Maximal and Submaximal Intensity Isometric Knee Extensions Induce an Underestimation of Time Estimates with Both Younger And Older Adults: A Randomized Crossover Trial.

Our perception of time plays a critical role in nearly all daily activities and especially in sports. There are no studies that have investigated and compared time perception during exercise in young and older adults. Thus, this study aimed to compare the effects of exercise on time perception between younger and older adult populations. Thirty-three recreationally active participants were recruited and assigned to either the younger (university students, 9 males and 10 females) or older adults (>60 years, 8 males and 6 females). All participants completed four exercise conditions over two sessions on separate days: approximately 30-seconds of knee extensors 100%, 60% and 10% of maximum voluntary isometric contraction (MVIC), and control (no contractions). Prospective time perception was estimated (at 5-, 10-, 20-, and 30-seconds) at the beginning of each session and while performing the exercise. A main effect for condition (p < 0.001, d = 1.06) with subsequent post-hoc tests indicated participants significantly underestimated (estimated time was shorter than chronological time) time in all three exercise conditions compared to the control. There were no significant age group differences. In conclusion, exercise underestimated time estimates regardless of intensity or age. This questions the postulated intensity-dependent relationship between exercise and time perception. While older adults were expected to be less accurate in their time estimates, they may have been able to adopt alternative strategies for age-related changes in their internal clock, resulting in no significant age group differences.

Temporal perception is distorted by submaximal and maximal isometric contractions of the knee extensors in young healthy males and females.

Introduction: The estimate of time (temporal perception) is important for activities of daily living, sports and even survival, however time perception research needs greater scrutiny. Time estimation can influence movement decisions and determine whether the individual is successful at their goal, The objectives of this study were to examine participants perception of time at 5-, 10-, 20-, and 30-s intervals to determine possible distortions of time estimates caused by varying intensity isometric contractions, and sex differences. Methods: In this repeated measures study, 19 participants (10 females, 9 males) endured two sessions, which consisted of a cognitive task of estimating time intervals while performing an isometric knee extension at maximal, submaximal (60%), and distraction (10%) intensities and a non-active control. In addition to time estimates; heart rate (HR), tympanic temperatures and electromyography during the intervention contractions were monitored. Maximal contractions induced significantly greater time underestimations at 5-s (4.43 ± 0.93, p = 0.004), 20-s (18.59 ± 2.61-s, p = 0.03), and 30-s (27.41 ± 4.07-s, p = 0.004) than control. Submaximal contractions contributed to time underestimation at 30-s (27.38 ± 3.17-s, p = 0.001). Females demonstrated a greater underestimation of 5-s during the interventions than males (p = 0.02) with 60% submaximal (-0.64-s ± 0.26) and distraction (-0.53-s ± 0.22) conditions. For the other 10-, 20-, 30-s intervals, there was no significant time perception sex differences. The control condition exhibited lower HR (75.3 ± 11.6) than the maximal (92.5 ± 13.9), 60% submaximal (92.2 ± 14.4) or distraction (90.5 ± 14.7) conditions. Tympanic temperatures were not influenced by the contraction intensities. Discussion: There was greater integrated knee extensor electromyographic activity during the maximal contractions to suggest greater neuromuscular activation that may influence time perception. However, there was no consistent effect of changes in HR or temperature on time estimates. This work adds to the growing literature of time perception during exercise to state that time is significantly underestimated when performing moderate to vigorous intensity exercise.

Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma (FiTNEss (UK-MRA Myeloma XIV Trial)): a study protocol for a randomised phase III trial.

INTRODUCTION: Multiple myeloma is a bone marrow cancer, which predominantly affects older people. The incidence is increasing in an ageing population.Over the last 10 years, patient outcomes have improved. However, this is less apparent in older, less fit patients, who are ineligible for stem cell transplant. Research is required in this patient group, taking into account frailty and aiming to improve: treatment tolerability, clinical outcomes and quality of life. METHODS AND ANALYSIS: Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma is a national, phase III, multicentre, randomised controlled trial comparing standard (reactive) and frailty-adjusted (adaptive) induction therapy delivery with ixazomib, lenalidomide and dexamethasone (IRD), and to compare maintenance lenalidomide to lenalidomide+ixazomib, in patients with newly diagnosed multiple myeloma not suitable for stem cell transplant. Overall, 740 participants will be registered into the trial to allow 720 and 478 to be randomised at induction and maintenance, respectively.All participants will receive IRD induction with the dosing strategy randomised (1:1) at trial entry. Patients randomised to the standard, reactive arm will commence at the full dose followed by toxicity dependent reactive modifications. Patients randomised to the adaptive arm will commence at a dose level determined by their International Myeloma Working Group frailty score. Following 12 cycles of induction treatment, participants alive and progression free will undergo a second (double-blind) randomisation on a 1:1 basis to maintenance treatment with lenalidomide+placebo versus lenalidomide+ixazomib until disease progression or intolerance. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the North East-Tyne & Wear South Research Ethics Committee (19/NE/0125) and capacity and capability confirmed by local research and development departments for each participating centre prior to opening to recruitment. Participants are required to provide written informed consent prior to trial registration. Trial results will be disseminated by conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: ISRCTN17973108, NCT03720041.

Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment.

BACKGROUND: Chronic hepatitis C is common in people who inject drugs (PWID) and this population serves as a reservoir for infection. Treatment levels are low among this group, ranging from 1 to 19%. We explored whether a nurse-initiated community treatment model increased uptake of and adherence to interferon-based therapies. METHODS: This was a cluster randomized trial of nurse-initiated versus physician-initiated antiviral therapy with pegylated interferon and ribavirin for hepatitis C virus in community clinics (trial registration: ISRCTN07774040). RESULTS: The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each arm not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy. CONCLUSION: Despite easy access to antiviral therapy, uptake of treatment was poor, with no significant difference between the groups. Nurse-led initiation of interferon-based antiviral therapy in PWID did not lead to increased uptake of, response to or adherence with treatment. Further service improvement is unlikely to increase the proportion of PWID undergoing antiviral therapy for hepatitis C virus and early adoption of interferon-free regimens may increase the proportion initiating and completing treatment.