Is patients' activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

BACKGROUND: Prolonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients' activities of daily living (ADL) score may be a proxy for home care workers' standing time at work. The objective of the present study was to investigate the association between patients' ADL self-care score, and workers standing time. METHODS: This cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients' ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories. RESULTS: We analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients. CONCLUSION: Our findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers' total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Effects of Inpatient Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy on Sick Leave and Cost of Lost Production: 7-Year Follow-Up of a Randomized Controlled Trial.

OBJECTIVES: Previously, we reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective than outpatient Acceptance and Commitment Therapy (O-ACT) in reducing sickness absence and was cost-effective over a 24-month period. Here we present 7-years of follow-up on sick leave and the cost of lost production. METHODS: We randomized individuals aged 18-60, sick-listed due to musculoskeletal or mental health disorders to I-MORE (n = 82) or O-ACT (n = 79). I-MORE, lasting 3.5 weeks, integrated ACT, physical training, and work-related problem-solving. In contrast, O-ACT mainly offered six weekly 2.5 h group sessions of ACT. We measured outcomes using registry data for days on medical benefits and calculated costs of lost production. Our analysis included regression analyses to examine differences in sickness absence days, logistic general estimating equations for repeated events, and generalized linear models to assess differences in costs of lost production. RESULTS: Unadjusted regression analyses showed 80 fewer days of sickness absence in the 7-year follow-up for I-MORE compared to O-ACT (95% CI - 264 to 104), with an adjusted difference of 114 fewer days (95% CI - 298 to 71). The difference in costs of production loss in favour of I-MORE was 27,048 euros per participant (95% CI - 35,009 to 89,104). CONCLUSIONS: I-MORE outperformed O-ACT in reducing sickness absence and production loss costs during seven years of follow-up, but due to a limited sample size the results were unprecise. Considering the potential for substantial societal cost savings from reduced sick leave, there is a need for larger, long-term studies to evaluate return-to-work interventions.

Inpatient multimodal rehabilitation and the role of pain intensity and mental distress on return-to-work: causal mediation analyses of a randomized controlled trial.

OBJECTIVE: Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined whether pain intensity and mental distress mediate the effect of an inpatient programme on sustainable return-to-work. METHODS: The randomized controlled trial compared inpatient multimodal occupational rehabilitation (n = 82) with outpatient acceptance and commitment therapy (n = 79) in patients sick-listed due to musculoskeletal and mental health complaints. Pain and mental distress were measured at the end of each programme, and patients were followed up on sick-leave for 12 months. Cox regression with an inverse odds weighted approach was used to assess causal mediation. RESULTS: The total effect on return-to-work was in favour of the inpatient programme compared with the control (hazard ratio (HR) 1.96; 95% confidence interval (95% CI) 1.15-3.35). There was no evidence of mediation by pain intensity (indirect effect HR, 0.98; 95% CI, 0.61-1.57, direct effect HR, 2.00; 95% CI, 1.02-3.90), but mental distress had a weak suppression effect (indirect effect HR, 0.89; 95% CI, 0.59-1.36, direct effect HR, 2.19; 95% CI, 1.13-4.26). CONCLUSION: These data suggest that symptom reduction is not necessary for sustainable return-to-work after an inpatient multimodal occupational rehabilitation intervention.

Occupational physical activity and risk of mortality in women and men: the Tromsø Study 1986-2021.

OBJECTIVE: Associations between occupational physical activity (OPA) and mortality risks are inconclusive. We aimed to examine associations between (1) OPA separately and (2) jointly with leisure time physical activity (LTPA), and risk of all-cause, cardiovascular disease (CVD) and cancer mortality, over four decades with updated exposure and covariates every 6-8 years. METHODS: Adults aged 20-65 years from the Tromsø Study surveys Tromsø3-Tromsø7 (1986-2016) were included. We categorised OPA as low (sedentary), moderate (walking work), high (walking+lifting work) or very high (heavy manual labour) and LTPA as inactive, moderate and vigorous. We used Cox/Fine and Gray regressions to examine associations, adjusted for age, body mass index, smoking, education, diet, alcohol and LTPA (aim 1 only). RESULTS: Of 29 605 participants with 44 140 total observations, 4131 (14.0%) died, 1057 (25.6%) from CVD and 1660 (40.4%) from cancer, during follow-up (median: 29.1 years, 25th-75th: 16.5.1-35.3). In men, compared with low OPA, high OPA was associated with lower all-cause (HR 0.83, 95% CI 0.74 to 0.92) and CVD (subdistributed HR (SHR) 0.68, 95% CI 0.54 to 0.84) but not cancer mortality (SHR 0.99, 95% CI 0.84 to 1.19), while no association was observed for moderate or very high OPA. In joint analyses using inactive LTPA and low OPA as reference, vigorous LTPA was associated with lower all-cause mortality combined with low (HR 0.75, 95% CI 0.64 to 0.89), high (HR 0.67, 95% CI 0.54 to 0.82) and very high OPA (HR 0.74, 95% CI 0.58 to 0.94), but not with moderate OPA. In women, there were no associations between OPA, or combined OPA and LTPA, with mortality. CONCLUSION: High OPA, but not moderate and very high OPA, was associated with lower all-cause and CVD mortality risk in men but not in women. Vigorous LTPA was associated with lower mortality risk in men with low, high and very high OPA, but not moderate OPA.

Can home care work be organized to promote health among the workers while maintaining productivity? An investigation into stakeholders' perspectives on organizational work redesign concepts based on the Goldilocks Work principles.

BACKGROUND: Due to the aging population, the need for home care services is increasing in most Western countries, including Norway. However, the highly physical nature of this job could contribute to make recruiting and retaining qualified home care workers (HCWs) challenging. This issue may be overcome by adopting the Goldilocks Work principles, aiming at promoting workers' physical health by determining a "just right" balance between work demands and recovery periods while maintaining productivity. The aim of this study was to 1) gather suggestions from home care employees on suitable organizational (re)design concepts for promoting HCWs' physical health and 2) have researchers and managers define actionable behavioral aims for the HCWs for each proposed (re)design concept and evaluate them in the context of the Goldilocks Work principles. METHODS: HCWs, safety representatives, and operation coordinators (n = 14) from three Norwegian home care units participated in digital workshops led by a researcher. They suggested, ranked, and discussed redesign concepts aimed at promoting HCWs' health. The redesign concepts were subsequently operationalized and evaluated by three researchers and three home care managers. RESULTS: Workshop participants suggested five redesign concepts, namely "operation coordinators should distribute work lists with different occupational physical activity demands more evenly between HCWs", "operation coordinators should distribute transportation modes more evenly between HCWs", "Managers should facilitate correct use of ergonomic aids and techniques", "HCWs should use the stairs instead of the elevator", and "HCWs should participate in home-based exercise training with clients". Only the first two redesign concepts were considered to be aligned with the Goldilocks Work principles. A corresponding behavioral aim for a "just right" workload was defined: reduce inter-individual differences in occupational physical activity throughout a work week. CONCLUSIONS: Operation coordinators could have a key role in health-promoting organizational work redesign based on the Goldilocks Work principles in home care. By reducing the inter-individual differences in occupational physical activity throughout a work week, HCWs' health may be improved, thus reducing absenteeism and increasing the sustainability of home care services. The two suggested redesign concepts should be considered areas for evaluation and adoption in practice by researchers and home care services in similar settings.

Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders.

PURPOSE: To evaluate the cost-effectiveness and cost-benefit of inpatient multimodal occupational rehabilitation (I-MORE) compared to outpatient acceptance and commitment therapy (O-ACT) for individuals sick listed due to musculoskeletal- or common mental disorders during two-years of follow-up. METHODS: We conducted an economic evaluation with a societal perspective alongside a randomized controlled trial with 24 months follow-up. Individuals sick listed 2 to 12 months were randomized to I-MORE (n = 85) or O-ACT (n = 79). The outcome was number of working days. Healthcare use and sick leave data were obtained by registry data. RESULTS: Total healthcare costs during the 24 months was 12,057 euros (95% CI 9,181 to 14,933) higher for I-MORE compared to O-ACT, while the difference in production loss was 14,725 euros (95% CI -1,925 to 31,375) in favour of I-MORE. A difference of 43 (95% CI -6 to 92) workdays, in favour of I-MORE, gave an incremental cost-effectiveness ratio of 278 euros for one workday, less than the cost of one day production (339 euros). Net societal benefit was 2,667 euros during two years of follow-up. CONCLUSION: Despite considerable intervention costs, the lower production loss resulted in I-MORE being cost-effective when compared to O-ACT. Based on economic arguments, I-MORE should be implemented as a treatment alternative for individuals on long-term sick leave. However, more research on subgroup effects and further follow-up of participants' permanent disability pension awards are warranted.

Can home care work be organized to promote musculoskeletal health for workers? Study protocol for the Norwegian GoldiCare cluster randomized controlled trial.

BACKGROUND: Home care workers perform physically strenuous tasks, in particular when handling patients with high care demands. Thus, musculoskeletal pain and sick leave is greater in this group than in the general population. To ease these issues, we will implement a Goldilocks Work intervention (GoldiCare), redistributing schedules between workers to achieve a "just right" weekly structure of physical work that can promote health. This protocol paper describes the content, design, implementation and evaluation of the cluster randomized controlled trial of the GoldiCare intervention in home care. METHODS: The cluster randomized controlled trial is a 16-week workplace organizational intervention implemented through operations managers at the home care units. The operations managers will be introduced to the Goldilocks Work Principle and a GoldiCare tool, to assist the operations managers when composing a "just right" distribution of work schedules throughout the week. The GoldiCare tool provides an overview of the physical strain for each shift, based on the number of patients and their need for care. We expect to include 11 units, which will be randomized to either intervention or control at a 1:1 ratio. Home care workers assigned to the control group will continue to work as normal during the intervention period. Musculoskeletal pain in neck/shoulder and lower back will be the primary outcomes and we will also evaluate the composition of physical behaviors as well as fatigue after work as secondary outcomes. We will collect data using (1) daily questions regarding musculoskeletal pain and fatigue after work, (2) 7 days of objective measurements of physical behavior, (3) questionnaires about the participant's characteristics, health, and workplace psychosocial stressors and (4) information on the implementation of the GoldiCare tool. In addition, a process evaluation will be conducted using focus group discussions and individual interviews. DISCUSSION: Due to the increasing aging population in need of care, measures that can improve the health of home care workers are paramount for the sustainability of this sector. This organizational intervention is based on information available nation-wide, and therefore has the potential to be scaled to all municipalities in Norway if proven effective. TRIAL REGISTRATION: This clinical trial was registered on 08/05/2022 under NCT05487027 .

Effects of one long vs. two short resistance training sessions on training volume and affective responses in resistance-trained women.

The aim of this study was to compare the acute effects of performing a lower body resistance training program in one long or two shorter sessions in 1 day on training volume and affective measures. Employing a randomized-crossover design, 23 resistance-trained women (22 ± 2 years, 166 ± 6 cm, and 66.4 ± 7.5 kg) performed two training days consisting of (i) one long (46 min) or (ii) two short sessions (total of 43 min) separated by 3.5-5 h. Each training day was separated by 4-6 days and consisted of three sets to failure for six exercises. Training volume (number of repetitions lifted) were recorded during the sessions. Rating of perceived exertion for effort (RPE), rating of perceived exertion for discomfort (RPD), session displeasure/pleasure (sPDF) and exercise enjoyment (EES) were measured 10 min after each session. Participants also completed a readiness to train questionnaire (7 questions), 24 h after each session, and which training protocol they preferred, 48 h after the last session. The long session led to higher RPE (+1 point, p < 0.001, ES = 1.07), RPD (+1 point, p = 0.043, ES = 0.53) and sPDF (p = 0.010, ES = 0.59) compared to the short sessions. There was no difference in EES (p = 0.118, ES = 0.33). The short sessions had 3% higher training volume than the long session (p = 0.002, ES = 0.42). There were no differences in perceived readiness to train 24 h after the sessions (range: p = 0.166-0.856 and ES = 0.08-0.32). Twenty-two participants preferred the long session, while one preferred the short sessions. In conclusion, performing a longer, lower body, resistance training session led to greater perceptions of effort, discomfort and session pleasure than splitting the same program into two shorter sessions among resistance-trained women. However, two shorter sessions led to a greater training volume.

A Comparison of Affective Responses Between Time Efficient and Traditional Resistance Training.

The aim of the study was to compare the acute effects of traditional resistance training and superset training on training duration, training volume and different perceptive measures. Twenty-nine resistance-trained participants (27 ± 7 years, 173 ± 9 cm, and 70 ± 14 kg) performed a whole-body workout (i) traditionally and (ii) as supersets of exercises targeting different muscle groups, in a randomized-crossover design. Each session was separated by 4-7 days, and consisted of eight exercises and three sets to failure. Training duration and number of repetitions lifted were recorded during the sessions. Rate of perceived exertion for effort (RPE), rate of perceived exertion for discomfort (RPD), session displeasure/pleasure (sPDF), and exercise enjoyment (EES) were measured 15 min after each session. Forty-eight hours after the final session participants reported which session they preferred. The superset session led to significantly higher values for RPE (1.3 points, p < 0.001, ES = 0.96) and RPD (1.0 points, p = 0.008, ES = 0.47) and tended to be higher for sPDF, i.e., more pleasurable, (p = 0.059, ES = 0.25) compared to the traditional session. There was no difference in EES (p = 0.661, ES = 0.05). The traditional session led to significantly increased training volume (4.2%, p = 0.011, ES = 0.34) and lasted 23 min (66%, p < 0.001, ES = 7.78) longer than the superset session. Eighteen of the participants preferred the superset session, while 11 preferred the traditional session. In conclusion, performing a whole-body workout as a superset session was more time-efficient, but reduced the training volume and was perceived with greater exertion for effort and discomfort than a traditional workout.

Effects of barbell load on kinematics, kinetics, and myoelectric activity in back squats.

Shortly after beginning the upward phase of a free-weight barbell back squat there is often a deacceleration phase (sticking region) that may lead to repetition failure. The cause for this region is not well understood. Therefore, this study investigated the effects of 90%, 100%, and 102% of 1-RM barbell loads on kinematics, kinetics, and myoelectric activity in back squats. Twelve resistance-trained healthy males (body mass: 83.5 ± 7.8 kg, age: 27.3 ± 3.8 years, height: 180.3 ± 6.7 cm) participated in the study and lifted 134 ± 17 kg at 90% and 149 ± 19 kg at 100%, while they failed at 153 ± 19 kg with 102% load. The main findings were that barbell displacement and barbell velocity in the sticking region decreased with increasing loads. Moreover, the external hip extensor moment increased with heavier loads, whereas the knee extension and ankle plantarflexion moments were similar during the concentric phase. Also, reduced hip and knee extension together with lower myoelectric activity for all hip extensors and vastus lateralis were found for the 102% load compared to the others. Our finding suggests that the increased external hip extensor moment together with lower hip extensor myoelectric activity due to a reduced hip extension and thereby are responsible for lifting failure among resistance-trained males.

Muscle Strength Is Associated With Physical Function in Community-Dwelling Older Adults Receiving Home Care. A Cross-Sectional Study.

Background: Higher maximal- and explosive strength is associated with better physical function among older adults. Although the relationship between isometric maximal strength and physical function has been examined, few studies have included measures of isometric rate of force development (RFD) as a measure of explosive strength. Furthermore, little is known about the oldest old (>80 years), especially individuals who receive home care and use mobility devices. Therefore, the aim of this study was to examine the association between maximal- and explosive muscle strength with physical function in community-dwelling older adults receiving home care. Methods: An exploratory cross-sectional analysis including 107 (63 females and 43 males) community-dwelling older adults [median age 86 (interquartile range 80-90) years] receiving home care was conducted. Physical function was measured with five times sit-to-stand (5TSTS), timed 8-feet-up-and-go (TUG-8ft), preferred-, and maximal gait speed. Maximal strength was assessed as maximal isometric voluntary contraction (MVC) and explosive strength as RFD of the knee extensors. We used linear regression to examine the associations, with physical function as dependent variables and muscle strength (MVC and RFD) as independent variables. Results: MVC was significantly associated with 5TSST [standardized regression coefficient ß = -0.26 95% CI (-0.45, -0.06)], TUG-8ft [-0.6 (-0.54, -0.17)], preferred gait speed [0.39 (0.22, 0.57)], and maximal gait speed [0.45 (0.27, 0.62)]. RFD was significantly associated with 5TSST [-0.35 (-0.54, -0.17)], TUG-8ft [-0.43 (-0.60, -0.27)], preferred gait speed [0.40 (0.22, 0.57)], and maximal gait speed [0.48 (0.31, 0.66)]. Conclusions: Higher maximal- and explosive muscle strength was associated with better physical function in older adults receiving home care. Thus, maintaining and/or improving muscle strength is important for perseverance of physical function into old age and should be a priority.

A randomized trial on the efficacy of split-body versus full-body resistance training in non-resistance trained women.

BACKGROUND: The aim of this study was to assess the efficacy of a 12-week upper/lower split- versus a full-body resistance training program on maximal strength, muscle mass and explosive characteristics. Fifty resistance untrained women were pair-matched according to baseline strength and randomized to either a full-body (FB) routine that trained all of the major muscle groups in one session twice per week, or a split-body program (SPLIT) that performed 4 weekly sessions (2 upper body and 2 lower body). Both groups performed the same exercises and weekly number of sets and repetitions. Each exercise was performed with three sets and 8-12 repetition maximum (RM) loading. Study outcomes included maximal strength, muscle mass, jump height and maximal power output. RESULTS: No between-group differences were found in any of the variables. However, both FB and SPLIT increased mean 1-RM from pre- to post-test in the bench press by 25.5% versus 30.0%, lat pulldown by 27.2% versus 26.0% and leg press by 29.2% versus 28.3%, respectively. Moreover, both FB and SPLIT increased jump height by 12.5% versus 12.5%, upper-body power by 20.3% versus 16.7% and muscle mass by 1.9% versus 1.7%, p < 0.01, respectively. CONCLUSIONS: This study did not show any benefits for split-body resistance-training program compared to full-body resistance training program on measures of maximal- and explosive muscle strength, and muscle mass. TRIAL REGISTRATION: ISRCTN81548172, registered 15. February 2022.

The Readiness for Return to Work Scale; Does it Help in Evaluation of Return to Work?

Purpose The Readiness for Return to Work (RRTW) scale is used to evaluate workers' readiness to resume work after sick leave. Previous research has questioned the RRTW scale's constructs and stages. The aim of this study was to assess the unidimensionality of the RRTW scale and its six subscales by evaluating its fit to the Rasch model, and furthermore to assess if Rasch-based scaling would improve its predictive value, compared with the conventional use of the scale. Methods A prospective cohort study with 12 months of follow-up. Individuals (n = 397) sick-listed due to musculoskeletal, unspecified, or common mental health disorders undergoing rehabilitation were included: 191 were full-time sick-listed (not working), and 206 were part-time sick-listed (working). A Rasch analysis was applied to evaluate the measurement properties of the RRTW scale in the working and not working participants at baseline. Linear and logistic regressions were used to assess how well Rasch-based scaling predicted future work participation during the 12 months of follow-up. Results The RRTW subscales had too few items to represent underlying dimensions properly, and the items fitted poorly within the subscales. A constructed variable based on the items that fit together for not working individuals poorly predicted future work participation. The individuals' scores across stages were disordered, indicating a lack of ordered stages. Conclusions This study reveals poor measurement properties of the Norwegian version of the RRTW scale in individuals with musculoskeletal and common mental disorders, with neither the subscales nor the stages closely associated with return to work.

Insomnia is Associated with the Effect of Inpatient Multimodal Occupational Rehabilitation on Work Participation in Workers with Musculoskeletal or Mental Health Disorders: Secondary Analyses of a Randomized Clinical Trial.

STUDY OBJECTIVES: Insomnia is common among people with musculoskeletal and/or mental health disorders. This study aimed to assess whether insomnia is associated with the favorable effect from inpatient multimodal occupational rehabilitation on future work participation among individuals with these conditions. METHODS: Insomnia was measured at baseline through a randomized clinical trial that compared the effect of inpatient multimodal occupational rehabilitation with a less-comprehensive program of outpatient acceptance and commitment therapy on future work participation. The inpatient multimodal program lasted 3.5 weeks at the rehabilitation center, comprising psychoeducational sessions (including sleep education), fixed schedules, acceptance and commitment therapy, physical exercise and work-related problem-solving, whereas the outpatient program comprised mainly six weekly acceptance and commitment therapy sessions. Both programs were group-based. The study tracked cumulative sick leave during the 12 months of follow-up using national registry data. RESULTS: Among the 163 adults included in this subgroup analysis, 56% (n=91) reported insomnia. Overall, we found statistical evidence of interaction between the occupational program and insomnia concerning cumulative sick leave (p=0.03). Compared with people without insomnia in the comprehensive inpatient multimodal program, people with insomnia had 12 (95% CI: -48 to 24) fewer days with sick leave if they participated in the inpatient program and 46 (95% CI: 8 to 83) more days if they participated in the outpatient program. CONCLUSION: These findings suggest that insomnia should be addressed specifically before individuals on sick leave are considered for participation in occupational rehabilitation and that individuals with insomnia may benefit in particular from inpatient rehabilitation.

Aligning stakeholders' understandings of the return-to-work process: a qualitative study on workplace meetings in inpatient multimodal occupational rehabilitation.

Purpose: Although it is believed that involving the workplace and stakeholders in return-to-work interventions is beneficial, Norwegian occupational rehabilitation programmes rarely do. During 2015-2016, Hysnes Rehabilitation Centre provided inpatient multimodal occupational rehabilitation, including workplace meetings with employees, supervisors, and rehabilitation therapists. This study aims to explore the meetings´ content and stakeholders´ experiences.Methods: This was a multiple case study including non-participant observation of workplace meetings and interviews with participantsResults: Essential features of meetings included revealing and aligning the employee's and supervisor's understandings. Three components seemed instrumental in developing shared understandings leading to appropriate adjustments: 1) disclosing causes of absence, 2) validating difficulties, attitudes, and efforts, and 3) delimiting responsibility. Therapists played a vital role in addressing these components, supporting employees, and ensuring planning of appropriate solutions.Conclusion: Developing shared understandings by addressing and aligning illness- and return-to-work representations appears important for return-to-work interventions. Although pivotal to developing appropriate adjustments, disclosure depends upon supervisors' display of understanding and should not be encouraged without knowledge of the employee´s work situation. How supervisors relate to employees and implement adjustments may be as important as the types of adjustments. The therapist's support and validation of employees in vulnerable situations also seem valuable.Trial registration: The trial is registered at clinicaltrials.gov (NCT02541890), 4 September 2015. https://clinicaltrials.gov/ct2/show/NCT02541890.

Physical Activity Level Following Resistance Training in Community-Dwelling Older Adults Receiving Home Care: Results from a Cluster-Randomized Controlled Trial.

Older adults' physical activity (PA) is low. We examined whether eight months of resistance training increased PA level in community-dwelling older adults receiving home care. A two-armed cluster-randomized trial using parallel groups was conducted. The included participants were >70 years and received home care. The resistance training group performed resistance training using body weight, elastic bands, and water canes twice per week for eight months. The control group was informed about the national PA guidelines and received motivational talks. The ActiGraph GT3X+ accelerometer was used to estimate PA. Outcomes included total PA (counts per minute), sedentary behavior (min/day), light PA (min/day), moderate-to-vigorous PA (min/day), and steps (mean/day). Between-group differences were analyzed using multilevel linear mixed models. Twelve clusters were randomized to either resistance training (7 clusters, 60 participants) or the control group (5 clusters, 44 participants). A total of 101 participants (median age 86.0 (interquartile range 80-90) years) had valid accelerometer data and were included in the analysis. There were no statistically significant between-group differences for any of the PA outcomes after four or eight months. This study offers no evidence of increased PA level following resistance training in older adults with home care.

Comparison of Muscle Activity in Three Single-Joint, Hip Extension Exercises in Resistance-Trained Women.

The aim of the study was to compare neuromuscular activation in the gluteus maximus, the biceps femoris and the erector spinae from the Romanian deadlift, the 45-degree Roman chair back extension and the seated machine back extension. Fifteen resistance-trained females performed three repetitions with 6-RM loading in all exercises in a randomized and counterbalanced order. The activation in the whole movement as well as its lower and upper parts were analyzed. The results showed that the Romanian deadlift and the Roman chair back extension activated the gluteus maximus more than the seated machine back extension (94-140%, p < 0.01). For the biceps femoris the Roman chair elicited higher activation compared to both the Romanian deadlift and the seated machine back extension (71-174%). Further, the Romanian deadlift activated the biceps femoris more compared to the seated machine back extension (61%, p < 0.01). The analyses of the different parts of the movement showed that the Roman chair produced higher levels of activation in the upper part for both the gluteus maximus and the biceps femoris, compared to the other exercises. There were no differences in activation of the erector spinae between the three exercises (p = 1.00). In conclusion, both the Roman deadlift and the Roman chair back extension would be preferable to the seated machine back extension in regards to gluteus maximus activation. The Roman chair was superior in activating the biceps femoris compared to the two other exercises. All three exercises are appropriate selections for activating the lower back muscles. For overall lower limb activation, the Roman chair was the best exercise.

The bidirectional associations between leisure time physical activity change and body mass index gain. The Tromsø Study 1974-2016.

OBJECTIVES: To examine whether leisure time physical activity changes predict subsequent body mass index (BMI) changes, and conversely, whether BMI changes predict subsequent leisure time physical activity changes. METHODS: This prospective cohort study included adults attending ≥3 consecutive Tromsø Study surveys (time: T1, T2, T3) during 1974-2016 (n = 10779). If participants attended >3 surveys, we used the three most recent surveys. We computed physical activity change (assessed by the Saltin-Grimby Physical Activity Level Scale) from T1 to T2, categorized as Persistently Inactive (n = 992), Persistently Active (n = 7314), Active to Inactive (n = 1167) and Inactive to Active (n = 1306). We computed BMI change from T2 to T3, which regressed on preceding physical activity changes using analyses of covariance. The reverse association (BMI change from T1 to T2 and physical activity change from T2 to T3; n = 4385) was assessed using multinomial regression. RESULTS: Average BMI increase was 0.86 kg/m2 (95% CI: 0.82-0.90) from T2 to T3. With adjustment for sex, birth year, education, smoking and BMI at T2, there was no association between physical activity change from T1 to T2 and BMI change from T2 to T3 (Persistently Inactive: 0.89 kg/m2 (95% CI: 0.77-1.00), Persistently Active: 0.85 kg/m2 (95% CI: 0.81-0.89), Active to Inactive: 0.90 kg/m2 (95% CI: 0.79-1.00), Inactive to Active 0.85 kg/m2 (95% CI: 0.75-0.95), p = 0.84). Conversely, increasing BMI was associated with Persistently Inactive (odds ratio (OR): 1.17, 95% CI: 1.08-1.27, p < 0.001) and changing from Active to Inactive (OR: 1.16, 95% CI: 1.07-1.25, p < 0.001) compared with being Persistently Active. CONCLUSIONS: We found no association between leisure time physical activity changes and subsequent BMI changes, whereas BMI change predicted subsequent physical activity change. These findings indicate that BMI change predicts subsequent physical activity change at population level and not vice versa.

Two-Year Follow-Up of a Randomized Clinical Trial of Inpatient Multimodal Occupational Rehabilitation Vs Outpatient Acceptance and Commitment Therapy for Sick Listed Workers with Musculoskeletal or Common Mental Disorders.

Purpose There is a lack of results on long-term effects of return to work interventions. We previously reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective in reducing sickness absence and facilitating return to work (RTW) at 12 months follow-up compared to an outpatient program that consisted mainly of Acceptance and Commitment Therapy (O-ACT). We now report the 2-year outcome data. Methods A randomized clinical trial with parallel groups. Participants were 18-60 years old, sick listed with musculoskeletal, common mental or general/unspecified disorders. I-MORE lasted 3.5 weeks and consisted of ACT, physical training and work-related problem solving. O-ACT consisted mainly of 6 weekly sessions (2.5 h. each) of ACT in groups. Outcomes were cumulated number of days on medical benefits and time until sustainable RTW (1 month without medical benefits) during 2-years of follow-up, measured by registry data. Results For the 166 randomized participants, the median number of days on medical benefits was 159 (IQR 59-342) for I-MORE vs 249 days (IQR 103-379; Mann-Whitney U test, p = 0.07), for O-ACT. At 2 years, 40% in I-MORE received long-term benefits (work assessment allowance) vs 51% in O-ACT. The crude hazard ratio (HR) for sustainable RTW was 1.59 (95% CI 1.04-2.42, p = 0.03) and the adjusted HR 1.77 (95% CI 1.14-2.75, p = 0.01), in favor of I-MORE. Conclusions The 2-year outcomes show that I-MORE had long-term positive effects on increasing work participation for individuals sick listed with musculoskeletal and mental disorders. Further follow-up and economic evaluations should be performed.

Electromyographic Comparison of Flywheel Inertial Leg Curl and Nordic Hamstring Exercise Among Soccer Players.

PURPOSE: The Nordic hamstring exercise (NHE) has been shown to considerably reduce hamstring injuries among soccer players. However, as the load in the NHE is the person's own bodyweight, it is a very heavy exercise and difficult to individualize. The flywheel inertial leg curl (FLC) could be an alternative since the eccentric overload is based on the amount of work produced in the concentric movement. Therefore, the primary aim of this study was to compare the activation in the hamstrings at long muscle lengths in the NHE and the FLC in amateur soccer players. METHODS: Fifteen male amateur soccer players performed 5 repetitions in each exercise in a randomized and counterbalanced order. The concentric and eccentric movements were divided into lower and upper phases. Surface EMG was measured distally, proximally, and in the middle, at both muscles. RESULTS: In the lower phase in the eccentric movement, there were no significant differences between the 2 exercises (P = .101-.826). In the lower concentric movement, the FLC led to higher activation in all parts of both the biceps femoris (31%-52%, P < .001) and the semitendinosus (20%-35%, P = .001-.023). CONCLUSION: Both exercises activated the hamstrings similarly at long muscle lengths during eccentric contractions (Nordic hamstring, nonsignificantly higher). However, when performing concentric contractions, the FLC induced higher activations. Therefore, the FLC could be a useful alternative to the NHE and particularly suitable for weaker athletes before progressing to NHE.