Search

We assessed the validity and reliability of the new 15m square shuttle run test (SST) for predicting laboratory treadmill test (TT) maximal oxygen uptake (VO(2 max)) compared to the 20 m multistage shuttle run test (MST) in 45 adult males. Thirty participants performed a TT and a SST once to develop a VO( 2max) prediction model. The remaining 15 participants performed the TT and MST once and the SST twice for cross-validation purposes. Throughout testing V O(2max) was determined via portable indirect calorimetry while blood lactate concentration was assessed at the fifth recovery minute. Comparisons of TT V O(2 max) (51.3+/-3.1 ml kg(-1)min(-1)) with SST measured (51.2+/-3.2 ml kg(-1)min(-1)) and predicted (50.9+/-3.3 ml kg(-1)min(-1)) V O(2 max) showed no differences while TT blood lactate was higher compared to SST (10.3+/-1.7 mmol vs. 9.7+/-1.7 mmol, respectively). In contrast, MST measured (53.4+/-3.5 ml kg(-1)min(-1)) and predicted (57.0+/-4.5 ml kg(-1)min(-1)) V O(2 max) and blood lactate (11.2+/-2.0 mmol) were significantly higher compared to TT. No test-retest differences were detected for SST measured and predicted V O(2 max) and blood lactate. It is concluded that the SST is a highly valid and reliable predictive test for V O(2 max). [ABSTRACT FROM AUTHOR]

The physical demands imposed on contemporary dancers by choreographers and performance schedules make their physical fitness just as important to them as skill development. Nevertheless, it remains to be confirmed which physical fitness components are associated with aesthetic competence. The aim of this study was to: 1. replicate and test a novel aesthetic competence tool for reliability, and 2. investigate the association between selected physical fitness components and aesthetic competence by using this new tool. Seventeen volunteers underwent a series of physical fitness tests (body composition, flexibility, muscular power and endurance, and aerobic capacity) and aesthetic competence assessments (seven individual criteria commonly used by selected dance companies). Inter-rater reliability of the aesthetic competence tool was very high (r = 0.96). There were significant correlations between the aesthetic competence score and jump ability and push-ups (r = 0.55 and r = 0.55, respectively). Stepwise backward multiple regression analysis revealed that the best predictor of aesthetic competence was push-ups (R(2) = 0.30, p = 0.03). Univariate analyses also revealed that the interaction of push-ups and jump ability improved the prediction power of aesthetic competence (R(2) = 0.44, p = 0.004). It is concluded that upper body muscular endurance and jump ability best predict aesthetic competence of the present sample of contemporary dancers. Further research is required to investigate the contribution of other components of aesthetic competence, including upper body strength, lower body muscular endurance, general coordination, and static and dynamic balance. [ABSTRACT FROM AUTHOR]

RATIONALE: The acute effect of secondhand smoke (SHS) on lung function and the duration of system disruption remain unknown. OBJECTIVES: To assess the SHS effects and their duration on lung function and inflammatory markers. METHODS: In a randomized single-blind crossover experiment data were obtained from 16 (8 women) nonsmoking adults at baseline and at 0, 1, and 3 hours after a 1-hour SHS exposure set at bar/restaurant SHS levels. MEASUREMENTS AND MAIN RESULTS: Serum and urine cotinine, lung function, and cytokines IL-4, IL-5, IL-6, tumor necrosis factor (TNF)-alpha, and IFN-gamma. At 0 hours most lung function parameters were significantly reduced (indicative: FEV(1), 4.3 +/- 0.4 vs. 3.8 +/- 0.3 L; FEV(1)/FVC, 0.9 +/- 0.1 vs. 0.8 +/- 0.1; P < 0.05) but at 3 hours they were at baseline levels. In contrast, cotinine (serum, 8.9 +/- 3.2 vs. 35.5 +/- 10.2 ng x ml(-1)), IL-4 (41.3 +/- 5.8 vs. 44.2 +/- 4.5 pg x ml(-1)), IL-5 (36.1 +/- 3.2 vs. 60.1 +/- 7.0 pg x ml(-1)), IL-6 (2.5 +/- 0.3 vs. 7.6 +/- 1.4 pg x ml(-1)) and IFN-gamma (0.3 +/- 0.2 vs. 0.6 +/- 0.2 IU x ml(-1)) at 3 hours were higher than at baseline (P < 0.05). IL-4 and TNF-alpha increased only in men, whereas IL-5, IL-6, and IFN-gamma were different between sexes after exposure (P < 0.05). Regression analyses revealed inverse associations of FEV(1) and FEV(1)/FVC ratio with IL-5 (P < 0.05) in men and with IL-5 (P = 0.01), IL-6 (P < 0.001), IFN-gamma (P = 0.034) and serum cotinine (P < 0.001) in women. CONCLUSIONS: We conclude that 1 hour of SHS exposure at bar/restaurant levels is accompanied by significant decrements on lung function and marked increases in inflammatory cytokines, particularly in men. More importantly, whereas most smoke-induced effects on lung function appear to recede within 60 minutes, inflammatory cytokines remain elevated for at least 3 hours after exposure to SHS. [ABSTRACT FROM AUTHOR]

Limited data are available on whether different physical fitness levels are associated with injury severity in contemporary dancers. The aim of this study was to investigate this association in female dancers. Five professional contemporary dancers and 11 dance students in pre-professional training volunteered (n = 16). All participants underwent selected fitness assessments (anthropometry, flexibility, muscular power and endurance, aerobic capacity) and completed a seven-item recall questionnaire about their last 12-month injury history. Pearson's coefficients detected significant negative correlations between the total number of days off due to injuries and standing vertical jump (r = -0.66; p = 0.014). Backward regression analysis also revealed that days off due to injuries was best predicted from standing vertical jump performance (p = 0.014). Results suggest that a reduced level of lower body muscular power is associated with increased severity of injuries in female contemporary dancers. More research using appropriate methodological designs, such as sample size calculations and randomization and the use of contemporary dance movements only, is needed to investigate the effects of physical fitness levels on injury severity in contemporary dance. [ABSTRACT FROM AUTHOR]

To date, the effects of body composition on injury occurrence and healing times in dancers have received limited scientific attention. The aim of the current study was to determine possible associations between somatotype, percent body fat, and self-reported injury characteristics in dance students. Forty-two full-time ballet students (11 male, 31 female) from two vocational dance schools volunteered for the study. The Heath-Carter protocol and Siri equation were adopted to calculate somatotype and percent body fat (%BF), respectively. Injury types, together with the time taken to recover from injury, were assessed using a recall injury questionnaire. Results revealed that the sample was classified as balanced-mesomorph somatotype (endomorphy -- mesomorphy -- ectomorphy = 3.4±0.9 -- 3.9±1.4 -- 3.2±1.2). Ectomorphy was a strong predictor of the number of acute injuries sustained (F1,36 = 5.4, p = 0.026); these parameters also revealed a significant negative correlation (r = -0.37, p = 0.016). Significant negative correlations were observed between the dancers' total time off due to injury and %BF (r = -0.31, p = 0.048) and between the total time off resulting from acute injury and both %BF (r = -0.32, p = 0.04) and ectomorphy (r = -0.42, p = 0.005). The number of overuse injuries sustained and time off due to overuse injury also were correlated with mesomorphy (r = -0.38, p = 0.015 and r = -0.33, p = 0.032, respectively). It was concluded that high ectomorphy ratings, low %BF values, and low mesomorphy ratings are linked to injury. More relevant research is required on dancers from different genres. [ABSTRACT FROM AUTHOR]

We assessed validity and reliability of the new 20m square shuttle run test (SST) for predicting maximal oxygen uptake (V O(2max)) and compared it with its predecessor, the 20m Multistage Shuttle Run Test (MST). In a repeated-measures randomised-block design, 74 healthy adult males performed the SST, the MST and a treadmill test (TT). To assess reliability, 40 of the total 74 volunteers were randomly-selected to perform the SST and MST twice. Unlike the SST (p>0.05), mean predicted V O(2max)(V predO(2max)) from the MST was significantly increased from that measured during the TT (p<0.05). The V predO(2max) from SST and MST correlated with TT V O(2max) at r=0.95 (p<0.001) and r=0.63 (p<0.001), respectively. Prediction error of SST was -0.3+/-3.3mlkg(-1)min(-1) with a coefficient of variation of +/-3.5%, while the equivalent values for MST were 4.2+/-7.3mlkg(-1)min(-1) and +/-7.4%. Mean test-retest V predO(2max) did not differ for both SST and MST (p>0.05), while the corresponding test-retest correlation coefficients were r=0.85 (p<0.001) and r=0.72 (p<0.001). Reliability errors in 95% limits of agreement were 0.3+/-4.8 and 0.6+/-6.8mlkg(-1)min(-1) while coefficients of variation were +/-5.2% and +/-6.8% for the SST and MST, respectively. It is concluded that SST is a more valid proxy than MST for predicting laboratory V O(2max) based on the current procedures, while both tests are sufficiently reliable in healthy male adults. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Maximal oxygen uptake (Vo(2max)) of 44 ml kg(-1) min(-1) is an accepted criterion (Vo(2CR)) below which health and fitness for young male adults may be compromised. New algorithms validated for Vo(2CR) screening using the 20 m multistage shuttle run test (20mMST) were developed. METHODS: Vo(2max) was assessed in 110 males using a stationary gas analyser in a treadmill test (TT) and in 40 of these subjects using a portable gas analyser in the 20mMST. Vo(2max) predicted from the 20mMST in 70 subjects was used for cross validation. Two equations predicting Vo(2max) during 20mMST (EQ(MST)) and TT (EQ(TT)) were developed. RESULTS: Significant energy cost variance (EC(V)) was detected between TT and 20mMST (p<0.001), correlated significantly with subject height, and was a significant predictor of Vo(2max) differences between TT and 20mMST. The r(2) of EQ(MST) was 0.92 (p<0.001). Predicted Vo(2max) values from EQ(MST) correlated with directly measured 20mMST Vo(2max) at r = 0.96 (p<0.001). ANOVA detected no mean difference (p>0.05) between predicted and measured values. Prevalence of low fitness based on Vo(2CR) was 0.37. McNemar chi(2) indicated significant differences in sensitivity (p<0.001) and specificity (p<0.05) between the original 20mMST equation (EQ(LEG)) and EQ(TT), regarding Vo(2CR) screening. Cohen's kappa demonstrated higher agreement with TT Vo(2max) for EQ(TT) (p<0.001) than EQ(LEG) (p<0.05). TT Vo(2max) correlated with the end result of both EQ(LEG) and EQ(TT) at r = 0.75 (p<0.001). Unlike EQ(TT) (p>0.05), mean predicted Vo(2max) from EQ(LEG) was significantly higher compared to TT Vo(2max) (p<0.001). CONCLUSION: These algorithms increase the efficacy of 20mMST to accurately evaluate aspects of health and fitness. [ABSTRACT FROM AUTHOR]

Introduction: The 2018 published World Health Organisation (WHO) Europe physical activity factsheet reports, specify agreed targets for physical activity and articulate the need to improve the education of medical doctors and healthcare practitioners in order to increase physical activity and reduce sedentary time in people at risk and/or living with Noncommunicable Diseases (NCDs). Given the dearth of relevant initiatives and the continuous need to increase physical activity participation towards better health management of NCDs, the aim of this study is to embed physical activity in the undergraduate curricula of future frontline healthcare professionals (medical doctors and allied health professions) in European countries., Methods: The V irtual A dvice, N urturing, G uidance on U niversal A ction, R esearch and D evelopment for physical activity and sport engagement (VANGUARD) project consists of a collaborative partnership Consortium between six European Universities, WHO Europe and Ministry representatives that has been developed to implement physical activity in the curricula of medical schools and healthcare professions. The methodology of the VANGUARD project is informed by the WHO implementation guidance and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework., Discussion: Through a carefully planned implementation process and via using established appropriate implementation evaluation tools, the end result of the VANGUARD project will be the a) implementation of a physical activity module in six different European Universities (five medical schools and one physiotherapy department) and b) development of a toolkit/guide, in order to assist other healthcare systems and European Universities to develop relevant grass-root innovations for addressing the decline in physical activity levels., Competing Interests: The authors declare no conflict of interest., (© 2024 The Mediterranean Journal of Rheumatology (MJR).)

Background: The purpose of our systematic review was to examine the effects of any physical activity/exercise intervention combined with any diet/nutrition intervention on any biological/biochemical index, quality of life (QoL), and depression in breast, lung, colon and rectum, prostate, stomach, and liver cancer patients and/or cancer survivors., Methods: A systematic review and meta-analysis were undertaken, using PRISMA guidelines and the Cochrane Handbook. The systematic review protocol can be found in the PROSPERO database; registration number: CRD42023481429., Results: We found moderate-quality evidence that a combined intervention of physical activity/exercise and nutrition/diet reduced body mass index, body weight, fat mass, insulin, homeostatic model assessment for insulin resistance, C-reactive protein, triglycerides, and depression, while it increased high-density lipoprotein, the physical component of QoL, and general functional assessment of cancer therapy., Conclusions: We conclude that a combined intervention of physical activity/exercise and diet/nutrition may decrease body weight, fat mass, insulin levels, and inflammation, and improve lipidemic profile, the physical component of QoL, and depression in cancer patients and survivors. These outcomes indicate a lower risk for carcinogenesis; however, their applicability depends on the heterogeneity of the population and interventions, as well as the potential medical treatment of cancer patients and survivors.

Introduction: The importance and potential benefits of muscular strength in the adolescent's development for health and fitness has been demonstrated in the literature. Maximal muscular strength and its assessment, however, is not a primary assessment criterium in the selection of young talented dancers., Methods: The present study evaluated the within- and between session reliability, variability, and minimal detectable change (MDC) of the isometric mid-thigh pull (IMTP). Thirty-five participants (female n = 17) participated in 2 identical assessments on the same day with 4-hour break in between. Three 3-second IMTP were performed, and the mean peak force value was used for the analyses., Results: Within-session the ICC indicated excellent reliability (ICC = .99, 95% CI: 0.98-0.99). Between-session reliability was excellent (ICC = .98, 95% CI: 0.95-0.99). The standard error of measurement was 4% (48 N), the minimum detectable change was 12% (134 N) and the CV was 3%. There were no within-session statistically significant differences, but statistically significant differences between-session were observed ( P  < .001). Limits of agreement ranged from -121 N (95% CI -186 to -56 N) to 307 N (95% CI 243-372 N)., Conclusion: The observed results demonstrated excellent within- and between sessions reliability, low variability, and an MDC of 12%. The consistency of the within-session scores suggest that peak force data may be obtained with single try efforts. The statistically significant difference in the means of the retest session, however, suggests that the time of the day or the time since entrained awakening may be affecting performance in adolescent dancers. The results of the current study indicate that the IMTP is a reliable assessment tool for maximal muscular strength in adolescent dancers., 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.

Cardiometabolic diseases (CMDs) are complex disorders with a heterogenous phenotype, which are caused by multiple factors including genetic factors. Single nucleotide polymorphisms (SNPs) rs45539933 (p.Ala64Thr), rs10011540 (c.-112A>C), rs3811791 (c.-1766A>G), and rs1800592 (c.-3826A>G) in the UCP1 gene have been analyzed for association with CMDs in many studies providing controversial results. However, previous studies only considered individual UCP1 SNPs and did not evaluate them in an integrated manner, which is a more powerful approach to uncover genetic component of complex diseases. This study aimed to investigate associations between UCP1 genotype combinations and CMDs or CMD risk factors in the context of non-genetic factors. We performed multiple logistic regression analysis and proposed new methodology of testing different combinations of SNP genotypes. We found that probability of CMDs increased in presence of the three-SNP combination of genotypes with minor alleles of c.-3826A>G and p.Ala64Thr and wild allele of c.-112A>C, with increasing age, body mass index (BMI), body fat percentage (BF%) and may differ between sexes and between countries. The combination of genotypes with c.-3826A>G minor allele and wild homozygotes of c.-112A>C and p.Ala64Thr was associated with increased probability of diabetes. While combination of genotypes with minor alleles of all three SNPs reduced the CMD probability. The present results suggest that age, BMI, sex, and UCP1 three-SNP combinations of genotypes significantly contribute to CMD probability. Varying of c.-112A>C alleles in the genotype combination with minor alleles of c.-3826A>G and p.Ala64Thr markedly changes CMD probability., Competing Interests: Declaration of competing interest The authors have declared that no competing interests exist., (Copyright © 2023 Elsevier B.V. and Société Française de Biochimie et Biologie Moléculaire (SFBBM). All rights reserved.)

Objectives: To assess the effect of high-intensity interval training (HIIT) delivered in physiotherapy primary care on the primary outcome of cardiorespiratory fitness (CRF) in patients with inflammatory arthritis (IA). Additionally, to explore the effects of HIIT on secondary outcomes, including cardiovascular disease (CVD) risk factors and disease activity., Methods: Single-blinded randomised controlled trial with 60 patients randomly assigned to either a control group receiving usual care or an exercise group receiving usual care and 12 weeks of individualised HIIT at 90%-95% peak heart rate. Outcomes were assessed at baseline, 3 months and 6 months post baseline and included CRF measured as peak oxygen uptake (VO 2peak ), classic CVD risk factors, disease activity, anthropometry and patient-reported physical activity, pain, fatigue, disease impact and exercise beliefs and self-efficacy., Results: Intention-to-treat analysis demonstrated a significant between-group difference in VO 2peak at 3 months (2.5 mL/kg/min, 95% CI 0.9 to 4.0) and 6 months (2.6 mL/kg/min, 95% CI 0.8 to 4.3) in favour of the exercise group. A beneficial change in self-reported physical activity in favour of the exercise group was observed at 3 and 6 months. The HIIT intervention was well-tolerated with minimal adverse events and no apparent impact on disease activity. Differences in secondary outcomes related to CVD risk factors, disease impact, pain, fatigue and exercise beliefs and self-efficacy were generally small and non-significant., Conclusion: After 12 weeks of supervised HIIT delivered in physiotherapy primary care, patients with IA demonstrated a favourable improvement in CRF, with sustained effects at 6-month follow-up., Trial Registration Number: NCT04922840., Competing Interests: Competing interests: KRN has received lecture honoraria from UCB. AGS has received lecture honoraria from Merck/Schering-Plough, BMS, UCB, Pfizer/Wyeth, Sanofi, Novartis, Pfizer and Lilly and is secretary of ESC Cardiovascular Pharmacotherapy working group., (© 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.)

Background: Individuals with rheumatoid arthritis (RA) are at a high risk of cardiovascular diseases (CVD). A reduced chronotropic response (CR), which produces exercise intolerance, is known to be a contributing factor to CVD and mortality. Studies have shown that patients with RA have a reduced CR. However, knowledge of CR-related factors in patients with RA is limited. This study aimed to explore CR-related factors, including CVD risk factors, inflammatory markers, and cardiorespiratory fitness (VO 2PEAK )., Methods: A total of 106 RA patients underwent a treadmill test, heart rate monitoring, and various assessments, including serological CVD risk factors, inflammatory markers, and VO 2PEAK ., Results: A total of 34% of participants demonstrated a reduced CR (≤80%). Body mass index, HOMA, hsCRP, and fibrinogen were inversely related to CR, while HDL, QUICKi, VO 2PEAK , and RER exhibited a positive association. HDL and VO 2PEAK emerged as independent CR-related factors in regression analysis., Conclusions: The current findings suggest that reduced CR in RA is associated with several CVD risk factors, inflammatory markers, and cardiorespiratory fitness. Future studies should investigate the effects of controlling these associated variables on CR in patients with RA.

Cardiorespiratory fitness (CRF) is an excellent marker of overall health. This study aimed to assess criterion validity and responsiveness of estimated CRF models (eCRF) in patients with inflammatory joint disease (IJD). CRF was measured directly as peak oxygen uptake (VO 2peak ) by a Cardiopulmonary Exercise Test (CPET), while one generic eCRF model (eCRF GEN ) and two disease-specific eCRF models (eCRF ALT and eCRF PGA ) were used to estimate CRF at baseline and after 3 months in 55 Norwegian patients with IJD. Moderate correlations were observed between eCRF GEN , eCRF ALT , eCRF PGA , and VO 2peak at baseline (ICC 0.60, 0.64 and 0.62, respectively) and 3 months (ICC 0.62, 0.65 and 0.57, respectively). All eCRF models overestimated measured VO 2peak , and there was large variability in agreement of individual measurements at baseline and at 3 months. Weak correlations were observed for responsiveness of eCRF GEN (ICC 0.39), eCRF ALT (ICC 0.40) and eCRF PGA (ICC 0.39). Mean differences between change in eCRF models and change in VO 2peak were small, but the wide limits of agreement exceeded the pre-defined clinically acceptable margins. The eCRF models possessed adequate ability to detect ≥3.5 mL/kg/min improvement in VO 2peak . eCRF may suffice for group-level assessment, but caution is advised when applying eCRF to individual patients with IJD.

Introduction: Quantitative Sensory Testing (QST) modalities used to assess central pain mechanisms require different protocols in people with different musculoskeletal conditions., Objectives: We aimed to explore the possible effects of musculoskeletal diagnosis and test site on QST interrater and test-retest reliability., Methods: The study included participants with rheumatoid arthritis (RA, n = 18; QST conducted on lower leg) and low back pain (LBP, n = 25; QST conducted on forearm), plus 45 healthy control participants (n = 20 QST on lower leg and n = 25 QST on forearm). Test-retest reliability was assessed from QST conducted 1 to 3 weeks apart. Quantitative sensory testing modalities used were pressure pain detection threshold (PPT) at a site distant to tissue pathology, temporal summation (TS), and conditioned pain modulation (CPM). Temporal summation was calculated as difference or ratio of single and repeated punctate stimuli and unconditioned thresholds for CPM used single or mean of multiple PPTs. Intraclass correlation coefficients (ICCs) were compared between different subgroups., Results: High to very high reliability was found for all assessments of PPT and TS across anatomical sites (lower leg and forearm) and participants (healthy, RA, and LBP) (ICC ≥ 0.77 for PPT and ICC ≥ 0.76 for TS). Reliability was higher when TS was calculated as a difference rather than a ratio. Conditioned pain modulation showed no to moderate reliability (ICC = 0.01-0.64) that was similar between leg or forearm, and between healthy people and those with RA or LBP., Conclusion: PPT and TS are transferable tools to quantify pain sensitivity at different testing sites in different musculoskeletal diagnoses. Low apparent reliability of CPM protocols might indicate minute-to-minute dynamic pain modulation., Competing Interests: D.F.M. has grant support from Eli Lilly and Pfizer for projects outside of this study. D.A.W. has grant support from Eli Lilly, UCB and Pfizer for projects outside of this study. Consultancies for Pfizer, AbbVie, GSK. No other potential conflicts were declared by other authors.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)

Background: Lifestyle physical activity (PA) is defined as any type of PA undertaken as part of daily life. It can include engagement in activities of daily living (i.e., household chores, gardening, walking to work), incidental PA, walking and/or reducing sedentary or sitting behaviours (SB). Regular PA is recommended for people with Rheumatoid Arthritis (RA) to reduce disease activity and systemic inflammation, as well as to improve patient- and clinician-important health outcomes. However, there is no summarised evidence of the effectiveness of interventions specifically targeting lifestyle PA and SB in this population. The aims of this systematic review with meta-analysis were to evaluate interventions targeting lifestyle PA and/or SB on 1) disease activity; 2) PA, SB and 3) patient- and clinician-important outcomes in people with RA., Methods: Eight databases [Medline, Cochrane Library CENTRAL, Web of Science, PsychINFO, Cumulative Index to Nursing & Allied Health Literature, Scopus, Excerpta Medica database and Physiotherapy Evidence Database] were searched from inception-August 2022. Inclusion criteria required interventions to target lifestyle PA and/or SB, conducted in adults with RA, assessing patient- and/or clinician-important outcomes., Results: Of 880 relevant articles, 16 interventions met the inclusion criteria. Meta-analyses showed statistically significant effects of interventions on disease activity (standardised mean difference = -0.12 (95% confidence interval = -0.23 to -0.01, I 2  = 6%, z = 2.19, p = .03), moderate-to-vigorous PA, light/leisure PA, steps, functional ability, and fatigue. Whereas, no intervention effects were visualised for total PA, pain, anxiety or quality of life., Conclusions: Lifestyle PA interventions led to increased PA, reductions in SB and improvements in disease activity and other patient- and/or clinician-important health outcomes in people with RA. Future interventions should be less heterogenous in content, structure, focus and outcome measures used to aid understanding of the most effective intervention components for improving health. More SB interventions are needed to determine their effectiveness at producing clinical benefits., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Competing Interests: Competing interests: None declared.

Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and rank the importance of known barriers and facilitators for engaging in PA, from the perspective of people living with RMD. Five hundred thirty-three people with RMD responded to a survey (nine questions) disseminated by the People with Arthritis and Rheumatism (PARE) network of the European Alliance of Associations for Rheumatology (EULAR). The survey required participants to rank - based on their perceived importance - known PA barriers and facilitators from the literature, and specifically RMD symptoms as well as healthcare and community factors that may affect PA participation. Of the participants, 58% reported rheumatoid arthritis as their primary diagnosis, 89% were female, and 59% were between 51 and 70 years of age. Overall, participants reported fatigue (61.4%), pain (53.6%) and painful/swollen joints (50.6%) as the highest ranked barriers for engaging in PA. Conversely, less fatigue (66.8%) and pain (63.6%), and being able to do daily activities more easy (56.3%) were identified as the most important facilitators to PA. Three literature identified PA barriers, i.e., general health (78.8%), fitness (75.3%) and mental health (68.1%), were also ranked as being the most important for PA engagement. Symptoms of RMDs, such as pain and fatigue, seem to be considered the predominant barriers to PA by people with RMD; the same barriers are also the ones that they want to improve through increasing PA, suggesting a bi-directional relationship between these factors. Key Points • Symptoms of rheumatic and musculoskeletal disease (RMD) are the predominant barriers for lack of physical activity engagement. • RMD symptoms are the factors that people with RMDs want to improve when engaging in PA. • The barriers that stop people living with RMDs to do more PA are the ones that can be significantly improved through PA engagement., (© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Coronavirus Disease 2019 (COVID-19) has significantly affected different physiological systems, with a potentially profound effect on athletic performance. However, to date, such an effect has been neither addressed nor investigated. Therefore, the aim of this study was to investigate fitness indicators, along with the respiratory and metabolic profile, in post-COVID-19 athletes. Forty male soccer players, were divided into two groups: non-hospitalized COVID-19 ( n  = 20, Age: [25.2 ± 4.1] years, Body Surface Area [BSA]: [1.9 ± 0.2] m 2 , body fat: 11.8% ± 3.4%) versus [vs] healthy ( n  = 20, Age: [25.1 ± 4.4] years, BSA: [2.0 ± 0.3] m 2 , body fat: 10.8% ± 4.5%). For each athlete, prior to cardiopulmonary exercise testing (CPET), body composition, spirometry, and lactate blood levels, were recorded. Differences between groups were assessed with the independent samples t -test ( p  < 0.05). Several differences were detected between the two groups: ventilation ( V ˙ E : Resting: [14.7 ± 3.1] L·min -1 vs. [11.5 ± 2.6] L·min -1 , p  = 0.001; Maximal Effort: [137.1 ± 15.5] L·min -1 vs. [109.1 ± 18.4] L·min -1 , p  < 0.001), ratio V E /maximal voluntary ventilation (Resting: 7.9% ± 1.8% vs. 5.7% ± 1.7%, p  < 0.001; Maximal Effort: 73.7% ± 10.8% vs. 63.1% ± 9.0%, p  = 0.002), ratioV E /BSA (Resting: 7.9% ± 2.0% vs. 5.9% ± 1.4%, p  = 0.001; Maximal Effort: 73.7% ± 11.1% vs. 66.2% ± 9.2%, p  = 0.026), heart rate (Maximal Effort: [191.6 ± 7.8] bpm vs. [196.6 ± 8.6] bpm, p  = 0.041), and lactate acid (Resting: [1.8 ± 0.8] mmol·L -1 vs. [0.9 ± 0.1] mmol·L -1 , p  < 0.001; Maximal Effort: [11.0 ± 1.6] mmol·L -1 vs. [9.8 ± 1.2] mmol·L -1 , p  = 0.009), during CPET. No significant differences were identified regarding maximal oxygen uptake ([55.7 ± 4.4] ml·min -1 ·kg -1 vs. [55.4 ± 4.6] ml·min -1 ·kg -1 , p  = 0.831). Our findings demonstrate a pattern of compromised respiratory function in post-COVID-19 athletes characterized by increased respiratory work at both rest and maximum effort as well as hyperventilation during exercise, which may explain the reported increased metabolic needs., Competing Interests: 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., (© 2022 Chengdu Sport University. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.)

Research evidence suggests that, individually, diet and physical activity are effective interventions for reducing levels of inflammation in inflammatory joint diseases (IJD), however little is known about their combined use. This systematic review and meta-analysis aimed to examine the effects and/or associations of combined diet and physical activity interventions in IJD, specifically rheumatoid arthritis (RA) and the spondyloarthropathies (SpA) (PROSPERO registration number: CRD42022370993). Ten out of 11 eligible studies examined RA patients. We found that a combination of diet/nutrition and physical activity/exercise improved Health Assessment Questionnaire score (standardized mean difference = -1.36, confidence interval (CI) = (-2.43)-(-0.30), I 2 = 90%, Z = 2.5, p = 0.01), while surprisingly they increased erythrocyte sedimentation rate (mean difference = 0.20, CI = 0.09-0.31, I 2 = 0%, Z = 3.45, p < 0.01). No effects were found on C-reactive protein or weight ( p > 0.05) of RA patients. We did not find studies in other IJDs that provided sufficient data for a meta-analysis. The narrative data synthesis provided limited evidence to address our research question. No firm conclusions can be made as to whether the combination of diet/nutrition and physical activity/exercise affects inflammatory load in IJDs. The results of this study can only be used as a means of highlighting the low-quality evidence in this field of investigation and the need for further and better-quality research.

Background: Inflammatory joint diseases (IJD) are accompanied by an increased risk of cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable CVD risk factor and low levels of CRF associate with an elevated CVD risk. This study aimed to investigate the associations between CVD risk factors, disease activity and CRF in patients with IJD and to explore differences between patients with normal versus low levels of CRF., Methods: CRF was measured as peak oxygen uptake (VO 2peak ) with a cardiopulmonary exercise test. Participants were also evaluated for: Body composition, blood pressure, blood lipids, inflammatory markers and disease activity. Patient-reported use of cigarettes/snuff, medication, disease duration, pain, fatigue, CVD history, habitual physical activity and exercise beliefs and self-efficacy were collected by questionnaire. Cross-sectional associations between CVD risk factors, disease-related factors and CRF were analyzed by multiple linear regression. CRF was categorized to normal CRF (VO 2peak  ≥ 80%) or low CRF (VO 2peak  < 80%) according to age- and gender-stratified reference data. Differences in demographic, CVD and disease-related factors between patients with normal versus low CRF were explored., Results: In 60 Norwegian patients with IJD [34 females, age 59 years (IQR: 52-63)], mean VO 2peak was 30.2 (± 6.9) mL/kg/min, corresponding to 83% (± 18) of normative reference values. Age (coefficient: - 0.18 years, p = 0.01) and fat mass (coefficient: - 0.67 %, p < 0.001) were inversely associated with CRF, while physical activity index (coefficient: 0.13 points, p = 0.05) was positively associated with CRF (R 2  = 0.66). There were no significant associations between CRF, classical CVD risk factors and disease-related variables. Compared to patients with low CRF (n = 30), patients with normal CRF (n = 30) had higher peak oxygen uptake (+ 9.4 mL/kg/min, p < 0.001), high-density lipoprotein cholesterol (+ 0.5 mmol L -1 , p < 0.001), and exercise self-efficacy (+ 6.9, p < 0.01) as well as lower fat mass (- 8.7%, p < 0.001), resting heart rate (- 8.0 beats/min, p < 0.01) and triglycerides (- 0.5 mmol L -1 , p < 0.01)., Conclusions: In this sample of IJD-patients, age, fatmass and physical activity level were associated with CRF. CRF was lower than reference values and patients with normal CRF presented with a more favorable health profile. There is a continued need for exercise interventions to improve CRF in patients with IJD., Trial Registration: NCT04922840., (© 2023. The Author(s).)

Purpose of Review: In addition to disease-modifying anti-rheumatic drug (DMARD) treatment, exercise is increasingly promoted in patients with rheumatoid arthritis (RA). Although both are known to reduce disease activity, few studies have investigated the combined effects of these interventions on disease activity. The aim of this scoping review was to provide an overview of the reported evidence on whether a combined effect-i.e., a greater reduction in disease activity outcome measures-can be detected in studies where an exercise intervention was performed in addition to the DMARD treatment in patients with RA. This scoping review followed the PRISMA guidelines. A literature search was performed for exercise intervention studies in patients with RA treated with DMARDs. Studies without a non-exercise control group were excluded. Included studies reported on (components of) DAS28 and DMARD use and were assessed for methodological quality using version 1 of the Cochrane risk-of-bias tool for randomized trials. For each study, comparisons between groups (i.e., exercise + medication vs. medication only) were reported on disease activity outcome measures. Study data related to the exercise intervention, medication use, and other relevant factors were extracted to assess what may have influenced disease activity outcomes in the included studies., Recent Findings: A total of 11 studies were included of which 10 between-group studies on DAS28 components were made. The remaining one study focused on within-group comparisons only. Median duration of the exercise intervention studies was 5 months, and the median number of participants was 55. Six out of the 10 between-group studies reported no significant differences between groups in DAS28 components between exercise + medication vs. medication only. Four studies showed significant reductions in disease activity outcomes for the exercise + medication group compared with the medication-only group. Most studies were not adequately designed methodologically in order to investigate for comparisons of DAS28 components and had a high risk of multi-domain bias. Whether the simultaneous application of exercise therapy and DMARD medication in patients with RA has a combined effect on disease outcome remains unknown, due to weak methodological quality of existing studies. Future studies should focus on the combined effects by having disease activity as the primary outcome., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study examined the dose-response effects of a 1-year hybrid-type, multicomponent interval training programme (DoIT) on various musculoskeletal fitness parameters in inactive overweight and obese adults in a gym setting. Ninety-seven middle-aged (44.8 ± 5.2 years) individuals with overweight/obesity (31.2 ± 5.7 kg/m 2 ) (66% female) were randomly assigned to the following groups: (i) no-intervention control (CON, n  = 29), (ii) DoIT performed once weekly (DoIT-1, n  = 24), (iii) DoIT performed twice weekly (DoIT-2, n  = 23) and (iv) DoIT performed thrice weekly (DoIT-3, n  = 21). DoIT was a time-efficient, intermittent-based, multicomponent exercise protocol using progressive loaded fundamental movement patterns with prescribed work-to-rest intervals (1:3-2:1) in a circuit format (2-3 rounds). Muscular strength, muscular endurance, flexibility, passive range of motion (PRoM), static balance and functional movement screen (FMS®) were assessed at baseline, 6 and 12 months following intervention. At post-training, all exercise groups exhibited superior changes than CON in (i) muscular strength (+13%-38%, p <  0.001); (ii) muscular endurance (+42%-159%, p  < 0.001); (iii) flexibility (+12%-42%, p  < 0.001); (iv) PRoM (+6%-50%, p  = 0.001-0.026); (v) static balance (+61%-163%, p <  0.001); and (vi) FMS (+18%-39%, p  < 0.001). Although a single exercise session/week improved musculoskeletal fitness, changes demonstrated a step-wise improvement with two and three sessions/week suggesting a dose-dependent response. The response rate to training was 100% for all exercise groups. These findings suggest that a multicomponent exercise approach incorporating bodyweight drills and resistance-based alternative modes performed under real-world conditions may improve several musculoskeletal fitness indicators in a dose-dependent manner in inactive, middle-aged adults with overweight/obesity. Trial registration: ClinicalTrials.gov identifier: NCT03759951.

In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?, (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: In patients with rheumatoid arthritis (RA) with cardiovascular disease risk, it is unknown whether exercises are safe, improve cardiorespiratory fitness and reduce disease-related symptoms and cardiovascular-disease (CVD) risk factors. We aimed to investigate in RA patients with CVD risk: (1) safety of medium to high-intensity aerobic exercises, (2) potential changes of cardiorespiratory fitness and (3) disease activity and CVD risk factors in response to the exercises., Methods: Single-arm pilot-exercise intervention study including 26 consecutive patients (21 women) with > 4% 10-year risk of CVD mortality according to the Dutch Systematic Coronary Risk Evaluation. Aerobic exercises consisted of two supervised-sessions and five home-sessions per week for 12 weeks. Patients were required to exercise at intensities between 65 and 85% of their maximum heart rate. To assess safety, we recorded exercise related adverse events. Before and after the exercises, cardiorespiratory fitness was assessed with a graded maximal oxygen-uptake exercise test, while disease activity was evaluated via the Disease Activity Score-28 (DAS28) using the erythrocyte segmentation rate (ESR). Resting blood pressure, ESR and total cholesterol were assessed as CVD risk factors., Results: Twenty out of 26 patients performed the 12-week exercises without any adverse events. According to patients, withdrawals were unrelated to the exercises. Exercises increased cardiorespiratory fitness (pre: 15.91 vs. post: 18.15 ml.kg -1  min -1 , p = 0.003) and decreased DAS28 (pre: 2.86 vs. post: 2.47, p = 0.04). No changes were detected in CVD risk factors., Conclusion: A 12-week exercise intervention seems to be safe and improves cardiorespiratory fitness and disease activity in patients with RA with a high risk for cardiovascular diseases. Key Points 1. Rheumatoid arthritis patients with high cardiovascular disease risk were able to perform a maximum exercise test and a 12-week aerobic-based medium-to-high intensity exercise intervention. 2. The exercise intervention improved cardiorespiratory fitness and disease activity in rheumatoid arthritis patients with high cardiovascular disease risk. 3. Cardiorespiratory fitness levels were still low post-exercise intervention (i.e. 18.15 ml.kg-1min-1 compared to the 20.9 ml.kg-1min-1 baseline mean of the RA patients without CVD risk)., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Background: This longitudinal study investigated whether changes in autonomous and controlled motivation to reduce sedentary behaviour were associated with variability in sedentary, standing and stepping time and, in turn, disease activity, systemic inflammation, pain and fatigue in rheumatoid arthritis (RA)., Methods: People with RA undertook assessments at baseline (T1, n = 104) and 6 months follow-up (T2, n = 54) to determine autonomous and controlled motivation to reduce sedentary behaviour (Behavioural Regulation in Exercise Questionnaire-2), free-living sedentary, standing and stepping time (7 days activPAL3 μ wear), Disease Activity Score-28 (DAS-28), systemic inflammation (c-reactive protein [CRP]), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). N = 52 participants provided complete data at T1 and T2., Statistical Analyses: In a series of models (A and B), path analyses examined sequential associations between autonomous and controlled motivation to reduce sedentary behaviour with activPAL3 μ -assessed behaviours and, in turn, RA outcomes., Results: Models demonstrated good fit to the data. Model A (sedentary and stepping time): autonomous motivation was significantly negatively associated with sedentary time and significantly positively related to stepping time. In turn, sedentary time was significantly positively associated with CRP and pain. Stepping time was not significantly associated with any health outcomes. Model B (standing time): autonomous motivation was significantly positively associated with standing time. In turn, standing time was significantly negatively related to CRP, pain and fatigue., Conclusions: Autonomous motivation to reduce sedentary behaviour is associated with sedentary and standing time in RA which may, in turn, hold implications for health outcomes., (© 2022. The Author(s).)

Introduction: It is well documented that there is high prevalence of injuries in pre-professional and professional ballet dancers. Current evidence from high in quality and quantity research on in- jury prevention in sport indicates that interventions can reduce injury risks by 30% to 50%. Injury prevention research in dance is limited. The aim of this study was to assess the feasibility (adherence, fidelity, and practicality) of a randomized controlled trial for the utilization of neuromuscular training in pre-professional ballet dancers.
Methods: A convenience sample of 22 pre-professional ballet dancers were randomized into an intervention and control group. The intervention group took part in a neuromuscular-based training workout, five times per week before the ballet class, for 10 weeks. The intervention was an adaptation of the FIFA 11+, an injury prevention intervention and is called 11+ Dance. The intervention consisted of low intensity bodyweight exercises that lasted 20 to 30 minutes performed daily.
Results: Intervention adherence was 38% ± 8%, with higher participation at the beginning of the study. Attendance for post-testing was low 45% and 36% for the intervention and control group, respectively, mainly due to injury. There were no adverse effects reported, however, the participants reported delayed onset muscle soreness at the beginning of the intervention, indicating that there may be a potential training effect. Fear of muscle hypertrophy and fatigue were also reported as reasons for attrition. The repeated measures ANOVA revealed statistically non-significant differences for the countermovement jump F(1, 9) = 0.36, p = 0.564, η ² p = 0.04; reactive strength index F(1, 7) = 0.02, p = 0.885, η ² p = 0.003; and the isometric mid-thigh pull F(1, 12) = 0.002, p = 0.967, η ² p = 0.000.
Conclusion: The results of the study, together with the feedback from the participants, suggest that some protocol modifications are necessary for the feasibility of a randomized controlled trial in a pre-professional setting. The current trial has produced valuable information for the intervention frequency and load prescription.

Introduction: Pre-professional ballet training involves long training hours from an early age that could influence young dancers' physical performance and injury incidence. This cross-sectional analysis investigated the relationship of year group and sex with countermovement jump and injury incidence (primary outcome) in adolescent ballet dancers at a pre-professional dance school.
Method: Countermovement jump (CMJ) height was recorded at the start of the academic year for 179 participants (M = 68, F = 111) spread across eight year-groups. Injury etiology and incidence was prospectively recorded over a 6-month period (September through February) by the medical team using a time-loss definition.
Results: Between-subject statistically significant differences were reported for sex [F(1, 153) = 101.46; p < 0.001], year group [F(7, 153) = 12.57; p < 0.001], and sex*year group [F(7, 153) = 9.22; p < 0.001]. Mean CMJ across the year groups ranged between 24.7 to 41.3 cm for males and 23.5 to 25.1 cm for females. Injury incidence per dancer was 0.84 (CI: 0.13, 1.56) and injury incidence per 1,000 hours of dance was 1.94 (CI: 1.63, 2.25). No statistically significant differences between sexes or year groups were reported for injury incidence per 1,000 dance hours and time-loss. Hours dancing was statistically significantly positively associated with CMJ (r = .481, p < 0.05) and negatively associated with injury incidence (r = -.253, p < 0.05) for males; for females it was positively associated with time-loss (r = .254, p < 0.05).
Conclusion: Even though CMJ was cross-sectionally monitored, the expected increased physical abilities in males as they grew older and progressed through their training was observed. Females did not indicate a similar increase in their physical ability, but they seemed to become more susceptible to injuries as they grow older. The lack of this speculative physiological development for the females may be associated with the ballet-only approach in their training. The use of CMJ as an injury screening tool may be limited, however, it could still be used as a tool to monitor physiological and fundamental motor skill development of adolescent dancers, as jumping is an integral part of ballet.

Background: Although regular exercise is recommended for preventing and treating overweight/obesity, the most effective exercise type for improving cardiometabolic health in individuals with overweight/obesity remains largely undecided. This network meta-analysis aimed to evaluate and rank the comparative efficacy of 5 exercise modalities on cardiometabolic health measures in individuals with overweight/obesity., Methods: A database search was conducted in MEDLINE, Embase, Scopus, and Web of Science from inception up to September 2020. The review focused on randomized controlled trials involving exercise interventions consisting of continuous endurance training, interval training, resistance training, combined aerobic and resistance training (combined training), and hybrid-type training. Exercise interventions aimed to improve somatometric variables, body composition, lipid metabolism, glucose control, blood pressure, cardiorespiratory fitness, and muscular strength. The Cochrane risk of bias tool was used to evaluate eligible studies. A random-effects network meta-analysis was performed within a frequentist framework. The intervention ranking was carried out using a Bayesian model where mean and SD were equal to the respective frequentist estimates., Results: A total of 4331 participants (59% female; mean age: 38.7±12.3 years) from 81 studies were included. Combined training was the most effective modality and hybrid-type training the second most effective in improving cardiometabolic health-related outcomes in these populations suggesting a higher efficacy for multicomponent exercise interventions compared to single-component modalities, that is, continuous endurance training, interval training, and resistance training. A subgroup analysis revealed that the effects from different exercise types were mediated by gender., Conclusions: These findings corroborate the latest guidelines on exercise for individuals with overweight/obesity highlighting the importance of a multicomponent exercise approach to improve cardiometabolic health. Physicians and healthcare professionals should consider prescribing multicomponent exercise interventions to adults with overweight/obesity to maximize clinical outcomes., Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020202647.

Contribution of UCP1 single nucleotide polymorphisms (SNPs) to susceptibility for cardiometabolic pathologies (CMP) and their involvement in specific risk factors for these conditions varies across populations. We tested whether UCP1 SNPs A-3826G, A-1766G, Ala64Thr and A-112C are associated with common CMP and their risk factors across Armenia, Greece, Poland, Russia and United Kingdom. This case-control study included genotyping of these SNPs, from 2,283 Caucasians. Results were extended via systematic review and meta-analysis. In Armenia, GA genotype and A allele of Ala64Thr displayed ~2-fold higher risk for CMP compared to GG genotype and G allele, respectively (p<0.05). In Greece, A allele of Ala64Thr decreased risk of CMP by 39%. Healthy individuals with A-3826G GG genotype and carriers of mutant allele of A-112C and Ala64Thr had higher body mass index compared to those carrying other alleles. In healthy Polish, higher waist-to-hip ratio (WHR) was observed in heterozygotes A-3826G compared to AA homozygotes. Heterozygosity of A-112C and Ala64Thr SNPs was related to lower WHR in CMP individuals compared to wild type homozygotes (p<0.05). Meta-analysis showed no statistically significant odds-ratios across our SNPs (p>0.05). Concluding, the studied SNPs could be associated with the most common CMP and their risk factors in some populations., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Inflammatory joint disease (IJD) is associated with increased risk of cardiovascular disease (CVD) fostered by systemic inflammation and a high prevalence of CVD risk factors. Cardiorespiratory fitness (CRF) is an important health parameter and CRF-measures are advocated in routine health evaluations. CRF associates with CVD risk, and exercise modalities such as high intensity interval training (HIIT) can increase CRF and mitigate CVD risk factors. In IJD, exercise is rarely used in CVD risk management and the cardioprotective effect of HIIT is unclear. Furthermore, the clinical applicability of HIIT to primary care settings is largely unknown and warrants investigation. The primary aim is to assess the effect of a HIIT programme on CRF in patients with IJD. Second, we will evaluate the effect of HIIT on CVD risk and disease activity in patients with IJD, feasibility of HIIT in primary care and validity of non-exercise algorithms to detect change in CRF., Methods and Analysis: ExeHeart is a single-blinded, randomised controlled trial. Sixty patients with IJD will be recruited from the Preventive Cardio-Rheuma clinic at Diakonhjemmet Hospital, Norway. Patients will be assigned to receive standard care (relevant lifestyle advice and cardio-preventive medication) or standard care plus a 12-week HIIT intervention by physiotherapists in primary care. HIIT sessions will be prescribed at 90%-95% of peak heart rate. Outcomes include CRF (primary outcome), CVD risk factors, anthropometric measures, disease activity and patient-reported outcomes related to pain, fatigue, disease, physical activity and exercise and will be assessed at baseline, 3 months (primary endpoint) and 6 months postbaseline., Ethics and Dissemination: Ethical approval has been obtained from the Regional Committee for Medical and Health Research Ethics (201227). Participants are required to sign a written informed consent form. Results will be discussed with patient representatives, submitted to peer-reviewed journals and presented at relevant platforms., Trial Registration Number: NCT04922840., Competing Interests: Competing interests: AGS has received lecture honoraria from AbbVie, Novartis, Bayer, Eli Lilly and Sanofi. AGS is secretary of ESC Cardiovascular Pharmacotherapy working group, nucleus member of EACP Risk Factor Management and Primary care and steering committee member for ATACC-RA, all gratuitous. GSM has received lecture honoraria from Novartis. JH has received lecture honoraria from Amgen. KRN, HD, KV, JSe, CF, JSk, TB and ATT have nothing to disclose., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

There is convincing evidence to suggest that exercise interventions can significantly improve disease-related outcomes as well as comorbidities in rheumatic and musculoskeletal diseases (RMDs). All exercise interventions should be appropriately defined by their dose, which comprises of two components: a) the FITT (frequency, intensity, time and type) and b) the training (ie, specificity, overload, progression, initial values, reversibility, and diminishing returns) principles. In the published RMD literature, exercise dosage is often misreported, which in "pharmaceutical treatment terms", this would be the equivalent of receiving the wrong medication dosage. Lack of appropriately reporting exercise dosage in RMDs, therefore, results in limited clarity on the effects of exercise interventions on different outcomes while it also hinders reproducibility, generalisability and accuracy of research findings. Based on the collective but limited current knowledge, the main purpose of the present Position Statement is to provide specific guidance for RMD researchers to help improve the reporting of exercise dosage and help advance research into this important field of investigation. We also propose the use of the IMPACT-RMD toolkit, a tool that can be used in the design and reporting phase of every trial., (© 2021 The Mediterranean Journal of Rheumatology (MJR).)

Lower cardiorespiratory fitness (CRF) and physical activity (PA) associate with higher cardiovascular disease (CVD) risk, but the relationship between CRF and PA in people who have rheumatoid arthritis (RA) at an increased CVD risk (CVD-RA) is not known. The objectives of this study were to determine the levels of CRF and PA in people who have CVD-RA and to investigate the association of CRF with PA in people who have CVD-RA. A total of 24 consecutive patients (19 women) with CVD-RA (> 4% for 10-year risk of fatal CVD development as calculated using the Systematic Coronary Risk Evaluation)-were included in the study. CRF was assessed with a graded maximal exercise test determining maximal oxygen uptake (VO 2max ). PA was assessed with an accelerometer to determine the amount of step count, sedentary, light and moderate-to-vigorous physical activity (MVPA) minutes per day. Mean age of patients was 65.3 ± 8.3 years. CRF mean values were 16.3 ± 1.2 ml·kg -1  min -1 , mean step count per day was 6033 ± 2256, and the mean MVPA time was 16.7 min per day. Significant positive associations were found for CRF with step count (B = 0.001, P = 0.01) and MVPA time (B = 0.15, P = 0.02); a negative association was found for CRF with sedentary time (B =  - 0.02, P = 0.03). CRF is low and is associated with step count, sedentary time and MVPA time in people who have RA at an increased CVD risk., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA., Methods: People living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to assess physical function (HAQ), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). Participants' free-living sedentary, standing and stepping time (min/day) were assessed over 7 days using the activPAL3µ™. For the statistical analysis, hierarchical regression analysis was employed to inform the construction of path models, which were subsequently used to examine bi-directional associations of pain and fatigue with sedentary, standing and stepping time. Specifically, where significant associations were observed in longitudinal regression analysis, the bi-directionality of these associations was further investigated via path analysis. For regression analysis, bootstrapping was applied to regression models to account for non-normally distributed data, with significance confirmed using 95% CIs. Where variables were normally distributed, parametric, non-bootstrapped statistics were also examined (significance confirmed via β coefficients, with P < 0.05) to ensure all plausible bi-directional associations were examined in path analysis., Results: Longitudinal bootstrapped regression analysis indicated that from T1 to T2, change in pain, but not fatigue, was positively associated with change in sedentary time. In addition, change in pain and fatigue were negatively related to change in standing time. Longitudinal non-bootstrapped regression analysis demonstrated a significant positive association between change in fatigue with change in sedentary time. Path analysis supported the hypothesized bi-directionality of associations between change in pain and fatigue with change in sedentary time (pain, β = 0.38; fatigue, β = 0.44) and standing time (pain, β = -0.39; fatigue, β = -0.50)., Conclusion: Findings suggest pain and fatigue are longitudinally and bi-directionally associated with sedentary and standing time in RA., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Background: An important but often insufficient aspect of care in people with inflammatory arthritis (IA) is empowering patients to acquire a good understanding of their disease and building their ability to deal effectively with the practical, physical and psychological impacts of it. Self-management skills can be helpful in this regard., Objectives: To develop recommendations for the implementation of self-management strategies in IA., Methods: A multidisciplinary taskforce of 18 members from 11 European countries was convened. A systematic review and other supportive information (survey of healthcare professionals (HCPs) and patient organisations) were used to formulate the recommendations., Results: Three overarching principles and nine recommendations were formulated. These focused on empowering patients to become active partners of the team and to take a more proactive role. The importance of patient education and key self-management interventions such as problem solving, goal setting and cognitive behavioural therapy were highlighted. Role of patient organisations and HCPs in promoting and signposting patients to available resources has been highlighted through the promotion of physical activity, lifestyle advice, support with mental health aspects and ability to remain at work. Digital healthcare is essential in supporting and optimising self-management and the HCPs need to be aware of available resources to signpost patients., Conclusion: These recommendations support the inclusion of self-management advice and resources in the routine management of people with IA and aim to empower and support patients and encourage a more holistic, patient-centred approach to care which could result in improved patient experience of care and outcomes., Competing Interests: Competing interests: EN reports personal fees and other from AbbVie, Eli-Lilly, Gilead, Celltrion and Pfizer and other from Sanofi, outside the submitted work. JWJB reports personal fees from Roche, Lilly and Galapagos, outside the submitted work. CID reports personal fees and other from AbbVie, Abivax, BMS, Fresenius, Galapagos, Lilly, Pfizer, Roche-Chugaï and Sanofi, outside the submitted work. BAE has received speaking fees from Pfizer and Eli Lilly. RJOF reports personal fees from Sanofi and UCB, outside the submitted work. GEF reports honoraria from UCB and Aenorasis, outside the submitted work. TAS has received grant/research support from AbbVie and Roche, has been consultant for AbbVie and Sanofi Genzyme and has been a paid speaker for AbbVie, Roche, Sanofi and Takeda. EJFS, AM, PB, PH, HM, GSM, RHM, AdT, CZ, LC and AB report no conflicts of interest., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Three years of study showed that female and male vocational dancers displayed lower bone mass compared to controls, at forearm, lumbar spine and femoral neck. Energy intake was found to positively predict bone mass accruals only in female dancers at femoral neck. Vocational dancers can be a risk population to develop osteoporosis., Purpose: To determine whether risk factors normally associated with low bone mass in athletic populations (i.e. nutrition intake, energy expenditure and energy availability) are significant predictors of bone mass changes in vocational dance students., Methods: The total of 101 vocational dancers (63 females, 12.8 ± 2.2 years; 38 males, 12.7 ± 2.2 years) and 115 age-matched controls (68 females, 13.0 ± 2.1 years; 47 males, 13.0 ± 1.8 years) were monitored for 3 consecutive years. Bone mass parameters were measured annually at impact sites (femoral neck, FN; lumber spine, LS) and non-impact site (forearm) using DXA. Nutrition (3-day record), energy expenditure (accelerometer), energy availability and IGF-1 serum concentration (immunoradiometric assays) were also assessed., Results: Female and male vocational dancers had consistently reduced bone mass at all anatomical sites (p < 0.001) than controls. IGF-1 did not differ between male vocational dancers and controls, but female dancers showed it higher than controls. At baseline, calcium intake was significantly greater in female vocational dancers than controls (p < 0.05). Male vocational dancers' fat and carbohydrate intakes were significantly lower than matched controls (p < 0.001 and p < 0.05, respectively). Energy availability of both female and male vocational dancers was within the normal range. A significant group effect was found at the FN regarding energy intake (p < 0.05) in female dancers. No significant predictors were found to explain bone mass differences in males., Conclusion: Our 3-year study revealed that both female and male vocational dancers displayed lower bone mass compared to controls, at both impact and non-impact sites. The aetiology of these findings may be grounded on factors different than those usually considered in athletic populations., (© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.)

Physical inactivity is prevalent in rheumatoid arthritis (RA) patients, increasing the risk of poor physical health and compromised well-being. Interventions are therefore required to support physical activity (PA) behavior change in this population. This study examined whether a self-determination theory (SDT) based exercise intervention for people with RA, increased autonomous motivation for PA and in turn, moderate-to-vigorous PA (MVPA) and subjective vitality RA patients (n = 115) were randomized to a 3-month SDT-based psychological intervention + RA-tailored exercise program (experimental group, n = 59) or a RA-tailored exercise program only (control group, n = 56). During the program, the SDT-based intervention group received one-on-one consultations with a PA advisor trained in delivering strategies to promote autonomous motivation for PA. Well-established questionnaires assessed autonomous and controlled motivation for PA, MVPA (min/week), and subjective vitality at baseline (T1) and 3 months (T2). Path analysis examined the hypothesized theoretical process model. The model demonstrated an excellent fit to the data (n = 70, χ2 (26) = 28.69, p = .33, comparative fit index = 0.99, root square mean error of approximation = 0.04). The intervention corresponded to higher autonomous motivation and lower controlled motivation for PA at T2, after controlling for T1 autonomous and controlled motivation. In turn, changes in autonomous motivation from T1 to T2 significantly positively predicted changes in MVPA and subjective vitality. Results suggest an SDT based psychological intervention comprising autonomy-supportive strategies for PA predicted greater reported autonomous reasons for PA in RA patients participating in a tailored 3-month exercise program. Increased autonomous motivation linked to increased engagement in MVPA and feelings of vitality in these patients., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)