The Effects of Core Stabilization Trunk Muscle Fatigue on Lower Limb Stiffness of Basketball Players.

Core stability is the ability to control the position and motion of the trunk over the pelvis and legs to allow the optimum production and transfer of force to the terminal segment in sporting activities. The effect of fatigue, especially core muscle fatigue, on stiffness as a performance index requires more study. This research aimed to investigate the effect of the core stabilization muscles' fatigue on lower limb stiffness during hopping. Thirty active basketball players participated in this study (age: 20.90 ± 1.49 years; weight: 60.30 ± 3.10 kg; height: 163.2 ± 5.04 cm). The hopping test (15 jumps) was performed before and after the fatigue protocol in three states including at a preferred (no frequency control), maximum, and 2.2 Hz frequency on the force plate. The stiffness of the lower extremities was measured before and after the fatigue protocol. The results of the dependent t-test showed core muscle fatigue led to reduced lower extremity stiffness under all three hopping-test conditions by 15.3-15.9% (p ≤ 0.005). It seems that core muscle function affects lower extremity stiffness, and can function as a performance index in athletes. Although performed in healthy volunteers, this study may have implications for injury prevention, highlighting the necessity to perform interspersed endurance training using the different body parts of the kinetic chain.

The effect of foot posture on static balance, ankle and knee proprioception in 18-to-25-year-old female student: a cross-sectional study.

BACKGROUND & PURPOSE: Afferent input from the sole affects postural stability. Cutaneous reflexes from the foot are important to posture and gait. Lower-limb afferents alone provide enough information to maintain upright stance and are critical in perceiving postural sway. Altered feedback from propreoceptive receptors alters gait and patterns of muscle activation. The position and posture of the foot and ankle may also play an important role in proprioceptive input.Therefore, the current research aims to compare static balance and ankle and knee proprioception in people with and without flexible flatfeet. METHODOLOGY: 91 female students between the ages of 18 and 25 voluntarily participated in this study, of which 24 were in the flexible flatfoot group and 67 were in the regular foot group after evaluating the longitudinal arch of the foot. The position sense of ankle and knee joints were measured using the active reconstruction test of the ankle and knee angle; Static balance was measured using the Sharpened Romberg test. Data were non-normally distributed. Accordingly, non-parametric tests were applied. The Kruskal-Wallis test was applied to compare differences between groups in variables. RESULT: Kruskal-Wallis test showed a significant difference between two groups of flat feet and normal feet in the variables of static balance and position sense of ankle plantarflexion, ankle dorsiflexion, and knee flexion (p ≤ 0.05). A significant correlation was found between static balance and sense of ankle and knee position in the group with normal feet. The analysis of the regression line also showed that ankle and knee position sense could predict the static balance score in the regular foot group (ankle dorsiflexion position sense 17% (R2 = 0.17), ankle plantarflexion position sense 17% (R2 = 0.17) and knee flexion position sense 46% (R2 = 0.46) explain of changes in static balance). DISCUSSION & CONCLUSION: Flexible flatfoot soles can cause loss of balance and sense of joint position; therefore, according to this preliminary study, clinicians must be aware and should take into account this possible deficit in the management of these patients.

Rosai Dorfman Disease in Mandible: A Rare Case Report.

Rosai Dorfman disease is generally defined as a massive bilateral painless cervical lymphadenopathy accompanied with both fever and leukocytosis with neutrophilia. Additionally, it may possibly be associated with polyclonal hypergammaglobulinemia, reversal of CD4/CD8 ratio, the elevated erythrocyte sedimentation rate (ESR), microcytic anemia, and thrombocytosis. Rosai-Dorfman disease is known as a benign self-limiting disease, so no treatment is required in many cases, although it causes death in some cases by involving vital organs like kidney. The treatment is required when there is a life-threatening situation such as airway obstruction or involvement of vital organs such as kidney, liver, and lower respiratory tract. The required treatment choices include steroid therapy, chemotherapy, radiotherapy, and surgery. Surgical treatment is performed for bulk removal to resolve the obstruction caused by the mass as well as taking biopsy for the definite histopathologic diagnosis of disease. A 26-year-old man was referred to oral and maxillofacial surgery (OMFS) clinic of Taleghani hospital with chief complaints of pain and swelling of left submandibular space. According to the patient himself, the swelling had been started three months earlier. After rejecting dental source of the lesion, we decided to remove the mass by excisional biopsy concerning the patient's discomfort. Histopathology report verified Rosai Dorfman disease as definite diagnosis of the mass.

Investigating the effect of insertion torque on marginal bone loss around dental implants.

BACKGROUND/PURPOSE: The use of dental implants in restoring function, esthetics, speech, and health of oral tissues has been growing in recent years. Evaluating marginal bone resorption and the survival rate of implants placed with different torques values is crucial. The primary aim of the present study was to evaluate the effect of different insertion torque values on marginal bone loss around dental implants placed in the posterior region of the mandible. MATERIALS AND METHODS: 37 patients were involved in this study. Patient data (age, gender), implant characteristics (length, diameter), insertion torque values, gingival biotype, and bone quality were recorded, and parallel periapical radiographs measured marginal bone loss. The relationship between variables was obtained using independent t-tests, Pearson correlations, and regressions. RESULTS: The present study found a positive and significant correlation between implant insertion torque and marginal bone loss (MBL)around the dental implants during the first year after placement. Furthermore, patients with D2 bone density at the implant placement site and thin gingival biotype also had significantly higher MBLs from baseline until crown delivery and first-year follow-up than those with D3 bone density and thick gingival biotypes, respectively. CONCLUSION: A lower torque is necessary for high-risk patients to increase implantation success due to identifying patients with an increased risk for MBL.

Effects of Running-induced Fatigue on the Trunk-pelvis-hip Coordination Variability During Treadmill Running at Different Speeds.

OBJECTIVE: The objective of this study was to examine the effects of fatigue on the coordination variability between the trunk, pelvis, and hips during treadmill running. METHODS: The kinematics data were recorded during ten successive treadmill steps running at the preferred speed and at 80% and 120% of the preferred speed. The angle segment data obtained during the running cycles were normalized to 100 data points, and they were split into ten periods. The coordination variability was calculated using the continuous relative phase (CRP) and variability (VCRP) methods for the trunk, pelvic and hip segments before and after the fatigue protocol. RESULTS: The repeated measures analysis of variance showed significant differences in the trunk-pelvic and trunk-hip CRPs and in the CRP variability during the last 30% of the treadmill running cycles after fatigue (p≤0.05). In addition, significant differences were observed in the pelvic-hip CRP and the CRP variability in 40% of the initial treadmill running cycles after fatigue (p≤0.05). CONCLUSION: According to the results of this study, fatigue reduces coordination and increases variability. The central nervous system probably exerts more control on the distal segments for maintaining moving patterns in fatigue conditions.

Comparison of unilateral and bilateral strength ratio, strength, and knee proprioception in older male fallers and non-fallers.

BACKGROUND: Asymmetry of lower limb muscle strength and knee proprioception have been linked with risk of falling among elderly with and without history of falling. OBJECTIVE: This study aimed to determine the comparison of hamstrings to quadriceps strength ratio (CSR) and bilateral knee strength ratio, hamstrings and quadriceps muscles' strength and knee proprioception in elderly male fallers and non-fallers. METHODS: Sixty older adults, 65 years and older were recruited into faller (fell twice in the last six months) and non-faller groups. Then, the knee extension and flexion strength and proprioception at 45° knee flexion for the dominant leg (DL) and non-dominant legs (NDL) were measured with a Biodex Isokinetic Dynamometer. RESULTS: The strength of quadriceps and hamstring muscles showed significantly higher values in DL by 5.4 %, 9.2 % and NDL by 11.7 %, 15.5 % in the non-faller compared to the faller (p < 0.05). Significantly greater bilateral asymmetry (>10 % difference) was observed with the quadriceps (p = 0.014, -7.9 %, ES = 0.76) and hamstrings (p < 0.001, -18.4 %, ES = 1.5) as well as reduced CSR (<72 %) by 7.6 % in DL (ES = 0.64) and 11.3 % in NDL (ES = 0.81) with fallers versus non-fallers. Significantly less knee proprioception was found with the DL by -1.5 % (ES = 1.15) and NDL (ES = 1.50) by -2.1 % (p < 0.001) in non-faller compared to faller. CONCLUSION: It concluded that non-fallers have better strength symmetry, bilateral and unilateral knee strength ratios as well as more sensitive knee proprioception than fallers. It is suggestive that older adult fallers may need to improve bilateral knee strength symmetry and proprioception to prevent the risk of falling.

Can different training methods reduce the kinematic risk factors of ACL injuries in children?

According to the research, a lack of neuromuscular control is a major cause of non-contact anterior cruciate ligament (ACL) injury during locomotion. This study aimed to determine the influence of various prescriptive and Constrained Led Approach (CLA) training approaches on lower extremity kinematics and stride length in children aged 3-5 years old while walking and running. Thirty-six children with a mean age of 4.79 years were separated into three groups: 1- prescriptive training group (n = 10), 2- CLA training group (n = 11), and 3- Control group (n = 10). The kinematics of the hip, knee and ankle joints in the sagittal plane at the moment of heel contact and toe-off were recorded before and after six weeks of intervention. According to the MANOVA, there was no statistically significant difference between the two training techniques in the joint angles at heel contact and toe-off during walking and running after intervention (p ≥ 0.05). However, there was a significant difference in the kinematic characteristics of walking and running between the training and the control groups (p ≤ 0.05). The two training techniques showed a statistically significant difference in stride length during running (p ≤ 0.05). The results indicated that prescriptive and CLA training are effective at altering the kinematics and distance factors underlying children's walking and running abilities.

Patients Satisfaction and Nasal Morphologic Change after Orthognathic Surgery.

Background: Patients' attitudes about their nose changes after orthognathic surgeries. We aimed to evaluate the patient's opinion about nasal change and morphologic changes following orthognathic surgery. Methods: This was a cross-sectional study. The sample was derived from the population of patients who underwent orthognathic surgery in the Oral and Maxillofacial Surgery Department of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2019. Subjects who underwent orthognathic surgery were studied. Subjects filled a modified nose evaluation form before and nine months after orthognathic surgery. For objective assessment, the nasolabial angle, nasofrontal angle, nasofacial angle, tip projection, and tip deviation and alar width were evaluated. Sixty-two patients were studied. Results: Forty (64.5%) patients did not absolutely like their nose before orthognathic surgeries, two (3.2 %) expressed a little satisfaction, 17(27.4%) answered they liked more or less, and three liked very much. Nine months after orthognathic surgeries, 4 (6.5%) patients did not like their nose, nine patients (14.5%) liked a little, 30 (48.4%) liked more or less, and 19 liked very much. Analysis of the data demonstrated a significant difference in patients' satisfaction with their noses before and nine months after orthognathic surgeries (P<0.001). Patients' satisfaction nine months after orthognathic surgery was not affected by nasal morphologic changes. Conclusion: It seems, patients' satisfaction with their nose improved after orthognathic surgeries. Patients' attitude was not associated with nasal morphologic changes.

Primary melanoma of submandibular gland: case report and literature review of a very rare entity.

BACKGROUND: Cutaneous melanomas account for more than 95% of all cases of primary melanoma, making non-cutaneous primary melanomas truly rare. Cases of primary mucosal melanomas of the oral cavity have been widely described; however, instances of primary melanomas arising from salivary glands have been rarely described. To date, this is only the second case of primary melanoma of the submandibular gland. CASE PRESENTATION: This is a report of a case of a 36-year-old healthy male patient, who was referred to us with the chief complaint of a growing swelling on the left side of his lower jaw. Evaluations revealed an evident facial asymmetry in the frontal view with a firm, non-tender swelling. Initial orthopantomogram did not reveal any alterations in the trabeculation or morphology of the jaws and the surrounding structures. A soft tissue ultrasonography of the left submandibular gland and anterior region of mandible revealed a hypoechoic cystic mass with numerous micro-echoes. Further para-clinical examinations yielded the definitive diagnosis of primary melanoma of the submandibular gland. Moreover, no evidence of distant osteometastasis was observed in whole-body scans. Subsequent surgical management with the approach of excising the submandibular salivary gland and concurrent selective neck dissection was implemented. CONCLUSIONS: This report emphasizes the importance of thorough examination and prompt referral to designated specialists in cases with suspicious behaviors which are unresponsive to treatments. It can be further concluded that melanoma can mimic a range of benign pathologies; therefore, putting it in the list differential diagnosis of similar lesions seems plausible.

Does Biphasic Calcium Phosphate-Coated Surface Increase the Secondary Stability in Dental Implants? A Split-Mouth Study.

Purpose: This study aimed to evaluate biphasic calcium phosphate coating (BCPC) on the secondary stability of dental implants compared to sand-blasted and acid-etched (SLA) implants. Materials and Methods: This is a split-mouth study. Thirty subjects (20 males and ten females) underwent a dental implant procedure to replace mandibular first or second molars bilaterally. The subjects were randomly assigned to BCPC or SLA groups. The resonance frequency analysis measurements were performed two, four, six, and eight weeks after the implant placement. Results: Sixty implants were placed in the two groups (30 implants per group). The mean ISQ was 52.26 ± 3.73 in group 1 and 50.21 ± 2.59 in group 2 on day 14 after the implant insertion, 63.20 ± 2.76 in group 1 and 58.80 ± 2.14 in group 2 on day 28, 72.30 ± 3.15 in group 1 and 64.53 ± 3.19 in group 2 on day 42, and 78.70 ± 1.56 in group 1 and 71.63 ± 3.22 in group 2 on day 56. The data analysis demonstrated significant differences between the two groups in terms of the mean ISQ at various evaluation times. Conclusion: Regarding ISQ measurements, the secondary stability in BCPC implants may be higher compared to SLA implants in two months after implant insertion.

Aggressive fibromatosis in the submandibular region of a child.

Aggressive fibromatosis is proliferation of well-differentiated fibroblasts. Submandibular region is rare location for fibromatosis. We report a case of a rapidly growing mass in submandibular region of 5-year-old girl, excised surgically and ascertained to be aggressive fibromatosis on histological examination. Recovery was uneventful, and she was disease-free in 6-month follow-up.

Effects of fundamental movement skills based dual-task and dance training on single- and dual-task walking performance in older women with dementia.

OBJECTIVE: The purpose of this study was to compare the effects of fundamental movement skills (FMS)-based dual-task training and dance training on spatio-temporal characteristics of gait performance under single- and dual-task walking conditions among older women with dementia. METHOD: Thirty-eight elderly females with dementia were randomly assigned to one of two groups: (1) dual-task intervention (DTI, age: 73 ± 6.5 years) or (2) Iranian dance intervention (IDI, age: 72.52 ± 6.01 years). Both groups participated in a 10-week intervention program (3 sessions per week, each lasting 50 min). Gait performance parameters (gait speed, cadence, and stride length) and dual-task costs (DTC) were examined using a gait analysis system. The participants completed three walking trials under two conditions: single- and dual-task. The video data was analyzed using motion analysis software (Frame-DIAS II, DKH, DKH Inc., Tokyo, Japan). RESULTS: The results showed that both groups significantly improved in terms of all gait variables, and DTC decreased (p < .001) from pre- to post-test for both conditions. However, the main effects for the group and the group-by-time interactions were not significantly different between the two groups (p > .05). CONCLUSION: These findings showed that DTI and IDI effectively improved gait performance following a 10-week intervention for older women with dementia. Therefore, it is suggested that either training program could decrease DTC and increase gait speed, stride length, and cadence among older females with dementia.

The Predictive Power of Near-Infrared Spectroscopy in Improving Cognitive Problems in Patients Undergoing Brain Surgeries: A Systematic Review.

One of the main objectives in neurosurgical procedures is the prevention of cerebral ischemia and hypoxia leading to secondary brain injury. Different methods for early detection of intraoperative cerebral ischemia and hypoxia have been used. Near-infrared spectroscopy (NIRS) is a simple, non-invasive method for monitoring cerebral oxygenation increasingly used today. The aim of this study was to systematically review the brain monitoring with NIRS in neurosurgery. The search process resulted in the detection of 324 articles using valid keywords on the electronic databases, including Embase, PubMed, Scopus, Web of Science, and Cochrane Library. Subsequently, the full texts of 34 studies were reviewed, and finally 11 articles (seven prospective studies, three retrospective studies, and one randomized controlled trial) published from 2005 to 2020 were identified as eligible for systematic review. Meta-analysis was not possible due to high heterogeneity in neurological and neurosurgical conditions of patients, expression of different clinical outcomes, and different standard reference tests in the studies reviewed. The results showed that NIRS is a non-invasive cerebral oximetry that provides continuous and measurable cerebral oxygenation information and can be used in a variety of clinical settings.

Evaluation of Bone Density in Sinus Elevation by Using Allograft and Xenograft: A CBCT Study.

PURPOSE: The stability and density of the grafted bone in the maxillary sinus are essential for dental implant survival. This study aimed to compare bone density following mineralized allogeneic bone and deproteinized bovine bone and evaluate the volumetric changes as the secondary outcome. MATERIALS AND METHODS: In this prospective cohort study, subjects were randomly allocated into two groups of mineralized bone and deproteinized bone to augment the maxillary sinus. Subjects underwent CBCT immediately after augmentation and 9 months later. The relative bone density was the primary outcome, and the volumetric change after 9 months was the secondary outcome of the study. The authors used an independent t test for assessing the bone density and volumetric change between the two groups. RESULTS: Fifty patients were studied (n = 25 in each group). At 9 months after sinus elevation, the mean bone density was 237.20 ± 55.72 Hounsfield units (HU) in group 1 (mineralized bone) and 634.8 ± 166.11 HU in group 2 (deproteinized bone). There was a substantial difference statistically for the mean of HU between groups 1 and 2 (P < .001). The mean volume change was 0.25 ± 0.13 cm3 in group 1 (mineralized bone) and 0.06 ± 0.05 cm3 in group 2 (deproteinized bone). Assessment of the data showed a substantial difference in the mean volume change at 9 months after sinus elevation between groups 1 and 2 (P < .001). CONCLUSION: Considering the results of this study, the deproteinized bone was associated with higher relative bone density than the mineralized bone 9 months after sinus elevation. The volume change of the deproteinized bone was less than the mineralized bone in the study time.

The effects of learning with various noise on Gait Kinematics in 3-to-5-year-old children: a randomized controlled trial.

BACKGROUND: Lack of the neuromuscular control during locomotion in the knee joint leads to an increased risk of anterior cruciate ligament (ACL) injury in children. Hence, we aimed to explore the effects of a repetitive, model-oriented, and self-organized approach on lower limb kinematics during gait in children. METHODS: In randomized controlled trial, 36 children with 4 ± 0.79 years of age from the children gym were randomly (a lottery method) allocated into three groups, including (1) the model-oriented (n = 10), (2) Differential Learning (n = 11), and (3) control (n = 10) groups. Kinematic data of hip, knee, and ankle joints in the sagittal plane were recorded by a GoPro camera at the moments of heel-ground contact and toe-off the ground before and after a 6-week intervention (two sessions per week). RESULTS: The results indicate a 35% post-intervention increase of ankle dorsiflexion (95% CI: - 5.63 _ - 0.96) in the moment of heel-ground contact in the model-oriented group; however, knee flexion (95% CI: - 1.05 _ 8.34) and hip flexion (95% CI: 3.01 _ 11.78) were respectively decreased by 20% and 20%. After the intervention, moreover, ankle plantar flexion (95% CI: - 9.18 _ - 2.81) and hip extension (95% CI: - 12.87 _ - 3.72) have respectively increased by 37% and 37%, while knee flexion (95% CI: 3.49 _ 11.30) showed a %16 decrease in the moment of toe off the ground. As for the Differential Learning group, ankle dorsiflexion (95% CI: - 5.19 _ - 1.52) increased by 33%, and knee (95% CI: 0.60 _ 5.76) and hip flexion (95% CI: 2.15 _ 7.85) respectively decreased by 17% and 17% at the moment of the heel-ground contact following the intervention. At toe lifting off the ground, the plantar flexion (95% CI: - 7.77 _ - 2.77) increased by 35%, knee flexion (95% CI: 2.17 _ 7.27) decreased to 14%, and hip extension (95% CI: - 9.98 _ - 4.20) increased by %35 following the intervention for the Differential Learning group subjects. Based on the results obtained from the one-way ANOVA, there was a significant difference between these groups and the control group in all kinematic gait variables (p ≤ 0.05). However, no statistically significant differences were found between the two experimental groups. CONCLUSIONS: The results implied that the model-oriented repetitive and the self-organized Differential Learning approach were both appropriate to alter the kinematic gait pattern in the 3-5-year-old children. Previous research has almost exclusively recommended a model-oriented approach to change kinematic patterns and preventing non-contact motor injuries. However, the present study showed that the Differential Learning approach can help children to achieve the same goal by continuously changing environments and stimulating challenges. TRIAL REGISTRATION: Current Controlled Trials using the IRCT website with ID number of, IRCT20130109012078N5 "Prospectively registered" at 14/5/2021.

Peri-implant squamous cell carcinoma mimicking peri-implantitis: a case report.

Peri-implant oral lesions, benign or malignant, may be misdiagnosed as peri-implantitis. Squamous cell carcinoma is the most common cancer reported around dental implants. Malignant peri-implant lesions are life-threatening, and their resemblance to peri-implantitis, especially in their early stage, necessitates a precise differential diagnosis. This report presents a case of a 55-year-old woman with a peri-implant squamous cell carcinoma mimicking peri-implantitis.

The Effect of a Handball Warm-Up Program on Dynamic Balance among Elite Adolescent Handball Players.

This study examined the effect of the handball warm-up program (HWP) on dynamic balance among elite adolescent handball players. In this case, 24 handball players were randomly assigned into experimental warm-up and control groups. The HWP was performed over 8 weeks (3 times per week). Dynamic balance before and after the intervention training programs were measured by the Biodex Balance System (BBS) and Y Balance test for the dominant (DL) and non-dominant legs (non-DL). After HWP training, BBS scores significantly improved in the overall (OSI) (30.4% and 31.1%), anterior-posterior (APSI) (44.6% and 35.2%), and medial-lateral stability indexes (MLSI) (38.8% and 43%) for both DL and non-DL. Post-training, the Y Balance test exhibited significant improvements in OSI (13.2% and 10.6%), anterior (17.2% and 12.6%), posteriolateral (12.8% and 11.3%), and posteriomedial stability indexes (9.2% and 7.9%) with DL and non-DL, respectively. In conclusion, dynamic balance improved overall after eight weeks of the HWP, with this improvement significantly greater with the trained versus the control group. Optimal balance during handball is an important factor to ensure coordinated and efficient movements and it is speculated that improved balance could positively impact injury prevention. Hence, the HWP program can be used as an alternative to a conventional warm-up program.

The expression of ACAT1 in oral squamous cell carcinoma and the adjacent pre-tumour tissue.

Background: Altered acetyl CoA acetyltransferase 1 (ACAT1) expression has been reported in diverse cancers. However, the expression of ACAT1 and its prognostic value in oral squamous cell carcinoma (OSCC) has remained unexplored. Materials and methods: In this study, the expression of ACAT1 was analysed by immunohistochemistry (IHC) in 61 OSCC patients and compared between OSCC and adjacent pre-tumour tissue of 21 patients. Results: The expression of ACAT1 in OSCC tumours is heterogeneous between patients. More specifically, 52.38% of the patients show low expression of ACAT1 in both tumour and adjacent pre-tumour tissues, 9.52% of the patients show high expression of ACAT1 in both tumour and adjacent pre-tumour, 19.05% of the patients have high expression of ACAT1 in tumour tissue and low expression of ACAT1 in adjacent pre-tumour tissue and another 19.05% of the patients have low expression of ACAT1 in tumour tissue and high expression of ACAT1 in adjacent pre-tumour tissue. Conclusion: Comparison of ACAT1 expression, one of the key enzymes in the ketone body metabolic pathway, divided OSCC patients into two groups: 1) similar expression and 2) different expression of ACAT1 in tumour and adjacent pre-tumour tissue. No significant association between ACAT1 levels and overall survival was observed.

Exergaming to improve physical, psychological and cognitive health among home office workers: A COVID-19 pandemic commentary.

BACKGROUND: The COVID-19 pandemic has resulted in increased sedentary behaviour and poorer health among office workers. Exergaming is a technology-driven mode of exercise that can improve health while physically distancing. OBJECTIVE: The purpose of this commentary was to explain the benefits of exergaming on physical function, psychological health, and cognition among office workers. RESULTS: Exergaming improves these health outcomes, reduces pain, and decreases the risk for chronic disease. It is easily accessible on smart devices and can be performed both indoors and outdoors. CONCLUSIONS: Twenty-one minutes of exergaming per day can improve health outcomes and reduce the risk of pain and disease. Employers and policy-makers should consider promoting exergaming among office workers.