The effectiveness of exercise prehabilitation on aerobic capacity, muscle strength and body composition in patients with cirrhosis awaiting liver transplantation: a systematic review and meta-analysis protocol.

INTRODUCTION: Cirrhosis is the main cause of morbidity and mortality globally, accounting for approximately 1.2 million deaths annually. Impaired aerobic capacity, muscle wasting and reduced muscle strength are significant complications in patients with cirrhosis. Preoperative exercise intervention "prehabilitation" has been recognised as a potential approach to optimise muscle strength, aerobic capacity and body composition as well as quality of life in patients awaiting abdominal surgery. However, there is little evidence on the effects of preoperative exercise on older adults with cirrhosis and awaiting liver transplant. Thus, the primary objective of this systematic review and meta-analysis will be to assess the effects of exercise interventions in improving aerobic capacity, muscle strength and body composition of older adults with cirrhosis and awaiting liver transplant. METHODS AND ANALYSIS: This systematic review and metaanalysis protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review will include all peer-reviewed randomised controlled trials (RCTs), including cluster RCTs, controlled (non-controlled), complex clinical trials (CCTs) or cluster trials, cohort, observational studies published in English from inception until July 2024. The following electronic databases will be searched: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO) and Scopus (Elsevier) and supplemented by a secondary screening of the reference lists of all included articles. Searches will involve studies with both male and female participants aged ≥ 18 years with cirrhosis and awaiting liver transplant. Primary outcomes will include muscle strength, and aerobic capacity. The secondary outcomes include body composition (e.g. body mass index, and thigh circumference). The Cochrane Collaboration Risk of Bias Tool will be used to evaluate quality of the studies and Review Manager (RevMan) V.5.3 (Copenhagen, Denmark: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Effect sizes will be expressed as a standardised mean difference, and their 95% confidence intervals will be calculated and presented as a forest plot. The standard χ2 and I2 tests will be used to test heterogeneity. CONCLUSION: This systematic review and meta-analysis is anticipated to provide meaningful and contemporary evidence on the effects of preoperative exercise in older adults living with cirrhosis and awaiting liver transplant. In addition, the findings will help clinicians with developing safe and effective preoperative exercise regimens for these patients.

A Qualitative Analysis of Workers Perceptions on the Role of Management in Promoting Health Behavior, Informed by the COM-B Model.

BACKGROUND: The primary objective of this study was to explore the viewpoints held by employees at a pharmaceutical manufacturing workplace in a middle-income country regarding management's role in promoting health behaviors in the workplace. METHODS: This study used transcripts of focus group discussion from an original study that investigated employee perceptions of factors associated with healthy behaviors among South African pharmaceutical manufacturing factory workers. RESULTS: Participants felt that workplace managers could improve capability through health promotion strategies, supportive leadership, and promoting a culture of health. They could provide opportunity through employee engagement programs and resources, and physical activity opportunities were specifically identified. CONCLUSIONS: This study demonstrates that managers in a middle-income country have the potential to contribute to workplace health in a range of ways that include addressing capability, opportunity, and motivation of their workers.

Obesity, beverage consumption and sleep patterns in rural African women in relation to advertising of these beverages.

BACKGROUND: The burden of obesity-related, non-communicable diseases in South Africa is persistent, with poor and black South African women particularly vulnerable. The purpose of the present study was to determine relationships between obesity, physical activity, sleep patterns and beverage consumption among black South African women in a rural village in the Limpopo province. METHODS: A cross-sectional study was conducted among 200 rural-dwelling African women. Data were collected on beverage consumption, sociodemographic information, sleep patterns and anthropometry using self-reported questionnaires. RESULTS: The mean body mass index (BMI) was 28.5±7.3 kg/m2, with 40% being classified as obese (BMI ≥30 kg/m2) and the mean sleep score was 4.68±2.51. Participants with very bad habitual sleeping patterns consumed significantly more sugar-sweetened beverages and alcohol than those with very good sleeping patterns. We also observed that when total coffee with sugar, fruit juice, total sugar-sweetened beverages and weight decreased the number of hours participants slept increased. CONCLUSIONS: The study identified significant associations between body weight, sleep duration and sugar-sweetened beverage consumption among rural black South African women. This underscores a need to address unhealthy lifestyle behaviours to lower incidences of non-communicable diseases in rural-dwelling women.

Ukumela impilo randomised trial: preliminary findings of height-adjustable sit-to-stand workstations on health outcomes of South African office workers.

BACKGROUND: The prevalence of sedentary behaviour has concurrently risen with multiple cardiometabolic risk markers independent of physical activity levels. Office-based workers accumulate the highest levels of sitting time during occupational times. This study aims to investigate the short-term effects of using height-adjustable sit-to-stand workstations on cardiometabolic risk markers of office-based workers in South Africa. RESULTS: Sixty-two office-based workers were randomized into intervention (n = 44), and the control group (n = 18). Small improvements were observed in BMI, blood pressure, and cholesterol levels in this cohort. CONCLUSION: This preliminary investigation confirms that short-term height-adjustable sit-stand interventions are effective in reducing workplace sitting time and selected health outcomes. South Africa has been attributed with the highest burden of obesity in Sub-Saharan Africa, as a result, there is a need to implement long-term workplace intervention to reverse these implications. TRIAL REGISTRATION: Pan African Clinical Trial Registry, PACTR201911656014962 on the 12th of November 2019.

Employee Perceptions of an Established Health and Wellness Coaching Program to Improve Behavior.

OBJECTIVE: There is limited evidence, particularly qualitative analysis, of health and wellness interventions within the South African workplace. The purpose of this study is to explore whether health and wellness coaching when offered as part of an employee wellness program has potential for developing lifestyle change in a South African workplace. METHODS: There were four, 45-minute focus group discussions, where employees discussed their experiences of the workplace health and wellness intervention program. RESULTS: Main categories identified from the coding of the transcripts were purpose of the health and wellness coaching program, as well as employees' program experience and improvement to the program. Common barriers to engagement, positive and negative experiences, and suggested improvements were defined by the employees. CONCLUSIONS: The study highlighted the need of understanding employee perceptions in the development and implementation of a workplace health and wellness program.

Employee perceptions of non-communicable diseases health risks, absenteeism and the role of organisational support in a South African pharmaceutical manufacturing company.

BACKGROUND: The growing prevalence of non-communicable diseases (NCDs) in South African workers has been shown to be associated with absenteeism and increased risk of morbidity. Low-income workers living in urban settings are particularly vulnerable. Consultation with workers is crucial for understanding risks and identifying opportunities for intervention to promote health in the workplace. The purpose of this study was to examine South African pharmaceutical manufacturing workers' perspectives of health risk factors and absenteeism, and to identify how they perceived a role for the organisation to initiate interventions to improve their health. MATERIALS AND METHODS: Five focus groups were conducted to capture 27 employees' perspectives. The semi-structured focus group discussions were recorded and analysed using a thematic content analysis approach. RESULTS: Participants indicated that they were aware of behavioural health risks such as prolonged sitting. They showed insight into strategies to prevent injuries and stay healthy, but also expressed dissatisfaction about the lack of organisational support, leading to stress and consequently absenteeism. Participants emphasized the responsibility of the organisation to support a range of health promoting strategies. CONCLUSIONS: The findings of this study are important for cultivating a tailored workplace intervention to reduce NCD risk factors in the pharmaceutical manufacturing workforce. It is vital that these be supported by leadership of the company through the provision of funding and the development of internal healthcare services.

The negative association of lower body fat mass with cardiometabolic disease risk factors is partially mediated by adiponectin.

Gluteofemoral fat correlates negatively with a number of cardiometabolic disease risk factors, but the mechanisms involved in these relationships are unknown. The aim of this study was to test the hypothesis that gluteofemoral fat attenuates the risk of cardiometabolic disease by increasing blood adiponectin levels. This was a cross-sectional study in which arm, leg, gluteofemoral, abdominal s.c. and visceral fat levels were measured by dual-energy X-ray absorptiometry in 648 African females. Fasting serum adiponectin, lipid, insulin and plasma glucose levels and blood pressure were measured. Relationships between variables were analysed using multivariable linear regression and structural equation modelling. Adiponectin correlated positively (ß = 0.45, P < 0.0001) with gluteofemoral fat in a multivariable regression model that included age, height, and arm, s.c. and visceral fat levels. In further regression models, there was a negative correlation of gluteofemoral fat with fasting glucose (ß = -0.28; P < 0.0001) and triglyceride levels (ß = -0.29; P < 0.0001) and insulin resistance (HOMA; ß = -0.26; P < 0.0001). Structural equation modelling demonstrated that adiponectin mediated 20.7% (P < 0.01) of the association of gluteofemoral fat with insulin resistance and 16.1% (P < 0.01) of the association with triglyceride levels but only 6.67% (P = 0.31) of the association with glucose levels. These results demonstrate that gluteofemoral and leg fat are positively associated with adiponectin levels and that the negative association of lower body fat with insulin resistance and triglyceride levels may partially be mediated by this adipokine. Further studies are required to determine other factors that mediate the effect of lower body fat on cardiometabolic disease risk factors.

Pharmaceutical workers' perceptions of physical activity and healthy eating: a qualitative study.

OBJECTIVE: The public health message 'move for health' is relevant given the high prevalence of insufficient physical activity, particularly in African countries. The call for behaviour modification including limiting unhealthy dietary patterns in these settings is therefore critical; however, there is limited knowledge on the adoption of health promotion strategies in the workplace. This study aimed to investigate workers' perceptions of physical activity and healthy eating. RESULTS: Five focus groups were conducted with 28 participants employed in a South African pharmaceutical manufacturing company to explore perceptions of physical activity and healthy eating. Results showed that two categories emerged: physical activity and unhealthy behaviours. Participants recognised the importance of obtaining sufficient physical activity in various domains, however believed that contemporary lifestyle limited opportunities for movement. Likewise, participants viewed healthy eating as unrealistic due to financial constraints. There was however agreement that total physical activity time could be increased during recreational pursuits outside of vocational time and may include intermittent walking for travel. These findings are important for workplace interventions and provide a more robust understanding of workers' perceptions of physical activity and healthy eating.

Physical activity, diet and quality of life during mandatory (COVID-19) quarantine following repatriation.

The coronavirus disease 2019 crisis in South Africa has been managed through an effective evidence-based approach. The aim of this case report was to determine the value of staying physically active during the coronavirus disease 2019 pandemic, using online resources to prevent the harmful effects of sedentary behaviour under confined living conditions. A repatriated South African citizen was placed into monitored 14-day quarantine confined to a room, self-monitoring dietary intake and physical and health measures, while engaged in online exercise videos and indoor walking. This study demonstrates that structured indoor activity improves physical and mental health outcomes, despite prolonged sitting time during the day. During the current pandemic and in the presence of limited freedom of movement, sustained physical activity is made feasible by accessing online tools and resources, essentially reducing vulnerability to existing cardiovascular health concerns. However, these findings are based on a single participant and therefore further study is required.

Development and validation of the body shape scale (BOSHAS) for assessing body shape perception in African populations.

BACKGROUND: As a consequence of 'Western' acculturation, eating disorders and body image disturbances, such as fatness phobia and body dysmorphic disorders towards musculature and body shape, are emerging in Africa, with young people the most affected. It is therefore important to accurately assess perceptions of body shape. However, the existing body image assessment scales lack sufficient accuracy and validity testing to compare body shape perception across different African populations. The purpose of this study was to develop and validate the Body Shape Scale (BOSHAS) to evaluate body shape perceptions related body image disorders in African populations. METHODS: To develop the BOSHAS, anthropometric measures of 80 Cameroonians and 81 Senegalese (both sexes included; 40.1% females overall) were taken for three body shape criteria: somatotype components, body mass index (BMI) and waist-to-hip ratio. Subjects were selected to cover a wide variability in body shape and were photographed in full face and profile positions. To validate the BOSHAS, the scale was administered twice (2 weeks apart) to 106 participants (aged 31.2 ± 12.6 years) to assess its reliability. In addition, a questionnaire measuring different aspects of body shape (e.g. musculature) was also administered (n = 597; aged 36.7 ± 15.6 years) to assess its convergent validity. RESULTS: The BOSHAS includes two sex-specific subscales of 10 photographs each. Most participants were able to repeat their BOSHAS preference order. Test-retest reliability was also consistent in estimating Current Body Shape (CBS), Desired Body Shape and Ideal Body Shape for participants and their partners. CBS was correlated with BMI, and different BOSHAS indices were consistent with declarations obtained by questionnaire. CONCLUSIONS: The BOSHAS is the first sex-specific scale of real African models photographed in face and profile, including large body shape variability. The validation protocol showed good validity and reliability for evaluating body shape perceptions and dissatisfaction of Africans.

Anthropometric and Motor Characteristics of South African National Level Female Soccer Players.

Data regarding anthropometric and motor characteristics of elite national level female soccer players are scarce. Determining these characteristics may likely assist in evaluating the specificity of current training programmes, identify players who might lack specific qualities deemed critical for the successful execution of their tactical roles, and benchmark norms for developing future playing talent. Therefore, the aims of this study were to describe anthropometric and motor characteristics of South African national level female soccer players (n = 37) and determine possible differences with regard to their playing position. The following measurements and tests were performed: anthropometry (body mass index and sum-of-skinfolds), the countermovement jump, sprints (10 m, 20 m and 40 m), upper body muscle endurance (push-ups) and the Yo-Yo Intermittent Recovery Test - level 1. One-way analysis of variance revealed few differences in the main outcome variables. Fischer Least Significant Difference (LSD) showed that strikers had a greater body mass index than midfielders and defenders (both p = 0.04) and goalkeepers were heavier than defenders (p = 0.02). Goalkeepers were slower than strikers and defenders over 10 m (p = 0.01; p = 0.03) and 20 m (p = 0.001; p = 0.01). Midfielders were slower than strikers over 20 m (p = 0.02), and with strikers and defenders over 40 m (both p = 0.04). Defenders performed better than goalkeepers in the upper body muscle endurance test (p = 0.02). In conclusion, both strikers and defenders require speed to win ball possession, which may explain their fast sprint times. However, the similarity of certain motor characteristics across playing positions may suggest that conditioning coaches train players similarly, irrespective of their tactical position. The authors suggest that South African fitness professionals, particularly at a club level, develop physical conditioning programs specific to each field position. Furthermore, fitness assessments should occur on a continuous basis and comparisons should be made with existing normative data in order to guide the development of players over the course of their careers.

Relationship Between Body Mass Index and Body Image Disturbances Among South African Mothers and Their Daughters Living in Soweto, Johannesburg.

In South African families, a phenomenon of mothers' acceptance of stoutness coexists with their daughters' appreciation for thinness. A sample of N = 615 mother-and-daughter pairs was recruited to conjointly identify the relationships toward body image and body mass index between both groups by assessing body weight satisfaction, body esteem, and eating disorders risk. We observed higher prevalence of obesity in mothers and higher eating disorders risk in daughters, while mother-daughter relationships were identified for body mass index and psychometric dimensions. The high prevalence of obesity in mothers and their tolerance for stoutness could expose their daughters to eating disorders and obesity.

Biocultural determinants of overweight and obesity in the context of nutrition transition in Senegal: a holistic anthropological approach.

Senegal is experiencing a rising obesity epidemic, due to the nutrition transition occurring in most African countries, and driven by sedentary behaviour and high-calorie dietary intake. In addition, the anthropological local drivers of the social valorization of processed high-calorie food and large body sizes could expose the population to obesity risk. This study aimed to determine the impact of these biocultural factors on the nutritional status of Senegalese adults. A mixed methods approach was used, including qualitative and quantitative studies. Between 2011 and 2013, fourteen focus group discussions (n=84) and a cross-sectional quantitative survey (n=313 women; n=284 men) of adults in three different socio-ecological areas of Senegal (rural: n=204; suburban: n=206; urban: n=187) were conducted. Dietary intake (Dietary Diversity Scores), physical activity (International Physical Activity Questionnaire), body weight norms (Body Size Scale), weight and health statuses (anthropometric measures and blood pressure) were measured. Middle-aged and older Senegalese women were found to value overweight/obesity more than younger Senegalese in all regions. In addition, young urban/suburban adults had a tendency for daily snacking whilst urban/suburban adults tended to be less physically active and had higher anthropometric means. A binary logistic regression model showed that being female, older, living in urban/suburban areas and valuing larger body size were independently associated with being overweight/obese, but not high-calorie diet. Univariate analyses showed that lower physical activity and higher socioeconomic status were associated with being overweight/obese. Finally, overweight/obesity, which is low in men, is associated with hypertension in the total sample. The nutrition transition is currently underway in Senegal's urban/suburban areas, with older women being more affected. Since several specific biocultural factors jointly contribute to this phenomenon, the study's findings suggest the need for local public health interventions that target women and which account for the anthropological specificities of the Senegalese population.

Influence of socioeconomic status on changes in body size and physical activity in ageing black South African women.

BACKGROUND: The increasing prevalence of obesity in sub-Saharan African women is not well understood, and black South African women in the region are particularly vulnerable. This study aimed to examine whether the relationship of socioeconomic status (SES) with changes in body mass index (BMI) and waist circumference (WC) is mediated by physical activity in ageing African women. METHODS: In a longitudinal analysis of the 518 caregivers associated with the Birth to Twenty Plus study, the role of SES associated with 10-year changes in BMI and WC was tested using structural equation modelling (SEM). The degree of mediation of moderate-vigorous physical activity (MVPA) and sitting time in this association was also assessed. RESULTS: The prevalence of obesity increased significantly from baseline to follow-up (p < 0.0001). In the SEM models, baseline SES had a direct positive effect on changes in BMI (ß, 95% CI, 0.02 (0.005 to 0.04), and a direct negative effect on changes in MVPA (ß, 95% CI, - 3.81 (- 6.92 to - 0.70). Baseline MVPA had a direct negative effect (ß, 95% CI, - 0.002 (- 0.003 to - 0.0003) and indirect positive effect via change in MVPA (ß, 95% CI, 0.01 (0.0001 to 0.001) on change in WC. CONCLUSIONS: Our study demonstrates the role and interaction of sociodemographic and behavioural predictors of obesity, and suggests a multifaceted approach to management of the crisis in communities of ageing urban African women.

Walking as a feasible means of effecting positive changes in BMI, waist, and blood pressure in black South African women.

BACKGROUND: In the context of a growing obesity pandemic in sub-Saharan African countries little is known on how to address the problem /disease in the region. METHODS: A randomised controlled trial of walking to decrease obesity was conducted using 115 women employed at the University of Venda, Limpopo province. 49 of these participants were randomly selected into an intervention group, which walked for 30 minutes, 3 days per week for a period of 12 weeks on treadmills located in the university gym. The control group were instructed to continue with usual activities. Baseline and follow-up body mass index (BMI), waist circumference, blood pressure (BP), body size discrepancy (measured by a feel-minus-ideal (FID) index), and physical activity were collected on all participants. RESULTS: The absolute changes in BMI, waist, systolic and diastolic BP in the intervention group was -0.80, -1.50, -4.02 and -2.37, respectively. In contrast, the absolute changes for these were +1.05, +1.73, +4.64 and +4.94, respectively in the control group. The results of the FID analysis showed that most had a desire for thinness. CONCLUSION: Our data demonstrates that positive changes in BMI, waist, and BP were observed in the intervention group, indicating the potential scalability of the intervention.

A comparative study on the cardiac morphology and vertical jump height of adolescent black South African male and female amateur competitive footballers.

OBJECTIVE: The aim of this comparative study was to determine the gender differences in cardiac morphology and performance in adolescent black South African footballers. METHODS: Anthropometry, electrocardiography and echocardiography data were measured in 167 (85 males and 82 females) adolescent black South African footballers (mean age: 14.8 ± 1.3 years). Vertical jump height was used as a performance measure of explosive lower-limb power. RESULTS: The males had less body fat compared with the females (12.1 ± 3.6 vs 16.8 ± 4.1%, p < 0.05), while females had higher left ventricular end-diastolic diameters compared with males (48.7 ± 3.7 vs 40.7 ± 8.1, p < 0.05). Vertical jump height was higher in males (37.2 ± 10.3) compared with females (31.2 ± 8) and was inversely associated with body fat (ß = -0.2, p < 0.05) and positively associated with lean mass (ß = 0.5, p < 0.05). CONCLUSION: The findings showed that adolescent black South African male footballers had a performance advantage over females for explosive lower-limb power, which was explained by differences in body composition and not cardiac morphology.

Factors associated with obesity and metabolic syndrome in ageing black South African women.

BACKGROUND: The incidence of obesity and related metabolic diseases is high and increasing in sub-Saharan African women. Evidence on the determinants of these diseases is limited, particularly in black South African women. OBJECTIVE: This PhD review attempts to understand the determinants of obesity and metabolic syndrome (MetS) in a population of ageing urban-dwelling black South African women. METHODS: Drawing on the longitudinal Birth-to-Twenty-Plus cohort, data were collected in 2002/03 and 2012/13, including information on behavioural factors (smoking, sitting time, physical activity, smokeless tobacco, and alcohol consumption), body-size perception, body composition (measures of adiposity and lean mass), blood pressure, and cardiometabolic biomarkers (lipid profile, fasting insulin, fasting blood glucose, insulin resistance, leptin, and adiponectin). RESULTS: The prevalence of obesity and related cardiovascular disease risk was high and increased significantly over the 10 year period. Despite most of the study population being physically active, sitting time was high and associated with elevated blood pressure and hypertriglyceridaemia. Two groups of people were observed, those who were happy and those who were unhappy with their body size. In logistic regression analysis, the risk of MetS was lowered by abdominal subcutaneous adipose tissue and adiponectin, and increased by age, smoking, truncal lean mass, and insulin resistance. CONCLUSIONS: Obesity was confirmed to be increasing in black South African women, despite most women being sufficiently active according to guidelines of ≥150 min activity/week. Nevertheless, the contribution of sitting time to poor health outcomes is evident in this study population and must be addressed, particularly in women who are content with being obese. The novel finding of the effects of abdominal subcutaneous tissue and truncal lean mass with MetS requires further investigation. The protective effect of adiponectin against MetS is an important finding which highlights the novel interaction between adiposity and cardiometabolic diseases in black South African women.

Review: Metabolic Syndrome in Black South African Women.

The prevalence of metabolic syndrome is increasing in African populations, and is particularly high in Black South African women (42%) vs women in the United Kingdom (23%) and the United States of America (36%). This population group is also known to have the highest prevalence of obesity in the sub-Saharan African region (42%), and consequently, a high risk of non-communicable diseases. In this article, we discuss factors (abdominal subcutaneous fat, visceral fat, lean mass, adiponectin, leptin, vitamin D, smoking and menopausal status) that have been investigated for their possible association with metabolic syndrome in African women, and discuss some recommendations for management of the syndrome. In particular, the infrastructural development of HIV/AIDS clinics in South Africa provides an ideal integrated platform to cater to the treatment needs of patients with multiple chronic morbidities.