Multicomponent Program Research Articles

Evaluating a multicomponent survivorship programme for men with prostate cancer in Australia: a single cohort study

ObjectiveTo evaluate the implementation of a multicomponent survivorship programme for men with prostate cancer and their carers.DesignA single cohort study, guided by the RE-AIM framework.SettingMultiple health services in Australia.ParticipantsMen with...

Impact of a Summer Nutrition and Physical Activity Intervention to Attenuate Obesity in Urban African-American Youth

Improved eating behaviors and daily participation in physical activity such as swimming might abate the likelihood of African American youth becoming obese. Yet many African American youth neither consume the recommended daily servings of nutritious foods nor know how to swim. The purpose of this study was to investigate the impact of a culturally tailored multicomponent summer intervention to reduce obesity and unintentional drownings among underserved African American youth. Children (n = 145) participated in a three-hour, community-based intervention for four weeks. Measures of children’s attitudes perceived behavioral control, and subjective norms toward swimming, nutrition, and physical fitness were taken at baseline and 4 weeks later (n = 47). The only post-intervention significant finding indicated an improvement in children’s skillfulness in floating on their back without help. The limited changes in this multi-component program suggested that such interventions need to be longer in duration, intensity, and be required to reduce attrition.

A 16-week multicomponent exercise training program improves menopause-related symptoms in middle-aged women. The FLAMENCO project randomized control trial.

To investigate the influence of a supervised multicomponent exercise training program on menopause-related symptoms, particularly vasomotor symptoms (VMS), in middle-aged women. A total of 112 middle-aged women (mean age 52 ± 4 y old, age range 45-60 y) from the FLAMENCO project (exercise [n = 59] and counseling [n = 53] groups) participated in this randomized controlled trial (perprotocol basis). The exercise group followed a multicomponent exercise program composed of 60-minute sessions 3 days per week for 16 weeks. The 15-item Cervantes Menopause and Health Subscale was used to assess the frequency of menopause-related symptoms. After adjusting for body mass index and Mediterranean diet adherence, the subscales measuring menopause-related symptoms and VMSs decreased 4.6 more in the exercise group compared to the counseling group (between-group differences [B]: 95% CI: -8.8 to -0.2; P = 0.040). The exercise group also showed significant improvements in the subscales of couple relationships (between-group differences [B]: -1.87: 95% CI: -3.29 to - 0.45; P = 0.010), psychological state (between-group differences [B]: -2.3: 95% CI: -5 to -0.2; P = 0.035), and VMSs (between-group differences [B]: -4.5: 95% CI: -8.8 to -0.2; p = 0.040) in the Cervantes Menopause and Health Subscale compared with the counseling group. A 16-week multicomponent physical exercise program showed a positive effect on menopause- related symptoms especially in couple relationships, psychological state, and VMS, among 45 to 60 year old women.

The Effect of the Inner Engineering Online Program as a Positive Intervention on Subjective Well-Being and Positive Work Outcomes.

Objective: This study evaluates the effect of Inner Engineering Online (IEO) on subjective well-being and positive work outcomes. Design: The study uses a field quasi-experimental one group design with pre- and post-tests. Interventions: IEO is a multicomponent online self-paced program. The program consists of seven online sessions to be completed over a 4-week period. Results: The study finds that IEO has a positive effect on subjective well-being (mindfulness, joy, vitality, restfulness, and oneness) and positive work outcomes (meaningful work, psychological capital, and work engagement). Conclusion: The findings on IEO have important practical implications for improving subjective well-being and work experiences.

Hybrid-type, multicomponent interval training upregulates musculoskeletal fitness of adults with overweight and obesity in a volume-dependent manner: A 1-year dose-response randomised controlled trial

ABSTRACT This study examined the dose-response effects of a 1-year hybrid-type, multicomponent interval training programme (DoIT) on various musculoskeletal fitness parameters in inactive overweight and obese adults in a gym setting. Ninety-seven middle-aged (44.8 ± 5.2 years) individuals with overweight/obesity (31.2 ± 5.7 kg/m2) (66% female) were randomly assigned to the following groups: (i) no-intervention control (CON, n = 29), (ii) DoIT performed once weekly (DoIT-1, n = 24), (iii) DoIT performed twice weekly (DoIT-2, n = 23) and (iv) DoIT performed thrice weekly (DoIT-3, n = 21). DoIT was a time-efficient, intermittent-based, multicomponent exercise protocol using progressive loaded fundamental movement patterns with prescribed work-to-rest intervals (1:3–2:1) in a circuit format (2–3 rounds). Muscular strength, muscular endurance, flexibility, passive range of motion (PRoM), static balance and functional movement screen (FMS®) were assessed at baseline, 6 and 12 months following intervention. At post-training, all exercise groups exhibited superior changes than CON in (i) muscular strength (+13%–38%, p < 0.001); (ii) muscular endurance (+42%–159%, p < 0.001); (iii) flexibility (+12%–42%, p < 0.001); (iv) PRoM (+6%–50%, p = 0.001–0.026); (v) static balance (+61%–163%, p < 0.001); and (vi) FMS (+18%–39%, p < 0.001). Although a single exercise session/week improved musculoskeletal fitness, changes demonstrated a step-wise improvement with two and three sessions/week suggesting a dose-dependent response. The response rate to training was 100% for all exercise groups. These findings suggest that a multicomponent exercise approach incorporating bodyweight drills and resistance-based alternative modes performed under real-world conditions may improve several musculoskeletal fitness indicators in a dose-dependent manner in inactive, middle-aged adults with overweight/obesity. Trial registration: ClinicalTrials.gov identifier: NCT03759951.

Feasibility and preliminary efficacy of a school-based health and well-being program for adolescent girls

BackgroundThe primary aim of this pilot study was to evaluate the feasibility and preliminary efficacy of a school-based health and well-being program (Health and Well-being for Girls: HWBG) on adolescent girls’ well-being, mindfulness, screen-time, and physical activity.MethodThe HWBG program was evaluated using a group randomized controlled trial (RCT) in one secondary school. A convenience sample of female students in Grade 8 (mean age 14 ± 0.5 years) was recruited for the study (n=4 classes; 89 girls). The 20-week multi-component HWBG program, guided by Self-Determination Theory and Acceptance and Commitment Therapy, was designed and delivered by a member of the research team. Randomization occurred prior to baseline assessments at the class level (n=4 classes) into dose-matched treatment conditions (i.e., two classes received the HWBG intervention and two classes received an alternate elective course as a wait-list control group). Process evaluation measures of recruitment, retention, adherence, and satisfaction were used to determine program feasibility. This study was designed to assess feasibility (primary outcome) and preliminary efficacy (secondary outcomes), rather than effectiveness. Preliminary efficacy of HWBG for improving mental and social health, screen-time, and physical activity were measured and analyzed using linear mixed-models.Results“The health and well-being program” targeting adolescent girls was found to be feasible for implementation as an elective course in a secondary school setting. Participants in the HWBG program reported high levels of satisfaction, the majority of lessons (45 out of 50), were implemented as planned and adherence to the planned HWBG program content was very high. Medium positive effects on mental health (d=0.45) and social health (d=0.50) were observed. Small effects were observed for physical activity, and no significant intervention effects were found for levels of recreational screen time. Participant ratings showed high levels of perceived benefit and enjoyment as indicated in the evaluation data (mean rating of 4.44 out of a possible 5.0) when asked whether the program was enjoyable.ConclusionThe study provides preliminary support for HWBG as a potentially feasible and enjoyable program suitable for use with adolescent girls in the secondary school setting. Potential of the study for facilitating improvements in pro-social and psychological well-being is also supported.Trial registrationACTRN12617000157370. The trial was registered with the Australian New Zealand Clinical Trials Registry.

Promoting Physical Activity and Weight Loss With mHealth Interventions Among Workers: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BackgroundPhysical activity (PA) is a vital factor in promoting health in the workforce. Mobile health (mHealth) interventions have recently emerged in workplace health promotion as an effective strategy for inducing changes in health behaviors among workers; however, the effectiveness of mHealth interventions in promoting PA and weight loss for workers is unclear.ObjectiveThis study aims to provide a comprehensive analysis of current evidence on the effectiveness of mHealth interventions in promoting PA and weight loss among workers.MethodsWe searched relevant databases, including PubMed, Embase, CINAHL Complete, and the Cochrane Library, for publications on mHealth interventions in the English or Korean language from inception to December 2020. Randomized controlled trials that evaluated the effectiveness of mHealth in improving PA and weight loss were retrieved. A meta-analysis with a random effects model and subgroup analyses was performed on PA types and mHealth intervention characteristics.ResultsA total of 8 studies were included in this analysis. More than half of the studies (5/8, 63%) were identified as having a high risk of bias. The mHealth intervention group showed a significant improvement in PA (standardized mean difference [SMD] 0.22, 95% CI 0.03-0.41; P<.001; I2=78%). No significant difference in weight loss was observed when comparing the intervention group with the control groups (SMD 0.02, 95% CI –0.07 to 0.10; P=.48; I2=0%). A subgroup analysis was also performed; walking activity (SMD 0.70, 95% CI 0.21-1.19; P<.001; I2=83.3%), a multicomponent program (SMD 0.19, 95% CI 0.05-0.33; P=.03; I2=57.4%), objective measurement (SMD 0.58, 95% CI 0.05-1.10; P<.001; I2=87.3%), and 2 or more delivery modes (SMD 0.44, 95% CI 0.01-0.87; P<.001; I2=85.1%) were significantly associated with an enhancement in PA.ConclusionsThis study suggests that mHealth interventions are effective for improving PA among workers. Future studies that assess long-term efficacy with a larger population are recommended.

Effect of an Exercise Intervention on Functional Decline in Very Old Patients During Acute Hospitalizations

This randomized clinical trial examines the effectiveness and generalizability of implementing a multicomponent exercise program for treating functional decline associated with acute hospitalization in very old patients.

Riesgo de caídas en personas mayores: comparación de resultados pre y postaplicación de un programa de ejercicios multicomponentes basado en subsistemas de la estabilidad postural

Background and objectiveMulticomponent Exercise Programs have shown adequate effectiveness in older people. However, they do not always show direct benefits on balance and risk of falls. This implies the need to apply these exercise programs with a strong a strong postural stability training component. The objective was to compare the risk of falls before and after the application of an Multicomponent Exercise Program based on specific components of postural stability. Material and methodsThrough a quasi-experimental research, 72 people aged 60 years and over participated, who were evaluated based on the following clinical tests: Five Times Sit to Stand (FTST); Unipedal Stance Test (UST); Timed Up and Go (TUG); Self-Selected Walking Speed (SSWS) and Falls Efficacy Scale (FES). Subsequently, an intervention of 12 45-minute sessions was carried out three times per week, which consisted of a Multicomponent Exercise Program with 6 specific stations of physical conditioning and stability exercises. A month later the volunteers were evaluated again. ResultsSignificant improvements were observed in the FTST tests (P<.0001); Right EUP (P=.006), Left EUP (P=.010) and TUG (P<.0001). There were no significant changes in the SSWS tests (P=.938), and FES (.767) ConclusionsThe multicomponent training plan based on postural stability subsystems could be associated with the best significant performance in the EUP, TUG and FTST tests, and with it to a possible reduction of the risk of falls.

Effects of a Clinical Exercise Program on Health-Related Fitness and Quality of Life in Spanish Cancer Patients Receiving Adjuvant Therapy.

To report the feasibility and effectiveness of a newly developed clinical exercise program for improving maximal cardiorespiratory fitness in Spanish cancer patients receiving adjuvant chemotherapy or radiation. We also examined the effectiveness of the exercise program for improving maximal muscular strength, body composition, fatigue, and quality of life, and explored if the effectiveness varied based on selected patient characteristics. The study was a single group implementation feasibility study using a pre-posttest design. Participants performed a 12-week, twice-weekly, supervised, multi-component exercise program during adjuvant therapy. Paired t-tests were used to assess pre-post changes, and analyses of covariance were used to compare effectiveness based on selected patient characteristics. We had 100 cancer patients referred to the clinical exercise program of which 85 (85%) initiated the exercise program and 76 (89%) completed the post-intervention fitness assessment. Exercise significantly improved VO2max by 4.8 mL/kg/minutes (P < .001, d = 0.74). Exercise also significantly improved chest strength (P < .001, d = 0.82), leg strength (P < .001, d = 1.27), lean body mass (P < .001, d = 0.11), skeletal muscle mass (P < .001; d = 0.09), fat mass (P < .001; d = 0.10), % body fat (P < .001; d = 0.17), quality of life (P = .0017; d = 0.41), and fatigue (P = .007; d = 0.46). Treatment modality, cancer type, and age affected some exercise responses, especially related to body composition changes. A 12-week, supervised, multi-component exercise program was effective for improving health-related fitness and quality of life in Spanish cancer patients receiving adjuvant therapy. Our results show the benefits of incorporating clinical exercise programming into the supportive care of cancer patients receiving treatments. The study protocol is registered at ClinicalTrials.gov (NCT05078216).

Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia.

Background:About 4 out of 10 fibromyalgia patients suffer from depression. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend using antidepressants to treat fibromyalgia.Objective:To determine predictors of improved outcomes following a multicomponent treatment program.Design:We designed this longitudinal treatment outcome study to evaluate the prevalence of depression symptoms in patients diagnosed with fibromyalgia at a tertiary care facility, and the impact of depression on functional outcomes after completing a multicomponent fibromyalgia treatment program.Setting:Tertiary care center.Patients:This study included 411 adult patients with fibromyalgia who completed a multicomponent treatment program for fibromyalgia. Expert physicians performed comprehensive evaluations following American College of Rheumatology (ACR) criteria to confirm fibromyalgia before referral to the program.Intervention:An intensive outpatient multicomponent treatment program consisting of 16 hours of cognitive behavioral strategies served as the intervention.Measurements:Functional status was assessed using the Fibromyalgia Impact Questionnaire Revised (FIQR). Depression was evaluated with the Center for Epidemiologic Study of Depression (CES-D) measure. Measures were administered prior to participation in the program and approximately 5 months following completion of the program.Results:The cohort had a high prevalence of depressive symptoms (73.2% had depression at admission). Higher depression scores at baseline predicted poorer outcomes following multi-component treatment. Effectively treated depression resulted in improved functioning at follow-up.Limitations:Findings limited to tertiary care center cohort of fibromyalgia patients. Patients did not undergo a structured clinical diagnostic interview to diagnose depression.Conclusions:The current data links depression to poorer outcomes in patients with fibromyalgia. Depression is an important modifiable factor in the management of fibromyalgia. Guidelines should reflect the importance of assessing and effectively treating depression at the time of diagnosis of fibromyalgia, to improve functional outcomes.Registration:Specific registry and specific study registration number—Institutional Review Board—(IRB# 19-000495).Funding Source:No funding.

Analysis of postural control and muscle function performance of older adults participating in a multicomponent exercise program in primary health care

Objectives: This cross-sectional study aimed to investigate (1) postural control performance in different postural tasks and (2) muscle strength and power of the hip, knee, and ankle of active vs inactive older adults. Methods: The sample consisted of 61 healthy community-dwelling older adults, classified into 2 groups: active, consisting of participants of a multicomponent exercise program offered through the Exercise Orientation Service; and inactive. Participants were considered physically active/inactive in the past 3 months. Postural control was assessed using a force plate in 8 postural tasks. Muscle function was evaluated using an isokinetic dynamometer. T-tests were used to compare clinical characteristics between the groups. ANCOVA and MANCOVA were used to compare differences in variables of postural control and muscle function. Results: Active participants had higher levels of physical activity, clinical balance, and quality of life than inactive participants. The active group had lower values for area (center of pressure) than the inactive group under the following conditions: bipedal stance on an unstable surface with eyes open and with eyes closed, and semi-tandem stance on an unstable surface with eyes open. The active group showed greater muscle power, with higher mean power values for hip abduction and adduction, knee extension, and knee flexion and shorter time to peak torque for hip adduction and ankle dorsiflexion than the inactive group. Conclusions: Multicomponent exercise programs delivered in primary health care settings contributed to improving postural control and muscle power in this sample of older adults, which can potentially help prevent falls and improve quality of life.

Effectiveness of multicomponent lifestyle intervention programs on adiposity indicators in schoolchildren from vulnerable groups: a review article.

Vulnerable groups are those who, due to their age, sex, race/ethnicity, health status, income level, etc., are at higher risk of poor health. Vulnerable school populations are distinguished by having predisposing factors to overweight and obesity, which results in a greater risk of suffering from the disease and its ravages. Additionally, the effects of the COVID-19 contingency can worsen the situation. Previous reviews of prevention, treatment and control of the disease have focused on schoolchildren from high- and middle-income countries. The objective of this review was to gather the evidence from the studies that evaluate the effectiveness of multicomponent lifestyle intervention programs (MLIP) on adiposity indicators in vulnerable populations. Five electronic databases were searched: PubMed, MEDLINE, Cochrane Library, EMBASE, and Google Scholar. The eligibility criteria were schoolchildren (5 to 12 years old), inhabitants of rural area, with low socioeconomic level and/or belonging to an indigenous community. Randomized and quasi-experimental controlled trials were included. Interventions that included two or more of the following components were considered: physical activity, nutrition, psychology, school meals and/or family/community involvement. Of the 11 interventions included 73 % had significant improvements in at least one variable related to adiposity. The most successful interventions had components of nutrition, physical activity and family/community involvement, the majority (80 %) had a duration of ≥ 6 months and were provided, in 80 % of the cases, by previously trained teachers. In conclusion, there is evidence that MLIPs are effective in improving indicators of adiposity in vulnerable schoolchildren.

Factor affecting the activities of daily living among aging people during the COVID-19 pandemic - a structural equation modelling.

IntroductionThe activities of daily living (ADLs) are a set of basic skills necessary for self-care. The inability of elderly people to perform ADLs leads to dependence, insecure conditions, and poor quality of life. The COVID-19 pandemic has affected all aspects of the daily life of the elderly. This study aimed to determine the factors associated with ADLs among elderly people during the COVID-19 pandemic using structural equation modelling/path analysis.Material and methodsIt was a descriptive-analytical study which had conducted on 487 elderly people who were selected randomly to participate in the study. Data collection tools included a demographic information questionnaire, an activities of daily living questionnaire, a knee pain and personal performance questionnaire Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and the falls efficacy scale, which were completed by interview and self-report methods. SPSS-22 and AMOS software were used for data analysis.ResultsTwo structures of the fear of falling (FOF) and knee pain and personal performance questionnaire WOMAC had a significant role in explaining the ADL variance among the studied elderly people (p < 0.001, root mean square error of approximation = 0.063). These variables explained 64% of the ADL variance.ConclusionsThe structures of this model (FOF and WOMAC) can be used as a reference framework to design effective interventions for improving ADLs among elderly people during the COVID-19 epidemic. It is also recommended that a multi-component program be provided, which includes exercise and psychological strategies for this population during the COVID-19 pandemic through online videos, distance health programs, etc.

Cost-effectiveness of dementia training for caregivers in caregiver-patient dyads: A randomized controlled study.

IntroductionWe evaluated the cost‐effectiveness of the “More at Home with Dementia” intervention, a multicomponent training program for co‐residing caregivers of people with dementia (PwDs).MethodsWe performed a two‐armed randomized controlled trial with an intervention and a control group. Participants were community‐dwelling caregivers living with a person with dementia (59 randomized to intervention and 50 to control arm). The training program lasted 5 days and took place in a holiday accommodation. Quality‐adjusted life‐years (QALYs) were calculated using the EuroQol‐5 Dimensions 3 Levels (EQ‐5D‐3L) for caregivers and PwDs. Costs for informal and formal social care, as well as health care, were collected at four times over a 6‐month period from baseline. Information on nursing home admission or death was collected for 2 years after baseline.ResultsQALYs for caregivers and PwDs added together were 0.12 higher in the intervention group compared with the control group (P = .11). After 1 year, there tended to be fewer nursing home admissions in the intervention group, but this difference was lost by 2 years (P = .19). The cost of the intervention was estimated at €1000 (USD 1090) per dyad. Compared with the control group, the intervention group used other health care and formal social care significantly less for a year after baseline (P = .02 and .001, respectively). The estimated decrease in total costs was €10,437 (P = .07), with an estimated 96% probability that the intervention was cost‐effective vs usual care.DiscussionThe multicomponent “More at Home with Dementia” training program is effective and appears to save costs compared with usual care. Savings appear to be achieved by delaying nursing home admissions and by reducing the use of other care resources. Further research is also needed to clarify if this intervention is effective for caregivers who do not live with a PwD, such as adult children, and for the caregivers of patients with other debilitating chronic diseases. At the same time, effort is advised to implement caregiver training in standard care programs.

Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents' Functional Capacity.

We aimed to determine whether the benefits of long (24weeks) and short (4weeks) training programs persisted after short (6weeks) and long (14weeks) periods of inactivity in older adult nursing home residents with sarcopenia. Multicenter randomized trial. The Vivifrail tailored, multicomponent exercise program (http://vivifrail.com) was conducted to individually prescribe exercise for frail older adults, depending on their functional capacity. The training included 4 levels combining strength and power, balance, flexibility, and cardiovascular endurance exercises. Twenty-four institutionalized older adults (87.1 ± 7.1years, 58.3% women) diagnosed with sarcopenia were allocated into 2 groups: the Long Training-Short Detraining (LT-SD) group completed 24weeks of supervised Vivifrail training followed by 6weeks of detraining; the Short Training-Long Detraining (ST-LD) group completed 4weeks of training and 14weeks of detraining. Changes in functional capacity and strength were evaluated at baseline, and after short and long training and detraining periods. Benefits after short and long exercise interventions persisted when compared with baseline. Vivifrail training was highly effective in the short term (4weeks) in increasing functional and strength performance (effect size= 0.32-1.44, P < .044) with the exception of handgrip strength. Continued training during 24weeks produced 10% to 20% additional improvements (P < .036). Frailty status was reversed in 36% of participants, with 59% achieving high self-autonomy. Detraining resulted in a 10% to 25% loss of strength and functional capacity even after 24weeks of training (effects size= 0.24-0.92, P < .039). Intermittent strategies such as 4weeks of supervised exercise 3 times yearly with no more than 14weeks of inactivity between exercise periods appears as an efficient solution to the global challenge of maintaining functional capacity and can even reverse frailty in vulnerable institutionalized older adults.

Association between ACE and ACTN3 genetic polymorphisms and the effects of different physical training models on physically active women aged 50 to 75.

The aim of this study was to analyze the association between ACE (DD + ID versus II) and ACTN3 (TT + TC versus CC) polymorphisms in the response of multicomponent physical training programs and combined in the health parameters of physically active women aged 50 to 75 years. Participants were randomly divided into two groups: multi-component training and combined training. Intervention lasted 14 weeks, 180 minutes a week. Genomic DNA was extracted from blood samples and genotyping analyzes were performed by conventional and real-time PCR. Associations were observed between polymorphisms in anthropometric measurements, blood pressure, physical capacity and quality of life in both models physical training, with improvement in group II - (ACE- multicomponent training in terms of abdominal circumference and sit-to - Combined training in terms of waist circumference) and TT + TC group (ACTN3 - multicomponent training in tests of muscle strength and mental quality of life domain, and combined training in body mass index, waist circumference, diastolic blood pressure, upper limb strength and cardiorespiratory capacity). Fourteen weeks of multicomponent and combined physical training in physically active women aged 50 to 75 years resulted in greater health benefits for genotypes II (ACE) and TT + TC (ACTN3).

Effectiveness of a Workplace-Based, Multicomponent Hypertension Management Program in Real-World Practice: A Propensity-Matched Analysis.

Limited studies had investigated the potential benefits of workplace-based hypertension management programs on long-term blood pressure (BP) control and health outcomes. This study used the propensity score matching to examine the effectiveness of a workplace-based hypertension management program on BP control and risks of major adverse cardiovascular events and all-cause mortality. Within the Kailuan study, a workplace-based hypertension management program was initiated in 2009 among men with hypertension, which included regular BP measuring (twice a month), free antihypertensive medications, and individualized health consultation. Participants were followed until loss to follow-up, death, or December 31, 2019. Among 17 724 male hypertensives aged 18 to 60 years, 6400 participated in the program. The propensity score matching yielded 6120 participants in the management group and 6120 participants in the control group. Both systolic and diastolic BPs were significantly lower in the management group than in the control group over follow-up, and the mean between-group difference at the 10th year was -7.83 (95% CI, -9.06 to -6.62) mm Hg for systolic BP and -4.72 (95% CI, -5.46 to -3.97) mm Hg for diastolic BP. Participants in the program were more likely to achieve BP control (odds ratio, 1.70 [95% CI, 1.41-2.06]) and had significantly lower risks of major adverse cardiovascular events (hazard ratio, 0.83 [95% CI, 0.72-0.94]) and all-cause mortality (hazard ratio, 0.71 [95% CI, 0.58-0.86]), compared with those who were not in the program. A workplace-based hypertension management program was related to reduced BP levels and lower risks of major adverse cardiovascular events and mortality in Chinese men with hypertension.

Functional improvements to 6months of physical activity are not related to changes in size or density of multiple lower-extremity muscles in mobility-limited older individuals.

Older adults are encouraged to engage in multicomponent physical activity, which includes aerobic and muscle-strengthening activities. The current work is an extension of the Vitality, Independence, and Vigor in the Elderly 2 (VIVE2) study - a 6-month multicenter, randomized, placebo-controlled trial of physical activity and nutritional supplementation in community dwelling 70-year-old seniors. Here, we examined whether the magnitude of changes in muscle size and quality differed between major lower-extremity muscle groups and related these changes to functional outcomes. We also examined whether daily vitamin-D-enriched protein supplementation could augment the response to structured physical activity. Forty-nine men and women (77±5yrs) performed brisk walking, muscle-strengthening exercises for the lower limbs, and balance training 3 times weekly for 6months. Participants were randomized to daily intake of a nutritional supplement (20g whey protein+800IU vitamin D), or a placebo. Muscle cross-sectional area (CSA) and radiological attenuation (RA) were assessed in 8 different muscle groups using single-slice CT scans of the hip, thigh, and calf at baseline and after the intervention. Walking speed and performance in the Short Physical Performance Battery (SPPB) were also measured. For both CSA and RA, there were muscle group × time interactions (P<0.01). Significant increases in CSA were observed in 2 of the 8 muscles studied, namely the knee extensors (1.9%) and the hip adductors (2.8%). For RA, increases were observed in 4 of 8 muscle groups, namely the hip flexors (1.1HU), hip adductors (0.9HU), knee extensors (1.2HU), and ankle dorsiflexors (0.8HU). No additive effect of nutritional supplementation was observed. While walking speed (13%) and SPPB performance (38%) improved markedly, multivariate analysis showed that these changes were not associated with the changes in muscle CSA and RA after the intervention. We conclude that this type of multicomponent physical activity program results in significant improvements in physical function despite relatively small changes in muscle size and quality of some, but not all, of the measured lower extremity muscles involved in locomotion.

Anterior cruciate ligament injury prevention.

Anterior cruciate ligament injuries are a prominent issue in the field of sports medicine, especially for the female athlete. Extensive research has been performed that acknowledges the disparity in anterior cruciate ligament injury rates between male and female athletes and the high prevalence of risk factors specific to females. The underlying causes of anterior cruciate ligament injuries are widespread and are important to consider when approaching injury prevention. For example, prevention techniques aim to correct neuromuscular imbalances and improve biomechanical deficits, which are some of the most significant risk factors leading to these injuries. While there is a lack of opportunity for intervention related to anatomical and hormonal risks, awareness of their influence on injury mechanisms remains an important factor in clinical decision-making. In pursuit of addressing the risks of this injury, several prevention programs have been established that have been shown to successfully reduce anterior cruciate ligament injury rates when properly executed. The most effective programs include early intervention with continuous training and are multicomponent programs including various targeted exercises to modify associated risk factors. Unfortunately, despite the development of these readily available programs, anterior cruciate ligament injury rates remain high due to insufficient implementation of these methods. Recognizing the efficacy and feasibility of utilizing prevention strategies and continuing to develop effective techniques remain of utmost importance to reduce the incidence of this substantial injury among athletes.