Exercise Research Articles

Active longevity and aging: dissecting the impacts of physical and sedentary behaviors on longevity and age acceleration.

To examine the associations of physical activity (PA) and sedentary behavior (SB) with longevity and age acceleration (AA) using observational and Mendelian randomization (MR) studies, and quantify the mediating effects of lipids. In Guangzhou Biobank Cohort Study (GBCS), PA and SB were assessed by the Chinese Version of the International Physical Activity Questionnaire. Longevity was defined as participants whose age at follow-up or at death was at or above the 90th age percentile. AA was defined as the residual resulting from a linear model that regressed phenotypic age against chronological age. Linear regression and Poisson regression with robust error variance were used to assess the associations of total and specific PA in different intensities, and SB with AA and longevity, yielding βs or relative risks (RRs) and 95% confidence intervals (CIs). Two-sample MR was conducted to examine the causal effects. Mediation analysis was used to assess the mediating effects of lipids. Of 20,924 participants aged 50 + years in GBCS, during an average follow-up of 15.0years, compared with low PA, moderate and high PA were associated with higher likelihood of longevity (RR (95% CI): 1.56 (1.16, 2.11), 1.66 (1.24, 2.21), respectively), and also cross-sectionally associated with lower AA (β (95% CI): -1.43 (-2.41, -0.45), -2.09 (-3.06, -1.11) years, respectively). Higher levels of moderate PA (MPA) were associated with higher likelihood of longevity and lower AA, whereas vigorous PA (VPA) showed opposite effects. The association of PA with longevity observed in GBCS was mediated by low-density lipoprotein cholesterol (LDL-C) by 8.23% (95% CI: 3.58-39.61%), while the association with AA was mediated through LDL-C, triglycerides and total cholesterol by 5.13% (3.94-7.30%), 7.81% (5.98-11.17%), and 3.37% (2.59-4.80%), respectively. Additionally, in two-sample MR, SB was positively associated with AA (β (95% CI): 1.02 (0.67, 1.36) years). PA showed protective effects on longevity and AA, with the effects being partly mediated through lipids. Conversely, SB had a detrimental impact on AA. MPA was associated with higher likelihood of longevity and reduced AA, whereas VPA showed adverse effects. Our findings reinforce the recommendation of "sit less and move more" to promote healthy longevity, and highlight the potential risks associated with VPA in the elderly.

Physical Activity and Neurocognitive Symptoms in Older Adults During COVID-19 Pandemic.

Objectives: Examine whether physical activity (PA) changes during the COVID-19 pandemic were related to subjective cognitive decline (SCD), depression, and anxiety in older adults and whether these varied by sociodemographic variables. Methods: 301 older adults completed an online survey between May and October 2020 and 3 months later, including self-report questionnaires of SCD, depression, and anxiety. PA changes were determined with a question. Results: 60% of participants reported decreased PA. Those who reduced their PA were more likely to be from low to middle income and younger. PA increase was related to less SCD and depressive symptoms compared to those who decreased it. Participants who maintained their PA had fewer SCD concerns, depressive, and anxiety symptoms than those who decreased it. Discussion: Reducing PA was associated with worse neuropsychiatric and cognitive symptoms. Encouraging older adults to increase PA may help mitigate some of the pandemic's adverse effects on psychological well-being.

Supporting movement and physical activity in people with psychosis: A qualitative exploration of the carer perspective.

The need to increase exercise and decrease sedentary behaviour in people diagnosed with psychosis is well-recognised. We set out to explore caregivers' perspectives on what supports and prevents physical activity, and how to use carers' support most effectively. Fourteen caregivers of people diagnosed with psychosis were interviewed. Data were analysed using reflexive thematic analysis, in collaboration with caregivers. Four themes were developed, the first flagging the importance of physical activity, then the others calling for action: (a) Physical inactivity matters: carers are keen to support efforts to increase physical activity in their family or friends because of the enormous impact physical inactivity has on patients, and consequently on carers themselves, such as social isolation and reduction in their own activity. (b) Tell us: without being well-informed about how to help, carers can feel like they are powerless to stop a 'slow suicide' or 'decline' in patients. (c) Listen to us: through knowing their family and friends well, carers are able to identify important changes in patients and identify successful motivators for them, but these insights can feel uninvited. (d) Ask us: being invited to support activity as a partner in a patients' care is desirable but having offers of help rejected can "demotivate the motivator." Caregivers described strong motivation to help patients to be more physically active but can feel that their support is overlooked and under-used by services. Clinical recommendations for carer involvement in physical activity interventions are offered.

An 18-month multimodal intervention trial for preventing dementia: J-MINT PRIME Tamba.

The number of people with dementia is increasing in Japan, and establishing evidence for preventing dementia is necessary. This study was a randomized controlled trial in cognitively normal community-dwelling older adults aged 65 to 85 with diabetes and/or hypertension. Participants were randomly assigned in a 1:1 ratio. The intervention group underwent 90min of group-based weekly physical exercise, cognitive training, nutritional counseling, and vascular risk management for 18 months. The primary endpoint was the change in a cognitive composite score calculated by averaging the z-scores of seven neuropsychological tests from baseline to 18 months. We randomly assigned 203 participants to two groups, and 178 (87.7%) completed the 18-month follow-up. There was a significant group difference in the cognitive composite score change at 18 months (mean difference 0.16, 95% confidence interval: 0.04 to 0.27; p=0.009). An 18-month multimodal intervention for older adults at risk of dementia could improve their cognitive function. The trial was registered in the Clinical Trial Registration System (UMIN000041938). Japan-Multimodal Intervention Trial for Prevention of Dementia (J-MINT) PRIME Tamba was a randomized controlled trial to prevent dementia. We provided a multifactorial intervention based on the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial methodology. The primary outcome, the cognitive composite score, improved with our intervention. Executive function/processing speed and memory improved in the intervention group. Intervention adherence was high, and no serious adverse events occurred.

Low food security is associated with frailty status and frailty components among people with HIV.

Low food security is common among people with HIV (PWH) and is associated with poorer health outcomes. Frailty, an aging-related outcome that is increasingly prevalent among PWH, may be stimulated by low food security. We assessed associations between food security and frailty among PWH. The Impact of Physical Activity Routines and Dietary Intake on the Longitudinal Symptom Experience of People Living with HIV (PROSPER-HIV) study follows PWH to evaluate how diet and physical activity impact symptoms. We utilized food security and frailty data from PROSPER-HIV Year 1 visits (January 2019 to July 2022) to estimate associations. Food security was measured via the validated two-item Food Security Questionnaire and categorized as Food Secure, Low Food Security, or Very Low Food Security. Frailty was measured with the Fried frailty phenotype, and categorized as robust, prefrail, and frail. We used relative risk regression to estimate associations between food security and frailty status, adjusted for demographic characteristics. Among 574 PWH, nearly one-quarter were women (22%), mean age was 52 years old, 8% were frail, and 46% prefrail. Low food security was reported among nearly one-third of PWH: 13% Low Food Security and 18% Very Low Food Security. Compared with being Food Secure, we found Low Food Security was associated with frailty [prevalence ratio: 4.06 (95% confidence interval (CI) 2.16-7.62] and Very Low Food Security was associated with both prefrailty [1.48 (1.23-1.78)] and frailty [5.61 (3.14-10.0)], as compared with robust status. Low food security was associated with increased frailty among PWH in this study, suggesting a potential intervention point to promote healthy aging.

Digital motor intervention effects on physical activity performance of individuals with developmental disabilities: a systematic review.

Post-pandemic, use of digital technologies (e.g., mobile app, Zoom, virtual reality, and videogaming) to promote physical activity (PA) in populations with intellectual and developmental disabilities (IDD) has increased. The efficacy of various digital technologies in promoting PA in individuals with IDD varies. We conducted a systematic review to examine current literature findings on the efficacy of digital PA interventions on PA outcomes in individuals with IDD. Articles published between 1900 and 2024 that examined effects of technology-based PA interventions on PA levels/fitness of individuals with IDD using experimental or quasi-experimental study designs were included. Sixteen articles were retrieved from four health databases PubMed (914), PsycInfo (1201), SCOPUS (1910), and CINAHL (948). Findings based on 604 participants (Autism: 383; Down Syndrome: 106; Developmental Disability: 83, Developmental Coordination Disorder: 37) provide the most support for exergaming/digital PA intervention benefits for populations with ID, Down Syndrome, and Autism; however, there was limited support for its use in those without ID (e.g., DCD). Digital technology is an effective tool to promote improvements in PA/fitness, motor, cardiovascular performance in individuals with ID. Future studies need to build on this evidence to support the use of PA outcomes in individuals with different IDD diagnoses.

Commuter exposure to ultrafine particulate matter (UFP), lung deposited surface area (LDSA), and noise in Ho Chi Minh City, Vietnam

IntroductionTransport is a main contributor to air and noise pollution, particularly in urban areas with the high number of motorized vehicles. Promoting active transport (i.e., cycling and walking) and public transport is an instrumental factor in reducing traffic-related air and noise pollution. However, commuters of these transport modes are often exposed to high air and noise pollution than other commuter groups. MethodsThe levels of exposure to UFP, LDSA, and noise during commuting of different transport modes in Ho Chi Minh City (HCMC) were measured and compared. Then, the dose of inhaled pollutants during commuting was calculated for each commuter group by considering the travel time and minute ventilation. ResultsThe level of exposure to air and noise pollution varies across transport modes. Cyclists and motorcyclists were exposed to the highest level of air and noise pollution. Motorcyclists and cyclists were exposed to the highest UFP number concentrations during their trips, 3.6*105 and 3.1*105 particles/cm3, respectively. Car commuters were exposed to the lowest air and noise pollution level, followed by bus commuters. When considering the minute ventilation and travel time, cyclists inhaled significantly higher levels of air pollution than other commuters, followed by pedestrians, motorcyclists, bus commuters, and car users. As a result, the health impacts of exposure to traffic-related air and noise pollution for active commuters could be greater than other commuter groups. ConclusionsPromoting active and public transport is a promising approach to improving air quality and reducing congestion in HCMC. Using these transport modes also has potential positive health effects on commuters through physical activities. However, active commuters are faced with the highest risk of exposure to high air and noise pollution levels. To promote active transport and public transport in HCMC, measures to reduce the level of exposure to air and noise pollution for these commuter groups are needed.

Exploring decision-making practices during coaching sessions in grassroots youth soccer: a mixed-methods study.

Decision-making ability in players during match-play is mostly acquired through practice activities with the same underlying structure as competition. However, researchers have not fully investigated how coaches design practice sessions at the participation level of the sport (i.e. 'grassroots'), or why they use a particular activity at a specific time point. This study explores the practice activities employed by youth soccer coaches at the participation level in England and aims to understand their underlying intentions. Twelve male coaches working with players aged 9-11 years across ten clubs in the London region participated. Thirty-five practice sessions were filmed and analysed to assess the proportion of time spent in activities involving 'non-active decision-making' (e.g., technical practices, fitness training) versus 'active decision-making' (e.g., small-sided and conditioned games, skills practice with realistic opposition). A brief on-field interview with the coaches about the session purpose took place immediately after each systematic observation. Coaches allocated similar amounts of time to activities with active (M = 41%) and non-active (M = 42%) decision making, with the remaining 17% being transitions. There was a common progression from non-active decision-making activities early in the session towards increased active decision-making later in the session. Interviews with coaches revealed a belief in the necessity of frequent non-active decision-making practices for technique development, despite potential disparities with improving match performance. Findings highlight a potential gap between scientific understanding and coaching practices for young soccer players at the participation level, suggesting implications for coach education programmes and the optimisation of player development strategies.

The Discrepancy Between External and Internal Load/Intensity during Blood Flow Restriction Exercise: Understanding Blood Flow Restriction Pressure as Modulating Factor.

Physical exercise induces acute psychophysiological responses leading to chronic adaptations when the exercise stimulus is applied repeatedly, at sufficient time periods, and with appropriate magnitude. To maximize long-term training adaptations, it is crucial to control and manipulate the external load and the resulting psychophysiological strain. Therefore, scientists have developed a theoretical framework that distinguishes between the physical work performed during exercise (i.e., external load/intensity) and indicators of the body's psychophysiological response (i.e., internal load/intensity). However, the application of blood flow restriction (BFR) during exercise with low external loads/intensities (e.g., ≤ 30% of the one-repetition-maximum, ≤ 50% of maximum oxygen uptake) can induce physiological and perceptual responses, which are commonly associated with high external loads/intensities. This current opinion aimed to emphasize the mismatch between external and internal load/intensity when BFR is applied during exercise. In this regard, there is evidence that BFR can be used to manipulate both external load/intensity (by reducing total work when exercise is performed to exhaustion) and internal load/intensity (by leading to higher physiological and perceptual responses compared to exercise performed with the same external load/intensity without BFR). Furthermore, it is proposed to consider BFR as an additional exercise determinant, given that the amount of BFR pressure can determine not only the internal but also external load/intensity. Finally, terminological recommendations for the use of the proposed terms in the scientific context and for practitioners are given, which should be considered when designing, reporting, discussing, and presenting BFR studies, exercise, and/or training programs.

An exploration into self-reported inactivity behaviours of adults with an intellectual disability using physical activity questionnaires.

Inactivity is a correlate of adverse health. Adults with an intellectual disability (ID) are more inactive than the general population and often present with more complex health issues. Self-reported activity questionnaires such as the International Physical Activity Questionnaire - Short Form (IPAQ-SF) and Rapid Assessment of Physical Activity (RAPA) questionnaire are the predominant source of activity information because of their low cost, non-invasive nature, ease of administration and interpretation of results. Correlates of inactivity among the general and ID populations were identified through a literature scoping review. Inactivity was measured using the RAPA and the IPAQ-SF. A multiple-imputation chained equation was used to impute missing data. Using Pearson chi-squared analyses, relationships between these correlates as well as covariates of age, sex, level of ID, body mass index (BMI) and aetiology, and RAPA and IPAQ-SF categories were explored. Logistic regression provided more detailed analyses. Results were summarised using the Systems of Sedentary Behaviour framework. Spearman correlations examined the IPAQ-SF and RAPA relationships. Three correlates for inactivity emerged from the IPAQ-SF and RAPA questionnaire. Up after 07:00h was a correlate for both. Difficulty walking 100yards and epilepsy were additional correlates of inactivity. Weak but significant correlations were seen between IPAQ-SF and RAPA scores. High inactivity levels are present in adults with an ID. The IPAQ-SF and RAPA questionnaires are weakly correlated.

Accelerometer-Based Physical Activity and Health-Related Quality of Life in Korean Adults: Observational Study Using the Korea National Health and Nutrition Examination Survey.

Health-related quality of life (HRQoL) reflects an individual's perception of their physical and mental health over time. Despite numerous studies linking physical activity to improved HRQoL, most rely on self-reported data, limiting the accuracy and generalizability of findings. This study leverages objective accelerometer data to explore the association between physical activity and HRQoL in Korean adults. The objective of this study is to analyze the relationship between objectively measured physical activity using accelerometers and HRQoL among Korean adults, aiming to inform targeted interventions for enhancing HRQoL through physical activity. This observational study included 1298 participants aged 19-64 years from the Korea National Health and Nutrition Examination Survey (KNHANES) VI, who wore an accelerometer for 7 consecutive days. HRQoL was assessed using the EQ-5D questionnaire, and physical activity was quantified as moderate-to-vigorous physical activity accelerometer-total (MVPA-AT) and accelerometer-bout (MVPA-AB). Data were analyzed using logistic regression to determine the odds ratio (ORs) for low HRQoL, adjusting for socioeconomic variables and mental health factors. Participants with higher HRQoL were younger, more likely to be male, single, highly educated, employed in white-collar jobs, and had higher household incomes. They also reported less stress and better subjective health status. The high HRQoL group had significantly more participants meeting MVPA-AB ≥600 metabolic equivalents (P<.01). Logistic regression showed that participants meeting MVPA-AB ≥600 metabolic equivalents had higher odds of high HRQoL (OR 1.55, 95% CI 1.11-2.17). Adjusted models showed consistent results, although the association weakened when adjusting for mental health factors (OR 1.45, 95% CI 1.01-2.09). The study demonstrates a significant association between HRQoL and moderate to vigorous physical activity sustained for at least 10 minutes, as measured by accelerometer. These findings support promoting physical activity, particularly sustained moderate to vigorous activity, to enhance HRQoL. Further interventional studies focusing on specific physical activity domains such as occupational, leisure-time, and commuting activities are warranted.

Trauma clinicians’ views of physical exercise as part of PTSD and complex PTSD treatment: A qualitative study

Physical exercise has the potential to be a helpful, adjunctive intervention for supporting people with post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). However, little is known about the views of clinicians on including physical exercise in treatment. We aimed to explore trauma clinicians’ perspectives on the role of physical exercise in PTSD and CPTSD treatment and to understand key barriers and facilitators in recommending physical exercise as an adjunctive treatment. Twelve specialist trauma clinicians from across the UK were interviewed to explore their views on the role of physical exercise and the key barriers and facilitators in recommending it as an adjunctive treatment for PTSD and CPTSD. We used a qualitative explorative methodology with semi-structured interviews and analysed transcripts using reflexive thematic analysis. Trauma clinicians viewed physical exercise as a potentially beneficial supportive intervention for PTSD and CPTSD, and perceived several ways in which physical exercise could be included in the treatment process, with an individualised approach to care underpinning inclusion. However, there were also notable barriers to including exercise at environmental, client and clinician/service levels, including; limited access to exercise resources, client-related factors such as agoraphobia and physical health problems, clinician-related factors such as lack of confidence and training, and service-level factors such as gaps in service provision. The findings highlight the importance of considering individualised approaches to physical exercise interventions in trauma treatment. Addressing identified barriers, such as improving access to resources and providing training for clinicians, is crucial for successful integration of physical exercise into PTSD and CPTSD treatment protocols. This study underscores the need for further research to inform future policies and provide guidance for trauma clinicians on how to effectively incorporate physical exercise as an adjunctive treatment.

Combined associations of obesity and physical activity with pain, fatigue, stiffness, and anxiety in adults with spondyloarthropathies: UK Biobank study

Abstract Objective Inflammatory spondyloarthropathies (ISpAs) are associated with pain, fatigue, stiffness, and anxiety. The National Institute for Care and Excellence (NICE) and the European Alliance of Associations for Rheumatology (EULAR) provide limited lifestyle guidance for managing symptoms with ISpAs. We investigated the combined associations of obesity and physical activity with symptom severity in ISpAs. Methods The relationship between BMI, physical activity, and symptom severity (spinal and general pain, fatigue, anxiety, mobility) was examined in people with ISpAs (n = 1,577). BMI categories were normal weight (18·5-24·9 kg/m2), overweight (25·0-29·9 kg/m2), and obese (≥30 kg/m2). Physical activity was assessed via the International Physical Activity Questionnaire (low&amp;lt;600 metabolic equivalent of task (MET)-min/week, moderate≥600METs, high≥3000METs). Statistical models adjusted for confounders, including medication, estimated the likelihood (odds ratios; OR) of higher symptom severity across BMI and physical activity categories. Results Overweight and obesity, compared to normal weight, were linked to higher severity of all symptoms, with stronger associations for obesity (OR ≥ 2·34, P &amp;lt; 0·001) than overweight (OR ≥ 1.37, P ≤ 0·032). Moderate activity, compared to low, was associated with lower severity of all symptoms (OR ≤ 0·77, P ≤ 0·032). High activity, compared to low, was associated with lower severity of fatigue, anxiety, and mobility issues (OR ≤ 0·74, P ≤ 0·029), but associations with spinal and general pain were not significant (OR ≤ 0·80, P ≥ 0·056). No BMI-by-physical activity combinations were detected, indicating physical activity benefits all BMI groups to a similar extent. Conclusion NICE and EULAR guidance for ISpAs should emphasise maintaining a normal weight. Moderate physical activity is optimal for reducing symptom severity and should be promoted in lifestyle guidance.

Developing community-based physical activity interventions and recreational programming for children in rural and smaller urban centres: a qualitative exploration of service provider and parent experiences.

Children's physical inactivity is a persisting international public health concern. While there is a large body of literature examining physical activity interventions for children, the unique physical activity context of low-density communities in rural areas and smaller urban centres remains largely underexplored. With an influx of families migrating to rural communities and small towns, evaluations of health promotion efforts that support physical activity are needed to ensure they are meeting the needs of the growing populations in these settings. The aim of this community-based research was to explore service providers' and parents' perspectives on physical activity opportunities available in their community and recommendations toward the development and implementation of efficacious physical activity programming for children in rural communities and smaller urban centres. Three in-person community forums with recreation service providers (n = 37 participants) and 1 online community forum with the parents of school-aged children (n = 9 participants) were hosted. An online survey and Mentimeter activity were conducted prior to the community forums to gather participants' views on the barriers and facilitators to physical activities and suggestions for activity-promoting programs. The service provider and parent discussions were audio-recorded, transcribed verbatim, and analyzed following a deductive approach guided by Hseih and Shannon's (2005) procedure for direct content analysis. A code list developed from the responses to the pre-forum survey and Mentimeter activity was used to guide the analysis and category development. Seven distinct categories related to the existing physical activity opportunities and recommendations for programs in rural communities and smaller urban centres were identified during the analysis: (1) Recovery from Pandemic-Related Measures, (2) Knowledge and Access to Programs, (3) Availability, (4) Personnel Support, (5) Quality of Programs and Facilities, (6) Expenses and Subsidies, and (7) Inclusivity and Preferences. To improve the health and well-being of children who reside in low-density areas, the results of this study highlight service provider and parent recommendations when developing and implementing community-based physical activity programs and interventions in rural and smaller urban settings, including skill development programs, non-competitive activity options, maximizing existing spaces for activities, and financial support.

Supporting Students’ Physical Activity Self-Efficacy within High School Physical Education

Research examining physical activity (PA) is significant because of the known benefits of PA. Studying high school (HS) students is particularly important due to the consistent decline in PA as students age. One strategy to increase PA is to increase someone’s self-efficacy (confidence) to be physically active which is commonly positively associated with PA. Most of the research on how to support physical activity self-efficacy (PASE) comes from outside-of-school interventions with minimal literature on how to support students’ PASE within HS physical education (PE). This study attempted to identify and share practices that current HS PE teachers were implementing to support students’ PASE and further develop previous recommendations to support PASE. The study participants were 14 current HS PE teachers that participated in one individual semi-structured interview that lasted approximately 50-60 minutes. Interview questions were designed to ask participants about their daily in-person class routines and how they support PASE based on the four sources of self-efficacy. The results include three themes to assist in supporting HS students’ PASE which include: (a) Maximizing initial success, (b) Redefining success, and (c) Increasing PA awareness and monitoring. All themes and examples coincide with previous recommendations on how best to support PASE. PE teachers have the opportunity to design PA experiences that maximize the chances of students interpreting their experiences as successful and allow students to manage their PA participation. Implementing these types of strategies can hopefully increase students’ overall participation in PA by supporting their PASE.

The effects of the ‘active before school’ programme on the academic skills of 8–9-year-old children: a physically and cognitively engaging intervention

IntroductionLiterature underscores the significance of exercise and cognitive stimulation for achieving academic success. This study aims to investigate the effects of the technology-based “Active Before the First School Bell” programme, comparing the effects of two school-based interventions (physical activity vs. cognitive engagement) on the academic skills of 8–9-year-old children.MethodsThis encompasses their school skills, visual-motor coordination, levels and attitudes towards physical activity, and fitness. The study involved 88 primary school children (age: 8.3 years, 58.0% girls). To assess the programme’s distinct effects children were categorised into three groups. The first group (n = 31) participated in cognitive classes (CEG), the second (n = 27), in physical activity classes (PAEG), and the third (n = 30), was a control one (CG). A 12-week intervention, consisting of three 15-min sessions per week before school, was implemented. Self-report questionnaires gauged levels of physical activity. Academic skills were assessed using a battery of diagnostic methods for school failure in early childhood education. Fitness was measured using selected items from the Eurofit test battery. Pre- and post-test measures were collected and analysed, employing one-way ANOVA on ranks with Dunn’s post-hoc tests.ResultsSignificant post-test differences between the groups were observed in visual spatial function, with the PAEG outperforming the CG, and in auditory and language functions, where both experimental groups outperformed the CG. Results suggest that before school physical activities may be more effective than cognitive activities in improving the academic skills.ConclusionThe short-term effects obtained provide insights for implementing before-school programmes for children in the early school years.

Multilevel Longitudinal Functional Principal Component Model.

Sensor devices, such as accelerometers, are widely used for measuring physical activity (PA). These devices provide outputs at fine granularity (e.g., 10-100Hz or minute-level), which while providing rich data on activity patterns, also pose computational challenges with multilevel densely sampled data, resulting in PA records that are measured continuously across multiple days and visits. On the other hand, a scalar health outcome (e.g., BMI) is usually observed only at the individual or visit level. This leads to a discrepancy in numbers of nested levels between the predictors (PA) and outcomes, raising analytic challenges. To address this issue, we proposed a multilevel longitudinal functional principal component analysis (mLFPCA) model to directly model multilevel functional PA inputs in a longitudinal study, and then implemented a longitudinal functional principal component regression (FPCR) to explore the association between PA and obesity-related health outcomes. Additionally, we conducted a comprehensive simulation study to examine the impact of imbalanced multilevel data on both mLFPCA and FPCR performance and offer guidelines for selecting optimal methods.

Impact of Physical Activity on DNA Methylation Signatures in Breast Cancer Patients: A Systematic Review with Bioinformatic Analysis

Breast cancer (BC) continues to significantly impact women worldwide. Numerous studies show that physical activity (PA) significantly enhances the quality of life, aids recovery, and improves survival rates in BC patients. PA’s influence extends to altering DNA methylation patterns on both a global and gene-specific scale, potentially reverting abnormal DNA methylation, associated with carcinogenesis and various pathologies. This review consolidates the findings of the current literature, highlighting PA’s impact on DNA methylation in BC patients. Our systematic analysis indicates that PA may elevate global DNA methylation within tumour tissues. Furthermore, it appears to modify gene-specific promoter methylation across a wide spectrum of genes in various tissues. Through bioinformatic analysis, to investigate the functional enrichment of these affected genes, we identified a predominant enrichment in metabolic pathways, cell cycle regulation, cell cycle checkpoints, mitosis, cellular stress responses, and molecular functions governing diverse binding processes. The Human Protein Atlas corroborates this enrichment, indicating gene functionality across 266 tissues, notably within various breast tissues. This systematic review unveils PA’s capacity to systematically alter DNA methylation patterns across multiple tissues, particularly in BC patients. Emphasising its influence on crucial biological processes and functions, this alteration holds potential for restoring normal cellular functionality and the cell cycle. This reversal of cancer-associated patterns could potentially enhance recovery and improve survival outcomes.

Combined knee osteoarthritis and diabetes is associated with reduced muscle strength, physical inactivity, and poorer quality of life.

This study delves into the intriguing connection between knee osteoarthritis and diabetes in Malaysia. Specifically, the exacerbation of knee osteoarthritis in the presence of diabetes in terms of symptoms, physical performance, physical activity, psychological status, social participation, and quality of life was discussed. This cross-sectional study recruited adults aged 50 and above by convenient sampling and grouped them into: knee osteoarthritis-diabetes-, knee osteoarthritis+diabetes-, knee osteoarthritis-diabetes+, and knee osteoarthritis+diabetes+. Of 436 recruited participants, 261 (59.8%) participants reported knee osteoarthritis. Handgrip strength, Timed Up and Go test, 6 Meter Walk Test, and 5 Times Sit to Stand Test were measured using standardized procedures. Six questionnaires were administered for the remaining parameters. Across groups, there were significant differences: 6 Meter Walk Test (p = 0.024), Timed Up and Go test (p = 0.020), and 5 Times Sit to Stand Test (p < 0.001), quality of life (p = 0.009), and physical activity (p = 0.036). Knee osteoarthritis+diabetes+ was independently associated with reduced handgrip strength, 5 Times Sit to Stand Test, quality of life, and physical inactivity after adjustment. Knee osteoarthritis+diabetes- was independently associated with reduced Timed Up and Go test and social isolation. The findings revealed the diabetic knee osteoarthritis subgroup's unique physical and psychosocial features of reduced muscle strength and physical inactivity. Future studies should investigate whether managing metabolic factors, and enhancing physical activity and strength exercises, can reduce knee osteoarthritis symptoms and disease severity.

The Translation, Cross-Cultural Adaptation and Validation of the Italian Version of the Hip and Groin Outcome Score Questionnaire for a Young and Active Population

The HAGOS (Hip and Groin Outcome Score) questionnaire is a valid and reliable measure of the self-assessment of symptoms, activity limitation, participation restriction, and quality of life (Qol) of subjects with hip and/or groin pain. The aims of this study are to translate and transculturally adapt the HAGOS into Italian (HAGOS-I) and to assess its internal consistency, validity, and reliability in physically active, young, and middle-aged subjects. The translation and transcultural adaptation of (HAGOS-I) was carried out according to international guidelines. Eight-one subjects (mean age 28.19) were included in this study. All the participants completed the HAGOS-I, the Lower Extremity Functional Scale (LEFS-I), the Oxford Hip Score (OHS-I), and the Short Form 36 Health Surveys (SF-36-I). The Cronbach’s α for the six HAGOS subscales ranged from 0.63 to 0.87. Statistically significant correlations were obtained between the six HAGOS-I subscales and the LEFS-I (rs = 0.44–0.68; p &lt; 0.01). Only one HAGOS-I subscale (Participation in Physical Activities) did not reach statistical significance with the OHS-I, while the remaining five had a moderate correlation (rs = 0.40–0.60; p &lt; 0.01). The test–retest reliability (Intraclass Correlation Coefficient) ranged from 0.57 to 0.86 for the six HAGOS-I subscales. The HAGOS-I is a valid and reliable instrument that can be used in clinical settings with young and middle-aged subjects with hip and/or groin pathologies.