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Objective: Physical activity confers physical and psychosocial benefits for cancer patients and decreases morbidity and mortality, but adherence varies. High-intensity interval training (HIIT) is time-efficient and may improve adherence. Our aim was to determine barriers and enablers of adherence to HIIT in patients diagnosed with cancer., Design: Systematic review and meta-analysis., Data Source: PubMed-MEDLINE, Scopus and Web of Science., Eligibility Criteria: Intervention studies including patients diagnosed with any type of cancer, who engaged in HIIT with or without co-intervention in any stage of treatment and have reported outcomes for adherence., Results: Eight hundred articles were screened and 22 were included (n=807); 19 were included in the meta-analysis (n=755). Weighted adherence to HIIT was 88% (95% CI, 81% to 94%). None of the studies reported serious adverse events. Although being a woman and having breast cancer were associated with lower adherence (p<0.05), age was not (p=0.15). Adherence was significantly lower during the treatment phase in comparison with pre- and post-treatment phases, 83% versus 94% and 96%, respectively (p<0.001). Session time of more than 60 min, when unsupervised and combined with other interventions, was associated with decreased adherence (p<0.05)., Conclusion: Adherence to HIIT programmes among cancer patients varies and is improved when the intervention is supervised, of shorter duration, consists of solely HIIT and not in combination with other exercise and occurs during pre- and post-treatment phases. Strategies to improve adherence to HIIT in specific subpopulations may be needed to ensure all patients with cancer are provided optimal opportunities to reap the benefits associated with physical activity., Prospero Registration: CRD42023430180., Competing Interests: Competing interests: JST is an Editor of the BJSM., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Physical inactivity is a critical predictor of all-cause mortality and many non-communicable diseases (NCD) including coronary heart disease, diabetes, hypertension, dementia, and several cancers. The main objective of this study was to determine the main barriers to physical activity based on the STEPwise Surveillance in Iran in 2021, to guide policymakers in developing the most effective physical activity increasing strategies., Methods: This cross-sectional study was conducted on 27,515 female and male individuals aged over 18 years from the STEPwise Surveillance 2021. The barriers to physical activity according to the modified version of barriers questionnaire and intrapersonal, interpersonal, economic, cultural, and environmental domains based on social-ecological models were determined. Association between barriers domain and physical activity level was assessed., Results: Lack of time due to job commitments (31.4%) and family (19.3%) and inappropriate physical conditions including illness, pain, injury, disability, and fatigue (30.4%) were the most frequent barriers to physical activity. Interest in sedentary leisure time activities including virtual space, computer games and watching TV were the next frequent barriers to physical activity (10.01%). Intrapersonal domain had the highest frequency (62.9%) and cultural domain had the lowest frequency (2.3%). Intrapersonal and interpersonal barriers reduced the odds of engaging in physical activity (OR: 0.62, P value < 0.001, OR: 0.76, P value < 0.001)., Conclusion: Intra- and inter-personal domain barriers might reduce the odds of being active. Developing action plans addressing these factors is suggested to increase physical activity levels., (© 2024. The Author(s).)

The purpose of this study is to assess the impact of pre-surgery exercise training on cardiopulmonary fitness. Ten articles (six RCTs and four non-RCTs) involving 281 individuals were finally included in the synthesis. Regarding the effect on VO2 peak, overall standardized mean differences were 0.71 (95% CI, 0.31 to 1.11, n = 103) with heterogeneity (I 2  = 0%, P = 0.49). For 6MWT, overall weighted mean differences (distance in meters) were 31.87 (95% CI, 27.84 to 35.89, n = 100) with heterogeneity (I 2  = 0%, P = 0.96). Engaging in pre-bariatric metabolic surgery exercise training might improve anthropometric parameters and cardiopulmonary fitness with no significant changes in components of quality of life. However, considering high levels of heterogeneity, the results should be generalized cautiously., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Oral cancers are the 6th most common malignancy worldwide and oral squamous cell carcinoma, comprises over 90% of oral cancers. This study investigates the relationship between physical activity level during the lifetime and oral squamous cell carcinoma risk., Methods: 100 oral squamous cell carcinoma patients and 200 healthy individuals participated in this case-control study. Physical activity level was evaluated via the Lifetime Physical Activity Questionnaire. The occupational, household, and sports domains of lifetime physical activity were determined. Case and control groups' participants were matched in terms of sex, age, smoking, and alcohol consumption by the Frequency Matching Method. Mann-Whitney U Test was applied to compare physical activity levels between groups., Results: The Body Mass Index was higher among cases compared with controls. The average amounts of lifetime physical activity among cases and controls were approximately identical. However, only a statistically significant difference between time spent on total lifetime physical activities and the oral squamous cell carcinoma risk was discovered. Moreover, there were no statistically significant odds ratios in examining the risk associated with each domain of activities., Conclusions: The total time spent on lifetime physical activity may decrease the risk of oral squamous cell carcinoma; However, the total level and intensity of lifetime physical activity are not significantly associated with the oral squamous cell carcinoma risk. Further studies are required in this field., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tabatabaie-Zadeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Upper-extremity fractures (UEFs) account for a large proportion of bone fractures and are costly to both health and the economy. The fracture burden in the Middle East and North Africa (MENA) is influenced by the region's diverse cultural, economic, and political status. This study examined UEF epidemiology and causes across the MENA region and within the 21 MENA countries as categorized by the Global Burden of Disease (GBD) data set., Methods: On the basis of GBD data, this study evaluated the epidemiology of UEFs from 1990 to 2019. The causes of injuries, incidence, number of years of healthy life lost due to disability (YLD), and their association with the Socio-demographic Index (SDI) were obtained and calculated for males and females in all age groups., Results: From 1990 to 2019, the age-standardized incidence rate (ASIR) of UEFs in the MENA region increased by 2.33%, to 1,086.39 per 100,000 people, and the YLD rate increased 15.69%, to 9.17 per 100,000, opposing the global decreasing trends. Fractures of the radius and/or ulna had the highest ASIR (505.32 per 100,000) of all UEF types in 2019. The clavicle, scapula, and humerus had the highest increasing trend among the fracture sites. In 2019, Saudi Arabia had the highest ASIR of UEFs (2,296.93 per 100,000). Afghanistan had the highest age-standardized YLD rate due to UEFs (19.6 per 100,000) in 2019, with Syria (153.32%) and Iran (37.04%) experiencing the greatest increase and decrease, respectively, from 1990 to 2019. Falling was the leading cause of UEFs, accounting for 45.05% of incidence and 41.19% of YLD overall., Conclusions: Contrary to global trends, UEFs increased in the MENA region during the study period. Countries with higher fracture incidence and YLD should consider preventive and rehabilitation strategies., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H754 )., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

We aimed to evaluate the dose-dependent effects of aerobic exercise on systolic (SBP) and diastolic blood pressure (DBP) and haemodynamic factors in adults with hypertension. PubMed, Scopus, and Web of Science were searched to April 2022 for randomized trials of aerobic exercise in adults with hypertension. We conducted a random-effects meta-analysis to estimate mean differences (MDs) and 95%CIs for each 30 min/week increase in aerobic exercise. The certainty of evidence was rated using the GRADE approach. The analysis of 34 trials with 1787 participants indicated that each 30 min/week aerobic exercise reduced SBP by 1.78 mmHg (95%CI: -2.22 to -1.33; n = 34, GRADE=low), DBP by 1.23 mmHg (95%CI: -1.53 to -0.93; n = 34, GRADE=moderate), resting heart rate (MD = -1.08 bpm, 95%CI: -1.46 to -0.71; n = 23, GRADE=low), and mean arterial pressure (MD = -1.37 mmHg, 95%CI: -1.80 to -0.93; n = 9, GRADE = low). A nonlinear dose-dependent decrement was seen on SBP and DBP, with the greatest decrement at 150 min/week (MD 150 min/week  = -7.23 mmHg, 95%CI: -9.08 to -5.39 for SBP and -5.58 mmHg, 95%CI: -6.90 to -4.27 for DBP). Aerobic exercise can lead to a large and clinically important reduction in blood pressure in a dose-dependent manner, with the greatest reduction at 150 min/week. The dose-dependent effects of aerobic exercise on systolic and diastolic blood pressure and haemodynamic factors in adults with hypertension., (© 2023. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Background: Shift work has been related to adverse health outcomes that can partially be attributed to physical inactivity. However, our knowledge of the influence of shift work on physical activity and sedentary behavior is inconclusive. Therefore, this study aimed to assess physical activity levels among shift and non-shift workers among a sample of Iranian adults., Methods: Baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study were used. All participants of RaNCD except those excluded due to unemployment or considerable disability were included in the study. We evaluated participants' physical activity levels using the PERSIAN cohort questionnaire and examined its associations with being a shift worker., Results: A total of 4695 participants with a mean age of 46.1 (SD = 7.74) were included in the study. In total, 1108 (23.6%) participants were shift workers, 1420 (30.2%) had insufficient physical activity levels, and 4283 (91.2%) were male. The prevalence of physical inactivity was significantly lower among shift workers compared to non-shift workers (21% vs. 33.1%, p < 0.001). Multiple backward stepwise binary logistic regression tests indicated that being a shift worker was significantly associated with a lower chance of having insufficient physical activity levels (OR = 0.77, 95% CI = 0.65-0.92, p = 0.003)., Conclusions: The prevalence of insufficient physical activity was higher among non-shift workers than shift workers in our study. By providing the factors associated with insufficient physical activity among the workers in a region of Iran, the current study findings might help policymakers target groups at higher risk of physical activity in Iran and design interventions to improve physical activity, especially among non-shift workers., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: The COVID-19 pandemic has caused serious consequences for global health and economy. The important question is whether the level of physical activity might influence the risk of COVID-19 incidence or clinical outcomes, including the severity or mortality of infected patients. The objective of this systematic review and meta-analysis is to evaluate the association between sufficient physical activity and incidence, hospitalization, severity, recovery, and mortality of COVID-19., Methods: A systematic search of Web of Sciences, PubMed, and Scopus between December 2019 and November 2021 was conducted. Studies were screened based on the inclusion criteria, i.e. observational studies (case-control, prospective or retrospective longitudinal designs, and cross-sectional studies) which have determined the association of physical activity, exercise, sports participation, or sedentary behavior with COVID-19 incidence or outcomes, including mortality, severity, recovery and hospitalization in healthy population or population with any specific comorbidity., Results: Based on eligibility criteria, 27 articles were finally included in the qualitative synthesis. The meta-analysis of five studies evaluating the association of physical activity and COVID-19 mortality showed a weighted OR of OR of 0.61 (CI 95%: 0.50-0.75) with heterogeneity (I 2 = 45.8%, P < 0.001) and in seven studies regarding physical activity and COVID-19 hospitalization, weighted OR was 0.541 (CI 95%: 0.491-0.595) with heterogeneity (I 2 = 81.7%, P < 0.001)., Conclusion: Participating in sufficient physical activity might decrease COVID-19 related COVID-19-related hospitalization and mortality. Developing programs to increase physical activity during the COVID-19 pandemic might be an appropriate health strategy., Competing Interests: Authors state no conflict of interests., (©2023 Pacini Editore SRL, Pisa, Italy.)

Background: Built environment determinants of engaging in physical activity are dependent on the properties of societies. This study investigates the relationship between structural variables of the environment using geographic information systems (GIS) and the level of physical activity in 22 districts of Tehran., Methods: This cross-sectional study was based on Urban Health Equity Assessment and Response Tool (Urban HEART-2). Physical activity level was assessed via the Global Physical Activity Questionnaire (GPAQ). The characteristics of the neighborhood environment, including land use, street pattern, population density, and traffic, were determined via ArcGIS software. Walkability index (population density, street pattern, land use) was calculated to assess the effect of the main variables of living environment on physical activity level., Results: Among the built environmental variables, land use was associated with the total physical activity and travel-related physical activity level (r: 0.155, P value: 0.001, and r: 0.122, P value: 0.007, respectively). The walkability index indicated an association with the total physical activity level and travel-related physical activity level (r: 0.126, P value: 0.006, and r: 0.135, P value: 0.001, respectively). Higher levels of the walkability index were associated with an improved level of physical activity (OR: 2.04)., Conclusions: Walkability index and land use positively correlate with total physical activity level, and providing action plans that improve walkability index and land use might lead to increased physical activity level., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Preventive Medicine.)

Background: This study aimed to translate and cross-culturally adapt the Lifetime Total Physical Activity Questionnaire (LTPAQ) for use in Persian-speaking countries as well as evaluate its validity and reliability., Methods: There were 3 stages to this study. First, a forward-backward translation method was used to develop a Persian version of the LTPAQ. In the second stage, the Persian version of the LTPAQ was evaluated for its face validity and content validity. Finally, test-retest reliability and known-group validity were assessed. The LTPAQ has occupational and volunteer activities, including travel to work, exercise and sports, and household activities. Frequency, duration, and estimated metabolic costs of activities with light, moderate, and heavy intensities were used to calculate the metabolic equivalent of each domain during life (in metabolic equivalent-hour/week). Metabolic equivalents of each domain and in total were used to evaluate the reliability and validity of the questionnaire., Results: In total, 60 people (41.7% females) with a mean age of 33.9 (SD = 11.5) years participated in this study. All domains showed excellent test-retest reliability (intraclass correlation coefficient > .9). All items had content validity indexes higher than 0.85. In addition, males had significantly higher physical activity levels than females (P = .022), indicating the known-group validity of the questionnaire., Conclusions: The LTPAQ was translated into Persian and trans-culturally adapted. This study indicates that the Persian version of the LTPAQ has adequate reliability and validity and can be utilized in future studies to assess physical activity in the Persian population.

Background: There are limited studies on food security, physical activity, and social capital in the Iranian population. This study aimed to evaluate the social capital's associations with physical inactivity and food insecurity in a large-scale study in Iran, Urban HEART-2., Methods: This cross-sectional study was conducted in 22 districts of Tehran, the capital of Iran. Residents of Tehran who were 15 years or older were selected by a multi-stage, stratified, and random sampling method. Food insecurity and physical activity were evaluated using Household Food Security Scale and Global Physical Activity Questionnaire, respectively, and their associations with social capital were evaluated., Results: A total of 5030 individuals were included in this study, with 3139 (62.4%) males. The mean age of participants was 44.08 years (SD = 16.33, range = 15-90). Participation in social events (OR = 0.893, 95% CI = 0.819-0.974, P  = 0.011), social network (OR = 0.849, 95% CI = 0.786, P  < 0.001), and voluntary activities (OR = 0.865, 95% CI = 0.812-0.921, P  < 0.001) were all negatively associated with food insecurity. Also, voluntary activities (OR = 0.823, 95% CI = 0.776-0.872, P  < 0.001) and participation in the associations activities (OR = 0.665, 95% CI = 0.582-0.759, P  < 0.001) were negatively associated with physical inactivity., Conclusion: The prevalence of food insecurity and physical inactivity is relatively high among Tehran residents. As a factor affecting the physical activity and food security, social capital can be targeted in interventions to improve physical activity and food security among Iranians., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2022 Amin Nakhostin-Ansari et al.)

Background: Lower limb disability is common in chronic stroke patients, and aquatic therapy is one of the modalities used for the rehabilitation of these patients., Objectives: To summarize the evidence of the effects of aquatic therapy on lower limb disability compared to land-based exercises in post-stroke patients., Methods: MEDLINE, PsycInfo, CENTRAL, SPORTDiscus, PEDro, PsycBITE, and OT Seeker were searched from inception to January 2019. The search included only randomized clinical trials. Two reviewers independently examined the full text and conducted study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from the included studies. The quantitative analysis incorporated fixed-effect models., Results: Of the 150 studies identified in the initial search, 17 trials (629 participants) satisfied the eligibility criteria. Aquatic therapy improved balance based on the Berg Balance Scale (BBS) (standardized mean difference [SMD], 0.72; 95% confidence interval [CI], 0.50-0.94; I 2  = 67%) compared with land-based exercises (control). Also, aquatic therapy had a small positive effect on walking speed (SMD, -0.45; 95% CI {-0.71 - (-0.19)}; I 2  = 57%), based on the results of the 10-m walking test, compared to controls. Aquatic therapy had a small positive effect on mobility (based on Timed Up and Go), (SMD, -0.43; 95% CI {-0.7-(- 0.17)}; I 2  = 71%) compared to land-based exercise (control)., Conclusions: Aquatic therapy had a more positive effect on walking speed, balance, and mobility than land-based exercises. Further research is needed to confirm the clinical utility of aquatic therapy for patients following stroke in the long term.

Background: According to the importance of physical activity in the child's physical and mental development and cognitive health, developing a valid, reliable, and comprehensive assessment tool for children's physical activity is mandated. The purpose of this study is the translation, cross-cultural adaptation, and validation of the Persian version of the Thailand Physical Activity Children Survey questionnaire to measure the level of physical activity in children aged between 6-9 years in Iran., Methods: This study consisted of three stages, first, the questionnaire translation into Persian language and modification of the sections according to the Iranian culture, then the evaluation of the questionnaire via a pilot study, and finally, assessing the reliability and validity of the tool. Participants of the pilot study were 250 healthy children, aged 6 to 9 years, meeting eligibility criteria, recruited through a stratified cluster sampling method from schools across Tehran., Results: The Persian version of the questionnaire demonstrated an acceptable content validity (Content Validity Index between 0.88-1). The test-retest reliability reported the Intra-Class Correlation coefficient in the acceptable range in all sections (between 0.71-1). Cronbach's alpha was reported 0.993, which indicated excellent internal consistency., Conclusions: According to the acceptable validity and reliability of the Persian version of the Thailand Physical Activity Children Survey for children aged 6-9 years, it is recommended in research and surveillance studies to determine the level of physical activity of children of that age group in Iran., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Purpose: Considering the role of physical activity on public health and the high prevalence of physical inactivity worldwide, determining physical activity barriers is critical and will be a road map for future planning. This study aimed to develop a comprehensive questionnaire to determine physical activity barriers., Methods: By reviewing previous studies, the main domains of the questionnaire were established. A physical activity expert interviewed 20 individuals aged 18 to 65 years. The results were evaluated by an expert panel for a content validity index. Face validity, test-retest reliability, and internal consistency were established on 204 individuals., Results: The content validity index in all items was within the acceptable range (&gt;0.85). Face validity was appropriate, and the misunderstanding index was &lt; 20% in all items. Test-retest reliability in the final questionnaire in all items based on Cohen's kappa was &gt; 0.20, indicating fair agreement. Internal consistency with Cronbach's alpha of 0.63 was within the acceptable range., Conclusion: The study revealed that the newly designed survey is valid, accurate, and reliable. The use of this comprehensive tool by policymakers would help them properly identify the perceived barriers, and thus perform better physical activity interventions as promotional health programs.

Purpose: Disturbance to physical and psychological characteristics among COVID-19 survivors are not uncommon complications. In the current systematic review, we aimed to investigate the role of exercise rehabilitation programs, either in acute or post-acute phase, on COVID-19 patients' outcomes., Methods: A systematic search was conducted in November 2021 of Web of Sciences, PubMed-Medline, Google Scholar, and Scopus. Observational and intervention studies on COVID-19-infected patients undergoing a rehabilitation program including any type of exercise were included if they reported physical or psychological factors as outcomes. The Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute (JBI) critical appraisal checklist were used by two independent reviewers., Results: A total number of 469, and 957 patients were included in 9 intervention studies, and 14 observational studies, respectively. Most factors reported by studies as outcomes fell in the categories of exercise capacity, respiratory function, as well as psychological aspects. The reported outcomes in almost all studies, disclosed the overall beneficial role of exercise rehabilitation in improving the outcomes., Conclusion: The current review demonstrated that exercise rehabilitation generally could have a beneficial role in improvement of both physical and psychological related outcomes. As the best onset time, and FITT components are not yet completely clear, further large, well-designed RCTs are suggested to provide details of exercise rehabilitation program., Competing Interests: Competing interestsThe authors declare no competing interests.Conflict of interestAll authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer-Verlag Italia S.r.l., part of Springer Nature 2022.)

Introduction. The objective of the present study was to investigate whether certain intrinsic factors (foot hyperpronation, generalized joint laxity) and clinical tests (anterior drawer and talar tilt tests, single-leg balance test and star excursion balance test, ankle and first metatarsophalangeal range of motion) could predict the incidence of lateral ankle sprains among elite football and basketball players during a full year. Method. In a prospective cohort study, 106 elite basketball and football players were recruited. During the preseason period, players underwent baseline measurements. Team physicians in following year reported occurrence of new ankle sprains. Results. Ankle sprain was more frequent among basketball players ( P = .01). The history of recurrent ( P = .001) and acute ankle sprain ( P = .01) and each 5-year increase in age ( P = .039) were predictive factors for ankle sprain. No evidence for relationship between other risk factors and occurrence of ankle sprain were achieved. Conclusion. In our study, the history of recurrent and acute ankle sprain was the strongest predictor for ankle injuries. Considering the limitations of this study, it seems mandatory to conduct more prospective studies with a larger sample size and longer follow-up period. Levels of Evidence: Level II: Prognostic.

Insufficient physical activity (IPA) caused approximately 5% of mortalities in 2017 in Iran, almost double its global average. Despite the relatively considerable burden, a knowledge gap exists regarding the trend of IPA in recent years. We described the trend of IPA prevalence utilizing the data from six rounds of STEPwise approach to risk factor Surveillance (STEPS) in Iran. We estimated the physical activity status of Iranian adults from 2006 to 2016 after adjusting for years of schooling, urbanization percentage, and wealth index. We used the spatiotemporal model to interpolate and extrapolate the IPA prevalence for the years in-between the series and from 2001 to 2006, respectively. We used the data of 177,910 participants from six STEPS surveys and found that the national prevalence of IPA had steadily increased over the course of 16 years and had almost doubled in this time period (23.1% in 2001 to 55.4% in 2016). The increase was persistent across all age and gender strata and in every province. Moreover, IPA was more prevalent among women than their male peers regardless of their age category or province of residence. The prevalence of IPA in Khuzestan (highest prevalence) was almost double compared to that in Lorestan (lowest prevalence) in 2016. The IPA prevalence increased considerably and almost doubled in 16 years among Iranian adults, particularly women. Policies need to target IPA as a high priority contributing to the burden of Non-communicable diseases., (© 2021. The Author(s).)

Background: Excessive competitive anxiety induces adverse effects on athletic performance and planning efficient management methods is crucial. Objectives: We aimed to assess the effects of acupuncture on competitive anxiety., Methods: In this cross-over study, 20 male soccer players under 21 years (U-21) were randomized equally into acupuncture or control groups. The acupuncture group received acupuncture on fifteen anxiety-related points and the control group received acupuncture on fifteen points unrelated to anxiety for thirty minutes. We measured the participants' resting heart rate and galvanic skin conduction and asked them to answer the Competitive State Anxiety Inventory-2 (CSAI-2) questionnaire at baseline and the end of the intervention., Results: We detected a significant treatment effect in the cognitive anxiety level (-1.05 ± 0.91; p = 0.02) but not in the somatic anxiety level (-0.46 ± 1.68; p = 0.43), Sport Self-Confidence (-1.06 ± 2.21; p = 0.11), heart rate (0.20 ± 2.2; p = 0.93), and skin conductance (-0.50 ± 0.77; p = 0.19)., Conclusion: Based on these results, acupuncture might decrease cognitive anxiety but might not affect somatic anxiety.

Background: Due to widespread abuse of anabolic-androgenic steroids among professional athletes and amateur sportsmen and their health-related problems, determining the prevalence and the pattern of anabolicandrogenic steroid misuse at the national level seems to be vital for designing efficient preventive and educational measures., Methods: This systematic review and meta-analysis was conducted via comprehensive searches of the electronic databases including PubMed, MedLine, Scopus, Google Scholar and National Persian Databases including SID, Magiran, IranDoc (between 1980 and Dec 2019 in English and Persian languages) and also from citations in the selected papers. Overall, 39 articles met the criteria and were included in qualitative and quantitative synthesis., Results: The overall prevalence rate of anabolic-androgenic steroid misuse in the Iranian athletic population was 36.2% (95% confidence interval (CI), 29-43) with significant heterogeneity between studies (I 2 =99.0%, P <0.001). Prevalence rate of anabolic-androgenic steroid misuse among elite, male and younger athletes was higher ( P <0.05). Moreover, prevalence rate of anabolic-androgenic steroid misuse among body-building athletes (36.3%) was higher compared to other athletes (30.9%), ( P <0.001)., Conclusion: Due to the higher prevalence of anabolic-androgenic steroids misuse in Iran compared to global statistics and the potential for serious adverse effects, preventive strategies and policies should be regarded as a real concern for public health., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2021 Selk-Ghaffari et al. Published by Tehran University of Medical Sciences.)

Background: Due to widespread use of supplement among athletes, determining the prevalence and pattern of dietary supplement consumption and its moderators will be a road map for developing a strategic planning in the national level to achieve healthy lifestyle and avoid harmful nutritional approaches., Methods: A systematic search of the electronic resources including Medline, PubMed, Scopus, Google Scholar and National Persian Databases including Magiran, SID, IranDoc and CIVILICA (between 1979 and November 2019 in Persian and English language) was accomplished. Inclusion criteria were (a) studies containing the prevalence rate of dietary supplement consumption, specifically (b) studies were conducted in athletes. Finally, 32 articles were included., Results: The prevalence rate of supplement use in overall Iranian athletic population was 64.8% (95% CI, 55.8%-73.8%) with significant heterogeneity (I 2 = 99.7%, P < 0.001). The prevalence rate was reported to be higher in male athletes, athletes aged 25 and older and elite athletes ( P < 0.05). The most prevalent source of information about supplement use among athletes were trainers, followed by physicians, friends-teammates and dietitians., Conclusions: According to the high prevalence of supplement consumption among Iranian athletes, policy making for educational programs is mandated. Trainers are the most popular source to provide information about supplements and educational programs should be conducted for this target population., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)

Ocular tumors are rarely seen in farm animals. Iridociliary epithelial tumors are the second most common tumor of the eye in dogs and cats, but there is just one report of this tumor in sheep. This case report described the history, clinical signs, histopathological and immunohistochemical findings, and surgical management of an iridociliary adenoma tumor in a 3-year-old Iranian Shaal sheep with signs of anorexia, depression, loss of vision, and a mass covering the left eye. The mass had protruded from the left eye globe but had not penetrated the periocular tissues. Enucleation was performed to excise the tumor. Periodic acid-Schiff (PAS) and Alcian blue staining methods were done for the mass, but the result for both of them was negative. Slides were also immunostained for antibodies against cytokeratin AE1/AE3, vimentin, and S-100 protein. The results were positive for vimentin but negative for cytokeratin and S-100. According to the results of histopathology and immunohistochemistry, the type of tumor was diagnosed as iridociliary adenoma. To our knowledge, it was the second report of the iridociliary tumor in the sheep and the first report of this tumor in the Iranian Shaal breed., Competing Interests: The authors declare no conflict of interest.

Objective: To investigate the effect of the Feldenkrais method versus core stability exercises on pain, disability, quality of life and interoceptive awareness in patients with chronic non-specific low back pain., Design: A single-blinded, randomised, controlled trial., Setting: Outpatient, sports medicine clinic of Mazandaran medical university., Participants: Sixty patients with chronic non-specific low back pain randomised equally into the Feldenkrais method versus core stability exercises groups., Intervention: Intervention group received Feldenkrais method consisting of training theoretical content and supervised exercise therapy two sessions per week for five weeks. Control group received educational programme and home-based core stability exercises for five weeks., Outcome Measures: All patients were examined by World Health Organization's Quality of life Questionnaire, McGill Pain Questionnaire, Oswestry Disability Questionnaire and Multidimensional Assessment of Interoceptive Awareness Questionnaire. All outcomes were measured at baseline and the end of the intervention., Results: There were statistically significant differences between groups for quality of life ( P  = 0.006, from 45.51 to 60.49), interoceptive awareness ( P  > 0.001, from 2.74 to 4.06) and disability ( P  = 0.021, from 27.17 to 14.5) in favour of the Feldenkrais method. McGill pain score significantly decreased in both the Feldenkrais (from 15.33 to 3.63) and control groups (from 13.17 to 4.17), but there were no between-groups differences ( P  = 0.16)., Conclusion: Feldenkrais method intervention gave increased benefits in improving quality of life, improving interoceptive awareness and reducing disability index.

Objectives: The present study was undertaken to determine the possible effects of the placement two different types of eyelid speculum on intraocular pressure (IOP) measurement in clinically normal cats., Methods: Thirty healthy cats were divided randomly into two groups of 15, group B (Barraquer wire speculum) and group W (Williams eye speculum). All cats were sedated with intramuscular medetomidine (Dorbene vet; 100 μg/kg) then placed in right lateral recumbency, and IOP was recorded in the left eye using a Tono-Pen Vet tonometer without and with an eyelid speculum in place in both groups., Results: The without-speculum IOPs for cats in group B and group W were 13.8 ± 3.0 mmHg and 13.2 ± 3.6 mmHg, respectively, and did not differ significantly. A significant increase in IOP (19.8 ± 3.7 mmHg) was observed in group W in with-speculum measurements in comparison to the without-speculum values ( P <0.001).There was no significant difference between with- and without-speculum IOP values (13.8 ± 2.7 mmHg) in group B ( P  = 1.0)., Conclusions and Relevance: The Barraquer wire speculum has no effect on IOP compared with the Williams eye speculum in normal cats, and may be an appropriate choice in cats for intraocular surgeries that cannot tolerate acute increases in IOP.

Objectives The objective of this study was to investigate the effect of body position on intraocular pressure in clinically normal cats. Methods Sixteen clinically normal cats without any ocular abnormalities were used in this study. Cats were sequentially placed in three different recumbency positions (sternal recumbency, right lateral recumbency and dorsal position). For each of the three body positions, intraocular pressure (IOP) was recorded in the left eye using a Tono-Pen Vet tonometer (Reichert). Results Mean IOP readings in cats in the sternal recumbency, right lateral recumbency and dorsal positions were 15.6 ± 4.1, 16.6 ± 6.4 and 18.6 ± 6.8 mmHg, respectively. A significant increase was observed in IOP in cats in the dorsal position compared with the IOP observed in cats in sternal recumbency ( P = 0.01) and right lateral recumbency ( P = 0.04). There was no significant difference between the IOP recorded in the lateral recumbency and sternal recumbency ( P = 0.17) positions. Conclusions and relevance Body position has a significant effect on the IOP of cats. IOP increases when cats are placed in dorsal recumbency.

A 10-year-old, male Rottweilerdog was presented to Small Animal Hospital of Tehran University with a history of lethargy, anorexia, weight loss, vomiting, polyuria, polydipsia and blindness. The dog showed symptoms of depression, high body temperature (39.2 ˚C), tachypnea (40 breaths min -1 ) and cachexia. In ophthalmic examination, bilateral hyphema (hemmorrahge in anterior chamber of the eye) and blindness were detected. The pulse of the animal was normal (90 beats min -1 ) and obvious general lymphadenopathy was determined. Lymph nodes were firm, freely movable, and painless on palpation. Initial differential diagnosis of lymphoma included lymphoma, metastatic neoplasia, lymphoid hyperplasia, and lymphadenitis. In hematology and cytology tests, this case was suspected to lymphoma. Immunohistochemical staining of neoplastic lymph node revealed that nearly 20.00 - 25.00% of neoplastic cells were strongly positive for anti CD3, whereas they were negative for both CD20 and CD79a. According to the microscopic and immunohistochemical findings, a diagnosis of T cell lymphoma was made. The present report is the first case of multicentric lymphoma with ocular metastasis in a dog in Iran., Competing Interests: The authors declare that there was not any conflict of interest.

This study was conducted to establish normal reference range for the Schirmer tear test (STT) and intraocular pressure (IOP) in clinically normal donkeys for use in clinical practice. Sixteen adult Ethiopian domestic donkeys were used in this study. Complete ophthalmic examinations were performed without chemical restraint. STT values were evaluated in both eyes of all donkeys using a commercial STT strip. IOP was measured in both eyes with a Tono-Pen Vet (Reichert. USA) without using regional nerve blocks. STT values for all eyes (n=32) were 22.1±6.9 mm/minute with a range of 13-35 mm/minute. Comparison of mean STT values between right (n=16) and left eyes (n=16) showed no differences (P=0.6). Mean ±sd IOP values by applanation tonometry were 17.8±3.7 mmHg (range 13.5-24.5 mmHg). Comparison of mean IOP values between right (n=16) and left eyes (n=16) showed no differences (P=0.7). This initial survey provides means and ranges for IOP and STT values in donkeys. These data will assist veterinary ophthalmologists in more accurate diagnosis and management of ophthalmic diseases in donkeys, including keratoconjunctivitis sicca and glaucoma., Competing Interests: Competing interests: None declared., (© British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: The aim of this study was to evaluate the effect of topical tropicamide at two concentrations (0.5% and 1.0%) on the Schirmer tear test (STT) results in clinically normal cats., Methods: Twenty-four adult domestic shorthair cats were randomly assigned to three groups. In all three groups, ophthalmic solutions were instilled in a randomly selected eye and the opposite eye served as the control. In groups 1, 2 and 3 one drop of 0.5% tropicamide, 1.0% tropicamide and distilled water was used, respectively. Tear production in both eyes was tested 30 and 60 mins after instillation in all three groups., Results: Baseline mean ± SEM STT values for the treated eyes in groups 1, 2 and 3 were 13.37 ± 2.91 mm/min, 10.87 ± 1.39 mm/min and 11.37 ± 1.65 mm/min, respectively. Thirty minutes after the drug instillation in the treated eye, mean ± SEM STT values in groups 1, 2 and 3 were 4.87 ± 3.05 mm/min, 2.00 ± 0.84 mm/min and 11.25 ± 1.81 mm/min, respectively. The mean ± SEM STT levels of the treated eye after 60 mins were 3.75 ± 1.87 mm/min, 0.5 ± 0.37 mm/min and 11.42 ± 1.78 mm/min in groups 1, 2 and 3, respectively., Conclusions and Relevance: Use of 0.5% topical tropicamide, instead of 1.0% tropicamide, as a mydriatic agent, can be recommended in cats. Tear production measurement should be performed prior to the administration of tropicamide, regardless of the concentration of this drug., (© The Author(s) 2015.)

Objectives: This study aimed to determine the effects of intramuscular medetomidine on the results of tonometry in healthy cats., Methods: Sixteen healthy cats were randomly divided into two groups of eight cats. The first group was sedated with intramuscular medetomidine alone (100 µg/kg) and the second group received only saline (0.5 ml/5 kg). Intraocular pressure (IOP) values were measured immediately before (T0) and after the injections at 15 mins (T15) and 25 mins (T25) in both groups., Results: Sedation with medetomidine did not cause a statistically significant change in the mean IOP values. The pretreatment mean ± SD IOPs in the treatment and control groups were 16.2 ± 3.1 and 15.9 ± 4.0 mmHg, respectively. In the medetomidine group the mean ± SD IOPs at T15 and T25 were 16.1 ± 4.1 (P = 0.9) and 14.6 ± 2.2 (P = 0.1)., Conclusions and Relevance: Based on this study in healthy cats, medetomidine may be a good choice as a sedative agent in uncooperative cats when IOP measurements are needed. Further investigations in cats with abnormal IOPs are warranted., (© ISFM and AAFP 2015.)

The objective of this study was to measure intraocular pressure (IOP) in intact, healthy guinea pigs (15 male, 15 female) every 2 h for a 24-h period. First, IOP was measured by using rebound tonometry (RBT). After a 1-min rest period, 0.5% proparacaine ophthalmic solution, a topical anesthetic, was applied to both eyes; 4 min after anesthetic instillation, IOP was measured by using applanation tonometry (APT). The IOP was lower during the light period (0700 to 1900) than during the dark phase (2000 to 0600). The lowest IOP by both RBT and APT (3.68 and 13.37 mm Hg, respectively) occurred at 0700, whereas maximal IOP occurred at 2300 for RBT (8.12 mm Hg) but at 2100 for APT (20.62 mm Hg). No significant differences in IOP between the left and right eyes or between RBT and APT were noted. In addition, daily variations in the IOP of guinea pigs seem to be independent of sex and body weight. The results of this study may be beneficial in the diagnosis and observation of glaucoma in guinea pigs.

To evaluate tear production in the common mynah ( Acridotheres tristis ) using the phenol red thread test (PRTT) and to make a comparison of measurements with the PRTT placed in the fornices of lower and upper eyelids, tear production of both eyes in 22 healthy adult captive mynah birds was evaluated. After positioning of threads in the fornices of upper and lower eyelids, the PRTT values of the birds were 17.5 ± 3.1 mm/15 s and 19.2 ± 2.5 mm/15 s, respectively. A significant difference was found between PRTT values for upper eyelids and lower eyelids (P = 0.01). This study provides novel data for normal reference ranges of PRTT values in healthy common mynah birds and shows that a difference is found depending on where the PRTT thread is placed.

Objective: To determine effects of 14 days of oral administration of trimethoprim-sulfamethoxazole on aqueous tear production in clinically normal Syrian hamsters., Animal Studied: Fifteen healthy adult Syrian hamsters., Procedure: Baseline phenol red thread test (PRTT) values were recorded 1 day prior to treatment. Eight hamsters in treated group received 15 mg/kg trimethoprim-sulfamethoxazole orally twice a day for 14 days. The remaining seven hamsters were used as untreated controls and received a placebo. All ophthalmic tests were performed without chemical restraint. PRTT values were evaluated in both eyes of all Syrian hamsters using a commercial PRTT strip of a single lot number., Results: The mean ± SD baseline PRTT values for treatment group and control group were 7.25 ± 1.3 mm/15 s and 5.42 ± 1.13 mm/15 s, respectively. After 14 days of drug administration, the mean ± SD PRTT values for treatment group and control group were 5.62 ± 1.5 and 5.64 ± 0.74, respectively. Significant decreases in the PRTT values, compared with baseline values, were observed in the treatment group on day 15 (P = 0.042)., Conclusions: Trimethoprim-sulfamethoxazole decreased tear production in the hamster in this study., (© 2014 American College of Veterinary Ophthalmologists.)

Objective: To observe the effect of topical 1% tropicamide on equine tear production as measured by Schirmer I tear test., Materials and Methods: Fourteen adult horses received one drop of 1% tropicamide ophthalmic solution in one eye and the opposite eye served as the control. The tear production in both eyes was tested at 1, 2, 4, 6, and 24 h after 1% tropicamide administration., Results: Measurements made 1 h after treatment revealed a significant reduction in Schirmer tear test values in tropicamide treated eyes (P = 0.002). The observed decrease in tear production was maintained up to 4 h after treatment (P = 0.002). Although tropicamide-induced decrease in STT values was observed in the treated eyes, the contralateral eyes did not show significant changes in Schirmer tear test results., Conclusion: Single dose of topical 1% tropicamide resulted in statistically significant reduction in Schirmer tear test values in clinically normal horses.

A 3-year-old crossbreed male dog was presented with a history of blunt facial trauma. Skull radiographs showed right zygomatic arch fracture. An electrocardiogram revealed bradycardia, first-degree atrioventricular block and QT prolongation. Standard biochemical profile including electrolytes was normal. Atropine response test (0.04 mg/kg intravenously) restored normal sinus rhythm at a rate of 140 bpm with normal QT and PR intervals. This observation is consistent with oculocardiac reflex secondary to zygomatic arch fracture.