Risk profile and mode of transmission of Mpox: A rapid review and individual patient data meta-analysis of case studies.

Since May 2022, an outbreak of Mpox in non-endemic countries has become a potential public health threat. The objective of this rapid review was to examine the risk profile and modes of transmission of Mpox. PubMed, Web of Science, and Scopus were searched from inception through July 30 to collect case reports/series on patients with Mpox infection. For meta-analysis, data on the total number of participants and deaths by binary categories of exposure (age, sex, country, other co-infections or existing conditions, and mode of contagion) were used. A total of 62 studies (4659 cases) were included. Most cases came from Africa (84.3%), followed by Europe (13.9%). In 63.6% of the cases, the mode of contagion was human contact, while 22.8% of the cases were by animal contact, and 13.5% were unknown or not reported. The mortality rate was 6.5% throughout these studies. The risk of mortality was higher in the younger age group (risk difference: 0.19; 95% CI: 0.02-0.36), in cases with other co-infections or current chronic conditions (risk difference: 0.03; 95% CI: 0.01-0.05) and in the category of low- and middle-income countries (risk difference: 0.06; 95% CI: 0.05-0.08). There were no significant differences with respect to sex or mode of contagion. These results help to understand the major infection pathways and mortality risk profiles of Mpox and underscores the importance of preventing outbreaks in specific settings, especially in settings densely populated by children, such as day care centres and schools.

Correlation of Self-Efficacy for Pelvic Floor Muscle Exercise with Symptoms of Stress Urinary Incontinence in Women.

INTRODUCTION AND HYPOTHESIS: Self-efficacy for pelvic floor exercises, i.e. confidence in achieving pelvic floor contractions, may predict adherence to treatment. However, there is a paucity of literature investigating the clinical relevance of this outcome. The aim was to determine the relationship between self-efficacy for pelvic floor exercise and symptom severity, pelvic floor distress and impact on quality of life, as well as sociodemographic characteristics and pelvic floor muscle strength in women with stress urinary incontinence (SUI). METHODS: A cross-sectional study was conducted in women with SUI. The Spanish version of the Broome Pelvic Muscle Self-Efficacy Scale was used to assess self-efficacy for pelvic floor exercise. The dependent variables were: urinary incontinence symptoms using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF), pelvic floor distress symptoms using the Urogenital Distress Inventory-6, impact on quality of life using the Incontinence Impact Questionnaire (IIQ-7), leakage using the 1-h pad test, number of SUI episodes per week and pelvic floor muscle strength. RESULTS: A total of 56 women with a median age of 44.5 years were included. Self-efficacy for pelvic floor exercise correlated negatively and moderately with the ICIQ-SF (r = -0.529; p < 0.001), IIQ-7 (r = -0.442; p = 0.001), 1-h pad test (rs = -0.467; p < 0.001); and number of SUI episodes/week (rs = -0.489; p < 0.001). Correlation with the other outcomes was weak or non-existent. Linear regression with forward selection showed that the ICIQ-SF was the variable most related to self-efficacy (ß: -3.01, 95% CI: -4.03 to -1.69). CONCLUSIONS: These findings highlight the importance of assessing self-efficacy for pelvic floor exercise in the treatment of women with SUI. Future prospective studies are needed to confirm these findings.

Neuromuscular Responses and Perceptions of Health Status and Pain-Related Constructs in End-Stage Knee Osteoarthritis During Resistance Training With Blood Flow Restriction.

ABSTRACT: Ogrezeanu, DC, López-Bueno, L, Sanchís-Sánchez, E, Carrasco, JJ, Cuenca-Martínez, F, Suso-Martí, L, López-Bueno, R, Cruz-Montecinos, C, Martinez-Valdes, E, Casaña, J, and Calatayud, J. Neuromuscular responses and perceptions of health status and pain-related constructs in end-stage knee osteoarthritis during resistance training with blood flow restriction. J Strength Cond Res 38(4): 762-772, 2024-We aimed to evaluate the neuromuscular responses and their relationship with health status, kinesiophobia, pain catastrophizing, and chronic pain self-efficacy in patients with end-stage knee osteoarthritis during acute resistance training with different levels of blood flow restriction (BFR). Seventeen patients with end-stage knee osteoarthritis participated in 3 experimental sessions separated by 3 days, performing 4 sets of knee extensions with low load and 3 levels of concurrent BFR performed in a random order: control (no BFR), BFR at 40% arterial occlusion pressure (AOP), and BFR at 80% AOP. Normalized root-mean-square (nRMS), nRMS spatial distribution (centroid displacement, modified entropy, and coefficient of variation), and normalized median frequency (nFmed) were calculated from the vastus medialis (VM) and lateralis (VL) using high-density surface electromyography. Subjects were asked to report adverse effects after the sessions. In the VM, nRMS was higher with 80% AOP than with 40% AOP ( p = 0.008) and control ( p < 0.001), whereas there were no differences between conditions in the VL. Normalized root-mean-square also showed an association with pain catastrophizing, chronic pain self-efficacy, and health status (VM: -0.50, 0.49, -0.42; VL: -0.39, 0.27, -0.33). Spatial distribution varied between conditions but mostly in the VL. Overall, nFmed did not vary, with only a slight increase in the VL with 40% AOP, between set 3 and 4. BFR during knee extensions at 80% AOP increases VM activity and VL amplitude distribution more than 40% AOP and control. Importantly, muscle activity increases are modulated by pain catastrophizing, chronic pain self-efficacy, and health status in these patients, and kinesiophobia seems to especially modulate entropy.

Dose-response association of handgrip strength and risk of depression: a longitudinal study of 115 601 older adults from 24 countries.

BACKGROUND: Prior research has solely focused on the association between handgrip strength and risk of depression in single countries or general populations, but more knowledge is required from wider-spread cohorts and target populations. AIMS: This study aimed to investigate the association between handgrip strength and risk of depression using repeated measures in adults aged 50 years and over. METHOD: Data on handgrip strength and risk of depression were retrieved from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 1, 2, 4, 5, 6 and 7, using a hand dynamometer (Smedley, S Dynamometer, TTM) and the EURO-D 12-item scale, respectively. Time-varying exposure and covariates were modelled using both Cox regression and restricted cubic splines. RESULTS: A total of 115 601 participants (mean age 64.3 years (s.d. = 9.9), 54.3% women) were followed-up for a median of 7.3 years (interquartile range: 3.9-11.8) and 792 459 person-years. During this period, 30 208 (26.1%) participants experienced a risk of depression. When modelled as a continuous variable, we observed an inverse significant association for each kg increase of handgrip strength and depression up to 40 kg in men and up to 27 kg in women. CONCLUSIONS: Being physically strong may serve as a preventive factor for depression in older adults, but this is limited up to a maximum specific threshold for men and women.

Barriers and facilitators of physical activity in adults with severe haemophilia: A qualitative study.

BACKGROUND: People with haemophilia (PWH) tend to be less physically active than the general population, but there is a lack of research on the specific barriers and facilitators affecting their participation in physical activities. OBJECTIVES: This study aims to explore perceived barriers and facilitators to physical activity in severe PWH. DESIGN: An explorative qualitative study based on focus groups. METHODS: Four focus groups including 16 participants (severe haemophilia A patients) were conducted to examine the factors perceived as facilitators or barriers to haemophiliacs engaging in physical activity. One researcher conducted a thematic analysis of all data. RESULTS: Three themes were identified: body function, personal factors, and environmental factors. Key facilitators identified were access to prophylaxis treatment to reduce the risk of bleeding(s), the enjoyability of physical activity, fitness and health motives, social interaction, support, and low cost. PWH faced additional barriers to being physically active including hurtful joints, mobility issues, haemophilic arthropathy, dislike or disinterest, lack of motivation, fear of injury, tiredness, lack of time, lack of guidance, negative social influence, restriction, and lack of coordination of prophylaxis treatment. CONCLUSION: This exploratory study demonstrated that participation in physical activity in PWH is influenced not only by their own abilities and attitudes, but also by external variables, including family, friends, healthcare professionals, structures, and communities. The results of this study may be used to assist caregivers and health professionals, inform programs, interventions, and policies to promote physical activity and health in severe PWH.

Effectiveness of progressive moderate-vigorous intensity elastic resistance training on quality of life and perceived functional abilities in people with hemophilia: Secondary analysis of a randomized controlled trial.

INTRODUCTION AND AIM: Strength exercise training is advised for people with hemophilia (PWH); however, few studies have been published and have methodological limitations. The purpose of this study was to evaluate the effectiveness of progressive elastic resistance training on quality of life and perceived functional abilities in PWH. METHODS: Participants were randomly allocated to the intervention (n = 10) or control (n = 10) group. The intervention group performed progressive moderate-vigorous elastic resistance training (2 days/week, a total of 8 weeks), focusing on the muscles of the knee, elbow, and ankle joints. The control group continued its usual daily activities for 8 weeks. Quality of life (A36 Hemofilia-QoL®) and perceived functional abilities (Haemophilia Activities List) were assessed at baseline and an 8-week follow-up. RESULTS: The intervention group improved the quality-of-life dimension of joint damage perception in comparison to the control group (p = .015, large effect size). Regarding perceived functional abilities, the intervention group improved lying, sitting, kneeling, and standing (p = .006, small effect size), and complex lower extremities activities (i.e., walking short and long-distance, and up-down stairs) (p = .006, small effect size) compared to the control group. No other significant differences were observed. CONCLUSIONS: Eight weeks of progressive moderate-vigorous elastic resistance training in PWH improve the quality-of-life dimension of joint damage perception and perceived functional abilities (lying/sitting/kneeling/standing, and complex lower extremities activities). Our results suggest a limited effect of the program on the other items of quality of life measured by the questionnaire as emotional functioning, mental health, and social relationships. Importantly, no serious adverse effects occurred.

Safety, feasibility, and neuromuscular activity of acute low-load resistance exercise with or without blood flow restriction in patients with severe hemophilia.

OBJECTIVE: To compare the safety, feasibility, and neuromuscular activity of acute low-load resistance exercise with/without blood flow restriction (BFR) in people with severe hemophilia (PwH). METHODS: Eight PwH under prophylaxis (5 with resistance training experience) performed 6 randomly ordered conditions of 3 intensity-matched knee extensions: no external load and no BFR, no external load and light BFR (20% of arterial occlusion pressure [AOP]), no external load and moderate BFR (40% AOP), external low load and no BFR, external low load with light BFR, and external low load with moderate BFR. Rated perceived exertion, pain, exercise tolerability, and adverse effects were assessed. Normalized root-mean-square (nRMS), nRMS spatial distribution, and muscle fiber-conduction velocity (MFCV) were determined using high-density surface electromyography for the vastus medialis and lateralis. RESULTS: Exercises were tolerated, without pain increases or adverse events. Externally resisted conditions with/without BFR provided greater nRMS than nonexternally resisted conditions (p < 0.05). Spatial distribution and MFCV did not vary between conditions. CONCLUSIONS: In these patients, knee extensions with low external resistance and BFR at 20% or 40% AOP appear safe, feasible and do not cause acute/delayed pain. However, BFR during three consecutive repetitions does not increase nRMS nor changes nRMS spatial distribution or MFCV.

Association of occupational physical activity and disability pension in 756,159 Spanish workers: A prospective cohort study with 13 years follow-up.

Recent research from Nordic countries identified occupational physical activity (OPA) as a risk factor for disability pension, but further research accounting for exhaustive analyses in novel populations is warranted. Our objective was to assess the association between OPA and disability pension using administrative data. This prospective registry-based cohort study used data from the Spanish Continuous Working Life Sample (CWLS). Participants were followed up from baseline (January 1, 2006) to first event of disability pension, mortality, or end of follow-up (September 1, 2019). The assessment of OPA was based on registers of economic activity and their correspondence with a validated OPA index. To examine the association between OPA and disability pension, adjusted proportional hazard, and Fine-Gray models using mortality as competing risk were conducted. We retrieved data from 756,159 workers (57.7% men) with an average age of 38.5 years (SD 11.9). During 13.6 years from baseline to the end of follow-up (9,463,041 person-years), 18,191 men (4.2%) and 9631 (3.0%) women received a disability pension. In the fully adjusted model, participants exposed to higher levels of OPA showed higher risk for disability pension in an exposure-response fashion. Men and women exposed to very high OPA showed the highest HR for disability pension (2.31 [95% CI, 2.17 to 2.46] and 1.68 [95% CI, 1.56 to 1.81], respectively. These results warrant preventative measures to address early involuntary exit from the labour market in workers exposed to high physical work demands.

Validation of the International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS) for Spanish-speaking children.

The International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS) is a 12-item self-administered tool to screen lower urinary tract symptoms (LUTS) in children. The aim of this study is to translate and validate the ICIQ-CLUTS into Spanish (ICIQ-CLUTS-Sp) and to study its psychometric properties. The cross-cultural adaptation of the ICIQ-CLUTS was performed following international recommendations. The psychometric analysis of the ICIQ-CLUTS-Sp was carried out to determine the reliability, validity, and diagnostic accuracy in a sample of 155 children and parents who completed the Spanish version ICIQ-CLUTS. The reliability indicators for the ICIQ-CLUTS-Sp were excellent (Cronbach's alpha was > 0.8 and ICC > 0.9 both for children's and parents' versions). There was a high Pearson r > 0.6 and a high agreement level between children's and parents' answers (ICC > 0.6), except in 4 items. For parents, the standard error of measurement (SEm) was 0.41, and the minimal detectable change (MDC) was 1.14 points. In children, these results were 0.42 and 1.16 points, respectively. Cut-off points greater than 15 points in the parent version or 16 points in the children version have the highest sensitivity and specificity for detecting LUTS.  Conclusion: The Spanish version of the ICIQ-CLUTS questionnaire is a valid, reliable, and diagnostically accurate instrument to identify cases of children with LUTS. Therefore, it can be used to screen for lower urinary tract symptoms in Spanish speaking children and/or parents, as well as to monitor the effects of interventions. What is Known: • Lower urinary tract symptoms in children should be assessed multimodally using minimally invasive diagnostic procedures. One way to do this is to use the questionnaire to differentiate these cases in paediatric patients. • A cross-cultural adaptation of the ICIQ-CLUTS questionnaire to Spanish has not yet been done. What is New: • Based on a comprehensive validation methodology, this study highlights that the ICIQ-CLUTSSp questionnaire has good psychometric properties.

Effectiveness of Therapeutic Exercise Models on Cancer-Related Fatigue in Patients With Cancer Undergoing Chemotherapy: A Systematic Review and Network Meta-analysis.

OBJECTIVE: To assess and compare the effectiveness of different exercise modalities in reducing cancer-related fatigue (CRF) in patients with cancer undergoing chemotherapy. Exercise intensities for selected exercise types were also compared. DATA SOURCES: We conducted a search in MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science from inception to October 15, 2021. STUDY SELECTION: Randomized controlled trials concerning the effectiveness of exercise modalities on CRF in patients with cancer undergoing chemotherapy were included. DATA EXTRACTION: Study characteristics were extracted using a structured protocol. Methodological quality was assessed employing the PEDro scale and risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. The certainty of evidence was assessed based on Grading of Recommendations, Assessment, Development and Evaluation. The measure of effect used was the adjusted standardized mean difference (SMD) or Hedge's g, together with the corresponding 95% confidence intervals (CI). DATA SYNTHESIS: Forty-seven studies were included. Data were pooled employing a random-effects model. There was a trend that adding low-intensity aerobic and resistance exercise (SMD=1.28, 95% CI -0.18; 2.75, P=.086), or moderate-intensity aerobic and resistance exercise (SMD=0.85; 95% CI -0.12; 1.82, P=.087), was more effective than adding flexibility training to usual care (UC). There was also a trend that UC alone was less effective than adding moderate-intensity aerobic and resistance exercise (SMD=-0.47, 95% CI -0.96, 0.02, P=.060) to UC. CONCLUSIONS: The addition of low- to moderate-intensity aerobic and/or resistance exercise demonstrated a positive trend for improvement in CRF in patients with cancer undergoing chemotherapy, when compared with UC alone or UC with flexibility training.

Association of difficulties in daily physical activities and handgrip strength with cancer diagnoses in 65,980 European older adults.

BACKGROUND: People with cancer usually report physical deconditioning, which can limit daily activities. AIMS: Our aim was to analyze associations between daily physical activities and handgrip strength with cancer diagnoses among European older adults. METHODS: We used data from SHARE (a representative survey of individuals aged 50 years or older) wave 7, residing in 27 European countries and Israel. Participants self-reported difficulties in daily physical activities and cancer diagnoses, and handgrip strength was objectively assessed using a handheld dynamometer. Data were analyzed using binary logistic regression. RESULTS: Overall, 65,980 participants (average age 67.6 years (SD = 9.4)) were analyzed. Having difficulties in any daily physical activity was significantly associated with higher odds of cancer diagnoses. Lower handgrip strength was significantly associated with cancer diagnoses among participants included in the first (adjusted odds ratio (AOR) = 1.27 [95%CI = 1.11-1.45]) and the second third (AOR = 1.15 [95%CI = 1.03-1.28]) when compared with participants from the last third in the final adjusted model. DISCUSSION: Having difficulties in daily physical activities as well as lower levels of handgrip strength is positively associated with cancer diagnoses. CONCLUSION: Adults with difficulties lifting or carrying weights over 5 kilos or having difficulties in two or more activities showed critical associations with cancer diagnosis.

The Influence of the Weight of the Backpack on the Biomechanics of the Child and Adolescent: A Systematic Review and Meta-analysis With a Meta-Regression.

PURPOSE: To evaluate and explore the influence of the weight of a backpack on standing posture and gait in children and adolescents. METHODS: We conducted a search of MEDLINE (PubMed), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science, with the last search in July 2021. Standardized mean differences (SMD) and 95% confidence intervals were calculated for relevant outcomes and were pooled in a meta-analysis using the random-effects model. The participants were healthy children or adolescents. The outcomes were postural variables, spatiotemporal gait variables, gait kinematics, and muscle activity. We analyzed the influence of a loaded backpack on posture while standing and spatiotemporal and kinematic variables while walking. We used GRADE, Risk of Bias 2, ROBINS-I, MINORS, and PEDro scales to rate the quality, certainty, and applicability of the evidence. RESULTS: Wearing a loaded backpack induces a significant increase of the craniohorizontal angle while standing and a decrease of walking speed and stride length while walking. Only the craniovertebral angle had a significant relationship with the weight of the backpack. CONCLUSIONS: Wearing a backpack induces postural changes while standing and affects gait in children and adolescents; however, almost all the changes are not related to the backpack weight.

Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries.

BACKGROUND: mixed evidence exists on the association between muscle strength and mortality in older adults, in particular for cancer mortality. AIM: to examine the dose-response association of objectively handgrip strength with all-cause and cancer mortality. STUDY DESIGN AND SETTING: data from consecutive waves from the Survey of Health, Ageing and Retirement in Europe comprising 27 European countries and Israel were retrieved. Overall, 54,807 men (45.2%; 128,753 observations) and 66,576 women (54.8%; 159,591 observations) aged 64.0 (SD 9.6) and 63.9 (SD 10.2) years, respectively, were included. Cox regression and Fine-Grey sub-distribution method were conducted. RESULTS: during the follow-up period (896,836 person-year), the fully adjusted model showed the lowest significant risk estimates for the highest third of handgrip strength when compared with the first third (reference) in men (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.34-0.50) and women (HR, 0.38; 95% CI, 0.30-0.49) for all-cause mortality. We identified a maximal threshold for reducing the risk of all-cause mortality for men (42 kg) and women (25 kg), as well as a linear dose-response association in participants aged 65 or over. No robust association for cancer mortality was observed. CONCLUSION: these results indicate an inverse dose-response association between incremental levels of handgrip and all-cause mortality in older adults up to 42 kg for men and 25 kg for women, and a full linear association for participants aged 65 years or over. These findings warrant preventive strategies for older adults with low levels of handgrip strength.

Effectiveness of Pain Neuroscience Education in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the effects of pain neuroscience education (PNE) on patients with fibromyalgia in terms of pain intensity, fibromyalgia impact, anxiety, and pain catastrophizing. METHODS: A systematic review with meta-analysis of randomized controlled trials was conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated with RStudio software (RStudio, Boston, MA) for relevant outcomes and were pooled in a meta-analysis with the random effects model. RESULTS: A total of eight studies were included. The meta-analysis showed statistically significant differences in pain intensity with a moderate clinical effect in seven studies at the post-intervention assessment (SMD: -0.76; 95% CI: -1.33 to -0.19; P < 0.05) with evidence of significant heterogeneity (P < 0.05, I2 = 92%), but it did not show statistically significant differences in fibromyalgia impact, anxiety, and pain catastrophizing (P > 0.05). With regard to the follow-up assessment, only the fibromyalgia impact showed significant improvements, with a very small clinical effect in nine studies (SMD: -0.44; 95% CI: -0.73 to -0.14; P < 0.05) and evidence of significant heterogeneity (P < 0.05, I2 = 80%). After the application of a sensitivity analysis with the PNE face-to-face interventions, the meta-analysis showed a significant decrease in pain intensity, with a moderate clinical effect at the post-intervention and follow-up assessments without evidence of significant heterogeneity (P < 0.05, I2 = 10%). CONCLUSIONS: There is low-quality evidence that in patients with fibromyalgia, PNE can decrease the pain intensity in the post-intervention period and the fibromyalgia impact in the follow-up period. However, it appears that PNE showed no effect on anxiety and pain catastrophizing.

Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report.

OBJECTIVE: The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). METHODS: We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures. RESULTS: The systematic review included 22 studies (n = 978). More favorable outcomes were observed for NM on pain intensity compared with control interventions (standardized mean differences (SMDs) -0.92; 95% CI -1.66-0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI -0.02 to 2.15). Regarding neck pain intensity, no significant differences were found in favor of NM compared with OTs (SMD 0.37; 95% CI -0.35 to 1.1). However, between-treatment differences were found in favor of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI -0.06 to 0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD -0.08; 95% CI -0.36-0.20, and SMD -1.44; 95% CI -2.28-0.6, respectively). Finally, NM was associated with more favorable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). CONCLUSIONS: NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.

Effectiveness of HIIT in patients with cancer or cancer survivors: An umbrella and mapping review with meta-meta-analysis.

OBJECTIVE: To assess the available evidence on the effectiveness of high-intensity interval training (HIIT) in addition to first-choice cancer treatment on cardiorespiratory fitness (CRF), quality of life (QoL), adherence, and adverse effects of HIIT in patients with cancer or cancer survivors. METHODS: An umbrella review and meta-meta-analysis (MMA) was performed. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science until August 2021. Article selection, quality assessment, and risk of bias assessment were performed by two independent reviewers. The MMA were performed with a random-effects model and the summary statistics were presented in the form of forest plot with a weighted compilation of all standardized mean differences (SMD) and corresponding 95% confidence interval (CI). RESULTS: Seven systematic reviews were included. Regarding CRF, the addition of HIIT to cancer treatment showed statistically significant differences with a small clinical effect, compared with adding other treatments (SMD = 0.45; 95% CI 0.24 to 0.65). There was no significant difference when compared with adding moderate-intensity continuous training (MICT) (SMD = 0.23; 95% CI -0.04 to 0.50). QoL showed positive results although with some controversy. Adherence to HIIT intervention was high, ranging from 54% to 100%. Regarding adverse effects, most of the systematic reviews reported none, and in the cases in which they occurred, they were mild. CONCLUSION: In conjunction with first-choice cancer treatment, HIIT has been shown to be an effective intervention in terms of CRF and QoL, as well as having optimal adherence rate. In addition, the implementation of HIIT in patients with cancer or cancer survivors is safe as it showed no or few adverse effects.

Feasibility, safety and muscle activity during flywheel vs traditional strength training in adult patients with severe haemophilia.

INTRODUCTION: Eccentric training has been associated with several specific physiological adaptations. The flywheel machine is one of the easiest ways of performing eccentric overload training. However, no studies evaluated its feasibility, safety and muscle activity in patients with haemophilia (PWH). AIM: To evaluate feasibility and safety and compare muscle activity during flywheel vs weight machine knee extension exercise in severe PWH. METHODS: Eleven severe PWH [mean age of 33.5 (8.1) years] participated in this cross-sectional study after receiving prophylactic treatment. Surface electromyography (EMG) signals were recorded for the rectus femoris during the knee extension exercise performed with 2 different conditions (flywheel and weight machine) with matched intensity (6 on the Borg CR10 scale). Kinesiophobia was assessed before and after the experimental session. Participants were asked to rate tolerability of each condition. Adverse effects were evaluated 24 and 48 hours after the session. RESULTS: Kinesophobia did not increase after the experimental session, and no adverse effects were reported. At 60%-70% of the contraction cycle, the flywheel exercise showed higher (P = .024) eccentric rectus femoris muscle activity than the weight machine. In contrast, during the last 90%-100% of the contraction cycle, the traditional weight machine showed higher (P = .004) rectus femoris activity than the flywheel. CONCLUSION: The knee extension exercise performed with the flywheel at moderate intensity is safe and well tolerated among severe PWH under adequate factor coverage. Importantly, the flywheel variation provides higher eccentric rectus femoris activity at the breaking force moment, while it provides lower eccentric muscle activity at the end of the cycle.

Cardiorespiratory fitness in adolescents before and after the COVID-19 confinement: a prospective cohort study.

Long periods of free-movement restrictions may negatively affect cardiorespiratory fitness and health. The present study investigated changes after the COVID-19 confinement in maximal oxygen intake (VO2 max) levels in a sample of 89 Spanish school children aged 12 and 14 years at baseline (49.8% girls). The 20-m shuttle run test served to estimate VO2 max before and after the COVID-19 confinement. Paired t-tests estimated an overall difference of - 0.5 ml.kg-1.min-1 (SD 0.3) (p = 0.12), whereas the highest significant reductions were observed for girls aged 14 years (- 1.5 ml.kg-1.min-1 (SD 0.6) (p < 0.05)). Boys aged 14 years showed a slight increase (0.4 ml.kg-1.min-1 (SD 0.5) (p = 0.44)), whereas boys aged 12 years presented an important decrease (- 1.2 ml.kg-1.min-1 (SD 0.7) (p = 0.14)). Healthy Fitness Zone (HFZ) levels also experienced a decrease of - 3.4% as regards baseline levels over the examined period. All the examined subgroups showed lower levels in relation to a normal VO2 max rate development, although girls aged 14 and boys aged 12 years accounted for the highest part.Conclusion: The results indicate that COVID-19 confinement might delay the normal development of VO2 max in adolescents. Strategies to tackle this concerning decline are warranted. What is Known: • First study analyzing cardiorespiratory fitness levels in teenagers after COVID-19 confinement. What is New: • Important delay in maximal oxygen intake identified in a sample of Spanish teenagers. • These results should be considered to develop strategies of a more active lifestyle in teenagers during and after confinements.

Dose-response association between multi-site musculoskeletal pain and work ability in physical therapists: a cross-sectional study.

PURPOSE: Multi-site musculoskeletal pain (MP) is common among health care professionals and is considered a threat to work ability and thereby a long and healthy working life. However, literature is scarce regarding these associations among physical therapists (PTs). This study aims to quantify the prevalence of local and multi-site MP among PTs, to investigate the associations between pain intensity and number of pain sites, respectively, with the level of work ability. METHODS: We conducted a survey among 1006 PTs about pain the previous month in different body areas and work ability. Work ability was measured using the Work Ability Index (WAI) including its seven categories. The odds of having lower level of work ability as a function of pain intensity (0-10) and multi-site pain were determined using binary logistic regression controlled for relevant confounders. RESULTS: The neck (36.3%) and the low back (32.3%) were the most commonly affected body areas. Furthermore, a dose-response relationship was observed between the number of pain sites and lower work ability (trend test, p < 0.001). With low pain intensity as reference, a moderate to strong association existed for lower levels of work ability in PTs who reported pain intensity of > 5 in one to two body regions (OR 2.14, 95% CI 1.27-3.60). This association was stronger when participants reported pain in three to four sites (OR 4.02, 95% CI 2.36-6.82) and even stronger when pain was experienced in five or more sites (OR 6.13, 95% CI 3.31-11.38). CONCLUSIONS: Multi-site MP is strongly associated-in a dose-response fashion-with lower levels of work ability among PTs.

Professional experience, work setting, work posture and workload influence the risk for musculoskeletal pain among physical therapists: a cross-sectional study.

PURPOSE: Physical therapists (PTs) have a high risk of developing musculoskeletal pain (MP) due to the physically demanding nature of their work tasks. Experience or the specialty area, have been associated with MP, however, previous studies are few and small. The aim of this study was to investigate the association between work-related factors and MP among PTs. METHODS: In this cross-sectional study, we collected information about MP and work-related factors of 1006 PTs using an online questionnaire. Associations between various work-related factors and MP were modelled using logistic regression controlled for various confounders. RESULTS: Neck (57%) and low back pain (49%) were most common. Work-related factors associated with higher risk for having moderate-to-high MP (≥ 3 on a scale of 0-10) were "treating more patients at the same time" [OR 2.14 (95% CI 1.53-2.99)], "working ≥45 h per week" [OR 1.73 (95% CI 1.05-2.84)], and "work in a seated position" [OR 2.04 (95% CI 1.16-3.57)] for the low back. "More years of experience" showed a negative association for elbow pain [OR 0.41 (95% CI 0.21-0.78)] and low back pain [OR 0.48 (95% CI 0.29-0.79)] compared with their less experienced counterparts. CONCLUSIONS: The lack of professional experience, working in private clinics, working in a seated position and high workload are associated with the higher risk for MP among PTs. These results add further insight about the relevance of such factors, which might be considered for developing effective interventions to prevent work-related MP and better working conditions among PTs.