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Purpose: Exercise prescriptions for chronic low back pain (CLBP) often utilize reductionistic, trunk‐focused exercise aimed at addressing proposed pain mechanisms. It is unknown if the use of these trunk‐focused exercises imply beliefs to people with CLBP about the rationale for their use (e.g., etiology), even without concurrent biomedical narratives. This study aimed to explore people's perceptions of specific and general exercise without an accompanying narrative when experiencing CLBP. Methods: An anonymous online survey was distributed. Mixed methods were utilized for analysis. Six‐point Likert scales categorized people's beliefs about individual exercises. Open‐ended questions were used to gather further beliefs which were then coded into themes. Results: People with CLBP perceived specific exercise as more beneficial than general exercise. Eight themes and five subthemes were defined. A high volume of positive beliefs were centered around strengthening the low back and abdominal musculature, emphasizing the importance of correct technique. Negative beliefs were held against spinal flexion and external load. Both positive and negative beliefs were underpinned by spinal/pelvic stability being important as well as certain exercises being achievable or not. Conclusion: This study demonstrated that people with CLBP consider specific exercises to be more beneficial than general exercises for CLBP. Specific exercises irrespective of an accompanying narrative can imply meaning about the intent of an exercise. Understanding this requires practitioners to be mindful when prescribing and communicating exercise. [ABSTRACT FROM AUTHOR]

Perception has been conceptualised as an active and adaptive process, based upon incoming sensory inputs, which are modified by top-down factors such as cognitions. Visuospatial perception is thought to be scaled based on threat, with highly threatening objects or contexts visually inflated to promote escape or avoidance behaviours. This meta-analytical systematic review quantified the effect and evidence quality of threat-evoked visuospatial scaling, as well as how visuospatial scaling relates to affordances (perceived action capabilities) and behavioural avoidance/escape outcomes. Databases and grey literature were systematically searched inclusive to 10/04/24. Studies were assessed with a customised Risk of Bias form and meta-analysis was performed using a random-effects model. 12,354 records were identified. Of these, 49 experiments (n = 3027) were included in the review. There was consistent evidence that threat the of height influenced contextual perception (g = 0.66, 95% CI: 0.45, 0.88) and affordances (g = -0.43, 95% CI: -0.84, -0.03). Threatening objects were viewed as larger (g = 0.76, 95% CI: 0.26, 1.26) and as closer (g = 0.30, 95% CI: 0.17, 0.42). Bodily threat (pain) yielded conflicting effects on visuospatial perception/affordances. We conclude that threat may influence visuospatial perception and affordances. However, since behavioural measures were poorly reported, their relationship with visuospatial perception/affordances remains elusive., Competing Interests: Declaration of competing interest BM receives remuneration from Noigroup for the provision of continuing professional development workshops related to pain science education. FAB has received speaker fees for providing lectures relating to pain and blinding in clinical trials. TRS receives book royalties and speaker fees for lectures relating to pain and rehabilitation. EM, EP, MLH, AM, and CL have nothing to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: How we feel during exercise is influenced by exteroceptive ( e.g. , vision) and interoceptive ( i.e. , internal body signals) sensory information, and by our prior experiences and expectations. Deceptive visual cues about one's performance during exercise can increase work rate, without negatively impacting affective valence (good/bad responses) or perceived exertion. However, what is less understood is whether the perception of the exercise experience itself can be shifted, if work rate is held constant. Here we aimed to investigate whether deceptive vision-via illusory hills in a virtual reality (VR) cycling experience-alters affective valence and perceived exertion when physical effort is controlled. We also evaluated whether the accuracy with which one detects interoceptive cues influences the extent to which deceptive visual information can shift exercise experiences., Methods: A total of 20 participants (10 female; 30.2 ± 11.2 yrs) completed three VR cycling conditions each of 10-min duration, in a randomised, counterbalanced order. Pedal resistance/cadence were individualised (to exercise intensity around ventilatory threshold) and held constant across conditions; only visual cues varied. Two conditions provided deceptive visual cues about the terrain (illusory uphill, illusory downhill; resistance did not change); one condition provided accurate visual cues (flat terrain). Ratings of affective valence (Feeling Scale) and of perceived exertion (Borg's RPE) were obtained at standardised timepoints in each VR condition. Interoceptive accuracy was measured via a heartbeat detection test., Results: Linear mixed effects models revealed that deceptive visual cues altered affective valence ( f 2 = 0.0198). Relative to flat terrain, illusory downhill reduced affective valence (Est = -0.21, p  = 0.003), but illusory uphill did not significantly improve affective valence (Est = 0.107, p  = 0.14). Deceptive visual cues altered perceived exertion, and this was moderated by the level of interoceptive accuracy (Condition-Interoception interaction, p  = 0.00000024, f 2 = 0.0307). Higher levels of interoceptive accuracy resulted in higher perceived exertion in the illusory downhill condition ( vs flat), while lower interoceptive accuracy resulted in lower perceived exertion in both illusory hill conditions ( vs flat) and shifts of greater magnitude., Conclusions: Deceptive visual cues influence perceptual responses during exercise when physical effort does not vary, and for perceived exertion, the weighting given to visual exteroceptive cues is determined by accuracy with which interoceptive cues are detected. Contrary to our hypotheses, deceptive visual cues did not improve affective valence. Our findings suggest that those with lower levels of interoceptive accuracy experience most benefit from deceptive visual cues, providing preliminary insight into individualised exercise prescription to promote positive (and avoid negative) exercise experiences., Competing Interests: Brendan Mouatt receives remuneration from The Knowledge Exchange for provision of continuing professional development workshops related to pain and exercise rehabilitation. Tasha Stanton received payment for lectures on pain and rehabilitation and receives royalties for books on pain. No other authors report a conflict of interest., (©2023 Mouatt et al.)

Background and Aims: This cross-sectional study evaluated the nature of pain curriculum being taught in accredited exercise physiology degrees across Australian universities and its perceived usefulness for preparing exercise physiologists to treat people with chronic pain., Materials & Methods: Universities and graduates were asked about the nature and sufficiency of pain curriculum taught, with particular emphasis on competencies for physical therapists as outlined by the International Association for the Study of Pain., Results: Ten universities and 101 graduates responded. Median (interquartile range) instruction time on pain curriculum was 12 (7.25-18.75) hours. Few universities (30%) were aware of the guidelines for physical therapy pain curricula, although most (70%) agreed their degrees contained adequate instruction on pain assessment and management. In contrast, 74% of graduates felt their degree did not adequately prepare them to treat people with chronic pain. Half the graduates (51%) were not aware of the guidelines for physical therapy pain curricula., Discussion & Conclusion: There is a disconnect between perceptions of Australian universities and their graduates regarding the sufficiency of pain curriculum taught to student exercise physiologists. Benchmarking pain curriculum in Australian university programs against relevant international recommendations may enhance the suitability of pain curricula taught to exercise physiologists, thereby better preparing new graduates to treat people with pain., (© 2021 John Wiley & Sons Ltd.)

Background: Bodily state is theorised to play a role in perceptual scaling of the environment, whereby low bodily capacity shifts visuospatial perception, with distances appearing farther and hills steeper, and the opposite seen for high bodily capacity. This may play a protective role, where perceptual scaling discourages engaging with the environment when capacity is low., Methodology: Our protocol was pre-registered via Open Science Framework (https://osf.io/6zya5/) with all amendments to the protocol tracked. We performed a systematic review and meta-analysis examining the role of bodily state/capacity on spatial perception measures of the environment. Databases (Medline, PsychINFO, Scopus, Embase, and Emcare) and grey literature were searched systematically, inclusive to 26/8/21. All studies were assessed using a customised Risk of Bias form. Standard mean differences and 95% CIs were calculated via meta-analysis using a random-effects model., Results: A total of 8,034 studies were identified from the systematic search. Of these, 68 experiments (3,195 participants) met eligibility and were included in the review. These were grouped into the following categories: fatigue; pain; age; embodiment; body size/body paty size; glucose levels; fitness; and interoception, and interoceptive accuracy. We found low level evidence (limited studies, high risk of bias) for the effect of bodily state on spatial perception. There was consistent evidence that both glucose manipulations and age influence spatial perception of distances and hills in a hypothesised direction (lower capacity associated with increased distance and hill steepness). Mixed evidence exists for the influence of external loads, embodiment, body/body-part size manipulations, pain, and interoceptive accuracy. Evidence for fitness and/or fatigue influencing spatial perception was conflicting; notably, methodological flaws with fitness and fatigue paradigms and heterogenous spatial perception measures may underlie null/conflicting results., Conclusion: We found limited evidence for bodily state influencing spatial perception of the environment. That all studies had high risk of bias makes conclusions about reported effects reflecting actual perceptual shifts ( vs merely reflecting experimental demands or error due to inadequate study design) pre-emptive. Rigorous evaluation is needed to determine whether reported effects reflect more than bias ( e.g ., experimental demands, inadequate blinding). Future work using reliable measures of spatial perception, comprehensive evaluation of relevant confounders, and methodologically robust (and experimentally confirmed) bodily state experimental paradigms is warranted., Competing Interests: Felicity A. Braithwaite and Tasha R. Stanton have received speaker fees for providing lectures related to pain and rehabilitation. Brendan Mouatt receives renumeration from The Knowledge Exchange for provision of continuing professional development workshops related to pain and exercise rehabilitation. All other authors report no conflicts of interest., (© 2022 MacIntyre et al.)

Background: Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program., Methods: Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes., Discussion: We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA., Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020)., (© 2021. The Author(s).)

Background: Upper limb, cervical and thoracic pain is a common and burdensome problem in Australia. Office workers report high rates of upper body musculoskeletal complaints when compared with workers in other occupations., Objective: This article highlights challenges to providing comprehensive biopsychosocial care for neck, thoracic and related arm pain in office workers, and details the role of active, patient-centred therapies in management., Discussion: Cervical, thoracic and upper limb pain is common in office workers. Optimal management comprises a biopsychosocial patient-centred approach that includes education, reassurance and exercise. Best-evidence treatment of office workers with upper body pain involves an active approach that facilitates self-efficacy and physical activity and reflects a modern understanding of pain.

The dental health of children under five years has stagnated in recent years. In 2005, 39.6% of five year olds in England and Wales and 55.4% in Scotland had evidence of decay. Deprived communities are most at risk. All practitioners in child health, especially health visitor teams and general practitioners, must take the initiative in preventing oral disease, working more closely with dental health teams. A change in attitude is needed so that the whole community health team regard oral health as an integral part of general health. As well as monitoring pregnant women and young families, there are three key messages to get across for caries prevention. These are brushing with a fluoride toothpaste as soon as the first tooth erupts, keeping sugary foods to mealtimes and establishing a pattern of regular visits to the dentist. Minimising the frequency of exposure to sweet food and drink is much more important than the quantity of sugar ingested in preventing dental caries. Fluoridation of water supplies is another key preventive measure; at present, fluoridated water reaches less than 14% of the UK's population.

The key aspects of dental health in babies and children, teenagers, adults and the elderly are outlined, including tips for prevention of dental disease.

The author outlines improvements in Britain's dental health and summarises practical advice to pass on to families with young children and adults of all ages. The importance of fluoride and moderating the frequency of snacks is emphasised. Current thinking on diet and dental decay is discussed, including new developments in our understanding of the part played by carbohydrates, which is less simplistic than previously thought.

A former Chief Dental Officer explains the use of fluoride in preventing dental caries. He discusses the causes and process of dental caries and the basic health education messages to communicate to the public. Although the incidence of dental caries has reduced in the UK, mainly due to greater use of fluoride, decay remains prevalent among socially and economically disadvantaged groups. Dental health promotion is also needed for young parents who, having good teeth themselves, do not always realise that their children are still at risk of caries. Parents are not always aware of how to prevent dental caries in their children.