Health and lifestyle advisors in support of primary care: An evaluation of an innovative pilot service in a region of high health inequality.

INTRODUCTION: A health and lifestyle advisor service embedded within primary care was piloted in Kingston-upon-Hull from January 2021. We aimed to evaluate the first two years of service delivery by identifying patient demographics referred to the service, reason for referral, determine uptake and retention rates, and monitor individual lifestyle-related risk factor changes following discharge. METHODS: Anonymised data were extracted from the SystmOne database for all patients referred to the service between January 2021 and January 2023. RESULTS: In the initial two years of the service, 705 unique patients were referred at a mean rate of ∼29 per month. Each unique patient received a median (robust median absolute deviation; [MAD]) of 3 (Steel N, et al 2018) planned consultations prior to discharge over this period. The majority of referrals were for symptom management and health promotion purposes (95%). Of those referred, 69% attended their appointments, and 14% did not attend. The majority of referrals were white British (55%), however, the service did receive a substantial number of referrals from minority ethnic groups, with only 67% of referrals speaking English as their main language. Eighteen distinct languages were spoken. Most referrals were classified as class I obese (59.4%). Across initial and final appointments, median (robust MAD) systolic blood pressure was 130 (15) mmHg and 130 (15) mmHg, and median (robust MAD) waist circumference was 103.0 (13.3) cm and 101.0 (13.3) cm. CONCLUSION: The evaluation highlighted the demand for this service embedded within primary care settings in Kingston-upon-Hull. Service engagement was evident, and a large proportion of those who engaged were from minority ethnic groups. A high proportion of referrals presented with obesity and/or hypertension which requires further investigation.

Associations between physical activity, sedentary behaviour, and alcohol consumption among UK adults: Findings from the Health Behaviours during the COVID-19 pandemic (HEBECO) study.

INTRODUCTION: The COVID-19 pandemic and attendant lockdowns have had a substantial negative effect on alcohol consumption and physical activity globally. Pre-pandemic evidence in the adult population suggests that higher levels of physical activity were associated with higher levels of drinking, but it is unclear how the pandemic may have affected this. Therefore, this study aims to assess the association between alcohol consumption and physical activity in a UK cohort established during the COVID-19 pandemic. METHODS: Analyses utilized data from the Health Behaviours during the COVID-19 pandemic (HEBECO) study involving 2,057 UK adults (≥18 years). Participants completed self-report measures of alcohol consumption [frequency, quantity, frequency of heavy episodic drinking (HED) and AUDIT-C score] and physical activity [moderate-vigorous physical activity (MVPA), frequency of muscle strengthening activity (MSA) and sedentary behaviour] between November 2020 and January 2021. Ordinal logistic regression models were conducted, adjusting for sociodemographic factors. RESULTS: Fifteen percent of the sample reported abstinence from drinking. Overall, 23.4% of participants drank ≥4 times/week, 13.9% drank more than 6 units/single drinking occasion (HED), 7.5% reported HED daily/almost daily and 4.2% scored ≥11 on AUDIT-C. MSA 3 days/week compared with no MSA was significantly associated with higher odds of alcohol frequency [OR (95 CI%) = 1.41 (1.04-1.91)], quantity [OR (95 CI%) = 1.38 (1.02-1.87)], HED [OR (95 CI%) = 1.42 (1.05-1.94)] and possible dependence [OR (95 CI%) = 1.47 (1.05-2.06)]. The association of MVPA and sedentary behaviour with drinking measures was not significant (p>0.05). CONCLUSION: In contrast with previous research, MSA rather than aerobic physical activity was associated with increased alcohol consumption during the COVID-19 pandemic. It is conceivable that during lockdown while drinking was used as a coping strategy, limited opportunities for aerobic exercise made MSA a more convenient form of physical activity. To guide public health interventions, more research is required to examine the temporal relationship between different forms of physical activity and alcohol consumption.

Agreement and relationship between measures of absolute and relative intensity during walking: A systematic review with meta-regression.

INTRODUCTION: A metabolic equivalent (MET) is one of the most common methods used to objectively quantify physical activity intensity. Although the MET provides an 'objective' measure, it does not account for inter-individual differences in cardiorespiratory fitness. In contrast, 'relative' measures of physical activity intensity, such as heart rate reserve (HRR), do account for cardiorespiratory fitness. The purpose of this systematic review with meta-regression was to compare measures of absolute and relative physical activity intensity collected during walking. METHODS: A systematic search of four databases (SPORTDiscus, Medline, Academic Search Premier and CINAHL) was completed. Keyword searches were: (i) step* OR walk* OR strid* OR "physical activity"; (ii) absolute OR "absolute intensity" OR mets OR metabolic equivalent OR actigraph* OR acceleromet*; (iii) relative OR "relative intensity" OR "heart rate" OR "heart rate reserve" OR "VO2 reserve" OR VO2* OR "VO2 uptake" OR HRmax* OR metmax. Categories (i) to (iii) were combined using 'AND;' with studies related to running excluded. A Bayesian regression was conducted to quantify the relationship between METs and %HRR, with Bayesian logistic regression conducted to examine the classification agreement between methods. A modified Downs and Black scale incorporating 13 questions relative to cross-sectional study design was used to assess quality and risk of bias in all included studies. RESULTS: A total of 15 papers were included in the systematic review. A comparison of means between absolute (METs) and relative (%HRR, %HRmax, %VO2R, %VO2max, HRindex) values in 8 studies identified agreement in how intensity was classified (light, moderate or vigorous) in 60% of the trials. We received raw data from three authors, incorporating 3 studies and 290 participants. A Bayesian random intercept logistic regression was conducted to examine the agreement between relative and absolute intensity, showing agreement in 43% of all trials. Two studies had identical relative variables (%HRR) totalling 240 participants included in the Bayesian random intercept regression. The best performing model was a log-log regression, which showed that for every 1% increase in METs, %HRR increased by 1.12% (95% CI: 1.10-1.14). Specifically, the model predicts at the lower bound of absolute moderate intensity (3 METs), %HRR was estimated to be 33% (95%CI: 18-57) and at vigorous intensity (6 METs) %HRR was estimated to be 71% (38-100). CONCLUSION: This study highlights the discrepancies between absolute and relative measures of physical activity intensity during walking with large disagreement observed between methods and large variation in %HRR at a given MET. Consequently, health professionals should be aware of this lack of agreement between absolute and relative measures. Moreover, if we are to move towards a more individualised approach to exercise prescription and monitoring as advocated, relative intensity could be more highly prioritised.

The effect of bio-banding on technical and tactical indicators of talent identification in academy soccer players.

AIM: The aim of this study was to examine the effect of bio-banding on technical and tactical markers of talent identification in 11- to 14-year-old academy soccer players. METHODS: Using a repeated measures design, 92 players were bio-banded using percentage of estimated adult stature attainment (week 1), maturity-offset (week 2) and a mixed-maturity method (week 3). All players contested five maturity (mis)matched small-sided games with technical and tactical variables measured. Data were analysed using a series of Bayesian hierarchical models, fitted with different response distributions and different random and fixed effect structures. RESULTS: Despite differences during maturity-matched bio-banding for post-peak height velocity players, very few tactical differences were evident during the remaining maturity-matched and mis-matched fixtures for both banding methods. In fact, the results showed no consistent differences across both banding methods for practitioner and video analysis-derived technical performance characteristics during maturity matched and mis-matched fixtures. Both bio-banding methods explained similar levels of variance across the measured variables. CONCLUSION: Maturity-matched bio-banding had some effect on both technical and tactical characteristics of players during maturity-matched bio-banded formats. That said, this trend remained during maturity mis-matched bio-banded formats which restricts the conclusions that can be made regarding the effectiveness of bio-banding to manipulate technical and tactical measures in academy soccer players.

Quantifying technical actions in professional soccer using foot-mounted inertial measurement units.

OBJECTIVES: This study aimed to (i) establish the concurrent validity and intra-unit reliability of a foot-mounted inertial measurement unit for monitoring soccer technical actions, (ii) quantify the within-microcycle inter-positional differences in the technical actions of professional soccer training, and (iii) determine the influence of drill category on the technical actions of professional soccer training. METHODS: Twenty-one professional soccer players' technical performance data (ball touches, releases, ball touches per minute, releases per minute), collected during training sessions throughout twenty-four weekly microcycles, were analysed using general linear modelling. RESULTS: The inertial measurement unit exhibited good concurrent validity (PA = 95.1% - 100.0%) and intra-unit reliability (PA = 95.9% - 96.9%, CV = 1.4% - 2.9%) when compared with retrospective video analyses. The most ball touches (X‾ = 218.0) and releases (X‾ = 110.8) were observed on MD - 1, with MD - 5 eliciting the highest frequency of ball touches (X‾ = 3.8) and releases (X‾ = 1.7) per minute. Central midfielders performed the most ball touches (X‾ = 221.9), releases (X‾ = 108.3), ball touches per minute (X‾ = 3.4) and releases per minute (X‾ = 1.6). Small-sided games evoked more ball touches (X‾diff = 1.5) and releases per minute (X‾diff = 0.1) than previously reported in match-play. The fewest ball touches (X‾ = 1.2) and releases per minute (X‾ = 0.5) were observed during tactical drills. CONCLUSION: The results of this study provide a novel understanding of the within-microcycle, inter-positional and drill category differences in the technical actions performed by professional players during training.

Misuse of the term 'load' in sport and exercise science.

Despite the International System of Units (SI), as well as several publications guiding researchers on correct use of terminology, there continues to be widespread misuse of mechanical terms such as 'work' in sport and exercise science. A growing concern is the misuse of the term 'load'. Terms such as 'training load' and 'PlayerLoad' are popular in sport and exercise science vernacular. However, a 'load' is a mechanical variable which, when used appropriately, describes a force and therefore should be accompanied with the SI-derived unit of the newton (N). It is tempting to accept popular terms and nomenclature as scientific. However, scientists are obliged to abide by the SI and must pay close attention to scientific constructs. This communication presents a critical reflection on the use of the term 'load' in sport and exercise science. We present ways in which the use of this term breaches principles of science and provide practical solutions for ongoing use in research and practice.

The effect of bio-banding on academy soccer player passing networks: Implications of relative pitch size.

The primary aims of this study were to examine the effects of bio-banding players on passing networks created during 4v4 small-sided games (SSGs), while also examining the interaction of pitch size using passing network analysis compared to a coach-based scoring system of player performance. Using a repeated measures design, 32 players from two English Championship soccer clubs contested mixed maturity and bio-banded SSGs. Each week, a different pitch size was used: Week 1) small (36.1 m2 per player); week 2) medium (72.0 m2 per player); week 3) large (108.8 m2 per player); and week 4) expansive (144.50 m2 per player). All players contested 12 maturity (mis)matched and 12 mixed maturity SSGs. Technical-tactical outcome measures were collected automatically using a foot-mounted device containing an inertial measurement unit (IMU) and the Game Technical Scoring Chart (GTSC) was used to subjectively quantify the technical performance of players. Passing data collected from the IMUs were used to construct passing networks. Mixed effect models were used with statistical inferences made using generalized likelihood ratio tests, accompanied by Cohen's local f2 to quantify the effect magnitude of each independent variable (game type, pitch size and maturation). Consistent trends were identified with mean values for all passing network and coach-based scoring metrics indicating better performance and more effective collective behaviours for early compared with late maturation players. Network metrics established differences (f2 = 0.00 to 0.05) primarily for early maturation players indicating that they became more integral to passing and team dynamics when playing in a mixed-maturation team. However, coach-based scoring was unable to identify differences across bio-banding game types (f2 = 0.00 to 0.02). Pitch size had the largest effect on metrics captured at the team level (f2 = 0.24 to 0.27) with smaller pitch areas leading to increased technical actions. The results of this study suggest that the use of passing networks may provide additional insight into the effects of interventions such as bio-banding and that the number of early-maturing players should be considered when using mixed-maturity playing formats to help to minimize late-maturing players over-relying on their early-maturing counterparts during match-play.

Perceptions of professional soccer coaches, support staff and players toward virtual reality and the factors that modify their intention to use it.

A small evidence base supports the use of virtual reality in professional soccer, yet there is a lack of information available on perceptions and desire to use the technology from those employed at professional soccer clubs. Therefore, the aim of the study was to compare and quantify the perceptions of virtual reality use in soccer, and to model behavioural intentions to use this technology. This study surveyed the perceptions of coaches, support staff, and players in relation to their knowledge, expectations, influences and barriers of using virtual reality via an internet-based questionnaire. To model behavioural intention, modified questions and constructs from the Unified Theory of Acceptance and Use of Technology were used, and the model was analysed through partial least squares structural equation modelling. Respondents represented coaches and support staff (n = 134) and players (n = 64). All respondents generally agreed that virtual reality should be used to improve tactical awareness and cognition, with its use primarily in performance analysis and rehabilitation settings. Generally, coaches and support staff agreed that monetary cost, coach buy-in and limited evidence base were barriers towards its use. In a sub-sample of coaches and support staff without access to virtual reality (n = 123), performance expectancy was the strongest construct in explaining behavioural intention to use virtual reality, followed by facilitating conditions (i.e., barriers) construct which had a negative association with behavioural intention. Virtual reality has the potential to be a valuable technology within professional soccer although several barriers exist that may prevent its widespread use.

The effect of bio-banding on physical and psychological indicators of talent identification in academy soccer players.

The aim of this study was to examine the effect of bio-banding on indicators of talent identification in academy soccer players. Seventy-two 11 to 14-year-old soccer players were bio-banded using percentage of estimated adult stature attainment (week 1), maturity-offset (week 2) or a mixed-maturity method (week 3). Players contested five maturity (mis)matched small-sided games with physical and psychological determinants measured. Data were analysed using a series of Bayesian hierarchical models, fitted with different response distributions and different random and fixed effect structures. Few between-maturity differences existed for physical measures. Pre-peak height velocity (PHV) and post-PHV players differed in PlayerLoadTM (anterior-posterior and medial-lateral) having effect sizes above our criterion value. Estimated adult stature attainment explained more of the variance in eight of the physical variables and showed the greatest individual differences between maturity groups across all psychological variables. Pre-PHV and post-PHV players differed in positive attitude, confidence, competitiveness, total psychological score (effect sizes = 0.43-0.69), and session rating of perceived exertion. The maturity-offset method outperformed the estimated adult stature attainment method in all psychological variables. Maturity-matched bio-banding had limited effect on physical variables across all players while enhancing a number of psychological variables considered key for talent identification in pre-PHV players.

Characterising the application of the "progressive overload" principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme.

BACKGROUND: Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. DESIGN: Observational study. METHODS: We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. RESULTS: Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). CONCLUSION: The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.

The effects of the iPlayClean education programme on doping attitudes and susceptibility to use banned substances among high-level adolescent athletes from the UK: A cluster-randomised controlled trial.

Background This study examined the effects of the iPlayClean anti-doping intervention on attitudes towards doping and susceptibility, and whether delivery mode affected the results. Methods A total of 1081 high-level UK athletes (14-18 years old, 904 males, 177 females) were cluster-randomised to the control (11 teams/organisations/schools, 314 athletes), face-to-face group presentation (8 teams/organisations/schools, 254 athletes), online (11 teams/organisations/schools, 251 athletes), or face-to-face presentation with online access (5 teams/organisations/schools, 262 athletes). Results Compared to the control group, all modes of the iPlayClean anti-doping education programme reduced favourable attitudes towards doping immediately after the intervention, which was sustained across all intervention groups 8 weeks later. All delivery modes impacted doping susceptibility immediately after the intervention, in comparison to the control group, but the effects were only sustained for the face-to-face presentation group. Conclusion Contrary to findings within previous anti-doping interventions, we have shown that doping attitudes can be changed and that the results can be sustained across all modes of delivery, 8 weeks later. Research is required to assess for how long these changes are sustained, and how often anti-doping education should be delivered to high-level athletes to reinforce clean play values.

The relative contribution of training intensity and duration to daily measures of training load in professional rugby league and union.

This study examined the relative contribution of exercise duration and intensity to team-sport athlete's training load. Male, professional rugby league (n = 10) and union (n = 22) players were monitored over 6- and 52-week training periods, respectively. Whole-session (load) and per-minute (intensity) metrics were monitored (league: session rating of perceived exertion training load [sRPE-TL], individualised training impulse, total distance, BodyLoad™; union: sRPE-TL, total distance, high-speed running distance, PlayerLoad™). Separate principal component analyses were conducted on the load and intensity measures to consolidate raw data into principal components (PC, k = 4). The first load PC captured 70% and 74% of the total variance in the rugby league and rugby union datasets, respectively. Multiple linear regression subsequently revealed that session duration explained 73% and 57% of the variance in first load PC, respectively, while the four intensity PCs explained an additional 24% and 34%, respectively. Across two professional rugby training programmes, the majority of the variability in training load measures was explained by session duration (~60-70%), while a smaller proportion was explained by session intensity (~30%). When modelling the training load, training intensity and duration should be disaggregated to better account for their between-session variability.

A 12-month continuous and intermittent high-impact exercise intervention and its effects on bone mineral density in early postmenopausal women: a feasibility randomized controlled trial.

BACKGROUND: Intermittent mechanical loading generates greater bone adaptations than continuous mechanical loading in rodents but has never been evaluated in humans. This study aimed to evaluate the feasibility of a continuous and intermittent countermovement jump (CMJ) intervention for attenuating early postmenopausal BMD loss. METHODS: 41 healthy early postmenopausal women (age=54.6±3.4 years) were randomly assigned to a continuous countermovement jumping group, an intermittent countermovement jumping group or a control group for 12 months. Adherence and dropout rates were recorded along with bone mineral density (BMD) at lumbar spine, femoral neck and trochanter sites at baseline, 6 months and 12 months. RESULTS: 28 participants completed the study. Dropout rate during the intervention (from the initiation of exercise) was 36% from continuous and 38% from intermittent countermovement jumping groups. For the participants that completed the intervention, adherence was 60.0±46.8% for continuous and 68.5±32.3% for intermittent countermovement jumping. The control group lost significant lumbar spine BMD (% difference=-2.7 [95%CI: -3.9 to -1.4]) and femoral neck BMD (% difference=-3.0% [95%CI: -5.1 to -0.8]). There was no statistically significant change in BMD for either countermovement jumping group. There was no statistically significant difference in BMD change between continuous or intermittent countermovement jumping groups when compared with the control group. CONCLUSIONS: Adherence and dropout rates were in line with previous similar interventions. To evaluate the effect of continuous and intermittent exercise on BMD, future studies should focus on maintaining participant engagement and adherence to the exercise intervention.