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Purpose: Musculoskeletal pain (MP) is common among workers, especially for health-care professionals. Paradoxically, many of those rehabilitating patients for pain-that is, physical therapists (PTs)-also have pain. Adequate levels of physical activity are recommended for cardiovascular and musculoskeletal health. However, the association between physical activity and MP among PTs remains unknown. This study aims to determine the association between moderate and vigorous leisure-time physical activity levels and MP in PTs.Design: Cross-sectional study.Setting: Workplace.Participants: Nine hundred eighty-one PTs.Measures: Data on MP and leisure-time physical activity were collected using an online survey.Analysis: The odds for having lower level of MP as a function of physical activity were estimated using binary logistic regression controlled for various confounders.Results: Performing ≥75 min/week of vigorous leisure-time physical activity increased the odds of experiencing lower levels of neck-shoulder pain (odds ratio = 1.43, 95% confidence interval, 1.05-1.94). No association was found neither between vigorous nor between moderate leisure-time physical activity and MP in the arm-hand or back.Conclusion: Performing ≥75 min/week of vigorous leisure-time physical activity is associated with lower levels of MP in neck and shoulders among PTs. No associations were found between vigorous or moderate leisure-time physical activity and MP in arm-hand and back. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between adherence to muscle-strengthening guidelines in young adulthood and inflammation markers over a 17-year follow-up period. Additionally, it aims to examine whether body mass index (BMI) and waist circumference (WC) act as mediators in this relationship., Methods: The study analysed data from young adults aged 18-26 years who participated in waves III (2001-2002), IV (2008-2009) and V (2016-2018) of the Add Health Study. Adherence to muscle-strengthening guidelines was self-reported, and participants were classified as adherent if they engaged in strength training ≥2 days per week across all waves. Venous blood samples were collected at participants' homes to measure high-sensitivity C reactive protein (hs-CRP) levels and various cytokine concentrations, including interleukin (IL)-6, IL-1beta, IL-8, IL-10 and tumour necrosis factor-alpha (TNF-α). A global inflammation score was also calculated using z-scores of these markers., Results: A total of 2320 individuals participated (60.8% females). Participants adhering to muscle-strengthening guidelines exhibited significant reductions in hs-CRP, IL-6 and the inflammation z-score, with mean difference (MD) of -1.556 mg/L (95% CI BCa -2.312 to -0.799), -0.324 pg/mL (95% BCa CI -0.586 to -0.062), and -0.400 (95% BCa CI -0.785 to -0.035), respectively. Mediation analysis revealed that BMI and WC levels at wave V significantly mediated the relationship between strength training and inflammation z-score, with significant indirect effects of -0.142 (95% CI -0.231 to -0.055) for BMI and -0.210 (95% CI -0.308 to -0.124) for WC., Conclusion: Adherence to muscle-strengthening guidelines alone may not be sufficient to achieve a notable decrease in inflammation without concurrent reductions in these obesity parameters., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aimed to explore the association between handgrip strength, cardiometabolic risk (CMR) and body composition in youth with type 1 diabetes., Methods: For this prospective cohort study, muscular fitness was assessed via handgrip test and relativised by weight, and body composition, evaluated through dual-energy X-ray absorptiometry in type 1 diabetes patients aged 6-18 years. CMR score included z-scores for total body fat, blood pressure, glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride-glucose index., Results: Eighty-three patients were analysed at baseline and 1-year follow-up (44.6% females, mean age 12.77 years). Individuals with high handgrip strength tended to have lower CMR and body fat compared with those with low handgrip strength. Over a year, individuals with high handgrip strength showed reduced HbA1c, CMR and subcutaneous fat. Consistently meeting high handgrip strength criteria resulted in reductions in HbA1c levels, CMR score and subcutaneous adipose tissue compared with those who never complied or lost compliance during follow-up. Additionally, subjects classified with high handgrip strength both at baseline and follow-up had a lower likelihood of being classified with high CMR (OR=0.241, 95% CI 0.121 to 0.947, p=0.044)., Conclusions: High handgrip strength was associated with significant cardiometabolic and body composition benefits in youth with type 1 diabetes. This tool could be considered of potential clinical value for incorporating assessments like handgrip tests to monitor and address cardiometabolic health., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Hematopoietic stem cell transplantation (HSCT) has improved outcomes for severe hematologic, malignant, and immune disorders, yet poses an increased risk of subsequent malignancies. This study aimed to examine the risk of skin cancer following HSCT and identify potential risk factors. The search was conducted in MEDLINE, EMBASE, and CINAHL databases until December 2023. Cohort studies reporting standardized incidence ratios (SIRs) for post-HSCT skin cancer or investigating risk factors were included. SIRs, or hazard ratios (HRs) with 95% confidence interval (CI), were calculated using random-effects inverse-variance models. Outcome endpoints were SIRs of skin cancer post-HSCT and risk factors, including gender, chronic graft-versus-host disease (cGVHD), voriconazole exposure, and total body irradiation (TBI). Twenty-six studies involving 164,944 HSCT recipients (allogeneic HSCT, n = 68,637; autologous HSCT, n = 95,435; mean age: 38.5 ± 13.8 years; 71,354 females [43.3%]) were analyzed. Overall, SIR for skin cancer post-HSCT was 7.21 (95% CI 3.98-13.08), with SIRs of 2.25 (95% CI: 1.37-3.68) for autologous HSCT, and 10.18 (95% CI 5.07-20.43) for allogeneic HSCT. Risk factors for skin cancer risk included cGVHD (HR = 2.86 [95% CI: 2.01-4.07]), specifically for basal cell and squamous cell carcinoma (SCC) (HR = 1.80 [95% CI: 1.31-2.46] and HR = 3.68 [95% CI: 2.39-5.68], respectively), male gender (HR = 1.56 [95% CI: 1.15-2.13]), especially for SCC (HR = 1.70 [95% CI: 1.03-2.80]), and voriconazole exposure (HR = 2.01 [95% CI: 1.12-3.61]). TBI showed no statistically significant association with subsequent skin cancer (HR = 1.12 [95% CI: 0.73-1.71]). These findings highlight the importance of rigorous skin cancer surveillance and preventive strategies in HSCT recipients, particularly in male individuals undergoing allogeneic transplants and those with identifiable risk factors, to enable early detection and intervention., (© 2024 the International Society of Dermatology.)

Background/objectives: A notable decline in physical activity from late adolescence to early adulthood affects young women especially. This study aimed to investigate adherence to an unsupervised virtual-guided high-intensity interval training (HIIT) exercise program among young women in Spain., Methods: A total of 106 participants were recruited and randomized to the Women's Involvement in Steady Exercise (WISE) trial exercise program, administered remotely via a mobile app, and a control group. The primary outcome was adherence measured through daily steps. Secondary variables were patient-reported outcomes of physical activity, quality of sleep, and quality of life, assessed with the International Physical Activity Questionnaire (IPAQ), the Pittsburgh Sleep Quality Index (PSQI), and the Health Lifestyle and Personal Control Questionnaire (HLPCQ), respectively. The assessments were performed over 6 months, before the intervention (T0), at the halfway of the program (T1), and at the end (T2)., Results: Daily steps revealed a decrease from baseline to final assessment in both groups. Secondary outcomes indicated a shift in physical activity levels, showing a transition from low to moderate and high activity perception. While sleep quality deteriorated post-intervention, quality of life showed no changes., Conclusions: The WISE trial highlights the potential and challenges of an unsupervised virtual-guided HIIT program for young women. While an improvement in physical activity levels was noticed, it also led to a decrease in daily steps and poorer sleep quality. These findings suggest a complex relationship between exercise and lifestyle factors, which could potentially have the greatest impact.

Competing Interests: Declaration of competing interest The authors declare that they have no competing interests.

Background: The use of acupuncture is related to patients' expectations, and the therapeutic interaction effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with fibromyalgia (FM)., Objective: To determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect not attributed to specific effects in patients with FM., Design: Umbrella review of systematic reviews (SRs) and meta-analyses., Data Sources and Methods: An electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. We selected studies with a clinical diagnosis of FM and that analyzed the effectiveness of acupuncture compared with a placebo. Pain intensity, functional status, fatigue, sleep quality, and depression symptoms were assessed. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD). The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach., Results: Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = -1.13 cm, 95% CI -2.09 to -0.17, p  < 0.001), physical function (SMD = -0.63, 95% CI -1.67 to 0.41, p  = 0.06), sleep quality (SMD = -0.25, 95% CI -1.39 to 0.88, p  = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, p  < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI -0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21)., Conclusion: Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low; its effects are not clinically important, and more than 50% of the overall treatment effects were not attributed to the specific effects of acupuncture., Prospero Registration Number: CRD42023487315., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Objective: This study tried to examine the association between the frequency of family meals and excess weight using large and representative samples of children and adolescents from 43 countries., Methods: This cross-sectional study used data from the Health Behaviour in School-aged Children (HBSC), which included nationally representative samples of children and adolescents aged 10-17 years, involving a total of 155 451 participants (mean age = 13.6 years; standard deviation [SD] = 1.6; 51.4% girls). Family meal frequency was gauged through the following question: 'How frequently do you and your family typically share meals?' The possible responses were: 'never', 'less often', 'approximately once a week', 'most days' and 'every day'. The body weight and height of the participants were self-reported and utilized to calculate body mass index (BMI). Subsequently, BMI z-scores were computed based on the International Obesity Task Force criteria, and the prevalence of excess weight was defined as +1.31 SD for boys and + 1.24 SD for girls, with obesity defined as +2.29 SD for boys and + 2.19 SD for girls. Generalized linear mixed models were conducted to examine the associations between the frequency of family meals and excess weight or obesity., Results: The lowest predicted probabilities of having excess weight and obesity were observed for those participants who had family meals every day (excess weight: 34.4%, 95% confidence interval [CI] 31.4%-37.5%; obesity: 10.8%, 95% CI 9.0%-13.0%)., Conclusions: A higher frequency of family meals is associated with lower odds of having excess weight and obesity in children and adolescents., (© 2024 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Aims: This study sought to elucidate the interactions among physical activity (PA) patterns, mean glucose concentrations, and the incidence of nocturnal hypoglycemia events in children and adolescents with type 1 diabetes, examining the moderating influence of daily dosage on these associations., Material and Methods: Eighty-two participants aged 6 to 18 years (43.9% girls) from the Diactive-1 Cohort Study, diagnosed with type 1 diabetes, were included. Data collection involved continuous glucose monitoring, accelerometry to assess real-world PA, as well as documentation of daily insulin doses and carbohydrate counting over the same seven days., Results: A total of 19 participants experienced at least one nocturnal hypoglycemia event over a span of 574 measurement days (106 days with and 451 days without nocturnal hypoglycemia). Higher levels of vigorous PA (VPA) were associated with lower same-day mean glucose levels (p = 0.014). Additionally, higher levels of moderate PA (p = 0.023), VPA (p = 0.011), and moderate-to-vigorous PA (p = 0.010) were associated with a greater number of nocturnal hypoglycemia events. Specifically, a significant association was identified between VPA and nocturnal hypoglycemia events when the daily insulin dose were at or above 1.04 units per kilogram of body weight per day (p = 0.016)., Conclusions: Daily VPA is associated with glucose reductions, potentially leading to more hypoglycemic episodes, particularly when there's an excess of daily insulin. This highlights the need for careful insulin management in children and adolescents with type 1 diabetes engaging in VPA., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

OBJECTIVE: We aimed to quantify the proportion not attributable to the specific effects (PCE) of physical therapy interventions for musculoskeletal pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched Ovid, MEDLINE, EMBASE, CINAHL, Scopus, PEDro, Cochrane Controlled Trials Registry, and SPORTDiscus databases from inception to April 2023. STUDY SELECTION CRITERIA: Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain. DATA SYNTHESIS: Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (RoB 2). The proportion of physical therapy interventions effect that was not explained by the specific effect of the intervention was calculated, using the proportion not attributable to the specific effects (PCE) metric, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method). RESULTS: Sixty-eight studies were included in the systematic review (participants: n = 5238), and 54 placebo-controlled trials informed our meta-analysis (participants: n = 3793). Physical therapy interventions included soft tissue techniques, mobilization, manipulation, taping, exercise therapy, and dry needling. Placebo interventions included manual, nonmanual interventions, or both. The proportion not attributable to the specific effects of mobilization accounted for 88% of the immediate overall treatment effect for pain intensity (PCE = 0.88, 95% confidence interval [CI]: 0.57, 1.20). In exercise therapy, this proportion accounted for 46% of the overall treatment effect for pain intensity (PCE = 0.46, 95% CI: 0.41, 0.52). The PCE in manipulation excelled in short-term pain relief (PCE = 0.81, 95% CI: 0.62, 1.01) and in mobilization in long-term effects (PCE = 0.86, 95% CI: 0.76, 0.96). In taping, the PCE accounted for 64% of disability improvement (PCE = 0.64, 95% CI: 0.48, 0.80). CONCLUSION: The outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by factors not attributable to the specific effects of the interventions. Boosting these factors consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients. J Orthop Sports Phys Ther 2024;54(6):391-399. Epub 11 April 2024. doi:10.2519/jospt.2024.12126 .

Various studies have associated Attention-Deficit/Hyperactivity Disorder (ADHD) with obesity, but the role of physical activity in this connection is uncertain. This study examined whether adopting an active lifestyle can mitigate the link between adolescent ADHD and the risk of adult obesity. Longitudinal data from the Add Health Study (Waves I, III, and V) were used. Participants self-reported ADHD symptoms (hyperactivity/impulsivity, inattention, combined) during Wave III and self-assessed their recent moderate-to-vigorous physical activity. An "active lifestyle" required meeting activity criteria in both adolescence (Wave I) and adulthood (Wave III-V). Of 2609 participants, 1.42 % exhibited combined ADHD symptoms. A non-linear relationship was observed between inattentive/hyperactive scores and body mass index (BMI) and waist circumference (WC). Individuals with ≥ 6 hyperactivity/impulsivity symptoms had higher BMI (1.29 kg/m²) and WC (1.27 cm) at adulthood. Logistic regressions indicate that, compared to individuals without ADHD maintaining an active lifestyle, both inactive participants with and without ADHD show an elevated risk of obesity (odds ratio [OR]=1.56 to 2.63) and abdominal obesity in adulthood (OR = 1.51 to 2.50). Mediation analysis models further confirm these findings, suggesting that physical activity may explain this association. Though exact mechanisms warrant further exploration, adopting an active lifestyle offers promise for reducing obesity risk among individuals with ADHD symptoms., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aims: The aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022., Materials and Methods: Two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic)., Results: The study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10-14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090)., Conclusions: The IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM., (© 2023 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.)

Introduction: The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM., Methods and Analysis: A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed., Ethics and Dissemination: Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI&#95;2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system., Trial Registration: NCT06048757., 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 Hormazábal-Aguayo, Muñoz-Pardeza, López-Gil, Huerta-Uribe, Chueca-Guindulain, Berrade-Zubiri, Burillo Sánchez, Izquierdo, Ezzatvar and García-Hermoso.)

Aims: We aimed to determine whether physical activity attenuates preterm birth's adverse effects on adult cardiometabolic health., Methods: This retrospective study utilized data from the Add Health Study, a prospective cohort conducted in the United States. During Wave V (mean age: 37 years; 60.7% women; mean body mass index: 29 kg/m 2 ; mean waist circumference: 95 cm), we evaluated cardiometabolic risk factors and preterm birth status (i.e., born <37 weeks). Self-reported physical activity data was collected through questionnaires during Waves I (ages 12-19) and Wave V. An "active lifestyle" was defined by adherence to recommendations during both waves, spanning from adolescence to adulthood., Results: The sample, comprising 3320 individuals, with 9.5% being preterm, included 7.6% who remained physically active throughout both adolescence and adulthood. Preterm-born individuals who were inactive had higher rates of obesity (incidence rate ratio [IRR] = 1.39, 95% confidence interval (CI) 1.05-1.84), abdominal obesity (IRR = 1.46, 95% CI 1.11-1.92), hyperlipidemia (IRR 3.50, 95% CI 1.94-4.29), type 2 diabetes (IRR = 2.37, 95% CI 1.12-5.01), and metabolic syndrome (IRR = 2.61, 95% CI 1.17-5.80) compared to active term-born individuals. Maintaining an active lifestyle appeared to decrease the risk of obesity and hyperlipidemia in adults born preterm (p > 0.05)., Conclusions: While preterm birth is associated with an elevated risk of adult cardiometabolic risk, maintaining an active lifestyle appeared to slightly mitigate the risk of obesity and hyperlipidemia in adults born preterm., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Importance: Although benefits have been reported for most exercise modalities, the most effective exercise approaches for reducing insulin resistance in children and adolescents with excess weight and the optimal exercise dose remain unknown., Objective: To compare exercise training modalities and their association with changes in insulin resistance markers among children and adolescents with excess weight and to establish the optimal exercise dose., Data Sources: For this systematic review and network meta-analysis, 6 electronic databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and CINAHL) were searched for studies from inception to April 1, 2023., Study Selection: Randomized clinical trials (ie, randomized controlled trials and randomized trials without a control group) were included if they reported outcomes associated with aerobic training, resistance training, high-intensity interval training (HIIT), or a combination of these interventions., Data Extraction and Synthesis: Data extraction for this systematic review was conducted following a network meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Effect sizes were calculated as the mean difference (MD) with 95% CI using random-effects inverse-variance models with the Hartung-Knapp-Sidik-Jonkman method. The hierarchy of competing interventions was defined using the surface under the cumulative ranking curve. The Cochrane Risk-of-Bias tool, version 2 (RoB2), was used to independently assess the risk of bias of the included studies. The certainty of evidence in consistent networks was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. The study protocol was prospectively registered with PROSPERO. Data analyses were conducted between May and June 2023., Main Outcomes and Measures: The primary outcomes were fasting glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR)., Results: This analysis included 55 studies with a total of 3051 children and adolescents (mean [SD] age, 13.5 [2.3] years; 1537 girls [50.4%] and 1514 boys [49.6%]). Exercise was associated with reductions in fasting insulin (MD, -4.38 μU/mL [95% CI, -5.94 to -2.82 μU/mL]) and HOMA-IR (MD, -0.87 [95% CI, -1.20 to -0.53]). A nonlinear association in both markers was observed, with a required minimal exercise dosage of approximately 900 to 1200 metabolic equivalent of task minutes per week, especially in children and adolescents with insulin resistance at baseline. Combination HIIT and resistance training and concurrent training were the most effective approaches for reducing insulin resistance markers. On average, the certainty of evidence varied from low to moderate., Conclusions and Relevance: These findings underscore the role of exercise interventions in enhancing insulin resistance markers among children and adolescents with overweight and obesity. It is advisable to include resistance exercises alongside aerobic and HIIT programs for a minimum of two to three 60-minute sessions per week.

Purpose: To investigate the relationship between participation in physical education lessons (PELs), i.e., minutes or frequency per week, and meeting the 24-hour movement guidelines (i.e., physical activity, screen time, and sleep duration) during adolescence (12-17 years old) and adulthood (33-39 years old)., Methods: We analyzed data from individuals who participated in Waves I (1994-1995) and V (2016-2018) of the National Longitudinal Study of Adolescent Health. We determined total weekly minutes of PELs and PELs participation by asking how many days adolescents attended PELs in an average week at school, with three possible responses as follows: 0, 1-4, or 5 days/week. Movement behaviors were assessed through self-completed questionnaires in both waves., Results: Daily PELs participation during adolescence was related to higher odds of meeting five of more weekly sessions of moderate-to-vigorous physical activity and all three guidelines in both sexes compared with adolescents who reported no days of PELs per week (men: incidence rate ratio [IRR] = 1.70, 95% CI 1.02-3.12; women: IRR = 3.81, 95% CI 1.65-8.77). Additionally, each additional weekly hour of PELs increased the likelihood of meeting all three recommendations (men: IRR = 1.11, 95% CI 1.05-1.35; women: IRR = 1.67, 95% CI 1.27-2.24). During adulthood, daily PELs was also related to a higher likelihood of meeting all three recommendations in both sexes (men: IRR = 1.04, 95% CI 1.01-1.07; women: IRR = 1.07, 95% CI 1.00-1.11). Each additional weekly hour of PELs increased the odds of meeting all three recommendations (men: IRR = 1.02, 95% CI 1.01-1.05; women: IRR = 1.03, 95% CI 1.01-1.06)., Discussion: Daily PELs attendance was linked to healthy movement behaviors during adolescence, and these benefits could extend into adulthood., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of the study is to evaluate whether exercise interventions are associated with improved glycaemic control in children and adolescents with type 1 diabetes mellitus (T1DM), and to examine its relationship with the characteristics of the intervention (i.e. type, intensity, length, and duration of the sessions). Eligible criteria were randomised controlled trials of youth aged 6-18 years with T1DM, participating in an exercise-based intervention where glycaemic control is measured (i.e. glycated haemoglobin [HbA1c]). Pooled effect sizes (Hedges'g) were calculated using random-effects inverse-variance analyses. Fourteen studies enrolling 509 patients were analysed. Effect size was expressed as Hedges' g to correct for possible small sample bias. Overall, HbA1c levels in the exercise group (g = -0.38 95% confidence interval [CI], -0.66 to -0.11; mean difference [MD] = -0.62%) were reduced compared with the control group. Concurrent training (g = -0.63 95%CI, -1.05 to -0.21), high-intensity exercise (g = -0.43 95%CI, -0.83 to -0.03), interventions ≥24 weeks (g = -0.92 95%CI, -1.44 to -0.40), and sessions ≥60 minutes (g = -0.71 95%CI, -1.05 to -0.08) showed larger changes (MD = -0.66% to 1.30%). In conclusion, our study suggests that programmes longer than 24 weeks with at least 60 min/session of high-intensity concurrent exercise may serve as a supportive therapy to metabolic control in youth with T1DM. Highlights Exercise training has a moderate effect on the reduction of glycated haemoglobin (HbA1c) and insulin dose per day in youths with type 1 diabetes.Exercise training moderately increases cardiorespiratory fitness youths with type 1 diabetes.Reductions in HbA1c are stronger with high-intensity and concurrent training (i.e. aerobic and strength) interventions, and longer programmes.

Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.

To determine the association between adherence to the 24-h movement guidelines during adolescence with obesity at adulthood 14 years later in a nationally representative cohort. We analyzed data from 6984 individuals who participated in Waves I (1994-1995) and IV (2008-2009) of the National Longitudinal Study of Adolescent Health (Add Health) in the USA. Obesity was defined by the International Obesity Task Force cut-off points at Wave I and adult cut-points at Wave IV (body mass index [BMI]≥30 kg/m2 and waist circumference [WC]≥102 cm in male and 88 cm in female). Physical activity, screen time and sleep duration were self-reported. Adolescents who met screen time recommendation alone (β = -1.62 cm, 95%CI -2.68 cm to -0.56), jointly with physical activity (β = -2.25 cm, 95%CI -3.75 cm to -0.75 cm), and those who met all three recommendations (β = -1.92 cm, 95%CI -3.81 cm to -0.02 cm) obtained lower WC at Wave IV than those who did not meet any of these recommendations. Our results also show that meeting with screen time recommendations (IRR [incidence rate ratio] = 0.84, 95%CI 0.76 to 0.92) separately and jointly with physical activity recommendations (IRR = 0.86, 95%CI 0.67 to 0.97) during adolescence is associated with lower risk of abdominal obesity at adulthood. In addition, adolescents who met all 24-h movement recommendations had lower risk of abdominal obesity later in life (IRR = 0.76, 95%CI 0.60 to 0.97)., Conclusion: Promoting the adherence to the 24-h movement guidelines from adolescence, especially physical activity and screen time, seems to be related with lower risk of abdominal obesity later in life, but not for BMI., What Is Known: • Some studies have shown a relationship between adherence to 24-h movement guidelines and adiposity or obesity markers in youth. However, most of these studies have a cross-sectional design or a short follow-up., What Is New: • This is the first study which determined the association between adherence to the 24-h movement guidelines during adolescence with obesity at adulthood 14 years later in a nationally representative US cohort. • Meeting the 24-h movement guidelines from adolescence seems to be related with lower risk of abdominal obesity later in life, but not for body mass index., (© 2022. The Author(s).)

Purpose: The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes (glycated hemoglobin and fasting glucose) and type 2 diabetes mellitus (T2DM) in adulthood, 14 and 22 years later., Methods: We analyzed data from apparently healthy adolescents aged 12-18 years who participated in Waves I and II (1994-1996, n = 14,738), Wave IV (2008-2009, n = 8913), and Wave V (2016-2018, n = 3457) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the United States. Physical activity, screen time, and sleep duration were measured using questionnaires, and the 24-h guidelines were defined as: 5 or more times moderate-to-vigorous physical activity per week, ≤2 h per day of screen time, and 9-11 h of sleep for 12-13 years and 8-10 h for 14-17 years. Capillary and venous whole blood was collected and analyzed to determine glycated hemoglobin and fasting glucose for Waves IV and V, respectively., Results: Only 2.1% of the adolescents met all the 3 guidelines, and 37.8% met none of them. In both waves IV and V, adolescents who met physical activity and screen time guidelines had lower odds of T2DM in adulthood than those who did not meet any of these guidelines (Wave IV; prevalence ratio (PR) = 0.57, 95% confidence interval (95%CI): 0.21-0.89; Wave V: PR = 0.43, 95%CI: 0.32-0.74). Only for Wave V did adolescents who met all 3 guidelines have lower odds of T2DM at follow-up compared with those who did not meet any of these guidelines (PR = 0.47, 95%CI: 0.24-0.91). Also, for each increase in meeting one of the 24-h recommendations, the odds of T2DM decreased by 18% (PR = 0.82, 95%CI: 0.61-0.99) and 15% (PR = 0.85, 95%CI: 0.65-0.98) in adulthood for Waves IV and V, respectively., Conclusion: Promoting all 24-h movement guidelines in adolescence, especially physical activity and screen time, is important for lowering the potential risk of T2DM in adulthood., Competing Interests: Competing interests The authors declare that they have no competing interest., (Copyright © 2022. Production and hosting by Elsevier B.V.)

Objective: To estimate the global prevalence of meeting the WHO guidelines for both aerobic and muscle-strengthening activities (MSA) in populations aged ≥5 years, and whenever possible to explore this prevalence according to sociodemographic and lifestyle factors., Design: A systematic review and meta-analysis., Data Sources: Five databases were systematically searched for studies published from inception to September 2022., Eligibility Criteria for Selecting Studies: Articles with representative samples aged ≥5 years reporting the prevalence of meeting both aerobic and MSA guidelines were included., Results: Twenty-one studies comprising 3 390 001 individuals from 32 countries were included. Overall adherence to the aerobic and MSA guidelines was 17.12% (95% CI 15.42% to 18.88%) in adults ≥18 years (n=3 346 723). Among adolescents aged 12-17 years, adherence to both guidelines was 19.74% (95% CI 14.72% to 25.31%) (n=43 278). No studies reported data for children aged 5-11 years. Women, older age, low/medium education levels, underweight or obesity, and poor and moderate self-rated health were associated with lower adherence to the physical activity guidelines (p<0.001) among adults, although the prevalence remained very low in all cases. Subgroup analyses were not conducted with children and adolescents due to a lack of studies., Conclusions: Only one out of five adolescents and adults met the recommended combined aerobic and MSA guidelines. Large-scale public health interventions promoting both types of exercise are needed to reduce the associated burden of non-communicable diseases., Prospero Registration Number: CRD42022338422., Competing Interests: Competing interests: YE is an associate editor of BJSM., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims/hypothesis: This study sought to provide up-to-date pooled global estimates of diabetes-related amputation incidence from 2010 to 2020., Methods: Embase and Medline databases were searched for studies reporting the incidence rate (IR) of diabetes-related amputations from 2010 to 2020. IR estimates of diabetes-related amputations with associated 95% confidence interval (CI) per 100,000 individuals with diabetes were calculated., Results: 23 studies were included, reporting 505,390 diabetes-related lower extremity amputations. IR of minor amputations was 139.97 (95% CI 88.18-222.16) per 100,000 individuals with diabetes, among patients with type 1 diabetes was 148.59 (95% CI 65.00-339.68) and in type 2 diabetes was 75.53 (95% CI 29.94-190.54). IR of major amputations was 94.82 (95% CI 56.62-158.80) per 100,000 individuals with diabetes, among patients with type 1 diabetes was 100.76 (95% CI 53.71-189.01) and among type 2 diabetes was 40.58 (95% CI 11.03-149.28). There were 83.84 annual amputations (95% CI 41.67-168.65) per 100,000 women with diabetes and 178.04 (95% CI 81.16-390.55) per 100,000 men., Conclusions: Globally, annual incidence of diabetes-related amputations from 2010 to 2020 has shown to disproportionately affect men and individuals with type 1 diabetes mellitus, although its incidence is not uniform across countries., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The 24-h movement guidelines for youth and adults recommend the specific duration of physical activity, sedentary time, and sleep duration to ensure optimal health, but little is known about its relationship to mental health indicators. The aim of the study was to explore the association between 24-h movement guidelines in adolescence and its trajectories from middle adolescence (12-17 years old) to adulthood (33-39 years old) with depression and suicidal ideation in adulthood., Methods: This prospective cohort study included individuals who participated in Waves I (1994-1995) and V (2016-2018) of the National Longitudinal Study of Adolescent Health (Add Health) in the United States. Physical activity, screen time and sleep duration were measured using questionnaires. Adults were categorized as having depression if they had a self-reported history of depression and/or prescription medication-use for depression in the previous four weeks. Suicidal ideation was assessed by a self-reported single question in both waves. Poisson regression analyses were used to estimate the incidence rate ratio (IRR) of depression and suicidal ideation at adulthood, according to meeting specific and combinations of 24-h movement guidelines at Wave I and its trajectories from adolescence to adulthood., Results: The study included 7,069 individuals (56.8% women). Adolescents who met physical activity guidelines and all three guidelines at middle adolescence had lower risk of depression (IRR = 0.84, 95%CI 0.72 to 0.98) and suicidal ideation (IRR = 0.74, 95%CI 0.55 to 0.99) at adulthood than those who did not meet any of these guidelines, respectively. Individuals who met the guidelines for screen time and all three guidelines in both adolescence and adulthood had lower risk of depression (screen time, IRR = 0.87, 95% CI 0.72 to 0.98; all three, IRR = 0.37, 95% CI 0.15 to 0.92) and suicidal ideation (screen time, IRR = 0.74, 95% CI 0.51 to 0.97; all three, IRR = 0.12, 95% CI 0.06 to 0.33) than those who never met the guidelines. Additionally, individuals who did not meet all three guidelines in adolescence but met the guidelines in adulthood had lower risk of suicidal ideation than those who never met the guidelines (IRR = 0.81, 95%CI 0.45 to 0.89)., Conclusion: Our findings highlight the importance of promoting and maintaining adherence to the 24-h movement guidelines from middle adolescence to adulthood to prevent mental health problems. However, our findings must be interpreted carefully due to declared limitations, e.g., the self-reported assessments which are subject to sources of error and bias or that the dataset used to gauge meeting a guidelines (1994-1996) was made later (2016)., (© 2022. The Author(s).)

The relationship between adherence to the Mediterranean diet (MD), physical activity (PA), sedentary behaviour and physical fitness levels has been analysed in several studies; however, there is mixed evidence among youth. Thus, this study aimed to meta-analyse the associations between adherence to the MD, PA, sedentary behaviour and physical fitness among children and adolescents. Three databases were systematically searched, including cross-sectional and prospective designs with a sample of healthy youth aged 3-18 years. Random effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate the pooled effect size (correlation coefficient ( r )). Thirty-nine studies were included in the meta-analysis, yielding a total of 565 421 youth (mean age, 12·4 years). Overall, the MD had a weak-to-moderate positive relationship with PA ( r 0·14; 95 % CI 0·11, 0·17), cardiorespiratory fitness ( r 0·22; 95 % CI 0·13, 0·31) and muscular fitness ( r 0·11; 95 % CI 0·03, 0·18), and a small-to-moderate negative relationship with sedentary behaviour ( r -0·15; 95 % CI -0·20, -0·10) and speed-agility ( r -0·06; 95 % CI -0·12, -0·01). There was a high level of heterogeneity in all of the models ( I 2 ≥ 75 %). Overall, results did not remain significant after controlling for sex and age (children or adolescents) except for PA. Improving dietary habits towards those of the MD could be associated with higher physical fitness and PA in youth, lower sedentary behaviours and better health in general.

Objective: To quantify the association between physical activity and risk of SARS-CoV-2 infection, COVID-19-associated hospitalisation, severe illness and death due to COVID-19 in adults., Design: A systematic review and meta-analysis., Data Sources: Three databases were systematically searched through March 2022., Eligibility Criteria for Selecting Studies: Peer-reviewed articles reporting the association between regular physical activity and at least one COVID-19 outcome in adults were included. Risk estimates (ORs, relative risk (RR) ratios or HRs) were extracted and pooled using a random-effects inverse-variance model., Results: Sixteen studies were included (n=1 853 610). Overall, those who engaged in regular physical activity had a lower risk of infection (RR=0.89; 95% CI 0.84 to 0.95; I 2 =0%), hospitalisation (RR=0.64; 95% CI 0.54 to 0.76; I 2 =48.01%), severe COVID-19 illness (RR=0.66; 95% CI 0.58 to 0.77; I 2 =50.93%) and COVID-19-related death (RR=0.57; 95% CI 0.46 to 0.71; I 2 =26.63%) as compared with their inactive peers. The results indicated a non-linear dose-response relationship between physical activity presented in metabolic equivalent of task (MET)-min per week and severe COVID-19 illness and death (p for non-linearity <0.001) with a flattening of the dose-response curve at around 500 MET-min per week., Conclusions: Regular physical activity seems to be related to a lower likelihood of adverse COVID-19 outcomes. Our findings highlight the protective effects of engaging in sufficient physical activity as a public health strategy, with potential benefits to reduce the risk of severe COVID-19. Given the heterogeneity and risk of publication bias, further studies with standardised methodology and outcome reporting are now needed., Prospero Registration Number: CRD42022313629., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The present systematic review with meta-analysis sought to estimate the accuracy of different waist-to-height ratio (WHtR) cutoff ranges as risk indicators for cardiometabolic health in different populations of children and adolescents. Systematic searches were undertaken to identify studies in apparently healthy participants aged 3-18 years that conducted receiver operating characteristic curve analysis and reported area under the receiver operating characteristic curves for WHtR with any cardiometabolic biomarker. Forty-one cross-sectional studies were included in the meta-analysis, including 138,561 young individuals (50% girls). Higher area under summary receiver operating characteristic (AUSROC) values were observed in cutoffs between 0.46 and 0.50 (AUSROC = 0.83, 95%CI: 0.80-0.86) and ≥0.51 (AUSROC = 0.87, 95%CI: 0.84-0.90) (p < 0.001 in comparison with cutoffs 0.41 to 0.45), with similar results in both sexes. The AUSROC value increased in the East and Southeast Asian regions using a WHtR cutoff of ≥0.46 (AUSROC = 0.90, 95%CI: 0.87 to 0.92). A cutoff of ≥0.54 was optimal for the Latin American region (AUSROC = 0.96, 95%CI: 0.94-0.97). Our meta-analysis identified optimal cutoff values of WHtR for use in children and adolescents from different regions. Despite the widely accepted WHtR cutoff of 0.50, the present study indicated that a single cutoff value of WHtR may be inappropriate., (© 2021 World Obesity Federation.)

Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I 2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.

Aims/hypothesis: The aim of this work was to quantify racial/ethnic differences in risk for future diabetic complications and all-cause mortality by performing a meta-analysis of prospective studies., Methods: A systematic search in PubMed and EMBASE was performed from inception to May 2021. Prospective cohort studies that reported HRs and associated 95% CIs of diabetes complications and all-cause mortality among racial/ethnic groups, with White people as the reference group, were included. Study characteristics and HR estimates were extracted from each study. Estimates were pooled using random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman variance estimator., Results: A total of 23 studies were included, comprising 2,416,516 individuals diagnosed with diabetes (White 59.3%, Black 11.2%, Asian 1.3%, Hispanic-American 2.4%, Native American 0.2%, East Asian 1.9%, South Asian 0.8%, Pacific Islander 2.3%, Māori 2.4% and others 18.2%). Compared with White individuals with diabetes, individuals of Māori ethnicity were at higher risk for all-cause mortality (HR 1.88 [95% CI 1.61, 2.21]; I 2  = 7.1%), Hispanic-American individuals had a significantly lower risk for CVD (HR 0.66 [95% CI 0.53, 0.81]; I 2  = 0%) and Black individuals had higher risk for end-stage renal disease (HR 1.54 [95% CI 1.05, 2.24]; I 2  = 95.4%). No significant higher risk for diabetes complications was found in other racial/ethnic groups relative to White people., Conclusions/interpretation: Racial/ethnic differences exist in the risk for future diabetic complications and all-cause mortality. Our results support the use of such categories for international diabetes clinical guideline recommendations until better predictors become available. Efforts to identify high-risk groups and to better control cardiovascular risk factors across ethnically diverse populations are therefore needed., Registration: PROSPERO registration ID CRD42021239274., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The inverse association between cardiorespiratory fitness and all-cause mortality in apparently healthy populations has been previously reported; however, the existence of this association among adults diagnosed with cancer is unclear., Aim: To determine the association between cardiorespiratory fitness and all-cause mortality in adults diagnosed with cancer., Methods: Medline, Embase, and SPORTDiscus databases were searched. Eligible prospective cohort studies that examined the association of cardiorespiratory fitness with all-cause mortality in adults diagnosed with cancer were included. Hazard ratios (HRs) with associated 95% confidence intervals (CIs) were extracted from studies for all-cause mortality and pooled HRs were calculated using the random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment., Results: Data from 13 studies with 6,486 adults were included. Compared with lower levels of cardiorespiratory fitness, high levels were associated with a reduced risk of all-cause mortality among adults diagnosed with any cancer (HR = 0.52; 95% CI, 0.35-0.77), lung cancer (HR = 0.62; 95% CI, 0.46-0.83), and among those with cardiorespiratory fitness measurement via indirect calorimetry (HR = 0.47; 95% CI, 0.27-0.80). Pooled HRs for the reduction in all-cause mortality risk per 1-MET increase were also statistically significant (HR = 0.82; 95% CI, 0.69-0.99). Neither age at baseline nor the length of follow-up had a significant influence on the HR estimates for all-cause mortality risk., Conclusion: Cardiorespiratory fitness may confer an independent protective benefit against all-cause mortality in adults diagnosed with cancer. The use of cardiorespiratory fitness as a prognostic parameter might help determine risk for future adverse clinical events and optimize therapeutic management strategies to reduce long-term treatment-related effects in adults diagnosed with cancer., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Physical function is an independent predictor of numerous chronic diseases, but its association with all-cause mortality in older adults diagnosed with cancer has received little attention. The aim of this study was to conduct a systematic review and meta-analysis on the prospective association between physical function and all-cause mortality in older adults diagnosed with cancer., Methods: Two authors systematically searched MEDLINE, EMBASE, and SPORTDiscus databases. Prospective studies reporting associations of baseline physical function with all-cause mortality in patients aged 60 years or older diagnosed with any type of cancer were included. Hazard ratios (HR) with associated 95% confidence intervals (CI) were extracted from studies for all-cause mortality, and pooled HRs were then calculated using the random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment., Results: Data from 25 studies with 8109 adults diagnosed with cancer aged 60 and older were included in the study. Higher levels of physical function (short physical performance battery, HR = 0.44, 95% CI 0.29-0.67; I2 = 16.0%; timed up and go, HR = 0.40, 95% CI 0.31-0.53; I2 = 61.9%; gait speed, HR = 0.41, 95% CI 0.17-0.96; I2 = 73.3%; handgrip strength: HR = 0.61 95% CI 0.43-0.85, I2 = 85.6%; and overall, HR = 0.45 95% CI 0.35-0.57; I2 = 88.6%) were associated with a lower risk of all-cause mortality compared to lower levels of functionality. Neither age at baseline nor length of follow-up had a significant effect on the HR estimates for lower all-cause mortality risk., Conclusion: Physical function may exert an independent protective effect on all-cause mortality in older adults diagnosed with cancer., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Long periods of free-movement restrictions may negatively affect cardiorespiratory fitness and health. The present study investigated changes after the COVID-19 confinement in maximal oxygen intake (VO 2 max) levels in a sample of 89 Spanish school children aged 12 and 14 years at baseline (49.8% girls). The 20-m shuttle run test served to estimate VO 2 max before and after the COVID-19 confinement. Paired t-tests estimated an overall difference of - 0.5 ml.kg -1 .min -1 (SD 0.3) (p = 0.12), whereas the highest significant reductions were observed for girls aged 14 years (- 1.5 ml.kg -1 .min -1 (SD 0.6) (p < 0.05)). Boys aged 14 years showed a slight increase (0.4 ml.kg -1 .min -1 (SD 0.5) (p = 0.44)), whereas boys aged 12 years presented an important decrease (- 1.2 ml.kg -1 .min -1 (SD 0.7) (p = 0.14)). Healthy Fitness Zone (HFZ) levels also experienced a decrease of - 3.4% as regards baseline levels over the examined period. All the examined subgroups showed lower levels in relation to a normal VO 2 max rate development, although girls aged 14 and boys aged 12 years accounted for the highest part.Conclusion: The results indicate that COVID-19 confinement might delay the normal development of VO 2 max in adolescents. Strategies to tackle this concerning decline are warranted. What is Known: • First study analyzing cardiorespiratory fitness levels in teenagers after COVID-19 confinement. What is New: • Important delay in maximal oxygen intake identified in a sample of Spanish teenagers. • These results should be considered to develop strategies of a more active lifestyle in teenagers during and after confinements.

Lifestyle factors such as smoking, sedentarism, low physical activity levels, and overweight are associated with poor health, and they can potentially influence work ability. However, it remains unknown which lifestyle habits are associated with work ability among physical therapists (PTs). The aim of this study was to examine the associations between smoking, alcohol consumption, BMI, sitting time, and physical activity levels with work ability among PTs utilizing a nationwide questionnaire. Associations were modeled using logistic regression controlled for various confounders. Overweight, sitting >150 min/day, and <75 min/week of leisure-time vigorous physical activity were associated with lower work ability among PTs. Further, the existence of two unhealthy habits showed a weak-to-moderate positive association with lower work ability scores (Model 1: OR, 2.21, 95% CI = 1.16-4.22; Model 2: OR, 2.32, 95% CI, 1.18-4.54), with even stronger associations when three unhealthy habits (Model 1: OR = 3.30, 95% CI, 1.58-6.86; Model 2: OR, 3.34, 95% CI, 1.54-7.26) or four unhealthy habits (Model 1: OR = 8.91, 95% CI, 2.55-31.1; Model 2: OR = 8.20, 95% CI, 2.15-31.2) were present. In conclusion, overweight, low physical activity, and sedentarism were associated with lower levels of work ability, especially when ≥2 unhealthy lifestyle factors were present.

Objective: This study sought to analyze the prospective association between vigorous-intensity physical activity (VPA) and health-related outcomes in children and adolescents., Methods: Studies reporting associations between device-measured VPA and health-related factors in children and adolescents aged 3-18 years were identified through database searches (MEDLINE, EMBASE, and SPORTDiscus). Correlation coefficients were pooled if outcomes were reported by at least 3 studies, using DerSimonian-Laird random effects models., Results: Data from 23 studies including 13,674 participants were pooled using random effects models. Significant associations were found between VPA at baseline and overall adiposity (r = -0.09, 95% confidence interval (95%CI): -0.15 to -0.03; p = 0.002; I 2  = 89.8%), cardiometabolic risk score (r = -0.13, 95%CI: -0.24 to -0.02, p = 0.020; I 2  = 69.6%), cardiorespiratory fitness (r = 0.25, 95%CI: 0.15-0.35; p < 0.001; I 2  = 57.2%), and total body bone mineral density (r = 0.16, 95%CI: 0.06 to 0.25; p = 0.001; I 2  = 0%)., Conclusion: VPA seems to be negatively related to adiposity and cardiometabolic risk score and positively related to cardiorespiratory fitness and total body bone mineral density among children and adolescents at follow-up. Therefore, our findings support the need to strengthen physical activity recommendations regarding VPA due to its health benefits in children and adolescents., (Copyright © 2021. Production and hosting by Elsevier B.V.)

Knee osteoarthritis is a chronic joint disease which damages articular cartilage. In its severe stages, it results in impairments in balance and muscle strength loss, which affect daily life activities such as walking or climbing stairs. This study sought to investigate associated factors with stair-climbing ability in this population, with special interest in measuring the relevance of postural balance for this task. Forty-four patients scheduled to undergo unilateral total knee arthroplasty were assessed. Timed up and go test, stair ascent-descent test, three different isometric strength tests (knee flexion, knee extension and hip abduction), active knee extension and flexion range of movement and static postural balance assessment were evaluated. Spearman's correlation coefficients and multiple linear regression analysis determined the strength of association between the different variables and stair-climbing time. No significant association between the stair-climbing time and static balance was found. Significant associations were found between stair-climbing time and timed up and go (r = 0.71; p < 0.0001) and maximal knee extensor strength (r = -0.52; p = 0.0003). One-year increase in age was associated with 0.15 s (95% CI 0.00 to 0.30) slower stair-climbing time. In conclusion, muscle strength is more important than postural balance for stair-climbing ability in this population.

The Work Ability Index (WAI) is a validated and widely used tool in occupational research. However, normative values for physical therapists (PTs) by age and sex are lacking. Although the nature of PTs' work is physically demanding, it is unknown whether muscular fitness is associated with their WAI. This study sought to provide reference WAI data for Spanish PTs and to evaluate the association between PTs' muscular fitness and WAI. Data on WAI of 1005 PTs were collected using a questionnaire. A subgroup ( n = 68) performed a battery of physical tests including grip strength, push-ups and back-extension endurance. Associations between muscular fitness and WAI were evaluated using logistic regression controlling for various confounders. PTs aged 50 years or older had lower WAI scores than their younger counterparts. PTs with high back-extension endurance scored 3.5 (95% CI) higher in the WAI than those with low endurance. No associations were found between grip strength or number of push-ups and WAI. Our findings seem to highlight the importance of muscular fitness in PTs, especially the back-extension endurance.