The impact of uninterrupted sitting on central and peripheral cardiovascular function in pre-menopausal and post-menopausal women.

Independently, both prolonged uninterrupted sitting and the onset of menopause negatively impact markers of cardiovascular risk. Whether their combination augment these responses additively remains unknown. This study assessed whether prolonged uninterrupted sitting causes greater central and peripheral cardiovascular dysfunction in post-menopausal women compared to pre-menopausal women. To address this, 23 healthy women (13 pre-menopausal [43.77 ± 4.30 years] and 10 post-menopausal [57.20 ± 8.55 years]) sat uninterrupted for 2-h. Carotid-femoral pulse wave velocity (cf-PWV), pulse wave analysis (PWA), lower limb venous pooling (HHb), and calf circumference were assessed pre-and post-sitting using general linear mixed models, with age as a covariate. Changes in MAP over time (both between and within groups) was assessed using a two-way repeated-measures-ANOVA. There were no significant interactions for any outcome measures. However, for cf-PWV, there was a significant main effect of group (Δ = 0.854 ± 0.354 m s-1; p = 0.026, ηp2 = 0.707). For PWA, only heart rate (HR) and pressure forwards (Pf) showed significant main effects 13 of time [Δ = 6 ± 1 bts-min-1, p < 0.001, ηp2 = 0.861] and group [Δ = 3.893 ± 1.450 mmHg, p = 0.016, ηp2 = 0.271], respectively. Both HHb (Δ = 2.737 ± 0.952, p = 0.009, ηp2 = 0.742) and calf circumference (Δ = 0.812 ± 0.128 cm, p < 0.001, ηp2 = 0.863) significantly increased over time. Whilst post-menopausal women demonstrated greater overall arterial stiffness (increased cf-PWV at baseline), there was no difference in cardiovascular response (central or peripheral) to 2-h of prolonged sitting between the pre- and post-menopausal women.

Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis.

AIMS: Coronary heart disease is the most common reason for referral to exercise-based cardiac rehabilitation (CR) globally. However, the generalizability of previous meta-analyses of randomized controlled trials (RCTs) is questioned. Therefore, a contemporary updated meta-analysis was undertaken. METHODS AND RESULTS: Database and trial registry searches were conducted to September 2020, seeking RCTs of exercise-based interventions with ≥6-month follow-up, compared with no-exercise control for adults with myocardial infarction, angina pectoris, or following coronary artery bypass graft, or percutaneous coronary intervention. The outcomes of mortality, recurrent clinical events, and health-related quality of life (HRQoL) were pooled using random-effects meta-analysis, and cost-effectiveness data were narratively synthesized. Meta-regression was used to examine effect modification. Study quality was assessed using the Cochrane risk of bias tool. A total of 85 RCTs involving 23 430 participants with a median 12-month follow-up were included. Overall, exercise-based CR was associated with significant risk reductions in cardiovascular mortality [risk ratio (RR): 0.74, 95% confidence interval (CI): 0.64-0.86, number needed to treat (NNT): 37], hospitalizations (RR: 0.77, 95% CI: 0.67-0.89, NNT: 37), and myocardial infarction (RR: 0.82, 95% CI: 0.70-0.96, NNT: 100). There was some evidence of significantly improved HRQoL with CR participation, and CR is cost-effective. There was no significant impact on overall mortality (RR: 0.96, 95% CI: 0.89-1.04), coronary artery bypass graft (RR: 0.96, 95% CI: 0.80-1.15), or percutaneous coronary intervention (RR: 0.84, 95% CI: 0.69-1.02). No significant difference in effects was found across different patient groups, CR delivery models, doses, follow-up, or risk of bias. CONCLUSION: This review confirms that participation in exercise-based CR by patients with coronary heart disease receiving contemporary medical management reduces cardiovascular mortality, recurrent cardiac events, and hospitalizations and provides additional evidence supporting the improvement in HRQoL and the cost-effectiveness of CR.

Exercise-based cardiac rehabilitation for coronary heart disease.

BACKGROUND: Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS: We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS: We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point).  MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials;  NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS: This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.

Effect of combined home-based, overground robotic-assisted gait training and usual physiotherapy on clinical functional outcomes in people with chronic stroke: A randomized controlled trial.

OBJECTIVES: To assess the effect of a home-based over-ground robotic-assisted gait training program using the AlterG Bionic Leg orthosis on clinical functional outcomes in people with chronic stroke. DESIGN: Randomized controlled trial. SETTING: Home. PARTICIPANTS: Thirty-four ambulatory chronic stroke patients who recieve usual physiotherapy. INTERVENTION: Usual physiotherapy plus either (1)10-week over-ground robotic-assisted gait training program (n = 16), using the device for ⩾30 minutes per day, or (2) control group (n = 18), 30 minutes of physical activity per day. MEASUREMENTS: The primary outcome was the Six-Minute Walk Test. Secondary outcomes included: Timed-Up-and-Go, Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale. Physical activity and sedentary time were assessed using accelerometry. All measurements were completed at baseline, 10 and 22 weeks after baseline. RESULTS: Significant increases in walking distance were observed for the Six-Minute Walk Test between baseline and 10 weeks for over-ground robotic-assisted gait training (135 ± 81 m vs 158 ± 93 m, respectively; P ⩽ 0.001) but not for control (122 ± 92 m vs 119 ± 84 m, respectively). Findings were similar for Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale (all P ⩽ 0.01). For over-ground robotic-assisted gait training, there were increases in time spent stepping, number of steps taken, number of sit-to-stand transitions, and reductions in time spent sitting/supine between baseline and 10 weeks (all P < 0.05). The differences observed in all of the aforementioned outcome measures were maintained at 22 weeks, 12 weeks after completing the intervention (all P > 0.05). CONCLUSION: Over-ground robotic-assisted gait training combined with physiotherapy in chronic stroke patients led to significant improvements in clinical functional outcomes and physical activity compared to the control group. Improvements were maintained at 22 weeks.

Fitness and Fatness Are Both Associated with Cardiometabolic Risk in Preadolescents.

OBJECTIVE: To determine the associations between cardiorespiratory fitness (CRF) and fatness (overweight-obesity) with cardiometabolic disease risk among preadolescent children. STUDY DESIGN: This cross-sectional study recruited 392 children (50% female, 8-10 years of age). Overweight-obesity was classified according to 2007 World Health Organization criteria for body mass index. High CRF was categorized as a maximum oxygen uptake, determined using a shuttle run test, exceeding 35 mL·kg-1·minute-1 in girls and 42 mL·kg-1·minute-1 in boys. Eleven traditional and novel cardiometabolic risk factors were measured including lipids, glucose, glycated hemoglobin, peripheral and central blood pressure, and arterial wave reflection. Factor analysis identified underlying cardiometabolic disease risk factors and a cardiometabolic disease risk summary score. Two-way analysis of covariance determined the associations between CRF and fatness with cardiometabolic disease risk factors. RESULTS: Factor analysis revealed four underlying factors: blood pressure, cholesterol, vascular health, and carbohydrate-metabolism. Only CRF was significantly (P = .001) associated with the blood pressure factor. Only fatness associated with vascular health (P = .010) and carbohydrate metabolism (P = .005) factors. For the cardiometabolic disease risk summary score, there was an interaction effect. High CRF was associated with decreased cardiometabolic disease risk in overweight-obese but not normal weight children (P = .006). Conversely, high fatness was associated with increased cardiometabolic disease risk in low fit but not high fit children (P < .001). CONCLUSIONS: In preadolescent children, CRF and fatness explain different components of cardiometabolic disease risk. However, high CRF may moderate the relationship between fatness and cardiometabolic disease risk. TRIAL REGISTRATION: ACTRN 12614000433606.

Horseshoe-based Bayesian nonparametric estimation of effective population size trajectories.

Phylodynamics is an area of population genetics that uses genetic sequence data to estimate past population dynamics. Modern state-of-the-art Bayesian nonparametric methods for recovering population size trajectories of unknown form use either change-point models or Gaussian process priors. Change-point models suffer from computational issues when the number of change-points is unknown and needs to be estimated. Gaussian process-based methods lack local adaptivity and cannot accurately recover trajectories that exhibit features such as abrupt changes in trend or varying levels of smoothness. We propose a novel, locally adaptive approach to Bayesian nonparametric phylodynamic inference that has the flexibility to accommodate a large class of functional behaviors. Local adaptivity results from modeling the log-transformed effective population size a priori as a horseshoe Markov random field, a recently proposed statistical model that blends together the best properties of the change-point and Gaussian process modeling paradigms. We use simulated data to assess model performance, and find that our proposed method results in reduced bias and increased precision when compared to contemporary methods. We also use our models to reconstruct past changes in genetic diversity of human hepatitis C virus in Egypt and to estimate population size changes of ancient and modern steppe bison. These analyses show that our new method captures features of the population size trajectories that were missed by the state-of-the-art methods.

The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective.

BACKGROUND: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. METHOD: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. RESULTS: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. CONCLUSION: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

Validity and reliability of lower-limb pulse-wave velocity assessments using an oscillometric technique.

NEW FINDINGS: What is the central question of this study? There is growing interest in the effects of sedentarism on central and peripheral cardiovascular health. To permit further investigation, including larger epidemiological studies, there is a need to identify arterial health assessment tools that are valid (accurate) and reliable (precise), yet practical. What is the main finding and its importance? Lower-limb vascular health (femoral-ankle pulse-wave velocity) can be determined in a supine position with accuracy and precision using an oscillometrically based device. This technology might help to improve our understanding of the pathological mechanisms linking cardiovascular disease to sedentarism, including the interaction between peripheral and central vasculature. ABSTRACT: There is a growing interest in the deleterious effects of sedentary behaviour on lower-limb arterial health. To permit further investigation, including larger epidemiological studies, there is a need to identify lower-limb arterial health assessment tools that are valid and reliable, yet simple to administer. In this study, we sought to determine the validity and between-day reliability of femoral-ankle pulse-wave velocity (faPWV) measures obtained using an oscillometrically based device (SphygmocCor XCEL) in supine and seated positions. Doppler ultrasound was used as the criterion. A total of 47 healthy adults were recruited for validity (n = 32) and reliability (n = 15) analyses. Validity was determined by measuring faPWV in seated and supine positions using the XCEL and Doppler ultrasound devices, in a randomized order. Between-day reliability was determined by measuring seated and supine faPWV using the XCEL on three different mornings, separated by a maximum of 7 days. The validity criterion [absolute standard error of estimate (aSEE) < 1.0 m s-1 ] was met in the supine [aSEE = 0.8 m s-1 , 95% confidence interval (CI) 0.4-1.0], but not in the seated (aSEE = 1.2 m s-1 , 95% CI 1.1-1.2) position. Intraclass correlation coefficient (ICC) estimates revealed that the XCEL demonstrated good reliability in the supine position (ICC = 0.83, 95% CI 0.65-0.93), but poor reliability in the seated position (ICC = 0.29, 95% CI 0.23-0.63). The oscillometric XCEL device can be used to determine lower-limb pulse-wave velocity with acceptable validity and reliability in the conventionally recommended supine position, but not in the seated position.

A systematic review of the effectiveness of physical activity interventions in adults with breast cancer by physical activity type and mode of participation.

OBJECTIVES: Engaging in physical activity following a diagnosis in breast cancer patients improves both survival rates and psychosocial health outcomes. The factors influencing the effectiveness of physical activity interventions for breast cancer patients remain unclear. This systematic review focuses on two questions: are there differences in outcomes depending on; the mode of physical activity undertaken; and whether group-based, or individual, programmes are proposed. METHODS: Five databases were searched (PsycINFO, CINAHL, MEDLINE, EMBASE, and Central). Randomised control trials were included if they reported an intervention aiming to increase physical activity amongst breast cancer patients. A total of 1561 records were screened with 17 studies identified for final inclusion. Data extraction and risk of bias analysis were undertaken. A meta-analysis was not possible due to methodological differences between studies. RESULTS: Findings indicate no evident differences in outcomes based on exercise mode adopted. There are some indications that group interventions may have additional beneficial outcomes, in comparison to individual interventions, but this conclusion cannot be drawn definitively due to confounds within study designs, lack of group-based intervention designs, and overall lack of long-term intervention effects. CONCLUSIONS: Although there are no indications of negative intervention effects, only 6 of 17 trials demonstrated significant intervention effects were maintained. Greater transparency in reporting of interventions, and research enabling a comparison of physical activity delivery and mode is needed to determine optimum physical activity interventions to maintain patient physical activity and outcomes.

Barriers and facilitators to participating in physical activity for adults with breast cancer receiving adjuvant treatment: A qualitative metasynthesis.

OBJECTIVE: Physical activity can improve the health and well-being of individuals receiving adjuvant treatment for breast cancer, but engagement in physical activity can be low. This review synthesises the barriers and facilitators to engaging with and participating in physical activity whilst receiving treatment. METHODS: The metasynthesis of qualitative studies is reported in line with the PRISMA statement. We systematically searched eight databases (MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, British Library, OpenGrey, and Conference Proceedings Citation Index) from inception to November 30, 2017. A total of 1276 abstracts were retrieved and screened by two reviewers independently. Data from eligible studies were extracted and critically appraised. As this review concerns qualitative studies only, a CER-QUAL GRADE assessment was completed. RESULTS: A total of 13 studies were included. Four clear themes emerged (side effects of treatment, beliefs about physical activity, focus on health not illness, and social factors) each containing both barriers and facilitators. Key facilitators to participating in physical activity during adjuvant treatment included positive physical benefits, improvements in psychological well-being, and increased self-esteem and empowerment. Further, having a knowledgeable instructor, tailored information, and a supportive environment were important to women undergoing treatment. Main barriers included fatigue and pain, as well as work and caring responsibilities. CONCLUSIONS: Incorporating physical activity into treatment regimens is important. Focusing on being less sedentary and providing accurate, tailored information should be prioritised within future interventions. Having a supportive environment and accounting for the particular barriers or facilitators to engagement identified here should aid the success of future interventions.

High-intensity interval training and moderate-intensity continuous training in adults with Crohn's disease: a pilot randomised controlled trial.

BACKGROUND: This study assessed the feasibility and acceptability of two common types of exercise training-high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT)-in adults with Crohn's disease (CD). METHODS: In this mixed-methods pilot trial, participants with quiescent or mildly-active CD were randomly assigned 1:1:1 to HIIT, MICT or usual care control, and followed up for 6 months. The HIIT and MICT groups were offered three exercise sessions per week for the first 12 weeks. Feasibility outcomes included rates of recruitment, retention, outcome completion, and exercise attendance. Data were collected on cardiorespiratory fitness (e.g., peak oxygen uptake), disease activity, fatigue, quality of life, adverse events, and intervention acceptability (via interviews). RESULTS: Over 17 months, 53 patients were assessed for eligibility and 36 (68%) were randomised (47% male; mean age 36.9 [SD 11.2] years); 13 to HIIT, 12 to MICT, and 11 to control. The exercise session attendance rate was 62% for HIIT (288/465) and 75% for MICT (320/429), with 62% of HIIT participants (8/13) and 67% of MICT participants (8/12) completing at least 24 of 36 sessions. One participant was lost to follow-up. Outcome completion rates ranged from 89 to 97%. The mean increase in peak oxygen uptake, relative to control, was greater following HIIT than MICT (2.4 vs. 0.7 mL/kg/min). There were three non-serious exercise-related adverse events, and two exercise participants experienced disease relapse during follow-up. CONCLUSIONS: The findings support the feasibility and acceptability of the exercise programmes and trial procedures. A definitive trial is warranted. Physical exercise remains a potentially useful adjunct therapy in CD. [ID: ISRCTN13021107].

Reliability of muscle blood flow and oxygen consumption response from exercise using near-infrared spectroscopy.

NEW FINDINGS: What is the central question of this study? Continuous-wave near-infrared spectroscopy, coupled with venous and arterial occlusions, offers an economical, non-invasive alternative to measuring skeletal muscle blood flow and oxygen consumption, but its reliability during exercise has not been established. What is the main finding and its importance? Continuous-wave near-infrared spectroscopy devices can reliably assess local skeletal muscle blood flow and oxygen consumption from the vastus lateralis in healthy, physically active adults. The patterns of response exhibited during exercise of varying intensity agree with other published results using similar methodologies, meriting potential applications in clinical diagnosis and therapeutic assessment. Near-infrared spectroscopy (NIRS), coupled with rapid venous and arterial occlusions, can be used for the non-invasive estimation of resting local skeletal muscle blood flow (mBF) and oxygen consumption (mV̇O2), respectively. However, the day-to-day reliability of mBF and mV̇O2 responses to stressors such as incremental dynamic exercise has not been established. The aim of this study was to determine the reliability of NIRS-derived mBF and mV̇O2 responses from incremental dynamic exercise. Measurements of mBF and mV̇O2 were collected in the vastus lateralis of 12 healthy, physically active adults [seven men and five women; 25 (SD 6) years old] during three non-consecutive visits within 10 days. After 10 min rest, participants performed 3 min of rhythmic isotonic knee extension (one extension every 4 s) at 5, 10, 15, 20, 25 and 30% of maximal voluntary contraction (MVC), before four venous occlusions and then two arterial occlusions. The mBF and mV̇O2 increased proportionally with intensity [from 0.55 to 7.68 ml min-1  (100 ml)-1 and from 0.05 to 1.86 ml O2  min-1  (100 g)-1 , respectively] up to 25% MVC, where they began to plateau at 30% MVC. Moreover, an mBF/mV̇O2 muscle oxygen consumption ratio of ∼5 was consistent for all exercise stages. The intraclass correlation coefficient for mBF indicated high to very high reliability for 10-30% MVC (0.82-0.9). There was very high reliability for mV̇O2 across all exercise stages (intraclass correlation coefficient 0.91-0.96). In conclusion, NIRS can reliably assess muscle blood flow and oxygen consumption responses to low- to moderate-intensity exercise, meriting potential applications in clinical diagnosis and therapeutic assessment.

A Community-Based, Bionic Leg Rehabilitation Program for Patients with Chronic Stroke: Clinical Trial Protocol.

Stroke is a major global health problem whereby many survivors have unmet needs concerning mobility during recovery. As such, the use of robotic-assisted devices (i.e., a bionic leg) within a community setting may be an important adjunct to normal physiotherapy in chronic stroke survivors. This study will be a dual-center, randomized, parallel group clinical trial to investigate the impact of a community-based training program using a bionic leg on biomechanical, cardiovascular, and functional outcomes in stroke survivors. Following a baseline assessment that will assess gait, postural sway, vascular health (blood pressure, arterial stiffness), and functional outcomes (6-minute walk), participants will be randomized to a 10-week program group, incorporating (1) a physiotherapy plus community-based bionic leg training program; (2) physiotherapy only; or (3) usual care control. The training program will involve participants engaging in a minimum of 1 hour per day of bionic leg activities at home. Follow-up assessments, identical to baseline, will occur after 10 weeks, and 3 and 12 months postintervention. Given the practical implications of the study, the clinical significance of using the bionic leg will be assessed for each outcome variable. The potential improvements in gait, balance, vascular health, and functional status may have a meaningful impact on patients' quality of life. The integration of robotic devices within home-based rehabilitation programs may prove to be a cost-effective, practical, and beneficial resource for stroke survivors.

Effect of a Faith-Based Education Program on Self-Assessed Physical, Mental and Spiritual (Religious) Health Parameters.

The aim of the study was to determine the effect of attending a faith-based education program (FBEP) on self-assessed physical, mental and spiritual health parameters. The study was designed as a prospective, observational, cohort study of individuals attending a 5-day FBEP. Out of 2650 sequential online registrants, those previously unexposed to the FBEP received automated invitations to complete 5 sequential Self-Assessment Questionnaire's (SAQ's) containing: (1) Duke University Religion Index (DUREL); (2) Negative Religious Coping (N-RCOPE); (3) Perceived Stress Scale (PSS); (4) Center for Epidemiology and Statistics-Depression Scale (CES-D); (5) Brief Illness Perception Questionnaire (BIPQ); and the (6) State Trait Anxiety Inventory (STAI). Pre-attendance SAQ (S1) was repeated immediately post-FBEP (S2), at 30 days (S3), 90 days (S4) and after 1 year (S5). Of 655 invited, 274 (42 %) succeeded, 242 (37 %) failed and 139 (21 %) declined to complete S1. Of the 274, 37 (14 %) were excluded at on-site interview; 26 (9 %) never attended the FBEP (i.e., controls: 5♂; 21♀; 27-76 years); and 211 (77 %) participated (i.e., cases: 105♂; 106♀; 18-84 years) and were analyzed over time: 211 (S1); 192 (S2); 99 (S3); 52 (S4); 51 (S5). IRB approval was via the Human Research Ethics Committee of Stellenbosch University. DUREL showed significant, sustained changes in Intrinsic Religiosity. N-RCOPE showed significant, lasting improvement. In others, median values dropped significantly immediately after the FBEP (S1:S2) for STAI-State p < 0.0001; PSS p < 0.0001; BIPQ p < 0.0001; and CES-D p < 0.0001; and at 1 month (S1:S3) for STAI-Trait p < 0.001; all changes were sustained (S3 through S5). This FBEP produced statistically and clinically significant changes; these lasted in those followed up >1 year.

Prediction of peak oxygen uptake in children using submaximal ratings of perceived exertion during treadmill exercise.

PURPOSE: This study assessed the utility of the Children's Effort Rating Table (CERT) and the Eston-Parfitt (EP) Scale in estimating peak oxygen uptake ([Formula: see text]) in children, during cardiopulmonary exercise testing (CPET) on a treadmill. METHODS: Fifty healthy children (n = 21 boys; 9.4 ± 0.9 years) completed a continuous, incremental protocol until the attainment of [Formula: see text]. Oxygen uptake ([Formula: see text]) was measured continuously, and ratings of perceived exertion (RPE) were estimated at the end of each exercise stage using the CERT and the EP Scale. Ratings up to- and including RPE 5 and 7, from both the CERT (CERT 5, CERT 7) and EP Scale (EP 5, EP 7), were linearly regressed against the corresponding [Formula: see text], to both maximal RPE (CERT 10, EP 10) and terminal RPE (CERT 9, EP 9). RESULTS: There were no differences between measured- and predicted [Formula: see text] from CERT 5, CERT 7, EP 5 and EP 7 when extrapolated to either CERT 9 or EP 9 (P > 0.05). Pearson's correlations of r = 0.64-0.86 were observed between measured- and predicted [Formula: see text], for all perceptual ranges investigated. However, only EP 7 provided a small difference when considering the standard error of estimate, suggesting that the prediction of [Formula: see text] from EP 7 would be within 10 % of measured [Formula: see text]. CONCLUSIONS: Although robust estimates of [Formula: see text] may be elicited using both the CERT and EP Scale during a single CPET with children, the most accurate estimates of [Formula: see text] occur when extrapolating from EP 7.

The effectiveness of a high-intensity games intervention on improving indices of health in young children.

This study assessed the effectiveness of a 6-week, high-intensity, games-based intervention on physiological and anthropometric indices of health, in normal weight (n = 26; 32.5 ± 8.9 kg) and obese (n = 29; 49.3 ± 8.9 kg) children (n = 32 boys, 23 girls), aged 8-10 years. Children were randomised into an exercise or control group. The exercise group participated in a twice-weekly, 40 min active games intervention, alongside their usual school physical education classes. The control group did not take part in the intervention. Before and after the intervention, participants completed both a maximal and submaximal graded exercise test. The submaximal exercise test comprised of a 6 min, moderate- and 6 min heavy-intensity bout, interspersed with a 5 min recovery. The exercise group demonstrated improvements in maximal oxygen uptake (51.4 ± 8.5 vs 54.3 ± 9.6 ml · kg(-1) · min(-1)) and peak running speed (11.3 ± 1.6 vs 11.9 ± 1.6 km · h(-1)), and a reduction in the oxygen cost of submaximal exercise between assessments (P < .05). A decrease in waist circumference and increase in muscle mass were observed between assessments for the obese participants randomised to the intervention (both P < .05). This study demonstrates that a short-term, high-intensity games intervention may elicit positive changes in physiological and anthropometric indices of health in normal weight and obese children.

Reliability tests and guidelines for B-mode ultrasound assessment of central adiposity.

INTRODUCTION: Ultrasound represents a validated and relatively inexpensive diagnostic device for assessing central adiposity; however, widespread adoption has been impeded by the lack of reliable standard operating procedures. PURPOSE: To examine the reliability of, and describe guidelines for, ultrasound-derived recording of intra-abdominal fat thickness (IAT) and maximal preperitoneal fat thickness (PFT). METHODS: Ultrasound scans were obtained from 20 adults (50% female, 26 ± 7 years, 24·5 kg/m(2) ) on three different mornings. IAT was assessed 2 cm above the umbilicus (transverse plane) measuring from linea alba to: (i) anterior aorta, (ii) posterior aorta and (iii) anterior aspect of the vertebral column. PFT was measured from linea alba to visceral peritoneum in (i) sagittal and (ii) transverse planes, immediately over and inferior to the xiphi-sternum, respectively. RESULTS: For IAT, the criterion intraclass correlation coefficient (ICC) of 0·75 was exceeded for measurements to anterior aorta (0·95), posterior aorta (0·94) and vertebra (0·96). The reliability coefficient expressed as a percentage of the mean (RC%) was lowest (better) for measurement to vertebrae (9·8%). For PFT, mean thickness was comparable for sagittal (1·74 cm) and transverse (1·76 cm) planes; ICC values were also comparable for both planes (0·98 vs. 0·98, respectively), as were RC% (7·5% vs. 7·1%, respectively). CONCLUSIONS: IAT assessments to the vertebra were marginally more reliable than those to other structures. While PFT assessments were equally reliable for both measurements planes, precise probe placement was easier for the sagittal plane. Based on these findings, guidelines for the reliable measurement of central adiposity using ultrasound are presented.

A randomized controlled trial to assess the psychosocial effects of early exercise engagement in patients diagnosed with transient ischaemic attack and mild, non-disabling stroke.

OBJECTIVE: To examine the effect of an early exercise and education programme on psychosocial health of transient ischaemic attack (TIA) and mild, non-disabling stroke patients. DESIGN: Randomized, parallel-group, clinical trial. SETTING: Hospital and academic institution. PARTICIPANTS: A total of 55 newly diagnosed transient ischaemic attack/mild stroke patients (Mean[SD]; 69[11]y). INTERVENTION: Participants were randomized to either an eight-week, twice weekly, 90-minute exercise and education programme (experimental group) or to a usual care control group. MAIN MEASURES: Psychosocial measures (SF-36, Hospital Anxiety and Depression Scale, Profile of Mood States, International Physical Activity Questionnaire, Stroke Awareness Questionnaire) were assessed at baseline and eight-week and 12-month follow-up. RESULTS: The experimental group demonstrated improvements in the Physical Component Score (Mean[SD]; 44.1[11.7] to 47.4[11.3]%), Vitality (46.5[12.4] to 54.2[14.2]%), Physical Functioning (45.6[10.7] to 51.9[14.7]%), Role Physical (38.7[10.8] to 43.1[13.6]%) and Global Health (49.1[10.3] to 54.4[13.6]%) from the SF-36, at the eight-week follow-up assessment (P < 0.05). There were no further changes in these measures between the eight-week and 12-month follow-up assessment (P > 0.05). The experimental group demonstrated a greater awareness of the signs and symptoms associated with stroke (P < 0.05). There were no differences in the Mental Component Score (SF-36), the Hospital Anxiety and Depression Scale or the International Physical Activity Questionnaire between treatment groups (P > 0.05). CONCLUSION: Early engagement in an exercise and education programme may improve physical health perceptions in transient ischaemic attack/mild stroke patients. However, secondary prevention exercise and education programmes warrant further research with regards to their effects on perceptions of mental health in this population group.

Skin temperature of the knee was effectively reduced when using a new continuous cold-flow cryocompression device: a randomised controlled crossover trial.

OBJECTIVE: To determine which temperature settings on a new continuous cold-flow cryocompression device effectively reduce knee skin temperature to 10-15 °C, where pain and swelling are expected to be attenuated. DESIGN: Randomised controlled crossover trial. SETTING: University laboratory. PARTICIPANTS: 32 healthy adult participants recruited (1 dropout) with no contraindications to cryocompressive therapy. INTERVENTION: A k-type thermocouple was used to record skin temperature at baseline and every five minutes during a 30-minute cryocompression treatment in a control condition and when using four different device temperature settings (6 °C, 8 °C, 10 °C, and 12 °C) on a continuous cold-flow cryocompression device. Conditions were labelled Control, Con-6, Con-8, Con-10, and Con-12, respectively. MAIN OUTCOME MEASURES: Skin temperature change (°C) throughout cryocompression; time taken (mins) to achieve skin temperature < 15 °C; and the difference between final skin temperature and device temperature setting (°C). RESULTS: Median (IQR) skin temperature after cryocompression was 32.1 °C (29.3-33.4), 12.8 °C (12.1-14.6), 14.3 °C (13.8-15.7), 16.1 °C (15.2-17.3), and 17.7 °C (16.9-18.9) for the Control condition and Con-6, Con-8, Con-10 and Con-12, respectively. It took 20 min (Con-6) and 25 min (Con-8) for skin temperature to reach < 15 °C. A median (IQR) difference of 6.8 °C (6.1-8.6), 6.3 °C (5.8-7.7), 6.1 °C (5.2-7.3), and 5.7 °C (4.9-6.9) for Con-6, Con-8, Con-10, and Con-12, respectively was observed between device temperature setting and final skin temperature. CONCLUSIONS: The device is recommended as it reduced skin temperature to the therapeutic range of 10-15 °C during a 30-minute treatment when using the 6 °C or 8 °C device temperature settings. Future research should determine optimal treatment lengths for cryocompression. CONTRIBUTION OF THE PAPER.