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.

Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration.

Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.

Cardio-Respiratory Fitness and Cardiovascular Disease Risk Factors Among South African Medical Students.

Cardiovascular disease (CVD) risk factors have been associated with CVD mortality, and physicians use CVD risk factor profiles (smoking, dyslipidemia, hypertension, etc.) to address patient health. Furthermore, cardio-respiratory fitness (CRF) has been shown to be an independent risk factor for CVD and all-cause mortality. Cardio-respiratory fitness is also the risk factor that contributes the highest percentage to all-cause deaths when compared to other traditional risk factors. In addition, studies have reported that adding CRF to established CVD risk factors improves the precision of prediction for CVD morbidity and mortality. Medical students tend to adopt sedentary and unhealthy lifestyles during the course of their education that negatively affect CVD risk factors and CRF. The majority of research on CVD risk, health status and lifestyle factors of medical students has used self-reported data and questionnaires for CVD risk factors and not included CRF in the health status measurements. In addition, studies have found that future medical doctors' own health and lifestyle practices influence their counselling activities. Allowing future medical doctors to assess their personal CVD risk factors and CRF may thus be important in their use of physical activity counselling with patients' lifestyle management for health benefits and improvement. A descriptive, cross-sectional cohort study design was used with the aim to determine CVD risk factors using CRF measures and physical activity levels in a cohort of South African medical students. The most significant finding was that they were not meeting the PA levels recommended to maintain health and lower CVD risk.

Postactivation performance enhancement (PAPE) of sprint acceleration performance.

Postactivation performance enhancement (PAPE) is a principle that an acute bout of high-intensity voluntary exercise is followed by an enhancement in strength, speed or power production. This study intended to show a direct correlation between intensity, specificity and the outcome of a maximal task of sprint accelerations compared to a previously defined weighted plyometric intervention. In a randomised controlled, double-blind trial, professional footballers undertook 20 m maximal sprint accelerations at a baseline and at 2 and 6 min post-intervention after 1 of 3 interventions; 2 repetitions of 20 m sprint accelerations (S), 3 × 10 alternative leg weighted bounding (P) and control (C). Relative to the baseline there was a significant improvement for S over 10 and 20 m at 2 min of 0.12m.s-1 and 0.11m.s-1 and 6 min of 0.11m.s-1 and 0.12m.s-1. Relative to the baseline P also had a significant improvement over 10 and 20 m at 2 min 0.09m.s-1 and 0.09m.s-1 and 6 min of 0.11m.s-1 and 0.09m.s-1. There was a significant improvement in C between 2 and 6 min post-intervention at 10 and 20 m of 0.06m.s-1 and 0.08m.s-1. This finding suggests a maximal sprint acceleration may enhance the outcome of a subsequent maximal sprint acceleration at 2 min, but the latter results could not be directly attributed to the interventions as previous testing is likely to have influenced these outcomes.

Reduced bone mineral density among HIV infected patients on anti-retroviral therapy in Blantyre, Malawi: Prevalence and associated factors.

INTRODUCTION: Use of tenofovir based anti-retroviral therapy (ART) in HIV patients is associated with low bone mineral density (BMD). Low BMD predisposes people living with HIV (PLWHIV) to fractures thereby increasing morbidity and mortality. Since the introduction of tenofovir based ARV regimens in 2011, information on the prevalence of low BMD in PLWHIV and receiving ART is still scarce in Malawi. This study aimed to determine the prevalence and associated factors of low BMD among adults living with HIV and receiving ART in Blantyre, Malawi. METHODOLOGY: This was a cross sectional study involving 282 HIV-positive adults of whom 102 (36%) were males. The participants aged 18-45 years were recruited from three primary and one tertiary health care facilities. Patients with no other comorbidities or conditions associated with low BMD and on ART >12 months were included. Data on BMD (femoral neck and lumbar spine) were collected using Dual-Energy X-ray Absorptiometry (DEXA). The International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity (PA) levels. Participants' body weight (kg) and height (m) were also measured. Descriptive statistics, Chi-Square test and multivariable logistic regression were used to analyse data. RESULTS: Mean age of participants was 37(± 6.4) years, mean duration on ART was 5(± 3.5) years and mean body mass index (BMI) was 23(± 4.5) kg/m2. Twenty percent (55) had reduced BMD. More males (28%) had reduced BMD than females (14%) (p = 0.04). There was a significant association between lumbar BMD and femoral neck BMD (r = 0.66,p<0.001). However, on average, lumbar BMD (g/cm2) was significantly lower than the femoral BMD (p < 0.001). Participants with low PA level (OR 1.23,p = 0.6) had higher odds of having reduced BMD compared to those with high PA level. CONCLUSIONS AND RECOMMENDATION: Prevalence of reduced BMD is high among PLWHIV in Malawi especially male Malawian adults. Occurrence of low BMD is associated with low PA level. There is need for health care providers to routinely monitor BMD and PA levels of this population.

Cardiovascular Disease Risk Profile and Readiness to Change in Blue- and White-Collar Workers.

This study provides a health and risk profile of blue- (BCWs) and white-collar workers (WCWs). Health screening data (n = 603; age 38.2 ± 9.7 years) included cholesterol and glucose finger-prick test, blood pressure, body mass index, and self-reported stress levels and readiness to change. Blue-collar workers were significantly older and had higher blood pressure readings and were more likely to develop hypertension (odds ratio [OR]: 1.72; 95% confidence interval [CI]: 1.05-2.81; P = .03), but less likely to present with hypercholesterolemia (OR: 0.50; 95% CI: 0.31-0.81; P = .01) and overweight/obesity (OR: 0.65; 95% CI: 0.42-0.99; P = .047). White-collar workers showed significantly higher cholesterol and stress levels. This study highlights the importance of occupation type in workplace health screening and intervention planning.

Sport related stress fracture of the clavicle with non-union: Case report and review.

Stress fractures are relatively uncommon sports injuries and when they do occur, are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare, having been described in a number of non-sport related pathologies, such as nervous tics and post radical neck dissection. In sport, there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male, partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery.