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SLOfit Lifelong is a public health initiative which was created to upgrade a well-established, national physical fitness surveillance system for Slovenian schoolchildren that has been collecting annual fitness and health data for over three decades. The ultimate objective of creating SLOfit Lifelong was to build a modern societal infrastructure with the capacity and ability to detect future causal associations between childhood physical fitness trends and future health outcomes based on the lifelong surveillance of one’s own fitness status. By instilling citizens with an ambition to test, understand, and follow-up their own physical fitness and health status (including related health risk factors), this initiative provides the technical support and expert feedback needed to engender greater individual control over understanding (and thus modulating), one’s own physical fitness status as they progress into older adulthood. This perspective paper details the extensive approach taken to devise appropriate fitness test batteries for adults and older adults which can also relate to the student version of the original SLOfit test database, including establishing criterion health risk zones and a public approach to establish this national, citizen-driven health feedback framework. Through its sophisticated online web applications, social media, print media, and outreach workshops, SLOfit Lifelong provides the expert support for public health engagement by fostering positive lifelong physical literacy experiences an individual can enjoy across their aging journey.

In Slovenia, the national SLOfit surveillance system of the somatic and motor development of children and youth has been enabling researchers to observe the developmental trends of the entire population of school-aged children since 1987. The national database currently incorporates over 7.2 million sets of measurements of eight fitness tests and three anthropometric measurements. Since 1991, as in the rest of the world, in Slovenia, there is a common perception that the physical fitness of contemporary children is in decline and below the level of the physical fitness of the previous generation’s childhood fitness. Our paper examines the trends of physical fitness in 26 birth cohorts of 7–10-year-olds. The analysis shows that the secular trends of physical fitness in boys and especially in girls have been positive and that the level of physical fitness of recent birth cohorts exceeds the national average of physical fitness of the 1989–2019 period. At the same time, the analysis reveals that the distribution of physical fitness has been changing from almost normal in the cohorts born in the first half of the 1980s, toward positively skewed in the subsequent cohorts born before the year 2000, and bimodal distribution in the later cohorts, indicating growing inequality and polarization of the motor development of children.

The Republic of Slovenia implements the largest longitudinal database of child physical fitness in the world–SLOfit. Slovenia has some of the most physically active children globally, and it has responded rapidly to incorporate national physical activity (PA) interventions throughout the COVID-19 pandemic. Despite aggressive campaigns to maintain PA at home, the country has seen a tremendous decrease in child physical fitness over the past several months as self-isolation measures have been mandated by national authorities. These trends prompted researchers to create a method of tracking and communicating government decisions which have a direct impact on child physical activity, fitness and overall health (i.e., the SLOfit Barometer). The research team assembled experts for consultation on creation of the SLOfit Barometer after processing preliminary data on 20,000 schoolchildren which found the greatest decline in child physical fitness since systematic testing began more than 30 years ago. Only 2 months of self-isolation erased over 10 years of hard-fought health gains acquired from national public health policies and PA interventions. This crisis in child fitness requires integrated community participation and a robust public health policy response, and with the SLOfit Barometer acting as a national bellwether system, it is envisioned that policy makers and the public will advocate for bold, progressive actions to combat this national health emergency. This surveillance tool tracks government action to combat the increasing child physical inactivity and obesity trends brought on as a direct result of COVID-19 isolation regulations.

Body fat and muscle mass showed opposing associations with mortality. The results of research on the effectiveness of popular body mass (BM) loss diets in obese subjects showed 20 to 30% loss of muscle mass within the total BM loss; conversely, when the subjects used a whole-food, plant-based (WFPB) diet, the loss was up to 42%. Therefore, we suggest an improvement. The aim of this retrospective analysis of data was to examine the assessment of changes in the body composition of 217 participants from all over Slovenia who joined our ongoing, community-based WFPB lifestyle programme from 2016 to 2021 and underwent two successive measurements of medically approved bioelectrical impedance. The WFPB lifestyle programme consisted of (i) nutrition, (ii) physical activity (PA) and (iii) a support system. The primary outcomes included the (vector of) change of body fat mass (BFM) per body height (BH), fat-free mass (FFM) per BH and whole-body phase angle (PhA) from the initial values to the first follow-up (FU) of the whole sample and for both sexes. Further, we examined the FFM change within the total BM loss according to their BMI classification and depending on how much BM they lost (5 kg < BM ≥ 5 kg) within the FU time (103.6 ± 89.8 day). Participants experienced a decrease in BFM per BH (−0.02 ± 0.02 kg/cm, p < 0.001), no change in FFM and an increase in PhA (0.2 ± 0.7°, p < 0.001). Importantly, the participants in the obesity BMI class achieved only partial FFM preservation (−1.5 ± 3.6 kg, p = 0.032 of FFM loss (20%) within −7.5 ± 6.1 kg, p < 0.001 of BM loss). However, the participants who lost BM < 5 kg had a significantly increased FFM (0.8 ± 3.2 kg, p = 0.001 of FFM (57%) within −1.4 ± 1.8 kg, p < 0.001 of BM loss), whereas the participants who lost BM ≥ 5 kg experienced a decrease in FFM (−2.2 ± 3.9 kg, p < 0.001 of FFM (−25%) within −8.8 ± 5.2 kg, p < 0.001 of BM loss). To conclude, the WFPB lifestyle, on average, effectively preserved FFM during BM and/or BFM loss among the normal and pre-obesity BMI classes but only partially among the obese BMI class and those who lost ≥ 5 kg of BM. Importantly, a customized PA strategy is needed for obese BMI class participants, where general resistance training is not possible or safe in order to preserve their muscle mass more effectively. In addition, muscle mass preservation is important for further improvements of BM, body composition and visual body image.

Focusing on the steps that literally and metaphorically guide us today, this paper takes walking as its main subject and establishes it theoretically as a form of subversive bodily movement. If contemporary sociological and humanistic treatments of walking show that this everyday practice has not been completely overlooked, the gap opens at the level of thinking it in relation to the dominant social order and its spatial and temporal manifestations. As we argue, in the hegemonic neoliberal context, walking has the potential to manifest itself as a practice that breaks with the existing logic of both space and time. Through the methodological application of the cat’s cradle game, we develop a theoretical argumentation to ground walking as a bodily practice that requires different space and different time. Emanating from the body, it opens to the space and time of enjoyment – a heterotopia erected in relation to the current neoliberal hegemony, but in the manner of a crack, a path that carries the projection of a possible alternative.

Najpogosteje uporabljena metoda za zdravljenje kronične ledvične bolezni je hemodializa. Ti bolniki imajo običajno slabše gibalne sposobnosti in posledično težave z ravnotežjem, ki lahko povzročijo nepotrebne zaplete zaradi padcev. Ustrezna telesna aktivnost pri zdravih posameznikih izboljšuje vse gibalne sposobnosti, med katerimi je tudi ravnotežje. Namen magistrskega dela je bil ugotoviti, kako telesna vadba vpliva na statično in dinamično ravnotežje pri hemodializnih bolnikih. V raziskavi je sodelovalo 40 bolnikov, ki so se zdravili s hemodializo v Univerzitetnem kliničnem centru v Ljubljani. Naključno smo jih razdelili v kontrolno in eksperimentalno skupino. Eksperimentalna skupina je izvajala pred-dializno funkcionalno vadbo in med-dializno kolesarjenje. Kontrolna skupina je izvajala samo med-dializno kolesarjenje. Pred pričetkom vadbenega programa smo izvedli testiranje ravnotežja. Za preverjanje statičnega ravnotežja smo izbrali štorkljin test, za preverjanje dinamičnega pa test funkcionalnega dosega. Po končanem vadbenem programu, ki je potekal trikrat tedensko v obsegu 8 tednov, smo ponovno izvedli testiranje ravnotežja. Podatke smo nato zbrali in uredili ter jih primerjali z rezultati začetnega testiranja. Raziskavo je zaključilo 35 bolnikov. Ugotavljali smo povezanost obeh testov ravnotežja. Statično ravnotežje je statistično značilno povezano z dinamičnim ravnotežjem (p=0,006). Kontrolna skupina je rezultat funkcionalnega dosega izboljšala za 5 cm (p=0,008) ter štorkljinega testa za 2,76 s (p=0,008). Eksperimentalna skupina je prav tako izboljšala rezultat funkcionalnega dosega ter štorkljinega testa, in sicer za 12 cm (p

Glede na podatke Svetovne zdravstvene organizacije (WHO) ima trenutno okoli 285 milijonov ljudi sladkorno bolezen, a glede na projekcije bi se to število do leta 2030 povečalo na 438 milijonov. Globalni stroški za zdravljenje sladkorne bolezni so bili leta 2010 ocenjeni na 376 milijard ameriških dolarjev (USD) in bodo glede na projekcije leta 2030 znašali 490 milijard USD. Kljub množičnemu dostopu do zdravil in zdravnikov, urejenost glikemije ni samoumevna. Neurejena glikemija vpliva na rast pojavnosti zapletov sladkorne bolezni in posledično na stroške bolezni. Med pomembne vzroke neurejenosti prištevamo slabo sodelovanje bolnikov s sladkorno boleznijo. Svetovna zdravstvena organizacija (WHO) je definirala termin sodelovanje kot »obseg, v katerem bolnikovo obnašanje (jemanje zdravil, upoštevanje diete in/ali izvajanje sprememb v življenjskem slogu) ustreza dogovorjenim priporočilom zdravstvenega delavca«. V literaturi obstaja več objav, v katerih so raziskovalci hkrati vrednotili sodelovanje bolnikov pri jemanju zdravil in stroške sladkorne bolezni tipa 2 (SB2). Študije nakazujejo, da izboljšano sodelovanje zniža stroške SB2. Objav, ki ocenjujejo vpliv sodelovanja bolnikov pri uživanju ustrezne prehrane in izvajanju zadostne telesne aktivnosti na stroške SB 2, je znatno manj. Raziskave, ki primerjajo stroške bolezni z izboljšanjem sodelovanja bolnikov, so bile izvedene so kot retrospektivne in presečne študije in ne kot prospektivne študije z upoštevanjem stroškov za izboljšanje sodelovanja in vzdrževanja dosežene ravni sodelovanja. Po podatkih iz literature se z upoštevanjem sodelovanja spremenijo letni stroški zdravil in njihova učinkovitost. Hkrati se sodelovanje pri jemanju zdravil ne upošteva pri izračunih prirastka stroškov glede na prirastek učinkovitosti. Bolniki, ki uporabljajo DPP-4 inhibitorje, so značilno bolj sodelujoči kot bolniki, ki uporabljajo sulfonilsečnine. Pri slednjih namreč obstaja povečana možnost za nastanek hipoglikemije in povečanje telesne teže. V Sloveniji še ni bila izvedena raziskava obsega sodelovanja bolnikov s SB2 pri jemanju zdravil. Opravljena je bila raziskava, ki je obravnavala sledenje pravilni prehrani in ustrezni količini telesne aktivnosti, vendar so avtorji raziskave sledili drugim ciljem. Zaradi tega rezultati niso opredeljeni s stališča sodelovanja. Primerjava z ostalimi državami ni bila izvedena. V Sloveniji je bila leta 2006 objavljena ocena bremena SB2 s stališča plačnika, vendar breme ni bilo ovrednoteno celostno. Zaplete so predstavljali kardiovaskularni in cerebrovaskularni akutni dogodki, stroški nefropatije, retinopatije, nevropatije, razjed na stopalu in amputacije niso bili vključeni. Glede na navedeno, smo pripravili štiri študije z namenom opredelitve sodelovanja bolnikov s SB2 in ovrednotenja vpliva sodelovanja na stroškovno učinkovitost ter breme bolezni bolnikov s SB2. Namen prve raziskave je bil ovrednotiti sodelovanje slovenskih bolnikov s SB2 v primeru jemanja zdravil, prehrane in telesne aktivnosti. V raziskavo smo vključili 93 SB2 bolnikov, vključenih v prospektivno študijo o vplivu farmacevtske intervencije na urejenost glikemije. Bolnikom (intervencijska in kontrolna skupina) so pred in med intervencijo izmerili vrednosti HbA1c, HDL, LDL, pritisk, telesno maso in telesno višino. Prav tako so bolniki izpolnili vprašalnika Morisky “8-item” (MMAS-8) in The summary of diabetes self-care activities (SDSCA). Z dobljenimi rezultati pred izvedbo intervencije smo izvedli oceno sodelovanja in jih primerjali z rezultati objavljenimi drugje. Ugotovili smo, da so bolniki v Sloveniji dobro sodelujoči v primeru jemanja zdravil (90,75 %). V primeru ustrezne prehrane so bolniki srednje sodelujoči (60 %) in v primeru telesne aktivnosti dobro sodelujoči (90 %). Podatek pri telesni aktivnosti je z vidika vpliva na krvne vrednosti dejavnikov tveganja za SB2 precenjen. Sestavljen je iz dveh vprašanj, kjer prvo zajema delo okrog hiše in hojo, drugo vprašanje pa zajema intenzivne telesne aktivnosti, ki so po literaturnih podatkih učinkovite pri urejanju krvnih vrednosti dejavnikov tveganja. Rezultati prvega vprašanja so enkrat višji od rezultatov drugega. Kljub visoki stopnji sodelovanja pri jemanju zdravil smo pri vključenih bolnikih zaznali visoke vrednost Hba1c. Rezultati so skladni s kanadskimi podatki in nakazujejo na problem neurejene glikemije ob sočasnem rednem jemanju zdravil. Namen druge raziskave je bil oceniti breme SB2 s stališča plačnika zdravstvenega varstva v Sloveniji. Uporabili smo prevalenčni pristop in pristop ocenjevanja »od spodaj navzgor« (angl. »bottom up«). Ocenjeni so bili neposredni medicinski stroški. Breme plačnika zdravstvenega varstva (obvezno in dopolnilno zavarovanje) v Sloveniji smo ovrednotili na 99.120.419 EUR oz. 4,18 % planiranih javnih stroškov za zdravstvo, kar je primerljivo z zahodnimi državami. akutni dogodki, stroški nefropatije, retinopatije, nevropatije, razjed na stopalu in amputacije niso bili vključeni. Glede na navedeno, smo pripravili štiri študije z namenom opredelitve sodelovanja bolnikov s SB2 in ovrednotenja vpliva sodelovanja na stroškovno učinkovitost ter breme bolezni bolnikov s SB2. Namen prve raziskave je bil ovrednotiti sodelovanje slovenskih bolnikov s SB2 v primeru jemanja zdravil, prehrane in telesne aktivnosti. V raziskavo smo vključili 93 SB2 bolnikov, vključenih v prospektivno študijo o vplivu farmacevtske intervencije na urejenost glikemije. Bolnikom (intervencijska in kontrolna skupina) so pred in med intervencijo izmerili vrednosti HbA1c, HDL, LDL, pritisk, telesno maso in telesno višino. Prav tako so bolniki izpolnili vprašalnika Morisky “8-item” (MMAS-8) in The summary of diabetes self-care activities (SDSCA). Z dobljenimi rezultati pred izvedbo intervencije smo izvedli oceno sodelovanja in jih primerjali z rezultati objavljenimi drugje. Ugotovili smo, da so bolniki v Sloveniji dobro sodelujoči v primeru jemanja zdravil (90,75 %). V primeru ustrezne prehrane so bolniki srednje sodelujoči (60 %) in v primeru telesne aktivnosti dobro sodelujoči (90 %). Podatek pri telesni aktivnosti je z vidika vpliva na krvne vrednosti dejavnikov tveganja za SB2 precenjen. Sestavljen je iz dveh vprašanj, kjer prvo zajema delo okrog hiše in hojo, drugo vprašanje pa zajema intenzivne telesne aktivnosti, ki so po literaturnih podatkih učinkovite pri urejanju krvnih vrednosti dejavnikov tveganja. Rezultati prvega vprašanja so enkrat višji od rezultatov drugega.Kljub visoki stopnji sodelovanja pri jemanju zdravil smo pri vključenih bolnikih zaznali visoke vrednost Hba1c. Rezultati so skladni s kanadskimi podatki in nakazujejo na problem neurejene glikemije ob sočasnem rednem jemanju zdravil. Namen druge raziskave je bil oceniti breme SB2 s stališča plačnika zdravstvenega varstva v Sloveniji. Uporabili smo prevalenčni pristop in pristop ocenjevanja »od spodaj navzgor« (angl. »bottom up«). Ocenjeni so bili neposredni medicinski stroški. Breme plačnika zdravstvenega varstva (obvezno in dopolnilno zavarovanje) v Sloveniji smo ovrednotili na 99.120.419 EUR oz. 4,18 % planiranih javnih stroškov za zdravstvo, kar je primerljivo z zahodnimi državami.Namen tretje raziskave je bil prikazati vpliv intervencij za izboljšanje sodelovanja bolnikov s SB2 v primeru jemanja zdravil, prehrane in telesne aktivnosti na breme SB2 s stališča plačnika. Intervencije vplivajo na izboljšanje kliničnih vrednosti dejavnikov tveganja za SB2 in posledično na pojavnost in stroške zapletov. Stroški intervencije lahko izničijo prihranke zaradi manjših pojavnosti zapletov. Oceno vpliva na breme smo posledično izvedli z ovrednotenjem stroškovne učinkovitosti intervencij za izboljšanje sodelovanja. Vrsto in učinkovitost intervencij smo določili s sistematičnim pregledom literature. Raziskavo stroškovne učinkovitosti smo izvedli s simulacijskim modelom UKPDS Outcomes model verzija 2.0. Demografske (spol, etničnost, starost, trajanje SB2, telesna masa, telesna višina) in klinične podatke (HDL, LDL, sistolični krvni tlak, HbA1c) 93 SB2 bolnikov iz prve raziskave smo uporabili kot vhodne podatke modela. Povprečno vrednost srčnega utripa, število levkocitov, koncentracijo hemoglobina in hitrost glomerulne filtracije smo pridobili iz literature in jih z enačbami simulacijskega modela prilagodili posameznemu bolniku glede na ostale demografske in klinične vrednosti. Obdobje simulacije je bilo doživljenjsko. Prikazali smo, da izboljšanje sodelovanja z uvedbo intervencij vpliva na breme SB2 s strani plačnika. Stroški bolezni na bolnika se z upoštevanjem stroška intervencij zvišajo od 233 EUR (trajanje intervencije eno leto) do 5568 EUR (trajanje intervencije 10 let). Intervencije, ki vplivajo na sodelovanje bolnikov pri jemanju zdravil, so stroškovno najbolj učinkovite, poleg tega v največji meri izboljšajo dejavnike tveganja za SB2. Razmerje prirastka stroškov glede na prirastek učinkovitosti (v EUR na pridobljeno kakovostno leto življenja – QALYg) intervencij, ki vplivajo na jemanje zdravil (trajanje intervencije 10 let) je znašalo od 9.983 do 30.967 EUR/QALYg. Strošek intervencije, ki uvaja mediteransko prehrano, je znašal 27.246 EUR/QALYg, pri intervenciji aerobne telesne aktivnosti je znašal 80.798 EUR/QALYg, pri intervenciji z rezistentno telovadbo 111.847 EUR/QALYg in pri kombinirani intervenciji telesne aktivnosti 46.411 EUR/QALYg. Namen četrte raziskave je bil opredeliti vpliv sodelovanja bolnikov pri jemanju zdravil na stroškovno učinkovitost zdravil. Oceno smo izvedli z ovrednotenjem prirastka stroškov glede na prirastek učinkovitosti za DPP-4 inhibitorje v primerjavi s sulfonilsečninami v drugi liniji zdravljenja. Učinkovitost in cene zdravil smo spreminjali glede na različne stopnje sodelovanja. Raziskavo smo izvedli s simulacijskim modelom UKPDS Outcomes model verzija 2.0. Demografske (spol, etničnost, starost, trajanje SB2, telesna masa, telesna višina) in klinične podatke (HDL, LDL, sistolični krvni tlak, HbA1c) 93 SB2 bolnikov iz prve raziskave smo uporabili kot vhodne podatke modela. Obdobje simulacije je bilo doživljenjsko.Prikazali smo, da sodelovanje vpliva na razmerje prirastka stroškov glede na prirastek učinkovitosti. Brez upoštevanja sodelovanja bolnikov je razmerje prirastkov znašalo 1.322.690 EUR/QALYg, z upoštevanjem sodelovanja pa od 297.698 EUR/QALYg (2,5 kg povečanje telesne mase pri uporabnikih sulfonilsečnin) do 553.170 EUR/QALG (1,5 kg povečanje telesne mase pri uporabnikih sulfonilsečnin). Zaradi visoke cene DPP-4 inhibitorjev (425,6 EUR/leto) so sulfonilsečnine (70,4 EUR/leto) predstavljale dominantno terapijo pred in po upoštevanju sodelovanja. According to the World Health Organization (WHO), 285 million people are currently suffering from diabetes. The latest projections predict that the number of cases will have risen to 439 million by 2030. Global costs for diabetes treatment in 2010 were estimated to 376billion dollars and according to the predictions they will have risen to 490 billion dollars by 2030. Despite the wide access to medication and physicians, good glycaemic control is not self-evident. Poor gylcemic control results in higher rates of diabetes complications occurrences and consequently influences diabetes costs. One of the vital factors is inappropriate medication adherence. WHO defined the term adherence as »extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider«. As literature shows, medication adherence and type 2 diabetes (SB2) costs are widely researched. Studies indicate adherence results in cost savings for the healthcare payer. There are significantly less publications on the cost impact of diet and exercise adherence. Studies correlating the cost of illness with patient adherence rates are retrospective and crosssectional. However, they lack adherence enhancement and adherence maintaining costs. According to the published data, adherence impacts annual costs and effectiveness of medication. Medication adherence is not considered in incremental cost-effectiveness ratio (ICER) calculations. Sulphonilurea treatment results in weight gain and higher hypoglycaemia rates therefore patients using DPP-4 inhibitors are significantly more adherent than sulphonilurea users. No type 2 diabetes medication adherence assessment has been conducted in Slovenia to date. Diet and exercise adherence were assessed before however, adherence determination was not the main study aim. The results are consequently not presented nor compared to the published literature from the adherence perspective. Type 2 diabetes burden from the healthcare payer perspective in Slovenia was published in 2006. Cardiovascular and cerebrovascular occurrences were taken into account. The burden assessment lacked information on nephropathy, retinopathy, neuropathy, foot ulcer and amputation impact. With regard to stated data, we prepared four studies aiming to assess adherence in SB2 patients, determine adherence impact on cost-effectiveness and assess type 2 diabetes patient burden of illness. The aim of the first study was medication, diet and exercise adherence determination on a cohort of Slovenian SB2 patients. 93 SB2 patients who participated in the prospective pharmaceutical intervention impact on glycaemic control study were included. Hba1c, HDL, LDL, blood pressure, body mass and height were measured before and during the intervention study. Adherence was assessed through the Morisky 8-item (MMAS-8) questionnaire and the Summary of diabetes self-care activities (SDSCA) questionnaire. Adherence levels were determined with the help of measurements conducted before the beginning of the study. Medication adherence was assessed as good (90.75%) as was exercise adherence (90%) while diet adherence was assessed as low (60%). However, exercise adherence results are overestimated regarding SB2 risk factor improvements. SDSCA exercise chapter consists of two questions with the first aiming at general activities like »work around the house, walking ...« and the second aiming at specific exercise sessions. The results from the second question are generally 50% lower than the results from the first one. Interventions which are effective in SB2 risk factor improvements are considered as intensive therefore results from the second question indicate a generally lower exercise adherence score. Despite high medication adherence, the average HbA1c value in the study cohort was also elevated. The results obtained were similar to Canadian data and indicate that glycaemic control is suboptimal despite the fact that patients use medication regulary. The aim of the second study was type 2 diabetes healthcare payer burden assessment. The study used the bottom-up approach, was prevalence-based and estimated direct medical costs. Diabetes healthcare payer burden was assessed to 99,120,418 EUR (4.18% of planned public healthcare expenditures) which is similar to the data published earlier. The purpose of the third study was determination of medication adherence or lifestyle intervention impact on type 2 diabetes healthcare payer burden. Interventions enhance type 2 diabetes risk factors, consequntly complications occurrence rates and costs are lowered. However intervention costs can exceed savings, therefore the burden impact was assessed with cost-effectiveness determination of medication adherence and lifestyle interventions. Intervention types and efficacies were determined by a systematic literature review. United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used (n=93) for cost-effectiveness analysis-required disease progression simulation. The patient data encompassed gender, ethnicity, age, SB2 duration, body mass, height, HDL, LDL, systolic blood pressure and HbA1c. Average heart rate, white blood cells (WBC) count, haemoglobin concentration and estimated glomerular filtration rate were derived from literature data and further adapted to each patient with simulation model internal equations considering individual demographic and clinical data. Lifetime time horizon was used. The results indicate that intervention-induced adherence improvement impacts type 2 diabetes healthcare payer burden. Disease costs increased for minimal 233 EUR (1 year intervention duration) to 5568 EUR (10 year intervention duration). Medication adherence intervention was the most cost-effective and had the highest efficacy and SB2 blood risk factors improvements. ICER in EUR/QALYg for medication adherence interventions (10 years duration) was assessed from 9,983 to 30,967 EUR/QALYg, for diet adherence interventions to 27,246 EUR/QALYg, for aerobic exercise interventions to 80,798 EUR/QALYg, for resistance exercise interventions to 111,847 EUR/QALYg and for combined exercise interventions to 46,411 EUR/QALYg. The goal of the fourth study was determination of type 2 diabetes medication adherence impact on medication cost-effectiveness. The impact was assessed with ICER determination of DPP-4 inhibitors compared to sulphonilureas as second line treatment. Medication costs and effectiveness were altered according to different adherence rates. United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used (n=93) for cost-effectiveness analysis-required disease progression simulation. The patient data encompassed gender, ethnicity, age, SB2 duration, body mass, height, HDL, LDL, systolic blood pressure and HbA1c. The results suggest that adherence impacts ICER. With no adherence consideration ICER amounted to 1,322,690 EUR/QALYg and with adherence consideration ICER amounted from 297,698 EUR/QALYg (2.5 weight increase in sulphonilurea users) to 553,170 EUR/QALYg (1.5 weight increase in sulphonilurea users). As a result of high DPP-4 inhibitors costs (425,6 EUR/year), sulphonilureas (70,4 EUR/year) represented a dominant treatment approach irrespective of adherence values.

V diplomski nalogi smo preučili vpliv socioekonomskega statusa na prekomerno telesno težo in debelost mladih v Sloveniji. Prvi, teoretični del naloge obsega predstavljene pojme, uporabljene v nalogi, sledijo jim izsledki raziskav na področju razširjenosti prekomerne telesne teže in debelosti tako v Sloveniji, kot po svetu, v tem delu smo predstavili dejavnike omenjene problematike, med njimi tudi odnos med socioekonomskim statusom in prekomerno telesno težo in debelostjo. Sledi drugi, empirični del, katerega analiza temelji na sekundarni analizi podatkov, pridobljenih na vzorcu slovenske mladine v starostni skupini 16–27 let. Za pridobitev čim bolj relevantnih podatkov smo izbrali različne spremenljivke, in sicer socioekonomski status v odnosu do izobrazbe matere in izobrazbe očeta ter v odnosu do samoocene materialnega položaja družine. Na razlike v kvaliteti življenja mladostnikov vpliva namreč predvsem socioekonomski položaj družine - njeno finančno stanje ter izobrazba in zaposlitev staršev. Preučevali smo torej dejstvo, da imajo mladostniki, katerih starši imajo boljše službe in višje dohodke, bolj kvalitetno in zdravo življenje, kot pa tisti iz finančno šibkejših družin. In the diploma thesis, we studied the impact of socioeconomic status on youth overweight and obesity in Slovenia. The first, theoretical part of the thesis explains specific terms that were used throughout the thesis, followed by research findings regarding the prevalence of overweight and obesity in Slovenia, as well as all around the world. We continued with presentation of factors of this issue, one of them being the connection between socioeconomic status and overweight and obesity. The theoretical part is followed by the second, empirical part, within which the analysis was based on secondary data analysis, carried out with the help of a sample of Slovenian youth in the age group from 16 to 27 years. In order to obtain the most relevant data possible, we chose different variables – socioeconomic status in relation to mother’s and father’s education, as well as in relation to self-assessed family’s material situation. The differences in youth’s quality of life are conditioned by family’s socioeconomic status – their financial situation, as well as education and employment of the parents. We, therefore, analysed the assumption that young people, whose parents have better jobs and higher incomes, live a more quality and healthy life than those that come from financially weaker families.

Several factors that follow the development of society affect physical inactivity, which primarily includes the development of technology and digitalization and the increasing choice of unhealthy lifestyle habits. However, certain shifts in the fitness industry have been noted in the last decade. The development of wearable technologies and artificial intelligence is one of the leading fitness trends and undoubtedly represents the future of the fitness industry. On the other hand, the significant influence of social media and networks affects the development and attitudes of people related to physical activity. Therefore, this review paper evaluates the advantages and disadvantages of wearable technologies and artificial intelligence, the positive and negative effects of social networks, and points out the problems accompanying these new fitness trends. The development of fitness trends follows humanity's needs, and one of the biggest challenges is incorporating these novelties in a mission to improve physical activity levels worldwide.

Symptoms of psychological distress and disorder have been widely reported in people under quarantine during the COVID-19 pandemic;in addition to severe disruption of peoples’ daily activity and sleep patterns This study investigates the association between physical-activity levels and sleep patterns in quarantined individuals An international Google online survey was launched in April 6th, 2020 for 12-weeks Forty-one research organizations from Europe, North-Africa, Western-Asia, and the Americas promoted the survey through their networks to the general society, which was made available in 14 languages The survey was presented in a differential format with questions related to responses “before” and “during” the confinement period Participants responded to the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the short form of the International Physical Activity Questionnaire 5056 replies (59 4% female), from Europe (46 4%), Western-Asia (25 4%), America (14 8%) and North-Africa (13 3%) were analysed The COVID-19 home confinement led to impaired sleep quality, as evidenced by the increase in the global PSQI score (4 37 ± 2 71 before home confinement vs 5 32 ± 3 23 during home confinement) (p

To date, few data on how the COVID-19 pandemic and restrictions affected children’s physical activity in Europe have been published. This study examined the prevalence and correlates of physical activity and screen time from a large sample of European children during the COVID-19 pandemic to inform strategies and provide adequate mitigation measures. An online survey was conducted using convenience sampling from 15 May to 22 June, 2020. Parents were eligible if they resided in one of the survey countries and their children aged 6–18 years. 8395 children were included (median age [IQR], 13 [10–15] years; 47% boys; 57.6% urban residents; 15.5% in self-isolation). Approximately two-thirds followed structured routines (66.4% [95%CI, 65.4–67.4]), and more than half were active during online P.E. (56.6% [95%CI, 55.5–57.6]). 19.0% (95%CI, 18.2–19.9) met the WHO Global physical activity recommendation. Total screen time in excess of 2 h/day was highly prevalent (weekdays: 69.5% [95%CI, 68.5–70.5]; weekend: 63.8% [95%CI, 62.7–64.8]). Playing outdoors more than 2 h/day, following a daily routine and being active in online P.E. increased the odds of healthy levels of physical activity and screen time, particularly in mildly affected countries. In severely affected countries, online P.E. contributed most to meet screen time recommendation, whereas outdoor play was most important for adequate physical activity. Promoting safe and responsible outdoor activities, safeguarding P.E. lessons during distance learning and setting pre-planned, consistent daily routines are important in helping children maintain healthy active lifestyle in pandemic situation. These factors should be prioritised by policymakers, schools and parents. HIGHLIGHTS: To our knowledge, our data provide the first multi-national estimates on physical activity and total screen time in European children roughly two months after COVID-19 was declared a global pandemic. Only 1 in 5 children met the WHO Global physical activity recommendations. Under pandemic conditions, parents should set pre-planned, consistent daily routines and integrate at least 2-hours outdoor activities into the daily schedule, preferable on each day. Schools should make P.E. lessons a priority. Decision makers should mandate online P.E. be delivered by schools during distance learning. Closing outdoor facilities for PA should be considered only as the last resort during lockdowns.

V naši raziskavi smo želeli ozavestiti tako oblikovalce zdravstvenih politik kot tudi dializne in ostale kronične bolnike, o pomenu vsakodnevne telesne dejavnosti v boju proti posledicam bolezni. Ključni prispevek naloge je bil ugotoviti, ali vadbeni program, kjer med-dializnem kolesarjenju dodamo še funkcionalno vadbo izboljša zmogljivost bolnikov za aktivnosti v vsakdanjem življenju v primerjavi s trenutno široko uporabljeno metodo vadbe z med-dializnim kolesarjenjem. Zanimalo nas je tudi v kolikšni meri predhodna telesna pripravljenost in starost vplivata na izboljšanje splošne telesne aktivnosti in zmogljivosti dializnih bolnikov. V vzorec je bilo zajetih 40 oseb z diagnozo končne ledvične odpovedi. Vse osebe so bile na nadomestnem zdravljenju s hemodializo v Univerzitetnem kliničnem centru Ljubljana. Za raziskovalni instrument smo uporabili vprašalnik gibalne aktivnosti HAP (Human Activity Profile Questionnaire). Merjenci so izpolnili vprašalnik trikrat (pred začetkom raziskave, po 8. tednu in po 16. tednu). Po prvih, začetnih meritvah, smo bolnike naključno razdelili v eksperimentalno (n=20) in kontrolno (n=20) skupino. Obe skupini sta trikrat tedensko izvajali med-dializno kolesarjenje, eksperimentalna skupina pa je poleg tega še trikrat tedensko pred dializo izvajala 30-45 minutno funkcionalno vadbo. Statistična analiza je obsegala postopke osnovne opisne statistike, test Shapiro-Wilkov, parni t-test in ANOVE. Podatke smo obdelali s SPSS 22.0 in Microsoft Excel 2013. Ugotovili smo, da je prišlo do izboljšanja splošne telesne aktivnosti in zmogljivosti tako v eksperimentalni kot tudi kontrolni skupini, vendar pa med skupinama ni prišlo do statistično značilnih razlik. Poleg tega smo ugotovili, da se splošna telesna aktivnost statistično značilno najbolj izboljša pri osebah, ki so bile v začetku raziskave uvrščene v skupino neaktivnih oseb, najmanj pa pri osebah, ki so bile ob začetku raziskave uvrščene v skupino aktivnih oseb. Kot zadnje smo ugotovili, da starost ne vpliva značilno na izboljšanje maksimalnega številka točk (AAS vrednosti) vprašalnika HAP, statistično značilno pa vpliva na prilagojeno oceno aktivnosti (MAS vrednosti) vprašalnika HAP. Zaključujemo, da bi bilo smiselno ponuditi možnost med-dializnega kolesarjenja in funkcionalne vadbe vsem dializnim bolnikom, ki se zdravijo v hemodializnih centrih. Kljub temu, da nismo ugotovili statistično značilnih razlik med obema oblikama vadbe, bi bilo smiselno vključiti funkcionalno vadbo v vadbeni program, saj je izredno pomembno, da poleg aerobnih sposobnosti bolniki razvijajo tudi moč, koordinacijo, ravnotežje in gibljivost. Z vadbo bi preprečili dodatne pridružene bolezni in zaplete povezane s končno ledvično odpovedjo. Posledično bi prišlo do izboljšanja kvalitete življenja bolnikov. In our study, we wanted to raise awareness among health policy makers, dialysis and other chronic disease patients about the importance of daily physical activity in the fight against the consequences of the disease. The key contribution of the thesis is to determine whether an exercise programme where functional training is added to intra-dialytic cycling improves patients' capacity for activities of daily living compared to the currently widely used method of exercise with intra-dialytic cycling. We were also interested in the extent to which previous physical fitness and age influence the improvement of overall physical activity in dialysis patients. The sample included 40 subjects with a diagnosis of end-stage kidney disease. All subjects were undergoing haemodialysis therapy at the University Medical Centre Ljubljana. The research instrument used was the Human Activity Profile Questionnaire (HAP). Subjects completed the questionnaire three times (before the start of the study, after 8 weeks and after 16 weeks). After the first, initial measurements, patients were randomly divided into an experimental (n=20) and a control (n=20) group. Both groups performed intra-dialytic cycling three times a week, while the experimental group also performed before dialysis 30–45 minutes of functional training three times a week. The statistical analysis included basic descriptive statistics, the Shapiro-Wilk test, paired t-test and the analysis of variance (ANOVA). Data were processed using SPSS 22.0 and Microsoft Excel 2013. We found that there was an improvement in general physical activity and performance in both the experimental and control groups, however, no statistically significant differences were found between the groups. In addition, we found that the most statistically significant improvement in general physical activity was observed in the group considered as inactive at the beginning of the study, and the least improvement in the group considered as active. Finally, we found that age does not significantly affect the improvement of the adjusted activity score (AAS) of the HAP Questionnaire, but it does have a statistically significant effect on the maximum activity score (MAS) of the HAP Questionnaire. We conclude that it would be useful to offer the possibility of intra-dialytic cycling and functional training to all dialysis patients treated in haemodialysis centres. Although we did not find statistically significant differences between the two exercise types, it would be helpful to include also functional training in the exercise programme as it is extremely important that patients develop strength, coordination, balance and flexibility in addition to aerobic capacity. Such an exercise programme would prevent additional comorbidities and complications associated with end-stage kidney failure. As a consequence, the quality of life of patients would be improved.

This study summarized the relevant literature and aimed to determine the effect of exercisebased interventions after myocardial infarction in middle-aged and older adults. Studies were identified and analyzed according to the PRISMA guidelines. The following electronic databases were used: Google Scholar, PubMed, Mendeley, Science Direct, and Scopus. The identified studies had to be longitudinal, be published in English, have taken place between 2010 and 2020, involve participants who had suffered myocardial infarction, and address different types of exercise-based interventions to be included. Of the 592 relevant studies identified, 20 were included in the qualitative analysis. After analyzing the results obtained, it could be concluded that different types of exercisebased interventions or their combination have a positive effect after myocardial infarction in middleaged and elderly adults. It can also be suggested that the combination of a cycle ergometer and a treadmill may be the most effective exercise-based intervention. An adequate choice of intensity and volume is crucial, with the optimal duration of the experimental program and the type(s) of exercises adapted to participants after myocardial infarction.

Uvod: V raziskavi smo: 1) Analizirali vpliv intrinzičnih dejavnikov na predoperativno stanje bolnikov z osteohondralno lezijo talusa (OLT) 2) Primerjali predoperativno stanje bolnikov z OLT z bolniki pred drugimi pogostimi operativnimi posegi na gležnju 3) Primerjali uspešnost operativnega zdravljenja OLT z različnimi kirurškimi metodami, ter preučili vpliv intrinzičnih dejavnikov na stanje po operaciji. Metode: Preučili smo skupino 610 bolnikov po operaciji gležnja v obdobju med 2009-2018. Vsi bolniki so predoperativno izpolnili standardizirane vprašalnike FAOS (Foot and Ankle Outcome Score), EQ-5D (European Quality of Life in 5 Dimensions) in TAS (Tegner lestvico aktivnosti). 1) Iz primarne kohorte smo izbrali bolnike, ki so bili v opazovanem obdobju operativno zdravljeni zaradi kakršnekoli OLT. Z modelom linearne regresije smo analizirali vpliv značilnosti bolnika in karakteristike gleženjskega sklepa na predoperativno stanje. 2) Iz primarne kohorte smo izbrali samo bolnike, ki so bili operirani zaradi izolirane problematike gležnja: 19 primarna OLT (P-OLT), 18 revizijska OLT (R-OLT), 22 osteoartroza (OA), 15 lateralna nestabilnost gležnja (LN), 20 sprednji (S-US), 13 zadnji (Z-US) in 16 kombinirani utesnitveni sindrom (K-US). Med skupinami smo primerjali aktivno gibljivost, delovanja gležnja, kvaliteto življenja in telesno aktivnost pred operacijo. 3) Bolniki iz točke 1 so bili zdravljeni s 4 različnimi kirurškimi metodami. Po operaciji smo bolnikom ponovno razposlali standardizirane vprašalnike. S parnimi testi smo preverjali predoperativne in pooperativne vrednosti vprašalnikov. Z modeli logistične regresije smo analizirali uspešnost različnih kirurških metod glede na lastnosti bolnika in karakteristike gležnja. Za ovrednotenje preživetja presadkov je bil uporabljen Cox-ov regresijski model sorazmernih tveganj. Rezultati: 1) Model linearne regresije razkrije korelacijo med spolom, indeks telesne mase (ITM), Kellgren-Lawrence (KL) stopnjo artroze in predoperativno vrednostjo vprašalnikov FAOS in TAS. 2) Pri vseh analiziranih gleženjskih patologijah smo zaznali statistično pomembno slabše predoperativne vrednosti vseh vprašalnikov v primerjavi z zdravo populacijo. Najizrazitejše poslabšanje je bilo prisotno v skupinah R-OLT ter OA. 3) Vse pooperativne vrednosti FAOS in EQ-5D vprašalnikov so se statistično pomembno zvišale glede na predoperativne. Starost, spol, ITM, etiologija OLT, trajanje simptomov, lokacija lezije, spremljajoči posegi, KL stopna artroze in operativna metoda niso pomembno vplivali na pooperativne vrednosti vprašalnikov. Enoletno preživetje presadkov je bilo 100% ne glede na spol 5-letno preživetje je bilo 77% moški (M) oz. 47% ženske (Ž). Cox-ov regresijski model sorazmernih tveganj razkrije 1,6-krat večje tveganje za odpoved presadka pri ženskah. Zaključki: 1) Ženski spol, višji ITM in višja KL stopnja artroze so napovedni dejavniki za slabše predoperativno stanje bolnikov z OLT. 2) Bolniki z OLT pred operativim posegom imajo slabše funkcionalno stanje gležnja in znižano kvaliteto življenja glede na zdravo populacijo. V primerjavi z drugim pogostimi patologijami gležnja, primarne OLT zmanjšajo delovanje gležnja primerljivo kot lateralna nestabilnost in utesnitveni sindromi, medtem ko recidivi OLT znižajo delovanje gležnja podobno kot napredovala osteoartroza tega sklepa. 3) Različne operativne metode so pomembno izboljšale stanje bolnikov z OLT. Značilnosti bolnika in uporabljena kirurška metoda niso vplivale na izid operativnega zdravljenja. Preživetje presadkov se po 2 letih slabša, izrazitejše pri ženskah. Introduction: The aim of current study was to: 1) analyse the impact of intrinsic factors on preoperative status of patients with osteochondral lesion of talus (OLT) 2) compare preoperative status of patients scheduled for surgical treatment of seven common ankle disorders 3) evaluate the outcome after various operative interventions for OLT and identify predicting factors for the patients’ subjective outcome. Methods: Hospital records of 610 patients that were admitted for surgical intervention on the ankle joint between 2009 and 2018 were reviewed. Patients’ general and ankle-related subjective status, quality of life, and activity levels were recorded at the admission by standard questionnaires (PROMs): FAOS (Foot and Ankle Outcome Score), EQ-5D (European Quality of Life in 5 Dimensions) and TAS (Tegner activity scale). 1) First, all the patients who were admitted for OLT surgery of any kind were selected. Their demographics, medical history, and the index ankle joint status were tested as possible predictors for patients’ subjective status by a linear regression model. 2) Secondly, all the patients who were treated operatively for an isolated ankle pathology were identified: 19 primary OLT (P-OLT), 18 recurrent OLT (R-OLT), 22 osteoarthritis (OA), 15 lateral instability, 20 anterior, 13 posterior, and 16 combined ankle impingement. Across these seven groups, preoperative active range of motion, subjective ankle status, quality of life, and patients’ activity levels were compared. 3) The patients from the first cohort (OLT of any kind) were cross-sectionally re-evaluated after the operation by using the same PROMs. Preoperative to postoperative values of PROMs were compared with a paired Student t-test. Possible predicting factors (patients’ demographics, ankle characteristics, surgical technique) for the treatment improvement (postoperative to preoperative PROMs differences) were tested via a linear regression model. A Cox proportional hazard model was used fort the graft survival analysis. Results: 1) Linear regression model revealed that gender, body mass index (BMI), and Kellgren-Lawrence (KL) osteoarthritis score were correlated with the preoperative FAOS and TAS. 2) All evaluated ankle disorders induced significant preoperative subjective joint dysfunction, decreased quality of life, and activity level. The most profound impairments were reported by patients treated for OA and recurrent OLT. 3) All FAOS and EQ-5Q values increased from preoperative to the final follow-up values. There was no correlation between age, gender, BMI, aetiology, symptoms duration, lesion characteristics, additional procedures, OA toward the postoperative improvement of PROMs values. Graft survival rates were 100% at 1 year and 77% (males)/47% (females) at 5 years. A Cox proportional hazard model revealed 1,6-times higher risk of graft failure for females. Conclusions: Female gender, higher BMI, and higher grade of ankle OA were negative predictors for the preoperative status of patients with OLT. 2) Patients amenable for surgical treatment of the common ankle pathology reported considerable functional decline in comparison to the general population. The worst subjective ankle status was reported equally by OA and R-OLT patients, while patients with other five disorders reported comparable values. 3) Various operative interventions for OLT significantly improved patients’ ankle status, and quality of life. Patients’ characteristics and surgical technique had no influence on the treatment outcome. High graft survival rates were demonstrated over first two years, but notable decline was confirmed thereafter, especially in females.

Sports performance is primarily perceived to be associated with elite sport, where athletes strive for a place on the podium, with the most prestigious result probably being an Olympic gold medal [...]

The present review aims to examine the effects of high blood lactate levels in healthy adult humans, for instance, after a period of exhaustive exercise, on the functioning of the cerebral cortex. In some of the examined studies, high blood lactate levels were obtained not only through exhaustive exercise but also with an intravenous infusion of lactate while the subject was immobile. This allowed us to exclude the possibility that the observed post-exercise effects were nonspecific (e.g., cortical changes in temperature, acidity, etc.). We observed that, in both experimental conditions, high levels of blood lactate are associated with a worsening of important cognitive domains such as attention or working memory or stress, without gender differences. Moreover, in both experimental conditions, high levels of blood lactate are associated with an improvement of the primary motor area (M1) excitability. Outside the frontal lobe, the use of visual evoked potentials and somatosensory evoked potentials allowed us to observe, in the occipital and parietal lobe respectively, that high levels of blood lactate are associated with an amplitude’s increase and a latency’s reduction of the early components of the evoked responses. In conclusion, significant increases of blood lactate levels could exercise a double-action in the central nervous system (CNS), with a protecting role on primary cortical areas (such as M1, primary visual area, or primary somatosensory cortex), while reducing the efficiency of adjacent regions, such as the supplementary motor area (SMA) or prefrontal cortex. These observations are compatible with the possibility that lactate works in the brain not only as an energy substrate or an angiogenetic factor but also as a true neuromodulator, which can protect from stress. In this review, we will discuss the mechanisms and effects of lactic acid products produced during an anaerobic exercise lactate, focusing on their action at the level of the central nervous system with particular attention to the primary motor, the somatosensory evoked potentials, and the occipital and parietal lobe.

ObjectiveTo determine to what extent physical fitness indicators and/or moderate to vigorous physical activity (MVPA) may account for final mathematics academic performance (APmath) awarded at the end of primary school.MethodsSchool-aged youth were sampled in a repeated-measures, longitudinal design in Grade 6 (∼11 years), and again in Grade 9 (∼14 years). The youth (N = 231, 111 girls) completed a fitness test battery consisting of: flamingo balance test, standing long jump, backward obstacle course, plate tapping, sit ups, sit and reach, handgrip, and 20-m shuttle run. APmath scores were obtained for all children at the end of Grade 5, end of Grade 8, and end of Grade 9 (their final year of primary school). In a sub-sample of Grade 6 youth (N = 50, 29 girls), MVPA was measured objectively via SenseWear Pro Armbands (MVPAOB) for seven consecutive days, with measurements repeated in Grade 9.ResultsMath scores decreased from Grade 6 to 9 for both boys and girls (95%CI: −0.89 to −0.53, p < 0.001). MVPAOB was reduced by ∼45.7 min (−33%) from Grade 6 to 9 (p < 0.01). Significant main and interaction effects are noted for each fitness indicator (p < 0.05). A backward stepwise multiple regression analysis determined significant shared variance in final APmath grade to the change scores from Grade 6 to Grade 9 in: ΔAPmath, Δbackward obstacle course, Δsit and reach, and Δsit-ups [R2 = 0.494, F(4,180) = 43.67, p < 0.0001]. A second regression was performed only for the youth who completed MVPAOB measurements. In this sub-sample, MVPAOB did not significantly contribute to the model.ConclusionLongitudinal changes in youth fitness and their delta change in APmath score accounted for 49.4% of the variance in the final math grade awarded at the end of Grade 9. Aerobic power, upper body strength, and muscular endurance share more common variance to final math grade in boys, whereas whole-body coordination was the more relevant index in girls; this finding suggests that future research exploring the relationship of AP and PF should not be limited to cardiorespiratory fitness, instead encompassing muscular and neuro-muscular components of PF.

Researching the relationship between physical activity and academic performance is becoming an important research topic due to increasing evidence about the positive effect of physical activity on cognitive functioning. The present systematic review and meta-analysis (PROSPERO registration number: CDR132118) is a unique contribution to the recently published reviews since it only includes interventions longer than 6 weeks and acknowledges the influence of the qualifications of practitioners who deliver interventions. After identifying 14,245 records in five databases and selecting 247 full-text articles assessed for eligibility, 44 interventions passed all eligibility criteria. This meta-analysis uses validity generalization in a random effects model, which shows that academic performance itself is not solely caused by increased physical activity. The weighted mean population effect of all included interventions was rw = 0.181. Most of the studies had serious limitations since they did not report physical activity intensity, which is an essential component to achieving positive exercise effects on cognition. In addition, the qualifications of the staff who administer the interventions were largely ignored in existing literature. It was found that 13 out of 20 physical activity interventions with significant positive effects on academic performance were performed by practitioners who held higher qualifications in the field of physical education and exercise science, who could mediate higher physical activity intensities of the given interventions. The population effect in studies where interventions were administered by practitioners with lower qualifications in the field (rw = 0.14) was lower compared to interventions performed by staff with higher qualifications (rw = 0.22). There was also a significant difference in academic performance with regard to staff qualification level (χ = 4.464 p = 0.035). In addition to activity duration, future physical activity intervention studies including those investigating academic performance should focus on the importance of physical activity intensity and include measures of physical fitness as objective indicators to enable more reliable analyses to establish physical activity influence on academic performance.

The present study aimed to verify the effect of a warm-up protocol with and without facemask-use on cognitive function. The sample was composed of 17 healthy, non-smoking physical education students (age = 17.6 years, height = 1.71 m, and body mass = 69.7 kg). They were randomized to perform 15 min of warm-up exercises, while wearing a cloth facemask (EXP) or no mask (CON) on two separate occasions, with at least 48-h separating conditions. Rate of perceived exertion (RPE) and d2 Attention assessment were used to verify cognitive function, using a repeated measures general linear model. The warm-up improved cognitive abilities and the results demonstrated significant differences between the EXP vs. CON groups in post-concentration performance (186.06 ± 15.47 EXP-score vs. 178.12 ± 13.66 CON-score), post the total number of errors (23.47 ± 14.50 EXP-frequency &lt, 29.06 ± 13.74 CON-frequency), and in the post RPE (6.0 ± 1.37 EXP-index &gt, 4.7 ± 0.85 CON-index). Wearing a cloth facemask caused positive effects on cognitive function. This data suggests that wearing a cloth facemask during warm-up may stimulate/improve the cognitive function.

The present study examined whether differences in the heart rate recovery following flywheel exercise cessation were associated with differences in maximal oxygen uptake ($${\dot{\text{V}}}$$ V ˙ O2 max.), age and sex in trained adults. Eleven men (age range 22–49 years, $${\dot{\text{V}}}$$ V ˙ O2 max. = 43.6 ± 7.6 mL kg min−1) and ten women (age range 20—53 years, $${\dot{\text{V}}}$$ V ˙ O2 max. = 38.0 ± 5.7 mL kg min−1) were randomly assigned to complete a squat-exercise on the flywheel ergometer set at three different moments of inertia, while their cardiovascular responses were continuously monitored. During the flywheel exercise the mean arterial pressure rose by ~ 35 to 40% (p = .001), and the increment was more robust in men than women. The cardiac index was two-fold greater across both sexes compared to the baseline (p = .001), while the rise in heart rate (~ 144 bpm) was more pronounced in women to compensate for their load-dependent stroke index decline (p = .001). The load-independent time-course changes in heart rate recovery markers were comparable between the sexes. When these indicators were pooled, a stepwise regression revealed age as the only relevant predictor of both fast and slow components of the heart rate recovery (~ 30% of the shared variance explained, p = .014). The present data suggest that the heart rate recovery declines with age, irrespective of sex, or well-preserved cardiorespiratory fitness in moderately-trained adults.

Introduction This paper aimed to review the effect of physical activity and exercise in frail older persons. As the process which leads to frailty and disability can be slowed down or even completely reversed, it can be appropriate for early interventions. Methodology A literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published from 2002 to 2017. From 620,043 initial hits, 25 publications were selected. Results Physical activity and exercise in frail elderly are effective and relatively safe and may reverse frailty. Conclusion Different exercise interventions in frail elderly persons can increase strength and power, improve balance and reduce fall incidence resulting in greater quality of life. From this perspective, physical exercise interventions should become daily routine in frail elderly persons.

Objective: The emergence of coronavirus in Serbia as well as in other European countries led to the declaration of a state of emergency, which, among other measures, included a switch to online education, the lockdown of public life and organized sports, and a curfew from 5 pm to 5 am. This study aimed to investigate the extent to which these measures affected children's daily routines. More specifically, it aimed to determine how children maintained their learning, physical activity, and screen time routines from the period before the state of emergency was declared.Methods: Response to an online parent-reported questionnaire was conducted (N = 450). The factorial validity of the scales was prepared using confirmatory factor analysis, with acceptable fit indices. Based on that, the authors tested the interrelations between dimensions using structural equation modeling in SPSS, AMOS 24.0.Results: The study results indicate a positive relationship between school achievement and study time (β = 0.25). They also indicate that children who were physically active before the pandemic continued their activities during the emergency state (β = 0.53). Physical activity impact during the COVID-19 emergency measures reduces children's behavior changes (β = 0.55). Finally, they highlight that children who spent more time with multimedia content had greater changes in anxiety, sensitivity, nervousness, and worry due to COVID-19 emergency measures (β = −0.38).Conclusions: Healthy lifestyle habits formed in childhood are suggested to be responsible for the greater “resistance to change” shown by the children from this study.

Background: The objectives of this systematic review and meta-analysis were to quantify the effectiveness of endurance training (ET) on aerobic performance (i.e., peak oxygen uptake (VO2peak)) in healthy and unhealthy middle and very old adults aged 70 years and older, and to provide dose response relationships of training prescription variables (in terms of frequency, and volume). Methods: Several scholarly databases (i.e., PubMed/MEDLINE, SpringerLink, ScienceDirect Journals, and Taylor & Francis Online Journals) were searched, identifying randomized controlled studies that investigated the effectiveness of ET on VO2peak in older adults. Standardized mean differences (SMD) were calculated. Results: In terms of changes differences between experimental and control group, ET produced significant large effects on VO2peak performance (SMD = 2.64 (95%CI 0.97%4.31)). The moderator analysis revealed that health status variable moderated ET effect onVO2peak performance. More specifically, ET produced larger SMD magnitudes on VO2peak performance in healthy compared with unhealthy individuals. With regard to the dose response relationships, findings from the meta-regression showed that none of the included training prescription variables predicted ET effects on VO2peak performance. Conclusions: ET is an effective mean for improving aerobic performance in healthy older adults when compared with their unhealthy counterparts.

Background Although evidence suggests that functional endurance capacity is the most important component associated with future health, little is known of how it is associated with multiple other physical fitness components. Since various physical fitness aspects do not change the same as functional endurance capacity during childhood, it is necessary to establish possible associations between functional endurance capacity and other physical fitness components in children. Therefore, the main purpose of the study was to test the associations between functional endurance capacity with other physical fitness components in 7–14-year-old children, stratified by gender. Methods In this cross-sectional study, we recruited 1612 children [mean age ± standard deviation (SD) = 9.72 ± 2.37 years; 52.5% girls). Health-related physical fitness components included: 1) body-mass index (kg/m2) calculated from height and weight (measure of body size), 2) sit-and-reach test (measure of flexibility), 3) standing broad jump (measure of explosive strength of lower extremities), 4) sit-ups in 30 s (measure of repetitive strength of the trunk), 5) 10 × 5 shuttle run test (measure of agility) and 6) 20-m shuttle run test (measure of functional endurance capacity). The associations were performed using generalized estimating equations with beta (β) coefficients. Results After adjusting for age, functional endurance capacity was associated with sit-and-reach test (β = 0.13, p β = 0.59, p β = 0.53, p β = − 0.56, p β = − 0.12, p β = 0.21, p β = 0.25, p β = 0.36, p β = − 0.40, p Conclusions Although significant, functional endurance capacity is weakly to moderately associated with other physical fitness components, pointing out that such measure should be tested separately from other aspects of physical fitness in school-aged children.

Introduction: Because healthy behaviors learned early in life are more likely to be maintained during adulthood, we aimed to investigate longitudinal changes of partici-pants that were regularly involved in extracurricular sport activities (athletes N = 7 4 boys) and those that were not (non-athletes, N = 6 3 boys)Methods: Participants of both groups were invited for re-assessment at the age of 27, in 2019, 12 years after they participated in a 5-year longitudinal study as adoles-cents (9–14 years of age, in the period 2001‒07). We investigated vastus lateralis (VL) and biceps femoris (BF) contractile properties (tensiomyography), maximal running speed (photocells), anthropometric measures (bioimpedance), maximal vertical jump-ing height (squat and countermovement jumps on a ground reaction force plate), and lifestyle characteristics (GPAQ and EHIS surveys).Results: Based on Cohen’s d effect size we found that athletes have lower body mass index, higher maximal running speed, better maximal vertical jumping height, and shorter BF contraction time, not found in VL, compared to non-athletes. Further-more, athletes also exhibit healthier lifestyle characteristics such as lower sedentary time and higher daily energy expenditure than non-athletes. Athletes follow diet regi-mens consisting of more regular meals with more protein and indulge less in health-risk behavior (smoking and alcohol consumption). However, the self-perception of health and quality of life was lower in athletes than in non-athletes. Conclusion: EU regulations and the beginning of the COVID-19 pandemics pre-vented us from conducting a study on a more representative sample. Nevertheless, we could confirm that regular sport participation yields better physical performance and a healthier lifestyle but could also have a negative impact on health (injuries) and quality of life. Uvod: Namen raziskave je ugotoviti longitudinalne spremembe v skupini preisko-vancev, ki so se redno ukvarjali z obšolskimi športnimi dejavnostmi (skupina športnikov N = 7, 4 dečki), in tistih, ki se niso kontinuirano ukvarjali s športom (skupina nešportnikov, N = 6, 3 dečki). Metode: Udeleženci obeh skupin so bili povabljeni na ponovne meritve pri starosti 27 let, leta 2019, torej 12 let po tem, ko so bili v starosti od 9-14 let, v obdobju 2001-2007 vključeni v petletno longitudinalno študijo. Preučevali smo kontraktilne lastnosti mišic: vastus lateralis (VL) in biceps femoris (BF) (z metodo tenziomiografije), hitrost sprinta z letečim štartom (s fotokamerami), antropometrične podatke (z bioimpedanco), dosežek navpičnega skoka (skoki na tenziometrijski plošči s pomočjo in brez pomo-či rok) ter nekatere značilnosti življenjskega sloga (anketi GPAQ in EHIS). Rezultati: Na podlagi velikosti učinka (Cohenove d) smo ugotovili, da imajo špor-tniki v primerjavi z nešportniki nižji indeks telesne mase, večjo hitrost teka, boljšo zmo-gljivost vertikalnih skokov in krajši čas krčenja BF, kar pri VL nismo ugotovili. Poleg tega imajo športniki tudi bolj zdrave vzorce življenjskega sloga, manj sedijo in več gibajo (večja dnevna poraba energije) kot nešportniki. Nadalje prehrano športnikov sestavljajo bolj redni obroki z več beljakovinami, poleg tega imajo manj zdravju ne-varnih praks (kajenje in uživanje alkohola). Kljub temu pa so športniki svoje zdravje in kakovost življenja ocenili nižje kot nešportniki. Zaključek: Regulativni predpisi EU za področje varovanja osebnih podatkov (GDPR) kot tudi začetek pandemije COVID-19 so nas pri izvedbi študije na bolj repre-zentativnem vzorcu močno ovirali. Kljub temu smo lahko potrdili, da redno ukvarjanje s športom ohranja boljšo telesno zmogljivost, bolj zdrav življenjski slog, kar pa lahko vpliva na zdravje (poškodbe) in kakovost življenja.