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Bjarne K Madsen,1 Karen Søgaard,2,3 Lars L Andersen,4 Jørgen Skotte,4 Birte Tornøe,5 Rigmor H Jensen1 1Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, 2Institute of Sports Science and Clinical Biomechanics, Physical Activity and Health in Work Life University of Southern Denmark, Odense, 3Department of Clinical research, University of Southern Denmark, Odense, 4National Research Centre for the Working Environment, Copenhagen, Denmark; 5Department of Health Sciences, Lund University, Lund, Sweden Introduction: Muscle pain has been associated with reduced maximal muscle strength, and reduced rate of force development (RFD). Strength training (ST) has shown an effect in not only normalizing muscle function but also reducing neck muscle pain.Aim: The aims of this study were to compare muscle function in terms of strength, force steadiness in neck flexion, as well as extension, and rate of RFD of the shoulder in tension-type headache (TTH) patients and healthy controls and to examine the correlation to tenderness. Furthermore, the aim of the study was to examine the effect of ST on neck and shoulder functions in TTH patients.Participants and methods: In all, 60 TTH patients and 30 sex- and age-matched healthy controls were included for a case–control comparison. The 60 patients with TTH were randomized into an ST and an ergonomic and posture correction (EP) control group. The ST group trained for 10 weeks with elastic bands.Results: TTH patients had a lower extension force steadiness with a significant 15% higher coefficient of variation (CoV) compared to healthy controls (p=0.047). A significantly lower RFD (25%) was noted in the TTH group than in the healthy controls (p=0.031). A significant (p

Birte Tornøe,1–4 Lars L Andersen,5,6 Jørgen H Skotte,5 Rigmor Jensen,7 Claus Jensen,8 Bjarne K Madsen,7 Gunvor Gard,1 Liselotte Skov,2 Inger Hallström,11Department of Health Sciences, Lund University, Lund, Sweden; 2Department of Pediatrics E, Children’s Headache Clinic, University of Copenhagen, Herlev and Gentofte Hospitals, Copenhagen, Denmark; 3Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark; 4Department of Physiotherapy, University of Copenhagen, Herlev and Gentofte Hospitals, Copenhagen, Denmark; 5National Research Centre for the Working Environment, Copenhagen, Denmark; 6Physical Activity and Human Performance group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; 7Department of Neurology, Danish Headache Centre, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark; 8Huge Consulting, ApS, Haslev, Denmark Background: Childhood tension-type headache (TTH) is a prevalent and debilitating condition for the child and family. Low-cost nonpharmacological treatments are usually the first choice of professionals and parents. This study examined the outcomes of specific strength training for girls with TTH. Methods: Forty-nine girls aged 9–18 years with TTH were randomized to patient education programs with 10 weeks of strength training and compared with those who were counseled by a nurse and physical therapist. Primary outcomes were headache frequency, intensity, and duration; secondary outcomes were neck–shoulder muscle strength, aerobic power, and pericranial tenderness, measured at baseline, after 10 weeks intervention, and at 12 weeks follow-up. Health-related quality of life (HRQOL) questionnaires were assessed at baseline and after 24 months. Results: For both groups, headache frequency decreased significantly, P=0.001, as did duration, P=0.022, with no significant between-group differences. The odds of having headache on a random day decreased over the 22 weeks by 0.65 (0.50–0.84) (odds ratio [95% confidence interval]). For both groups, neck extension strength decreased significantly with a decrease in cervicothoracic extension/flexion ratio to 1.7, indicating a positive change in muscle balance. In the training group, shoulder strength increased ≥10% in 5/20 girls and predicted VO2max increased ≥15% for 4/20 girls. In the training group, 50% of girls with a headache reduction of ≥30% had an increase in VO2max >5%. For the counseling group, this was the case for 29%. A 24-month follow-up on HRQOL for the pooled sample revealed statistically significant improvements. Fifty-five percent of the girls reported little to none disability. Conclusion: The results indicate that both physical health and HRQOL can be influenced significantly by physical exercise and nurse counseling. More research is needed to examine the relationship between physical exercise, VO2max, and TTH in girls. Thus, empowering patient education to promote maximum possible outcomes for all children needs more attention. Keywords: empowering patient education, neck and shoulder muscles, muscular fitness, cardiovascular fitness, headache, child, health and physical therapy

Birte Tornøe,1,2,5,6 Lars L Andersen,3 Jørgen H Skotte,3 Rigmor Jensen,4 Gunvor Gard,1 Liselotte Skov,2 Inger Hallström1 1Department of Health Sciences, Lund University, Scania, Sweden; 2Children's Headache Clinic, Department of Pediatrics, University of Copenhagen, Herlev Hospital, Herlev, Denmark; 3National Research Centre for the Working Environment, Copenhagen, Denmark; 4Danish Headache Center, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark; 5Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark; 6Department of Physiotherapy, Medical Department, University of Copenhagen, Herlev Hospital, Herlev, Denmark Background: Frequent or chronic tension-type headache in children is a prevalent and debilitating condition for the child, often leading to medication overuse. To explore the relationship between physical factors and tension-type headache in children, the quality of repeated measures was examined. The aim of the present study was to determine the test-retest repeatability of parameters determining isometric neck and shoulder strength and stability, aerobic power, and pericranial tenderness in children. Methods: Twenty-five healthy children, 9 to 18 years of age, participated in test-retest procedures within a 1-week interval. A computerized padded force transducer was used for testing. The tests included the isometric maximal voluntary contraction and force steadiness of neck flexion and extension, and the isometric maximal voluntary contraction and rate of force of the dominant shoulder. Pericranial tenderness was recorded by means of standardized manual palpation, and a submaximal cycle ergometer test predicted maximal oxygen uptake (VO2 max). The measurements were evaluated in steps, using the intraclass correlation coefficient (ICC); changes in the mean between the two test occasions; the levels of agreement, visualized in Bland-Altman Plots; and by quantifying the variability. Results: The results showed an acceptable test-retest repeatability of isometric maximal voluntary contraction (ICC 0.90-0.97). The force steadiness measurements revealed a trend of systematic changes in the direction of neck flexion and need further examination in both healthy and ill children. The rate of force development, Total Tenderness Score, and prediction of VO2 max showed repeatability, with ICC 0.80-0.87. Conclusion: The measurements of strength capacity, aerobic power, and tenderness provide acceptable repeatability, suitable for research in children. Keywords: muscle strength, intratester reliability, cardiovascular fitness

Objective: We aimed to explore: (i) the association of sedentary time (ST) and physical activity (PA) during pregnancy with the placental expression of genes related to glucose and lipid metabolism in pregnant women who are obese; (ii) maternal metabolic factors mediating changes in these placental transcripts; and (iii) cord blood markers related to the mRNAs mediating neonatal adiposity. Design: Multicentre randomised controlled trial. Setting: Hospitals in nine European countries. Population: A cohort of 112 pregnant women with placental tissue. Methods: Both ST and moderate‐to‐vigorous PA (MVPA) levels were measured objectively using accelerometry at three time periods during pregnancy. Main outcome measures: Placental mRNAs (FATP2, FATP3, FABP4, GLUT1 and PPAR‐γ) were measured with NanoString technology. Maternal and fetal metabolic markers and neonatal adiposity were assessed. Results: Longer periods of ST, especially in early to middle pregnancy, was associated with lower placental FATP2 and FATP3 expression (P < 0.05), whereas MVPA at baseline was inversely associated with GLUT1 mRNA (P = 0.02). Although placental FATP2 and FATP3 expression were regulated by the insulin–glucose axis (P < 0.05), no maternal metabolic marker mediated the association of ST/MVPA with placental mRNAs (P > 0.05). Additionally, placental FATP2 expression was inversely associated with cord blood triglycerides and free fatty acids (FFAs; P < 0.01). No cord blood marker mediated neonatal adiposity except for cord blood leptin, which mediated the effects of PPAR‐γ on neonatal sum of skinfolds (P < 0.05). Conclusions: In early to middle pregnancy, ST is associated with the expression of placental genes linked to lipid transport. PA is hardly related to transporter mRNAs. Strategies aimed at reducing sedentary behaviour during pregnancy could modulate placental gene expression, which may help to prevent unfavourable fetal and maternal pregnancy outcomes. Reducing sedentary behaviour in pregnancy might modulate placental expression of genes related to lipid metabolism in women who are obese. Reducing sedentary behaviour in pregnancy might modulate placental expression of genes related to lipid metabolism in women who are obese. [ABSTRACT FROM AUTHOR]

Aim: To investigate the influence of physical and psychosocial working conditions on the risk of disability pension among eldercare workers. Methods : After responding to a questionnaire in 2005, 4699 healthy female eldercare workers – free from chronic musculoskeletal pain, depressive symptoms and long-term sickness absence – were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated the hazard ratio (HR) for disability pension from physical exertion during work, emotional demands, influence at work, role conflicts, and quality of leadership. Analyses were mutually adjusted for these work environmental factors as well as for age, education, smoking, leisure physical activity and body mass index. Results : During follow-up, 7.6% received disability pension. Physical exertion and emotional demands were associated with risk of disability pension, and both interacted with age. In age-stratified analyses, older eldercare workers (mean age 53 years at baseline) with moderate and high physical exertion (reference: low) were at increased risk with HRs of 1.51, 95% CI [1.06–2.15] and 2.54, 95% CI [1.34–4.83], respectively. Younger eldercare workers (mean age 36 years at baseline) with moderate emotional demands (reference: low) were at decreased risk with an HR of 0.57, 95% CI [0.37–0.85]. Conclusions : While a higher level of physical exertion is a risk factor for disability pension among older female eldercare workers, a moderate level of emotional demands is associated with lower risk among the younger workers. The age of the worker may be an important factor when providing recommendations for promoting a long and healthy working life. [ABSTRACT FROM AUTHOR]

Objectives To compare the rates of urinary incontinence ( UI) and other complications of subtotal abdominal hysterectomy ( SAH) with total abdominal hysterectomy ( TAH) at 5 years after surgery. Design Randomised clinical trial with central, computer-generated randomisation. Setting Danish multi-centre trial performed in 11 departments of gynaecology. Population Women referred with benign uterine diseases scheduled for abdominal hysterectomy. Methods Women were randomised to either SAH ( n = 161) or TAH ( n = 158). Follow-up data were collected from participants using postal questionnaires sent out 5 years after surgery. Complications of hysterectomy were further examined by scrutinising registered discharge summaries following hospitalisation. Intention-to-treat and per-protocol analyses were conducted. Potential bias caused by missing data was handled using multiple imputation. Main outcome measures The primary outcome was UI. Secondary outcomes included constipation, prolapse of the vaginal vault or cervical stump, satisfaction with sexual life, pelvic pain, postoperative complications and vaginal bleeding. Results The response rate was 234/319 (73.4%). A significantly higher proportion of respondents had urinary incontinence 5 years after SAH 34/113 (30.1%) than TAH 21/119 (17.6%) ( RR 1.71, 95% confidence interval 1.06-2.75, P = 0.026). This difference reduced after multiple imputation to account for missing data ( RR 1.37, 95% confidence interval 0.99-1.89, P = 0.052). Eleven of the 101 women (11%) in the SAH group still experienced vaginal bleeding. No other differences were found between the two types of abdominal hysterectomy. Authors' conclusions A smaller proportion of women suffered from UI after TAH than after SAH 5 years postoperatively. Around one in ten women continued to experience vaginal bleeding 5 years after SAH. [ABSTRACT FROM AUTHOR]

The aim of this randomized controlled trial was to assess changes in myalgic trapezius activation, muscle oxygenation, and pain intensity during repetitive and stressful work tasks in response to 10 weeks of training. In total, 39 women with a clinical diagnosis of trapezius myalgia were randomly assigned to: (1) general fitness training performed as leg-bicycling (GFT); (2) specific strength training of the neck/shoulder muscles (SST) or (3) reference intervention without physical exercise. Electromyographic activity (EMG), tissue oxygenation (near infrared spectroscopy), and pain intensity were measured in trapezius during pegboard and stress tasks before and after the intervention period. During the pegboard task, GFT improved trapezius oxygenation from a relative decrease of -0.83 ± 1.48 μM to an increase of 0.05 ± 1.32 μM, and decreased pain development by 43%, but did not affect resting levels of pain. SST lowered the relative EMG amplitude by 36%, and decreased pain during resting and working conditions by 52 and 38%, respectively, without affecting trapezius oxygenation. In conclusion, GFT performed as leg-bicycling decreased pain development during repetitive work tasks, possibly due to improved oxygenation of the painful muscles. SST lowered the overall level of pain both during rest and work, possibly due to a lowered relative exposure as evidenced by a lowered relative EMG. The results demonstrate differential adaptive mechanisms of contrasting physical exercise interventions on chronic muscle pain at rest and during repetitive work tasks. [ABSTRACT FROM AUTHOR]

Unlabelled: Regular physical exercise is a cornerstone in rehabilitation programs, but adherence to comprehensive exercise remains low. This study determined the effectiveness of small daily amounts of progressive resistance training for relieving neck/shoulder pain in healthy adults with frequent symptoms; 174 women and 24 men working at least 30 h per week and with frequent neck/shoulder pain were randomly assigned to resistance training with elastic tubing for 2 or 12 minutes per day 5 times per week, or weekly information on general health (control group). Primary outcomes were changes in intensity of neck/shoulder pain (scale 0 to 10), examiner-verified tenderness of the neck/shoulder muscles (total tenderness score of 0 to 32), and isometric muscle strength at 10 weeks. Compared with the control group, neck/shoulder pain and tenderness, respectively, decreased 1.4 points (95% confidence interval -2.0 to -0.7, p<0.0001) and 4.2 points (95% confidence interval -5.7 to -2.7, p<0.0001) in the 2-minute group and 1.9 points (95% confidence interval -2.5 to -1.2, p<0.0001) and 4.4 points (95% confidence interval -5.9 to -2.9, p<0.0001) in the 12-minute group. Compared with the control group, muscle strength increased 2.0 Nm (95% confidence interval 0.5 to 3.5Nm, p=0.01) in the 2-minute group and 1.7Nm (95% confidence interval 0.2 to 3.3 Nm, p=0.02) in the 12-minute group. In conclusion, as little as 2 minutes of daily progressive resistance training for 10 weeks results in clinically relevant reductions of pain and tenderness in healthy adults with frequent neck/shoulder symptoms.Trial Registration: www.isrctn.org/ISRCTN60264809. In generally healthy adults with frequent neck/shoulder muscle pain, as little as 2 minutes of daily progressive resistance training reduces pain and tenderness. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate if different types, body positions, and levels of progression of functional coordination exercises can provide sufficiently high levels of muscle activity to improve strength of the neck, shoulder, and trunk muscles. Nine untrained women were familiarized with 7 functional coordination exercises 12 times during 4 weeks before testing. Surface electromyographic (EMG) activity was obtained from rectus abdominus, erector spinae, obliquus externus, and trapezius during the exercises with 2-4 levels of progression. Electromyography was normalized to the maximal EMG activity during maximal voluntary contractions, and a p value < 0.05 was considered significant. All recorded muscles reached sufficiently high levels of activity during the coordination exercises for strength gain (>60% of maximal EMG activity). Type of exercise played a significant role for the attained muscle activity. Body position during the exercises was important for the activity of the erector spinae, and level of progression was important for the activity of the trapezius. The findings indicate that depending on type, body position, and level of progression, functional coordination training can be performed with a muscle activity sufficient for strength gain. Functional coordination training may therefore be a good choice for prevention or rehabilitation of musculoskeletal pain or injury in the neck, shoulder, or trunk muscles. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study is to investigate the effect of three different workplace interventions on long-term compliance, muscle strength gains, and neck/shoulder pain in office workers. Methods: A 1-yr randomized controlled intervention trial was done with three groups: specific resistance training (SRT, n = 180), all-round physical exercise (APE, n = 187), and reference intervention (REF, n = 182) with general health counseling. Physical tests were performed and questionnaires answered at pre-, mid-, and postintervention. The main outcome measures were compliance, changes in maximal muscle strength, and changes in intensity of neck/shoulder pain (scale 0-9) in those with and without pain at baseline. Results: Regular participation was achieved by 54%, 31%, and 16% of those of the participants who answered the questionnaire in SRT (78%), APE (81%), and REF (80%), respectively, during the first half of the intervention period, and decreased to 35%, 28% and 9%, respectively, during the second half. Shoulder elevation strength increased 9-11% in SRT and APE (P < 0.0001). Participants with neck pain at baseline decreased the intensity of neck pain through SRT, from 5.0 +/- 0.2 to 3.4 +/- 0.2 (P < 0.0001), and through APE, from 5.0 +/- 0.2 to 3.6 +/- 0.2 (P < 0.001), whereas REF caused no change. For participants without shoulder pain at baseline, there was a significantly greater increase in pain over the 1-yr period in REF compared with SRT and APE (P < 0.01). Conclusion: Compliance was highest in SRT but generally decreased over time. SRT and APE caused increased shoulder elevation strength, were more effective than REF to decrease neck pain among those with symptoms at baseline, and prevent development of shoulder pain in those without symptoms at baseline. [ABSTRACT FROM AUTHOR]

The article analyses one case: a sickness benefit office in a social services department. It takes as a starting point that organisations function as projection surfaces for fantasies, emotions and reactions. The psycho-societal perspective clarifies how a social services department transfers a crucial dilemma in social work onto social workers by processes of individualising. The dilemma relates to the disparity between clients' complex life situations and the limited possibilities for social workers to resolve them. There is an ambiguity in this transference. In cases of failure, management seeks explanations not by looking at possible organisational or societal restrictions or explanations, but rather at the social workers' personal and professional life histories--they are subjected to a life historic individualisation and stigmatisation.1 Social workers, on the other hand, display ambivalence towards influencing case administrative work, which can be interpreted as an adequate defence mechanism. The article then introduces the concept of individualisation that reflects the dialectic processes of subjectivity and objectivity and leads to a contextualised analysis of social work. [ABSTRACT FROM AUTHOR]

Context: Gestational diabetes mellitus (GDM) increases the risk of future type 2 diabetes (T2DM), but effective and feasible interventions to reduce this risk are lacking., Objective: To evaluate the effectiveness of a family-based health promotion intervention on T2DM risk factors and quality of life among women with recent GDM., Design: Multicenter, parallel, open-label randomized controlled trial with 2:1 allocation ratio., Setting: Three sites in Denmark., Participants: Women diagnosed with GDM., Intervention(s): The intervention consisted of (i) home visits with tailored family-based counseling (ii) digital health coaching, (iii) structured cross-sectoral communication., Main Outcome Measures: Primary outcomes were body mass index (BMI) and quality of life (SF12 MCS) 1-year after delivery., Results: We randomized 277 women to the intervention (n=184) or usual care group (n=93). The intervention did not result in significantly lower BMI (-0.44 kg/m2; 95%CI -0.98 to 0.11) or higher SF12 MCS (0.06; 95%CI -2.15 to 2.27) compared to the usual care group. A pre-specified post hoc analysis demonstrated a reduced BMI in the intervention group among women with BMI ≥25 kg/m2 (-0.86 kg/m2; (-1.58 to -0.14)).Analyses of secondary and tertiary outcomes indicated significantly lower 2-h insulin (-94.3 pmmol/L; 95%CI -167.9 to -20.6) and triglycerides (-0.18 mmol/L; 95%CI -0.30 to -0.05) levels, and odds of fasting plasma glucose ≥6·1 mmol/L (OR 0.33; 95%CI 0.12 to 0.91) in the intervention group., Conclusion: The intervention did not result in lower BMI or increased quality of life, but seemingly reduced other risk factors, and lowered BMI in the subgroup of overweight women., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background & Aims: Questions remain whether higher handgrip strength confers additional health advantages beyond adherence to current physical activity guidelines. We aimed to evaluate prospective associations of joint objectively measured handgrip strength and physical activity with incident cardiovascular disease (CVD) and all-cause mortality., Methods: We analysed the UK Biobank study in a cohort of participants who wore accelerometers for one week, with follow-up based on hospital records until 2022. Patterns of physical activity were compared: participants who met current moderate-vigorous physical activity guidelines (150 min per week) and those who did not. Handgrip strength was classified into sex- and age-specific tertiles. CVD events were identified as primary or secondary by examination of inpatient records and data extracted from the death registry. CVD-related deaths were also identified from the death registry. We examined prospective associations of moderate-vigorous physical activity with incident CVD and all-cause mortality by level of handgrip using Cox regressions, adjusted for confounding factors., Results: A total of 76 074 persons were included (mean 55.2 years). Meeting physical activity guidelines is necessary to reduce all-cause mortality in those at the lower and middle thirds of handgrip strength. However, meeting physical activity guidelines did not confer additional reduction of all-cause mortality of those with high handgrip strength. Those with the lowest handgrip strength showed the greatest benefit from meeting physical activity guidelines for reducing all-cause mortality (HR 0.74; 95 % CI 0.65-0.85)., Conclusion: Our results indicate that, while following physical activity guidelines does not reduce mortality in individuals with high handgrip strength, it is essential for preventing cardiovascular disease across all levels of handgrip strength. This underscores the importance of these guidelines for cardiovascular health., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Ageing is associated with a gradual loss of muscle strength, which in the end may have consequences for survival. Whether muscle strength and mortality risk associate in a gradual or threshold-specific manner remains unclear. This study investigates the prospective association of muscle strength with all-cause mortality in the oldest old., Methods: We included 1890 adults aged ≥ 90 years (61.6% women, mean age 91.0 ± 1.5 years) from 27 European countries and Israel participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) study. Muscle strength was assessed using handgrip dynamometry (unit: kilogram). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with mortality, controlling for age, sex, smoking, BMI, marital status, education, geographical region and self-perceived health., Results: Over a mean follow-up of 4.2 ± 2.4 years, more than half of the participants died (n = 971, 51.4%). The mean handgrip strength was 20.4 ± 8.0 kg for all participants, with men (26.7 ± 7.5 kg) showing significantly higher strength than women (16.4 ± 5.4 kg) (p < 0.001). Using the median level of muscle strength as reference (18 kg), lower and higher levels were associated in a gradual and curvilinear fashion with higher and lower mortality risk, respectively. The 10 th percentile of muscle strength (10 kg) showed a hazard ratio (HR) of 1.27 (95% CI 1.13-1.43, p < 0.001). The 90 th percentile (31 kg) showed an HR of 0.69 (95% CI 0.58-0.82, p < 0.001). Stratified for sex, the median levels of muscle strength were 26 kg for men and 16 kg for women. The 10 th percentile of muscle strength showed HRs of 1.33 (95% CI 1.10-1.61, p < 0.001) at 15 kg for men and 1.19 (95% CI 1.05-1.35, p < 0.01) at 10 kg for women. The 90 th percentile of muscle strength showed HRs of 0.75 (95% CI 0.59-0.95, p < 0.01) at 35 kg for men and 0.75 (95% CI 0.62-0.90, p < 0.001) at 23 kg for women. Sensitivity analyses, which excluded individuals who died within the first 2 years of follow-up, confirmed the main findings., Conclusion: Rather than a specific threshold, muscle strength is gradually and inversely associated with mortality risk in the oldest old. As muscle strength at all ages is highly adaptive to resistance training, these findings highlight the importance of improving muscle strength in both men and women among the oldest old., (© 2024 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Objective: The aging population of European countries highlights the need for extended working lives. This study aims to investigate facilitators and barriers for working beyond the statutory pension age (SPA)., Methods: Using data from waves 1, 2, 4-9 of the Survey of Health, Ageing and Retirement in Europe (SHARE) (2004-2022), we followed 9131 workers with a mean age of 56.9 [standard deviation (SD) 3.5] years from 26 European countries until they surpassed the SPA for their respective country, sex and year of participation. Using robust Poisson regression, we modelled the prospective association of work factors, lifestyle, health, and demographics at baseline with working at least one year beyond the SPA., Results: Participants were followed for 9.5 (SD 3.9) years. After surpassing the SPA by at least one year, 18% were still working. Among the work factors, opportunities for skill development [risk ratio (RR) 1.20, 95% confidence interval (CI) 1.07-1.34] and recognition at work (RR 1.13, 95% CI 1.01-1.26) facilitated working beyond SPA, while time pressure (RR 0.89, 95% CI 0.81-0.97) and poor prospects for job advancement (RR 0.76, 95% CI 0.70-0.83) were barriers. For the other factors, smoking was negatively associated with working beyond the SPA, while living in the northern part of Europe, higher level of education, and being divorced or separated were positively associated with working beyond the SPA., Conclusion: This prospective cohort study across 26 European countries identified four modifiable work factors that influenced working beyond the SPA. Addressing modifiable barriers and facilitators at the workplace and through public health initiatives could help extend working lives in Europe.

Purpose: Work-related musculoskeletal disorders are prevalent among healthcare workers. These workers experience high rates of low-back pain; partly due to the high physical demands of patient transfers. Understanding the specific transfer scenarios that contribute to high physical loads is therefore crucial for developing strategies to improve working conditions., Methods: This study utilized electromyography to measure muscle activity in the erector spinae muscles during patient transfers, performing measurements in real-life hospital settings to identify the physical load associated with different transfer scenarios. Using linear mixed models, the 95th percentile ranks of the normalized root mean square (nRMS) values were analyzed for a range of different patient transfers., Results: The results revealed significant differences in physical load across various patient transfer scenarios. High-load activities included sitting to lying down or lying down to sitting (nRMS 32.7, 95% CI: 28.9-36.6) and lifting the upper body (32.4, 95% CI: 28.8-35.9), while low-load activities such as supporting patients while walking or standing (21.9, 95% CI: 18.6-25.1) and mobilizing in bed (19.9, 95% CI: 16.1-23.8) required less muscle activation. Moderate-load activities included bed to chair transfers (28.1, 95% CI: 24.9-31.3) and lifting the head (26.3, 95% CI: 22.7-29.9)., Conclusion: Understanding the physical load associated with different patient transfer scenarios allows for better organization of work in healthcare settings. These novel findings emphasize the need for effective task allocation, rotational schedules, and the use of assistive devices to distribute physical load and reduce injury risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Vinstrup, Jakobsen, Nielsen and Andersen.)

Objective: Knee pain is highly prevalent and disabling among the general and working population. This systematic review explored the effectiveness of workplace-based interventions on knee pain among workers., Methods: A PICO-guided systematic search was performed in PubMed and Web of Science Core Collection for articles published from 2003 until January 2023. Eligible articles included randomized and non-randomized controlled trials assessing the effect of workplace-based interventions on knee pain among currently employed adult workers. The quality assessment and evidence synthesis adhered to the systematic review approach, which the Institute for Work & Health developed, and was focused on developing practical recommendations for stakeholders., Results: Of the 13 identified studies, 11 medium- and high-quality studies were entered into the evidence synthesis. Importantly, none of the included studies specifically aimed at reducing of knee pain. Still, among the included studies, a strong level of evidence suggested no benefit of workplace-based physical exercise/activity intervention on knee pain. The level of evidence was deemed too uncertain to guide current policy/practices for ergonomic and multifaceted interventions. No intervention types were associated with negative effects on knee pain., Conclusions: The current evidence-base pertaining to workplace-based prevention and management of knee pain is insufficient to guide effective preventive workplace practice or policy development. Considering the global prevalence and health impact of knee pain, development and implementation of effective workplace interventions aimed at prevention and management of knee pain is needed.

Background: There is a dearth of knowledge regarding the relationship between engaging in moderate and vigorous physical activity and long-term sickness absence (LTSA), particularly among various population subgroups such as individuals of different ages or body mass indices. We aimed to evaluate the prospective associations of moderate and vigorous leisure-time physical activity with the risk of LTSA in the general working population., Methods: A prospective cohort study with a 2-year register follow-up was conducted, where 68,222 representative workers from Denmark completed a questionnaire about work environment, lifestyle, and health. Data on LTSA (≥6 consecutive weeks of sickness absence) were obtained from the Danish Register for Evaluation of Marginalization. We used Cox regression for the statistical analysis, adjusting for relevant confounding factors. We also performed age- and BMI-stratified analyses., Results: In the fully adjusted model, 2 to 4 hours per week of moderate activity (hazard ratios [HR] = 0.87; 95% CI, 0.77 to 0.99) and ≥2 hours per week of vigorous activity reduced LTSA risk compared with no physical activity. However, 2 to 4 hours per week of vigorous activity (HR = 0.84; 95% CI, 0.76 to 0.91) provided the greatest risk reduction. In the total sample, the complete absence of vigorous activity was associated with increased risk of LTSA (HR = 1.13; 95% CI, 1.05 to 1.22). In stratified analyses, the results were consistent for workers <50 years (HR = 1.14; 95% CI, 1.03 to 1.26), ≥50 years (HR = 1.13; 95% CI, 1.02 to 1.26), and those with a BMI ≥ 25 (HR = 1.16; 95% CI, 1.06 to 1.28). The complete absence of moderate activity was not associated with LTSA., Conclusion: Vigorous leisure-time physical activity appears to be more important than moderate activity to prevent LTSA.

Objective: To investigate the prospective dose-response association of accelerometer-measured moderate-to-vigorous physical activity (PA;MVPA) with all-cause mortality and cardiovascular disease (CVD) incidence., Methods: This prospective cohort of 76,074 participants from the UK Biobank study contained one week of individual accelerometer-based PA data collected between June 1, 2013 and December 23, 2015. Using restricted cubic splines to allow for potential non-linearity, we examined dose-response associations of MVPA with all-cause mortality and incident CVD, respectively., Results: The median follow-up time was 8.0 years (IQR 7.5-8.5). The dose-response association of MVPA with all-cause mortality and CVD showed a similar L-shaped association, with significant risk reductions already from 10 min of MVPA per week for all-cause mortality (hazard ratio [HR], 0.98 [95 % CI,0.98-0.99]) and 15 min per week for CVD incidence (HR, 0.99 [95 % CI,0.98-0.99]). Doing more MVPA was associated with further risk reduction, but beyond around 500 min per week the benefits levelled off at HR's around 0.6 to 0.7. The highest additional benefit of adding more minutes per week for all-cause mortality and CVD incidence were observed between 100 and 250 weekly minutes of MVPA. From this point forward, the mean risk reduction rates decreased and were close to 0 beyond 500 weekly minutes., Conclusions: Significant, but small, risk reductions in all-cause mortality and CVD incidence can be achieved with as little as 10 and 15 min of MVPA per week, respectively. However, public health organizations should promote the attainment of 250 min of MVPA per week (with 100 min as a possible first target for inactive individuals), as these thresholds are associated with the greatest efficiency. Beyond that, less pronounced risk reductions can be achieved by accumulating additional MVPA, with hardly any additional benefits beyond 500 weekly minutes., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate whether acts of offensive behaviour (threats, violence, workplace bullying and sexual harassment) in the workplace and type of perpetrator (internal or external to the workplace) of the offensive behaviours predicted risk of disability pension in Danish eldercare workers., Methods: We merged survey responses from 8731 female eldercare workers with a national register on social transfer payments (Danish Register for Evaluation of Marginalisation (DREAM)), including all types of disability benefits. Using Cox proportional hazards models, we investigated the prospective association between self-reported exposures at baseline and the risk of receiving disability pension (any type of disability benefit payment) during 11 years of follow-up, while adjusting for potential confounders., Results: Self-reported exposure to threats (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.00-1.32), violence (HR 1.16; 95% CI 1.00-1.35) and bullying (HR 1.44; 95% CI 1.22-1.71) predicted increased risk of disability pension during follow-up, when adjusted for age and educational attainment. When further adjusted for psychosocial working conditions only bullying remained a statistically significant (HR 1.39; 95% CI 1.16-1.67) predictor of disability pension. The results indicated no elevated risk for participants reporting sexual harassment. Moreover, we observed stronger associations between self-reported exposure to threats, violence and workplace bullying and risk of disability pension when the perpetrator was internal to the workplace (i.e. colleagues, managers and/or subordinates), than when the perpetrator was reported to be external to the workplace (i.e. service users, and/or relatives of service users)., Conclusions: Results indicate that prevention of work-related exposure to threats, violence and workplace bullying may contribute to reduce involuntary early retirement in female eldercare workers., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Major organizational changes may be associated with both positive and negative uncertainty in working life. This study described the prevalence of organizational changes (reorganizations or round of layoffs) within different job functions in Denmark and investigated whether quality of the implementation process (measured as "information", "involvement" and "consent") was associated with employees' expectations regarding retirement age., Methods: A representative sample of older Danish employees ≥ 50 years (n = 12,269) replied to a questionnaire survey in 2020. In cross-sectional analyses, we compared employee's expected retirement age being either not exposed to organizational changes or exposed to implementation processes of high, moderate or low-quality, respectively. Analyses were further stratified for job function: office work, work with people and work in the field of production., Results: More than half (56%) of the employees had experienced organizational changes within the past 2 years, and 23% of those effected reported that the changes had led to considerations of earlier retirement. Organizational changes were most prevalent within office work, and least prevalent within the job function working with people. The analyses showed significantly lower expected retirement age when the implementation process had been of moderate (mean reduction of 0.45 years) or low quality (mean reduction of 0.71 years) compared to high quality implemented changes., Conclusions: Experiences of organizational change processes of moderate or poor quality were associated with expectations of earlier retirement, while well implemented changes were not. This study underscores the importance of good implementation when changes at the organizational level are needed., (© 2024. The Author(s).)

Objective: This study aimed to determine the optimal exercise for improving Upper Crossed Syndrome (UCS) using electromyographic (EMG) activity of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) during ten exercises., Method: A cross-sectional study involved 30 male students (mean age: 25.3 ± 2.5 years; height: 176.8 ± 7.2 cm; weight: 77.7 ± 2.5 kg; BMI: 23.8 ± 0.72 kg/m 2 ) with UCS. Participants were selected based on postural assessments (forward head posture ≥44°, rounded shoulder ≥49°, thoracic kyphosis ≥42°). EMG was used to measure activation levels of UT, MT, LT, and SA, and the UT activation ratio relative to MT, LT, and SA during ten exercises. One-way ANOVA was applied for data analysis., Results: Side-lying external rotation, standing diagonal flexion with Thera-band, and lying prone "V" demonstrated the least UT activity, with the highest MT and LT activation. The standing diagonal flexion with Thera-band elicited the highest SA activity. UT/MT, UT/LT, and UT/SA ratios were less than one in multiple exercises. Significant differences in muscle activation levels and ratios were observed across all exercises (P ≤ 0.05)., Conclusion: The findings suggest significant clinical implications for UCS rehabilitation. The identified exercises effectively engage MT and LT while minimizing UT activation, addressing muscular imbalances. Favorable UT/MT, UT/LT, and UT/SA ratios further support these exercises in correcting UCS. These exercises may help counteract the underlying muscular imbalance in UCS by promoting a more balanced activity ratio among the shoulder girdle muscles, potentially improving posture and reducing UCS symptoms., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose and declare that they have no competing interests for the manuscript entitled “Exercise Selection for Scapulothoracic Muscles Rehabilitation in Men with Upper Crossed Syndrome: A Cross-Sectional Study”., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The main objective of this study was to investigate the effect of a self-regulated dual task on muscle endurance within a single rehabilitation session in patients recovering from an elbow fracture., Design: This is a cross-sectional study of individuals recovering from elbow fractures ( N = 20). Muscle endurance was tested using elastic bands at Borg's CR10 intensity 3-during four conditions: single-task and dual-task for elbow flexion and extension., Results: The cognitive condition significantly influenced muscle endurance ( P < 0.001), while the type of elbow exercise (flexion or extension) did not show significant differences ( P = 0.592). The perceived difficulty of the tasks showed a significant interaction effect ( P = 0.032). The dual-task condition showed an average increase of about 15 repetitions. A moderate negative correlation was found between the differences in repetitions and the perceived difficulty of the flexion exercise ( r = 0.677, P = 0.001)., Conclusions: Dual-task with self-regulation enhances muscle endurance among patients recovering from an elbow fracture. However, the improvements seem to depend on the perceived difficulty of the cognitive task. Future randomized controlled trials are required to understand the therapeutic implications of dual-tasking., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The worldwide prevalence of diabetes is increasing, particularly among older adults. Understanding the association between muscle strength and mortality in this population is crucial for developing targeted exercise recommendations., Objectives: To assess the prospective association of muscle strength with mortality in older adults with diabetes., Methods: From the Survey of Health, Ageing and Retirement in Europe (SHARE) study, spanning 28 countries, we included 16 149 diabetic adults aged 50 years and older (mean age 68.2 [standard deviation, SD, 9.2] years). Participants fulfilled two criteria: (1) diabetes diagnosis (ever) and (2) current use of diabetes medication. Muscle strength was assessed using handgrip dynamometry (unit: kg). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with all-cause and cause-specific mortality, controlling for various confounders., Results: Over a mean follow-up of 5.9 years (SD 3.8), 2754 participants died (17%). Using the median level of muscle strength as reference (30 kg), lower and higher levels were associated in a curvilinear fashion with higher and lower all-cause mortality risk, respectively. The 10th percentile of muscle strength (17 kg) showed a hazard ratio (HR) of 1.65 (95% confidence interval (CI) 1.53-1.79). The 90th percentile (47 kg) of muscle strength showed a HR of 0.55 (95% CI 0.49-0.63). A somewhat similar pattern, with varying strength of associations, was seen for mortality due to cardiovascular disease (CVD), respiratory disease, severe infectious disease, digestive system disease and cancer., Conclusion: Muscle strength is gradually and inversely associated with all-cause and cause-specific mortality risk in older adults with diabetes. As muscle strength is highly adaptable to resistance training at all ages, the present findings highlight the importance of improving muscle strength in older adults with diabetes., (© 2024 John Wiley & Sons Ltd.)

Background Selection, optimisation, and compensation (SOC) can be important strategies for maintaining work ability as we age. This study aimed to explore differences in self-reported individual and collective use of SOC strategies across job functions, as well as their association with self-rated work ability., Methods: In the third wave of the SeniorWorkingLife study, 10,798 workers aged 50 + , across the job function categories "Office work", "work with people", and "work in the field of production", replied to questions about collective and individual SOC strategies and work ability. Using multiple regression, we modelled associations between SOC and work ability., Results: Associations between SOC and work ability were generally weaker among participants working in the field of production. Both individual and collective use of selection had much weaker associations with work ability in the job functions "office work" and "working with people". In the job function "working in the field of production", only collective compensation was positively associated with work ability while individual selection was significantly but negatively associated with work ability., Conclusions: The use of SOC may be particularly beneficial for older employees working with people. Optimisation and compensation may be the most important SOC strategies for maintaining the work ability of older employees working with people and doing office work. For older employees working in the field of production, collective optimisation may support the maintenance of work ability while reduced work ability may be associated with the use of individual selection as a "coping strategy"., (© 2024. The Author(s).)