the leading cause of disability and one of the most common reasons for physician visits in primary care, with a 33% rate of recurrence during the first year. However, the most optimal exercise program in this context remains unknown. The objective was to evaluate the effectiveness of a group-based progressive strength training program in non-specific chronic LBP (CLBP) patients in primary care on pain recurrence and physical function. Eighty-five patients with non-specific CLBP were separated into two groups (Intervention group: completed a progressive strength training program 3 days per week for 8 weeks; Control group: received the usual care). The intervention group showed a recurrence rate of 8.3%, while the control group had a recurrence rate of 33.3% and a shorter time until the first recurrent episode. The intervention group showed increased lumbar extensor strength, left-hand handgrip strength, and reduced the number of pain sites compared with the control group. Results also showed greater odds for reducing LBP intensity and disability in the intervention group. In conclusion, a group-based progressive strength training program is a more effective and efficient alternative than Back-School programs and can easily be carried out in the primary health care context.

The surface brachytherapy Task Group report number 253 discusses the common treatment modalities and applicators typically used to treat lesions on the body surface. Details of commissioning and calibration of the applicators and systems are discussed and examples are given for a risk-based analysis approach to the quality assurance measures that are necessary to consider when establishing a surface brachytherapy program.

INTRODUCTION: Prevention of chronic conditions is a major public health challenge, and achieving minimum recommended levels of physical activity aids in reaching this objective. The aim of our study was to investigate whether levels of physical activity were associated with the prevalence of common chronic conditions among the Spanish workforce. METHODS: We retrieved data from the Spanish National Health Survey 2017 (N = 9, 695) in which the mean age of participants was 44.4 (standard deviation, 10.4 y), and 47.4% were women. Workers self-reported a set of 6 chronic conditions (ie, chronic low-back pain, chronic neck pain, diabetes, hypertension, depression, and anxiety), and we used the International Physical Activity Questionnaire short form to estimate physical activity. We performed multivariable logistic regression adjusted for possible confounders to assess associations between physical activity and chronic conditions. RESULTS: The final adjusted model showed that performing less than 600 metabolic equivalent-minutes per week of physical activity was associated with significantly increased odds for chronic conditions (adjusted odds ratio [aOR] = 1.18; 95% CI, 1.07-1.30). Of the sex and age subgroups analyzed, this association was significant in men aged 17 to 44 (aOR = 1.21; 95% CI, 1.00-1.46). Among chronic conditions, low-back pain and anxiety were associated with low levels of physical activity, whereas covariates such as body mass index, smoking habits, education level, and occupational class had an important influence on the association between physical activity and chronic conditions. CONCLUSION: Results suggest that achieving sufficient physical activity could reduce chronic conditions among Spanish workers.

Three different correction factors for measurements with the parallel-plate ionization chamber PTW T34013 on the Esteya electronic brachytherapy unit have been investigated. This chamber type is recommended by AAPM TG-253 for depth-dose measurements in the 69.5 kV x-ray beam generated by the Esteya unit. Monte Carlo simulations using the PENELOPE-2018 system were performed to determine the absorbed dose deposited in water and in the chamber sensitive volume at different depths with a Type A uncertainty smaller than 0.1%. Chamber-to-chamber differences have been explored performing measurements using three different chambers. The range of conical applicators available, from 10 to 30 mm in diameter, has been explored. Using a depth-independent global chamber perturbation correction factor without a shift of the effective point of measurement yielded differences between the absorbed dose to water and the corrected absorbed dose in the sensitive volume of the chamber of up to 1% and 0.6% for the 10 mm and 30 mm applicators, respectively. Calculations using a depth-dependent perturbation factor, including or excluding a shift of the effective point of measurement, resulted in depth-dose differences of about $\pm0.5\%$ or less for both applicators. The smallest depth-dose differences were obtained when a shift of the effective point of measurement was implemented, being displaced 0.4~mm towards the center of the sensitive volume of the chamber. The correction factors were obtained with combined uncertainties of 0.4 % (k = 2). Uncertainties due to chamber-to-chamber differences are found to be lower than 2%. The results emphasize the relevance of carrying out detailed Monte Carlo studies for each electronic brachytherapy device and ionization chamber used for its dosimetry.

The World Health Organization (WHO) has declared a world pandemic due to COVID-19, and several enacted measures such as compulsory confinement may have collateral consequences on both physical and mental health. We aimed to investigate associations between current physical activity (PA) and current perceived anxiety and mood among a sample of Spanish adults confined due to COVID-19 restrictions of movement. Using an online survey, we collected data on the Spanish adult population regarding health habits during the first days of enacted confinement. A total of 2250 participants (54.8% women) aged 35.3 (SD 13.6) completed the survey, which included questions about sociodemographic characteristics (i.e. age, gender, civil status, education, and occupation), health habits (i.e. prior PA, alcohol consumption, smoking, screen exposure, and sleep hours) and COVID-19 confinement context (i.e. number of isolation days, solitude, and exposure to COVID-19). Physical Activity Vital Sign (PAVS) short form was used to estimate weekly minutes of PA, whereas a single-item question was used to assess both current perceived anxiety and mood. We conducted weighted binomial logistic regressions to check associations between current adherence to WHO guidelines of PA and current perceived anxiety and mood of confined adults. Significant inverse associations between overall adherence to PA and current perceived anxiety in the final adjusted model (OR, 0.66; 95% CI, 0.54–0.79) as well as in several subgroup analyses such as younger women were observed. In addition, a borderline significant inverse association was found between current PA and current perceived worse mood when fully adjusted (OR, 0.82; 95% CI, 0.68–1.00); this association was significantly stronger in women than men. The results of the present study indicate that current PA adherence to WHO guidelines in the initial phase of COVID-19 confinement associates with both lower current perceived anxiety and lower current perceived worse mood among a sample of Spanish adults.