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Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution., Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol., Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa., Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development., Methods: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time., Findings: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries., Interpretation: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: Gaining a deeper understanding of the dynamic relationships between the transition to parenthood and moderate-to-vigorous physical activity (MVPA) amongst men and women in Australia., Methods: 12 years of nationally representative panel data from the Household, Income and Labour Dynamics in Australia Survey and a piecewise pre/post fixed-effect modelling strategy that controls for person-specific unobserved effects and allows for non-linear associations are used., Results: Both men and women decrease the frequency of MVPA in the years preceding the birth of their first child. An abrupt fall amongst men and a smooth, non-linear decreasing trend amongst women are apparent in the post-birth years. Neither men nor women recover their pre-birth MVPA frequency in subsequent years., Conclusions: Parenthood is an important factor influencing MVPA, with more marked impacts on women's than men's behaviour. Policymakers interested in promoting MVPA should focus on parenthood as a critical deterring factor that can trigger long-term trends of low MVPA. The proposed model can be expanded to explore the influence on MVPA of other life-course transitions.

Objective. To review the literature on the effects of whole-body vibration therapy in patients with fibromyalgia. Design. Systematic literature review. Patients. Patients with fibromyalgia. Methods. An electronic search of the literature in four medical databases was performed to identify studies on whole-body vibration therapy that were published up to the 15th of January 2015. Results. Eight articles satisfied the inclusion and exclusion criteria and were analysed. According to the Dutch CBO guidelines, all selected trials had a B level of evidence. The main outcomes that were measured were balance, fatigue, disability index, health-related quality of life, and pain. Whole-body vibration appeared to improve the outcomes, especially balance and disability index. Conclusion. Whole-body vibration could be an adequate treatment for fibromyalgia as a main therapy or added to a physical exercise programme as it could improve balance, disability index, health-related quality of life, fatigue, and pain. However, this conclusion must be treated with caution because the paucity of trials and the marked differences between existing trials in terms of protocol, intervention, and measurement tools hampered the comparison of the trials.

Objective: To test the feasibility and effectiveness of whole-body vibration (WBV) therapy on fall risk, functional dependence and health-related quality of life in nursing home residents aged 80+ years., Design: Twenty-nine 80-95 years old volunteers, nursing home residents were randomized to an eight-week WBV intervention group) (n=15) or control group (n=14). Functional mobility was assessed using the timed up and go (TUG) test. Lower limb performance was evaluated using the 30-s Chair Sit to Stand (30-s CSTS) test. Postural stability was measured using a force platform. The Barthel Index was used to assess functional dependence and the EuroQol (EQ-5D) was used to evaluate Health-Related Quality of Life. All outcome measures were assessed at baseline and at a follow-up after 8 weeks., Results: At the 8-week follow up, TUG test (p<0.001), 30-s CSTS number of times (p=0.006), EQ-5Dmobility (p<0.001), EQ-5DVAS (p<0.014), EQ-5Dutility (p<0.001) and Barthel index (p=0.003) improved in the WBV intervention group when compared to the control group., Conclusions: An 8-week WBV-based intervention in a nursing home setting is effective in reducing fall risk factors and quality of life in nursing home residents aged 80+., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration., Methods: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets., Findings: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990., Interpretation: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action., Funding: Bill & Melinda Gates Foundation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery., Methods: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values., Findings: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland., Interpretation: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa., Funding: Bill & Melinda Gates Foundation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study is to provide a comprehensive analysis of the associations between the frequency of moderate or vigorous physical activity (MVPA) and quality of life (QoL) measures using longitudinal data and panel regression models on a large, representative sample of the Australian population., Methods: This study used yearly panel data on over 23,000 individuals collected by the Household, Income and Labour Dynamics in Australia Survey between 2001 and 2011. Ordinary least squares and fixed effects regression models were used to examine the associations between the weekly frequency of MVPA and several indicators of QoL, including both measures of health-related QoL (such as those derivable from the SF-36) and global subjective well-being assessments (such as self-reported life satisfaction), controlling for observable and unobservable factors., Results: Our results provided consistent evidence that the frequency of MVPA is related to QoL and proved to be robust. A higher frequency of MVPA was related to higher scores in each of the outcomes analysed and using either of two different estimation strategies. The most pronounced associations emerged between the frequency of MVPA and the physical and vitality dimensions of the SF-36. A change from undertaking no MVPA at all to undertaking such activity once a week was remarkably associated with higher QoL. The influence of MVPA on global life satisfaction was only partially channelled through physical and mental health., Conclusion: We provide strong evidence that MVPA is related to QoL, thus adding to the large body of scientific literature demonstrating the benefits of becoming physically active.

Purpose: To assess the intraclass correlation coefficients (ICCs) and to determine the minimal detectable change (MDC95 ) scores of the data for the Hand Grip Strength Test, the Chair Sit and Reach Test (CSRT), the Timed "Up and Go" (TUG) test, the 6-Minute Walk Test (6MWT) and 30 seconds Sit to Stand Test (30s-STS) test in older adults with type 2 NIDDM., Design: Test-retest reliability., Methods: Eighteen subject participated in two sessions (1 week apart), which included the different tests., Findings: High ICCs (≥ 0.92) were found for all tests. The MDC₉₅ scores were as follows: 4.0 kg for Hand Grip Strength Tests, 7.5 cm for the right leg-CSRT, 9.0 cm for the left leg-CSRT, 1.0 second for the TUG test, 27 m for the 6MWT, and 3.3 repetitions for the 30s-STS test., Conclusions: All tests evaluated are reliable outcome measures for type 2 NIDDM patients., Clinical Relevance: This study has generated novel MCD₉₅ data, which will assist nursing practitioners in both prescribing the most beneficial exercise and interpreting posttreatment changes after rehabilitation in patients with T2DM., (© 2013 Association of Rehabilitation Nurses.)

Purpose: To contribute to the ongoing discussion on the choice of a preference-based health-related quality of life (HRQoL) instrument to be used in cost-effectiveness analysis by studying and comparing the validity, sensitivity and relative efficiency of 15-D and EuroQol 5D 5L (EQ-5D-5L) in a Spanish Parkinson's disease (PD) population sample., Methods: One hundred and thirty-three volunteers were asked to complete an interview using 15-D and EQ-5D-5L. Spearman's rank correlation coefficient (r) was used to test the convergent validity of these instruments with specific PD measures. Sensitivity and efficiency were compared using receiver operating characteristic (ROC) curves and relative efficiency statistic, respectively., Results: A strong correlation (r > 0.65; p < 0.001) was found between both 15-D and EQ-5D-5L utilities with the summary score of the PDQ-8, and a strong correlation (r > 0.50; p < 0.001) was found between 15-D and EQ-5D-5L utilities with the EQ-VAS. The areas under the ROC of both instruments all exceeded 0.5 (p < 0.001). The 15-D instrument was 4.1-29.8 % less efficient at detecting differences between patients with optimal HRQoL, while this instrument was 11 % more efficient at detecting differences between patients at mild and moderate to strong severity of the PD symptoms., Conclusions: 15-D and EQ-5D-5L are showed to be valid and sensitivity generic HRQoL measures in Spanish PD patients with both instruments showing similar HRQoL dimension coverage and ceiling/floor effects. The 15-D has better efficiency and greater sensitivity to detect clinical changes in PD severity of the symptoms meanwhile the EQ-5D-5L is better to detect clinical HRQoL changes. Additionally, the EQ-5D-5L questionnaire requires less time than 15-D to be administered, and it might be more appropriate for studies conducted in Spain, since a country-specific "value set" is available for this instrument and not for the 15-D.

The impact of aging and physical capacity on coenzyme Q10 (Q10) levels in human blood is unknown. Plasma Q10 is an important factor in cardiovascular diseases. To understand how physical activity in the elderly affects endogenous Q10 levels in blood plasma, we studied a cohort of healthy community-dwelling people. Volunteers were subjected to different tests of the Functional Fitness Test Battery including handgrip strength, six-minute walk, 30 s chair to stand, and time up and go tests. Anthropometric characteristics, plasma Q10 and lipid peroxidation (MDA) levels were determined. Population was divided according to gender and fitness. We found that people showing higher levels of functional capacity presented lower levels of cholesterol and lipid peroxidation accompanied by higher levels of Q10 in plasma. The ratio Q10/cholesterol and Q10/LDL increased in these people. No relationship was found when correlated to muscle strength or agility. On the other hand, obesity was related to lower Q10 and higher MDA levels in plasma affecting women more significantly. Our data demonstrate for the first time that physical activity at advanced age can increase the levels of Q10 and lower the levels of lipid peroxidation in plasma, probably reducing the progression of cardiovascular diseases., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To test the feasibility, safety and effectiveness of a 12-wk whole body vibration (WBV) intervention on glycemic control, lipid-related cardiovascular risk factors and functional capacity among type 2 diabetes mellitus (T2DM) patients in a primary care context., Methods: Fifty non-insulin dependent T2DM patients were randomized 1:1 to an intervention group that, in addition to standard care, received a 12-wk WBV intervention, and a control group receiving only standard care (from February 2012 through May 2012). Outcomes, including glycated hemoglobin (HbA1c), fasting blood glucose, lipid-related cardiovascular risk factors (i.e., cholesterol, triglycerides, lipoproteins, LDL/HDL and atherogenic index) and functional capacity were measured at baseline and after the 12-wk intervention., Results: After intervention, there was a reduction in HbA1c and fasting blood glucose when compared to the control group, with a mean difference in change scores between groups of -0.55% (95% CI -0.15 to -0.76) and -33.95 mm/dl (95% CI -51.38 to -3.47), respectively. Similarly, most lipid-related cardiovascular risk factors (i.e., cholesterol, triglycerides and atherogenic index) were also reduced (p<0.05)., Conclusion: A 12-wk WBV intervention in a primary care context is feasible, safe and effective in improving glycemic profile, lipid-related cardiovascular risk factors and functional capacity among T2DM patients., Trial Number: ACTRN12613000021774., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background and Objective: Despite the widespread use of trunk endurance tests, the reliability and validity of these tests in office workers with subacute nonspecific low back pain are unknown., Materials and Methods: This cross-sectional study involved 190 subjects: 30 men and 42 women without low back pain and 47 men and 71 women with low back pain. All subjects underwent timed prone and supine isometric lumbar and abdominal trunk endurance tests that were performed until subjective fatigue occurred. All subjects also completed the Roland Morris and Oswestry self-reported disability questionnaires. A test-retest study (7 days) was conducted with 31 participants with low back pain from the study., Results: For the abdominal trunk endurance test, males and females with low back pain had mean (SD) values of 62.06 (36.87) and 46.06 (29.28) seconds, respectively, both significantly lower than the asymptomatic workers. For the lumbar test, males and females with low back pain had mean (SD) values of 79.57 (30.66) and 75.49 (28.97) seconds, respectively, again, both significantly lower than the asymptomatic workers. The intraclass correlation coefficients of both tests exceeded 0.90 and the Kappa indices were excellent for both men and women. Receiver-operating curve analyses revealed areas under the curve very close to or exceeding 0.70 for both men and women for both tests., Conclusions: The lumbar and abdominal trunk muscle endurance tests appeared to be reliable and valid measures in office workers with subacute low back pain.

This study aimed at examined the effect of a 12-week whole body vibration (WBV) training program on leg blood flow and body composition in people with type 2 diabetes mellitus (T2DM). Forty participants were randomly assigned to either a WBV training group (WBV; n = 20) or usual-care control group (CON; n = 20). Body composition [waist circumference, waist to hip ratio (WHR), weight, height, percentage of body fat and fat-free mass], heart rate, and blood flow [femoral artery diameter, maximum systolic velocity, maximum diastolic velocity (DV), time averaged mean, pulsatility index and resistance index (RI), mean velocity (V med), and peak blood velocities (PBV)] were assessed at baseline and after 12 weeks. There were significant increases in the blood flow (p = 0.046), V med (p = 0.050), and DV (p = 0.037) after WBV compared with CON. Within-group analysis showed significant differences in V med, PBV, and DV in the WBV group. Significant decreases after the intervention in weight (p < 0.001), waist circumference (p < 0.001), WHR (p < 0.05), and body fat (p < 0.05) were also found, with significant between-groups decreases in all these outcomes in the WBV group. Significant correlations existed between changes in percent body fat and blood flow [blood flow (-0.761), V med (-0.607), PBV (-0.677), and RI (0.0510)]. WBV training can be considered an effective means to increase leg blood flow and to reduce adiposity in patients with T2DM.

Objectives: To test the feasibility, safety, and efficacy of a web-based multidisciplinary intervention for office workers with subacute, nonspecific low back pain., Methods: The randomized controlled trial included 100 office workers with subacute low back pain. The intervention group had access to both the study intervention and standard care. The control group had access to standard care only. Standard care was defined as all existing non-web-based interventions offered by the University of Extremadura's Preventive Medicine Service. The web-based program was offered via the Preventive Medicine Service website. The participants in the intervention group were asked to engage in the web-based program at their work site for 11 minutes each day, 5 days a week. Primary outcomes were functional disability, as measured by the Roland-Morris Disability Questionnarie, and health-related quality of life, as measured by the European Quality of Life-5 Dimensions-3 Levels. Secondary outcomes were the number of episodes of low back pain and trunk muscles endurance. Outcomes were measured before and after the 9-month intervention period., Results: Over the 9-month study, the score on the Roland-Morris Disability Questionnaire for the participants in the web-based intervention group improved by a mean of -7.36 points (95% confidence interval [CI]:-8.41, -6.31) compared to a worsening of 1.89 points (95% CI: 0.71, 2.65) in the control group. The between-group difference in change on the Roland-Morris Disability Questionnarie over the study period was -9.25 points (95% CI:-10.57, -7.89). Similarly, over the compared to the control group., Conclusions: A 9 month web-based intervention is feasible and effective to improve function and health-related quality of life and to decrease episodes of low back pain among office workers with a history of subacute, nonspecific low back pain.

Objective: To explore the relationship between nutritional status, functional capacity and health-related quality of life (HRQoL) in older adults with type 2 diabetes (T2DM)., Design: Cross-sectional study., Setting and Participants: Forty two non-insulin dependent older adults from a primary care center in Seville, Spain., Measurements: Function was assessed with a battery of standardized physical fitness tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the European Quality of Life Questionnaire (EQ-5D-3L) was used to assess HRQoL., Results: There was an association between MNA-nutritional status and lower body strength as assessed by the chair sit-stand test (rho= .451; p= .037) and between MNA-nutritional status and EQ-5D-3L-HRQoL (EQ-5D-3Lutility, rho= .553; p<.001 and EQ-5D-3LVAS rho= .402; p<.001). An MNA item by item correlation analysis with HRQoL and lower limb strength demonstrated that HRQoL appears to be related to functional capacity (principally lower body strength, motor agility and cardiorespiratory fitness) among participants. These results were maintained when correlations were adjusted for co-morbidity., Conclusion: Our results demonstrated that nutritional status is moderately associated with HRQoL and lower limb strength in patients with T2DM. Our data suggest that more emphasis should be placed on interventions to encourage a correct diet and stress the needed to improve lower body strength to reinforce better mobility in T2DM population.

Objective: To reanalyse a web-based intervention for physically untrained office workers with sub-acute non-specific low back pain in low back pain-related exercise behaviour terms., Design: Reanalysis of a randomized controlled trial., Setting: Occupational Preventive Medicine of University., Methods: Participants were randomized to an intervention group (proposed intervention plus standard care) or a control group (usual care only). The intervention exercise and education materials were developed as an online resource, and included video demonstrations recorded in a laboratory. Resources were loaded onto a dedicated section of the University Preventive Medicine Service website. All sessions included stretching, and exercises to improve postural stability (abdominal, lumbar, hip and thigh muscles) strength, flexibility and mobility. Outcome measures were self-reported health status (visual analogue scale (VAS) of the Euroquol-5D questionnaire); functional health status (Oswestry disability questionnaire); and the stage of change questionnaire. At nine months, outcomes in the intervention group were analysed and compared with baseline and outcomes in controls., Results: In the intervention group, significant positive effects were observed at nine-month follow up for stage of change in the behavioural domain as related with low back pain for all phases except for the contemplation phase. The positive change in the stage of change questionnaire correlated with the improvement observed in Oswestry (r = .388) and VAS (r = -.612)., Conclusions: The reanalysis of the trial suggests that exercise behaviour related to low back pain improve after the intervention period. This improvement correlates with changes in clinical low back pain-related outcomes.

Objective: To test the clinical effect of a web-based lower back pain intervention on quality of life and selected lower back pain outcomes., Design: A prospective single-blinded randomized intervention., Setting: Occupational preventive service., Subjects: One hundred office workers with non-specific subacute lower back pain., Intervention: The 50 intervention group subjects were educated daily about sitting correctly and asked to perform exercises shown by video demonstrations on the university website. The exercise routines included strengthening, mobility and stretching exercises focused on the postural stability muscles. The 50 control group subjects only received standard occupational care., Measures: Outcomes were measured by the EuroQol questionnaire five dimensions three levels, the Oswestry Disability Index, and the StarT Back Screening Tool questionnaires. At nine months, the intervention group outcomes were compared to the baseline data and the control group outcomes., Results: For 97% (n = 45) of the experimental group quality of life (clinical utility) improved significantly; 3.58 times greater than the control group. Oswestry Disability Index showed an odds ratio (OR) of 5.42 with a 37% (n = 17) change for the intervention group with respect to the control group. With regard to the StarT Back Screening Tool, 76% (n = 35) of the intervention group improved their clinical state (odds ratio = 3.04 with respect to the control group improvement). Logistic regression analysis revealed positive changes in EuroQol questionnaire, increasing the likelihood of observing positive changes in StarT Back Screening Tool (OR = 15.5) and Oswestry Disability Index (OR = 4.5)., Conclusions: The intervention showed clinical improvements in quality of life and selected lower back pain outcomes in the experimental group compared to the control group.

Study Design: Randomized controlled trial., Objectives: To test the feasibility, safety, and efficacy of a web-based multidisciplinary intervention for office workers with subacute, nonspecific low back pain., Background: Low back pain is one of the most frequent ailments seen in primary care consultations., Methods: The trial included 100 office workers with subacute low back pain. The intervention group had access to both the study intervention and standard care. The control group had access to standard care only. Standard care was defined as all existing non-web-based interventions offered by the University of Extremadura's Preventive Medicine Service. The web-based program was offered via the Preventive Medicine Service website. The participants in the intervention group were asked to engage in the web-based program at their work site for 11 minutes each day, 5 days a week. Primary outcomes were functional disability, as measured by the Roland-Morris Disability Questionnaire, and health-related quality of life, as measured by the European Quality of Life-5 Dimensions-3 Levels. Secondary outcomes were the number of episodes of low back pain and trunk muscle endurance. Outcomes were measured before and after the 9-month intervention period., Results: Over the 9-month study, the score on the Roland-Morris Disability Questionnaire for the participants in the web-based intervention group improved by a mean of -7.36 points (95% confidence interval [CI]: -8.41, -6.31) compared to a worsening of 1.89 points (95% CI: 0.71, 2.65) in the control group. The between-group difference in change on the Roland-Morris Disability Questionnaire over the study period was -9.25 points (95% CI: -10.57, -7.89). Similarly, over the 9-month study, the intervention group had a significant improvement in quality of life of 0.24 points (95% CI: 0.20, 0.29) compared to the control group., Conclusion: A 9-month web-based intervention is feasible and effective to improve function and health-related quality of life and to decrease episodes of low back pain among office workers with a history of subacute, nonspecific low back pain.

Objective: To investigate whether an online occupational postural and exercise intervention reduced patients' overall risk status for chronicity in subacute non-specific low back pain compared with conventional treatment, and to determine whether changes in risk of chronicity correlate with changes in specific outcomes (i.e. Functional Status and QoL) for low back pain., Design: Prospective, single-blinded randomized intervention study., Subjects: University office workers with subacute non-specific low back pain (n=100) were randomized 1:1 to an intervention group, who received an online occupational postural and exercise intervention, and a control group., Methods: Exercise and education materials used in the intervention were developed as an online resource, and included video demonstrations recorded in a laboratory. All sessions included exercises combining postural stability (for abdominal, lumbar, hip and thigh muscles) strengthening, flexibility, mobility, and stretching. Outcome measures included STarT Back Screening Tool (SBST), Roland Morris score, and European Quality of Life Questionnaire -5 dimensions - 3 levels. At 9 months, SBST was analysed and compared with the baseline and controls., Results: Significant positive effects were found on mean scores recorded in the online occupational exercise intervention group for risk of chronicity (p<0.019). A correlation between functional disability, health-related quality of life and risk of chronicity of low back pain was observed., Conclusion: This study supports the potential utility of a real-time occupational internet-based intervention for preventing progression to chronicity of subacute non-specific low back pain among office workers.

Aim: Fibromyalgia (FM) is a chronic disorder characterized by widespread pain. Fibromyalgia is associated with balance problems and increased fall frequency. Whole-body vibration therapy had been used for improve balance in special populations but not in fibromyalgia. The main objective of this study was to analyze the effects of 12 weeks of tilting whole-body vibration therapy on static balance in fibromyalgia patients., Methods: Women with FM were randomly and sequentially assigned to either the vibration group (N.=21) or the control group (N.=20) based on a randomly generated number table, and a code number was assigned to each participant. All participants received standard care that included medical care through the public health system (hospital and outpatient clinic, including primary care) and social support through the local fibromyalgia association. Participants in the exercise group received whole-body vibration therapy (12 weeks, 12.5 Hz frequency and 3 mm amplitude). Outcome measure was determined using postural stability indices (overall, anterior-posterior and medial-lateral) assessed by the Biodex Balance System in a single dominant limb stance., Results: Treatment effect after 12-weeks of tilting whole body vibration therapy were 57.1% on overall stability and 66.6% on anterior-posterior stability., Conclusion: Tilting whole-body vibration therapy effectively improves static balance in patients with FM.

Objectives: This systematic review critically evaluates the effects of whole body vibration (WBV) exercises on gait, balance, proprioception, strength, and health-related quality of life in patients with common neurological diseases. It specifically focuses on assessing the quality of reported studies and comparing quantitative results., Design: This is a systematic literature review., Results: A specific search strategy of 11 databases identified 13 published articles (5 studies of patients with Parkinson disease, 2 with cerebral palsy, 3 with multiple sclerosis, and 3 with stroke) that fulfilled the selection criteria. The quality of the articles was evaluated using a Physiotherapy Evidence Database scale and Dutch Institute for Healthcare Improvement guidelines., Conclusions: There is moderate evidence that one session of WBV has positive effects on strength, whereas there is a weak level of evidence that WBV could improve proprioception and health-related quality of life measures in neurological patients. With respect to long-term effects of WBV, there is minor evidence from the studies with the best methodological quality that WBV improves strength, proprioception, gait, and balance. Further research on the intervention is strongly needed.

Question: What is the effect of a balance training protocol with the Biodex Balance System in institutionalised older people with fear of falling?, Design: Randomised controlled trial with concealed allocation and assessor blinding., Participants: Forty older people who lived in a nursing home and had fear of falling., Intervention: The experimental group completed a 12-week balance training protocol based on balancing/rebalancing training with the Biodex Balance System, with two sessions per week. During the training period, participants in both groups received the same multidisciplinary care (such as physiotherapy, occupational therapy and nursing) that they usually received in the nursing home., Outcome Measures: The primary outcome was fear of falling (Falls Efficacy Scale International questionnaire). Secondary outcomes were dynamic balance (Fall Risk Test) and isometric strength (torque of knee flexor and extensor isometric strength measured with an isokinetic dynamometer). Outcome measures were taken before and after the training program protocol., Results: Compared to the control group, the exercise group had significantly greater improvements at 12 weeks in fear of falling (by 8 points, 95% CI 4 to 12), in dynamic balance (by 2 degrees, 95% CI 1 to 3), and in isometric strength of the knee flexors (by 7Nm, 95% CI 3 to 11) and knee extensors (by 7Nm, 95% CI 1 to 13)., Conclusion: The training program was feasible and effective in reducing fear of falling and improving dynamic balance and isometric strength in institutionalised older people with fear of falling., Trial Registration: ISRCTN21695765., (Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.)

Objective: To investigate the reliability of isokinetic peak torque and work and isometric peak torque measurements for knee flexion and extension in fibromyalgia (FM) patients by determining the smallest real difference (SRD)., Design: Test-retest reliability study., Setting: University laboratory., Participants: Women with FM (N=37) aged between 34 and 74 years., Interventions: Not applicable., Main Outcome Measures: The participants performed isometric, concentric, and eccentric tests of the knee. Unilateral maximal peak torque and average work were measured for each direction (flexion, extension) and contraction (isometric, concentric, eccentric) type. Relative reliability, absolute reliability, and SRD were calculated. The 3 tests were repeated after an interval of 7 days., Results: With the exception of eccentric flexion, all peak torque measures had an intraclass correlation coefficient (ICC) of > 0.90, and all work measures had an ICC of > 0.85. The SRD ranged between 21% and 37% for all peak torque measures and between 40% and 73% for all work measures., Conclusions: Isokinetic dynamometry provides reliable measurement of peak torque and work for isometric, concentric, and eccentric knee flexion and extension in patients with FM. The present study has generated novel SRD data, which will assist physicians, therapists, and clinicians in interpreting posttreatment changes in patients with FM., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to analyze the effect of 12-week tilting Whole Body Vibration therapy (WBV) on Health Related Quality of Life (HRQoL) in fibromylagia (FM) within the context of a randomized control trial (ISRCTN16950947)., Subjects and Methods: Thirty-six (36) women with FM were randomly allocated to either an exercise or a control group. The women in the exercise group were assigned to a 12-week course of tilting WBV (12.5-Hz frequency; 3-mm amplitude). HRQoL was assessed using the Fibromyalgia Impact Questionnaire (FIQ) and a 15D questionnaire., Results: A 12-week course of tilting WBV therapy was associated with improvements in FIQ scores (12%) but not in the 15D questionnaire., Conclusions: Tilting WBV was a feasible intervention that prevented the loss of HRQoL in previously physically untrained women with FM.

Objective: The aim of this study was to translate and culturally adapt the original version of the STarT Back Screening Tool (SBST) to Spanish for different population subgroups., Design: Translation and cultural adaptation of a questionnaire., Setting: Primary care settings., Method: Thirty-eight people distributed by: gender; adults and elderly; and with or without pain. Phases: a) Forward translation (English-Spanish); b) Evaluation of the clarity, the acceptability and the familiarity of the content of the obtained Spanish version by means of cognitive interviews to participants, and c) Translation of the final Spanish version of the questionnaire back into the original language., Results: The participants interviewed indicated that most of the items of the questionnaire were clear and comprehensible, showing greater difficulty in understanding in the dimensions of disability and anxiety. Furthermore, the questionnaire was more difficult to understand by the elderly and patients with a previous non-specific low back pain episode., Conclusion: The Spanish version of the SBST questionnaire was obtained, which was shown to be comprehensible and adapted to the general population in Spain. Due to being short and easy to use, it is a potentially useful tool for use in primary care., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Objective: The aim of this study was to determine whether a 12-week course of low-frequency vibrating board therapy is a feasible therapy for non-specific chronic low back pain, and whether it improves the main outcome measures., Design: Randomized controlled trial., Patients: A total of 50 patients with non-specific low back pain were included. They were randomly assigned to either a vibrating plate via reciprocation therapy group (n = 25) or a control group (n = 25)., Methods: The 12-week vibration therapy programme consisted of a total of 24 training sessions (2 times/week, with 1 day of rest between sessions). Assessments of the main outcome measures for non-specific low back pain were performed at baseline and at 12 weeks., Results: In the vibration therapy group there was a statistically significant improvement, of 20.37% (p = 0.031) in the Postural Stability Index (anterior-posterior); 25.15% (p = 0.013) in the Oswestry Index; 9.31% in the Roland Morris Index (p = 0.001); 8.57% (p = 0.042) in EuroQol 5D-3L; 20.29% (p = 0.002) in the Sens test; 24.13% (p = 0.006) in visual analogue scale back; and 16.58% (p = 0.008) in the Progressive Isoinertial Lifting Evaluation test., Conclusion: A 12-week course of low-frequency vibrating board therapy is feasible and may represent a novel physical therapy for patients with non-specific low back pain.