Daily Exercise Research Articles

Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, affecting about 1/4th of the global population and causing a huge global economic burden. To date, no drugs have been approved for the treatment of NAFLD, making the correction of unhealthy lifestyles the principle method of treatment. Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important. AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions. METHODS The Exercise and Diet Adherence Scale (EDAS) was designed based on compilation using the Delphi method, and its reliability was subsequently evaluated. Demographic and laboratory indicators were measured, and patients completed the EDAS questionnaire at baseline and after 6 months. The efficacy of the EDAS was evaluated in the initial cohort. Subsequently, the efficacy of the EDAS was internally verified in a validation cohort. RESULTS The EDAS consisted of 33 items in six dimensions, with a total of 165 points. Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake (P < 0.05 each), but not with overall weight loss. A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake (> 500 kacl/d), (sensitivity/specificity was 100.0%/75.8%), while patients score below 97 could nearly rule out the possibility of daily exercise (sensitivity/specificity was 89.5%/44.4%). Total EDAS scores ≥ 116, 97-115, and < 97 points were indicative of good, average, and poor adherence, respectively, to diet and exercise recommendations. CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.

Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial

BackgroundMusculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes. ObjectiveTo compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders. MethodsWe conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate. ResultsIn total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035). ConclusionsThis study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs.Trial registration: ClinicalTrials.gov (NCT02702466) retrospectively registered.

Effect of Respiratory Telerehabilitation on Pulmonary Function Parameters and Quality of Life in Patients with COVID-19: A Randomized Controlled Trial

Background: Given the heightened impact of post-COVID-19, active involvement in the rehabilitation process, particularly in respiratory rehabilitation, is essential for these patients. This study addresses the urgent need for developing and evaluating remote respiratory rehabilitation methods post-COVID-19, focusing on enhancing patients' quality of life and pulmonary function. Objectives: The study aimed to investigate how respiratory telerehabilitation influences pulmonary function and the quality of life in this patient population. Methods: In this randomized controlled clinical trial, 60 COVID-19 patients from two major hospitals in Mashhad were evaluated during 2021 - 2023. The control group received a training booklet and an incentive spirometer, while the intervention group participated in a telerehabilitation program. This program involved four-week daily respiratory rehabilitation exercises conducted online using the Skyroom platform. At the end of each session, the patient's fatigue and shortness of breath were assessed using the Borg Rating of Perceived Exertion (RPE) Scale and the number of physical exercises completed. All patients completed the Quality of Life (QOL) Questionnaire and undertook the 6-Minute Walk Test (6MWT). Heart rate, respiratory rate, blood oxygen saturation (SPO2), maximum inspiratory pressure (MIP), fatigue, and shortness of breath were measured on the day of discharge and two and four weeks post-discharge. Covariance (ANCOVA) and repeated measures analysis of variance (RMANOVA) were analyzed for data analysis. Results: In both baseline-adjusted and fully-adjusted ANCOVA models, the results indicated a significant intervention effect after 4 weeks for MIP (73.43 ± 5.77), SPO2 (96.90 ± 1.21), Borg scale score (9.77 ± 1.59), and MWT6 (455.90 ± 37.70), (all P < 0.0001), with significantly higher changes observed in MIP, SPO2, Borg Scale score, and MWT6 after 2 weeks as well as after 4 weeks in the intervention group than the control groups. Also, in both models, the results indicated a significant intervention effect after 2 weeks as well as 4 weeks for physical functioning, role physical, vitality, social functioning, role emotional, Physical Health Scale score, and total SF36 score (60.37 ± 6.93) (P < 0.001). Conclusions: Using bidirectional audio and video communication in the telerehabilitation of COVID-19 patients significantly improved their pulmonary function and QOL. Based on these findings, it is recommended that this method be considered as an integral component in rehabilitation programs for COVID-19 patients.

Evaluation of a Four-Week Online Resilience Training Program for Multiple Sclerosis Patients.

The diagnosis of a chronic disease, such as multiple sclerosis, has both psychological and physical effects. Living with the disease and its uncertain consequences requires a great deal of psychological resilience in order to employ more comprehensive coping strategies in stressful situations. This study investigated the effect of a four-week online self-directed resilience training program on the perception of psychological resilience among multiple sclerosis patients. A total of 94 MS patients were recruited for a randomised controlled trial. The experimental group underwent a 28-day online self-directed training program consisting of daily exercises aimed at strengthening a resilient mindset. Psychological resilience was measured through self-assessment immediately before, immediately after, and three months after the training. A repeated measures ANOVA revealed a statistically significant improvement in the perception of four factors related to stress: perceived worries, tension, joy, and demands. Two resilience coping strategies were measured, of which one, a resilient orientation, improved significantly in the short and long term. The study suggests that online self-directed resilience training might provide an easily accessible, low-cost option for patients with MS to improve their psychological resilience. This is a pilot study to assess the general applicability to people with MS. Future studies should examine the transferability of results in relation to disease stage and co-morbidities.

Qualitative Description of the Exertional Symptoms of Participants with Persistent Symptoms of Lyme Disease during a Low Intensity Resistance Training Intervention

Introduction: Greater emphasis needs to be placed on approaches to improve the health-related quality of life of patients with persistent symptoms of Lyme disease (PSLD), but little information exists to inform an exercise professional’s expectations of their supervision of resistance training (RT) programs with PSLD patients. In order to build this knowledge base, a secondary qualitative analysis was performed to explore the RT exertional symptoms of PSLD patients that participated in a 4-week study investigating the feasibility of an RT intervention. Methods: Comments regarding exertional symptoms that were recorded in a daily exercise log were the main source of data for this secondary analysis. A manifest content analysis was performed in order to identify recurrent themes of exertional symptoms experienced by this sample of PSLD patients during RT. Results: The reported findings revealed that strain, discomfort, crepitus, tightness, shaking, and control loss were the major themes of exertional symptoms recorded during the RT intervention. Conclusions: These results provide insights intended to inform the expectations of supervisors of exercise (personal trainers, physical therapists, exercise researchers, etc.) when directing RT programming with patients with PSLD.

How to Suppress Mineral Loss and Stimulate Anabolism in Postmenopausal Bones with Appropriate Timing of Exercise and Nutrients.

Background. Bone Health and Osteoporosis Foundation (BHOF) reports that as of 2023, approximately 10 million of older Americans have osteoporosis and another 44 million have low bone density. Osteoporosis is a serious handicap for the elderly and, in particular, for estrogen-deficient postmenopausal women, as it increases the risk of debilitating bone weakness and fractures. The BHOF recommendations for prevention of osteopenia, osteoporosis and bone fractures are to perform weight-bearing and muscle-strengthening exercises and to take recommended amounts of daily calcium and vitamin D. Methods. The purpose of this review is to describe and discuss recent evidence-based research on how to effectively utilize timing of exercise and calorie intake for stimulation of postmenopausal bone anabolism, and to provide this new information in the form of specific and actionable recommendations. Results. The five evidence-based recommendations are as follows: 1. Select an appropriate circadian time of day for exercise; 2. Increase walking speed to raise the movement momentum; 3. Eat a weight-maintenance meal one or two hours before the exercise bout; 4. Sustain the duration of walking activity (impulse) for 40 to 45 min; and 5. Repeat effective exercise stimulus 7 to 8 h after the first one to double the anabolic effect. Osteogenesis can also be increased with subthreshold mechanical loading, where needed, under several special circumstances. Conclusions. This review should provide pragmatic actionable pointers on how to utilize the idiosyncratic bone responsiveness to timing of movement and meals to prevent osteoporosis and encourage research toward a better understanding of how bone detects adequacy of a mechanical stimulus and determines duration of necessary rest to recover its sensitivity to mechanical stimulation and nutrients.

Effect of Impaired Awareness of Hypoglycemia on Glucose Decline During and After Exercise in the T1DEXI Study.

Adults with type 1 diabetes (T1D) face the necessity of balancing the benefits of exercise with the potential hazards of hypoglycemia. This work aimed to assess whether impaired awareness of hypoglycemia (IAH) affects exercise-associated hypoglycemia in adults with T1D. We compared continuous glucose monitoring (CGM)-measured glucose during exercise and for 24 hours following exercise from 95 adults with T1D and IAH (Clarke score ≥4 or ≥1 severe hypoglycemic event within the past year) to 95 "aware" adults (Clarke score ≤2 and no severe hypoglycemic event within the past year) matched on sex, age, insulin delivery modality, and glycated hemoglobin A1c. A total of 4236 exercise sessions, and 1794 exercise days and 839 sedentary days, defined as 24 hours following exercise or a day without exercise, respectively, were available for analysis. Participants with IAH exhibited a nonsignificant trend toward greater decline in glucose during exercise compared to "aware" (-21 ± 44 vs -19 ± 43 mg/dL [-1.17 ± 2.44 vs -1.05 ± 2.39 mmol/L], adjusted group difference of -4.2 [95% CI, -8.4 to 0.05] mg/dL [-0.23 95% CI, -.47 to 0.003 mmol/L]; P = .051). Individuals with IAH had a higher proportion of days with hypoglycemic events below 70 mg/dL [3.89 mmol/L] (≥15 minutes <70 mg/dL [<3.89 mmol/L]) both on exercise days (51% vs 43%; P = .006) and sedentary days (48% vs 30%; P = .001). The increased odds of experiencing a hypoglycemic event below 70 mg/dL (<3.89 mmol/L) for individuals with IAH compared to "aware" did not differ significantly between exercise and sedentary days (interaction P = .36). Individuals with IAH have a higher underlying risk of hypoglycemia than "aware" individuals. Exercise does not appear to differentially increase risk for hypoglycemia during the activity, or in the subsequent 24 hours for IAH compared to aware individuals with T1D.

Influence of a 7-day Transalpine Trail Run on cardiac biomarkers and myocardial function.

Intense physical exercise is known to increase cardiac biomarkers; however, it is unclear, whether this phenomenon is physiological, or if it indicates myocardial tissue injury. The aim of our study was to investigate the effects of seven consecutive days of excessive endurance exercise on continuous assessment of cardiac biomarkers, function, and tissue injury. During a 7-day trail-running competition (Transalpine Run, distance 267.4 km, altitude ascent/descent 15556/14450 m), daily blood samples were obtained for cardiac biomarkers (hs-TnT, NT-proBNP, and suppression of tumorigenicity-2 protein (ST2)) at baseline, after each stage and 24-48 h post-race. In addition, echocardiography was performed every second day, cardiac magnetic resonance imaging (CMR) before (n = 7) and after (n = 16) the race. Twelve (eight males) out of 17 healthy athletes finished all seven stages (average total finish time: 43 ± 8 h). Only NT-proBNP increased significantly (3.6-fold, p = 0.009) during the first stage and continued to increase during the race. Hs-TnT revealed an incremental trend during the first day (2.7-fold increase, p = 0.098) and remained within the pathological range throughout the race. ST2 levels did not change during the race. All cardiac biomarkers completely returned to physiological levels post-race. NT-proBNP kinetics correlated significantly with mild transient reductions in right ventricular function (assessed by TAPSE, tricuspid annular plane systolic function; r = -0.716; p = 0.014). No significant echocardiographic changes in LV dimensions, LV function, or relevant alterations in CMR were observed post-race. In summary, this study shows that prolonged, repetitive, high-volume exercise induced a transient, significant increase in NT-proBNP associated with right ventricular dysfunction without corresponding left ventricular functional or structural impairment.

Effect of Adding Neurofeedback to Neuromuscular Training on Brain Waves in Athletes With Chronic Ankle Instability: A Randomized Clinical Trial

Background and Aims This study evaluated the effects of neuromuscular training compared with neurofeedback and neuromuscular training on brain waves, foot and ankle ability, and pain intensity of table tennis players with chronic ankle instability. Methods This clinical trial study was conducted on 29 table tennis players with chronic ankle instability, which were randomly divided into combined neurofeedback+neuromuscular (Mean±SD age: 21.73±2.60 years, hieght: 173.42±5.57 cm, wieght: 77.10±10.42 kg) and neuromuscular groups (Mean±SD age: 22.14±2.53 years, Mean±SD height: 169.26±6.77 cm, Mean±SD weight:77.95±15.70 kg). ProComp Infiniti System and BioGraph Infiniti version 5 software were used to measure brain waves and perform neurofeedback protocol. The foot and ankle disability questionnaire and the visual analog scale were employed to assess foot and ankle ability and pain intensity, respectively. The rehabilitation protocol was performed for eight weeks. The paired t test and 1-way analysis of covariance were used for the data analyses. Results The paired t test results revealed a significant decrease in the amplitude of theta, alpha, and sensorimotor rhythm (SMR) waves in both groups (P&lt;0.05) and an increase in the amplitude of the beta wave only in the combined group (P&lt;0.05). In addition, ankle ability was significantly increased during daily activities and exercise in both groups (P&lt;0.05). On the other hand, the results of a 1-way analysis of covariance indicated a significant difference between the two groups regarding theta and beta amplitudes and degree of ankle disability during exercise, and the improvement was greater in the combined group (P&lt;0.05). Conclusion According to the results, combined exercises (neuromuscular and neurofeedback) can be used as rehabilitation in table tennis players with chronic ankle instability to correct brain waves, improve leg and ankle ability, and reduce pain.

Deep breathing exercises in easing educational stress among Indian high school students.

In this educational landscape, the pervasive issue of stress among higher secondary students has emerged as a serious matter. Acknowledging the challenges posed by educational stress, this research explores holistic and accessible interventions, with a focus on the promising avenue of deep breathing exercises known for their effectiveness in promoting relaxation and reducing stress. The study employs a quasi-experimental design, comparing an experimental group engaged in daily deep breathing exercises with a control group following a regular routine. Sixty higher secondary students in Visnagar participate through purposive sampling, adhering to specific inclusion criteria. The intervention includes a pre-tested questionnaire to assess stress levels, the implementation of daily deep breathing exercises in the experimental group, and a post-intervention stress level reassessment in both groups. The findings reveal a notable reduction in stress levels post-intervention, particularly in the experimental group practicing deep breathing exercises. Statistically significant reductions in mean stress scores underscore the effectiveness of this intervention, with the experimental group demonstrating a significantly lower mean stress score compared to the control group. This study contributes vital insights into stress management strategies for higher secondary students, highlighting the efficacy of incorporating deep breathing exercises into their routine. The observed reductions in stress levels emphasize the potential benefits of practical stress reduction techniques within the educational milieu.

The relationship between nighttime exercise and problematic smartphone use before sleep and associated health issues: a cross-sectional study

ObjectivePhysical exercise has the potential to mitigate addictive behaviors and relevant health issues. However, the nighttime exercise has not been studied regarding this research topic. This study aims to explore the association between nocturnal physical exercise and problematic smartphone use before sleep, as well as related health issues.MethodsTo explore the association between nighttime physical exercise and problematic smartphone use before sleep as well as related health issues, we conducted a cross-sectional survey among 1,334 college students. Their daily exercise behaviors (including timeframe, rationale, frequency, and duration), smartphone use before sleep, sleep quality, smartphone addiction, anxiety, and depression were measured by questionnaires. The associations were assessed using generalized linear models.ResultsOur findings indicate that nearly 70% of participants chose to perform exercise at nighttime. Among these individuals who exercised at nighttime, the frequency and duration of nighttime exercise were significantly associated with decreased probabilities of smartphone use before sleep. Additionally, the frequency and duration of nighttime exercise were associated with lower levels of smartphone addiction and anxiety disorders.ConclusionNighttime Exercise behaviors can effectively reduce sleep delays caused by problematic smartphone use before bedtime. These findings contribute to understanding the potential effects of nighttime exercise on problematic smartphone use and relevant health issues. Future research should employ more precise methodologies to examine these associations.

Effect of five hours of mixed exercise on urinary nitrogen excretion in healthy moderate-to-well-trained young adults.

Carbohydrates and fats are the primary energy substrates during exercise, but proteins can also contribute. When proteins are degraded in the body, the amino groups are mainly converted to urea and excreted. Therefore, nitrogen excretion has been used as a marker of protein degradation, but a clear conclusion has yet to be reached on the effect of exercise on nitrogen excretion. Thus, we tested whether exercise increases nitrogen excretion. Fifteen young, healthy, moderate-to-well-trained participants (4 females, 11 males, VO2max 54.4 ± 1.7 mL·kg-1·min-1; mean ± SEM) participated in a randomized, balanced cross-over design investigation consisting of 1 day with 5 h of exercise (exercise day, EX) and 1 day with no exercise (control day, CON). The participants recorded their dietary intake the day before from 16:00 and throughout the intervention day. They then repeated these dietary intakes on the second trial day. A standardized lunch was provided on both days. In addition, participants were allowed to consume almost protein-free snacks in EX to ensure the same energy balance during both trial days. Urine was collected throughout the whole testing period, and urinary 3-methylhistidine (3-MH) excretion was measured to examine muscular catabolism. The sweat rate was calculated during the exercise period. The urinary nitrogen and 3-MH excretions did not differ significantly between EX and CON (p = 0.764 and p = 0.953). The sweat rate was 2.55 ± 0.25 L in EX and 0.14 ± 0.15 L in CON (p < 0.001), and by estimating sweat nitrogen excretion, total nitrogen excretion was shown to differ with exercise. Our results showed that 5 hours of mixed exercise did not significantly impact urinary nitrogen and 3-MH excretions in healthy moderate-to-well-trained young adults.

Cognitive and immunological effects of yoga compared to memory training in older women at risk for alzheimer’s disease

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) accompanied by cerebrovascular risk factors (CVRFs) are known to increase the risk of developing dementia. Mind-body practices such as yoga and meditation, have been recognized as safe techniques with beneficial effects on cognitive functions in older adults at risk for cognitive decline. We conducted a randomized, controlled trial to assess the efficacy of Kundalini yoga training (KY) compared to memory enhancement training (MET) on mood and cognitive functioning in a group of older women with CVRFs and SCD (clinicaltrials.gov = NCT03503669). The KY intervention consisted of weekly, 60-min in-person classes with a certified instructor for 12 weeks, with a 12-min guided recording for daily homework practice at home. MET involved 12 weekly in-person group classes with 12-min daily homework exercises. Objective and subjective memory performance were the primary outcomes. Peripheral whole blood samples were collected at baseline, 12-weeks, and 24-weeks follow-up for RNA sequencing and cytokine/chemokine assays. A total of 79 patients (KY = 40; MET = 39) were randomized, and 63 completed the 24-week follow-up (KY = 65% completion rate; MET = 95%; χ2(1) = 10.9, p < 0.001). At 24-weeks follow-up, KY yielded a significant, large effect size improvement in subjective cognitive impairment measures compared to MET. KYOn a transcriptional level, at 12- and 24-week follow-up, KY uniquely altered aging-associated signatures, including interferon gamma and other psycho-neuro-immune pathways. Levels of chemokine eotaxin-1, an aging marker, increased over time in MET but not KY participants. These results suggest clinical and biological benefits to KY for SCD, linking changes in cognition to the anti-inflammatory effects of yoga.

Assessment of Anti-Inflammatory and Antioxidant Activities of a Proprietary Preparation of Quercetin-Rutin Blend (SophorOx™) in Exercised Rats.

Flavonoids comprise a huge class of phenolic compounds widely distributed throughout the plant kingdom. Although quercetin and rutin have been studied individually for their therapeutic value, the synergistic effect of combining the two has previously not been measured. The objective of this trial was to evaluate the anti-inflammatory and antioxidant properties of both quercetin and rutin when combined in the form of SophorOx™ (a proprietary preparation of quercetin-rutin) in exercised rats. Sprague-Dawley rats were orally administered SophorOx™ at 500 mg·kg-1·b.w. and subjected to daily exercise on a fabricated treadmill for 4 weeks. A total of 24 animals were randomly divided into four groups. All the animals were examined for body weight, feed consumption, signs of clinical abnormalities, and morbidity. In addition, serum collected on days 8, 15, 22, and 29 were measured for the liver function test (LFT), random blood sugar (RBS), inflammatory markers C-reactive protein (CRP), oxidative stress markers (8-isoprostane (8-iso-PGF2α), malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), and cytokine levels interleukin-1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α)) by the ELISA method. Rats that received SophorOx™ showed no signs of adverse effects, and no significant changes were observed in body weight, feed consumption, liver enzymes, and blood glucose levels. The exercise-treated rats administered with SophorOx™ exhibited a significant reduction in oxidative and inflammatory marker levels, viz., CRP (113.32 ng·mL-1) and oxidative stress markers 8-OHdG (19.32 pg·mL-1), MDA (1.06 nmol·mL-1), 8-iso-PGF2α (1.29 ng·mL-1), IL-1β (0.77 pg·mL-1), and IL-6 (317.14 pg·mL-1) in comparison to those rodents that were exercised without SophorOx™. Oral administration of SophorOx™ significantly reduced oxidative stress and inflammatory marker levels when measured in the rodents subjected to high-intensity exercise.

Exercise Intervention and Hospital-Associated Disability

Inpatient exercise interventions may prevent, at least partly, hospital-associated disability (HAD) in older adults, but whether they also confer clinical benefits in the months following discharge is unclear. To examine the association of exercise and health education with HAD incidence in hospitalized older adults receiving acute hospital care at discharge and 3 months later. This single-center open-label, nonrandomized controlled clinical trial included patients aged 75 years or older seen at an acute care for elders unit at a tertiary public hospital in Madrid, Spain, from May 1, 2018, to June 30, 2022. Patients were allocated to an intervention or control group. Both groups received usual care, but the intervention group also performed a supervised multicomponent exercise program (daily strength, balance, and walking exercises along with inspiratory muscle training) during hospitalization and received health education on how to exercise at home and telephone counseling during follow-up. The primary outcome was HAD incidence (determined by the Katz Index of Independence in Activities of Daily Living [hereafter, Katz Index]) at discharge and after 3 months compared with baseline (ie, 2 weeks before admission). Secondary outcomes included HAD incidence determined by the Barthel Index for Activities of Daily Living, ambulatory capacity decline at discharge and follow-up, changes in physical performance at discharge, and incidence of falls, readmissions, and mortality during the follow-up period. The study included 260 patients (134 women [51.5%]; mean [SD] age, 87.4 [4.9] years [range, 75-105 years]; median hospital length of stay, 7 days [IQR, 5-10 days]), of whom 130 received the intervention and 130 were in the control group. Differences in HAD incidence did not reach statistical significance at discharge (odds ratio [OR], 0.62; 95% CI, 0.37-1.05; P = .08) or follow-up (OR, 0.65; 95% CI, 0.36-1.17; P = .15) when using the Katz Index. A lower HAD incidence was observed in the intervention group at discharge (OR, 0.47; 95% CI, 0.27-0.81; P = .01) and at follow-up (OR, 0.36; 95% CI, 0.20-0.66; P = .001) when using the Barthel Index for Activities of Daily Living. The intervention was also associated with a lesser decline in ambulatory capacity (OR, 0.55; 95% CI, 0.32-0.96; P = .03) and improved physical performance at discharge (Cohen d, 0.39; 95% CI, 0.12-0.65; P = .004). No significant associations were observed for readmissions, falls, or mortality. In this nonrandomized controlled clinical trial, an exercise and health education intervention was not significantly associated with reduced HAD incidence when measured by the Katz Index. However, the benefits found for several secondary outcomes might support the implementation of in-hospital exercise programs for older patients. ClinicalTrials.gov Identifier: NCT03604640.

Female tilapia, Oreochromis sp. mobilised energy differently for growth and reproduction according to living environment

This study was conducted to investigate the energy mobilisation preference and ionoregulation pattern of female tilapia, Oreochromis sp. living in different environments. Three different treatments of tilapia as physiology compromising model were compared; tilapia cultured in recirculating aquaculture system (RAS as Treatment I—RAS), tilapia cultured in open water cage (Treatment II—Cage) and tilapia transferred from cage and cultured in RAS (Treatment III—Compensation). Results revealed that tilapia from Treatment I and III mobilised lipid to support gonadogenesis, whilst Treatment II tilapia mobilised glycogen as primary energy for daily exercise activity and reserved protein for growth. The gills and kidney Na+/K+ ATPase (NKA) activities remained relatively stable to maintain homeostasis with a stable Na+ and K+ levels. As a remark, this study revealed that tilapia strategized their energy mobilisation preference in accessing glycogen as an easy energy to support exercise metabolism and protein somatogenesis in cage culture condition, while tilapia cultured in RAS mobilised lipid for gonadagenesis purposes.

Physiotherapist-supervised exercises versus unsupervised home-based exercises after nonsurgically treated proximal humerus fracture: a multicenter randomized controlled trial

BackgroundProximal humerus fracture (PHF) is a common fragility fracture in older adults and can have a substantial impact on upper limb function. Although most patients with PHF can be treated non-surgically, it is unknown whether older adults benefit from supervised exercise therapy after PHF. Therefore, the objective of this trial was to investigate whether 10 weeks of physiotherapist-supervised exercises once a week was superior to 10 weeks of non-supervised home-based exercises in older adults with a non-surgically treated displaced 2-part PHF. MethodsThis was designed as an assessor-blinded, prospective, randomized controlled trial and took place in three Nordic countries. In total, 72 patients (≥60 years) with non-surgically treated displaced 2-part PHF were randomized to either physiotherapist-supervised exercises once a week for 10 weeks combined with daily home-based exercises were compared to 10 weeks of daily non-supervised home-based exercises. The primary outcome measure was the Disability of the Arm, Shoulder, and Hand (DASH) with a primary endpoint at 3 months. Secondary outcomes were DASH (at 12 months), Constant-Murley Score, the 15D-instrument, Visual Analog Scale, General Self-Efficacy Scale, and Pain Catastrophizing Scale, with follow-up visits after 3 and 12 months. Non-union and patient death within 3 months were counted as complications. ResultsThe mean age of the patients in both groups was 73 years. At 3 months follow-up, the mean DASH score in the supervised group was 25.9 (SD 16.0) compared to 22.4 (18.9) in the non-supervised group. The mean between-group difference (3.5, 95% CI -5.0 to 12.5) was not clinically relevant. None of the secondary outcome measures presented any clinically relevant or statistically significant between-group differences at 3 or 12 months follow-up. One patient in the supervised group and three in the non-supervised group were diagnosed with non-union. One patient from each group died before 3 months follow-up. ConclusionsThis trial provides no evidence that supervised exercises are superior to non-supervised home-based exercises in improving functional outcome or quality of life in older patients with a non-surgically treated 2-part PHF. Further, our results suggest that most older adults with a non-surgically treated 2-part PHF can perform home-based exercises without the supervision of a physiotherapist.

The effects of daily dose of intense exercise on cardiac responses and atrial fibrillation.

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia that is strongly associated with cardiovascular (CV) disease and sedentary lifestyles. Despite the benefits of exercise on overall health, AF incidence in high-level endurance athletes rivals that of CV disease patients, suggesting a J-shaped relationship with AF. To investigate the dependence of AF vulnerability on exercise, we varied daily swim durations (120, 180 or 240minday-1 ) in 7-week-old male CD1mice. We assessed mice after performing equivalent amounts of cumulative work during swimming (i.e. ∼700L O2 kg-1 ), as determined from O2 consumption rates ( ). The mean during exercise increased progressively throughout the training period and was indistinguishable between the swim groups. Consistent with similar improvements in aerobic conditioning induced by swimming, skeletal muscle mitochondria content increased (P=0.027) indistinguishably between exercise groups. Physiological ventricular remodelling, characterized by mild hypertrophy and left ventricular dilatation, was also similar between exercised mice without evidence of ventricular arrhythmia inducibility. By contrast, prolongation of daily swim durations caused progressive and vagal-dependent heart rate reductions (P=0.008), as well as increased (P=0.005) AF vulnerability. As expected, vagal inhibition prolonged (P=0.013) atrial refractoriness, leading to reduced AF vulnerability, although still inducible in the 180 and 240min swim groups. Accordingly, daily swim dose progressively increased atrial hypertrophy (P=0.003), fibrosis (P<0.001) and macrophage accumulation (P=0.006) without differentially affecting the ventricular tissue properties. Thus, increasing daily exercise duration drives progressively adverse atrial-specific remodelling and vagal-dependent AF vulnerability despite robust and beneficial aerobic conditioning and physiological remodelling of ventricles and skeletal muscle. KEY POINTS: Previous studies have suggested that a J-shaped dose-response relationship exists between physical activity and cardiovascular health outcomes, with moderate exercise providing protection against many cardiovascular disease conditions, whereas chronic endurance exercise can promote atrial fibrillation (AF). We found that AF vulnerability increased alongside elevated atrial hypertrophy, fibrosis and inflammation as daily swim exercise durations in mice were prolonged (i.e. ≥180minday-1 for 6weeks). The MET-hweek-1 (based on O2 measurements during swimming) needed to induce increased AF vulnerability mirrored the levels linked to AF in athletes. These adverse atria effects associated with excessive daily exercise occurred despite improved aerobic conditioning, skeletal muscle adaptation and physiological ventricular remodelling. We suggest that atrial-specific changes observed with exercise arise from excessive elevations in venous filling pressures during prolonged exercise bouts, which we argue has implications for all AF patients because elevated atrial pressures occur in most cardiovascular disease conditions as well as ageing which are linked to AF.

Finite Element Analysis of Stress Distribution and Range of Motion in Discogenic Back Pain.

Precise knowledge regarding the mechanical stress applied to the intervertebral disc following each individual spine motion enables physicians and patients to understand how people with discogenic back pain should be guided in their exercises and which spine motions to specifically avoid. We created an intervertebral disc degeneration model and conducted a finite element (FE) analysis of loaded stresses following each spinal posture or motion. A 3-dimensional FE model of intervertebral disc degeneration at L4-5 was constructed. The intervertebral disc degeneration model was created according to the modified Dallas discogram scale. The von Mises stress and range of motion (ROM) regarding the intervertebral discs and the endplates were analyzed. We observed that mechanical stresses loaded onto the intervertebral discs were similar during flexion, extension, and lateral bending, which were greater than those occurring during torsion. Based on the comparison among the grades divided by the modified Dallas discogram scale, the mechanical stress during extension was greater in grades 3-5 than it was during the others. During extension, the mechanical stress loaded onto the intervertebral disc and endplate was greatest in the posterior portion. Mechanical stresses loaded onto the intervertebral disc were greater in grades 3-5 compared to those in grades 0-2. Our findings suggest that it might be beneficial for patients experiencing discogenic back pain to maintain a neutral posture in their lumbar spine when engaging in daily activities and exercises, especially those suffering from significant intravertebral disc degeneration.

Deteksi Perubahan Berat Badan Akseptor KB Hormonal dengan Menggunakan Model Regresi Linear Berganda

Hormonal contraception, which uses estrogen and progesterone preparations, is a contemporary method of contraception that is popular among active birth control participants. Apart from stopping population growth, it also has negative effects on its users. The side effect of increasing body weight can occur due to the nature of the acceptor and the use of hormonal contraceptives for a long period of time. The aim of the study was to detect changes in body weight of hormonal birth control acceptors based on age, parity and length of use of contraception using a multiple linear regression model. Non-experimental quantitative analytical research method with a cross sectional design. The research was conducted at several PMBs in Palembang City in July-September 2023 with samples consisting of hormonal birth control acceptors taken using a purposive sampling technique. Data were collected using questionnaires and body weight measurements and analyzed by multiple linear regression. The results of the research show that the prediction model for weight change = 5.789 - 0.098 Age + 1.4 Parity - 0.008 Length of birth control. Weight gain will definitely affect the health of the recipient and can increase the risk of obesity if it continues. To maintain a stable weight, birth control acceptors must pay attention to their daily diet and exercise regularly. It is very important to obtain information about the effects caused by the use of hormonal birth control with a high number of parities and ages at risk.