Behaviour change interventions to improve physical activity in adults: a systematic review of economic evaluations.

BACKGROUND: Behaviour change interventions can result in lasting improvements in physical activity (PA). A broad implementation of behaviour change interventions are likely to be associated with considerable additional costs, and the evidence is unclear whether they represent good value for money. The aim of this study was to investigate costs and cost-effectiveness of behaviour change interventions to increase PA in community-dwelling adults. METHODS: A search for trial-based economic evaluations investigating behaviour change interventions versus usual care or alternative intervention for adults living in the community was conducted (September 2023). Studies that reported intervention costs and incremental cost-effectiveness ratios (ICERs) for PA or quality-adjusted life years (QALYs) were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC-list). A Grading of Recommendations Assessment, Development and Evaluation style approach was used to assess the certainty of evidence (low, moderate or high certainty). RESULTS: Sixteen studies were included using a variety of economic perspectives. The behaviour change interventions were heterogeneous with 62% of interventions being informed by a theoretical framework. The median CHEC-list score was 15 (range 11 to 19). Median intervention cost was US$313 per person (range US$83 to US$1,298). In 75% of studies the interventions were reported as cost-effective for changes in PA (moderate certainty of evidence). For cost per QALY/gained, 45% of the interventions were found to be cost-effective (moderate certainty of evidence). No specific type of behaviour change intervention was found to be more effective. CONCLUSIONS: There is moderate certainty that behaviour change interventions are cost-effective approaches for increasing PA. The heterogeneity in economic perspectives, intervention costs and measurement should be considered when interpreting results. There is a need for increased clarity when reporting the functional components of behaviour change interventions, as well as the costs to implement them.

Breaking the cycle of reoccurring low back pain with integrated motivational interviewing and cognitive behavioural therapy to facilitate education and exercise advice: a superiority randomised controlled trial study protocol.

BACKGROUND: Non-specific low back pain is a common and costly global issue. Many people with low back pain live for years with ongoing symptom recurrence and disability, making it crucial to find effective prevention strategies. Motivational interviewing (MI) is an evidence-based patient-centred counselling style that helps motivate individuals to change their behaviours. In combination, MI and cognitive-behavioural therapy (MI-CBT) has the potential to yield long term improvements in pain and disability and reduce incidence of recurrence. METHOD: This is a two-arm superiority randomised controlled trial comparing MI-CBT and Education (n = 83) with Education only (n = 83). Participants that have recovered from a recent episode of non-specific low back pain (7th consecutive day with pain ≤ 2 on a 0-10 numeric pain rating scale) will be eligible for inclusion into the study. Both groups will receive five 30-min sessions over a 10-week period as well as the Navigating Pain booklet, homework book and a standardised exercise programme. In the intervention group, MI-CBT techniques will be used to provide individualised support, identify beliefs, and increase engagement with the resources provided. Outcomes measures include pain (current and in the last 7 days) as rated on the numeric pain rating scale. This will be used to determine recurrence (number of participants who report back pain ≥ 3 out of 10 on the numeric pain rating scale). Furthermore, self-reported (1) pain intensity; (2) pain catastrophizing; (3) fear-avoidance beliefs; (4) pain self-efficacy; (5) depression and anxiety; (6) disability will be measured. All outcomes will be measured at baseline, and again at 3-, 6-, and 12-months post allocation. DISCUSSION: The effective delivery of self-management strategies to prevent recurrence of low back pain is an important aspect that requires urgent attention. This study will provide new information on the effectiveness of using an MI-CBT approach to facilitate self-management through education and exercise to improve low back pain outcomes. Evidence emerging from this trial has the potential to inform clinical practice and healthcare management of non-specific low back pain. TRIAL REGISTRATION: Prospectively registered with Australian New Zealand Clinical Trials Registry: ACTRN12623000746639 (10/07/2023).

Assessment, diagnosis and management characteristics of people with acute Charcot neuro-osteoarthropathy in a regional Australian health service: A 3-year retrospective audit.

OBJECTIVE: Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service. DESIGN: Three-year retrospective medical record audit. SETTING: Large regional health service with catchment area of >250 000 people in regional Australia. PARTICIPANTS: People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC). MAIN OUTCOME MEASURES: Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale. RESULTS: Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14-47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases. CONCLUSIONS: Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.

The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis.

BACKGROUND: Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain. METHODS: This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS: Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m2. CONCLUSION: Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain. TRIAL REGISTRATION: The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).

Habitual Physical Activity of People with or at Risk of Diabetes-Related Foot Complications.

Regular physical activity is an important component of diabetes management. However, there are limited data on the habitual physical activity of people with or at risk of diabetes-related foot complications. The aim of this study was to describe the habitual physical activity of people with or at risk of diabetes-related foot complications in regional Australia. Twenty-three participants with diabetes from regional Australia were recruited with twenty-two participants included in subsequent analyses: no history of ulcer (N = 11) and history of ulcer (N = 11). Each participant wore a triaxial accelerometer (GT3X+; ActiGraph LLC, Pensacola, FL, USA) on their non-dominant wrist for 14 days. There were no significant differences between groups according to both participant characteristics and physical activity outcomes. Median minutes per day of moderate-to-vigorous physical activity (MVPA) were 9.7 (IQR: 1.6-15.7) while participants recorded an average of 280 ± 78 min of low-intensity physical activity and 689 ± 114 min of sedentary behaviour. The sample accumulated on average 30 min of slow walking and 2 min of fast walking per day, respectively. Overall, participants spent very little time performing MVPA and were largely sedentary. It is important that strategies are put in place for people with or at risk of diabetes-related foot complications in order that they increase their physical activity significantly in accordance with established guidelines.

Position-Specific Running and Technical Demands During Male Elite-Junior and Elite-Senior Australian Rules Football Match-Play.

ABSTRACT: Jennings, J, Staka, Z, Wundersitz, DW, Sullivan, CJ, Cousins, SD, Custovic, E, and Kingsley, MI. Position-specific running and technical demands during male elite-junior and elite-senior Australian rules football match-play. J Strength Cond Res 37(7): 1449-1455, 2023-The aim of this study was to compare position-specific running and technical demands of elite-junior and elite-senior Australian rules football match-play to better inform practice and assist transition between the levels. Global positioning system and technical involvement data were collated from 12 Victorian U18 male NAB League ( n = 553) and 18 Australian Football League ( n = 702) teams competing in their respective 2019 seasons. Players were grouped by position as nomadic, fixed, or ruck, and data subsets were used for specific analyses. Relative total distance ( p = 0.635, trivial effect), high-speed running (HSR) distance ( p = 0.433, trivial effect), acceleration efforts ( p = 0.830, trivial effect), deceleration efforts ( p = 0.983, trivial effect), and efforts at >150 m·min -1 ( p = 0.229, trivial effect) and >200 m·min -1 ( p = 0.962, trivial effect) did not differ between elite-junior and elite-senior match-play. Elite juniors covered less total and HSR distance during peak periods (5 seconds-10 minutes) of demand ( p ≤ 0.022, small-moderate effects). Within both leagues, nomadic players had the greatest running demands followed by fixed position and then rucks. Relative disposals ( p = 0.330, trivial effect) and possessions ( p = 0.084, trivial effect) were comparable between the leagues. During peak periods (10 seconds to 2 minutes), elite juniors had less technical involvements than elite seniors ( p ≤ 0.001, small effects). Although relative running demands and positional differences were comparable between the leagues, elite juniors perform less running, HSR, and technical involvements during peak periods when compared with elite seniors. Therefore, coaching staff in elite-senior clubs should maintain intensity while progressively increasing the volume of training that recently drafted players undertake when they have transitioned from elite-junior leagues.

Effects of a targeted resistance intervention compared to a sham intervention on gluteal muscle hypertrophy, fatty infiltration and strength in people with hip osteoarthritis: analysis of secondary outcomes from a randomised clinical trial.

BACKGROUND: People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis. METHODS: Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time. RESULTS: In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm3/kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention. CONCLUSION: Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017.

On-Court Activity and Game-Related Statistics during Scoring Streaks in Basketball: Applied Use of Accelerometers.

The aim of this observational study was to determine if on-court activity and match statistics differed between periods of scoring streaks and regular play in basketball. Thirty-seven basketballers including professional women, semi-professional women and semi-professional men wore accelerometers during competitive matches throughout a season. Accelerometry-derived live-time individual on-court exercise intensity and team game-related statistics were compared between scoring streaks (periods of play where the teams participating in the study scored at least three times in a row), streaks against (periods of play where the opposition teams scored at least three times in a row) and regular play. Few differences existed in the average exercise intensity between streak types. During streaks against, there was a 5-15% lower proportion of 2-point attempts, 0.8-1.3 fewer defensive rebounds per minute and 0.3-1.6 fewer shot attempts per minute compared to regular play and scoring streaks, and there were 0.3 fewer offensive rebounds per minute compared to regular play. During scoring streaks, there were 0.5 more defensive rebounds per minute, 1.3 more shot attempts per minute, a 43% greater shooting percentage and a 10% lower proportion of 3-point attempts compared to regular play. To reduce the chances of streaks against, teams should focus on facilitating 2-point shot attempts and consider implementing a 3:1 ratio of 2-point to 3-point attempts to maximize scoring success, and they should focus on winning rebounds to facilitate more shot attempts.

Acute physiologic effects of N95 respirator use on gastroenterologists performing simulated colonoscopy.

BACKGROUND AND AIMS: During the severe acute respiratory syndrome coronavirus 2 pandemic, N95 filtering facepiece respirator (FFR) use was required while performing aerosol-generating procedures. We studied the physiologic effects of N95 FFR use in a cohort of gastroenterologists performing simulated colonoscopies. METHODS: Data collection and comparisons included (1) symptoms and change in vital signs in 12 gastroenterologists performing simulated colonoscopy for 60 minutes while wearing a surgical mask (SM) and faceshield (FS); N95 FFR, SM, and FS; and powered air-purifying respirator (PAPR) and (2) respiratory belt plethysmography and continuous electrocardiographic frequency-based heart rate (HR) variability indices including very low frequency power (measures intracardiac sympathetic tone) and low frequency to high frequency ratios (intracardiac sympathetic to vagal ratio) in 11 gastroenterologists performing simulated colonoscopy while wearing an SM (15 minutes), N95 FFR and SM (60 minutes), and SM (15 minutes) in rapid sequence. RESULTS: Ten of 12 gastroenterologists (83%) reported symptoms with N95 FFR use, most commonly breathing difficulty, frustration, fatigue, and headache. Nine of these gastroenterologists (75%) had associated significant HR elevation. Respiratory peak to trough measurement showed a significant increase (F(2) = 7.543, P = .004) during the N95 FFR stage, which resolved after removal of the N95 FFR. Although not statistically different, all gastroenterologists showed a decrease in sympathetic to vagal ratios and an increase in intracardiac sympathetic effects in the N95 FFR stage. PAPR use was better tolerated but was associated with headache and elevated HR in 4 gastroenterologists (33%). CONCLUSIONS: N95 FFR use by gastroenterologists is associated with development of acute physiologic changes and symptoms.

The effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital settings: a systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to investigate whether behaviour change interventions promote changes in physical activity and anthropometrics (body mass, body mass index and waist circumference) in ambulatory hospital populations. METHODS: Randomised controlled trials were collected from five bibliographic databases (MEDLINE, Embase, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO). Meta-analyses were conducted using change scores from baseline to determine mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (95% CI). The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. RESULTS: A total of 29 studies met the eligibility criteria and 21 were included in meta-analyses. Behaviour change interventions significantly increased physical activity (SMD: 1.30; 95% CI: 0.53 to 2.07, p < 0.01), and resulted in significant reductions in body mass (MD: -2.74; 95% CI: - 4.42 to - 1.07, p < 0.01), body mass index (MD: -0.99; 95% CI: - 1.48 to - 0.50, p < 0.01) and waist circumference (MD: -2.21; 95% CI: - 4.01 to - 0.42, p = 0.02). The GRADE assessment indicated that the evidence is very uncertain about the effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital patients. CONCLUSIONS: Behaviour change interventions initiated in the ambulatory hospital setting significantly increased physical activity and significantly reduced body mass, body mass index and waist circumference. Increased clarity in interventions definitions and assessments of treatment fidelity are factors that need attention in future research. PROSPERO registration number: CRD42020172140.

The influence of playing surface on external demands and physiological responses during a soccer match simulation.

We investigated the effects of playing surfaces with different impact absorption characteristics on external demand and physiological responses. Fifteen participants completed a soccer match simulation on natural grass, synthetic turf and concrete surfaces. Accelerometry-derived PlayerLoadTM per minute (PL·min-1) and average net force (AvFNet) were used to quantify external demands at the centre of mass (CoM), upper-back, mid-back and hip. Heart rate, oxygen uptake, energy expenditure and RPE quantified physiological responses. The concrete surface exhibited the least impact absorption, with peak decelerations ~3.5x synthetic turf and ~10x natural grass (p < 0.001). Despite this, there was no differences in external demand between surfaces (surface: p ≥ 0.194; η2p≤0.092). Both AvFNet and PL·min-1 (location: p < 0.001; η2p≥0.859) were higher at the hip (613(91)N; 12.5(1.2)arb.u), reduced at the mid-back (521(67)N; 8.8(0.7)arb.u) and upper-back (502(60)N; 8.8(0.7)arb.u) when compared to CoM (576(78)N; 10.7(1.0)arb.u). Although playing surface did not influence the external demands, heart rate or oxygen uptake (p > 0.05), energy expenditure was highest on natural grass compared to synthetic turf (P = 0.034) and RPE was highest on synthetic turf compared to concrete (p = 0.026). Different playing surfaces can alter physiological responses to soccer-specific activity even when the external demands are similar.

Deep Learning to Predict Energy Expenditure and Activity Intensity in Free Living Conditions using Wrist-specific Accelerometry.

Wrist-worn accelerometers are more comfortable and yield greater compliance than hip-worn devices, making them attractive for free-living activity assessments. However, intricate wrist movements may require more complex predictive models than those applied to hip-worn devices. This study developed a novel deep learning method that predicts energy expenditure and physical activity intensity of adults using wrist-specific accelerometry. Triaxial accelerometers were worn by 119 participants on their wrist and hip for two weeks during waking hours. A deep learning model was developed from week 1 data of 60 participants and tested using week 2 data for: (i) the remaining 59 participants (Group UT), and (ii) participants used for training (Group TR). Estimates of physical activity were compared to a reference hip-specific method. Moderate-to-vigorous physical activity predicted by the wrist-model was not different to the reference method for participants in Group UT (5.9±3.1vs. 6.3±3.3 hour/week) and Group TR (6.9±3.7 vs. 7.2±4.2 hour/week). At 60-s epoch level, energy expenditure predicted by the wrist-model on Group UT was strongly correlated with the reference method (r=0.86, 95%CI: 0.84-0.87) and closely predicted activity intensity (83.7%, 95%CI: 80.9-86.5%). The deep learning method has application for wrist-worn accelerometry in free-living adults.

Podiatrist-Delivered Health Coaching to Facilitate the Use of a Smart Insole to Support Foot Health Monitoring in People with Diabetes-Related Peripheral Neuropathy.

This trial evaluated the feasibility of podiatrist-led health coaching (HC) to facilitate smart-insole adoption and foot monitoring in adults with diabetes-related neuropathy. Adults aged 69.9 ± 5.6 years with diabetes for 13.7 ± 10.3 years participated in this 4-week explanatory sequential mixed-methods intervention. An HC training package was delivered to podiatrists, who used HC to issue a smart insole to support foot monitoring. Insole usage data monitored adoption. Changes in participant understanding of neuropathy, foot care behaviours, and intention to adopt the smart insole were measured. Focus group and in-depth interviews explored quantitative data. Initial HC appointments took a mean of 43.8 ± 8.8 min. HC fidelity was strong for empathy/rapport and knowledge provision but weak for assessing motivational elements. Mean smart-insole wear was 12.53 ± 3.46 h/day with 71.2 ± 13.9% alerts not effectively off-loaded, with no significant effect for time on usage F(3,6) = 1.194 (p = 0.389) or alert responses F(3,6) = 0.272 (p = 0.843). Improvements in post-trial questionnaire mean scores and focus group responses indicate podiatrist-led HC improved participants' understanding of neuropathy and implementation of footcare practices. Podiatrist-led HC is feasible, supporting smart-insole adoption and foot monitoring as evidenced by wear time, and improvements in self-reported footcare practices. However, podiatrists require additional feedback to better consolidate some unfamiliar health coaching skills. ACTRN12618002053202.

Criterion Validity of a MARG Sensor to Assess Countermovement Jump Performance in Elite Basketballers.

ABSTRACT: Staunton, CA, Stanger, JJ, Wundersitz, DW, Gordon, BA, Custovic, E, and Kingsley, MI. Criterion validity of a MARG sensor to assess countermovement jump performance in elite basketballers. J Strength Cond Res 35(3): 797-803, 2021-This study assessed the criterion validity of a magnetic, angular rate, and gravity (MARG) sensor to measure countermovement jump (CMJ) performance metrics, including CMJ kinetics before take-off, in elite basketballers. Fifty-four basketballers performed 2 CMJs on a force platform with data simultaneously recorded by a MARG sensor located centrally on the player's back. Vertical accelerations recorded from the MARG sensor were expressed relative to the direction of gravity. Jumps were analyzed by a blinded assessor and the best jump according to the force platform was used for comparison. Pearson correlation coefficients (r) and mean bias with 95% ratio limits of agreement (95% RLOA) were calculated between the MARG sensor and the force platform for jumps performed with correct technique (n = 44). The mean bias for all CMJ metrics was less than 3%. Ninety-five percent RLOA between MARG- and force platform-derived flight time and jump height were 1 ± 7% and 1 ± 15%, respectively. For CMJ performance metrics before takeoff, impulse displayed less random error (95% RLOA: 1 ± 13%) when compared with mean concentric power and time to maximum force displayed (95% RLOA: 0 ± 29% and 1 ± 34%, respectively). Correlations between MARG and force platform were significant for all CMJ metrics and ranged from large for jump height (r = 0.65) to nearly perfect for mean concentric power (r = 0.95). Strong relationships, low mean bias, and low random error between MARG and force platform suggest that MARG sensors can provide a practical and inexpensive tool to measure impulse and flight time-derived CMJ performance metrics.

The Effect of Structured Exercise Compared with Education on Neuropathic Signs and Symptoms in People at Risk of Neuropathic Diabetic Foot Ulcers: A Randomized Clinical Trial.

Background and Objectives: Lifestyle interventions such as exercise prescription and education may play a role in the management of peripheral neuropathy in people with diabetes. The aim of this study was to determine the effect of undertaking an exercise program in comparison with an education program on the signs and symptoms of peripheral neuropathy in people with diabetes at risk of neuropathic foot ulceration. Materials and Methods: Twenty-four adult participants with diabetes and peripheral neuropathy were enrolled in this parallel-group, assessor blinded, randomised clinical trial. Participants were randomly allocated to one of two 8-week lifestyle interventions, exercise or education. The primary outcome measures were the two-part Michigan Neuropathy Screening Instrument (MNSI) and vibratory perception threshold (VPT). Secondary outcome measures included aerobic fitness, balance and lower limb muscular endurance. Results: Participants in both lifestyle interventions significantly improved over time for MNSI clinical signs (MD: -1.04, 95% CI: -1.68 to -0.40), MNSI symptoms (MD: -1.11, 95% CI: -1.89 to -0.33) and VPT (MD: -4.22, 95% CI: -8.04 to -0.40). Although the interaction effects did not reach significance, changes in values from pre to post intervention favoured exercise in comparison to control for MNSI clinical signs (MD -0.42, 95% CI -1.72 to 0.90), MNSI clinical symptoms (MD -0.38, 95% CI -1.96 to 1.2) and VPT (MD -4.22, 95% CI -12.09 to 3.65). Conclusions: Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy. These findings support a role for lifestyle interventions in the management of peripheral neuropathy.

Coronavirus (COVID-19), Coagulation, and Exercise: Interactions That May Influence Health Outcomes.

The proinflammatory cytokine storm associated with coronavirus disease 2019 (COVID-19) negatively affects the hematological system, leading to coagulation activation and endothelial dysfunction and thereby increasing the risk of venous and arterial thrombosis. Coagulopathy has been reported as associated with mortality in people with COVID-19 and is partially reflected by enhanced D-dimer levels. Poor vascular health, which is associated with the cardiometabolic health conditions frequently reported in people with severer forms of COVID-19, might exacerbate the risk of coagulopathy and mortality. Sedentary lifestyles might also contribute to the development of coagulopathy, and physical activity participation has been inherently lowered due to at-home regulations established to slow the spread of this highly infectious disease. It is possible that COVID-19, coagulation, and reduced physical activity may contribute to generate a "perfect storm," where each fuels the other and potentially increases mortality risk. Several pharmaceutical agents are being explored to treat COVID-19, but potential negative consequences are associated with their use. Exercise is known to mitigate many of the identified side effects from the pharmaceutical agents being trialled but has not yet been considered as part of management for COVID-19. From the limited available evidence in people with cardiometabolic health conditions, low- to moderate-intensity exercise might have the potential to positively influence biochemical markers of coagulopathy, whereas high-intensity exercise is likely to increase thrombotic risk. Therefore, low- to moderate-intensity exercise could be an adjuvant therapy for people with mild-to-moderate COVID-19 and reduce the risk of developing severe symptoms of illness that are associated with enhanced mortality.

Assessing the association of university stress and physiological reactivity with decision-making among students.

Compared with age-matched employees, university students report higher levels of chronic stress and this may affect their decision-making. The impact of chronic stress and physiological reactivity upon cognitive function is receiving more attention, but few studies have empirically assessed the associations of these variables concurrently. Our aim was to investigate if chronic student stress, as assessed by effort-reward imbalance (ERI) and overcommitment, and physiological reactivity, were related to decision-making. As measures of physiological reactivity, we collected salivary alpha-amylase (sAA) and continuously recorded heart rate variability (HRV) data from male students (n = 79) at pretest and immediately after some computerized decision-making tasks (simple and choice- reaction times). Our findings suggest that students who are higher in overcommitment and who are more physiologically reactive (sAA and HRV indices) at the pretest stage may be more "at-risk" of poor decision-making than others. If others can replicate our findings in more diverse samples, this will contribute to an evidence base for interventions targeted at reducing overcommitment, ERI, and dysregulated autonomic reactivity to improve decision-making.

A physical activity coaching intervention can improve and maintain physical activity and health-related outcomes in adult ambulatory hospital patients: the Healthy4U-2 randomised controlled trial.

BACKGROUND: The Healthy 4 U-2 study sought to evaluate the effect of a twelve-week, physical activity (PA) coaching intervention for changes and maintenance in PA, anthropometrics and health-related outcomes in adults presenting to an ambulatory hospital clinic. METHODS: One hundred and twenty insufficiently active adults were recruited from an ambulatory hospital clinic and randomised to an intervention group that received an education session and five 20-min telephone sessions of PA coaching, or to a control group that received the education session only. ActiGraph GT3X accelerometers were used to measure moderate-to-vigorous physical activity (MVPA) at baseline, post-intervention (3-months) and follow-up (9-months). Secondary outcome measures (anthropometrics, PA self-efficacy, and health-related quality of life) were also assessed at the three time points. RESULTS: At baseline, the mean age and body mass index of participants were 53 ± 8 years and 31 ± 4 kg/m2, respectively. Relative to control, the intervention group increased objectively measured MVPA at post-intervention (p < 0.001) and 9 months follow-up (p < 0.001). At the 9-month follow-up the intervention group completed 22 min/day of MVPA (95% CI: 20 to 25 min/day), which is sufficient to meet the recommended PA guidelines. The intervention group exhibited beneficial changes in body mass (p < 0.001), waist circumference (p < 0.001), body mass index (p < 0.001), PA self-efficacy (p < 0.001), and health-related quality of life (p < 0.001) at the 9-month follow-up. CONCLUSIONS: This study demonstrates that a low contact PA coaching intervention results in beneficial changes in PA, anthropometrics and health-related outcomes in insufficiently active adults presenting to an ambulatory care clinic. The significant beneficial changes were measured at post-intervention and the 9-month follow-up, demonstrating a maintenance effect of the intervention. TRIAL REGISTRATION: Prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, Trial registration number: ACTRN12619000036112 .

Multiple short bouts of exercise are better than a single continuous bout for cardiometabolic health: a randomised crossover trial.

PURPOSE: To compare cardiometabolic responses to five consecutive days of daily postprandial exercise accumulated in three 10-min bouts or a single 30-min bout to a no-exercise control. METHODS: Ten insufficiently active adults completed three trials in a randomised order. Each trial comprised five consecutive days of 30 min of exercise either accumulated in three separate 10-min bouts (ACC) after main meals; a single 30-min bout after dinner (CONT); or a no-exercise control (NOEX). Glucose regulation was assessed from an oral glucose tolerance test. Applanation tonometry was used to assess pulse wave velocity approximately 12 h following completion of the final trial. RESULTS: Area under the 2-h glucose curve was similar for CONT (mean; 95% CI 917 mmol L-1 2 h-1; 815 to 1019) and ACC (931 mmol L-1 2 h-1; 794 to 1068, p = 0.671). Area under the 2-h insulin curve was greater following NOEX (70,328 pmol L-1 2 h-1; 30,962 to 109,693) than ACC (51,313 pmol L-1 2 h-1: 21,822 to 80,806, p = 0.007). Pulse wave velocity was lower for ACC (5.96 m s-1: 5.38 to 6.53) compared to CONT (6.93 m s-1: 5.92 to 7.94, p = 0.031) but not significantly lower for ACC compared to NOEX (6.52 m s-1: 5.70 to 7.34, p = 0.151). CONCLUSION: Accumulating 30 min of moderate-intensity walking in three bouts throughout the day is more effective at reducing markers of cardiometabolic health risk in insufficiently active, apparently healthy adults than a single daily bout. Both accumulated and single-bout walking were equally as effective at reducing postprandial glucose concentrations compared to a no-exercise control. Therefore, accumulating exercise in short bouts after each main meal might be more advantageous for overall cardiometabolic health.

Physiological and biomechanical comparison between electrically assisted bicycles and motorbikes during simulated mail delivery.

Electrically assisted bicycles (EABs) and motorbikes were compared in terms of energy expenditure, internal and external forces, and technique when delivering mail with different loads at different distances from the mailbox. Twenty-two postal workers performed two simulated postal tasks (foot placement [close vs. far] and delivery, and simulated mail delivery circuit) while carrying 0 and 32 kg. Independent of mail load, delivering mail with EABs was classified as moderate intensity and resulted in 33% higher energy expenditure when compared to motorbikes. Ground reaction forces were larger (7-25%) for EAB when compared to motorbike. Larger ground reaction forces were observed when both EABs and motorbikes were positioned further from the mailbox (5-23%). Using EABs during mail delivery has potential to result in numerous health benefits that are associated with moderate intensity physical activity, but can lead to larger external forces when compared to motorbikes. Practitioner summary: In order to compare electrically assisted bicycles (EAB) and motorbikes, postal workers performed simulated deliveries in the laboratory whilst measurements of energy expenditure, body loads and movement patters were undertaken. Body loads and energy expenditure were larger using EAB, which result in health benefits associated with moderate intensity exercise. Abbreviations: EAB: electrically assisted bicycles; CI: confidence interval; UHEC: University Human Ethics Committee; MB: motorbike;SH: seat height; SF: seat to floor distance; VO2: oxygen uptake; VCO2: exhaled carbon dioxide; RER: respiratory exchangeratio; TTL signal: Transistor-Transistor Logic; MET: metabolic equivalent; 3D: three-dimensional; IIR: infinite impulse response; Hz:Hertz; N: Newtons; ROM: range of motion; SD: standard deviation; p: significance level; d: Cohen effect sizes.