The Association of Physical Activity and Urinary Incontinence in US Women: Results from a Multi-Year National Survey.

OBJECTIVES: To evaluate the relationships between physical activity, both work and recreational, and urinary incontinence among women. METHODS: We assessed women aged 20 years and older in 2008-2018 NHANES (National Health and Nutrition Examination Survey) cycles who answered self-reported urinary incontinence and physical activity questions. Weighted, multivariate logistic regression model was used to determine the association between incontinence and physical activity levels after adjusting for age, body mass index, diabetes, race, parity, menopause and smoking. RESULTS: A total of 30,213 women were included in analysis, of whom 23.15% had stress incontinence, 23.16% had urge incontinence, and 8.42% had mixed incontinence (answered "yes" to both stress and urge incontinence). Women who engaged in moderate recreational activity were less likely to report stress and urge incontinence (OR 0.79, 95% CI 0.62-0.99 and OR 0.66, 95% CI 0.48-0.90, respectively). Similarly, women who engaged in moderate activity work were less likely to report stress, urge and mixed incontinence (OR 0.84, 95% CI 0.70-0.99; OR 0.84, 95% CI 0.72-0.99; and OR 0.66 95% CI 0.45-0.97, respectively). CONCLUSIONS: Moderate physical activity and greater time spent participating in moderate physical activity are associated with a decreased likelihood of stress, urge and mixed incontinence in women. This relationship holds for both recreational and work-related activity. We hypothesize that the mechanism of this relationship is multifactorial, with moderate physical activity improving pelvic floor strength and modifying neurophysiological mediators (such as stress) involved in the pathogenesis of incontinence.

From Cancer Rehabilitation to Recreation: A Coordinated Approach to Increasing Physical Activity.

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes.

Recreational football is medicine against non-communicable diseases: A systematic review.

The purpose of this research was to conduct a systematic review of published articles related to the effect of recreational football on non-communicable diseases. A systematic review of Web of Science, SPORTDiscus, MEDLINE, and PubMed databases was performed according to PRISMA guidelines. Only empirical studies were included. There were no restrictions on the types of study design eligible for inclusion. The primary outcome measures result from the potential effects of recreational football on non-communicable diseases (eg, blood pressure, bone density, LDL cholesterol, and fat mass). A total of 44 articles met the inclusion criteria and were included. Recreational football is shown to: (a) decrease blood pressure and resting heart rate, improve cardiac structure and functioning, as well as increase maximal oxygen uptake in both sexes; (b) reduce cholesterol and triglycerides levels, increase insulin sensitivity, and have a positive impact on glycemic control; (c) improve bone mineralization, increase both bone mineral density and content, as well as acting as a stimulus for osteogenesis; and (d) be clearly beneficial for bone health, while slightly beneficial for body composition, muscle strength, and maximal oxygen uptake in adults with prostate cancer. The present systematic review demonstrated the benefits of recreational football practice on non-communicable diseases related to cardiovascular and bone health, body composition, type 2 diabetes, and prostate cancer. The effectiveness of recreational football on the aforementioned diseases may be related to age and gender; however, further research is required.

Understanding limitations in sport 1 year after an Achilles tendon rupture: a multicentre analysis of 285 patients.

PURPOSE: The purpose of this study was to determine patient-related and treatment-related predictors of superior and inferior function in sport and recreational activities 1 year after an Achilles tendon rupture. METHODS: This study is based on a multicentre cohort from 4 previous randomised controlled trials. All the patients who had responded to the Foot and Ankle Outcome Score (FAOS) at the 1-year follow-up were included. All the patients had a clinically verified Achilles tendon rupture and patients who underwent surgery were treated within 96 h of the time of rupture. Patients were excluded in the event of a previous Achilles tendon rupture or the presence of other lifestyle diseases. The primary outcomes of the study were reported in the 20th and 80th percentiles of the FAOS subscale, function in sports and recreational activities. RESULTS: A total of 285 (84% men) patients with an average age of 40.0 (SD 8.4) years were included. Smoking increased the odds of superior self-reported FAOS sport and recreation [OR 4.59 (95% CI 1.58-13.32), p = 0.005] compared with non-smoking, while being female [OR 0.38 (95% CI 0.16-0.93), p = 0.035] and every increment of one unit in BMI [OR 0.89 (95% CI 0.81-0.99), p = 0.029] reduced the odds. No variable was statistically significant when attempting to predict which patients report inferior FAOS sport and recreation. The recovery of symmetry in heel-rise tests had no effect on 1-year FAOS sport and recreation. Patient-reported outcomes had a good-to-excellent explanatory capacity of superior and inferior 1-year function in sport and recreational activities (AUC = 0.87-0.93). CONCLUSION: BMI is a modifiable risk factor, which, when lowered, may be associated with less impairment in sports 1 year after an Achilles tendon rupture. Females appear to perceive more limitations than males. Unexpectedly, smokers experience less limitations in foot and ankle function. Patients who report no functional limitation in sport are characterised by an overall perception of adequate foot, ankle and Achilles function, despite not having recovered symmetry in the heel-rise test. LEVEL OF EVIDENCE: I.

Relationship of simple reaction time and aerobic and anaerobic capacities with performance of recreational adult orienteers / Relação do tempo de reação simples e das capacidades aeróbica e anaeróbica com o desempenho de adultos recreacionais em Orientação

Abstract This study aimed to examine the effects of Simple Reaction Time (SRT), MaximalOxygen Uptake ( V ? V ? O2max) and Maximal Anaerobic Power (Pmax) on the performance of category A recreational adult orienteers of both sexes. Sixteen subjects (8 men and 8 women; age: 30 ± 4 and 27 ± 5 years; body mass 78.8 ± 5.9 and 69.2 ± 10.4 kg; SRT: 1.391 ± 0.19 and 1.317 ± 0.25 ms; V ? V ? O2max: 67.4 ± 3.22 and 48.5 ± 8.28 ml.kg-1.min-1; Pmax: 675.0 ± 149.6 and 458.4 ± 88.62 W), were submitted to three evaluation sessions: sample characterization (1st session); SRT - Reaction Time Task v.2.0, V ? V ? O2max, and Pmax - Running Anaerobic Sprint Test (2nd session); official Orienteering test (3rd session). Results of comparison (Student's T-test) and relation (Pearson Product-Moment Correlation and Multiple Linear Regression) tests showed significant relationships between independent variables and performance. Pmax presented strong predictive power in the male group (41%), followed by SRT (32%) and V ? V ? O2max (27%). In the female group, SRT was the most predictive variable (54%), followed by V ? V ? O2max (32%) and Pmax (12%). These findings indicated that SRT, V ? V ? O2max, and Pmax are variables predictive of performance in recreational category A orienteers. Specifically in recreational orienteers with high cardiorespiratory capacities, Pmax seems to be the mainpredictor variable. Conversely, SRT becomes the variable with the greatest predictive power.

Resumo Objetivou-se investigar as relações do Tempo de Reação Simples (TRS), do Consumo Máximo de Oxigênio ( V ? V ? O2max) e da Potência Máxima Anaeróbica (Pmáx) no desempenho de homens e mulheres, adultos da categoria A, praticantes recreacionais de Orientação. Dezesseis sujeitos (8 homens e 8 mulheres; idade: 30 ± 4 e 27 ± 5 anos; massa corporal 78,8 ± 5,9 e 69,2 ± 10,4 kg; TRS: 1,391 ± 0,19 e 1,317 ± 0,25 ms; V ? V ? O2max: 67,4 ± 3,22 e 48,5 ± 8,28 ml.kg-1.min-1; Pmáx: 675,0± 149,6 e 458,4 ± 88,62 W), foram submetidos a três sessões de avaliação: caracterização amostral (1a sessão); mensurações do TRS - Reaction Time Task v.2.0, do V ? V ? O2max e da Pmáx - Running Anaerobic Sprint Test (2a sessão); prova de Orientação (3a sessão). Os resultados de comparação (teste T de Students) e de relação (Correlação Linear Produto-Momento de Pearson e Regressão Linear Múltipla) demonstraram relações estatisticamente significativas entre as variáveis independentes e o desempenho. A Pmáx apresentou forte poder de predição no grupo masculino (41%), seguida do TRS (32%) e do V ? V ? O2max (27%). No grupo feminino, o TRS foi a variável mais preditora (54%), seguida do V ? V ? O2max (32%) e da Pmáx (12%). Pode-se concluir que o TRS, o V ? V ? O2max e a Pmáx são variáveis preditoras do desempenho em adultos praticantes recreacionais de Orientação da categoria A. Especificamente, em sujeitos com maiores capacidades cardiorrespiratórias, a Pmáxparece ser a principal variável preditora. Em contrapartida, o TRS passa a ser a variável com maiorpoder de predição

TV Viewing in 60,202 Adults From the National Brazilian Health Survey: Prevalence, Correlates, and Associations With Chronic Diseases.

BACKGROUND: This study describes the levels and patterns of television (TV) viewing in Brazilian adults and investigates associations of TV viewing with hypertension, type 2 diabetes, and heart disease. METHODS: Data from the Brazilian Health Survey, a nationally representative survey that was conducted in 2013 (N = 60,202 men and women aged ≥18 y), were used. Information regarding TV viewing, physician diagnoses of type 2 diabetes, hypertension, and heart disease was collected via interview-administered questionnaire. Data on covariables (including chronological age, educational status, skin color, sodium consumption, sugar consumption, tobacco smoking, alcohol consumption, and leisure-time physical activity) were also self-reported. Logistic regression models and population attributable fractions were used for the etiological analyses. RESULTS: The prevalence (95% confidence interval) of >4 hours per day of TV viewing was 12.7% (12.0-13.4) in men and 17.5% (16.8-18.3) in women. Men and women being younger or older, moderately educated, living alone, smoking tobacco, and drinking alcohol were associated with higher reported TV viewing time. Odds ratios (95% confidence interval) revealed that >4 hours per day of TV viewing was associated with type 2 diabetes [male: 1.64 (1.23-2.17) and female: 1.33 (1.09-1.63)], hypertension [male: 1.36 (1.14-1.63) and female: 1.20 (1.05-1.37)], and heart disease [male: 1.96 (1.43-2.69) and female: 1.30 (1.00-1.68)]. Exceeding 4 hours per day of TV viewing was responsible for 6.8% of type 2 diabetes, 3.7% of hypertension, and 7.5% of heart disease cases. CONCLUSIONS: Independent of covariates, >4 hours per day of TV viewing was associated with type 2 diabetes, hypertension, and heart disease. High volumes of TV viewing are prevalent and appear to contribute to chronic disease burden.

Trends in incidence and long-term outcomes of myelomeningocele in British Columbia.

PURPOSE: Myelomeningocele is typically a disabling condition that results in neurologic, orthopedic, and urologic morbidity. The aim of this study was to examine the trends over time in both incidence and outcomes of myelomeningocele (MMC) in British Columbia (BC). METHODS: A retrospective chart review was performed of all children with MMC followed in the British Columbia Children's Hospital (BCCH) Spinal Cord Clinic between 1971 and 2016. The incidence of new MMC cases and the long-term outcomes of MMC were compared between two 10-year cohorts. The first cohort comprised children born with MMC between 1971 and 1981, and the second cohort comprised children born with MMC between 1996 and 2006. RESULTS: A total of 309 children with MMC were followed in the BCCH Spinal Cord Clinic between 1971 and 2016. There were 101 and 46 children with MMC in the two-time cohorts, respectively. Between the earlier and later cohorts, there was a significant difference in the following: MMC incidence [2.5/10,000 births vs 1.1/10,000 births, respectively (p = 0.0002)], mortality [18 vs 0% (p = 0.0009)], and the proportion of cases repaired in under 48 h [56 vs 98% (p < 0.0001)]. For surviving children, the proportion of children attending special classes was significantly different between the earlier and later cohorts [16 vs 46%, respectively (p = 0.0002)], whereas all other outcome measures, including the proportion with hydrocephalus, kyphoscoliosis, Chiari II surgery, bowel and bladder continence, recreation participation, obesity, and ambulation, were not significantly different. CONCLUSIONS: In BC, the incidence of new cases of MMC has decreased between 1971 and 2016, while the probability of survival for these patients has increased. Despite earlier and more universal post-natal repair, long-term outcomes have not improved significantly over time. Future research should focus on developing ways of reducing disability and improving quality of life for MMC patients and their families.

Myocardial fatigue in recreational marathon runners: A speckle-tracking echocardiography study.

BACKGROUND: Prolonged aerobic exercise such as marathon running produces supraphysiological hemodynamic stress that can potentially affect the athlete's cardiac homeostasis. While cardiac structural and functional adaptations in professional athletes are well characterized, only a limited information is available for recreational runners undergoing this supraphysiological stress. METHODS: Premarathon and post-marathon echocardiography was performed in 50 recreational marathon runners [age 40.8 ± 7.5 years, 44 (88%) males; running distance 42.195 km]. All the runners received 4-month training for the marathon. The baseline echocardiogram and N-terminal B-type natriuretic peptide (NT-proBNP) were obtained before training, whereas the post-marathon study was performed within 10 days (7.27 ± 0.92 days) of completion of marathon. Two-dimensional speckle-tracking echocardiography was used for characterizing the changes in myocardial mechanics. RESULTS: There was a significant reduction in heart rate post-marathon, whereas the levels of NT-proBNP increased significantly (86.0 ± 9.5 pg/ml vs 106.5 ± 24.2 pg/ml, p = 0.001). The left ventricular (LV) end-diastolic volume (61.8 ± 16.5 ml vs 72.8 ± 5.1 ml, p < 0.001), LV mass (120.2 ± 30.0 gm vs 160.3 ± 43.0 gm, p < 0.001), and LV ejection fraction (64.9 ± 5.6% vs 72.0 ± 5.7%, p < 0.001) also increased significantly. However, there was a significant attenuation in LV global longitudinal (-19.3 ± 2.71% vs -16.5 ± 4.6%, p = 0.003) and circumferential strain (-17.2 ± 2.41% vs -15.2 ± 2.6%, p = 0.001) post-marathon. The LV global radial strain showed a nonsignificant reduction. CONCLUSION: Recreational marathon runners have reduced longitudinal and circumferential shortening of the left ventricle with elevation of NT-proBNP. However, the LV ejection performance remains maintained because of an increase in the LV end-diastolic volume and mass. These changes suggest the possibility of "myocardial fatigue" occurring in response to supraphysiological hemodynamic stress of marathon running.

Impact of rotator cuff surgery on postoperative sporting activity.

INTRODUCTION: The aim of this study was to systematically review the literature for the impact of rotator cuff tear (RCT) surgery on postoperative sporting activity in professional and recreational athletes. EVIDENCE ACQUISITION: To identify any published clinical study on return to sports data for athletes following rotator cuff surgery, a systematic search in literature was conducted. Inclusion criteria were partial and full-thickness rotator cuff tears and any open or arthroscopic RCT surgery in sports participating people. E-published and print journal articles with a Level of Evidence I, II, III and IV were acceptable. The review was based on using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Guidelines. Included studies were assessed for reporting quality by using the Coleman Methodology Score (CMS). EVIDENCE SYNTHESIS: Twelve studies including 314 athletes met the inclusion criteria. From the 12 identified studies there were 10 studies with Level IV evidence with an average CMS of 45.2 (poor rating) and 2 studies with Level III evidence with an average CMS of 47 (poor rating). The mean time for returning to sports participation following RCT surgery was 8.3 months (4.8-10.7 months), 79% of all athletes returned to sports participation, therefrom 60.5% were able to return to their pre-injury level of competition. Forty-eight percent of the professional overhead athletes had reached their pre-injury level after RCT surgery. 20.3% participated at a lower level. Amongst professional overhead athletes, 54.5% were treated using arthroscopic debridement and 32.5% were treated using an arthroscopic repair technique. RTS rate to prior level of competition for arthroscopic debridement was 53.7% and 47.5% for arthroscopic repair. For recreational athletes RCT repair was reported for 62%. RTS rate to prior level of competition was 69.4% in this group of athletes. 38% were treated with an arthroscopic RCT repair. RTS rate to same level was 76% in this group. In contact athletes arthroscopic repair resulted in RTS rate of 91% to prior level of competition. CONCLUSIONS: Approximately 50% of professional overhead athletes return to their prior level of competition after arthroscopic RCT surgery. Professional athletes underwent arthroscopic surgery more often compared to recreational athletes with a comparable RTS rate after either arthroscopic debridement or repair. Open repair of RCT is mainly used for recreational athletes and results in a RTS rate of 70% to same level of competition. Although there is a lack of high quality studies in recent literature regarding this topic this study shows that RCT surgery has a crucial impact on postoperative level of competition in professional and recreational athletes. The present study enables the sports physician to better understand and discuss the consequences of rotator cuff surgery with athletes in daily clinical practice.

The association of lifetime physical inactivity with head and neck cancer: a hospital-based case-control analysis.

Despite mounting epidemiological evidence suggesting an inverse association between recreational physical activity and cancer risk, evidence associated with head and neck cancer is scant. We conducted a case-control analysis to examine the associations of lifetime physical inactivity with the risk of head and neck squamous cell carcinoma (HNSCC). We utilized data from the Patient Epidemiology Data System at Roswell Park Cancer Institute (RPCI). Participants included 246 patients with HNSCC and 504 cancer-free controls who received medical services at RPCI between 1990 and 1998. Participants were considered physically inactive if they did not participate in any regular, weekly recreational physical activity throughout their lifetime, prior to diagnosis. Multivariate logistic regression models were utilized to estimate odds ratios (OR) and 95% confidence intervals (CI) representing the association between lifetime physical inactivity and HNSCC risk. We observed a significant positive association between recreational physical inactivity and HNSCC risk (OR = 2.73, 95% CI 1.87-3.99, p < 0.001). In subgroup analyses by body mass index (BMI) (underweight/normal-weight: OR = 3.40, 95% CI 1.89-6.12, p < 0.001; overweight/obese: OR = 2.40, 95% CI 1.43-4.02, p < 0.001) and smoking status (former smoker: OR = 3.12, 95% CI 1.89-5.14, p < 0.001; never smoker: OR = 2.71, 95% CI 1.21-6.05, p = 0.020; current smoker: OR = 1.61, 95% CI 0.66-3.95, p = 0.300), significant positive associations were also observed. Results of the current analyses suggest that lifetime physical inactivity associates with HNSCC independent of BMI. In addition, physical inactivity may be a modifiable risk factor among never smokers. These data add to the growing body of evidence suggesting that physical inactivity may be an independent risk factor for cancer.

Recreational Physical Activity in Relation to Prostate Cancer-specific Mortality Among Men with Nonmetastatic Prostate Cancer.

BACKGROUND: Large prospective cohort studies need to confirm the associations between recreational physical activity (PA), including the most common type-walking, and prostate cancer-specific mortality (PCSM) among prostate cancer patients. OBJECTIVE: To investigate the associations of recreational PA, reported before and after diagnosis, with PCSM, overall and by tumor risk category. DESIGN, SETTING, AND PARTICIPANTS: In a prospective cohort study conducted in the USA, men diagnosed with nonmetastatic prostate cancer between 1992/1993 and June 2011 were followed for mortality until 2012. Patients were included in pre- (n=7328) and/or postdiagnosis (n=5319) analyses. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cox proportional hazards models were used to assess PCSM with recreational PA. RESULTS AND LIMITATIONS: A total of 454 and 261 prostate cancer deaths occurred during pre- and postdiagnosis follow-up, respectively. Prior to diagnosis, engaging in ≥17.5 metabolic equivalent hours per week (MET-h/wk) of recreational PA, compared with 3.5-<8.75 MET-h/wk, was associated with a significant 37% lower risk of PCSM (hazard ratio: 0.63, 95% confidence interval: 0.43-0.91, p trend=0.03) only among men with lower-risk tumors (Gleason score 2-7 and T1-T2; p interaction=0.02). A similar result was seen for walking but not for other recreational PA. After diagnosis, the same comparison (≥17.5 vs 3.5-<8.75 MET-h/wk) was associated with a significant 31% lower risk of overall PCSM (hazard ratio: 0.69, 95% confidence interval: 0.49-0.95, p trend=0.006), which did not differ by tumor risk category. Postdiagnosis walking had a suggestive inverse association with PCSM (p trend=0.07). These results were observational and may not be generalized to patients with metastatic prostate cancer. Residual confounding due to a higher screening rate among men with lower-risk tumors cannot be ruled out. CONCLUSIONS: The findings provide additional evidence for prostate cancer survivors to adhere to PA recommendations, and support clinical trials of exercise among prostate cancer survivors with progression or mortality as outcomes. PATIENT SUMMARY: In a large follow-up study of men diagnosed with nonmetastatic prostate cancer, those who exercise more after diagnosis had a lower risk of dying from prostate cancer.

Moderate-vigorous recreational physical activity and breast cancer risk, stratified by menopause status: a systematic review and meta-analysis.

OBJECTIVE: Physical inactivity increases postmenopausal and possibly premenopausal breast cancer risk, although different biologic mechanisms are proposed. Our primary objective was to estimate breast cancer risk associated with high versus low levels of moderate-vigorous recreational activity, separately for premenopausal and postmenopausal women. METHODS: We conducted a systematic review of literature published to July 2015. Included reports were cohort or case-control studies relating moderate-vigorous recreational physical activity (metabolic equivalent ≥3.0) to breast cancer incidence, exclusively (≥90%) in premenopausal or postmenopausal women. We appraised study quality and performed meta-analyses using random effects modeling. Subgroup meta-analyses were based on tumor subtype, race, body mass index, parity, hormone therapy use, family history of cancer, and statistical adjustment for body fatness. Dose-response relations were examined. RESULTS: Pooled relative risks (RRs, 95% CI) for women with higher versus lower levels of moderate-vigorous recreational activity were RR = 0.80 (0.74-0.87) and RR = 0.79 (0.74-0.84) for premenopausal (43 studies) and postmenopausal (58 studies) breast cancer, respectively, with high heterogeneity. Inverse associations were weaker among postmenopausal cohort studies (RR = 0.90 [0.85-0.95]) and studies that statistically adjusted for nonrecreational (eg, occupational, household) activity (RR = 0.91 [0.77-1.06] premenopausal, RR = 0.96 [0.86-1.08] postmenopausal). Risk estimates with versus without body fatness adjustment did not vary by menopause status, although other subgroup effects were menopause-dependent. Among studies of overweight/obese women, there was an inverse association with postmenopausal but not premenopausal breast cancer (RR = 0.88 [0.82-0.95] and RR = 0.99 [0.98-1.00], respectively). Dose-response curves were generally nonlinear. CONCLUSIONS: Although risk estimates may be similar for premenopausal and postmenopausal breast cancer, subgroup effects may be menopause-dependent.

Physical Activity and Anthropometric Characteristics Among Urban Youth in Mexico: A Cross-Sectional Study.

BACKGROUND: Obesity is a critical problem among Mexican youth, but few studies have investigated associations among physical activity (PA) modes and anthropometrics in this population. This study examined associations among active commuting to school (ACS), sports or other organized PA, outdoor play, and body mass index (BMI) percentile and waist circumference (WC) among Mexican youth. METHODS: Parents of school children (N = 1996, ages 6 to 14 years, 53.1% female) in 3 Mexican cities reported PA participation using the (modified) fourth grade School Physical Activity and Nutrition Survey. Trained assessors measured BMI percentile and WC in person. RESULTS: Parents reported that 52.3% of children engaged in ACS, 57.3% participated in sports or organized PA, and a median of 2 days in the previous week with at least 30 minutes of outdoor play. In complete case analyses (n = 857), ACS was negatively associated with BMI percentile, and outdoor play was negatively associated with WC after adjusting for school, age, sex, and income. In analyses incorporating data from multiple imputation (N = 1996), outdoor play was negatively associated with WC (all Ps < . 05). CONCLUSIONS: ACS and outdoor play are favorably associated with anthropometrics and may help prevent childhood obesity in Mexico. ACS and outdoor play should be priorities for increasing youth PA in Mexico.

Recreational physical inactivity and mortality in women with invasive epithelial ovarian cancer: evidence from the Ovarian Cancer Association Consortium.

BACKGROUND: Little is known about modifiable behaviours that may be associated with epithelial ovarian cancer (EOC) survival. We conducted a pooled analysis of 12 studies from the Ovarian Cancer Association Consortium to investigate the association between pre-diagnostic physical inactivity and mortality. METHODS: Participants included 6806 women with a primary diagnosis of invasive EOC. In accordance with the Physical Activity Guidelines for Americans, women reporting no regular, weekly recreational physical activity were classified as inactive. We utilised Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) representing the associations of inactivity with mortality censored at 5 years. RESULTS: In multivariate analysis, inactive women had significantly higher mortality risks, with (HR=1.34, 95% CI: 1.18-1.52) and without (HR=1.22, 95% CI: 1.12-1.33) further adjustment for residual disease, respectively. CONCLUSION: In this large pooled analysis, lack of recreational physical activity was associated with increased mortality among women with invasive EOC.

Chronic Recreational Physical Inactivity and Epithelial Ovarian Cancer Risk: Evidence from the Ovarian Cancer Association Consortium.

BACKGROUND: Despite a large body of literature evaluating the association between recreational physical activity and epithelial ovarian cancer (EOC) risk, the extant evidence is inconclusive, and little is known about the independent association between recreational physical inactivity and EOC risk. We conducted a pooled analysis of nine studies from the Ovarian Cancer Association Consortium to investigate the association between chronic recreational physical inactivity and EOC risk. METHODS: In accordance with the 2008 Physical Activity Guidelines for Americans, women reporting no regular, weekly recreational physical activity were classified as inactive. Multivariable logistic regression was utilized to estimate the ORs and 95% confidence intervals (CI) for the association between inactivity and EOC risk overall and by subgroups based upon histotype, menopausal status, race, and body mass index. RESULTS: The current analysis included data from 8,309 EOC patients and 12,612 controls. We observed a significant positive association between inactivity and EOC risk (OR = 1.34; 95% CI, 1.14-1.57), and similar associations were observed for each histotype. CONCLUSIONS: In this large pooled analysis examining the association between recreational physical inactivity and EOC risk, we observed consistent evidence of an association between chronic inactivity and all EOC histotypes. IMPACT: These data add to the growing body of evidence suggesting that inactivity is an independent risk factor for cancer. If the apparent association between inactivity and EOC risk is substantiated, additional work via targeted interventions should be pursued to characterize the dose of activity required to mitigate the risk of this highly fatal disease. Cancer Epidemiol Biomarkers Prev; 25(7); 1114-24. ©2016 AACR.

Pumping Iron in Australia: Prevalence, Trends and Sociodemographic Correlates of Muscle Strengthening Activity Participation from a National Sample of 195,926 Adults.

OBJECTIVE: The current Australian Physical Activity Guidelines recommend that adults engage in regular muscle-strengthening activity (e.g. strength or resistance training). However, public health surveillance studies describing the patterns and trends of population-level muscle-strengthening activity participation are sparse. The aim of this study is to examine the prevalence, trends and sociodemographic correlates of muscle-strengthening activity participation in a national-representative sample of Australians aged 15 years and over. METHODS: Between 2001 and 2010, quarterly cross-sectional national telephone surveys were conducted as part of the Australian Sports Commission's 'Exercise, Recreation and Sport Survey'. Pooled population-weighted proportions were calculated for reporting: [i] no muscle-strengthening activity; [ii] insufficient muscle-strengthening activity, and [iii] sufficient muscle-strengthening activity. Associations with sociodemographic variables were assessed using multiple logistic regression analyses. RESULTS: Out of 195,926 participants, aged 15-98 years, only 10.4% (95% CI: 10.1-10.7) and 9.3% (95% CI: 9.1-9.5) met the muscle-strengthening activity recommendations in the past two weeks and in the past year, respectively. Older adults (50+ years), and those living in socioeconomically disadvantaged, outer regional/remote areas and with lower education were less likely to report sufficient muscle-strengthening activity (p<0.001). Over the 10-year monitoring period, there was a significant increase in the prevalence of sufficient muscle-strengthening activity (6.4% to 12.0%, p-value for linear trend <0.001). CONCLUSIONS: A vast majority of Australian adults did not engage in sufficient muscle-strengthening activity. There is a need for public health strategies to support participation in muscle-strengthening activity in this population. Such strategies should target older and lower educated adults, and those living in socioeconomically disadvantaged, outer regional/remote and areas.

Physical Activity, Sedentary Behaviors, and Retinal Vascular Caliber in Children and Adolescents With Type 1 Diabetes.

PURPOSE: The aim of this study was to investigate associations of physical activity and sedentary behaviors with retinal vascular caliber in children and adolescents with type 1 diabetes. DESIGN: This was a hospital-based cross-sectional study. METHODS: A study of 122 children and adolescents with type 1 diabetes was conducted over an 8-month period. Self-reported physical activity time and time spent watching TV or playing computer or video games were obtained using interviewer-administered questionnaires. Retinal vascular caliber was measured by a trained grader using a standardized protocol and later summarized as central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) using a semiautomated computer program. RESULTS: After adjusting for confounders (age, sex, ethnicity, body mass index, systolic blood pressure, HbA1c, maternal smoking status, age at which cow's milk was introduced, and CRVE/CRAE, respectively), narrower CRAE was independently related to more time spent playing computer/video games [ExpB = -3.85; 95% confidence interval (CI), -6.41 to -1.29; P = 0.004], whereas wider CRVE was independently related to lower physical activity level (ExpB = -1.08; 95% CI, -2.01 to -0.15; P = 0.03) and more time spent playing computer/video games (ExpB = 4.72; 95% CI, 0.52-8.92; P = 0.02). Television viewing time was not associated with retinal vascular caliber after adjustment. CONCLUSIONS: The results of this study suggest that physical activity and sedentary behaviors in the form of "screen viewing time" are associated with retinal vessel caliber early in life. These results suggest that retinal vascular caliber may provide prognostic information beyond current traditional cardiovascular risk factors. Future longitudinal and interventional studies are warranted to evaluate the relevance of these observations.

Physical Activity and Survival After Prostate Cancer.

BACKGROUND: Despite the high global prevalence of prostate cancer (PCa), few epidemiologic studies have assessed physical activity in relation to PCa survival. OBJECTIVE: To evaluate different types, intensities, and timing of physical activity relative to PCa survival. DESIGN, SETTING, AND PARTICIPANTS: A prospective study was conducted in Alberta, Canada, in a cohort of 830 stage II-IV incident PCa cases diagnosed between 1997 and 2000 with follow-up to 2014 (up to 17 yr). Prediagnosis lifetime activity was self-reported at diagnosis. Postdiagnosis activity was self-reported up to three times during follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cox proportional hazards models related physical activity to all-cause and PCa-specific deaths and to first recurrence/progression of PCa. RESULTS AND LIMITATIONS: A total of 458 deaths, 170 PCa-specific deaths, and, after first follow-up, 239 first recurrences/progressions occurred. Postdiagnosis total activity (>119 vs ≤42 metabolic equivalent [MET]-hours/week per year) was associated with a significantly lower all-cause mortality risk (hazard ratio [HR]: 0.58; 95% confidence interval [CI], 0.42-0.79; p value for trend <0.01). Postdiagnosis recreational activity (>26 vs ≤4 MET-hours/week per year) was associated with a significantly lower PCa-specific mortality risk (HR: 0.56; 95% CI, 0.35-0.90; p value for trend = 0.01). Sustained recreational activity before and after diagnosis (>18-20 vs <7-8 MET-hours/week per year) was associated with a lower risk of all-cause mortality (HR: 0.66; 95% CI, 0.49-0.88). Limitations included generalisability to healthier cases and an observational study design. CONCLUSIONS: These findings support emerging recommendations to increase physical activity after the diagnosis of PCa and would inform a future exercise intervention trial examining PCa outcomes. PATIENT SUMMARY: In a 17-yr prostate cancer (PCa) survival study, men who survived at least 2 yr who were more physically active postdiagnosis or performed more recreational physical activity before and after diagnosis survived longer. Recreational physical activity after diagnosis was associated with a lower risk of PCa death.

Return to Sports Activity and Work After Autologous Chondrocyte Implantation of the Knee: Which Factors Influence Outcomes?

BACKGROUND: Autologous chondrocyte implantation (ACI) has been associated with satisfying results in everyday activities. Clinical results after ACI treatment of femorotibial lesions are superior in comparison with patellofemoral lesions. There is limited information regarding at which level recreational, amateur, and professional athletes can resume sports and physical activities as well as work after ACI and what parameters influence return to work and sports. HYPOTHESIS: Return to sports activity and work is dependent on defect characteristics such as location and size. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 130 patients with isolated full-thickness cartilage defects of the knee joint treated with ACI between June 2000 and October 2007 were retrospectively studied by an established questionnaire that assessed sports-specific questions such as frequency, duration, and intensity. Engagement in 32 different sports disciplines was evaluated. In addition, work-specific data were evaluated according to classifications established by the REFA Association. Results were evaluated depending on patient- and defect-specific parameters. RESULTS: The mean ± SD patient age at ACI was 36.2 ± 9.2 years, with a mean defect size of 4.4 ± 1.7 cm(2). Defects were located at the femorotibial compartment in 55.7% of cases, whereas lesions of the patellofemoral compartment were found in 44.3%. Mean duration of inability to work after ACI was 13.6 ± 11.0 weeks and did not appear to be influenced by patient age. Defect location and defect size did not appear to significantly influence return-to-work rates, but work intensity before surgery significantly influenced return-to-work rates and duration of absence from work. Workplace adaptations were necessary in only 9.2% of cases postoperatively. With regard to postoperative sports activity, 73.1% of patients were able to return to sports. Neither defect location nor size significantly influenced return to physical activity. Patients participated in a mean of 2.3 different sports during their lifetime. Both duration of exercise and number of sessions per week significantly decreased from before to after surgery. Detailed analysis of 32 different sporting activities revealed that high-impact as well as start-stop sports were generally abandoned in favor of endurance and low-intensity exercises. A lifetime level of competitiveness was maintained in 31.3% of cases, while return to elite sports at the time of the survey became highly unlikely (0.8%). CONCLUSION: The study results illustrate that treatment of articular cartilage defects of the knee joint leads to satisfactory results concerning everyday activities. With the exception of physical labor, no essential adaptations needed to be made at work. Regarding sports activity, return to low- and moderate-intensity levels appears realistic in the majority of cases, whereas the likelihood of returning to activities with high stress applied on the knee joint is low. Neither defect location nor size appears to significantly influence postoperative sports activity or return-to-work rates.

Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water.

Dive-related injuries are relatively common, but almost exclusively occur in recreational or scuba diving. We report 2 children with acute central nervous system complications after breath-hold diving. A 12-year-old boy presented with unilateral leg weakness and paresthesia after diving beneath the water surface for a distance of ∼25 m. After ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. Neurologic examination revealed right leg weakness and sensory deficits with a sensory level at T5. Spinal MRI revealed a nonenhancing T2-hyperintense lesion in the central cord at the level of T1/T2 suggesting a spinal cord edema. A few weeks later, a 13-year-old girl was admitted with acute dizziness, personality changes, confusion, and headache. Thirty minutes before, she had practiced diving beneath the water surface for a distance of ∼25 m. After stepping out, she felt sudden severe thoracic pain and lost consciousness. Shortly later she reported headache and vertigo, and numbness of the complete left side of her body. Neurologic examination revealed reduced sensibility to all modalities, a positive Romberg test, and vertigo. Cerebral MRI revealed no pathologic findings. Both children experienced a strikingly similar clinical course. The chronology of events strongly suggests that both patients were suffering from arterial gas embolism. This condition has been reported for the first time to occur in children after breath-hold diving beneath the water surface without glossopharyngeal insufflation.