Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial.

BACKGROUND AND AIMS: Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD. METHODS: The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health. RESULTS: The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P = .038; effect size 0.34], body mass index [mean difference -0.7 kg/m2 (95% CI -1.3; -0.1); P = .022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P = .044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P = .007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent. CONCLUSIONS: This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease.

Tracking of Cardiorespiratory Fitness from Childhood to Mid-adulthood.

High cardiorespiratory fitness (CRF) in adulthood is important for survival from major chronic diseases and preserving good health. We examined how childhood CRF tracks, or persists, into adulthood. Among a cohort of 748 school children followed over 34 years, we found child CRF correlated with young- (r = 0.30) and mid-adulthood (r = 0.16) CRF.

Physical Fitness and Body Mass Index Status of Hong Kong Primary Schoolchildren across the COVID-19 Pandemic, before and after School Closure.

OBJECTIVE: To determine whether health-related physical fitness and body mass index (BMI) status differed before and after school closure from the COVID-19 pandemic in a population-based cohort of Hong Kong primary schoolchildren. STUDY DESIGN: We examined the BMI z score, BMI status, and physical fitness z scores including (i) upper limb muscle strength, (ii) 1-minute sit-up test, (iii) sit-and-reach test, and (iv) endurance run tests, among 3 epochs: prepandemic (September 2018-August 2019), before school closure (September 2019-January 2020), and partial school reopening (September 2021-August 2022), using a repeated cross-sectional approach. RESULTS: A total of 137 752 primary schoolchildren aged 6-12 years were recruited over 3 academic years. Obesity increased significantly from 25.9% in 2018/19 to 31.0% in 2021/22, while underweight increased slightly from 6.1% to 6.5%. All tested parameters were adversely affected by the pandemic. The negative trend over time was far more pronounced in all 4 physical fitness scores in the underweight group, although performance in handgrip strength had no significance between 2018/19 and 2021/22. CONCLUSIONS: Schoolchildren who are both underweight and overweight/obese are vulnerable to adverse changes in physical fitness during the COVID-19 pandemic. To eliminate the negative health and fitness outcomes, it is urgent to develop strategies for assisting schoolchildren in achieving a healthy weight, especially in the postpandemic era.

Effect of Physical Exercise on MRI-Assessed Brain Perfusion in Chemotherapy-Treated Breast Cancer Patients: A Randomized Controlled Trial.

BACKGROUND: Exercise is a promising intervention to alleviate cognitive problems in breast cancer patients, but studies on mechanisms underlying these effects are lacking. PURPOSE: Investigating whether an exercise intervention can affect cerebral blood flow (CBF) in cognitively impaired breast cancer patients and to determine if CBF changes relate to memory function. STUDY TYPE: Prospective. POPULATION: A total of 181 chemotherapy-treated stage I-III breast cancer patients with cognitive problems and relatively low physical activity levels (≤150 minutes moderate to vigorous physical activity per week), divided into an exercise (N = 91) or control group (N = 90). FIELD STRENGTH/SEQUENCE: Two-dimensional echo planar pseudo-continuous arterial spin labeling CBF sequence at 3 T. ASSESSMENT: The 6-month long intervention consisted of (supervised) aerobic and strength training, 4 × 1 hour/week. Measurements at baseline (2-4 years post-diagnosis) and after 6 months included gray matter CBF in the whole brain, hippocampus, anterior cingulate cortex, and posterior cingulate cortex. Physical fitness and memory function were also assessed. Subgroup analyses were performed in patients with high fatigue levels at baseline. STATISTICAL TESTS: Multiple regression analyses with a two-sided alpha of 0.05 for all analyses. RESULTS: There was a significant improvement in physical fitness (VO2peak in mL/minute/kg) in the intervention group (N = 53) compared to controls (N = 51, ß = 1.47 mL/minute/kg, 95% CI: 0.44-2.50). However, no intervention effects on CBF were found (eg, whole brain: P = 0.565). Highly fatigued patients showed larger but insignificant treatment effects on CBF (eg, whole brain: P = 0.098). Additionally, irrespective of group, a change in physical fitness was positively associated with changes in CBF (eg, whole brain: ß = 0.75, 95% CI: 0.07-1.43). There was no significant relation between CBF changes and changes in memory performance. DATA CONCLUSION: The exercise intervention did not affect CBF of cognitively affected breast cancer patients. A change in physical fitness was associated with changes in CBF, but changes in CBF were not associated with memory functioning. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 5.

Impact of physical fitness and exercise training on subcutaneous adipose tissue beiging markers in humans with and without diabetes and a high-fat diet-fed mouse model.

AIMS: Exercise training induces white adipose tissue (WAT) beiging and improves glucose homeostasis and mitochondrial function in rodents. This could be relevant for type 2 diabetes in humans, but the effect of physical fitness on beiging of subcutaneous WAT (scWAT) remains unclear. This translational study investigates if beiging of scWAT associates with physical fitness in healthy humans and recent-onset type 2 diabetes and if a voluntary running wheel intervention is sufficient to induce beiging in mice. MATERIALS AND METHODS: Gene expression levels of established beiging markers were measured in scWAT biopsies of humans with (n = 28) or without type 2 diabetes (n = 28), stratified by spiroergometry into low (L-FIT; n = 14 each) and high physical fitness (H-FIT; n = 14 each). High-fat diet-fed FVB/N mice underwent voluntary wheel running, treadmill training or no training (n = 8 each group). Following the training intervention, mitochondrial respiration and content of scWAT were assessed by high-resolution respirometry and citrate synthase activity, respectively. RESULTS: Secreted CD137 antigen (Tnfrsf9/Cd137) expression was three-fold higher in glucose-tolerant H-FIT than in L-FIT, but not different between H-FIT and L-FIT with type 2 diabetes. In mice, both training modalities increased Cd137 expression and enhanced mitochondrial content without changing respiration in scWAT. Treadmill but not voluntary wheel running led to improved whole-body insulin sensitivity. CONCLUSIONS: Higher physical fitness and different exercise interventions associated with higher gene expression levels of the beiging marker CD137 in healthy humans and mice on a high-fat diet. Humans with recent-onset type 2 diabetes show an impaired adipose tissue-specific response to physical activity.

Effects of a staff-led multicomponent physical activity intervention on preschooler's fundamental motor skills and physical fitness: The ACTNOW cluster-randomized controlled trial.

BACKGROUND: Fundamental motor skills (FMS) and physical fitness (FIT) play important roles in child development and provide a foundation for lifelong participation in physical activity (PA). Unfortunately, many children have suboptimal levels of PA, FMS, and FIT. The Active Learning Norwegian Preschool(er)s (ACTNOW) study investigated the effects of a staff-led PA intervention on FMS, FIT, and PA in 3-5-year-old children. METHODS: Preschools in Western Norway having ≥ six 3-4-year-old children were invited (n = 56). Of these, 46 agreed to participate and were cluster-randomized into an intervention (n = 23 preschools [381 children, 3.8 yrs., 55% boys]) or a control group (n = 23 [438, 3.7 yrs., 52% boys]). Intervention preschools participated in an 18-month PA intervention involving a 7-month staff professional development between 2019 and 2022, amounting to 50 h, including face-to-face seminars, webinars, and digital lectures. Primary outcomes in ACTNOW were cognition variables, whereas this study investigated effects on secondary outcomes. FMS was measured through 9 items covering locomotor, object control, and balance skills. FIT was assessed as motor fitness (4 × 10 shuttle-run test) and upper and lower muscular strength (handgrip and standing long jump). PA was measured with accelerometers (ActiGraph GT3X +). All measures took place at baseline, 7-, and 18-month follow-up. Effects were analysed using a repeated measures linear mixed model with child and preschool as random effects and with adjustment for baseline scores. RESULTS: Participants in the intervention preschools showed positive, significant effects for object control skills at 7 months (standardized effect size (ES) = 0.17) and locomotor skills at 18 months (ES = 0.21) relative to controls. A negative effect was found for handgrip strength (ES = -0.16) at 7 months. No effects were found for balance skills, standing long jump, or motor fitness. During preschool hours, sedentary time decreased (ES = -0.18), and light (ES = 0.14) and moderate-to-vigorous PA (ES = 0.16) increased at 7 months, whereas light PA decreased at 18 months (ES = -0.15), for intervention vs control. No effects were found for other intensities or full day PA. CONCLUSIONS: The ACTNOW intervention improved some FMS outcomes and increased PA short-term. Further research is needed to investigate how to improve effectiveness of staff-led PA interventions and achieve sustainable improvements in children's PA, FMS, and FIT. TRIAL REGISTRATION: Clinicaltrials.gov, identifier NCT04048967 , registered August 7, 2019. FUNDING: ACTNOW was supported by the Research Council of Norway (grant number 287903), the County Governor of Sogn og Fjordane, the Sparebanken Sogn og Fjordane Foundation, and the Western Norway University of Applied Sciences.

Secular trends of physical fitness in Austrian children attending sports schools: An analysis of repeated cross-sections from 2006 to 2023.

BACKGROUND: Physical fitness (PF) offers numerous physical and mental health benefits, especially during childhood. Previous studies investigating trends in children's PF over the years reported contradictory findings. OBJECTIVE: To identify and analyse secular trends in PF among Austrian schoolchildren from 2006 to 2023. METHOD: A repeated cross-sections design was used to examine the PF of children enrolling in sports schools between 2006 and 2023. During this period, a standardized eight-item motor performance testing battery was administered yearly to capture markers of strength, speed, endurance, agility and reaction time in Austrian schools. RESULTS: A total of n = 3827 children (996 girls) with a mean age of 9.9 ±â€¯1.0 years were included. Linear mixed models indicated significant declines in sprint performance (5, 10, 20 m), tapping, jump (long jump and drop jump), throwing (medicine ball), and agility (snake run). No changes were observed in cardiorespiratory fitness (8 min run) or reaction time. CONCLUSION: There has been a steady decline in PF among Austrian children attending sports schools. This finding underscores the need for enhanced PF monitoring and training in schools to improve public health outcomes.

Possible determinants of physical fitness in Japanese school children: A cross-sectional study.

BACKGROUND: Physical fitness is one of the most important health indicators in children. Although appropriate body composition or certain lifestyle factors such as frequent physical activity are thought to improve physical fitness, results of previous studies are inconsistent, and most studies were from Western countries. OBJECTIVES: We investigated associations of body composition and modifiable lifestyle factors such as physical activity, screen time, diet and sleep duration with physical fitness in Japanese primary school children. METHODS: 2308 children (age 10-12 years old) in 12 primary schools were analysed in this cross-sectional study. Physical fitness was evaluated by sports battery tests conducted routinely and annually at schools. The total score of sports battery tests, 20-m shuttle run (laps) and grip strength (kg) were selected as outcomes. Information about lifestyle factors was collected by two questionnaires. Associations between lifestyle factors and physical fitness were assessed by multivariable linear mixed models by sex. RESULTS: Frequent exercise was related to better overall physical fitness. Regarding the 20-m shuttle run, many unfavourable lifestyle factors such as higher BMI in boys (ß -7.37, 95% confidence interval [CI] -8.39, -6.35) and girls (ß -3.54, 95% CI -4.50, -2.58), longer screen time (ß -4.31, 95% CI -7.29, -1.34) in boys and girls (ß -5.65, 95% CI -9.01, -2.30); shortest (reference) versus longest, breakfast skipping in boys (ß -5.24, 95% CI -8.71, -1.77) and girls (ß -3.57, 95% CI -6.84, -0.30); consumers (reference) versus skippers were associated with worse performance. Better quality of diet was associated with better results in the 20-m shuttle run only in girls (ß 2.58, 95% CI 0.24, 4.93); lowest (reference) versus highest. CONCLUSIONS: Frequent exercise was related to better physical fitness. Higher BMI and unfavourable lifestyle factors such as longer screen time and breakfast skipping were associated with worse results of the 20-m shuttle run.

Physical fitness in Indian women with epilepsy on anti-seizure medications and its association with reproductive status, quality of life and stigma: A cross-sectional study.

PURPOSE: To determine the status of physical fitness, reproductive abnormalities, QOL and epilepsy associated stigma in women with epilepsy (WWE) and their association with ASM therapy and seizure frequency. METHODS: This cross-sectional study included WWE of reproductive age (18-50 years) on antiseizure medications (ASMs) for at least three months before enrolment. Physical fitness was assessed using International Physical Activity Questionnaires (IPAQ) and Body composition analysis. Subjects were interviewed for menstrual abnormalities [menstrual disturbance or Polycystic Ovary Syndrome (PCOS)/hirsutism]. Validated questionnaires were used for assessment of, QOL (QOLIE-10) and Stigma in epilepsy (Epilepsy Stigma Scale). Sub-group analysis was done to compare the above parameters on the basis of a) type of therapy (mono or polytherapy), b) type of ASMs treatment (conventional, newer, or conventional + newer ASMs), and c) seizure type and (d) seizure frequency. Correlation and regression analysis were done to find out the association among different variables with physical fitness. RESULTS: The overall prevalence of poor physical fitness, reproductive abnormalities, worsened QOL and stigma in the enrolled WWE (n = 203) were 21.18 %, 20.19 %, 52.7 %, and 21.67 %, respectively. Sub-group analysis revealed that WWE on monotherapy (n = 99) had higher median IPAQ score (p = 0.002), comparatively less reproductive abnormalities (24.03 %, p = 0.008), and higher stigma (24.03 %, p = 0.04) than polytherapy group. WWE on conventional ASMs had significantly higher IPAQ scores compared to newer and conventional + newer ASMs groups (p = 0.02). The prevalence of poor physical fitness and stigma was significantly higher in WWE with higher number of seizures (p = 0.007, <0.001, respectively). No significant difference in QOL was observed on the basis of ASM type and therapy; however, WWE with generalized onset seizures had worsened QOL compared to those with focal onset seizures (p = 0.04). A significant negative correlation was found among seizure frequency and IPAQ score in WWE (p = 0.04). CONCLUSION: WWE on polytherapy were physically less active, higher occurrence of reproductive abnormalities, and stigma compared to the monotherapy group. WWE with higher seizure frequency had poor physical fitness, and higher stigma compared to those with lesser number of seizures. These findings may aid value in optimization of ASM treatment in WWE of reproductive age.

We like to move it - patients with schizophrenia spectrum disorders are impaired in estimating their physical fitness levels and benefit from individualized exercise.

BACKGROUND: People with schizophrenia spectrum disorders (SSD) engage less in physical activity than healthy individuals. The impact of subjectively assessed physical fitness levels on motivation for sports engagement and its relation to objective fitness parameters in SSD is unclear. METHODS: 25 patients with SSD (P-SSD) and 24 healthy controls (H-CON) participated in a randomized controlled study. Individual anaerobic thresholds (AT) were determined by an incremental exercise test and on separate days, aerobic exercise (cycling at 80% of workload at AT) and non-exercise control (sitting on an ergometer without cycling) sessions were performed. Demographic, clinical and objective physical fitness data (i.e., weekly physical activity, workload at AT, heart rate) were collected. Subjective physical fitness parameters were assessed before and after exercise and control sessions. RESULTS: Weekly physical activity in P-SSD was lower than in H-CON (p < 0.05) attributed to reduced engagement in sport activities (p < 0.001). Workload and percentage of predicted maximal heart rate at AT were also reduced in P-SSD compared to H-CON (both p < 0.05). Although objective and subjective physical fitness parameters were related in H-CON (p < 0.01), this relationship was absent in P-SSD. However, during exercise sessions subjective physical fitness ratings increased to a stronger extent in P-SSD than H-CON (p < 0.05). CONCLUSION: The missing relationship between subjective and objective physical fitness parameters in people with SSD may represent a barrier for stronger engagement in physical activity. Accordingly, supervised exercise interventions with individually adjusted workload intensity may support realistic subjective fitness estimations and enhance motivation for sports activity in individuals with SSD.

Effects of qigong exercise on physical fitness and patient-reported health outcomes in lung cancer survivors.

PURPOSE: The aim of this study was to investigate the effects of a three-month Guolin Qigong (GQ) intervention on physical fitness and patient-reported health outcomes among patients with lung cancer. METHODS: This pilot study was a non-randomized controlled trial. Eligible participants who were over 18 years of age and diagnosed with stage I-IV lung cancer were enrolled in the study and received either the GQ intervention or usual care (UC). Participants in the GQ group performed GQ at least twice a week (one hour per session) for three months. Physical fitness (chair stand, arm curl, sit and reach, back scratch, 8-foot up and go, 6-min walk test) was assessed at baseline, post-intervention, six months, and 12 months. Self-reported quality of life and sleep (European Organization for Research and Treatment of Cancer Quality of Life questionnaire and Pittsburgh Sleep Quality Index) were assessed at baseline, post-intervention, and six months. RESULTS: Forty-nine participants (65% females, 59.1 ± 7.0 years old, ranging from 39 to 71 years old) were enrolled in the study, and 25 participants completed all tests at 12-month follow-up (13 in GQ vs. 12 in UC; 68% females, 59.3 ± 5.5 years old). Compared to the UC group, results for the chair stand and arm curl tests improved significantly in the GQ group from baseline to post-intervention (P = 0.024 and P = 0.041, respectively). Similarly, the 8-foot up and go test improved in the GQ group from baseline to post-intervention and 12 months (P = 0.004 and P = 0.008, respectively) when compared to the UC group. Between-group analyses also revealed a statistically significant improvement in global health status/quality of life from baseline to six months (P = 0.018) and quality of sleep from baseline to post-intervention (P = 0.034) in favor of the GQ group. CONCLUSION: GQ had a beneficial effect on lower and upper body strength, locomotor performance (speed, agility, and balance while moving), quality of sleep, and quality of life among lung cancer survivors, but further randomized controlled trials are warranted to confirm these findings. TRIAL REGISTRATION: The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR2200059145).

Effects of multi-gravitational suspension-based therapy on posture, physical fitness, quality of life, depression, and sleep quality in women without regular exercise habits.

BACKGROUND: Multi-gravitational suspension-based therapy (M-Gravity) is a comprehensive discipline based on the principles of non-gravity, which serves to increase the quality of life and holistic health of the individual with the rehabilitation content of non-pressure inversion therapy and suspension systems. AIMS: To examine the effects of M-Gravity exercise on posture, physical fitness, quality of life, depression, and sleep quality in women without regular exercise habits. METHODS: This study included 20 women without regular exercise habits, who participated in M-Gravity exercise and 20 women who did not participate in any exercise program. Posture was measured by the New York posture rating chart, flexibility of the hamstring and pectoral muscles were assessed with flexibility tests, and endurance of the core muscles was measured with plank test. Depression levels were measured by Beck Depression Inventory, sleep quality was measured by Pittsburgh Sleep Quality Index, and Nottingham Health Profile was used to measure the perceived health levels of the subjects. Measurement of the core stability was performed with the Stabilizer Pressure Biofeedback. Two evaluations were made at baseline and after 4 weeks of exercise program. RESULTS: Although statistically significant results were achieved for all parameters in the M-Gravity group, no differences were observed in the control group between baseline and post-test scores (p < 0.05). CONCLUSIONS: We came to the idea that eight sessions of M-Gravity program may have positive effects on posture, physical fitness and quality of life in women who do not have regular exercise habits.

Steps per day and health-related quality of life in schoolchildren: the mediator role of cardiorespiratory fitness.

To analyse the relationship between steps per day and health-related quality of life (HRQoL) and cardiorespiratory fitness (CRF) and to examine whether the relationship between steps per day and HRQoL is mediated by CRF in schoolchildren. This was a cross-sectional study including 501 schoolchildren (aged 9-12 years, 47% girls), from Cuenca, Spain. Steps per day were measured using the Xiaomi Mi Band 3 Smart Bracelet, HRQoL was estimated by the KIDSCREEN-27 questionnaire, and CRF was assessed using the 20-m shuttle run test. Analysis of covariance and multivariate analysis of covariance models showed that children with a higher mean number of steps per day (> 9000 steps/day) had better HRQoL (global score, and physical and psychological well-being) and higher CRF levels than their peers with a lower number of steps per day (p < 0.05); however, these differences were no longer significant when controlling for sex, age, mother's education level, and CRF (p > 0.05). Linear regression models estimated that each 1000-step increment was associated with better CRF (ß = 0.350; 95% CI, 0.192 to 0.508). In addition, the relationship between steps per day and HRQoL was mediated by CRF (p < 0.05).    Conclusion: Steps per day are a good metric to estimate daily physical activity because of its positive relationship with CRF. Moreover, those children taking more than 9000 steps per day are associated with higher levels of physical and psychological well-being. Finally, a substantial part of the improvement in HRQoL achieved through the increase in physical activity (steps per day) is mediated by CRF. What is Known: • Physical activity is known to have a positive impact on health-related quality of life in children. Steps per day are commonly used as a measure of physical activity. • Cardiorespiratory fitness is a recognized indicator of overall health in youth. What is New: • Increments of steps per day were associated with better CRF, with a nonlinear association after approximately 9000 steps/day. • Schoolchildren with > 9000 steps/ day showed better HRQoL.

Adiponectin concentration and cardiometabolic risk factors: the moderator role of cardiorespiratory fitness in adolescents.

The aim of this study was to examine the moderating role of cardiorespiratory fitness (CRF) between the relationship of cardiometabolic risk factors and adiponectin in adolescents. This is a cross-sectional study conducted with 255 adolescents of both sexes, aged 11 to 17 years. Anthropometric and biochemical parameters such as body mass, height, fat mass (FM), fat-free mass, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, adiponectin, systolic blood pressure, diastolic blood pressure, and peak oxygen consumption (VO2peak) were measured. Body mass index z-score (BMI-z), tri-ponderal mass index (TMI), homeostasis model assessment insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and age peak height velocity were calculated. The moderation analyses were tested using linear regression models. Interaction was observed with low CRF, indicating that those who achieved more than 2.27 (BMI-z), 2.18 (TMI), 2.10 (FM), 2.57 (insulin), 2.65 (HOMA-IR), and 2.81 (QUICKI) in L·min-1 on the CRF test may experience reduced risks in cardiometabolic risk factors. CONCLUSION: The deleterious effects attributed to excess adiposity and unfavorable changes related to insulin resistance and sensitivity may be attenuated by CRF. WHAT IS KNOWN: • Adiponectin, a protein derived from adipose tissue, may play a role as a potential marker of protection and predictor of cardiometabolic disorders and its relationship with cardiorespiratory fitness is controversial. WHAT IS NEW: • The deleterious effects attributed to overweight and unfavorable changes related to insulin resistance and sensitivity may be attenuated by high cardiorespiratory fitness in adolescents.

Physical fitness in children with Marfan and Loeys-Dietz syndrome: associations between cardiovascular parameters, systemic manifestations, fatigue, and pain.

Children with Marfan (MFS) and Loeys-Dietz syndrome (LDS) report limitations in physical activities, sports, school, leisure, and work participation in daily life. This observational, cross-sectional, multicenter study explores associations between physical fitness and cardiovascular parameters, systemic manifestations, fatigue, and pain in children with MFS and LDS. Forty-two participants, aged 6-18 years (mean (SD) 11.5(3.7)), diagnosed with MFS (n = 36) or LDS (n = 6), were enrolled. Physical fitness was evaluated using the Fitkids Treadmill Test's time to exhaustion (TTE) outcome measure. Cardiovascular parameters (e.g., echocardiographic parameters, aortic surgery, cardiovascular medication) and systemic manifestations (systemic score of the revised Ghent criteria) were collected. Pain was obtained by visual analog scale. Fatigue was evaluated by PROMIS® Fatigue-10a-Pediatric-v2.0-short-form and PROMIS® Fatigue-10a-Parent-Proxy-v2.0-short-form. Multivariate linear regression analyses explored associations between physical fitness (dependent variable) and independent variables that emerged from the univariate linear regression analyses (criterion p < .05). The total group (MFS and LDS) and the MFS subgroup scored below norms on physical fitness TTE Z-score (mean (SD) -3.1 (2.9); -3.0 (3.0), respectively). Univariate analyses showed associations between TTE Z-score aortic surgery, fatigue, and pain (criterion p < .05). Multivariate analyses showed an association between physical fitness and pediatric self-reported fatigue that explained 48%; 49%, respectively, of TTE Z-score variance (F (1,18) = 18.6, p ≤ .001, r2 = .48; F (1,15) = 16,3, p = .01, r2 = .49, respectively).    Conclusions: Physical fitness is low in children with MFS or LDS and associated with self-reported fatigue. Our findings emphasize the potential of standardized and tailored exercise programs to improve physical fitness and reduce fatigue, ultimately enhancing the physical activity and sports, school, leisure, and work participation of children with MFS and LDS. What is Known: • Marfan and Loeys-Dietz syndrome are heritable connective tissue disorders and share cardiovascular and systemic manifestations. • Children with Marfan and Loeys-Dietz syndrome report increased levels of disability, fatigue and pain, as well as reduced levels of physical activity, overall health and health-related quality of life. What is New: • Physical fitness is low in children with Marfan and Loeys-Dietz syndrome and associated with self-reported fatigue. • Our findings emphasize the potential of standardized and tailored exercise programs to improve physical fitness and reduce fatigue, ultimately enhancing the physical activity and sports, school, leisure, and work participation of children with Marfan and Loeys-Dietz syndrome.

Validation of VO2max Prediction Using International Formulae for Young Saudi Men.

Objectives: In this study, we aimed to assess the maximal oxygen uptake (VO2max) of young, healthy, non-athletic Saudi men using maximum graded exercise with instant breath-by-breath analysis and to compare this value to the predicted VO2max by international formulae. Methods: In this cross-sectional study, 88 young non-athletic normal-weight Saudi subjects were recruited from Eastern Province of Saudi Arabia with mean age (21.3 ± 1.5 years), weight: (64.7 ± 7.5 kg), height: (172.3 ± 6.1 cm) and body mass index: (21.8 ± 2.1). All subjects were interviewed and examined for eligibility, after which they performed maximum graded exercise testing on a treadmill to obtain VO2max. The predicted VO2max was also generated using the following formulae (Edvardsen, Fairbarns, FRIENDS, Hansen, and Jones). Results: The mean measured VO2max was 41.9 ± 7.2 ml/kg/min. While the predicted VO2max using the formulae were: Edvardsen = 66.8 ± 7.9, Fairbarns = 64.1 ± 4.7, FRIENDS = 53.5 ± 2.2, Hansen = 42.8 ± 0.54, and Jones = 50.9 ± 5.1 ml/kg/min. There was a significant difference between all the predicted VO2max and the measured one using the paired t-test (P < 0.001), except for the Hansen's predicted value (P = 0.212). The effect size index (Cohen's d) for the comparison of Hansen's VO2max and measured VO2max was trivial and equal to 0.13. The Bland-Altman test showed good agreement between the measured and Hansen's predicted VO2max. Conclusion: This study demonstrated the mean VO2max value of young, healthy, and non-athletic Saudi men. This value was lower than Western values, which might be due to low physical activity or racial differences. Most international formulae overestimate the VO2max in this population, except for the Hansen equation. Therefore, Hansen's predicted VO2max might be the best available reference value for the diagnosis and prognosis of young Saudi individuals undergoing maximum exercise testing.

Effects of Inspiratory Muscle Training on Stress Urinary Incontinence in North African Women: A Randomized Controlled Trial.

INTRODUCTION AND HYPOTHESIS: Pelvic floor muscles (PFMs) are involved in respiratory mechanisms. Additionally, stress urinary incontinence (SUI) can affect physical function. This randomized controlled trial was aimed at investigating the effects of inspiratory muscle training (IMT) on SUI severity, PFM function, and physical function in Tunisian women with SUI. METHODS: Twenty-seven incontinent women were randomly assigned to either the experimental group or the control group. The following parameters were assessed: respiratory muscle strength (RMS; maximal inspiratory and expiratory pressures), SUI severity (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; pad test), PFM function (Modified Oxford Scale, electromyography, and endurance), and physical function (Timed Up & Go test; 6-min walk test; incremental shuttle walking test). IMT was conducted using threshold IMT. RESULTS: The IMT program significantly reduced the severity of SUI (p < 0.01), improved PFM function (p < 0.001), enhanced physical function (p < 0.01), and increased RMS (p < 0.001). CONCLUSION: Inspiratory muscle training could be an effective method for improving pelvic floor disorders and physical function in women with SUI.

Evaluation of salivary α-amylase and immunoglobulin A responses after endurance exercise in adolescent males and females with similar aerobic fitness.

The objective of this study was to clarify whether there are sex-specific differences in salivary α-amylase and immunoglobulin A responses following acute endurance exercise in adolescent males and females with equivalent cardiorespiratory fitness levels. Twenty-six aerobically trained adolescent males and females with similar training status were enrolled in this study. Each individual executed a 1-h prolonged cycling exercise corresponding to a constant power output at 65% of peak oxygen uptake. Unstimulated whole salivary samples were taken with the passive drooling method at the 10-min period before and after exercise for the determination of salivary responses [α-amylase, immunoglobulin A, total protein and flow rate]. Salivary α-amylase activity, immunoglobulin A concentration and total protein concentration were significantly augmented immediately after acute endurance exercise. Regarding sex differences, only the salivary flow rate was significantly lower in females than in males. The findings of the present study imply that adolescent males and females appear to have similar salivary responses after acute endurance exercise, as represented by salivary α-amylase activity and immunoglobulin A concentration in connection with total protein concentration and salivary flow rate, when they are matched for peak oxygen uptake relative to fat-free body mass.

Association of neighbourhood walkability and haemoglobin A1c levels among Latino and non-Hispanic White patients with diabetes.

BACKGROUND: Neighbourhood walkability can benefit cardiovascular health. Latino patients are more likely than non-Hispanic White patients to have diabetes, and evidence has shown better diabetes-related outcomes for patients living in neighbourhoods conducive to physical activity. Our objective was to determine whether neighbourhood walkability was associated with haemoglobin A1c (HbA1c) levels among English- and Spanish-preferring Latino patients compared to non-Hispanic White patients. METHODS: We used electronic health record data from patients in the OCHIN, Inc. network of community health centres (CHC) linked to public walkability data. Patients included those age ≥ 18 with ≥ 1 address recorded, with a study clinic visit from 2012 to 2020, and a type 2 diabetes diagnosis (N = 159,289). Generalized estimating equations logistic regression, adjusted for relevant covariates, was used to model the primary binary outcome of always having HbA1c < 7 by language/ethnicity and walkability score. RESULTS: For all groups, the walkability score was not associated with higher odds and prevalence of always having HbA1c < 7. Non-Hispanic White patients were most likely to have HbA1c always < 7 (prevalence ranged from 32.8% [95%CI = 31.2-34.1] in the least walkable neighbourhoods to 33.4% [95% CI 34.4-34.7] in the most walkable), followed by English-preferring Latinos (28.6% [95%CI = 25.4-31.8]-30.7% [95% CI 29.0-32.3]) and Spanish-preferring Latinos (28.3% [95% CI 26.1-30.4]-29.3% [95% CI 28.2-30.3]). CONCLUSIONS: While walkability score was not significantly associated with glycaemic control, control appeared to increase with walkability, suggesting other built environment factors, and their interaction with walkability and clinical care, may play key roles. Latino patients had a lower likelihood of HbA1c always < 7, demonstrating an opportunity for equity improvements in diabetes care.

Lower adiponectin is associated with higher anthropometry and insulin resistance but not with low cardiorespiratory fitness in adolescents.

PURPOSE: The aim of this study was to analyze the relationship between adiposity, cardiometabolic risk and cardiorespiratory fitness (CRF) according to different groups of adiponectin concentration. METHODS: 255 adolescents of both sexes, aged 11-17 years old, participated. Anthropometric and biochemical parameters such as body mass, height, abdominal circumference (AC), waist circumference (WC), fat mass, fat-free mass, total cholesterol (TC), high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglycerides (TG), glucose, insulin, adiponectin, blood pressure, peak oxygen consumption (VO2peak) were measured. Body mass index (BMI), z-score BMI (BMI-z), triponderal mass index (TMI), waist-to-height ratio (WHtR), homeostasis model to assessment insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) were calculated. Adiponectin was categorized: low adiponectin concentration (LAC ≤ 5.18 µg/mL-1), intermediate (IAC = 5.18 and 7.63 µg/mL-1) and high (HAC ≥ 7.63 µg/ml-1). RESULTS: LAC showed higher BMI, BMI-z and TMI than the other groups (p < 0.05) and higher AC, WC and WHtR that the HAC (p < 0.05). IAC showed lower values of TC, LDL-c and TG, and the LAC presented the highest values of insulin, HOMA-IR and QUICKI (p < 0.05) to the IAC and HAC. HAC presented the lower VO2peak than the other groups (p < 0.01). BMI, TMI, glucose, insulin, HOMA-IR showed inverse, and QUICKI a direct and weak correlation with adiponectin (p < 0.05). No significant association was found between adiponectin and VO2peak (p > 0.05). CONCLUSION: The LAC group had higher means in the anthropometric variables and the worst results related to insulin resistance and sensitivity. Thus, adiponectin may play an important role in obesity and reduced concentration may be a factor in the development of obesity-associated morbidities.