How much does it cost to implement a community-based walking football programme for patients with type 2 diabetes?

Objectives: The current study analysed the implementation costs of a community-based walking football exercise programme for patients with type 2 diabetes. Methods: The direct costs of a community-based walking football programme for middle-aged and older male patients with type 2 diabetes, designed and tested in Porto (Portugal), were calculated from the payer's perspective. One season of this programme consists of three sessions per week (60 min per session) for nine months (October to June). Cost calculations were based on two groups of 20 patients and included the sports infrastructure and equipment, human resources, pre-exercise clinical evaluation, medical equipment, technical training and other consumable costs. An economic depreciation of 1 year using the linear method for sports and electronic materials was considered. Cost analysis dated December 2021 and is expressed in international dollars ($). Results: This programme was estimated to have a total implementation cost of $22 923.07; $2547.01/month; $573.08/patient; $106.13/session; $63.68/patient/month and $5.31/patient/session. Conclusion: A community-based walking football programme for patients with type 2 diabetes is affordable and can be scaled up by local communities to promote physical activity and manage type 2 diabetes with the involvement of multiple stakeholders such as the football clubs, municipalities and primary healthcare units.

Invasive assessment of aortic stenosis in contemporary practice.

The authors review the current role of cardiac catheterization in the characterization of aortic stenosis, its main clinical applications, its pitfalls, and its additional value to the information provided by echocardiography. Discrepancies that may arise between these two modalities are discussed and further explained. Hemodynamic variables besides transvalvular pressure drop are described, and emphasis is given to an integrative approach to aortic stenosis assessment, that includes invasive and noninvasive evaluation.

Economic evaluation of physical activity interventions for type 2 diabetes management: a systematic review.

BACKGROUND: Economic evaluation of physical activity interventions has become an important area for policymaking considering the high costs attributable to physical inactivity. However, the evidence for such interventions targeting type 2 diabetes control is scarce. Therefore, the present study aimed to synthesize economic evaluation studies of physical activity interventions for type 2 diabetes management. METHODS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement (PROSPERO reference number CRD42021231021). An electronic search was performed in PubMed, Web of Science, Cochrane Library and NHS Economic Evaluation Database. Studies were eligible if they included: adults with type 2 diabetes; any physical activity intervention in the community settings; an experimental or quasi-experimental design; and a parameter of economic evaluation [cost analysis of interventions, cost-effectiveness analysis (including cost-utility analysis) and cost-benefit analysis] as an outcome. RESULTS: Ten studies were included in this review: seven were randomized controlled trials and three were quasi-experimental studies. All studies included direct costs, and four also included indirect costs. Four studies demonstrated that physical activity interventions were cost-saving, six studies showed cost-effectiveness, and two studies reported cost-utility. The estimates varied considerably across the studies with different analytical and methodological approaches. CONCLUSION: Overall, this systematic review found that physical activity interventions are a worth investment for type 2 diabetes management. However, comparability across interventions was limited due to heterogeneity in interventions type, design and delivery, which may explain the differences in the economic measures.

Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40821 real-world procedures over a 12-year period.

INTRODUCTION AND OBJECTIVES: Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. METHODS: We retrospectively determined the per-procedure prevalence of physiological assessment in 40821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. RESULTS: Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages <40, 40-55 and >55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology. CONCLUSIONS: Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.

Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40821 real-world procedures over a 12-year period.

INTRODUCTION AND OBJECTIVES: Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. METHODS: We retrospectively determined the per-procedure prevalence of physiological assessment in 40821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. RESULTS: Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages <40, 40-55 and >55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology. CONCLUSIONS: Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.

Phase angle cutoff value as a marker of the health status and functional capacity in breast cancer survivors.

Accurate predictive tools are key factors for cancer care. Phase angle (PhA) has been proposed as a marker of cellular health, particularly of cell-membrane integrity. Cutoff values have been proposed, including for cancer survivors. This study aimed to assess the usefulness of the proposed PhA cutoff, as a marker of bioelectrical impedance analysis (BIA) assessed health-status, and functional capacity in breast cancer (BC) survivors. This cross-sectional study included 25 women (50.6 ± 8.6 yrs) survivors of BC, divided into two groups according to the PhA reference value of 5.6° (group 1 [G1]: PhA ≤ 5.6° [n=13]; group 2 [G2]: PhA > 5.6° [n=12]) (Gupta et al. 2008). BIA-assessed health status parameters included: extracellular water (ECW), intracellular water (ICW), total body water (TBW), PhA, body mass, fat-free mass, muscle mass, body cell mass (BCM). Four functional tests were performed: 30 s chair-stand test, timed up and go test, ball throw test and 6-minute walking test. Results showed G2 had lower ECW/ICW ratio (p=0.001; ES=1.2), ECW/BCM ratio (p=0.001; ES=3.2) and ECW/TBW ratio (p=0.001; ES=4.8). There was no difference in functional capacity between groups. The results of the present study show that patients with higher PhA values have a higher ICW values and preservation in the ECW/ICW ratio, suggesting it's a better cell membrane quality and integrity. Relation of both PhA and cell membrane integrity with functional capacity warrants further research.

Can Tracking Data Help in Assessing Interpersonal Contact Exposure in Team Sports during the COVID-19 Pandemic?

During the COVID-19 pandemic, the temporary closure of physical activity and sports facilities, and the generalized cancellation or postponement of sports events have a massive impact on social and economic development. In this study, we explored the feasibility of using tracking data from a football match to assess interpersonal contact between individuals by calculating two measures of respiratory exposure. The dynamic tracking positioning of all players and referees during one international football match was analyzed. For each individual, two measures of respiratory exposure were calculated, based on the 2 m interpersonal distance recommendations for contact tracing for COVID-19 control. Overall, individuals spent a median of 0.12 mm:ss (IQR = 0.45 mm:ss) exposed to interpersonal contact of fewer than 2 m from others. The highest value of exposure was observed between two players of opposing teams (6.35 mm:ss). The results suggest that tracking data can be used to assess respiratory exposure to interpersonal contact in team sports, such as football. The measures of exposure calculated can be used to the prompt identification of high-risk contacts of COVID-19 cases during a match or a training session, but also the risk stratification of different sports and physical activities.

Effects of Backpack Load and Trekking Poles on Energy Expenditure During Field Track Walking.

This study evaluates the effects of the use of backpack load and trekking poles on field track walking energy expenditure. Twenty male volunteer pole walkers (age: 22.70±2.89 years; body mass: 77.90±11.19 kg; height: 1.77±0.06 m; percentage of body fat: 14.6±6.0%) walked at a self-selected pace on a pedestrian field track over a period of more than six months. Each subject was examined at random based on four walking conditions: non-poles and non-load, with poles and non-load, non-poles and with load, with poles and with load. Heart rate, oxygen uptake and energy expenditure were continuously recorded by a portable telemetric system. Non-load walking speed was lower during walking with poles when compared with no poles ( p ≤0.05). Oxygen uptake, energy expenditure and heart rate varied significantly across different conditions. Our results suggest that the use of trekking poles does not influence energy expenditure when walking without an additional load, but it can have an effect during backpack load walking. Moreover, our results indicate that the use of trekking poles may not be helpful to lower the exertion perceived by the subjects when walking with an additional load.

Nonobstructive coronary disease leading to STEMI: assessment of residual stenosis after thrombus aspiration.

AIMS: Nonobstructive coronary atherosclerotic lesions can lead to ST-elevation myocardial infarction (STEMI). Thrombus aspiration during a primary percutaneous coronary intervention provides a setting to evaluate the degree of stenosis of culprit lesions leading to STEMI. The aim of this study was to assess the degree of culprit lesion residual stenosis after thrombus aspiration and to compare the demographic, clinical, and angiographic characteristics between patients with obstructive versus nonobstructive residual stenosis. METHODS AND RESULTS: From a single-center registry of 483 consecutive patients with STEMI undergoing a primary percutaneous coronary intervention, 172 patients underwent thrombus aspiration and were eligible for our study. We defined two groups according to the residual stenosis after thrombus aspiration: group A (n=119, 69%) with residual stenosis greater than or equal to 50%, and group B (n=53, 31%) with residual stenosis less than 50%.In terms of the baseline angiographic characteristics, patients with residual stenosis less than 50% had significantly lower prevalence of multivessel disease (15.1 vs. 46.2%, P<0.001). On multivariable analysis of the preprocedural variables, absence of vascular disease (odds ratio 4.99, 95% confidence interval 1.08-23.12, P=0.040) and age less than 59 years (odds ratio 2.67, 95% confidence interval 1.25-5.73, P=0.011) were independent predictors of culprit residual stenosis less than 50%. CONCLUSION: In this population, a significant proportion of patients with STEMI had nonobstructive residual stenosis after thrombus aspiration. These patients were younger, had a lower prevalence of vascular disease in other vascular territories, and less multivessel disease, suggesting an earlier stage of atherosclerosis.