Enhancing physical function and activity level in malnourished older adults through oral nutrition supplements: a randomized controlled trial.

BACKGROUND: Malnutrition of older individuals, leads to significant functional decline, reducing their quality of life. Lifestyle interventions; dietary improvements and supplementation are explored to enhance the physical function of older adults. The current study aimed to assess the impact of oral nutritional supplements (ONS) on the functional and activity levels of Sri Lankan older adults. METHODS: This randomized controlled trial included; an intervention group (IG) receiving 200 mL of ONS providing 247 kcal per serving, for 12 weeks and a control group (CG) receiving an equivalent volume of water. Changes in handgrip strength, knee extension strength, gait speed, functional and activity levels were assessed. RESULTS: The IG showed significant improvements in handgrip strength (43.96 ± 18.61 kg vs. 32.81 ± 17.92 kg; p < 0.001) and knee extension strength (23.45 ± 2.29 kg vs. 16.41 ± 2.09 kg; p < 0.001) following 12 weeks compared to the CG. The IG also exhibited significant improvements in gait speed (1.31 ± 0.52 m/s vs. 0.87 ± 0.26 m/s), Barthel index score, (0.30 ± 0.47 vs. -0.18 ± 0.66), PASE score (0.52 ± 17.79 vs. -1.60 ± 21.77) and IPAQ categories. CONCLUSIONS: ONS was found to be effective in improving the functional and physical activity levels of malnourished older adults. TRIAL REGISTRATION: Sri Lanka Clinical Trial Registry SLCTR/2022/021. Registered on 06/10/2022.

Impact of an oral nutritional supplement on the body composition of older adults with or at risk of malnutrition in an institutionalised setting: A randomised controlled trial.

BACKGROUND: Malnutrition often manifests as a body weight (BW) reduction and unhealthy alteration in body composition. The present study aimed to assess the efficacy of an oral nutritional supplement (ONS) in improving BW and body composition among older adults with malnutrition. METHODS: An open-label randomised controlled, parallel-group study was conducted among older adults (age ≥ 60 years) with/at risk of malnutrition (mini nutrition assessment-short form score ≤ 11). In total, 50 participants were randomly assigned to the intervention (IG) and control (CG) groups (1:1 ratio). The IG received the ONS (57 g/day; 247 kcal/serving, 12 g protein) before bedtime for 12 weeks. CG received 200 mL of water. Anthropometric measurements, body composition analysis, and dietary and physical activity assessments were performed at the beginning and end of the study. RESULTS: Forty-two participants (IG: 20, CG: 22) completed the study. The mean ± SD ages of the IG and CG were 75.4 ± 6.1 and 74.8 ± 5.2 years, respectively (p = 0.73). The IG had a significant increase in BW (+1.68 ± 1.16 vs. -0.46 ± 0.95 kg; p < 0.001), lean mass (+1.23 ± 0.93 vs. -0.45 ± 0.90 kg; p < 0.001) and fat mass (+0.54 ± 0.82 vs. -0.06 ± 0.82 kg; p = 0.02) compared to the CG. One-quarter of the IG (n = 5) achieved a weight gain > 5% of BW, whereas none in the CG did (p = 0.01). No significant changes were observed in bone mineral content in either group. CONCLUSIONS: For malnourished older adults, supplementing with an ONS, along with regular food intake, significantly increased BW, lean mass and fat mass compared to control following the regular diet without supplementation.

An exploration of the determinants of overweight and obesity and the capacity to intervene in North-West Tasmania: A stakeholder consultation.

ISSUE ADDRESSED: The capacity of communities to develop effective obesity prevention initiatives varies and should be a focus for obesity prevention intervention planning and investment. This research aimed at engaging and consulting local community stakeholders to identify determinants, needs, strategic priorities and capacity to act on overweight and obesity prevention in North-West (NW) Tasmania. METHODS: A series of semi-structured interviews and thematic analyses was implemented to explore the knowledge, insights, experiences and attitudes of stakeholders. RESULTS: Mental health and obesity were identified as major concerns and were often reported to share similar determinants. This study has identified health promotion capacity assets (existing partnerships, community capital, local leadership and some pockets of health promotion activity), and a range of capacity deficits (limited investment in health promotion, a small workforce, limited access to pertinent health information). CONCLUSIONS: This study has identified health promotion capacity assets (existing partnerships, community capital, local leadership and some pockets of health promotion activity), and a range of capacity deficits (limited investment in health promotion, a small workforce, limited access to pertinent health information). SO WHAT?: Broad upstream socio-economic, cultural and environmental determinants underpin the conditions by which the local community develops overweight/obesity and/or health and wellbeing outcomes. Including stakeholder consultations as a significant technique within a comprehensive plan of action aimed at achieving a sustainable, long-term strategy for obesity prevention and/or health promotion, should be considered in future programs.

Trends and associations between maternal characteristics and infant birthweight among Indigenous and non-Indigenous people in Tasmania, Australia: a population-based study.

OBJECTIVE: This study aimed to investigate the trends and associations of maternal characteristics and birthweight among Indigenous and non-Indigenous infants. STUDY DESIGN: This was a retrospective population-based study. METHODS: Fourteen years (2005-2018) of birthweight and perinatal health data of live-born singletons and their mothers obtained from the Tasmanian Data Linkage Unit were used to assess the trends and associations between maternal characteristics and infant birthweight using regression modelling. RESULTS: Compared with non-Indigenous mothers (n = 76,750), Indigenous mothers (n = 3805) had a significantly higher prevalence of risk factors during the 14-year period. Although the prevalence of prepregnancy obesity and gestational diabetes mellitus (GDM) markedly increased in both groups, the rate of increase was higher (P < 0.001) for Indigenous than non-Indigenous mothers. Smoking, alcohol consumption and illegal drug use during pregnancy reduced over the years, and there was no significant difference in the rate of reduction between the groups. Large-for-gestational-age (LGA) births increased while small-for-gestational-age (SGA) births decreased in both groups over time. In addition, high birthweight (HBW) births decreased while low birthweight (LBW) births increased. The rates of increase in LGA and LBW births and the rates of decrease in SGA and HBW births were significantly higher in Indigenous mothers compared with non-Indigenous mothers (P < 0.001 for all). The association between Indigenous ethnicity and LBW and SGA births weakened after adjusting for other confounding maternal and perinatal variables. LBW and SGA were positively associated with Indigenous ethnicity, age <18 years, smoking, alcohol consumption and illegal drug use, pre-eclampsia, underweight prepregnancy body mass index and low socio-economic status. Women with higher parity, pre-existing diabetes and prepregnancy overweight or obesity were more likely to give birth to an infant with HBW or LGA. CONCLUSIONS: The prevalence of risk factors for abnormal birthweight is higher among Tasmanian Indigenous mothers, contributing to a gap in birthweight outcomes between Indigenous and non-Indigenous infants. The dramatic increase in prepregnancy obesity and GDM in both groups highlight the importance of screening and management of GDM during pregnancy. Comprehensive programmes co-designed and co-managed in consultation with Indigenous people are needed to support healthy lifestyle choices among Indigenous women to address the barriers to individuals adopting behaviour change and to help close the health outcomes-related gap between Indigenous and non-Indigenous mothers and infants.

Why some do but too many don't? Barriers and enablers to physical activity in regional Tasmania - an exploratory, mixed-methods study.

BACKGROUND: The interconnectedness of physical inactivity and sedentarism, obesity, non-communicable disease (NCD) prevalence, and socio-economic costs, are well known. There is also strong research evidence regarding the mutuality between well-being outcomes and the neighbourhood environment. However, much of this evidence relates to urban contexts and there is a paucity of evidence in relation to regional communities. A better understanding of available physical activity (PA) infrastructure, its usage, and community perceptions regarding neighbourhood surroundings, could be very important in determining requirements for health improvement in regional communities. The aims of this research were to 1. Explore and evaluate the public's perception of the PA environment; and 2. Evaluate the quantity, variety, and quality of existing PA infrastructure in regional Northwest (NW) Tasmania. METHODS: A mixed methods approach guided data collection, analysis, and presentation. Quality of PA infrastructure was assessed using the Physical Activity Resource Assessment (PARA) instrument and public perception about PA environment was evaluated using the International Physical Activity Questionnaire - Environmental (IPAQ-E) module. Quantitative data were analysed using descriptive summative methods and a team-based researcher triangulation approach was utilised for qualitative data. RESULTS: Overall, a wide array of high-quality PA infrastructure (with minimal incivilities such as auditory annoyance, litter, graffiti, dog refuse, and vandalism etc.) was available. Survey respondents rated neighbourhoods positively. The overall quality of PA infrastructure, rated on a scale from 0 to 3, was assessed as high (all rated between 2 to 3) with minimal incivilities (rated between 0 and 1.5). Of note, survey respondents confirmed the availability of numerous free-to-access recreational tracks and natural amenities across the 3 local government areas (LGAs) studied. Importantly, most respondents reported minimal disruption to their routine PA practices due to the COVID-19 pandemic. CONCLUSION: This exploratory research confirmed the availability of a wide range of high-quality PA infrastructure across all three LGAs and there was an overwhelming public appreciation of this infrastructure. The challenge remains to implement place-based PA interventions that address extant barriers and further increase public awareness and utilisation of high-quality PA infrastructure.

Is abdominal adiposity in healthy Sri Lankan neonates different from the rest of the world?

BACKGROUND AND OBJECTIVES: Adiposity at birth is a predictor of childhood obesity. Abdominal circumference (AC) at birth has been shown to correlate well with visceral adipose tissue and abdominal subcutaneous adipose tissue. Adiposity differs according to ethnicity and geography. The aim of this study was to describe the anthropometry derived adiposity phenotype in neonates from Colombo, Sri Lanka and compare it with global data. METHODS AND STUDY DESIGN: Birth anthropometry was performed within 12-24 hours by the same investigator as part of a prospective cohort study on healthy term babies, at a tertiary care hospital in Colombo, Sri Lanka, 2015-2019. The anthropometry derived adiposity phenotype was indicated by skinfold thickness, AC and upper arm fat area (UFA) derived from the mid-upper arm circumference (MUAC). RESULTS: Sri Lankan neonates had a significantly lower weight with significantly higher AC (n=337, 2.9±0.4 kg, 30.6±2.3 cm) compared to Canadian (n=389, 3.5±0.02 kg, 29.9±2.1 cm; p<0.001) and Australian (n=1270, 3.4±0.4 kg, 28.5±1.9 cm; p<0.001) neonates. Anthropometry derived adiposity at birth showed a significant correlation with weight and BMI of both mother and father (p<0.05) as opposed to their income or education (p>0.05). CONCLUSIONS: Healthy neonates from Colombo, Sri Lanka demonstrated significantly higher AC despite significantly lower weight, indicating increased abdominal adiposity compared to neonates from high-income countries as well as Indian neonates with the thin-fat phenotype.

Akt1 signalling supports acinar proliferation and limits acinar-to-ductal metaplasia formation upon induction of acute pancreatitis.

Molecular signalling mediated by the phosphatidylinositol-3-kinase (PI3K)-Akt axis is a key regulator of cellular functions. Importantly, alteration of the PI3K-Akt signalling underlies the development of different human diseases, thus prompting the investigation of the pathway as a molecular target for pharmacologic intervention. In this regard, recent studies showed that small molecule inhibitors of PI3K, the upstream regulator of the pathway, reduced the development of inflammation during acute pancreatitis, a highly debilitating and potentially lethal disease. Here we investigated whether a specific reduction of Akt activity, by using either pharmacologic Akt inhibition, or genetic inactivation of the Akt1 isoform selectively in pancreatic acinar cells, is effective in ameliorating the onset and progression of the disease. We discovered that systemic reduction of Akt activity did not protect the pancreas from initial damage and only transiently delayed leukocyte recruitment. However, reduction of Akt activity decreased acinar proliferation and exacerbated acinar-to-ductal metaplasia (ADM) formation, two critical events in the progression of pancreatitis. These phenotypes were recapitulated upon conditional inactivation of Akt1 in acinar cells, which resulted in reduced expression of 4E-BP1, a multifunctional protein of key importance in cell proliferation and metaplasia formation. Collectively, our results highlight the critical role played by Akt1 during the development of acute pancreatitis in the control of acinar cell proliferation and ADM formation. In addition, these results harbour important translational implications as they raise the concern that inhibitors of PI3K-Akt signalling pathways may negatively affect the regeneration of the pancreas. Finally, this work provides the basis for further investigating the potential of Akt1 activators to boost pancreatic regeneration following inflammatory insults. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Serine administration as a novel prophylactic approach to reduce the severity of acute pancreatitis during diabetes in mice.

AIMS/HYPOTHESIS: Compared with the general population, individuals with diabetes have a higher risk of developing severe acute pancreatitis, a highly debilitating and potentially lethal inflammation of the exocrine pancreas. In this study, we investigated whether 1-deoxysphingolipids, atypical lipids that increase in the circulation following the development of diabetes, exacerbate the severity of pancreatitis in a diabetic setting. METHODS: We analysed whether administration of an L-serine-enriched diet to mouse models of diabetes, an established method for decreasing the synthesis of 1-deoxysphingolipids in vivo, reduced the severity of acute pancreatitis. Furthermore, we elucidated the molecular mechanisms underlying the lipotoxicity exerted by 1-deoxysphingolipids towards rodent pancreatic acinar cells in vitro. RESULTS: We demonstrated that L-serine supplementation reduced the damage of acinar tissue resulting from the induction of pancreatitis in diabetic mice (average histological damage score: 1.5 in L-serine-treated mice vs 2.7 in the control group). At the cellular level, we showed that L-serine decreased the production of reactive oxygen species, endoplasmic reticulum stress and cellular apoptosis in acinar tissue. Importantly, these parameters, together with DNA damage, were triggered in acinar cells upon treatment with 1-deoxysphingolipids in vitro, suggesting that these lipids are cytotoxic towards pancreatic acinar cells in a cell-autonomous manner. In search of the initiating events of the observed cytotoxicity, we discovered that 1-deoxysphingolipids induced early mitochondrial dysfunction in acinar cells, characterised by ultrastructural alterations, impaired oxygen consumption rate and reduced ATP synthesis. CONCLUSIONS/INTERPRETATION: Our results suggest that 1-deoxysphingolipids directly damage the functionality of pancreatic acinar cells and highlight that an L-serine-enriched diet may be used as a promising prophylactic intervention to reduce the severity of pancreatitis in the context of diabetes.

Local hyperthyroidism promotes pancreatic acinar cell proliferation during acute pancreatitis.

Proliferation of pancreatic acinar cells is a critical process in the pathophysiology of pancreatic diseases, because limited or defective proliferation is associated with organ dysfunction and patient morbidity. In this context, elucidating the signalling pathways that trigger and sustain acinar proliferation is pivotal to develop therapeutic interventions promoting the regenerative process of the organ. In this study we used genetic and pharmacological approaches to manipulate both local and systemic levels of thyroid hormones to elucidate their role in acinar proliferation following caerulein-mediated acute pancreatitis in mice. In addition, molecular mechanisms mediating the effects of thyroid hormones were identified by genetic and pharmacological inactivation of selected signalling pathways.In this study we demonstrated that levels of the thyroid hormone 3,3',5-triiodo-l-thyronine (T3) transiently increased in the pancreas during acute pancreatitis. Moreover, by using genetic and pharmacological approaches to manipulate both local and systemic levels of thyroid hormones, we showed that T3 was required to promote proliferation of pancreatic acinar cells, without affecting the extent of tissue damage or inflammatory infiltration.Finally, upon genetic and pharmacological inactivation of selected signalling pathways, we demonstrated that T3 exerted its mitogenic effect on acinar cells via a tightly controlled action on different molecular effectors, including histone deacetylase, AKT, and TGFß signalling.In conclusion, our data suggest that local availability of T3 in the pancreas is required to promote acinar cell proliferation and provide the rationale to exploit thyroid hormone signalling to enhance pancreatic regeneration. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Correlates of sugar-sweetened beverage consumption of Malaysian preschoolers aged 3 to 6 years.

BACKGROUND: There is little information about the diet, lifestyle and parental characteristics associated with habitual sugar-sweetened beverage (SSB) consumption in Asian children. The aim of the present study was to assess cross-sectional associations between habitual SSB consumption and preschoolers' diet, physical activity, sedentary behaviour as well as parental and child characteristics in Malaysian preschoolers aged 3 to 6 y. METHODS: A total of 590 preschoolers, comprising 317 boys and 273 girls were included. Pre-pilot parental questionnaires were used to assess diet, physical activity (PA) and sedentary behaviour practices and anthropometry was assessed in preschoolers and their parents. RESULTS: Multiple logistic regression analyses showed that preschoolers with more frequent weekly intake of snacks [OR 2.7; 95% CI, 1.6-4.4; p < 0.001] and monthly fast food consumption [OR 3.5; 95% CI, 1.9-6.3; p < 0.001], were associated with higher SSB intake (≥5 days in a week), after adjustments of potential confounders. Preschoolers with higher daily fruit and vegetable intake had lower SSB intake [OR 0.4; 95% CI, 0.2-0.8; p = 0.011]. A positive association of higher weekly vigorous PA [OR 2.0; 95% CI, 1.1-3.7; p = 0.030] and daily screen-based practices [OR 2.0; 95% CI, 1.2-3.6; p < 0.001] on habitual SSBs intake was also substantiated. CONCLUSION: Multiple diet, physical activity and sedentary behaviour factors were significantly associated with SSB intake among Malaysian preschoolers. Continued effort is required to encourage healthier beverage choices, as well as healthy diet and active lifestyle practices among children during the critical early years of growth and development.

Birth anthropometry from a tertiary care hospital in Sri Lanka: Differs from the WHO growth standards.

BACKGROUND AND OBJECTIVES: The nutritional status of infants is assessed using the WHO growth references, based on the Multicenter Growth Reference Study (MGRS) in many countries including Sri Lanka. Birth parameters define infant growth curves. The aim of this study was to compare the birth anthropometric data of a healthy population of babies born in Colombo, Sri Lanka with the WHO MGRS birth data and determine its suitability for assessment of growth in this population. METHODS AND STUDY DESIGN: Birth data were obtained as part of a study on longitudinal infant body composition from birth to 2 years from 2015-2019. Healthy babies, born to non-smoking mothers, >18 years old, with a singleton pregnancy at term, living in the study area and intending to breastfeed, were recruited. The Ethical Review Committee of the Faculty of Medicine, University of Colombo, approved the study. RESULTS: Compared to WHO data, the mean birth weight (2.9±0.4 kg), length (48.2±2.7 cm) and head circumference (33.6±1.2 cm) of our study population (n=337) was significantly lower with a left shift in the z score distribution. This was despite similar background characteristics except for significantly lower income (USD 200) and lower maternal (154.2±9.0 cm) and paternal height (165±11.6 cm) in our study population. A significant change in birth parameters was only seen with maternal height when disaggregated. CONCLUSIONS: WHO birth parameters were significantly higher and underestimated the growth of healthy babies in Sri Lanka.

Mental Health Considerations for International Students.

Collectively, universities and other tertiary education providers globally, attract significant numbers of international students each year. However, the extent and significance of the benefits derived by the host society from this international mobility is often misunderstood, or at best, underestimated. International students commonly provide multiple benefits to the financial and cultural health of the host institution and country but the economic benefit (for the host) is typically the primary consideration. A potential challenge or circuit-breaker for host institutions is the failure to acknowledge the particular differences between the needs of international students and their domestic counterparts. For some international students, the adjustment to studying offshore and experiencing an array of academic and personal development possibilities not otherwise available to them in their home country, may be overwhelming and contribute to unforeseen and unfortunate consequences for their mental health. All students in new settings, irrespective of background, require strong guidance, advice and support. However, the challenges of acculturation and adjustment to the stressors of academic study and everyday life in another country is accentuated for many international students rendering them a vulnerable student population. Irrespective of the number of international students in an educational setting, and given the steady growth in the number of students seeking educational opportunities overseas, there is an urgent need to ensure that adequate resources are provided for the support of all international students across all aspects of academic life. The importance of maximising the benefits and minimising the risks associated with international study for overseas students cannot be overstated. A quality experience for all, underpinned by an evidence-based and resourced safety net of support with specific training for mental health professionals, should be considered a global industry standard.

Metabolic syndrome in rural Australia: An opportunity for primary health care.

OBJECTIVE: To measure the impact of a 6-month home-based behaviour change intervention on reducing the risk of chronic disease as determined by metabolic syndrome status and cardiovascular risk score, and discuss implications for primary care in rural areas. DESIGN: A two-arm randomised controlled trial of rural adults. SETTING: The rural town of Albany in the Great Southern region of Western Australia. PARTICIPANTS: Participants (n = 401) aged 50-69 years who were classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or waitlisted control (n = 200) group. INTERVENTIONS: A 6-month intervention program incorporating goal setting, self-monitoring and feedback, with motivational interviewing was conducted. MAIN OUTCOME MEASURES: Change in metabolic syndrome status and cardiovascular risk. RESULTS: Significant improvements in metabolic syndrome status and cardiovascular disease risk score (-0.82) were observed for the intervention group relative to control group from baseline to post-test. CONCLUSION: This home-based physical activity and nutrition intervention reduced participants' risk of experiencing a cardiovascular event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long-term chronic diseases. However, for realistic application in this setting, hurdles such as current national health billing system and availability of resources will need to be considered.

Inhibition of Class I Histone Deacetylases Abrogates Tumor Growth Factor ß Expression and Development of Fibrosis during Chronic Pancreatitis.

Pancreatic fibrosis is the hallmark of chronic pancreatitis, a highly debilitating disease for which there is currently no cure. The key event at the basis of pancreatic fibrosis is the deposition of extracellular matrix proteins by activated pancreatic stellate cells (PSCs). Transforming growth factor ß (TGFß) is a potent profibrotic factor in the pancreas as it promotes the activation of PSC; thus, pharmacologic interventions that effectively reduce TGFß expression harbor considerable therapeutic potential in the treatment of chronic pancreatitis. In this study, we investigated whether TGFß expression is reduced by pharmacologic inhibition of the epigenetic modifiers histone deacetylases (HDACs). To address this aim, chronic pancreatitis was induced in C57BL/6 mice with serial injections of cerulein, and the selective class 1 HDAC inhibitor MS-275 was administered in vivo in a preventive and therapeutic manner. Both MS-275 regimens potently reduced deposition of extracellular matrix and development of fibrosis in the pancreas after 4 weeks of chronic pancreatitis. Reduced pancreatic fibrosis was concomitant with lower expression of pancreatic TGFß and consequent reduced PSC activation. In search of the cell types targeted by the inhibitor, we found that MS-275 treatment abrogated the expression of TGFß in acinar cells stimulated by cerulein treatment. Our study demonstrates that MS-275 is an effective antifibrotic agent in the context of experimental chronic pancreatitis and thus may constitute a valid therapeutic intervention for this severe disease.

Estimating an Individual's Probability of Revision Surgery After Knee Replacement: A Comparison of Modeling Approaches Using a National Data Set.

Tools that provide personalized risk prediction of outcomes after surgical procedures help patients make preference-based decisions among the available treatment options. However, it is unclear which modeling approach provides the most accurate risk estimation. We constructed and compared several parametric and nonparametric models for predicting prosthesis survivorship after knee replacement surgery for osteoarthritis. We used 430,455 patient-procedure episodes between April 2003 and September 2015 from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. The flexible parametric survival and random survival forest models most accurately captured the observed probability of remaining event-free. The concordance index for the flexible parametric model was the highest (0.705, 95% confidence interval (CI): 0.702, 0.707) for total knee replacement and was 0.639 (95% CI: 0.634, 0.643) for unicondylar knee replacement and 0.589 (95% CI: 0.586, 0.592) for patellofemoral replacement. The observed-to-predicted ratios for both the flexible parametric and the random survival forest approaches indicated that models tended to underestimate the risks for most risk groups. Our results show that the flexible parametric model has a better overall performance compared with other tested parametric methods and has better discrimination compared with the random survival forest approach.

Graded Combined Aerobic Resistance Exercise (CARE) to Prevent or Treat the Persistent Post-concussion Syndrome.

PURPOSE OF REVIEW: To review the growing body of indirect and direct evidence that suggests that exercise can be helpful for children, adolescents, and adults with persistent symptoms following a mild traumatic brain injury (mTBI). RECENT FINDINGS: The direct evidence shows that graded exercise assessments are safe, and that aerobic exercise interventions are associated with improvement of multiple symptoms and other benefits, including earlier return-to-sport. The indirect evidence supports this approach via studies that reveal the potential mechanisms, and show benefits for related presentations and individual symptoms, including headaches, neck pain, vestibular problems, sleep, stress, anxiety, and depression. We document the forms of exercise used for the post-acute management of mTBI, highlight the knowledge gaps, and provide future research directions. We recommend trialing a new approach that utilizes a graduated program of individually prescribed combined aerobic resistance exercises (CARE) if mTBI symptoms persist. This program has the potential to improve patient outcomes and add to the management options for providers.

Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial.

BACKGROUND: This cluster randomised controlled trial aimed to determine if a 6- month home-based intervention could improve the physical activity and dietary behaviours of adults aged 60 to 80 years living in retirement villages located in Perth, Western Australia. METHODS: Participants (n = 363) from 38 retirement villages were recruited into the trial and allocated to the intervention (n = 197: 17 sites) or control (n = 166: 21 sites) group and were blinded. Previously validated instruments-Fat and Fibre Barometer and International Physical Activity Questionnaire, along with anthropometric measures (weight, height, waist and hip circumferences) and blood pressure were collected at baseline and 6 ï»¿-month time period. Comparisons between intervention and control groups were undertaken pre- and post- intervention using univariate chi-square and t-tests. Multi-level mixed regression analyses were then conducted to ascertain the effects of the intervention on changes in the outcome variables over time and between groups. RESULTS: A total of 139 (70.5%) intervention and 141 (84.9%) control group participants completed the program and post-test assessments. The intervention group demonstrated significant increases in time (80 min more per week on average) devoted to moderate-intensity physical activity, engagement in strength exercises (from 23.7% to 48.2%), frequency of fruit consumed as well as fat avoidance and fibre intake scores, in addition to a 0.5 kg mean reduction in weight post program, whereas no apparent changes were observed in the control group. Mixed regression results further confirmed statistically significant improvements in weight loss (p < 0.05), engagement in strength exercises (p < 0.001) and fruit intake (p = 0.012) by the intervention participants at post-test relative to their controls. CONCLUSIONS: Retirement offers a time to reassess lifestyle, and adopt positive health enhancing physical activity and dietary behaviours. This intervention was successful in improving weight, engagement in strength exercises, increasing levels of moderate-intensity physical activity and consumption of fruit among retirement village residents. Further investigation is needed on how to better engage retirement village managers in such programs. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry (ACTRN12612001168842) registered November 2, 2012.

Developing dimensions for a multicomponent multidisciplinary approach to obesity management: a qualitative study.

BACKGROUND: There have been consistent recommendations for multicomponent and multidisciplinary approaches for obesity management. However, there is no clear agreement on the components, disciplines or processes to be considered within such an approach. In this study, we explored multicomponent and multidisciplinary approaches through an examination of knowledge, skills, beliefs, and recommendations of stakeholders involved in obesity management. These stakeholders included researchers, practitioners, educators, and patients. METHODS: We used qualitative action research methods, including convergent interviewing and observation, to assist the process of inquiry. RESULTS: The consensus was that a multicomponent and multidisciplinary approach should be based on four central meta-components (patient, practitioner, process, and environmental factors), and specific components of these factors were identified. Psychologists, dieticians, exercise physiologists and general practitioners were nominated as key practitioners to be included. CONCLUSIONS: A complex condition like obesity requires that multiple components be addressed, and that both patients and multiple disciplines are involved in developing solutions. Implementing cycles of continuous improvement to deal with complexity, instead of trying to control for it, offers an effective way to deal with complex, changing multisystem problems like obesity.

Higher BMI is associated with stronger effects of social cues on everyday snacking behaviour.

Discretionary food choices (snacks) contribute up to a third of the daily energy intake and potentially contribute to energy imbalance and weight gain. Individual snack intake behaviour is guided by internal and external cues, with social cues (seeing others eat, being alone) consistently showing large effects. A wide body of (mainly laboratory-based) research suggests marked differences in people's response to eating cues based on BMI. Here, we show that these BMI differences in cue responsiveness also pertain to everyday snacking behaviour. In two combined ecological momentary assessment studies, 122 participants with BMIs ranging from 18.34 to 45.71 kg/m2 logged their everyday snacking behaviour in real-time over two weeks along with the presence or absence of social cues. Random-effects modelling showed that people with higher BMI were more likely to consume high-energy snacks when alone, and were more likely to consume low-energy snacks in the presence of others eating. This suggests BMI differences in cue responsiveness that are in line with impression management theory and underlines the importance of social cues for snacking behaviour and provides avenues for both theory and intervention development.

Process evaluation of the Albany Physical Activity and Nutrition (APAN) program, a home-based intervention for metabolic syndrome and associated chronic disease risk in rural Australian adults.

Issue addressed The Albany Physical Activity and Nutrition (APAN) study investigated the effects of the APAN program, a home-based intervention on dietary and physical activity behaviours and chronic disease risk for rural Australian adults. This paper reports on the process evaluation to gain insight into the link between intervention elements and outcomes. Methods The APAN program comprised resources to improve participants' diet and physical activity. Printed and online resources were provided to participants, complemented by motivational interviews via telephone. Process evaluation used mixed-methods, with a sample of 201 intervention participants residing in a disadvantaged rural area. Participants were aged 50 to 69 years with, or at risk of, metabolic syndrome. Quantitative data were collected using an online survey (n=73); qualitative data were collected via telephone exit interviews with intervention completers (n=8) and non-completers (n=8), and recruitment notes recorded by research assistants. Results The attrition rate of the program was 18%; major reasons for withdrawal were health and personal issues and a loss of interest. The majority of participants found the printed resources useful, attractive, and suitable to their age group. The website was the least preferred resource. Reasons for completing the program included the desired health benefits, wanting to honour the commitment, and wanting to assist with research. Conclusions Carefully planned recruitment will reduce the burden on resources and improve uptake. Understanding reasons for attrition such as family or personal barriers and health issues will assist practitioners to support participants overcome these barriers. Given participants' preference for printed resources, and the known effectiveness of these in combination with other strategies, investigating methods to encourage use of telephone and online support should be a priority. So what? This process evaluation provided an overview of recruitment challenges and preferred intervention components. It is desirable that future work determines the most effective intervention components for rural adults at risk of chronic disease.