Personal Exercise Research Articles

Sex Differences in Glycemia and Self-Management Strategies for Exercise in an Active Adults Cohort with Type 1 Diabetes.

To examine potential differences in glucose levels during and after exercise between sexes in adults with type 1 diabetes. The T1DEXI study was a prospective, 4-week free-living observational study in adults with type 1 diabetes. Ninety-one females were matched on age and insulin-modality to 91 males. Participants completed exercise study videos and personal exercise sessions. Study-collected food, insulin, exercise, and glucose data surrounding exercise and on sedentary days were compared between sexes to examine how they impact glucose levels during and after exercise. Female participants had higher glucose levels than male participants when starting study exercise (8.5 ± 2.8 vs. 8.0 ± 2.8 mmol/L, p=0.01) and when starting personal exercise activities (8.4 ± 2.9 vs. 7.8 ± 2.7 mmol/L, p=0.05). Glucose declines during study exercise were comparable between female and male participants (adjusted mean: -0.8 vs. -1.0 mmol/L respectively, p=0.11), but smaller in female participants during personal exercise (adjusted mean: -0.9 vs. -1.4 mmol/L, p<0.001). 24-hour mean glucose levels were also higher in female participants on sedentary days (p=0.04). Daily macronutrient consumption was similar between sexes after adjusting for weight, as were food, exercise, and insulin habits surrounding exercise. Female participants had higher pre-exercise glucose levels compared to male participants, and smaller glucose declines during personal exercise, but there were no observable differences in food, exercise, and insulin habits.

Adaptive emotion regulation might prevent burnout in emergency healthcare professionals: an exploratory study.

Emergency department (ED) professionals face a high risk of physical, mental, and emotional strain, which can lead to burnout. Burnout arises from chronic work-related stress, which negatively impacts ED professionals, the healthcare system, as well as patient outcomes. Effective adaptive emotion regulation strategies (ERS) are crucial for handling stress in healthcare workplaces and mitigating the risk of burnout. High-quality patient-professional relationships, including empathy, significantly improve patient compliance and disease outcomes. This cross-sectional exploratory study aims to investigate the relationship between mental distress, burnout, adaptive and maladaptive ERS among healthcare professionals in an ED. A total of 159 ED workers participated in an online survey. Emotion regulation was assessed using the Cognitive Emotion Regulation Questionnaire, while burnout and mental distress were measured using the Maslach Burnout Inventory and the Depression, Anxiety, and Stress Scale. The findings revealed that more than 20% of participants displayed severe symptoms of stress (N = 35), anxiety (N = 36), and depression (N = 31), and only 10.7% (N = 27) had no signs of burnout. Despite these findings, it appears that the majority of ED professionals primarily utilise adaptive ERS (91.8%, N = 146). However, as burnout levels increased, the use of adaptive ERS declined compared to maladaptive strategies. Regression analysis identified several significant predictors of Emotional Exhaustion, Depersonalisation, and reduced Personal Accomplishment, including gender, age, physical exercise, smoking, sedative usage, stress, depression, maladaptive strategies and adaptive strategies such as positive reappraisal. These study results highlight the urgent need to address workplace stress, burnout, and mental distress among healthcare professionals in EDs. Implementing effective strategies for adaptive emotion regulation and promoting a supportive work environment can help mitigate burnout and enhance the well-being of ED workers, ultimately benefiting patient care and outcomes.

The impact of internet medical service on rural gender inequality in health opportunity: a cross-sectional study

BackgroundThe increasing popularity of Internet medical service may have alleviated the gender inequality in health opportunity faced by rural women. However, research to ascertain the association between Internet medical service and gender inequality in health opportunity is scarce. This study explored the impact of Internet medical service on gender inequality in health opportunity among rural women and the underlying mechanisms involved.MethodsA multistage stratified cross-sectional survey was conducted across six counties in three provinces in China, yielding 3,108 responses for a 97.13% response rate. The questionnaire was used to collect information on Internet healthcare use, health status, health behaviors, social activities and personal exercise, chronic disease status, and demographic and socio-economic characteristics of the participants. Based on Roemer's theory of equality of opportunity (EOP), we established a decomposition strategy for the fairness gap between genders, which we used for the measurement of the gender inequality in health opportunity Fixed effects models, propensity score matching (PSM), and least absolute shrinkage and selection operator (LASSO) regression were utilized to explore the impact of Internet medical service on rural gender inequality in health opportunity.ResultsOn average, rural women experienced a gender health fairness gap of 1.63. Internet medical service significantly mitigated this inequality (β = -0.0602, P = 0.0002), and this finding remained significant across propensity score matching (PSM) and LASSO regression analyses. Mechanistic analysis revealed that human capital positively moderates this effect (β = -0.0510, P < 0.01), while income (β = 0.0370, P < 0.001) and marital status (β = 0.2039, P < 0.001) have negative moderating effects.ConclusionsBy focusing on gender inequality in the digital era, this study highlights the mitigating role of Internet medical service on gender inequality in health opportunity in rural areas. This study proposes and validates the mechanisms through which Internet medical service alleviates gender inequality in health opportunity, suggesting that human capital amplifies this effect, while high personal income and marital status attenuate this effect. These findings contribute to understanding how the digital age can narrow gender health opportunity equality, providing support for future interventions aimed at promoting health equity and gender equality.

WeCare – Mental healthcare for health professionals

Abstract Issue/Problem Health professionals face physical and mental stressors (risk factors) due to challenging working conditions. Description of the Problem Despite high levels of health literacy among healthcare workers, maintaining healthy habits is challenging due to variable shifts, including nights, high workloads, and intense emotional and mental demands. Adopting a healthier lifestyle requires personal changes that can be difficult to implement, particularly in nursing and caregiving. This is critical, as retaining and attracting new staff in these fields is essential for the healthcare sector. Results/Effects/Changes To address these challenges, it’s crucial to boost intrinsic motivation and provide healthcare workers with practical tools to support their well-being and encourage them to remain in the sector. The WeCare project offers a mobile app designed as a ‘pocket coach,’ accessible at any time. Healthcare professionals can use the app to assess their current mental well-being through self-evaluation. With built-in assessments and predefined thresholds, the app tracks stress levels and quality of life. Depending on the outcomes, users are automatically guided to appropriate information, gamified activities, and exercises tailored to their specific needs. The project, running from 2022 to 2024, is co-funded by the European Union’s Erasmus+ programme. Lessons The app is beta-tested during 2024 in five countries: Germany, Austria, Serbia, Poland, and Italy, with local language support. The test group will consist of healthcare professionals and related professions. The results, including user engagement and motivational factors are analyzed. As the project concludes in autumn, comprehensive recommendations and lessons learned will be compiled and presented at the European Public Health (EPH) Conference. This will also include sharing the app and its solution with the broader healthcare community. Key messages • The WeCare app supports healthcare workers’ mental health with a mobile “pocket coach” that provides personalized exercises. Through gamification, it promotes healthy habits and boosts job motivation. • It is critical to support healthcare workers, as retaining and attracting new persons is essential for the healthcare sector.

The Role of Hospice and Palliative Medicine in the Ars Moriendi.

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM's goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion, while others think that HPM's practices should aim, like all other branches of medicine, at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, I argue that if HPM's practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM's practices were to aim at health. According to the ars moriendi, flourishing at the end of one's life requires that persons exercise their agency and pursue the goods most important to them. On this view, HPM's practices should promote patients' health to enable them to pursue these goods.

Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial.

While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511. DERR1-10.2196/60270.

Comparing cadence-based energy expenditure and oxygen cost indices in able-bodied male people.

Walking is a fundamental aspect of daily life and exercise, with clinical benefits for cardiovascular health and muscle strength. However, accurately measuring energy efficiency during walking poses challenges due to equipment and spatial constraints. In this study, we proposed the cadence-based energy expenditure index (cEEI) and analyzed its correlation with the previously proposed index for measuring energy expenditure under various gait conditions. We enrolled 15 healthy participants and conducted an experimental protocol on a treadmill to measure the following energy expenditure-related indices: oxygen cost index (OCI), energy expenditure index (EEI), and cEEI. The participants underwent stages of walking at different speeds and inclinations that comply with the modified Bruce protocol while their heart rate, oxygen uptake, and cadence were recorded. Participants showed significant increases in heart rate, oxygen uptake, and cadence with higher walking speeds and inclinations. Correlation analysis revealed strong associations between cEEI and OCI, especially during walking conditions. Bland-Altman plots and interclass correlation coefficient analysis demonstrated a favorable agreement between cEEI and OCI, outperforming EEI. In conclusion, this study proposes cEEI as a reliable metric for estimating energy expenditure during walking by proving a strong correlation and agreement with OCI across various gait conditions. This suggests the potential for cEEI to provide real-time, individualized feedback on energy expenditure during walking, facilitating more personalized exercise prescriptions.

Cardiopulmonary Fitness and Personalized Exercise Prescription in Patients With Hypertrophic Cardiomyopathy.

Patients with hypertrophic cardiomyopathy (HCM) are generally restricted regarding participation in competitive sports based on the potential risk of sudden cardiac death and malignant arrhythmias. As a result, they are often inactive and experience the negative consequences of a sedentary lifestyle. Hence, the need arises to strike the right balance between these 2 extremes through personalized exercise prescription. The aims of this study were (1) to assess the characteristics of patients with HCM practicing regular aerobic physical activity compared with sedentary patients; (2) to perform a personalized moderate-intensity exercise prescription and evaluate its effects. Patients with HCM were evaluated through clinical assessment, ECG, ambulatory ECG monitoring, echocardiography, and cardiopulmonary testing. A personalized moderate-intensity exercise prescription was performed, and the same investigations were repeated. Physically active patients with HCM demonstrated better cardiopulmonary functional capacity than sedentary patients (oxygen consumptionpeak/kg 32.9±7.4 versus 25.2±7.4 mL/min per kg P≤0.0001, ventilation/carbon dioxide production slope 26.7±4.3 versus 29.9±5.2 P=0.004), with similar prevalence of ventricular arrhythmias (P=0.43). Sedentary subjects showed a borderline higher prevalence of obesity (P=0.07) than physically active subjects. Moderate-intensity exercise prescription led to improved cardiopulmonary fitness without occurrence of adverse events. Patients with HCM practicing regular aerobic exercise have a better functional capacity in the absence of relevant events than sedentary patients. Conversely, a sedentary lifestyle led to a deterioration of cardiopulmonary functional capacity and fitness. The tailored moderate-intensity personalized exercise prescription appears to be a feasible approach in carefully selected patients with HCM to counterbalance the negative effects of sedentary behavior without significant major events.

ChatGPT-4 and wearable device assisted Intelligent Exercise Therapy for co-existing Sarcopenia and Osteoarthritis (GAISO): a feasibility study and design for a randomized controlled PROBE non-inferiority trial.

Sarcopenia and osteoarthritis are prevalent age-related diseases that mutually exacerbate each other, creating a vicious cycle that worsens both conditions. Exercise is key to breaking this detrimental cycle. Facing increasing demand for rehabilitation services within this patient demographic, ChatGPT-4 and wearable device may increase the availability, efficiency and personalization of such health care. To evaluate the clinical efficacy and cost-effectiveness of a rehabilitation system implemented on mobile platforms, utilizing the integration of ChatGPT-4 and wearable devices. The study design is a prospective randomized open blinded end-point (PROBE) non-inferiority trial. 278 patients diagnosed with osteoarthritis and sarcopenia will be recruited and randomly assigned to the intervention group and the control group. In the intervention group patients receive mobile phone-based rehabilitation service where ChatGPT-4 generates personalized exercise therapy, and wearable device guides and monitor the patient to implement the exercise therapy. Traditional clinic based face-to-face exercise therapy will be prescribed and implemented in the control group. All patients will receive three-months exercise therapies following the frequency, intensity, type, time, volume and progression (FITT-VP) principle. The patients will be assessed at baseline, one month, three months, and six months after initiation. Outcome measures will include ROM, gait patterns, Visual Analogue Scale (VAS) for pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) for functional assessment, Short-Form Health Survey 12 (SF-12) for quality of life, Minimal Clinically Important Difference (MCID), Patient Acceptable Symptom State (PASS), and Substantial Clinical Benefit (SCB) for clinically significant measures. A rehabilitation system combining the capabilities of ChatGPT-4 and wearable devices potentially enhance the availability and efficiency of professional rehabilitation services, thus enhancing the therapeutic outcomes for a substantial population concurrently afflicted with sarcopenia and osteoarthritis.

8068 Beneficial Effects of a Personalized Exercise Program for Patients with Cushing's Disease and Acromegaly After Biochemical Control

Abstract Disclosure: E. Valassi: None. L. Martel-Duguech: None. H. Bascuñana: None. V. Priego-Corredor: None. J. Viñals-Ribé: None. O. González-Viñuela: None. T. Caparrós-Pons: None. S.M. Webb: None. Background: Patients with Cushing’s disease (CD) in remission and controlled acromegaly (ACRO) present with residual metabolic derangements, muscle dysfunction, and poor quality of life (QoL). Although exercise is known to exert positive effects on psychophysical health in several conditions, evidence demonstrating its potential benefits in pituitary diseases is scanty. Main hypothesis: A personalized program of combined (aerobic and resistance training) exercise lasting 12 weeks improves cardiometabolic parameters, body composition, physical performance and QoL in patients with CD in remission and controlled ACRO. Methodology: Ten female patients with CD in remission [mean (±SD) age, 59±4 years, mean (±SD) BMI, 35±2 Kg/m2, median (IQR) duration of remission, 5(4) years] and 10 male patients with controlled ACRO [mean (±SD) age, 53±9 years, mean (±SD) BMI, 27±4 Kg/m2, median (IQR) duration of control, 6(3) years] underwent a 12-week, structured, personalized program of combined aerobic and resistance exercise, under the supervision of professional trainers. We evaluated the following parameters at baseline and within 72 hours after the completion of the exercise program: blood pressure (BP), BMI, waist and neck circumferences; physical performance (gait speed, hand grip strength, 30-Second Chair Stand; Timed “Up and Go”); lumbar and femoral bone mineral density (BMD) and body composition, using dual x-ray absorptiometry (DXA); muscle thickness (cm) at the middle and distal third of rectus femoris (RF) and vastus intermedius (VI) on both sides, using muscle ultrasound scans in the transverse plane (Philips Affiniti 70; The Netherlands); quality of life (QoL), using the questionnaires CushingQoL in CD patients and AcroQoL in ACRO patients. Major results: After completion of the exercise program, CD patients had lower diastolic BP and waist circumference as compared with baseline (p&amp;lt;0.05). Physical performance globally improved (p&amp;lt;0.01 for all function tests). Femoral BMD was higher, percentage of lean mass increased while trunk fat decreased (p&amp;lt;0.01). RF and VI muscle thickness was greater at both the middle and distal third on the right side (p&amp;lt;0.01), and at the distal third on the left as compared with baseline (p&amp;lt;0.05). ACRO patients had a lower systolic BP as compared with baseline. Gait speed and hand grip strength increased while performance on the 30-Second Chair Stand improved (p&amp;lt;0.05). Muscle thickness at the middle third of the right RF was greater as compared with baseline (p&amp;lt;0.05). QoL was unchanged in both CS and ACRO patients at the end of the program. Conclusions: A customized exercise program promotes beneficial cardiometabolic and muscle changes in patients with CD and ACRO and, therefore, should be offered in a specialized pituitary clinic, within an integrated multidisciplinary team approach. Study financed by ISCIII research project number FIS PI21/01223 Presentation: 6/1/2024

Promoting precision health using fitness wearable and apps among breast cancer survivors: Protocols of a smart health management trial

BackgroundAnnually, approximately 1.7 million women are diagnosed with breast cancer worldwide. Engaging in regular physical activity (PA) post-diagnosis brings significant health benefits, enhancing breast cancer survivors' (BCS) prognosis and overall health-related quality of life (HRQoL). Despite these benefits, a low percentage of Chinese BCS adhere to the recommended moderate-to-vigorous PA levels. This highlights the need for innovative PA interventions tailored for BCS management. eHealth technology, such as fitness wearables and apps, presents an opportunity to improve BCS healthcare by offering personalized exercise programs. MethodsThis study focuses on developing a precision eHealth PA program for 200 Chinese BCS in Guangdong Province, using a custom micro-application and a smart band for a 12-month trial. All participants will receive a Huawei Smart Band and be divided into 1) a personalized intervention group, receiving daily PA tracking and feedback, and 2) a control group receiving standard care. The primary outcome is PA and secondary outcomes include biomarkers, weight and body composition, functional fitness, HRQoL, and individual beliefs. Outcomes will be assessed at baseline, 6 months, and 12 months (endpoint). Successful outcomes could revolutionize PA programs for Chinese BCS, providing a model for future eHealth interventions.

The impact of exercise on mental health: a narrative review

It has become increasingly clear that exercise not only improves physical health but also significantly affects mental well-being, presenting a non-pharmaceutical approach to manage various psychological conditions. This narrative review summarizes studies from the literature to understand the effects of exercise on mental health, particularly in depression, anxiety, and global psychological well-being. Results indicate that regular physical activity, including aerobic and resistance exercises, reduces depression and anxiety symptoms, improves mood, and enhances cognitive abilities. Theoretical models, such as the endorphin hypothesis and neurogenesis hypothesis, explain these benefits through mechanisms including endorphin release, reduced stress hormones, improved sleep, and neurogenesis. Evidence suggests that structured exercise programs can match the effectiveness of psychotherapy or medication with fewer adverse effects. The benefits of regular exercise have garnered attention from professionals, physicians, and policymakers, highlighting the necessity of incorporating exercise plans into mental health clinical practice. Additionally, this review advocates for more specific and personalized exercise interventions tailored to individual characteristics and preferences. It also aims to inform health and research agendas by specifying the optimal exercise type and intensity for eliciting desired benefits, and evaluating the potential for exercise interventions to sustain long-term psychological well-being.

Impact of Combined Exercise Rehabilitation and Continuous Health Education on the Quality of Life and Mental Health of Patients Post-Coronary Stent Implantation

Objective: To evaluate the impact of patient-centered exercise rehabilitation combined with continuous health education on the quality of life and mental health of patients after coronary stent implantation to provide effective rehabilitation intervention strategies and scientific evidence for clinical practice. Methods: This retrospective cohort investigation involved patients who underwent coronary stent implantation at our hospital between January 2021 to December 2022. The control group (n = 81) received routine post-operative follow-up and health education, while the observation group (n = 68) additionally received personalized exercise rehabilitation and continuous health education. The short form-36 (SF-36) scale was used to assess quality of life, while the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate mental health. The Exercise of Self-Care Agency Scale (ESCA) was used to assess self-care ability. Results: At 6 months post-operation, the observation group showed significantly higher scores than the control group across all dimensions of the SF-36 scale, SAS, SDS, and ESCA (p &lt; 0.05). The observation group exhibited significantly improved quality of life, mental health, and enhanced self-care ability. Conclusion: Patient-centered exercise rehabilitation combined with continuous health education significantly positively impacts the quality of life and mental health of patients after coronary stent implantation. This comprehensive rehabilitation intervention strategy should be adopted in clinical practice to improve patient prognosis and quality of life.

Personalized Exercise Prescription in Long COVID: A Practical Toolbox for a Multidisciplinary Approach.

To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature. There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia's few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation. Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer's presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4-6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual's progress, at an intensity 4-6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥50% of their maximum inspiratory pressure). We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts. In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual's symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.

Internet Addiction among Egyptian Teens during COVID-19 Pandemic

BACKGROUND: Teens’ lifestyles have changed significantly during and after COVID-19 epidemic and they have started engaging in risky health behaviors like using smartphone more frequently. Everyone is compelled to use their smartphone more frequently than usual to access daily necessities during the COVID-19 pandemic lockdown. AIM: We aimed to evaluate the problem of internet addiction and the increasing use of smartphone among teenage Egyptian youth during COVID-19 pandemic. METHODS: Online surveys were sent to Egyptian teens (12–18 years old) in several governorates in June 2020, and they were completed by 154 youths over the course of one month. Different teenagers were required to respond to and share in this poll, and versions in both English and Arabic were used. At the outset of the questionnaire, the question about consent was viewed as mandatory. The extent of Internet use was evaluated using Young’s Internet Addiction Test (IAT). The survey was divided into four sections and created with the goals of understanding the modes (frequency, patterns, and goals) of internet use, the negative effects, linked parental behaviors, as well as the eventual occurrence and severity of addiction. The same data from the time before the epidemic was also looked into and analyzed. Version 23 of IBM SPSS Statistics was used for the analysis. The p-value threshold for significance was established at 0.05. RESULTS: The mean age of the teens was 14.38 ± 2.87 years and equal gender frequency (males of 50.6% and females of 49.4%. About 79.9% of them live in urban environment, 18.8% suffered from family problems and 40.9% were in the secondary educational level. Increased physical inactivity of participants was noticed after COVID-19 among participants (55.8%). About 87.7% of them used smartphone for online access (87.7%). Half of the subjects (50%) spent 1–3 h online before COVID, while more than half of them (59.1%) spent more than 6 hours online after COVID, with a statistically significant difference. Mean IAT was 61.91 ± 16.77 after COVID versus 45.26 ± 12.45 before COVID. The prevalence of internet addiction was increased from 67.5% before COVID-19 to 77.9% after COVID-19 infection. IAT score was normal, mild, moderate, and severe in 5.8%, 16.2%, 65.6%, and 12.3% after COVID-19, respectively, compared to normal, mild, moderate, and severe IAT score in 26.6%, 5.8%, 61.0%, and 6.5% before COVID, respectively, with significant differences between them before and after COVID (p &lt; 0.000). Increasing mother’s and father’s educational, increasing time spent online, decreasing duration of sleep, and lower the number of days of exercise for more than 30 min/week were associated with higher IAT score. CONCLUSIONS: During the COVID-19 pandemic, internet addiction was extremely common among teenagers (77.9%). The amount of time spent online, the length of sleep, and the number of days that a person exercises for more than 30 min/week were all predictors of addiction.

Personality profiles and exercise behaviour across adulthood

AbstractPersonality has constituted a significant psychological component predicting physical exercise. Prior research mostly focused on how personality domains are associated with exercise behaviour. Yet, focusing more closely on combinations of personality domains may be valuable in the future. The present cross‐sectional study aimed to bridge this gap by investigating the associations between Big Five personality profiles and exercise behaviour based on a person‐centred approach in adults. Data from the China Family Panel Studies (CFPS) were used (N = 28,304), in which participants reported their Big Five personality and exercise behaviour. Latent profile analyses, grounded in young adulthood, middle adulthood, and later adulthood sub‐samples, identified five personality profiles: moderate, reserved, confident, resilient, and vulnerable. Across three age groups, significant differences between the five personality profiles in relation to exercise behaviour were revealed. Individuals with the resilient or confident profiles generally had longer exercise duration while people with the vulnerable profile tended to exercise less. Our findings give greater insight into the relationship between exercise and personality, suggesting that different combinations of personality traits may determine individuals' exercise behaviour. It opens promising avenues for identification of adults at risk of lacking exercise, and for development of personality‐targeted exercise interventions.

Enhancing Palliative Care for Deep Vein Thrombosis: A Scoping Review with Clinical Insights on the Integration of Physical Activity

Abstract Objective: This review aims to explore the role of physical activity as an integral palliative care strategy in managing deep vein thrombosis (DVT), providing a comprehensive analysis and practical insights for clinicians. Methods: A thorough review of relevant literature was conducted, encompassing studies, clinical trials, and expert opinions that examine the relationship between physical activity and palliative care from the perspective of DVT. The search included databases such as PubMed, PEDro, and Scopus, with an emphasis on articles published within the last decade. Results: The review highlights the multifaceted benefits of incorporating physical activity into the palliative care approach for individuals with DVT. Physical activity has been effective in enhancing overall well-being, alleviating symptoms, and contributing to the holistic management of DVT-related complications. In addition, the literature underscores the importance of personalized exercise regimens tailored to the patient’s condition, ensuring safety and effectiveness. Conclusion: This comprehensive review underscores the significance of physical activity as a pivotal element in palliative care for individuals with DVT. Integrating personalized exercise regimens into the management strategy offers a holistic approach that addresses the physical and psychosocial aspects of DVT. As clinicians navigate the complexities of DVT palliative care, a thorough and timely incorporation of physical activity can significantly contribute to enhancing the overall quality of life for affected individuals.

The Best Exercise Modality and Dose to Reduce Glycosylated Hemoglobin in Patients with Type 2 Diabetes: A Systematic Review with Pairwise, Network, and Dose-Response Meta-Analyses.

Persistently elevated glycosylated hemoglobin (HbA1c)is associated with a higher risk of long-term vascular complications. We evaluated the effect of different exercise modalities and doses on HbA1c levels in patients withtype 2 diabetes. A systematic search for randomized controlled trials involving exercise interventions in patients with type 2 diabetes was conducted across seven electronic databases, encompassing data from their inception up to October 2023. Two independent reviewers assessed the quality of the literature. Pairwise, network, and dose-response meta-analyses using the random-effects model were conducted to analyze the effect of exercise on HbA1c levels. A total of 85 randomized controlled trials with 5535 participants were included. The network meta-analysis showed that high-intensity interval training(HIIT) has the highest ranked (MD = - 0.78% [- 8.50 mmol/mol]; 95% CrI: - 1.04, - 0.51), followed by combined aerobic and resistance exercise(CE) (MD = - 0.54% [- 5.90 mmol/mol]; 95% CrI: - 0.69, - 0.40), yoga (MD = - 0.45% [- 4.92 mmol/mol]; 95% CrI: - 0.77, - 0.13), and continuous aerobic exercise(CAE) (MD = - 0.42% [- 4.58 mmol/mol]; 95% CrI: - 0.54, - 0.30). In addition, a significant improvement in HbA1c levels can be observed when the totalexercise dose reaches 840 metabolic equivalent of tasks-min/week. There was low-quality evidence that HIIT, CE, yoga, and CAE may be effective treatment modalities for improving HbA1c in patients with type 2 diabetes, and there was no significant difference in efficacy. Moreover, a non-linear dose-response relationship was found for total exercise and HbA1c levels.Future research should further investigate the specific effects of different exercise doses on HbA1c levels in patients with type 2 diabetes and provide a more personalized exercise prescription.

Identifying the risk of exercises, recommended by an artificial intelligence for patients with musculoskeletal disorders

Musculoskeletal disorders (MSDs) impact people globally, cause occupational illness and reduce productivity. Exercise therapy is the gold standard treatment for MSDs and can be provided by physiotherapists and/or also via mobile apps. Apart from the obvious differences between physiotherapists and mobile apps regarding communication, empathy and physical touch, mobile apps potentially offer less personalized exercises. The use of artificial intelligence (AI) may overcome this issue by processing different pain parameters, comorbidities and patient-specific lifestyle factors and thereby enabling individually adapted exercise therapy. The aim of this study is to investigate the risks of AI-recommended strength, mobility and release exercises for people with MSDs, using physiotherapist risk assessment and retrospective consideration of patient feedback on risk and non-risk exercises. 80 patients with various MSDs received exercise recommendations from the AI-system. Physiotherapists rated exercises as risk or non-risk, based on patient information, e.g. pain intensity (NRS), pain quality, pain location, work type. The analysis of physiotherapists’ agreement was based on the frequencies of mentioned risk, the percentage distribution and the Fleiss- or Cohens-Kappa. After completion of the exercises, the patients provided feedback for each exercise on an 11-point Likert scale., e.g. the feedback question for release exercises was “How did the stretch feel to you?” with the answer options ranging from “painful (0 points)” to “not noticeable (10 points)”. The statistical analysis was carried out separately for the three types of exercises. For this, an independent t-test was performed. 20 physiotherapists assessed 80 patient examples, receiving a total of 944 exercises. In a three-way agreement of the physiotherapists, 0.08% of the exercises were judged as having a potential risk of increasing patients' pain. The evaluation showed 90.5% agreement, that exercises had no risk. Exercises that were considered by physiotherapists to be potentially risky for patients also received lower feedback ratings from patients. For the ‘release’ exercise type, risk exercises received lower feedback, indicating that the patient felt more pain (risk: 4.65 (1.88), non-risk: 5.56 (1.88)). The study shows that AI can recommend almost risk-free exercises for patients with MSDs, which is an effective way to create individualized exercise plans without putting patients at risk for higher pain intensity or discomfort. In addition, the study shows significant agreement between physiotherapists in the risk assessment of AI-recommended exercises and highlights the importance of considering individual patient perspectives for treatment planning. The extent to which other aspects of face-to-face physiotherapy, such as communication and education, provide additional benefits beyond the individualization of exercises compared to AI and app-based exercises should be further investigated.Trial registration: 30.12.2021 via OSF Registries, https://doi.org/10.17605/OSF.IO/YCNJQ.

Exercise and diet support in breast and prostate cancer survivors: findings from focus groups

PurposeCancer survival is improving, making optimal management of long-term treatment-related adverse effects increasingly important. Exercise and a healthy diet are beneficial and regularly recommended in cancer survivorship guidelines; however, few cancer survivors meet these recommendations so there is a need to explore why. This study aimed to understand experiences receiving exercise and diet support among Australian breast and prostate cancer survivors during and following treatment, and to explore what support they would like to receive.MethodsAdults who completed active treatment for breast or prostate cancer were recruited via a private cancer care centre. Using a qualitative descriptive study design, participants attended in-person focus groups that were recorded, transcribed, then analysed using reflexive thematic analysis.ResultsIn total, 26 cancer survivors (15 breast, 11 prostate) participated in one of seven focus groups (4 breast, 3 prostate). Two themes were developed: 1) It was just brushed over, and 2) Wanting more. Theme 1 reports that exercise, and especially diet, were rarely discussed. If they were, it was often limited to general recommendations. Theme 2 shows that participants wanted more specific and personalised support, and information about how exercise and/or diet could benefit their cancer treatment.ConclusionDespite strong interest in receiving personalised exercise and diet support, neither are routinely provided to Western Australian breast and prostate cancer survivors. If support was provided, there was inconsistency in the level and type of support provided. These findings identify important gaps in exercise and diet support provision to cancer survivors and will inform future strategies aiming to improve cancer survivorship care.