Low-intensity Group Research Articles

Abstract 4137181: High-Intensity Walking Exercise Minutes and Improved Walking Performance in Peripheral Artery Disease: LITE Randomized Clinical Trial

Background: The LITE randomized clinical trial evaluated the effect of high-intensity vs low-intensity walking exercise on walking ability for peripheral artery disease (PAD). In post-hoc analyses, this study evaluated whether people with PAD who walked more exercise minutes per week had greater six-minute walk (6MW) improvement, compared to those who walked fewer exercise minutes per week. Within each quartile of exercise minutes, change in 6MW was compared between high and low-intensity exercise groups. Methods: People with PAD were randomized to walking exercise that induced ischemic leg symptoms (high-intensity), walking exercise at a comfortable pace without ischemic leg symptoms (low-intensity), or a control group that did not exercise for 12 months. Participants randomized to exercise were asked to walk 5 days/week up to 50 minutes/day. High-intensity exercise was defined and objectively measured using an ActiGraph. Participants wore an ActiGraph during exercise to measure exercise minutes/week. The primary outcome was 12-month change in 6MW. Results: Of 305 PAD participants randomized (47% women, 59% Black), 208 were assigned to exercise and had data available for analyses. The high-intensity exercise group walked fewer exercise minutes/week than the low-intensity exercise group (51.95 vs 136.82, P< 0.0001). In each exercise group, greater exercise minutes/week at target intensity were associated with greater 6MW improvement (Table). Within each quartile of exercise minutes/week, high-intensity exercise improved 6MW significantly more than low-intensity (Table). Conclusion: In the LITE randomized trial, among people randomized to high-intensity and low-intensity exercise, respectively, more minutes of exercise per week were associated with greater 6MW improvement. However, within each quartile of exercise minutes/week, high-intensity exercise improved 6MW significantly more than low-intensity exercise.

Impact of physical activity on life satisfaction among middle-aged and older adults in China: A longitudinal national study.

This study examined the impact of physical activity on life satisfaction in middle-aged and older adults in China. Utilizing longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015 and 2018, a total of 6484 participants aged 45 or older were included in the analysis. Data were collected on sociodemographic, health, and lifestyle variables, physical activity, and life satisfaction. Physical activity was categorized into 3 levels: low (71%), moderate (25%), and high (4%). Ordinal logistic regression and subgroup analysis were used to examine the effect of baseline physical activity on life satisfaction, including the examination of interaction effects. After adjusting for age, gender, education, marriage, residence, smoking, alcohol use, depressive symptoms, and self-rated health at baseline (2015), compared to the moderate-intensity physical exercise group, those in the low-intensity group experienced significantly lower levels of life satisfaction on follow-up (2018). In the subgroup analyses, a significant negative effect of low-intensity physical activity on life satisfaction was found in all groups regardless of age, education, marital status, smoking, alcohol use, sleep duration, weight, presence of chronic diseases, or self-rated health. These results support the promotion of physical exercise to enhance life satisfaction among middle-aged and older adults in China.

Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial

Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children. This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2-3h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1-4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529. From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43)=21.47, p<0.0001, ηp 2=0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support. A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited. Emerging Researcher First Grant from the Health Research Council of New Zealand.

Low Versus Standard Intensity Heparin Protocols in Adults Maintained on Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study

Background: Patients maintained on extracorporeal membrane oxygenation (ECMO) often require systemic anticoagulation to prevent circuit clotting and systemic thromboembolic complications. The optimal intensity of anticoagulation to balance the risk of bleeding and prevention of thrombotic complications in this patient population is not well described. Objective: To compare bleeding events in patients on ECMO anticoagulated with standard vs low intensity heparin protocols. Methods: This single-center, retrospective cohort study included adult patients on VA- or VV-ECMO and anticoagulated with low or standard intensity heparin protocols. The primary outcome was the incidence of major bleeding; secondary outcomes included the incidence of minor bleeding, thrombotic complications, heparin-induced thrombocytopenia, in-hospital mortality, time in therapeutic range, anti-Xa correlation with aPTT, intensive care unit and hospital lengths of stay, oxygenator exchanges, and rate of protocol switching. Results: A total of 27 patients (14 low intensity, 13 standard intensity) were included. There were six major bleeding events in the low intensity group and four in the standard intensity group ( P = 0.69); there were four minor bleeding events in the low intensity group and five in the standard intensity group ( P = 0.69). Seven patients in the standard intensity group switched protocols; zero patients in the low intensity group switched protocols ( P = 0.002). There were no differences in any other outcomes. Conclusions: There was no difference in the incidence of any bleeding or thrombotic events when using a low vs standard intensity heparin protocol in patients on ECMO. A low intensity heparin strategy for patients on ECMO may be feasible and safe.

Dose‒response effects of resistance exercise on ameliorating cravings and executive functions in individuals with methamphetamine use disorders

PurposeResistance exercise (RE) can acutely benefit symptoms in individuals with methamphetamine use disorder (MUD), though the optimal dose has not yet been established. We aimed to determine the dose response relationship between RE intensity and cue-elicited cravings and executive functions in individuals with MUD. MethodsA total of 128 male participants with MUD (34.73 ± 5.65) were randomly assigned to the low-intensity (30%–35%1-RM) RE group (LREG), moderate-intensity (55%–60%1-RM) RE group (MREG), high-intensity (75%–80%1-RM) RE group (HREG), or control group (CONG). Cravings based on the cue-reactivity paradigm were measured before, immediately after, and 40 min after acute RE, and inhibitory control, working memory, and cognitive flexibility were measured before and after acute RE. ResultsImmediately after and 40 min after RE, the Δcue-elicited cravings of the MREG from baseline was significantly more negative than that of the LREG and CONG. Trend analyses revealed a U-shaped dose‒response curve for RE intensity and Δcue-elicited cravings, indicating that moderate-intensity RE had the greatest ameliorating effect on cue-elicited cravings. Δinhibitory control and Δworking memory scores increased only in the MREG, and Δcognitive flexibility scores significantly increased in all RE groups. Trend analyses revealed a cubic curvilinear relationship between RE intensity and inhibitory control and a quadratic curvilinear relationship with working memory and cognitive flexibility. ConclusionRE proved effective in diminishing cue-elicited cravings and enhancing executive functions. A significant dose‒response relationship existed among RE intensity, cue-elicited cravings and executive function, and moderate-intensity RE had a more pronounced ameliorative effect on individuals with MUD.

Effect of High-Intensity vs Low-Intensity Noninvasive Positive Pressure Ventilation on the Need for Endotracheal Intubation in Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease

The effect of high-intensity noninvasive positive pressure ventilation (NPPV) on the need for endotracheal intubation in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) is unknown. To determine whether the use of high-intensity NPPV vs low-intensity NPPV reduces the need for endotracheal intubation in patients with an acute exacerbation of COPD and hypercapnia. Randomized clinical trial conducted at 30 general respiratory non-intensive care unit wards of Chinese hospitals from January 3, 2019, to January 31, 2022; the last 90-day follow-up was on April 22, 2022. The included patients had an acute exacerbation of COPD and a Paco2 level greater than 45 mm Hg after receiving 6 hours of low-intensity NPPV. Patients were randomized 1:1 to receive high-intensity NPPV with inspiratory positive airway pressure that was adjusted to obtain a tidal volume 10 mL/kg to 15 mL/kg of predicted body weight (n = 147) or to continue receiving low-intensity NPPV with inspiratory positive airway pressure that was adjusted to obtain a tidal volume of 6 mL/kg to 10 mL/kg of predicted body weight (n = 153). Patients in the low-intensity NPPV group who met the prespecified criteria for the need for endotracheal intubation were allowed to crossover to high-intensity NPPV. The primary outcome was the need for endotracheal intubation during hospitalization, which was defined by prespecified criteria. There were 15 prespecified secondary outcomes, including endotracheal intubation. The trial was terminated by the data and safety monitoring board and the trial steering committee after an interim analysis of the first 300 patients. Among the 300 patients who completed the trial (mean age, 73 years [SD, 10 years]; 68% were men), all were included in the analysis. The primary outcome of meeting prespecified criteria for the need for endotracheal intubation occurred in 7 of 147 patients (4.8%) in the high-intensity NPPV group vs 21 of 153 (13.7%) in the low-intensity NPPV group (absolute difference, -9.0% [95% CI, -15.4% to -2.5%], 1-sided P = .004). However, rates of endotracheal intubation did not significantly differ between groups (3.4% [5/147] in the high-intensity NPPV group vs 3.9% [6/153] in the low-intensity NPPV group; absolute difference, -0.5% [95% CI, -4.8% to 3.7%], P = .81). Abdominal distension occurred more frequently in the high-intensity NPPV group (37.4% [55/147]) compared with the low-intensity NPPV group (25.5% [39/153]). Patients with COPD and persistent hypercapnia in the high-intensity NPPV group (vs patients in the low-intensity NPPV group) were significantly less likely to meet criteria for the need for endotracheal intubation; however, patients in the low-intensity NPPV group were allowed to crossover to high-intensity NPPV, and the between-group rate of endotracheal intubation was not significantly different. ClinicalTrials.gov Identifier: NCT02985918.

Low-Intensity Heparin Infusion Compared With High-Intensity Heparin Infusion Dosing in Patients With Mechanical Mitral Valves: A Retrospective Cohort Study.

Patients with a mechanical mitral valve have an increased risk of thrombosis, and guidelines recommend a higher international normalized ratio goal for vitamin K antagonists-based anticoagulation. Guidelines provide recommendations for bridging with unfractionated heparin; however, there is no clear guidance on the heparin infusion intensity that should be used. This study was a retrospective, single-center, cohort study of patients aged ≥18 years or older with a mechanical mitral valve admitted from June 2019 to September 2022 who were maintained on a singular heparin infusion intensity nomogram for at least 48 hours. The patients were stratified into either a low- or a high-intensity heparin infusion nomogram. The exclusion criteria included non-nomogram heparin infusions and patients within 30 days of valve implantation. The primary outcome of this study was a composite of all bleeding events (major, clinically significant nonmajor, and minor bleeding). The secondary outcomes included bleeding events, analyzed individually, and thrombotic events. Seven total bleeding events were observed between the 2 groups, with 1 minor bleeding event in the low-intensity group and 6 bleeding events in the high-intensity group. One thrombotic event occurred in the high-intensity group. No statistically significant differences were found between the primary and secondary outcomes. Future studies are necessary to guide heparin infusion intensity selection in patients with mechanical mitral valves.

Acute Aerobic Exercise Intensity on Working Memory and Vigilance After Nap Deprivation: Effects of Low-Intensity Deserve Attention.

Napping deprivation in habitual nappers leads to cognitive impairment. The ameliorative effect of acute aerobic exercise has been demonstrated for this post-cognitive impairment. However, it is still unclear which intensity of aerobic exercise is the most effective and how long this improvement can be sustained. Fifty-eight healthy adults with a chronic napping habit were randomly assigned to four intervention groups after undergoing nap deprivation: a sedentary control group, a low-intensity exercise group (50-59% maximum heart rate, HRmax), a moderate-intensity exercise group (60-69% HRmax), and a high-intensity exercise group (70-79% HRmax). Working memory (N-back task), vigilance (Psychomotor Vigilance Task, PVT), and response inhibitory capacity (Go/NoGo task) were measured. Regression analyses showed a quadratic trend between exercise intensity and working memory reaction time and accuracy (F =3.297-5.769, p < 0.05, R2 =10.7-18.9%). The effects of exercise were optimal at low-intensity. There was a significant quadratic trend between exercise intensity and PVT lapse (F =4.314, p =0.042, R² =7.2%). The effect of exercise increased with higher intensity. Prolonged observation found that the effect of low-intensity exercise on working memory was maintained for 2 hours. The effect of low-intensity exercise might be underestimated. Low-intensity exercise significantly improved working memory performance, and the effects could be maintained throughout the afternoon. In contrast, the effects of high-intensity exercise were unlikely to be maintained and might even have negative effects. Future researchers can broaden the categories of participants to enhance the external validity and collect diverse physiological indicators to explore related physiological mechanisms.

Benefits of inspiratory muscle training therapy in institutionalized adult people with cerebral palsy: A double-blind randomized controlled trial.

Respiratory health problems are one of the main causes of morbidity and mortality in adult people with cerebral palsy (CP). The influence of respiratory muscle training has not yet been studied in this population group. The objective of the study was to evaluate and compare the efficacy of two protocols with inspiratory muscle training (IMT), low intensity and high intensity, to improve respiratory strength and pulmonary function in adults with CP. The study was a controlled, randomized, double-blind trial with allocation concealment. Twenty-seven institutionalized CP patients were recruited and randomly distributed in the high-intensity training group (HIT) or low-intensity training group (LIT). Over 8 weeks, an IMT protocol was followed 5 days/week, 10 series of 1min with 1min rest between them. HIT trained with a load of 40% of the maximum inspiratory pressure (MIP) and LIT with 20%. Respiratory strength and pulmonary function were evaluated. After IMT intervention, MIP, maximum expiratory pressure, forced expiratory volume in 1s (FEV1) and peak expiratory flow increased in both groups; in HIT 29%, 19%, 13%, and 8%, respectively (p=0.000, p=0.000, p=0.002, p=0.001) and in LIT 17%, 7%, 3%, and 4%, respectively (p=0.000, p=0.000, p=0.049, p=0.113). All the improvements were significantly higher in HIT than in LIT. Inspiratory muscle training improved respiratory muscle strength and pulmonary function in adults with CP. Training with a 40% MIP load improved all the evaluated parameters and was the most effective treatment for adults with CP.

Gene Expression of Neurogenesis Related to Exercise Intensity in a Cerebral Infarction Rat Model.

Regular exercise improves several functions, including cognition, in patients with stroke. However, the effect of regular exercise on neurogenesis related to cognition remains doubtful. We investigated the most effective exercise intensity for functional recovery after stroke using RNA sequencing following regular treadmill exercise. Photothrombotic cerebral infarction was conducted for 10-week-old male Sprague-Dawley rats (n = 36). A Morris water maze (MWM) test was performed before a regular treadmill exercise program (5 days/week, 4 weeks). Rats were randomly divided into four groups: group A (no exercise); group B (low intensity, maximal velocity 18 m/min); group C (moderate intensity, maximal velocity 24 m/min) and group D (high intensity, maximal velocity 30 m/min). After 4 weeks, another MWM test was performed, and all rats were sacrificed. RNA sequencing was performed with ipsilesional hippocampal tissue. On the day after cerebral infarction, no differences in escape latency and velocity were observed among the groups. At 4 weeks after cerebral infarction, the escape latencies in groups B, C, and D were shorter than in group A. The escape latencies in groups B and C were shorter than in group D. The velocity in groups A, B, and C was faster than in group D. Thirty gene symbols related to neurogenesis were detected (p < 0.05, fold change > 1.0, average normalized read count > four times). In the neurotrophin-signaling pathway, the CHK gene was upregulated, and the NF-κB gene was downregulated in the low-intensity group. The CHK and NF-κB genes were both downregulated in the moderate-intensity group. The Raf and IRAK genes were downregulated in the high-intensity group. Western blot analysis showed that NF-κB expression was lowest in the moderate-intensity group, whereas CHK and Raf were elevated, and IRAK was decreased in the high-intensity group. Moderate-intensity exercise may contribute to neuroplasticity. Variation in the expression of neurotrophins in neurogenesis according to exercise intensity may reveal the mechanism of neuroplasticity. Thus, NF-κB is the key neurotrophin for neurogenesis related to exercise intensity.

Exploring the Association Between Physical Fitness (High Intensity and Low Intensity) and the Incidence of Temporomandibular Disorders: A Comparative Study.

Temporomandibular joint disorders affect the temporomandibular joint (TMJ), masticatory muscles, and associated structures. Symptoms include TMJ pain, limited jaw movement, muscle tenderness, and referred pain. Physical activity can alleviate musculoskeletal pain. This study explored the link between physical fitness (high and low intensity) and temporomandibular disorder (TMD) incidence. Sixty patients were divided into three groups in this comparative study. Group I underwent 30 minutes of high-intensity aerobic training. Group II had 30 minutes of low-intensity yoga sessions weekly. Group III received health education. TMD was diagnosed using the Fonseca Anamnestic Index (FAI). Pain intensity was measured using the Visual Analogue Scale (VAS) and the Pain Self-Efficacy Questionnaire (PSEQ). Of the participants, 38.1% were males and 61.9% were females. TMD severity was mild (25.0%), moderate (55.0%), and severe (20.0%). High-intensity training groups had higher TMD symptom severity than low-intensity groups (p = 0.001). VAS scores increased in group I and decreased in group II (significant). PSEQ scores decreased in group I and increased significantly in group II. Group III showed no significant differences in PSEQ scores. High-intensity training resulted in moderate TMD symptoms. Low-intensity training was beneficial for TMD pain. The study recommends combining low-intensity physical workouts with medications to alleviate TMD.

Impacts of three inspiratory muscle training programs on inspiratory muscles strength and endurance among intubated and mechanically ventilated patients with difficult weaning: a multicentre randomised controlled trial

BackgroundInspiratory muscle training (IMT) is well-established as a safe option for combating inspiratory muscles weakness in the intensive care setting. It could improve inspiratory muscle strength and decrease weaning duration but a lack of knowledge on the optimal training regimen raise to inconsistent results. We made the hypothesis that an innovative mixed intensity program for both endurance and strength improvement could be more effective. We conducted a multicentre randomised controlled parallel trial comparing the impacts of three IMT protocols (low, high, and mixed intensity) on inspiratory muscle strength and endurance among difficult-to-wean patients.MethodsNinety-two patients were randomly assigned to three groups with different training programs, where each performed an IMT program twice daily, 7 days per week, from inclusion until successful extubation or 30 days. The primary outcome was maximal inspiratory pressure (MIP) increase. Secondary outcomes included peak pressure (Ppk) increase as an endurance marker, mechanical ventilation (MV) duration, ICU length of stay, weaning success defined by a 2-day ventilator-free after extubation, reintubation rate and safety.ResultsMIP increases were 10.8 ± 11.9 cmH2O, 4.5 ± 14.8 cmH2O, and 6.7 ± 14.5 cmH2O for the mixed intensity (MI), low intensity (LI), and high intensity (HI) groups, respectively. There was a non-statistically difference between the MI and LI groups (mean adjusted difference: 6.59, 97.5% CI [− 14.36; 1.18], p = 0.056); there was no difference between the MI and HI groups (mean adjusted difference: − 3.52, 97.5% CI [− 11.57; 4.53], p = 0.321). No significant differences in Ppk increase were observed among the three groups. Weaning success rate observed in MI, HI and LI group were 83.7% [95% CI 69.3; 93.2], 82.6% [95% CI 61.2; 95.0] and 73.9% [95% CI 51.6; 89.8], respectively. MV duration, ICU length of stay and reintubation rate had similar values. Over 629 IMT sessions, six adverse events including four spontaneously reversible bradycardia in LI group were possibly related to the study.ConclusionsAmong difficult-to-wean patients receiving invasive MV, no statistically difference was observed in strength and endurance progression across three different IMT programs. IMT appears to be feasible in usual cares, but some serious adverse events such as bradycardia could motivate further research on the specific impact on cardiac system.Trial registration Clinicaltrials.gov identifier: NCT02855619. Registered 28 September 2014

Acute aerobic exercise and creative thinking: comparison of transient hypofrontality state and strength model of self-controls’ theoretical predictions

Creativity is a high-level cognitive activity that can" be affected by acute aerobic exercise. This paper aims to determine how acute aerobic exercise intensities may influence aspects of divergent and convergent creative thinking. In this regard, to give an insight into the results, the predictions of the transient hypofrontality thesis and the strength model of self-control have been taken into consideration. Ninety-three healthy male college students (age = 21.18 ±1.73 years) were randomly assigned to anaerobic threshold intensity (%85 HRmax, n = 31), low intensity (%60 HRmax, n = 31), and control (n = 31) groups Participants performed divergent (Alternate Uses Task) and convergent (Raven's Advanced Progressive Matrices Test) creative thinking tasks before, during, and after cessation of two anaerobic thresholds and low intensities and control conditions. For the divergent creative thinking, flexibility and fluency performances during and after cessation of exercise in anaerobic threshold and low-intensity groups were improved in comparison to the control group.These results were consistent with the transient hypofrontality thesis and inconsistent with the strength model of self-control pre-dictions. In contrast, the performance of convergent creative thinking was relatively stable during and after cessation of exercise in anaerobic threshold and low-intensity groups which was inconsistent with both the transient hypofrontality thesis and the strength model of self-control predictions. The findings suggest that theoretical predictions of transient hypofrontality thesis are more adaptable with literature than the strength model of self-control to consider the exercise-creative processes relationship and further study of the issue would be of interest. Key words: Cognition, Convergent, Creativity, Divergent, Self-depletion, Physical Activity

Different levels of continuous training improve echocardiographic parameters, quality of life, and functional capacity in heart failure with reduced ejection fraction patients

Abstract Background Various comorbidities and physiological alterations contribute to the complexity of heart failure conditions, influencing the optimal approach to exercise-based rehabilitation. Purpose This study sought to investigate and compare the effects of continuous training at three distinct intensities, specifically examining left ventricular (LV) remodeling, functional capacity, and quality of life in patients with heart failure with reduced ejection fraction (HFrEF). Methods In a randomized control trial, 60 male patients (mean age: 54.33 ± 2.35 years) diagnosed with HFrEF were randomly assigned to three groups: 1) High-Intensity Continuous Training group (HICT), 2) Moderate-Intensity Continuous Training group (MICT), and 3) Low-Intensity Continuous Training group (LICT). All participants underwent training on a bicycle ergometer three times per week for 12 weeks. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, N-terminal pro–B-type natriuretic peptide (NT-proBNP)), quality of life (assessed through the Minnesota Living with Heart Failure Questionnaire), and functional capacity (measured by the 6-minute walking test) were evaluated before and after the study. Results The HICT group exhibited the most significant improvements in all assessed variables compared to the other two groups (P &amp;lt; 0.05). These findings were consistently observed across all measured outcomes. Conclusion It was deduced that High-Intensity Continuous Training (HICT) emerged as the most advantageous approach in enhancing echocardiographic measures, NT-proBNP levels, quality of life, and functional capacity among patients with heart failure and reduced ejection fraction (HFrEF).

Surveillance for Distant Metastasis in Breast Cancer Patients Who Underwent Contemporary Management: A Report from the Korean Breast Cancer Society Survivor Research Group

BackgroundCurrent guidelines recommend against the use of routine imaging tests to detect distant metastasis in asymptomatic breast cancer patients. However, recent advancements in effective therapeutics and diagnostic accuracy have raised the need to reassess the clinical efficacy of intensive metastasis surveillance. We report the results of a multicenter retrospective study to investigate the association between intensive imaging studies and survival outcomes.Patients and MethodsWe retrospectively reviewed the data of 4130 patients who underwent surgery from 11 hospitals in Korea between January 2010 and December 2011. Patients were divided into two groups on the basis of the intensity of metastasis imaging studies during their disease-free period. The types and intervals of the imaging studies were based on each physician’s decisions.ResultsHigh-intensive screening showed a shorter distant metastasis-free survival [p < 0.001, hazard ratio (HR) 1.62; 95% confidence interval (CI) 1.29–2.04], especially for patients in whom bone or lung was the first site of metastasis. With a median follow-up period of 110.0 months, the 5-year breast cancer-specific survival (BCSS) rate was 96.5%. The high-intensity screening group showed significantly poorer BCSS compared with the low-intensity screening group (p < 0.001, HR 3.13; 95% CI 2.32–4.21). However, both multivariable analysis and propensity score matching analysis showed no significant association between the screening intensity and BCSS.ConclusionsFrequent imaging studies to detect distant metastasis were associated with earlier detection of distant metastasis, especially for lung and bone metastasis. However, intensive surveillance showed no apparent association with BCSS despite the use of currently available treatments.

Effect of 10-Week Whole-Body Vibration Training on Falls and Physical Performance in Older Adults: A Blinded, Randomized, Controlled Clinical Trial with 1-Year Follow-Up.

Whole-body vibration training (WBV) training has shown positive effects on bone strength, muscle strength, and balance, but the evidence on fall prevention is not yet persuasive. This study aimed to evaluate the effectiveness of WBV training in preventing falls and improving physical performance among older adults at fall risk. The study was an assessor- and participant-blinded, randomized, and controlled 10-week training trial with a 10-month follow-up. One hundred and thirty older adults (mean age 78.5 years, 75% women) were randomly allocated into the WBV group (n = 68) and the low-intensity wellness group (n = 62). Falls were prospectively collected using monthly returned and verified diaries. Physical performance was evaluated at baseline before randomization, after the intervention, and follow-up with established methods. The data were analyzed on an intention-to-treat basis. Negative binomial regression was used to estimate the incidence rate ratios for falls, and Cox regression models were used to calculate the hazard ratios for fallers. Between-group differences in physical performance were estimated by generalized linear mixed models. The retention rate was 93%, and the mean adherence to the WBV training was 88% and 86% to the wellness training. Sixty-eight participants fell at least once, and there were 156 falls in total. In the WBV group, the incidence rate of falls was 1.5 (95% confidence interval 0.9 to 2.5) compared to the wellness group (p = 0.11). The hazard ratio for fallers in the WBV group was 1.29 (0.78 to 2.15) (p = 0.32). There was no between-group difference in physical performance after the training period, but by the end of the follow-up, WBV-related benefits appeared. The chair-rising capacity was maintained in the WBV group, while the benefit disappeared in the wellness group (p = 0.004). Also, the 0.5-point difference in short physical performance battery (SPPB) score favored WBV training (p = 0.009). In conclusion, progressive side-alternating WBV training was feasible and well-tolerated among fall-prone older adults. During the one-year follow-up, WBV training was associated with improved physical performance but did not prevent falls compared to chair-based group exercises.

Adults in Low and Medium Intensity Group Pain Management Programs Achieve Similar Clinically Significant Outcomes: A Quasi-Experimental Study

Adults in Low and Medium Intensity Group Pain Management Programs Achieve Similar Clinically Significant Outcomes: A Quasi-Experimental Study

ANTI-SMOKING MESSAGES VERSUS PRO-SMOKING MESSAGES AMONG INDONESIAN ADOLESCENT SMOKERS

Background: Anti-smoking messages (ASM) is a program designed to educate the public about the dangers of tobacco use, aiming to prevent adolescents and young people from smoking cigarettes in any form and to assist smokers in giving up their smoking habit. On the contrary, pro-smoking messages (PSM) is a marketing technique to promote tobacco products. Aims: This study was conducted to describe the exposure to ASM and PSM among Indonesian adolescent smokers (IAS). Methods: This study analyzed secondary data from the 2019 Global Youth Tobacco Survey (GYTS) Indonesia. The outcome variable was the respondent's smoking intensity in the last 30 days. The independent variables were the exposure to ASM and PSM in the various below-the-line media. Results: Most IAS were male (93.4%), mostly in secondary school (60.3%) and spent more than IDR 11,000 per week (71.1%). Adolescent smokers were exposed to ASM at a rate of 92.4%. Furthermore, ASM exposure happened to 60.5% of the low-intensity youth smoker group and 39.5% of the high-intensity youth smoker group. Meanwhile, 93% of adolescent smokers were exposed to PSM, with 40.8% in the high-intensity youth smoker group and 59.2% in the low-intensity youth smoker group. Conclusion: The exposure to ASM and PSM in the adolescent smoker group was relatively the same. Keywords: ASM, PSM, prevention, public health, tobacco control, youth

Effects of different intensity aerobic exercise on intestinal flora and gastrointestinal hormones in type 2 diabetic rats

To examine the impact and mechanisms of the aerobics exercise on gut flora and gastrointestinal hormones in type 2 diabetes rats. Methods Adult male SD rats aged 8 weeks were divided into 5 groups at random (n= 10): a peaceful comparison group (N), a diabetic comparison group (D), a diabetic low-intensity exercise group (LD), a diabetic middle-intensity exercise group (MD), and a diabetes highintensity exercise group. (HD). The rat groups LD, MD, and HD performed aerobic exercise five times per week for a total of 6 weeks and compared general condition, blood glucose, blood lipids, insulin, leptin, gastrin (GAS) and motilin ( MOT), gastrointestinal motility, and intestinal flora. Results The levels of insulin, leptin, total cholesterol, triglycerides, E. coli, LDL-cholesterol, LDL-cholesterol, insulin, and gastric residual rate were significantly different from group N. Conclusion: Type 2 diabetic rats have gut flora imbalance and gastrointestinal hormone changes. Aerobic exercise with different intensity can alleviate gastrointestinal hormone imbalance and intestinal flora imbalance in type 2 diabetes rats, and the impact of moderate intensity exercise is the strongest.

Assessment of Surgical Complications Strengthen the Relationship Between Spine Surgery Procedure Intensity and Chronic Opioid Use After Surgery.

Prospective cohort using routinely collected health data. To compare opioid use based on surgery intensity (low or high). Many factors influence an individual's experience of pain. The extent to which postsurgical opioid use is influenced by the severity of spine surgery is unknown. The participants were individuals undergoing spine surgery in a large military hospital. Procedures were categorized as low intensity (eg, microdiscectomy and laminectomy) and high intensity (eg, fusion and arthroplasty). The Surgical Scheduling System and Military Health System Data Repository were queried for healthcare utilization the 1 year before and after surgery. We compared opioid use after surgery between groups, adjusting for prior opioid use and surgical complications. A total of 342 individuals met the inclusion criteria, with mean age 45.4 years (SD 10.9), and 33.0% were women. Of these, 221 (64.6%) underwent a low-intensity procedure and 121 (35.4%) underwent a high-intensity procedure. Mean postoperative opioid prescription fills were greater in the high- versus low-intensity group (9.0 vs. 5.7; P <0.001), as were the mean total days' supply (158.9 vs. 81.8; P <0.001). Median morphine milligram equivalents (MMEs) were not significantly different (40.2 vs. 42.7; P =0.287). Of the cohort, 26.3% were chronic opioid users after surgery. Adjusted rates of long-term opioid use were not different between groups when only accounting for prior opioid use but significantly higher for the high-intensity group when adjusting for surgical complications (OR=2.08; 95% CI 1.09-3.97). Of the entire cohort, 52.5% was still filling opioid prescriptions after 6 months. Higher-intensity procedures were associated with greater postoperative opioid use than lower-intensity procedures. Chronic opioid use was not significantly different between surgical intensity groups when considering only prior opioid use. Chronic opioid use was significantly higher among higher intensity procedures when accounting for surgical complications. The presence of surgical complications is a stronger predictor of postsurgical long-term opioid use in high-intensity surgeries than history of opioid use alone. Level III.