Usual care including home exercise with versus without spa therapy for chronic low back pain: protocol for the LOMBATHERM' study, a multicentric randomised controlled trial.

BACKGROUND: Low back pain is highly prevalent and a major source of disability worldwide. Spa therapy is frequently used to treat low back pain, but the associated level of evidence for efficacy is insufficient. To fill this knowledge gap, this protocol proposes an appropriately powered, prospective, evaluator-blinded, multi-centre, two-parallel-arm, randomised (1:1), controlled trial that will compare spa therapy in addition to usual care including home exercise (UCHE) versus UCHE alone for the treatment of chronic low back pain. METHODS: Eligible patients (anticipated sample size of 358) will have had low back pain for more than 3 months and scores for pain greater than 40 mm on a visual analogue scale (VAS). Following initial consent for UCHE and baseline evaluations, patients are randomised (1:1) to UCHE alone, or UCHE plus spa therapy (18 days of mud packs, underwater massages, showers and water exercises under medical supervision). Patients in the latter arm will be requested to sign an additional consent form as per Zelen randomisation. Follow-up visits will occur at approximately months 1, 6 and 12 and (along with baseline assessments) will cover changes over time in VAS pain scores, the impact of lower back pain on daily life (the Rolland and Morris Disability Questionnaire (RMDQ)), inappropriate fears and beliefs about lower back pain (the fear, avoidance, belief questionnaire (FABQ)), general quality of life (the Euroqol Group 5 dimension, 5 level questionnaire (EQ-5D-5 L)), Patient Acceptable Symptom State (PASS), consumption of analgesic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs), and overall state of health. Health resource use and days of sick leave (and subsequently the associated costs) will also be recorded. The primary outcome is the presence/absence of a clinically relevant change (improvement of at least 30%) in the VAS score for pain at 6 months. DISCUSSION: Despite the fact that previous, rather dated recommendations encourage spa therapy for the treatment of low back pain, the current literary corpus is methodologically poor. This protocol has been designed to provide results spanning a thorough range of outcomes at the highest evidence level possible. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03910023. Registered on 10 April 2019.

The value of monitoring data in a process evaluation of hygiene behaviour change in Community Health Clubs to explain findings from a cluster-randomised controlled trial in Rwanda.

BACKGROUND: A cluster-Randomised Controlled Trial evaluation of the impact of the Community Health Clubs (CHCs) in the Community Based Environmental Health Promotion Programme in Rwanda in 2015 appeared to find little uptake of 7 hygiene indicators 1 year after the end of the intervention, and low impact on prevention of diarrhoea and stunting. METHODS: Monitoring data was revisited through detailed community records with all the expected inputs, outputs and external determinants analysed for fidelity to the research protocol. Five household inventory observations were taken over a 40-month period including 2 years after the end of the cRCT in a random selection of the 50 intervention CHCs and data compared to that of the trial. Focus Group Discussion with all Environmental Health Officers of the Ministry of Health provided context to understand the long-term community dynamics of hygiene behaviour change. RESULTS: It was found that the intervention had been jeopardised by external determinants with only 54% fidelity to protocol. By the end of the designated intervention period in June 2014, the treatment had reached only 58% of households with 41% average attendance at training sessions by the 4056 registered members and 51% mean completion rate of 20+ sessions. Therefore only 10% of 50 CHCs provided the full so-called 'Classic' training as per-protocol. However, sustainability of the CHCs was high, with all 50 being active 2 years after the end of the cRCT and over 80% uptake of recommended practices of the same 7 key indicators as the trial was achieved by 2017. CONCLUSIONS: The cRCT conclusion that the case study of Rusizi District does not encourage the use of the CHC model for scaling up, raises concerns over the possible misrepresentation of the potential of the holistic CHC model to achieve health impact in a more realistic time frame. It also questions the appropriateness of apparently rigorous quantitative research, such as the cluster-Randomised Controlled Trial as conducted in Rusizi District, to adequately assess community dynamics in complex interventions.

Workplace health promotion for employees working in offshore wind parks in the German exclusive economic zone: a mixed-methods study.

OBJECTIVES: To investigate the awareness and use of health promotion offers among offshore wind workers and to study associations with demographic and workplace characteristics. To examine employees' reasons for (non-)participation and their wishes for health promotion activities offshore. DESIGN: Mixed-methods study presenting the results from semistructured telephone interviews and a web-based cross-sectional survey. SETTING: Offshore wind parks in the German exclusive economic zone in the North and Baltic Seas. PARTICIPANTS: 21 offshore workers in the qualitative study (19 male/2 female; all German). 303 offshore workers in the quantitative study (287 male/13 female; 275 German/24 other nationalities). OUTCOME MEASURES: Awareness and use of workplace health promotion offers and associations with demographic and workplace characteristics (age, work schedule and wind park phase); reasons for (non-)participation; needs and wishes for health promotion offers. RESULTS: Few workers indicated being aware of health promotion programmes at their workplace. Single offers were reported, with fitness facilities being the most common offer employees recognised and had used (n=168, 55.6%). Employees with a regular work schedule were more likely to have used fitness facilities offshore (adjusted OR (AOR)=3.22, 95% CI 1.53 to 6.80). Workers in the construction phase were more likely to have used massages (AOR=8.19, 95% CI 2.82 to 23.77). Younger workers were less likely to belong to the group of those who were aware of fitness facilities but had not used them (AOR=0.43, 95% CI 0.19 to 0.98). Employees expressed various needs and wishes for behavioural and environmental preventive measures offshore. CONCLUSIONS: The results demonstrate a perceived need among the workers for the development of health promotion programmes offshore. Since the awareness and use of offers may partly depend on personal and organisational characteristics, this should be taken into account in the planning of health promotion activities.

Exercise dependence and its relationship with supplementation at gyms in Brazil / Dependencia de ejercicio y su relación con la administración de suplementos en los gimnasios de Brasil

Introduction: Brazil is the second country in the world with the largest number of gyms, currently accounting for approximately 30 thousand units. There is increasing evidence that a significant part of gym-goers develop excessive commitment to practicing physical exercises, which may even generate pathological dependence. Aim: To determine the association between physical exercise addiction (ED) and supplement intake among gym-goers. Method: The exercise addiction scale was employed for gym-goers older than 19 years of both sexes. Individual interview was made by using nutritional history to determine supplement intake profile; data related to anthropometry and participation in the gym were also assessed. Results: The frequency of ED at gyms was 66.5% and the prevalence of supplementation was 51.5%, while the chances for an exercise addict to be a supplement consumer were estimated at 4.53. Conclusion: The relationship between ED and supplement intake was proven, constituting an alert for health professionals, who should consider the risk factors for the development of more severe signs and symptoms, including obsessive weight control by means of excessive practice of exercises, diets with no nutritional basis and unnecessary supplementation. It is recommended to include nutritional assessment among the instruments to detect ED and supplementation so that, if necessary, campaigns can be promoted to elucidate diets, healthy body composition patterns and drastic changes in eating patterns, as well as other issues related to nutritional care (AU)

Introducción: Brasil es el segundo país del mundo con el mayor número de gimnasios y actualmente representa aproximadamente 30 mil unidades. Cada vez hay más evidencias de que una parte significativa de los practicantes de actividad física desarrollan un compromiso exagerado con esta actividad, que incluso pueden generar dependencia patológica. Objetivo: determinar la asociación entre la práctica exagerada de ejercicio físico (ED) y el consumo de suplementos entre los practicantes. Método: se utilizó la escala de adicción al ejercicio en practicantes mayores de 19 años, de ambos sexos. Fue realizada una entrevista individual para determinar históricamente el consumo de suplementos; también se evaluaron los resultados de antropometría y la frecuencia de participación en el gimnasio. Resultados: la frecuencia de la práctica en el gimnasio fue del 66,5% y la prevalencia de la suplementación fue de 51,5%, la posibilidades de un adicto al ejercicio ser un consumidor de suplemento se estima en 4,53. Conclusión: la relación entre la adicción al ejercicio y el consumo de suplemento fue comprobada, constituyendo una alerta para los profesionales de la salud, que deben tener en cuenta los factores de riesgo para el desarrollo de los signos más graves y síntomas, incluyendo el control de peso obsesivo por medio de la práctica intensa de ejercicios físicos, consumo de dietas inadecuadas y uso de suplementos nutricionales. Se recomienda que la evaluación nutricional se complemente de otras determinaciones para detectar la adicción al ejercicio y el uso de suplementación nutricional. Si es necesario, se pueden promover campañas para avalar las dietas consumidas, la composición corporal ideal y detectar los cambios drásticos en la alimentación, así como otras cuestiones relacionadas con el cuidado nutricional en general (AU)

Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005-2011.

INTRODUCTION: Physical activity is known to prevent falls; however, use of widely available exercise programs for older adults, including EnhanceFitness and Silver Sneakers, has not been examined in relation to effects on falls among program participants. We aimed to determine whether participation in EnhanceFitness or Silver Sneakers is associated with a reduced risk of falls resulting in medical care. METHODS: A retrospective cohort study examined a demographically representative sample from a Washington State integrated health system. Health plan members aged 65 or older, including 2,095 EnhanceFitness users, 13,576 Silver Sneakers users, and 55,127 nonusers from 2005 through 2011, were classified as consistent users (used a program ≥2 times in all years they were enrolled in the health plan during the study period); intermittent users (used a program ≥2 times in 1 or more years enrolled but not all years), or nonusers of EnhanceFitness or Silver Sneakers. The main outcome was measured as time-to-first-fall requiring inpatient or out-of-hospital medical treatment based on the International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition and E-codes. RESULTS: In fully adjusted Cox proportional hazards models, consistent (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63-0.88) and intermittent (HR, 0.87; 95% CI, 0.8-0.94) EnhanceFitness participation were both associated with a reduced risk of falls resulting in medical care. Intermittent Silver Sneakers participation showed a reduced risk (HR, 0.93; 95% CI, 0.90-0.97). CONCLUSION: Participation in widely available community-based exercise programs geared toward older adults (but not specific to fall prevention) reduced the risk of medical falls. Structured programs that include balance and strength exercise, as EnhanceFitness does, may be effective in reducing fall risk.

Prevalence of protein supplement use at gyms.

At the present time, the abuse of all class of sport nutritional supplements (NS) has extended the people who go regularly to gymnasiums. Between these substances there are the Protein Powder Supplements (PPS). The purpose of this study is to examine the consumption of PPS in 415 individuals from Seville fitness centers. All individuals were evaluated with anthropometric measurements and completed a questionnaire previously reviewed, evaluating the validity of the content, application, structure and presentation. 28% of the individuals were using or used PPS. Of the total, 42.7% of male individuals compared to 3.2% of the females. The use of PPS was higher than what has been reported in previous studies about supplement use in fitness center, 28% vs 10-14% aprox. The SPP use is associated with sex, age, and time of sport practiced. More than a 25% of the total individuals that attend a gym use PPS. The total individuals that attend a gym and use PPS far exceed the RDA of protein for general population and/or athletes, being able to cause problems of health.

Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network.

BACKGROUND: The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care. METHODS: Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits. RESULTS: Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program "champions" among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall "reasonable support" for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated "reasonable support" for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions. CONCLUSIONS: The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.