Effectiveness of exercise programs to reduce low back pain among nurses and nursing assistants: A systematic review and meta-analysis.

INTRODUCTION: Nurses have a high prevalence of low back pain due to ergonomic hazards in healthcare workplaces. While exercise programs have been suggested as an intervention strategy, the effectiveness of low back pain programs has been inconsistent in the research literature. The purpose of study is to determine the effect of exercise programs to reduce low back pain among nursing staff. METHODS: A systematic review and meta-analysis was conducted with five databases and systematically searched. Following the PRISMA guidelines, included studies evaluated low back pain relief among nurses or nursing assistants and described the exercise program. Two reviewers independently appraised, extracted, and synthesized all available studies. The study protocol was registered in PROSPERO (CRD42022359511). RESULTS: A total of 296 articles with 1,355 nursing staff from nine countries were obtained. Nine randomized controlled trials with a moderate to low risk of bias quality were included. Exercise programs had a small but significant effect on low back pain of nursing staff (SMD = -0.48; 95% CI = -0.76 to -0.19; p = 0.03, I2 = 62%, p = 0.001). A subgroup analysis of nurses and nursing assistants showed moderate and small effects, respectively (I2 = 0% p < 0.0001, SMD -0.73 CI 95% [-0.97 to -0.48], p = 0.76, and I2 = 0% p = 0.002, SMD -0.23 CI 95% [-0.38 to -0.08], p < 0.88). Exercise for back and trunk exhibited a moderate effect on low back pain (SMD -0.56 CI 95% [-0.86 to -0.25], p = 0.01, I2 = 66%, p < 0.0004). A subgroup analysis comparing age, under 40 years old revealed a moderate effect size (SMD = -0.59; 95% CI = -0.83to -0.35; p = 0.06; I2 = 64%, p < 0.0001). CONCLUSIONS: Exercise programs are an effective treatment to reduce low back pain in nurses and nursing assistants, especially among younger staff. PRACTICAL APPLICATION: Back and trunk exercise programs should be recommended for nursing staff with low back pain.

Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward.

Nurses in neurological wards face numerous challenges when caring for patients with dementia, particularly those who also present other acute illnesses. However, studies focusing on this area are limited. This study aimed to explore the difficulties and strategies in caring for patients with dementia among nurses working in a neurological ward. A qualitative descriptive design was adopted. Twelve nurses from a neurology ward participated in individual semi-structured interviews. The data collected through these interviews were subjected to qualitative content analysis. Two main themes emerged from the analysis: (i) various shortcomings and concerns, which include subthemes: insufficient support, worry about patient safety, inadequate care ability of the caregiver, and insufficient self-competence, and (ii) unique clinical strategies, which include subthemes: cooperate with the caregiver, improve self-competence in dementia care, and employ meticulous resorts. The findings highlighted the nurses' dedication to minimizing patient risks and utilizing available resources as well as stakeholders to provide optimal care. To enhance patient care quality, it is essential to support nurses by addressing care-related barriers, offering continuous education, and establishing care pathways.

Effects of an ice roller on chronic kidney disease-associated pruritus in patients receiving haemodialysis.

BACKGROUND: Chronic kidney disease-associated pruritus is a distressing symptom and has a far-reaching impact on patients' sleep and quality of life for most patients receiving haemodialysis. Traditional therapies have limited effectiveness. OBJECTIVES: This study aimed to invent a self-operated ice roller and evaluate its efficacy in relieving pruritus, sleep quality, and quality of life. DESIGN: This study was experimental with a two-arm parallel group design. PARTICIPANTS: A convenient sampling method was used to recruit 60 patients receiving haemodialysis who reported pruritus (5D-Itch Scale score >5) lasting over 4 weeks in Taiwan. The participants were randomly assigned to one of two groups: the intervention group used an ice roller for 7 days, while the control group received no anti-pruritus treatment. MEASUREMENTS: This study was experimental with a two-arm parallel group design. The measurement instruments included the 5D-Itch Scale, Pittsburgh Sleep Quality Index and WHOQOL-BREF-Taiwan Version. The analysis of covariance, chi-square, Independent t tests, and partial Eta2 (η2 p) were used to analyse the data. RESULTS: The participants' mean age was 62.77 years. Application of the ice roller significantly decreased overall pruritus (p < .05; η2 p = .09) and distribution of pruritus-associated bodily parts (p = .03; η2 p = .08). There were no statistically significant differences in sleep quality and related indicators between the experimental and control groups at the study endpoint. Regarding quality of life, only the social relationship domain significantly differed between the two groups (p = .02; η2 p = .08). CONCLUSIONS: The ice roller can decrease pruritus and its distribution in patients receiving haemodialysis, serving as an adjunct therapy alongside conventional anti-pruritus treatments.

Work-related flow and its correlates among frontline nurses during the COVID-19 pandemic.

BACKGROUND: Ample evidence across non-healthcare fields highlights the role of work-related flow in enhancing resilience against work stress and work engagement. Understanding flow and its factors can support staff development and management. AIMS: This study aimed to investigate the level of work-related flow and its associated factors among frontline nurses during the COVID-19 pandemic. METHODS: A cross-sectional multicenter study included 336 nurses caring for COVID-19 patients between March and April 2022. Cluster random sampling was used to select 9 nurse groups from 29 Taiwanese hospitals specialized in COVID-19 care. A web survey link was shared on the selected nurses' social media. Hierarchical regression analyses examined predictor-outcome relationships, following the STROBE checklist for reporting findings. RESULTS: Among demographic characteristics, sex (ß = -0.11; p = 0.016) and living arrangement (ß = -0.12; p = 0.017) reached statistical significance in model 3. Social support from family, friends, and significant others, managerial position, and sufficiency of personal protective equipment showed significant associations with work-related flow (all ß > 0.12; p < 0.05). The variables included in the final model accounted for 35% of the variance in work-related flow for COVID-19 patient care tasks. CONCLUSIONS: Flow experience is influenced by factors associated with demographics, work conditions, and social support. Nurse administrators should consider these factors when evaluating nurses' flow at work. IMPLICATIONS FOR NURSING PRACTICE AND MANAGEMENT: Allocating care tasks to nurses based on their flow levels can be beneficial, particularly during healthcare crises. Ensuring a sufficient supply of personal protective equipment and offering social support to nurses are vital strategies for facilitating their flow experience in the workplace.

Machine learning approach to determine the decision rules in ergonomic assessment of working posture in sewing machine operators.

INTRODUCTION: There are some inherent problems with the use of observation methods in the ergonomic assessment of working posture, namely the stability and precision of the measurements. This study aims to use a machine learning (ML) approach to avoid the subjectivity bias of observational methods in ergonomic assessments and further identify risk patterns for work-related musculoskeletal disorders (WMSDs) among sewing machine operators. METHODS: We proposed a decision tree analysis scheme for ergonomic assessment in working postures (DTAS-EAWP). First, DTAS-EAWP used computer vision-based technology to detect the body movement angles from the on-site working videos to generate a dataset of risk scores through the criteria of Rapid Entire Body Assessment (REBA) for sewing machine operators. Second, data mining techniques (WEKA) using the C4.5 algorithm were used to construct a representative decision tree (RDT) with paths of various risk levels, and attribute importance analysis was performed to determine the critical body segments for WMSDs. RESULTS: DTAS-EAWP was able to recognize 11,211 samples of continuous working postures in sewing machine operation and calculate the corresponding final REBA scores. A total of 13 decision rules were constructed in the RDT, with over 95% prediction accuracy and 83% path coverage, to depict the possible risk tendency in the working postures. Through RDT and attribute importance analysis, it was identified that the lower arm and the upper arms exhibited as critical segments that significantly increased the risk levels for WMSDs. CONCLUSIONS: This study demonstrates that ML approach with computer vision-based estimation and DT analysis are feasible for comprehensively exploring the decision rules in ergonomic assessment of working postures for risk prediction of WMSDs in sewing machine operators. PRACTICAL APPLICATIONS: This DTAS-EAWP can be applied in manufacturing industries to automatically analyze working postures and identify risk patterns of WMSDs, leading to the development of effectively preventive interventions.

Development and psychometric properties of a friendly dietary function assessment scale for home-dwelling people with dementia.

BACKGROUND: Mealtime difficulties related to cognitive functioning negatively impact a patient's life during the various stages of dementia, and they typically cause a burden and stress on family caregivers. Most people with dementia live at home alone or are cared for by informal caregivers, typically their spouses or other family members. However, no suitable screening tools for home-dwelling patients with dementia have been developed, nor have measurements focused on executive and self-eating functions. This study aimed to develop and evaluate the psychometric properties of the Dietary Function Assessment Scale (DFAS) for community-dwelling persons with dementia. METHODS: A mixed-method design was used to develop the instrument. Methods included a comprehensive literature review to identify the item pool and an expert panel to assess the initial item pool. We performed convenience sampling of 190 home-dwelling people with dementia for psychometrical evaluation. The psychometric properties tests included item and factor analyses, criterion-related validity testing, internal consistency reliability testing, and defining the optimal cut-off values. The study was conducted from 2018 to 2019. RESULTS: Items were generated based on an extensive literature review and pre-existing scales related to mealtime and executive functions in persons with dementia. The S-CVI/Ave of the DFAS was 0.89. A Principal Component factor analysis demonstrated seven items, with a two-factor structure accounting for 56.94% of the total variance. The two extracted factors were Self-eating ability and Dietary executive function. The confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate (r = -0.528, p < 0.01). The reliability of Cronbach's alpha internal consistency was 0.74, and McDonald's Omega coefficient was 0.80; the optimal cut-off value of 13 points with an AUC of 0.74 was established to determine poor dietary functioning in persons with dementia. CONCLUSION: The DFAS was simple, user-friendly, and a valid and reliable instrument to assess dietary functioning in community-dwelling persons with dementia. This short scale can be helpful for caretakers, who can use it to identify the dietary needs of home-dwelling persons with dementia and improve their care and eating experience.

A Feasibility Evaluation of the Need-Centered Watch-Assess-Need Intervention-Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia.

BACKGROUND: Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program. PURPOSE: This study was designed to evaluate the feasibility of using the Watch-Assess-Need intervention-Think (WANT) education and training program for BPSD in long-term care settings. METHODS: A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis. RESULTS: Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.

The effect of sugammadex versus neostigmine on postoperative nausea and vomiting: a meta-analysis of randomized controlled trials with trial sequential analysis.

INTRODUCTION: Association between sugammadex and risk of postoperative nausea and vomiting remains unclear. EVIDENCE ACQUISITION: We performed meta-analysis of randomized controlled trials with trial sequential analysis to compare sugammadex with neostigmine in adults receiving elective surgery under general anesthesia with postoperative extubation. Databases of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to April 15, 2022. Primary outcome was risk of postoperative nausea and vomiting after patients received sugammadex or neostigmine. Secondary outcomes were incidences of sugammadex-related complications. EVIDENCE SYNTHESIS: Meta-analysis of 40 trials with 5455 patients showed an overall lower risk of postoperative nausea and vomiting in the sugammadex group than in the neostigmine group (risk ratio: 0.85, 95% CI [0.76-0.94], heterogeneity I2=4%, P=0.002). Subgroup analyses demonstrated a lower risk of postoperative nausea and vomiting associated with sugammadex than with neostigmine: 1) in the postanesthesia care unit (risk ratio: 0.77, 95% CI [0.66-0.90], I2=8%, P=0.001) but not in wards; 2) under volatile anesthetics but not total intravenous anesthesia; 3) regardless of the administration of prophylactic antiemetics; and 4) when sugammadex was administered at 2 mg/kg but not 4 mg/kg. No major complications such as cardiac arrest or refractory bradycardia were noted and every patient achieved adequate neuromuscular recovery before extubation in all of the included trials. The overall quality of evidence was moderate. CONCLUSIONS: Sugammadex was associated with a lower risk of postoperative nausea and vomiting compared with neostigmine immediately after surgery, especially for patients receiving volatile anesthetics regardless of the use of prophylactic antiemetics.

Developing and validating cardiovascular emergency gamification question cards.

BACKGROUND: Learning to handle cardiovascular emergencies is complex and can cause psychological stress for nursing students. Gamification using question cards as a learning aid is one of the creative educational strategies that can help students learn in a fun way. The design of cards with valid and reliable questions is essential in gamification; however, such cards are still lacking in cardiovascular emergency learning. OBJECTIVES: To develop and validate cardiovascular emergency question cards for the future use of gamification for education regarding cardiovascular emergencies among undergraduate nursing students. METHODS: The development process included two phases: designing the question cards and testing validity evidence. A table of specifications was used to select and assign questions based on three levels with six learning outcome categories. Five nurse experts assessed the evidence based on test content, including the relevance, clarity, and essentiality of the questions. Seven final-year nursing students evaluated the evidence based on the response process. After revision, 61 nursing students evaluated the internal consistency reliability of each level. RESULTS: In the design phase, ninety English question cards were categorized into three levels based on the learning outcomes expected in an undergraduate emergency nursing course. Most of the questions were multiple-choice questions, and some were short answer questions. The final item-content validity index = 1.00, the scale-content validity index/universal agreement = 1.00, and the content validity ratio = 1.00. Cronbach's α for internal structure was 0.81 for level I (n = 61), 0.92 for level II (n = 54), and 0.81 for level III (n = 46). CONCLUSION: The cardiovascular emergency question cards showed acceptable evidence based on the test content, response process, and internal structure. In the future, testing the feasibility of applying the question cards to gamification and assessing their learning effect on cardiovascular emergency knowledge retention will be necessary.

Research on the Impacts of Cognitive Style and Computational Thinking on College Students in a Visual Artificial Intelligence Course.

Visual programming language is a crucial part of learning programming. On this basis, it is essential to use visual programming to lower the learning threshold for students to learn about artificial intelligence (AI) to meet current demands in higher education. Therefore, a 3-h AI course with an RGB-to-HSL learning task was implemented; the results of which were used to analyze university students from two different disciplines. Valid data were collected for 65 students (55 men, 10 women) in the Science (Sci)-student group and 39 students (20 men, 19 women) in the Humanities (Hum)-student group. Independent sample t-tests were conducted to analyze the difference between cognitive styles and computational thinking. No significant differences in either cognitive style or computational thinking ability were found after the AI course, indicating that taking visual AI courses lowers the learning threshold for students and makes it possible for them to take more difficult AI courses, which in turn effectively helping them acquire AI knowledge, which is crucial for cultivating talent in the field of AI.

Effects of Aerobic Walking on Memory, Subjective Cognitive Complaints, and Brain-Derived Neurotrophic Factor Among Older Hypertensive Women.

Background:Hypertension is prevalent in older women and is associated with increased cognitive impairment. Exercise has demonstrated beneficial effects on cognitive function, but the impact of exercise on older hypertensive women remains unclear. We investigated the effects of an aerobic walking program on memory, subjective cognitive complaints, and brain-derived neurotrophic factor in older hypertensive women. Methods: A quasi-experimental study with a pretest-posttest design was conducted. Older hypertensive women were randomly assigned to the aerobic walking group or a control group with routine care. The intervention group received a 24-week aerobic walking program. Data were collected at baseline and 24 weeks after enrollment. Participants' characteristics, memory, subjective cognitive complaints, and plasma brain-derived neurotrophic factor were analyzed. Results: The aerobic walking group (n = 30) reported improvements in total recall, delayed recall, and subjective cognitive impairment after 24 weeks of aerobic walking. Compared to the control group (n = 28), the aerobic walking group showed significantly greater improvement in delayed recall at 24 weeks. However, aerobic walking had no significant effect on subjective cognitive complaints or brain-derived neurotrophic factor. Conclusion: The aerobic walking training significantly improved memory performance among older women with hypertension. A longer randomized controlled trial with a larger sample is necessary to confirm and further explore the effects of this intervention.

A mini-flipped, game-based Mediterranean diet learning program on dietary behavior and cognitive function among community-dwelling older adults in Taiwan: A cluster-randomized controlled trial.

The Mediterranean diet has been recommended to delay cognitive decline, but adherence to the diet among older adults remain poor, and research on interventions that effectively promote the diet has been inconclusive. This study examined the effects of a mini-flipped, game-based Mediterranean diet learning program in improving dietary behavior and cognitive function in community-dwelling older adults in Taiwan. A cluster randomized controlled trial was conducted. The experimental group completed an 8-week, mini-flipped, game-based learning program. Data were collected at baseline and 8 weeks after intervention. Outcome measures included dietary behavior, global cognitive function, and subjective cognitive dysfunction. Compared with the control group, the experimental group exhibited significantly improved Mediterranean diet behavior and global cognitive function after the intervention, although there was no significant difference in subjective cognitive function. Future research should be conducted with larger populations and longer-term follow-up to evaluate the effect of this learning program.

Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

BACKGROUND: Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. AIMS: The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. METHODS: Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1 week post-chemo (T2), and (4) 3 weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. RESULTS: One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F = 7.46), sleep quality (F = 2.74), symptom distress (F = 9.99), anxiety (F = 5.72), and depression (F = 4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. LINKING EVIDENCE TO ACTION: CRF worsens at 1 week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1 week after injection.

Development of an educational protocol for ergonomic risk assessment of working postures to enhance the competence of occupational health nurses.

AIM: To develop a protocol and provide a valid, evidence-based procedure for identifying the ergonomic risk of working postures by occupational health nurses. BACKGROUND: Although ergonomic risk assessment tools have been used for the early detection of risky working postures, their operational procedures and validations do not target the competence of occupational nursing personnel. DESIGN: This study developed and validated an educational protocol, comprised of 13 procedures in five stages. First, the number of work tasks in the workplace is determined. Second, the working postures are confirmed. Third, the raters are trained to use the assessment tools. Fourth, high-risk postures are identified and categorized. Fifth, the inter-rater reliability of the tool is reported. The content of the protocol is validated by experts, with a validity value of 0.87. DATA SOURCES: The protocol was created through review of literature published from 1991 to 2021, protocol development (between 2018 to 2020) and expert validation (2020). CONCLUSION: The protocol can be applied to educate occupational health nurses and increase their competence in detecting workers' ergonomic risks. It can be used as a reference in occupational health nursing education to evaluate work tasks and detect risky postures.

Psychometric Testing: Self-Efficacy for Calorie Control and Exercise.

Enhancing self-efficacy for calorie control and exercise is a crucial strategy for successful weight management. This study developed and psychometrically tested a 13-item quick checklist for assessing self-efficacy for calorie control and exercise (QCSE-CCE). A convenience sample of 425 adults between 18 and 69 years old completed the QCSE-CCE online. The principle axis factor analysis and a parallel analysis demonstrated a three-factor structure that accounts for 72.8% of the total variance. The confirmatory factor analysis indicated a good model fit (χ2/df = 2.168, GFI = .913, AGFI = .873, RMR = .049, RMSEA = .073, CFI = .959). The predictive validity was adequate (.38 < r < .39, p < .000), with Cronbach's alphas ranging from .87 to .91. The test-retest demonstrated good stability (r = .69; p < .001). The QCSE-CCE is a valid and reliable instrument for assessing self-efficacy for calorie control and exercise for weight management purposes.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women.

DESIGN: This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES: The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND: Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS: This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS: More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS: Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE: Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Beneficial Exercises for Cancer-Related Fatigue among Women with Breast Cancer: A Systematic Review and Network Meta-Analysis.

CONTEXT: Cancer-related fatigue (CRF) is the most common cause of physical powerlessness in women with breast cancer (BC). The practice of continuous effective exercise is beneficial with respect to reducing CRF. OBJECTIVE: To explore exercise efficacy and respective ranks with respect to reducing CRF in women with BC within the inter-treatment and post-treatment periods. METHODS: Throughout this systematic review and network meta-analysis, articles published from 2000 to March 2022 were included. Article searches were conducted on the MEDLINE, Embase, CINAHL, and CENTRAL databases. Adult women with BC and different exercise programs were compared with those involved in regular care as a control during or after treatment. In addition, randomized controlled trials (RCT) were also included. A risk-of-bias assessment, with the revised Cochrane risk-of-bias tool regarding RCT and probability-based ranking, was established based on the surface under the cumulative rank (SUCRA) method via network meta-analysis. RESULTS: a total of 5747 women with BC followed seven exercise interventions. Yoga (SMD = -0.54, 95% CI [-0.86, -0.22]) was ranked first (94.5%), with significant effects in respect of mitigating CRF, followed by resistance exercise (66.2%), and aerobic resistance (63.3%), while Qigong ranked last (22.2%) among the 36 RCT in inter-treatment. Aerobic resistance exercise (SMD = -0.52, 95% CI [-0.98, -0.07]) induced significant effects in respect of mitigating CRF in the 38 RCTs in the post-treatment period. Yoga, aerobic yoga, and aerobic resistance exercise ranked as the top three (75.5%, 75.0%, and 72.4%, respectively), whereas relaxation ranked last (38.8%) in the post-treatment period. CONCLUSION: Yoga, aerobic resistance, and aerobic yoga are recommended for the purposes of inter- and post-treatment exercise to reduce CRF in women with BC by enhancing their physical resilience and long-term quality of life.

Using a Socio-Environmental Approach to Explore the Determinants for Meeting the Recommended Physical Activity among Adults at Risk of Diabetes in Rural Indonesia.

Moderate-to-vigorous physical activity (PA) is recommended to mitigate the risk of diabetes. This study explored the PA of adults at risk for diabetes in rural Indonesia and determined the requirements for meeting the recommended PA level. In total, 842 adults were screened using a diabetes risk test in a rural health centre; among them, 342 were at risk of diabetes. The level of PA was assessed using the International Physical Activity Questionnaire, whereas the associated factors underlying the three domains -individual, support, and environment-were determined by the Influences on Physical Activity Instrument. The data analysis included a three-step multiple linear regression (MLR) and logistic regression (LR). Overall, 40.6% of the participants met the recommended PA. According to the MLR analysis, among males, individuals who gave PA a higher priority and had enough time to perform PA were predicted to have a higher activity energy expenditure (MET-minutes per week). According to the LR analysis, men were more likely to meet the recommended PA, and people who gave PA a lower priority and had less access to space for PA were less likely to meet the recommended PA level. Strategies for promoting PA in rural Indonesia include focusing on women, people who prioritize PA less, and those who have less time and space in which to be physically active.

A School-Based Progressive Muscle Relaxation Program for Female Adolescents: Development and the Effectiveness on Physiological and Psychological Evidence.

(1) Background: A variety of stressors may be potentially harmful to adolescents' health and well-being. Relaxation techniques have been recognized as a valid method for stress release, but the challenge is to apply them practically in schools to produce the desired effects. (2) Methods: This feasibility study used the Perceived Stress Scale (PSS) and hair cortisol concentration (HCC) to test the effects of an abbreviated progressive muscle relaxation (APMR) program on female adolescents. The participants were recruited from a high school and assigned by class cluster to either the experimental group (EG, n = 40) or the control group (CG, n = 35). Both received 4 weeks of stress-related lessons. The EG received 60 additional sessions of APMR over 12 weeks. (3) Results: The program dropout rate of the participants was 1.3%. The EG's program adhesion rate was 99.1%, and nearly half felt satisfied with the program. After adjusting for the BMI and the pretest in the ANCOVA, it was found that the CG had a greater change in HCC between the pre- and post-tests than the EG, while the PSS did not change significantly in either group. (4) Conclusion: APMR is a valid practice for physiological homeostasis of HCC for female adolescents, but it has no significant effect on perceived stress.