Association between natriuretic peptides and C-reactive protein with frailty in heart failure: a systematic review and meta-analysis.

BACKGROUND: Heart failure (HF) and frailty are accompanied by a bidirectional relationship, sharing common risk factors including elevated levels of natriuretic peptides and inflammation. The aim of this study was to compare biomarkers associated with poor clinical outcomes, that is, plasma brain natriuretic peptide (BNP), N-terminal-pro B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) in patients with HF and frailty vs. patients with HF without frailty. METHODS: From inception until July 2023, PubMed, Scopus, Web of Science, and Cochrane Library a systematic literature search was conducted. To evaluate whether frailty is linked with greater levels of BNP, NT-proBNP, and CRP, a meta-analysis using a random-effects model was used to calculate the pooled effects (CRD42023446607). RESULTS: Fifty-three studies were included in this systematic review and meta-analysis. Patients with HF and frailty displayed significantly higher levels of BNP (k = 11; SMD: 0.53, 95%CI 0.30-0.76, I2 = 86%, P < 0.01), NT-proBNP (k = 23; SMD: 0.33, 95%CI 0.25-0.40, I2 = 72%, P < 0.01), and CRP (k = 8; SMD: 0.30, 95%CI 0.12-0.48, I2 = 62%, P < 0.01) vs. patients with HF without frailty. Using meta-regression, body mass index (BMI) and age were deemed potential moderators of these findings. CONCLUSIONS: Frailty in HF is linked to increased concentrations of BNP, NT-proBNP, and CRP, which have been epidemiologically associated with adverse outcomes. The increased risk of NYHA III/IV classification further emphasizes the clinical impact of frailty in this population.

Hip rate of torque development, but not strength, is associated with single-leg squat kinematics in individuals with patellofemoral pain.

INTRODUCTION: Isometric hip strength seems to have limited association with frontal plane kinematics in individuals with patellofemoral pain (PFP), but little is known about the association with hip rate of torque development (RTD). OBJECTIVE: To explore the association of hip strength and RTD with trunk, pelvis, hip, and knee kinematics during a single-leg squat (SLS) in individuals with PFP. METHODS: Twenty individuals with PFP participated in this study. Hip abductor and extensor strength and RTD (early phase and late phase) were assessed using a hand-held dynamometer. Lateral trunk motion, pelvic drop, hip frontal plane projection angle (HFPPA), and knee frontal plane projection angle (KFPPA) were evaluated during a SLS using a two-dimensional motion analysis. RESULTS: Lower early and late phase hip abductor RTD were moderately associated with greater HFPPA (early phase: r = -0.501, p = .025; late phase: r = -0.580, p = .007) and KFPPA (early phase: r = -0.536, p = .015; late phase: r = -0.554, p = .011). Lower early phase hip extensor RTD was moderately associated with greater pelvic drop (r = 0.571, p = .009), HFPPA (r = -0.548, p = .012), and KFPPA (r = -0.530, p = .016). Hip abductor and extensor strength were not associated with any kinematic variables (p > .05). CONCLUSION: Lower hip RTD, but not strength, was associated with greater frontal plane kinematics during a SLS in individuals with PFP, indicating that the ability to produce torque rapidly may be important for kinematic control during functional tasks.

Habitual physical activity levels of adults with heart failure: systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to quantify habitual physical activity (PA) levels of patients with heart failure (HF) and assess the quality of reporting of device-assessed PA. METHODS: Eight electronic databases were searched up to 17 November 2021. Data on the study and population characteristics, method of PA measurement and PA metrics were extracted. A random-effects meta-analysis (restricted maximum likelihood with Knapp-Hartung SE adjustment) was conducted. RESULTS: Seventy-five studies were included in the review (n=7775 patients with HF). Meta-analysis was restricted to mean steps per day, encompassing 27 studies (n=1720 patients with HF). Pooled mean steps per day were 5040 (95% CI: 4272 to 5807). The 95% prediction interval for mean steps per day in a future study was 1262 to 8817. Meta-regression at the study level revealed that a 10-year increment in the mean age of patients was associated with 1121 fewer steps per day (95% CI: 258 to 1984). CONCLUSIONS: Patients with HF are a low-active population. These findings have implications for the way in which PA is targeted in patients with HF, and interventions should focus on addressing the age-related decline observed as well as increasing PA to improve HF symptoms and quality of life. PROSPERO REGISTRATION NUMBER: CRD42020167786.

Effectiveness and active ingredients of social prescribing interventions targeting mental health: a systematic review.

OBJECTIVE: This study aims to establish the effectiveness and active ingredients of UK-based social prescribing interventions targeting mental health and well-being outcomes. DESIGN: Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysies guidelines and a published protocol. DATA SOURCES: Nine databases were systematically searched up to March 2022. ELIGIBILITY CRITERIA: Social prescribing interventions in the UK involving adults aged ≥18 years, which reported on mental health outcomes. DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data on study characteristics; outcomes; referral pathways; treatment fidelity strategies; person-centredness; intervention development processes and theory-linked behaviour change techniques (BCTs). Data were narratively synthesised. RESULTS: 52 074 records were retrieved by the search, 13 interventions reported across 17 studies were included in this review (N=5036 participants at post-intervention). Fifteen studies were uncontrolled before-and-after designs, one a randomised controlled trial and one a matched groups design. The most frequently reported referral pathway was the link worker model (n=12), followed by direct referrals from community services (n=3). Participants were predominantly working age adults, and were referred for anxiety, depression, social isolation and loneliness. 16 out of 17 studies reported statistically significant improvements in outcomes (mental health, mental well-being, general health, or quality of life). Strategies to enhance treatment fidelity were suboptimal across studies. Only two studies used a specific theoretical framework. A few studies reported engaging service users in codesign (n=2) or usability and/or feasibility testing (n=4). Overall, 22 BCTs were coded across 13 interventions. The most frequently coded BCTs were social support-unspecified (n=11), credible source (n=7) and social support-practical (n=6). CONCLUSIONS: Robust conclusions on the effectiveness of social prescribing for mental health-related outcomes cannot be made. Future research would benefit from comprehensive intervention developmental processes, with reference to appropriate theory, alongside long-term follow-up outcome assessment, using treatment fidelity strategies and a focus on principle of person-centred care. PROSPERO REGISTRATION NUMBER: CRD42020167887.

Celiac Disease Symptoms in Athletes: Prevalence Indicators of Perceived Quality of Life.

BACKGROUND: Celiac disease (CD) is a common gastrointestinal pathology; however, prevalence and comorbidities are unknown in collegiate athletics. HYPOTHESES: (1) Athletes will have similar odds of CD as general population estimates (approximately 1 in 141) based on self-report and signs and symptoms, (2) athletes scoring higher on the Celiac Symptom Index (CSI) will have lower self-reported quality of life (QoL), (3) athletes scoring higher on the CSI will have higher depression scores, and (4) athletes scoring higher on the CSI will have higher perceived stress scores. STUDY DESIGN: Epidemiological cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: The CSI, WHO Quality of Life-BREF, Beck Depression Inventory, and Perceived Stress Scale were used to assess patients' signs and symptoms of CD and psychosocial measures/QoL in male and female National Collegiate Athletic Association (all divisions) athletes (N = 141). Participants also self-reported a formal diagnosis of CD. Chi-square analyses determined CD prevalence. Odds ratios determined risk for either being diagnosed with CD or reporting more symptoms than the general population. Correlational analyses determined whether symptoms correlated with QoL and psychosocial measures. RESULTS: Athletes were 3.85 times (95% CI, 0.42-34.89) more likely to report a CD diagnosis and were 18.36 times (95% CI, 2.40-140.48) more likely to report a high degree of CD symptoms than the general population. Athletes with more symptoms had worse physical, psychological, social, and environmental QoL indicators and higher depression and perceived stress scores. CONCLUSION: Athletes may be a higher risk population for experiencing CD and report greater signs/symptoms compared with general population estimates. Additionally, athletes with higher CD symptom scores also reported poorer QoL. CLINICAL RELEVANCE: Allied health care professionals should be aware of the diversity of CD symptoms and be prepared to refer athletes when gastrointestinal symptoms persist to ensure proper care and unhampered performance.