COVID-19: public health management of the first two confirmed cases identified in the UK.

We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.

Musculoskeletal fitness, health outcomes and quality of life.

The health benefits and quality-of-life outcomes of a fit musculoskeletal system (musculoskeletal fitness) are reviewed in this article. The World Health Organization suggests health is a state of complete physical, mental or social well-being and not merely the absence of disease or infirmity. Physical health includes such characteristics as body size and shape, sensory acuity, susceptibility to disease and disorders, body functioning, recuperative ability and the ability to perform certain tasks. One aspect of physical health is the musculoskeletal system, which consists of 3 components; muscular strength, endurance and flexibility. Muscular strength (dynamic) is defined as the maximum force a muscle or muscle group can generate at a specific velocity. Muscular endurance is the ability of a muscle or muscle group to perform repeated contractions against a load for an extended period of time. Flexibility has 2 components, dynamic or static, where dynamic flexibility is the opposition or resistance of a joint to motion, that is, the forces opposing movement rather than the range of movement itself. Static flexibility is the range of motion about ajoint, typically measured as the degree of arc at the end of joint movement. If strength, endurance and flexibility are not maintained, musculoskeletal fitness is then compromised which can significantly impact physical health and well-being. Many health benefits are associated with musculoskeletal fitness, such as reduced coronary risk factors, increased bone mineral density (reduced risk of osteoporosis), increased flexibility, improved glucose tolerance, and greater success in completion of activities of daily living (ADL). With aging, the performance of daily tasks can become a challenge. Additionally, falls, bone fractures and the need for institutional care indicate a musculoskeletal weakness as we age. The earlier in life an individual becomes physically active the greater the increase in positive health benefits; however, becoming physically active at any age will benefit overall health. Improved musculoskeletal fitness (for example, through resistance training combined with stretching) is associated with an enhanced health status. Thus, maintaining musculoskeletal fitness can increase overall quality of life.

The effects of changes in musculoskeletal fitness on health.

The objective of this review is to examine the effects of changes in the individual components of musculoskeletal fitness on indicators of health status. Available evidence regarding the impact of changes in musculoskeletal fitness on indicators of health status is summarized and evaluated. Intervention programs designed specifically to enhance musculoskeletal fitness have been effective in improving several indicators of health status including glucose metabolism, obesity, bone health, independent living, the incidence of falling and associated injuries, and/or psychological well-being. An enhanced musculoskeletal fitness is associated with an improvement in health status.

Musculoskeletal fitness and health.

The purpose is to examine the relationship between musculoskeletal fitness and health status. Muscular strength is positively associated with independence and overall quality of life, and negatively associated with morbidity and potentially premature mortality. Muscular endurance is positively related to overall quality of life. Elevated muscular endurance may reduce the incidence of falling and its associated injuries. Muscular power is predictive of functional capacity, resultant disability, and potentially premature mortality. Flexibility is positively associated with mobility and independence. Women and the aged may be susceptible to musculoskeletal impairments leading to reduced health status and thus may represent primary target groups for intervention programs. High levels of musculoskeletal fitness are associated with positive health status, and low levels of musculoskeletal fitness are associated with lower health status.

Left ventricular wall stress during leg-press exercise performed with a brief Valsalva maneuver.

STUDY OBJECTIVES: To assess the effects of leg-press (LP) exercise performed with a brief (2 to 3 s) Valsalva maneuver on left ventricular (LV) systolic function and LV wall stress in five healthy men (mean +/- SD age, 27.6 +/- 2.9 years). METHODS AND MEASUREMENTS: Subjects performed submaximal (80% one repetition maximum [1RM], 337.9 +/- 109.1 kg; 95% 1RM, 400.6 +/- 129.8 kg) and maximal LP exercise (420 +/- 118.6 kg) during which central arterial pressure, intrathoracic pressure, and two-dimensional echocardiographic analysis of LV systolic function and LV wall stress were measured. RESULTS: Compared with baseline, LP exercise resulted in an increase in intrathoracic pressure (baseline, 1.7 +/- 2.9 mm Hg; 80% 1RM, 111.7 +/- 20.2 mm Hg; 95% 1RM, 112.2 +/- 21.1 mm Hg; 100% 1RM, 111.0 +/- 21.3 mm Hg; p < 0.05) and LV end-systolic pressure (baseline, 120.0 +/- 13.2 mm Hg; 80% 1RM, 251.6 +/- 15.3 mm Hg; 95% 1RM, 255.3 +/- 12.2 mm Hg; 100% 1RM, 242.8 +/- 16.5 mm Hg; p < 0.05) with no changes in LV end-systolic transmural pressure (baseline, 118.3 +/- 12.6 mm Hg; 80% 1RM, 140.0 +/- 6.1 mm Hg; 95% 1RM, 143.1 +/- 16.1 mm Hg; 100% 1RM, 131.8 +/- 29.7 mm Hg; p > 0.05), LV end-systolic wall stress (baseline, 91.7 +/- 20.2 kilodyne/cm(2); 80% 1RM, 78.0 +/- 24.4 kilodyne/cm(2); 95% 1RM, 81.4 +/- 25.3 kilodyne/cm(2); 100% 1RM, 85.9 +/- 20.1 kilodyne/cm(2); p > 0.05), or LV fractional area change (baseline, 0.48 +/- 0.03; 80% 1RM, 0.52 +/- 0.11; 95% 1RM, 0.53 +/- 0.06; 100% 1RM, 0.52 +/- 0.05; p > 0.05). CONCLUSION: LP exercise performed with a brief Valsalva maneuver is not associated with an alteration in LV wall stress or LV systolic function in healthy young men.

Effects of 16 weeks of resistance training on left ventricular morphology and systolic function in healthy men >60 years of age.

Resistance training (RT) has gained popularity as an effective form of exercise for older adults. However, the effects of RT on left ventricular (LV) morphology and systolic function in older persons is not well known. The purpose of this study was to assess the effects of 16 weeks of RT on LV morphology and systolic function in healthy older men. Subjects were randomly assigned into a RT group (n = 10; mean+/- SD age, 68 +/- 3 years) or a nonexercise control group (n = 10; age 68 +/- 4 years). RT was performed 3 times per week for 16 weeks at a mean intensity between 60% and 80% of 1 repetition maximum. Leg and bench press 1 repetition maximum and 2-dimensional echocardiography were performed at baseline and after 4, 8, 12, and 16 weeks of training in the RT group. Sixteen weeks of RT was associated with an increase in leg press maximal strength (baseline, 285 +/- 48 kg; after 16 weeks, 367 +/- 47 kg; p <0.05) and bench press maximal strength (baseline, 59 +/- 11 kg; after 16 weeks, 69 +/- 11 kg; p <0.05). No change in leg press maximal strength (baseline, 291 +/- 59 kg; after 16 weeks, 290 +/- 53 kg; p >0.05) or bench press maximal strength (baseline, 60 +/- 9 kg; after 16 weeks, 61 +/- 13 kg; p > .05) was found in control subjects during the same time. RT was not associated with changes in LV cavity size, wall thickness, mass, or systolic function after 4, 8, 12, and 16 weeks of exercise. Thus, 16 weeks of RT was sufficient to increase leg press and bench press maximal strength but did not alter the size or systolic function of the senescent left ventricle.

Effects of long term resistance training on left ventricular morphology.

OBJECTIVES: To assess the effects of long term (mean +/- SD 10+/-5 years, range three to 25 years) resistance training on left ventricular (LV) dimensions and mass. METHODS AND RESULTS: The study participants were 21 elite male power-lifters (age 33.4+/-5.9 years) and 10 sedentary male control subjects (age 30.9+/-4.2 years). Two-dimensionally guided transthoracic M-mode echocardiograms were obtained at rest to quantify LV diastolic cavity dimension, posterior wall thickness, ventricular septal wall thickness and LV mass. Long term resistance training was not associated with an alteration in LV diastolic cavity dimension (resistance trained 54. 4+/-4.3 mm versus control 51.8+/-5.6 mm), ventricular septal wall thickness (resistance trained 9.7+/-1.0 mm versus control 10.1+/-0.7 mm), posterior wall thickness (resistance trained 9.6+/-1.5 mm versus control 9.3+/-1.4 mm) or LV mass (resistance trained 200. 3+/-32.5 g versus control 186.5+/-39.6 g). In addition, no resistance-trained athlete was found to have an LV mean wall thickness above clinical normal limits (12 mm or less). CONCLUSION: Contrary to common beliefs, long term resistance training as performed by elite male power-lifters does not alter LV morphology.

Left ventricular morphology in elite female resistance-trained athletes.

Long-term resistance training as performed by elite female resistance-trained athletes appears to be an insufficient stimulus to alter left ventricular cavity size, wall thickness, or estimated mass.

A study to validate the modified Canadian Aerobic Fitness Test.

This study evaluated the predictive ability of the modified Canadian Aerobic Fitness Test (mCAFT) on an independent sample of subjects and compared it to the original Canadian Aerobic Fitness Test (CAFT). Male and female subjects (n = 154), 15-69 yrs of age, performed the mCAFT and a maximal treadmill test. VO2max scores predicted from the mCAFT equation did not differ significantly from those measured during the treadmill test, whether the sample was analysed overall or categorized by sex, whereas the CAFT (Jetté) equation resulted in VO2max scores that were significantly lower than either the measured values or those predicted using the mCAFT. The strength of the linear relationship between predicted and measured VO2max scores is the same for both the mCAFT (r = 0.88) and CAFT (r = 0.89). However, the mCAFT results in a lower mean square error (37.0 for mCAFT vs. 63.3 for CAFT) and thus is an improvement over the CAFT prediction.

Reliability and validity of the measurement of position sense in women with osteoarthritis of the knee.

OBJECTIVE: We examined the test-retest reliability and the construct validity of the measurement of knee position sense for describing the functional weightbearing performance of women with osteoarthritis (OA) of the knee. METHODS: For the purpose of this study, position sense was defined as the error occurring when subjects attempted to reproduce a criterion angle in standing with visual cues eliminated. Five such tests were recorded photographically on 3 different occasions. On each occasion the 10 subjects also completed a self-paced walking test over a 13 m indoor walkway. RESULTS: The photographic measurements were reproducible (r = 0.90) and there was no change in positioning accuracy across sessions. There was a significant (p < 0.05) inverse correlation of 0.70 between the standard deviation of the mean individual measurements of position sense (precision of the test) and those of walking speed. CONCLUSION: Our study demonstrates good measurement reliability and a comparable mean angular error with repeated tests. It also suggests the amplitude of the variability of this error is a strong determinant of an individual OA patient's functional performance in walking.

Influence of concentric resistance training on concentric and eccentric strength.

This study investigated the effects of isokinetic concentric training on isokinetic concentric and eccentric torque outputs. Sixteen female subjects (mean age in years +/- SE = 21 +/- 1) were randomly assigned to either a training or a control group. Concentric and eccentric torques of the right knee extensors were assessed at 1.05rad.s-1 using a KinCom isokinetic dynamometer system. Each test consisted of a set of four maximal concentric and four maximal eccentric contractions of the knee extensors. The peak and average torques for each contraction were calculated using the computer software supplied by the KinCom manufacturer. On a separate day, after abstaining from heavy exercise for at least 12 hours, a single cross-sectional image of the thigh at midfemur was obtained using computer tomography (CT) scanning. From this image, cross-sectional area of the quadriceps femoris group was calculated using the computer software associated with the General Electric 9800 CT Scanning System. Training group subjects trained three days weekly for six weeks on a Cybex II+ isokinetic dynamometer, completing five sets of ten maximal effort knee extensions at an angular velocity of 1.05rad.s-1. Each set of exercise was separated by two minutes of self-selected recovery. Torque outputs were monitored daily to ensure that adequate recovery was provided between sets of exercise, and to document changes in strength as the program progressed. Significant (p less than .01) increases in peak and average concentric torque (11% and 12%, respectively), peak and average eccentric torque (18% and 21%, respectively), and muscle cross-sectional area (3.2%) were observed for training group subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of hydraulic circuit training on cardiovascular function.

The effect of hydraulic circuit training (HCT) on cardiovascular (CV) function was assessed in 32 healthy middle-aged males (X age = 42.2 +/- 2.1 yr). Maximal aerobic power (VO2max), with simultaneous measurement of stroke volume (SV) and cardiac output (CO), by impedance cardiography, was assessed pre- and post-training. Subjects were randomly assigned to a nonexercising control group, a cycle training group (cycle), or one of the two HCT groups. Training groups participated in a 9 wk program, 3 d.wk-1. Subjects assigned to HCT exercised on a 9 station circuit, completing 3 circuits.d-1. Each circuit consisted of three 20 s work intervals at each station with a 1:1 work:rest ratio. One HCT group (HCTmax) completed the maximal repetitions possible (RM) during each work interval. The other HCT group (HCTsub) exercised at 70-85% of RM. Following training VO2max (ml.kg-1 min-1) was significantly increased in all training groups (18.0, 12.5, and 11.3% for cycle, HCTsub, and HCTmax groups, respectively; P less than 0.05). The increase in VO2max observed in the cycle group was significantly greater than that recorded by the two HCT groups (P less than 0.05). For all three training groups, the increase in VO2max was associated with increases in SVmax and COmax (P less than 0.05 for both). These findings suggest that both maximal and submaximal HCT programs can elicit improvements in cardiovascular fitness.

[Correlations between the components of the test for the evaluation of physical performance II of the Canadian Association of Health, Physical Education and Recreation]. / Intercorrelations entre les composantes du test d'évaluation de la performance physique II de A.C.S.E.P.R.

The Fitness-Performance Tests developed in 1965 by the Canadian Association for Health, Physical Education and Recreation have been criticized with regard to the validity of the 300 yard run as an endurance measure and with regard to the redundance of some items involving lower limb performance. The purposes of this study were to identify a more appropriate endurance performance test item and to analyze the inter-dependence of the items which utilize leg power in their performance. A sample of 9000 young Canadians aged 6 to 17 years, was randomly selected from the 10 provinces and the 2 territories. Correlation coefficients were calculated between: standing long jump, the 50 m. run, and the endurance run (800 m. for 6-9 years, 1600 m. for 10-12 years and 2400 m. for 13-17 years). Among the different age and sex groups, the correlations between the endurance run and the 50 m. run varied from 0.40 to 0.49. The correlations between standing long jump, the agility run (4 x 10 m.) and the 50 m. run were from 0.69 to 0.83 for all the boys and girls. The correlations between these three items are even lower when performances are analyzed by age and sex groups. The highest variations are mainly in the preadolescent period for both sexes.