Neuroprotective Effects of Anti-diabetic Drugs in the Treatment of Patients with Diabetes and Glaucoma or at High Risk for Glaucoma. / Neuroprotektive Wirkungen von Antidiabetika in der Therapie von Patienten mit Diabetes und Glaukom oder hohem Glaukomrisiko.

There is an association between glaucoma and several risk factors and metabolic diseases, such as type 2 diabetes mellitus. Diabetes mellitus leads to neurodegenerative changes, both peripherally and in the brain. This might be a shared pathophysiology and etiology for both glaucoma and diabetes. It is interesting that drugs for the treatment of diabetes seem to have neuroprotective properties independent of their blood sugar reduction. Although prospective, randomized, clinical studies are still missing, particularly metformin and glucagon-like peptide receptor agonists (GLP 1 RA) seem to have neuroprotective effects. Sulphonylureas (e.g., glibenclamide, glimepiride) are still used. They frequently potently reduce blood pressure but may be less neuroprotective. In the present review, the evidence for neuroprotective effects of the different antidiabetic drugs is presented and a possible differential therapy for patients with diabetes and glaucoma, or at high risk of glaucoma, will be discussed.

Influence of Diabetes Mellitus on Glaucoma-Relevant Examination Results in Primary Open-Angle Glaucoma. / Einflussnahme des Diabetes mellitus auf glaukomrelevante Untersuchungsergebnisse beim primären Offenwinkelglaukom.

Primary open-angle glaucoma (POAG) is no longer considered an isolated eye pressure-dependent optic neuropathy, but a neurodegenerative disease in which oxidative stress and neuroinflammation are prominent. These processes may be exacerbated by additional systemic diseases. The most common are arterial hypertension, dyslipidemia, and diabetes mellitus. Using diabetes mellitus as an example, it will be shown how far-reaching the influence of such a systemic disease can be on both the functional and the structural diagnostic methods for POAG. This knowledge is essential, since these interferences can lead to misinterpretations of POAG, which can also affect therapeutic decisions.

Lifestyle Changes in Aging and their Potential Impact on POAG. / Lebensstiländerungen im Alter und ihr potenzieller Einfluss auf das primäre Offenwinkelglaukom.

Primary open angle glaucoma is a primary mitochondrial disease with oxidative stress triggering neuroinflammation, eventually resulting in neurodegeneration. This affects many other areas of the brain in addition to the visual system. Aging also leads to inflammaging - a low-grade chronic inflammatory reaction in mitochondrial dysfunction, so these inflammatory processes overlap in the aging process and intensify pathophysiological processes associated with glaucoma. Actively counteracting these inflammatory events involves optimising treatment for any manifest systemic diseases while maintaining chronobiology and improving the microbiome. Physical and mental activity also provides support. This requires a holistic approach towards optimising neurodegeneration treatment in primary open angle glaucoma in addition to reducing intraocular pressure according personalised patient targets.

CORE-CERT Items as a Minimal Requirement for Replicability of Exercise Interventions: Results From Application to Exercise Studies for Breast Cancer Patients.

ABSTRACT: Hacke, C, Knuth, J, Bucher, M, Weisser, B, and Schmidt, T. CORE-CERT items as a minimal requirement for replicability of exercise interventions: results from application to exercise studies for breast cancer patients. J Strength Cond Res 37(5): e346-e360, 2023-Exercise interventions have been demonstrated to be useful in the prevention and therapy for multiple different diseases. The Consensus on Exercise Reporting Template (CERT) has been developed as the reporting guideline for exercise studies. The main goals of CERT are to ensure completeness of reporting, to enable interpretation of exercise programs, and to allow extraction of data for meta-analyses and the development of guidelines. However, for clinicians, the most important aspect of good reporting might be the replicability of protocols for their patients. This study was designed to determine the core components of exercise interventions for breast cancer, which are considered as minimal requirement for replicability in practice. The original items of CERT were specified, subdivided, or extended by additional key items to develop a "CORE-CERT checklist." The original CERT and our CORE-CERT were then applied to 29 exercise RCTs for breast cancer obtained from the most frequently cited and most recent meta-analyses in current guidelines. The reporting quality using both templates were examined. Mean original CERT score was 11 of 19 (59%) of completed items and 13 of 19 (68%) of reporting completeness for CORE-CERT. Reporting quality using CORE-CERT items was approximately 8% higher, indicating a more precise description of items in CORE-CERT. Differences concerned exercise dosage, nonexercise components, supervision, and description of each exercise. We propose a novel CORE-CERT guideline necessary for the replicability of exercise interventions in clinical practice. The application of CORE-CERT demonstrated a slightly better but still insufficient reporting quality of exercise interventions for breast cancer.

Diving ergospirometry with suspended weights: breathing- and fin-swimming style matter.

PURPOSE: Scuba diving is a complex condition including elevated ambient pressure, limited air supply, increased breathing work, and unfamiliar fin-swimming. Earlier approaches to assess diving specific data did not comprehensively address these aspects. We first present an underwater ergospirometry system and then test the hypothesis that both breathing characteristics and fin-swimming style affect the air consumption. METHODS/PARTICIPANTS: A suspended-weights ergospirometry system was mounted inside a hyperbaric chamber. Ergo group: 25 divers (24.6 ± 4.1 years); three set-ups: dry normobaric cycling (75-225 W), dry cycling at 20 m simulated depth (75-225 W), fin-swimming at 20 m (5-8 kg suspended weights). Style group: 20 other divers (24.6 ± 4.1 years): fin-swimming at 20 m (5-8 kg) with regard to ventilation ([Formula: see text]E) and fin-swimming style. RESULTS: Ergo group: linear heart rate and oxygen uptake ([Formula: see text]O2) increases with both 50 W-bicycle steps and suspended-weights ergometry (r = 0.97). During hyperbaric conditions, [Formula: see text]E was less increased versus normobaric conditions. Style group: the more efficient hip/thigh-oriented style shifted towards the knee/calf-oriented style. [Formula: see text]E and [Formula: see text]O2 were higher in beginners (< 100 dives) versus advanced divers (≥ 100 dives). Significant differences on the 5 kg-step: [Formula: see text]E: 31.5 ± 7.1 l/min vs. 23.7 ± 5.9 l/min and [Formula: see text]O2: 1.6 ± 0.3 l/min vs. 1.2 ± 0.3 l/min. A comparison is presented, in addition to illustrate the impact of differences in breathing characteristics and fin-swimming style. CONCLUSIONS: Diving ergospirometry with suspended weights in a hyperbaric chamber allows for comprehensive studies. Little diving experience in terms of breathing characteristics and fin-swimming style significantly increases [Formula: see text]E thereby increasing the risk of running-out-of-air.

Short-term physical exercise impacts on the human holobiont obtained by a randomised intervention study.

BACKGROUND: Human well-being has been linked to the composition and functional capacity of the intestinal microbiota. As regular exercise is known to improve human health, it is not surprising that exercise was previously described to positively modulate the gut microbiota, too. However, most previous studies mainly focused on either elite athletes or animal models. Thus, we conducted a randomised intervention study that focused on the effects of different types of training (endurance and strength) in previously physically inactive, healthy adults in comparison to controls that did not perform regular exercise. Overall study duration was ten weeks including six weeks of intervention period. In addition to 16S rRNA gene amplicon sequencing of longitudinally sampled faecal material of participants (six time points), detailed body composition measurements and analysis of blood samples (at baseline and after the intervention) were performed to obtain overall physiological changes within the intervention period. Activity tracker devices (wrist-band wearables) provided activity status and sleeping patterns of participants as well as exercise intensity and heart measurements. RESULTS: Different biometric responses between endurance and strength activities were identified, such as a significant increase of lymphocytes and decrease of mean corpuscular haemoglobin concentration (MCHC) only within the strength intervention group. In the endurance group, we observed a significant reduction in hip circumference and an increase in physical working capacity (PWC). Though a large variation of microbiota changes were observed between individuals of the same group, we did not find specific collective alterations in the endurance nor the strength groups, arguing for microbiome variations specific to individuals, and therefore, were not captured in our analysis. CONCLUSIONS: We could show that different types of exercise have distinct but moderate effects on the overall physiology of humans and very distinct microbial changes in the gut. The observed overall changes during the intervention highlight the importance of physical activity on well-being. Future studies should investigate the effect of exercise on a longer timescale, investigate different training intensities and consider high-resolution shotgun metagenomics technology. TRIAL REGISTRATION: DRKS, DRKS00015873 . Registered 12 December 2018; Retrospectively registered.

Spiroergometric assessment of cardiorespiratory fitness in subjects with severe obesity: A challenge of reference.

BACKGROUND AND AIMS: Severe obesity is associated with poor physical performance but objective data are scarce. METHODS AND RESULTS: Bicycle spiroergometry data with focus on peak oxygen uptake (V˙O2,peak) and workload (Wpeak) from 476 subjects with severe obesity (BMI ≥ 35.0 kg/m2; 70% women) were analysed. In a first step, V˙O2,peak values were compared with reference values calculated upon different formulas (Wassermann; Riddle). Thereafter, multivariate regression analyses were performed to identify determinants of cardiorespiratory fitness. Cardiorespiratory fitness reference classes for V˙O2,peak and Wpeak were established by stratifying the sample upon identified determinants. Absolute V˙O2,peak (1.87 ± 0.47 vs. 2.40 ± 0.59 l/min) and Wpeak (131 ± 26 vs. 168 ± 44 W) were lower in women than men (both p<0.001). Same pattern was found for relative V˙O2,peak and Wpeak, respectively (both p < 0.05). In women, measured V˙O2,peak was lower than predicted by Wasserman (p < 0.001) but not by Riddle (p = 0.961). In men, V˙O2,peak was lower than calculated by both Wasserman and Riddle formulas (both p ≤ 0.003). Multivariate analyses revealed height and age to be the main determinants of cardiorespiratory fitness in both sexes. Subsequent statistical analyses of calculated reference fitness classes revealed that V˙O2,peak and Wpeak differed between the age- and height-defined groups in both sexes (all p < 0.001). CONCLUSION: Data indicate that the evaluation of cardiorespiratory fitness in subjects with severe obesity is largely biased by selected references values for comparison. Our newly established reference fitness classes upon height and age might be helpful in the clinical context when dealing with obese patients.

[The "Lübeck Worlds of Movement Model"-results of the effects evaluation]. / Das "Lübecker Modell Bewegungswelten" ­ Ergebnisse der Effektevaluation.

BACKGROUND: There are few standardized and evaluated intervention programs for elderly people in need of care that consider motor, cognitive and social aspects. Therefore, the "Lübeck Worlds of Movement Model" was developed by the Lübeck Geriatrics Research Group as a multidimensional standardized intervention program for continuous use in the nursing home. OBJECTIVES: The model was evaluated for its effects over the course of one year in the areas of self-care competence (primary endpoint), mobility, coordination, flexibility, strength, endurance, and cognition. The results are presented in this article. MATERIALS AND METHODS: The sample recruitment took place in 6 nursing homes in Kiel (control group) and 10 in Lübeck (intervention group). Care-dependent senior citizens from the neighborhood were also allowed to participate. Inclusion criteria were the ability to walk at least 6 m independently and the cognitive and sensory capacities to follow the group training. The evaluation study had 255 subjects. To verify the effects of the intervention, various tests were performed at baseline and after 3, 6, 9, and 12 months: Barthel Index, Timed Up and Go, 4­meter walk test, Romberg stand, one-leg stand, 20-Cents Test, 8­Point Reach Test, hand force, 5­Chair-Rise Test, 2­Minute Step Test, and Six-Item Screener. RESULTS: Comparison of the control group with the subjects who had participated in at least half of the training sessions (per-protocol analysis) showed the highest effect size in the multivariate analysis of variance after one year for the Barthel index, followed by the Timed Up and Go, cumulated over all times for the Romberg stand and 5­Chair-Rise Test. The maximum effect measured over the entire assessment occurred after 6 months (partial eta square ηp2 = 0.332). CONCLUSIONS: The model developed preventive effects on all investigated dimensions over the course of a year, but with differences in intensity and time of maximum effect. The motivation for long-term participation was high.

Do Exercise Trials for Hypertension Adequately Report Interventions? A Reporting Quality Study.

Non-pharmacological treatment, including exercise, is an important therapy option for patients with hypertension. The study assessed the reporting quality of exercise-based interventions included in the latest meta-analysis on that topic in order to evaluate the transferability of findings into clinical practice. Reporting quality of 24 randomised controlled trials from a meta-analysis assessing blood pressure lowering effects of endurance training in 1,195 hypertensive patients was evaluated using TIDieR (Template for Intervention Description and Replication) and CERT (Consensus on Exercise Reporting Template) guidelines. Associations between reporting quality, publication year and impact factor of the publishing journals were examined. None of the studies described all intervention components completely. On average 61% (95%CI: 52-69) (TIDieR) and 57% (95%CI: 49-64) (CERT) of core items required for replication were reported. Frequent shortcomings were the reporting of adherence, intervention provider, and adverse events. Details about exercise dosage were missing in 22% (95%CI: 4-40). Publication year was related to the adherence to TIDieR (r=0.549, P=0.007) but not to CERT. No associations with journal impact factor were found. Reporting of exercise-based interventions for hypertension is not sufficient to allow for replication and limits translation of evidence into clinical practice. Researchers should apply, and review authors, journal editors and reviewers should check adherence to reporting guidelines.

[Risk Factors and Therapeutic Goals for Primary and Secondary Cardiovascular Prevention: Significance for the Glaucoma Patient]. / Risikofaktoren und Zielwerte in der kardiovaskulären Primär- und Sekundärprävention: Bedeutung für das Glaukom.

Hypertension, diabetes mellitus and dyslipidaemia are among the most important cardiovascular risk factors. In addition, there is an association with the development and progression of glaucoma. During the last years, there has been an intense discussion concerning optimal treatment goals for these risk factors. Recently, the American Heart Association has defined a blood pressure greater than 130/80 mmHg as hypertension and the European guidelines will follow this definition. These lower blood pressure limits increase the risk for a too strict blood pressure treatment with night values, which might be too low for glaucoma patients. In contrast, the treatment goals for LDL cholesterol should be as low as possible ("the lower the better"). There is a more differentiated picture concerning treatment goals for diabetes mellitus. For elderly patients, which is the main group of the glaucoma patients, a less intense blood sugar reduction is currently recommended with an HbA1c value of above 7%. The present paper summarizes the significance of cardiovascular risk factors and the respective treatment goals for the therapy of patients with glaucoma.

Smoking and physical inactivity increase cancer prevalence in BRCA-1 and BRCA-2 mutation carriers: results from a retrospective observational analysis.

BACKGROUND: The aim of this analysis in a pilot study population was to investigate whether we can verify seemingly harmful lifestyle factors such as nicotine and alcohol indulgence, obesity, and physical inactivity, as well as a low socioeconomic status for increased cancer prevalence in a cohort of BRCA 1 and 2 mutation carriers. METHODS: The analysis data are derived from 68 participants of the lifestyle intervention study LIBRE-1, a randomized, prospective trial that aimed to test the feasibility of a lifestyle modification in BRCA 1 and 2 mutation carriers. At study entry, factors such as medical history, lifestyle behavior, and socioeconomic status were retrospectively documented by interview and the current BMI was determined by clinical examination. The baseline measurements were compared within the cohort, and presented alongside reference values for the German population. RESULTS: Study participants indicating a higher physical activity during their adolescence showed a significantly lower cancer prevalence (p = 0.019). A significant difference in cancer occurrence was observed in those who smoked prior to the disease, and those who did not smoke (p < 0.001). Diseased mutation carriers tended to have a lower BMI compared to non-diseased mutation carriers (p = 0.079), whereas non-diseased revealed a significantly higher physical activity level than diseased mutation carriers (p = 0.046). DISCUSSION: The present data in this small cohort of 68 mutation carriers suggest that smoking and low physical activity during adolescence are risk factors for developing breast cancer in women with BRCA1 or BRCA2 mutation. Further data of the ongoing LIBRE 2 study are necessary to confirm these findings in a larger cohort of 600 mutation carriers.

The effect of unilateral balance training on postural control of the contralateral limb.

To investigate the impact of unilateral balance training on postural control of the trained and contralateral limb in healthy elderly. Fifty-one healthy old adults were randomly assigned into training group (TG) and control group (CG). Participants of the TG performed unilateral balance training (dominant (DOM) leg) over 4 weeks (4×/week). Centre of pressure analysis was performed at baseline, 5 weeks follow-up and 9 weeks follow-up under the following conditions: (1) one-leg stance without additional task, (2) one-leg stance with motor task and (3) one-leg stance with cognitive task. From baseline to 5 weeks follow-up, a mixed analysis of variance detected a significant time × group interaction for the DOM leg (P < 0.05), indicating higher improvement of the TG in comparison to CG. No significant interaction effect was found for the non-DOM leg. Within the TG, the non-DOM leg significantly improved in mean velocity (P = 0.001) and anterior-posterior range (P < 0.001). Unilateral balance training was effective to improve postural control of the trained leg. The effect on the contralateral leg was small and not significant within this study design. Improvements were retained after 4 weeks without training. A tendency is given that unilateral balance training might be beneficial to improve postural control of the contralateral leg.

Prospective effects of pedometer use and class competitions on physical activity in youth: A cluster-randomized controlled trial.

OBJECTIVE: To evaluate the immediate effects of a school-based multi-component program to foster a physically active lifestyle in adolescence. DESIGN/PARTICIPANTS: In a cluster-randomized controlled trial with pre- and post-assessment in 2014, 29 schools with 1162 8th grade students (48% girls) from Germany were included. Age ranged from 12 to 17 years (M=13.74; SD=0.67). INTERVENTION: While the control group attended education as usual, students in the intervention group received pedometers and took part in a class competition over a time period of 12 weeks. Classes with the most steps and best creative ideas to promote physical activity in everyday life were awarded. MAIN OUTCOME MEASURES: Primary outcomes included out-of-school sports activities (h/week), moderate to vigorous physical activity (days/week with a minimum of 60 min), active commuting (min/day), doing chores (min/day), and sedentary behavior (h/day) assessed through self-administered questionnaires as well as cardiorespiratory fitness measured using the 20-m shuttle-run test (completed laps). RESULTS: Significant interaction terms between group and wave of assessment were found on out-of-school sports activities (b=-1.09 [-1.89; -0.29], p=0.008), moderate to vigorous physical activity (b=-0.29 [-0.47; -0.10], p=0.002), and active commuting (b=-20.41 [-32.32; -8.49], p=0.001): students in the intervention group showed a higher increase of physical activity levels than students in the control group. The intervention effect on cardiorespiratory fitness missed significance marginally (b=-1.52 [-3.14; 0.98], p=0.065), There was no effect on students' sedentary behavior (b=0.06 [-0.72; 0.84], p=0.881). CONCLUSIONS: An easy to administer school-based physical activity program (12 weeks) may enhance students' leisure-time physical activity. TRIAL REGISTRATION NUMBER: ISRCTN49482118.

Comparing the Fullerton Advanced Balance Scale with the Mini-BESTest and Berg Balance Scale to assess postural control in patients with Parkinson disease.

OBJECTIVES: To validate the Fullerton Advanced Balance (FAB) Scale for patients with idiopathic Parkinson disease (PD); and to compare the FAB Scale with the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Berg Balance Scale (BBS). DESIGN: Observational study to assess concurrent validity, test-retest, and interrater reliability of the FAB Scale in patients with PD and to compare the distribution of the scale with the Mini-BESTest and BBS. SETTING: University hospital in an urban community. PARTICIPANTS: Patients with idiopathic PD (N=85; Hoehn and Yahr stages 1-4). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FAB Scale, Mini-BESTest, BBS, timed Up and Go test, Unified Parkinson's Disease Rating Scale, and visual analog scale. RESULTS: Interrater (3 raters) and test-retest (3±1 d) reliability were high for all scales (ICCs≥.95). The FAB Scale was highly correlated with the Mini-BESTest (Spearman ρ=.87) and timed Up and Go test item of the Mini-BESTest (Spearman ρ=.83). In contrast with the BBS, the FAB Scale and Mini-BESTest have only minimal ceiling effects. The FAB Scale demonstrated the most symmetric distribution when compared with the Mini-BESTest and BBS (skewness: FAB scale: -.54; Mini-BESTest: -1.07; BBS: -2.14). CONCLUSIONS: The FAB Scale is a valid and reliable tool to assess postural control in patients with PD. No ceiling effect was noted for the FAB Scale. Although the items of the FAB Scale are more detailed when compared with the Mini-BESTest, interrater and test-retest reliability were excellent. The scale is a promising tool to detect small changes of the postural control system in individuals with PD.

Does an aerobic endurance programme have an influence on information processing in migraineurs?

BACKGROUND: Migraine is a disorder of central information processing which is characterized by a reduced habituation of event-related potentials. There might be positive effects of aerobic exercise on brain function and pain. The aim of this study was to investigate the influence of exercise on information processing and clinical course of migraine. METHODS: 33 patients completed a ten-week aerobic exercise programme. To examine the influence of the treatment on information processing and attention, Trail Making Test (TMT) A and B, d2-Letter Cancellation Test (LCT) and recordings of the Contingent Negative Variation (CNV) were performed before and after the training. RESULTS: Patients showed a significant reduction of the migraine attack frequency, the iCNV-amplitude and the processing time for TMT-A and TMT-B after treatment. Moreover, there was a significant increase of the habituation and positive changes in parameters of attention (d2-LCT) after the training. CONCLUSIONS: This study demonstrates that aerobic exercise programme influences central information processing and leads to clinical effects on the migraine symptomatology. The results can be interpreted in terms of an improvement of a dysfunctional information processing and a stimulus selection under aerobic exercise.

Effect of a single pill concept on clinical and pharmacoeconomic outcomes in cardiovascular diseases.

AIMS: Our study aimed to assess whether a single pill concept (SPC) is superior to a multi pill concept (MPC) in reducing cardiovascular (CV) events, all-cause death, and costs in CV patients. METHOD AND RESULTS: Anonymized medical claims data covering 2012-2018, including patients with hypertension, dyslipidemia, and CV diseases who started a drug therapy either as SPC or identical MPC were analyzed after 1:1-Propensity Score Matching (PSM). Hospitalizations with predefined CV events, all-cause mortality, and costs were studied in 25,311 patients with SPC and 25,311 patients with MPC using incidence rate ratios (IRRs) and non-parametric tests for continuous variables.IRRs were significantly lower for SPC: stroke (IRR=0.77; 95% CI 0.67-0.88; p<0.001), transitory ischemic attack (IRR=0.61; 95% CI 0.48-0.78; p<0.001), myocardial infarction (IRR=0.76; 95% CI 0.63-0.90; p=0.0016), coronary artery disease (IRR=0.66; 95% CI 0.57-0.77; p<0.001), heart failure (IRR=0.59; 95% CI 0.54-0.64; p<0.001), acute renal failure (IRR=0.54; 95% CI 0.56-0.64; p<0.001), all cause hospitalization (IRR=0.72; 95% CI 0.71-0.74; p<0.001), CV hospitalization (IRR=0.63; 95% CI 0.57-0.69; p<0.001), and all-cause mortality (IRR=0.62; 95% CI 0.57-0.68; p<0.001). Mean time to first events and time to death were also in favor of SPC. Mean total costs were 4,708 € for SPC vs. 5.669 € for MPC, respectively (MR 0.830, p<0.001). CONCLUSION: SPC is associated with lower incidence rates of CV events, time to CV events, and all-cause death, and is superior regarding pharmacoeconomic parameters and should therefore become standard of care to improve outcomes and reduce healthcare costs.

Exercise Training for Patients With Peripheral Arterial Occlusive Disease.

BACKGROUND: One-third of all persons with peripheral arterial occlusive disease (PAOD) suffer from intermittent claudication. Exercise training under appropriate supervision is recommended in the pertinent guidelines, but physicians order it too rarely, and so-called vascular exercise groups are not available everywhere. This situation needs improvement in view of the impor - tance of walking ability and cardiorespiratory fitness for patients' quality of life and long-term disease outcome. METHODS: We review the scientific evidence on exercise training and on ways to lower barriers to the ordering of exercise training and to patient participation, on the basis of pertinent articles retrieved by a search of PubMed and in specialized sports science journals. RESULTS: 10 meta-analyses, 12 randomized controlled trials (RCTs), and 7 cohort studies were considered for this review. Largescale cohort studies have shown that exercise is associated with a lower risk of death (relative risk 0.65-0.78 after 12 months of exercise training, compared to an inactive lifestyle). Exercise training also improves the maximal walking distance by a mean of 136 m (training at home) or 180-310 m (supervised training). An additional improvement by a mean of 282 m can be expected from a combination of exercise training and endovascular revascularization. Further behavior-modifying interventions, such as goal-setting, planning, and feedback, increase both the maximum walking distance and the weekly duration of exercise. CONCLUSION: Exercise improves walking ability and lowers mortality. To attract patients with intermittent claudication to exercise training, a broad assortment of analog, digital and telemetric tools and a dense network of vascular exercise groups should be made available, along with regular contact between physicians and patients.

Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients With Use of Single-Pill Combinations: Results From the START-Study.

BACKGROUND: Single-pill combination improves adherence and persistence to medication in hypertension. It remains unclear whether this also reduces cardiovascular outcomes and all-cause mortality. We analyzed whether single-pill combinations are superior to identical multiple pills on persistence to medication, cardiovascular outcomes, and all-cause mortality. METHODS: This was a retrospective claims data (German AOK PLUS) analysis. Data from hypertensive patients ≥18 years treated with renin-angiotensin system combinations given as single pill or identical multipills covering the years 2012 to 2018 were analyzed and followed up to at least 1 year. After 1:1 propensity score matching, persistence to medication, cardiovascular events, and all-cause mortality were compared using non-parametric tests. Results were reported as incidence rate ratios and hazard ratios. RESULTS: After propensity score matching data from 57 998 patients were analyzed: 10 801 patients received valsartan/amlodipine, 1026 candesartan/amlodipine, 15 349 ramipril/amlodipine, and 1823 amlodipine/valsartan/hydrochlorothiazide as single pill or identical multipill. No relevant differences in patient characteristics were observed within the 4 groups. In all groups, a significant lower all-cause mortality, a significant a higher persistence to medication, a significant lower event rate in 15 out of 20 comparisons, and a tendency in the remaining 5 comparisons was observed under single pills compared with multipill combinations. CONCLUSIONS: Antihypertensive combination therapy reduces all-cause mortality and cardiovascular events when provided as single pill compared to identical drugs as multipills. This strongly supports the European Society of Cardiology/European Society of Hypertension and International Society of Hypertension guidelines recommending the use of a single-pill combination and thus should be more rigorously implemented into daily clinical practice.

Survey of health problems in musical theater students: a pilot study.

UNLABELLED: Musical theater performers are the "triathletes" in the performing arts. The field requires versatility in a combination of skills including dancing, singing, and drama in a high frequency of performances. The aim of this study was to analyze and evaluate the health situation of musical theater students using a complete musical educational institute as an example (n = 37). METHODS: The basis for the evaluation was a questionnaire survey (standardized F 1000). All students of the school participated (20 males, 17 females). RESULTS: Of the students, 62% have a part-time job for financial reasons, and 67.7% state only a "partial satisfaction" with their body. Regarding injury, 45.9% claim to sustain an orthopaedic injury up to twice a year, and 29.7% up to three or four times. A total of 49 acute injuries (1.3/student) and 42 chronic complaints (1.1/student) were stated. The lower extremity was the most common acutely injured region (65.3%), followed by the spine (16.3%) and upper extremity (14.3%). Of chronic complaints, the lumbar spine was the most commonly affected area, followed by the hip joint and pelvic area. Thirty-three and 24% of acute injuries occurred during "spins" and/or "stretching," respectively. There were various causes for physical and mental problems. DISCUSSION: The results show both parallels and differences to the relevant literature. It is shown that health hazards already arise in the education of musical performers. This provides particulars for the implementation of injury prevention measures during the theoretical and practical education of musical students.