Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research.

BACKGROUND: Multiple long-term conditions-the co-existence of two or more chronic health conditions in an individual-present an increasing challenge to populations and healthcare systems worldwide. This challenge is keenly felt in hospital settings where care is oriented around specialist provision for single conditions. The aim of this scoping review was to identify and summarise published qualitative research on the experiences of hospital care for people living with multiple long-term conditions, their informal caregivers and healthcare professionals. METHODS: We undertook a scoping review, following established guidelines, of primary qualitative research on experiences of hospital care for people living with multiple long-term conditions published in peer-reviewed journals between Jan 2010 and June 2022. We conducted systematic electronic searches of MEDLINE, CINAHL, PsycInfo, Proquest Social Science Premium, Web of Science, Scopus and Embase, supplemented by citation tracking. Studies were selected for inclusion by two reviewers using an independent screening process. Data extraction included study populations, study design, findings and author conclusions. We took a narrative approach to reporting the findings. RESULTS: Of 8002 titles and abstracts screened, 54 papers reporting findings from 41 studies conducted in 14 countries were identified as eligible for inclusion. The perspectives of people living with multiple long-term conditions (21 studies), informal caregivers (n = 13) and healthcare professionals (n = 27) were represented, with 15 studies reporting experiences of more than one group. Findings included poor service integration and lack of person-centred care, limited confidence of healthcare professionals to treat conditions outside of their specialty, and time pressures leading to hurried care transitions. Few studies explored inequities in experiences of hospital care. CONCLUSIONS: Qualitative research evidence on the experiences of hospital care for multiple long-term conditions illuminates a tension between the desire to provide and receive person-centred care and time pressures inherent within a target-driven system focussed on increasing specialisation, reduced inpatient provision and accelerated journeys through the care system. A move towards more integrated models of care may enable the needs of people living with multiple long-term conditions to be better met. Future research should address how social circumstances shape experiences of care.

The Effect of Sex, Maturity, and Training Status on Maximal Sprint Performance Kinetics.

PURPOSE: The development of sprint running during youth has received renewed interest, but questions remain regarding the development of speed in youth, especially the influences of sex, training, and maturity status. METHODS: One hundred and forty-seven team sport trained (69 girls; 14.3 [2.1] y) and 113 untrained (64 girls; 13.8 [2.7] y) youth completed two 30-m sprints separated by 2-minute active rest. Velocity was measured using a radar gun at >46 Hz, with power and force variables derived from a force-velocity-power profile. RESULTS: Boys produced a significantly higher absolute peak power (741 [272] vs 645 [229] W; P < .01) and force (431 [124] vs 398 [125] N; P < .01) than girls, irrespective of maturity and training status. However, there was a greater sex difference in relative mean power and peak velocity in circa peak height velocity adolescents (46.9% and 19.8%, respectively) compared with prepeak height velocity (5.4% and 3.2%) or postpeak height velocity youth (11.6% and 5.6%). CONCLUSIONS: Sprint development in youth is sexually dimorphic which needs considering when devising long-term training plans. Further research is needed to explore the independent, and combined, effects of sex, training, and maturity status on sprint performance kinetics in youth.

The Role of Multi-Sensor Measurement in the Assessment of Movement Quality: A Systematic Review.

BACKGROUND: Movement quality is typically assessed by drawing comparisons against predetermined movement standards. Movements are often discretely scored or labelled against pre-set criteria, though movement quality can also be evaluated using motion-related measurements (e.g., spatio-temporal parameters and kinematic variables). Wearable technology has the potential to measure and assess movement quality and offer valuable, practical feedback. OBJECTIVES: A systematic approach was taken to examine the benefits associated with multi-sensor and multiple wearable-device usage, compared with unimodal applications, when assessing movement quality. Consequently, this review considers the additional variables and features that could be obtained through multi-sensor devices for use in movement analyses. Processing methods and applications of the various configurations were also explored. METHODS: Articles were included within this review if they were written in English, specifically studied the use of wearable sensors to assess movement quality, and were published between January 2010 and December 2022. Of the 62,635 articles initially identified, 27 papers were included in this review. The quality of included studies was determined using a modified Downs and Black checklist, with 24/27 high quality. RESULTS: Fifteen of the 27 included studies used a classification approach, 11 used a measurement approach, and one used both methods. Accelerometers featured in all 27 studies, in isolation (n = 5), with a gyroscope (n = 9), or with both a gyroscope and a magnetometer (n = 13). Sampling frequencies across all studies ranged from 50 to 200 Hz. The most common classification methods were traditional feature-based classifiers (n = 5) and support vector machines (SVM; n = 5). Sensor fusion featured in six of the 16 classification studies and nine of the 12 measurement studies, with the Madgwick algorithm most prevalent (n = 7). CONCLUSIONS: This systematic review highlights the differences between the applications and processing methods associated with the use of unimodal and multi-sensor wearable devices when assessing movement quality. Further, the use of multiple devices appears to increase the feasibility of effectively assessing holistic movements, while multi-sensor devices offer the ability to obtain more output metrics.

Investigating the kinetics of repeated sprint ability in national level adolescent hockey players.

Repeated sprint ability (RSA) is more closely related to match performance outcomes than single-sprint performance, but the kinetic determinants in youth athletes remain poorly understood. Therefore, the aim of the study was to explore the kinetic determinants of RSA in youth athletes. Twenty trained adolescents (15 girls; 14.4 ± 1.0 years) completed five 15 m repetitions interspersed with 5-s rest. Velocity was measured during each trial using a radar gun at >46 Hz, following which the force-velocity-power (F-v-P) profile was fitted to a velocity-time curve and instantaneous power and force variables calculated. The mechanical efficiency of force application (DRF) was the primary predictor of both single and repeated sprint performance in adolescents. Secondly, hierarchical analyses revealed the percentage reduction in peak velocity, DRF, and allometrically scaled peak force explained 91.5% of the variance in 15 m sprint time from sprints 1-5. Finally, declines in allometrically scaled peak power were more closely related to declines in peak force than reductions in velocity. In conclusion, given DRF was the primary predictor of both single and repeated sprint performance training programmes targeting RSA need to include technique, and skill acquisition, components.

The associations of physical activity, sedentary time, and sleep with V˙O2max in trained and untrained children and adolescents: A novel five-part compositional analysis.

The benefits of physical activity (PA) and the negative impacts of sedentary time (SED) on both short- and long-term health in youth are well established. However, uncertainty remains about how PA and SED jointly influence maximal oxygen uptake ([Formula: see text]). Therefore, the aim of this study was to determine the joint influence of PA and SED on [Formula: see text] using compositional analyses. 176 adolescents (84 girls, 13.8 ± 1.8 years) completed an incremental ramp test and supramaximal validation bout on a cycle ergometer, with PA and SED recorded for seven consecutive days on the right hip using a ActiGraph GT3X accelerometer. Time spent in Sleep, SED, light, moderate and vigorous PA was analysed using a compositional linear regression model. Compositions with 10 minutes more time in vigorous PA (> 27.5 mins⋅day-1) compared to the average 17.5 mins⋅day-1 were associated with a + 2.9% - 11.1% higher absolute and scaled [Formula: see text] whilst compositions with less (> -10 mins⋅day-1) VPA were associated with a reduced absolute and allometrically scaled [Formula: see text] (-4.6% - 24.4%). All associations were irrespective of sex, maturity, and training status. The proportion of time spent sedentary had little impact on absolute and scaled [Formula: see text] (0.01-1.98%). These findings therefore highlight that intensity of PA may be of greater importance for increases in [Formula: see text] than reductions in SED and should be incorporated into future intervention designs.

Effects of Sex, Training, and Maturity Status on the Cardiopulmonary and Muscle Deoxygenation Responses during Incremental Ramp Exercise.

Whilst participation in regular exercise and sport has generally increased over recent decades globally, fundamental questions remain regarding the influence of growth, maturation, and sex on the magnitude of training response throughout adolescence. Trained (108 participants, 43 girls; age: 14.3 ± 1.8 years) and untrained (108 participants, 43 girls; age: 14.7 ± 1.7 years) adolescents completed an incremental ramp test to exhaustion during which breath by gas exchange, beat-by-beat heart rate (HR), stroke volume (SV) and cardiac output (Q·) and muscle deoxygenation were assessed. Device-based physical activity was also assessed over seven consecutive days. Boys, irrespective of training status, had a significantly higher absolute (2.65 ± 0.70 L min−1 vs. 2.01 ± 0.45 L min−1, p < 0.01) and allometrically scaled (183.8 ± 31.4 mL·kg−b min−1 vs. 146.5 ± 28.5 mL·kg−b min−1, p < 0.01) peak oxygen uptake (V·O2) than girls. There were no sex differences in peak HR, SV or Q· but boys had a higher muscle deoxygenation plateau when expressed against absolute work rate and V·O2 (p < 0.05). Muscle deoxygenation appears to be more important in determining the sex differences in peak V·O2 in youth. Future research should examine the effects of sex on the response to different training methodologies in youth.

Moving Forward: Understanding Correlates of Physical Activity and Sedentary Behaviour during COVID-19 in Children and Adolescents-An Integrative Review and Socioecological Approach.

Novel coronavirus disease 2019 (COVID-19) pandemic restrictions have negatively impacted physical activity (PA) and sedentary time/behaviour. This integrative review systematically explored the socioecological factors that impacted and influenced these movement behaviours in children and adolescents during the pandemic. Five electronic databases were systematically searched in January 2021, with data extracted from 16 articles (n = 18,352; 5-17 years; 12 countries). Risk-of-bias was assessed using the Mixed Methods Assessment Tool (MMAT), with correlates identified, coded, and themed via thematic analysis. A socioecological model of during-pandemic PA and sedentary time/behaviour was conceptualised and mapped to the Capability, Opportunity, Motivation, and Behaviour (COM-B) model of behaviour-change mechanisms, illustrating influences over five levels: Individual (biological)-age and sex; Individual (psychological)-mental health, and cognition, motivation, and behaviour; Social-family factors, and structured support; Environmental-area of residence and resources; and Policy-COVID-19-related rules. For sedentary time/behaviour, individual-(age and sex), social-(family factors) and policy-(COVID-19-related rules) level factors may be important correlates. There were no age or sex associations with PA levels, though there was some indication that sedentary time/behaviour increased with age. Interventions seeking to enhance young people's movement behaviours during periods of enforced restrictions should focus on enhancing opportunities on a social and environmental level.

Impact of the COVID-19 Pandemic on Sedentary Time and Behaviour in Children and Adults: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to quantify the change in sedentary time during the COVID-19 pandemic and its effect on health outcomes in the general population. One thousand six hundred and one articles published after 2019 were retrieved from five databases, of which 64 and 40 were included in the systematic review and meta-analysis, respectively. Studies were grouped according to population: children (<18 years), adults (18-64 years) and older adults (>65 years). Average sedentary time was calculated, with sub-analyses performed by country, behaviour type and health outcomes. Children were most affected, increasing their sedentary time by 159.5 ± 142.6 min day-1, followed by adults (+126.9 ± 42.2 min day-1) and older adults (+46.9 ± 22.0 min day-1). There were no sex differences in any age group. Screen time was the only consistently measured behaviour and accounted for 46.8% and 57.2% of total sedentary time in children and adults, respectively. Increases in sedentary time were negatively correlated with global mental health, depression, anxiety and quality of life, irrespective of age. Whilst lockdown negatively affected all age groups, children were more negatively affected than adults or older adults, highlighting this population as a key intervention target. As lockdowns ease worldwide, strategies should be employed to reduce time spent sedentary. Trial registration: PROSPERO (CRD42020208909).

Moving Forward: Understanding Correlates of Physical Activity and Sedentary Behaviour during COVID-19-An Integrative Review and Socioecological Approach.

Population-level physical activity (PA) and sedentary time/behaviour estimates represent a significant public health issue exacerbated by restrictions enforced to control COVID-19. This integrative review interrogated available literature to explore the pandemic's impact on correlates of such behaviours in adults (≥18 years). Five electronic databases were systematically searched in January 2021. Data extracted from 64 articles were assessed for risk-of-bias using the Mixed Methods Assessment Tool, with correlates identified, coded, and themed via thematic analysis. A socioecological model of during-pandemic PA was conceptualized and mapped to the Capability, Opportunity, Motivation, and Behaviour (COM-B) model of behaviour change mechanisms, which illustrates influences over five levels: Individual (biological)-general health; Individual (psychological)-mental health, cognition, motivation, and behaviour; Social-domestic situation, sociodemographic factors, support, and lifestyle choices; Environmental-resources and area of residence; and Policy-COVID-19-related rules. For sedentary time/behaviour, individual level factors, namely general and mental health, may be important correlates. Neither age or sex were clearly correlated with either behaviour. As we transition into a new normal, understanding which behaviour mechanisms could effectively challenge physical inactivity is essential. Targeting capability on a psychological level may facilitate PA and limit sedentary time/behaviour, whereas, on a physical level, maximizing PA opportunities could be crucial.

Health Consequences of an Elite Sporting Career: Long-Term Detriment or Long-Term Gain? A Meta-Analysis of 165,000 Former Athletes.

INTRODUCTION: Exercise is widely accepted to improve health, reducing the risk of premature mortality, cardiovascular disease (CVD) and cancer. However, several epidemiological studies suggest that the exercise-longevity relationship may be 'J' shaped; with elite athlete's likely training above these intensity and volume thresholds. Therefore, the aim of this meta-analysis was to examine this relationship in former elite athletes. METHODS: 38,047 English language articles were retrieved from Web of Science, PubMed and SportDiscus databases published after 1970, of which 44 and 24 were included in the systematic review and meta-analysis, respectively. Athletes were split into three groups depending on primary sport: Endurance (END), Mixed/Team, or power (POW). Standard mortality ratio's (SMR) and standard proportionate mortality ratio (SPMR) were obtained, or calculated, and combined for the meta-analysis. RESULTS: Athletes lived significantly longer than the general population (male SMR 0.69 [95% CI 0.61-0.78]; female SMR 0.51 [95% CI 0.40-0.65]; both p < 0.01). There was no survival benefit for male POW athletes compared to the general population (SMR 1.04 [95% CI 0.91-1.12]). Although male athlete's CVD (SMR 0.73 [95% CI 0.62-0.85]) and cancer mortality (SMR 0.75 [95% CI 0.63-0.89]), were significantly reduced compared to the general population, there was no risk-reduction for POW athletes CVD mortality (SMR 1.10 [0.86-1.40]) or END athletes cancer mortality (SMR 0.73 [0.50-1.07]). There was insufficient data to calculate female sport-specific SMR's. DISCUSSION: Overall, athletes live longer and have a reduced incidence of both CVD and cancer mortality compared to the general population, refuting the 'J' shape hypothesis. However, different health risks may be apparent according to sports classification, and between sexes, warranting further investigation. Trial registration PROSPERO (registration number: CRD42019130688).