Exercise Regulates Myokines in Aging-Related Diseases through Muscle-Brain Crosstalk.

BACKGROUND: The related functions of skeletal muscle and brain decrease significantly with age, and muscle-brain-related diseases are primarily associated with each other. Exercise can promote the secretion of myokines in skeletal muscle, showing a beneficial effect on the function of both, reflecting muscle-brain crosstalk. However, the key mechanism of action of exercise-regulated myokines in muscle-brain diseases remains unclear. SUMMARY: This review is intended to sort out and explore the key mechanism of the effect of exercise regulatory myokines on muscle-brain diseases through summarizing the relevant literature on the level of motor regulatory myokines in recent years and pay special attention to the impact of exercise type, intensity, and duration on myokine expression levels. KEY MESSAGES: The mechanism by which exercise regulates myokine levels in muscle-brain diseases is explained, and an effective exercise prescription for myokine expression that is more suitable for the elderly based on relevant literature is proposed. This work may hold certain value for subsequent exercise treatment of chronic diseases in the elderly and for further research on muscle-brain crosstalk.

Effects of Multi-Task Mode on Cognition and Lower Limb Function in Frail Older Adults: A Systematic Search and Review.

The application of multi-tasking (MT), especially dual-tasking (DT), in frail older adults is currently gaining attention. The aim was to review the application of the MT mode on cognition and lower limb function in frail older adults, including the MT test and MT training. By searching five electronic databases, Scopus, PubMed, PEDro, Web of Science and the Chinese electronic database, a total of 18 studies were finally included in this study, with 7 articles on MT testing and 11 articles on MT training. The results of the study showed that the current testing and training of MT is mainly based on the DT mode, with a wide variety of test types and protocols, as well as a variety of outcomes. The included studies suggested that DT can be used as a test to assess cognitive and lower limb function in the frail population and that an MT (DT) training program with an intervention period of ≥3 months or a duration of ≥60 min per session could improve cognitive and lower limb function in the frail population, thereby reducing the risk of falls. Further research is required to explore the effects of different types of MT and task prioritization in frail older adults.

Identification of runner fatigue stages based on inertial sensors and deep learning.

Introduction: Running is one of the most popular sports in the world, but it also increases the risk of injury. The purpose of this study was to establish a modeling approach for IMU-based subdivided action pattern evaluation and to investigate the classification performance of different deep models for predicting running fatigue. Methods: Nineteen healthy male runners were recruited for this study, and the raw time series data were recorded during the pre-fatigue, mid-fatigue, and post-fatigue states during running to construct a running fatigue dataset based on multiple IMUs. In addition to the IMU time series data, each participant's training level was monitored as an indicator of their level of physical fatigue. Results: The dataset was examined using single-layer LSTM (S_LSTM), CNN, dual-layer LSTM (D_LSTM), single-layer LSTM plus attention model (LSTM + Attention), CNN, and LSTM hybrid model (LSTM + CNN) to classify running fatigue and fatigue levels. Discussion: Based on this dataset, this study proposes a deep learning model with constant length interception of the raw IMU data as input. The use of deep learning models can achieve good classification results for runner fatigue recognition. Both CNN and LSTM can effectively complete the classification of fatigue IMU data, the attention mechanism can effectively improve the processing efficiency of LSTM on the raw IMU data, and the hybrid model of CNN and LSTM is superior to the independent model, which can better extract the features of raw IMU data for fatigue classification. This study will provide some reference for many future action pattern studies based on deep learning.

Effect of Target Semantic Consistency in Different Sequence Positions and Processing Modes on T2 Recognition: Integration and Suppression Based on Cross-Modal Processing.

In the rapid serial visual presentation (RSVP) paradigm, sound affects participants' recognition of targets. Although many studies have shown that sound improves cross-modal processing, researchers have not yet explored the effects of sound semantic information with respect to different locations and processing modalities after removing sound saliency. In this study, the RSVP paradigm was used to investigate the difference between attention under conditions of consistent and inconsistent semantics with the target (Experiment 1), as well as the difference between top-down (Experiment 2) and bottom-up processing (Experiment 3) for sounds with consistent semantics with target 2 (T2) at different sequence locations after removing sound saliency. The results showed that cross-modal processing significantly improved attentional blink (AB). The early or lagged appearance of sounds consistent with T2 did not affect participants' judgments in the exogenous attentional modality. However, visual target judgments were improved with endogenous attention. The sequential location of sounds consistent with T2 influenced the judgment of auditory and visual congruency. The results illustrate the effects of sound semantic information in different locations and processing modalities.

Myokine, a key cytokine for physical exercise to alleviate sarcopenic obesity.

Skeletal muscle has a robust endocrine function as a powerful organ and can secrete and release cytokines or polypeptides known as myokines. These myokines have significant regulatory effects on signal transduction in skeletal muscle and the metabolism of peripheral tissues and organs and exert biological effects via autocrine, paracrine, or endocrine forms. Obesity and aging cause myokine secretion dysregulation, and hastening sarcopenic obesity (SO) development. Exercise is currently an excellent intervention and prevention method for SO. Meanwhile, exercise impacts many organs and tissues. These organs and tissues will produce various myokines in response to movement and metabolism throughout the body to govern muscle differentiation, growth, and remodeling. According to accumulating data, exercise can increase the release of myokines from diverse tissues into the blood and postpone the SO onset and progression by influencing protein metabolism, inflammation, mitochondrial quality control, and other mechanisms.

Nutritional Intervention Improves Muscle Mass and Physical Performance in the Elderly in the Community: A Systematic Review and Meta-Analysis.

Nutritional supplements have been extensively used as health interventions for the elderly. However, with the spread of COVID-19, no consensus exists on whether nutritional interventions could improve muscle mass and physical activity in community-dwelling older adults. To conduct a systematic review and meta-analysis to explore the effects of different nutritional interventions on muscle mass and physical performance in the elderly, we searched PubMed, Web of Science, Elsevier, and Cochrane databases from their founding dates to December 2023. The meta-analysis was performed using RevMan5.3 software. Only randomized controlled trials (RCTs) were considered, and the overall mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI) was calculated. There were 33 studies comprising 3579 elderly persons meeting the inclusion criteria. Comprehensive analysis suggested that the intervention effect of fat-free mass (FFM), appendix skeletal muscle mass (ASMM), handgrip strength (HGS), gait speed, and short physical performance battery (SPPB) score was higher in the nutritional supplement group than in the control group. The results of subgroup analysis demonstrated that protein supplementation (SMD = 0.82, p < 0.0001) had an optimal effect on ASMM (SMD = 0.89, p < 0.0001) and FFM (MD = 2.09, p < 0.0001) in the elderly. Vitamin D supplementation (SMD = 0.52, p < 0.0001) had a marginal effect on ASMM, and energy supplementation (SMD = 0.39, p = 0.0005) had the lowest effect. Moreover, nutritional interventions had the most significant impact on HGS (MD = 1.06, p < 0.0001) and TUG (MD = 0.14, p < 0.0001) in individuals aged 65-75 years old, with positive effects on FFM (MD = 1.62, p < 0.0001) and HGS (MD = 0.82, p < 0.0001) when compared to healthy elderly individuals, and had greater effect on ASMM (SMD = 0.69, p < 0.0001) than on the elderly with sarcopenia. Nutritional supplements can enhance muscle mass and physical performance in the elderly, while protein is recommended for muscle function. The golden period for implementing nutritional interventions to improve muscle function is before the age of 75 years. However, the impact of nutritional interventions varies with age and population. Given the limited evidence on nutritional interventions, more detailed and high-quality studies are highly warranted in the future.

Effects of perceptual-cognitive tasks on inter-joint coordination of soccer players and ordinary college students.

Perceptual-cognitive tasks play a pivotal role in performing voluntary movements, which is crucial for good performances among soccer players. This study explored the effect of perceptual-cognitive tasks on the inter-joint coordination of soccer players and college students during landing. The classic multiple objective tracking (MOT) task was used to simulate the perceptual-cognitive task under a sports environment. Fifteen soccer players (age: 20.1 ± 1.5 year, height: 181.4 ± 7.4 cm, weight: 75.4 ± 10.7 kg) and twenty ordinary college students (age: 20.0 ± 2.3 years, height: 177.9 ± 4.9 cm, weight: 71.6 ± 9.9 kg) were enrolled to the study. Participants in the two groups were subjected to a single task (landing task) and dual-task (MOT task and landing task). Coordination and variability indicators were recorded using a Vicon infrared motion capture system and a force measuring platform. The results showed that the mean absolute relative phase of hip and knee joint (MARPhip-knee), deviation phase of hip and knee joint (DPhip-knee), and deviation phase of knee and ankle joint (DPknee-ankle) of the two groups under the dual-task were significantly different compared with the parameters when participants were subjected to the single task. The dual-task had higher effect size on DPhip-Knee and MARPhip-knee, indicating that dual-task had a greater impact on coordination of the hip and knee joints. DPhip-knee and DPknee-ankle of ordinary students were more extensive relative to those of the soccer players, and hip joint stiffness (K hip) for ordinary students was lower than that of the soccer players under the different tasks. These findings implied that the perceptual-cognitive task markedly affected the inter-joint coordination of soccer players and college students, mainly by impairing the hip and knee coordination. Although there is less variability in lower extremity coordination patterns of soccer players compared to college students, the MOT task still affects their coordination ability.

A Preclinical Systematic Review of the Effects of Chronic Exercise on Autophagy-Related Proteins in Aging Skeletal Muscle.

Background: Exercise is one of the most effective interventions for preventing and treating skeletal muscle aging. Exercise-induced autophagy is widely acknowledged to regulate skeletal muscle mass and delay skeletal muscle aging. However, the mechanisms underlying of the effect of different exercises on autophagy in aging skeletal muscle remain unclear. Methods: A systematic review was performed following an electronic search of SCOPUS, PubMed, Web of Science, ScienceDirect, and Google Scholar and two Chinese electronic databases, CNKI and Wan Fang. All articles published in English and Chinese between January 2010 and January 2022 that quantified autophagy-related proteins in aging skeletal muscle models. Results: The primary outcome was autophagy assessment, indicated by changes in the levels of any autophagy-associated proteins. A total of fifteen studies were included in the final review. Chronic exercise modes mainly comprise aerobic exercise and resistance exercise, and the intervention types include treadmill training, voluntary wheel running, and ladder training. LC3, Atg5-Atg7/9/12, mTOR, Beclin1, Bcl-2, p62, PGC-1α, and other protein levels were quantified, and the results showed that long-term aerobic exercise and resistance exercise could increase the expression of autophagy-related proteins in aging skeletal muscle (p < 0.05). However, there was no significant difference in short term or high-intensity chronic exercise, and different types and intensities of exercise yielded different levels of significance for autophagy-related protein expression. Conclusion: Existing evidence reveals that high-intensity exercise may induce excessive autophagy, while low-intensity exercise for a short period (Intervention duration <12 weeks, frequency <3 times/week) may not reach the threshold for exercise-induced autophagy. Precise control of the exercise dose is essential in the long term to maximize the benefits of exercise. Further investigation is warranted to explore the relationship between chronic exercise and different exercise duration and types to substantiate the delaying of skeletal muscle aging by exercise.

Perceptual-Cognitive Tasks Affect Landing Performance of Soccer Players at Different Levels of Fatigue.

Background: There is a possible interaction between the underlying mechanisms of perceptual-cognitive tasks and motor control. For example, landing biomechanics changed during perceptual-cognitive tasks undertaken at different levels of fatigue of the athlete. Thus, this study explored the effect of perception-cognitive tasks interventions on male soccer players' landing mechanisms at different levels of fatigue. Methods: Perceptual-cognitive tasks during games were simulated using classic multiple object tracking (MOT) paradigms, and 15 male soccer players completed MOT tasks under nonfatigue (NF), moderate fatigue (MF), and severe fatigue (SF). Landing-associated indicators were collected and calculated using a Vicon and force measuring platform. Results: Level of fatigue and MOT task significantly affected hip and knee flexion angles, hip and knee extension moments, and vertical ground reaction force. Specifically, hip and knee flexion angles were significantly higher in MOT than non-MOT tasks at all levels of fatigue. In NF state, hip and knee extension moments were significantly smaller during MOT than non-MOT tasks. In SF state, the hip extension moment was larger during MOT than non-MOT tasks. In both MF and SF states, vertical ground reaction force was significantly higher in MOT than non-MOT tasks. Conclusion: Although soccer players landed cautiously when not fatigued, they were significantly less able to do this and handle challenging perceptual-cognitive task movements when fatigued. Thus, landing performance is affected by perceptual-cognitive task interference in fatigue conditions.

Research on Knee Joint Load and Influencing Factors of Typical Tai Chi Movements.

Background: Tai chi is recognized worldwide for its rehabilitation abilities and healthcare benefits. However, in recent years, some movements associated with tai chi have been shown to damage the lower limb joints. The purpose of this study was to investigate and compare the effects of different movements, postures, center of mass (COM) movements, and range of knee movement of tai chi exercises on knee joint load. Methods: Fourteen professional tai chi practitioners in two postures (high and low) were enrolled to perform the following four typical tai chi movements: wild horse's mane (WHM), repulse monkey (RM), wave-hand in cloud (WHIC), and grasp the bird's tail (GBT). Kinematic and kinetics data were synchronously collected using the Vicon infrared high-speed motion capture system and a three-dimensional (3D) force measurement platform. Variance analysis and partial correlation analysis were performed to investigate factors influencing peak knee joint moment and vertical ground reaction force (VGRF). Results: The results showed that the peak knee extension and abduction moment were larger in WHM and RM than those in WHIC and GBT (p < 0.05). WHM was associated with greater rotation moment than the other typical movements (p < 0.05). VGRF and joint moment among different poses were significantly different. Low-pose tai chi typical movements were associated with greater VGRF, knee joint extension and abduction, and rotation moments than high-pose movements (p < 0.05). The anteroposterior and mediolateral COM displacements were strongly and positively associated with VGRF (p < 0.001), while the mediolateral COM displacement was negatively associated with knee extension moment (p < 0.001). The knee internal-external rotation ROM and anteroposterior and mediolateral COM displacements were positively associated with knee abduction moment (p < 0.01). Conclusion: For long-term tai chi exercises, choosing a suitable posture based on an individual exercise level and reasonable control of knee ROM and COM displacement can reduce the risk of knee injury during exercise.

The effectiveness of traditional Chinese medicine-based exercise on physical performance, balance and muscle strength among older adults: a systematic review with meta-analysis.

BACKGROUND: Traditional Chinese medicine (TCM) based exercises have been widely used in the prevention and treatment of balance, cardiopulmonary, and other related diseases in older adults. However, there seems to be no consensus on the improvement and comparison of physical performance, balance, and muscle strength in the elderly population. OBJECTIVES: To systematically examine the impact of different TCM-based exercises on physical performance, balance, and muscle strength outcomes in the elderly. METHODS: We searched PubMed, EMBASE, Scopus, and Cochrane Center, CNKI and Wan Fang between their date of inception and March 2021. This meta-analysis was performed using RevMan5.3 software. Only randomized controlled trials (RCT) or controlled clinical trials (CCT) were considered in TCM-based exercises (Tai Chi, Ba Duan Jin, Qigong). The overall mean difference (MD) or standardized mean difference (SMD), and its 95% confidence interval (CI) were calculated. MAIN RESULTS: A total of 27 studies with 2580 older adults met the inclusion criteria. The pooled analysis indicated that Tai Chi could be more effective in Times up and go (TUG) (MD = - 2.62, 95% CI - 4.00 to - 1.24, P = 0.0002), 5 times sit-stand (MD = - 1.89; 95%CI - 3.38 to - 0.40; P = 0.01), and handgrip strength outcomes (SMD = 0.69; 95%CI 0.52-0.86; P < 0.0001) compared to Ba Duan Jin and Qigong. The older adults performing Qigong could have a better benefit in Single-bed balance (SLB) with eyes closed compared to Tai Chi and Ba Duan Jin (MD = 3.42; 95%CI 1.55 to 5.29; P = 0.0003). Tai Chi also had benefits in terms of balance outcomes compared to those in the control group: Berg Balance scale (BBS) (MD = 1.41; 95% CI 0.03-2.85; P = 0.05), Functional reach test (FRT) (MD = 1.57; 95%CI 1.22-1.93; P < 0.0001). The Tai Chi study meta-analysis demonstrated significant effects on lower limb strength: knee extension (SMD = 0.56; 95%CI 0.26-0.86; P = 0.0003), ankle dorsiflexion (SMD = 0.67; 95%CI 0.02-1.31; P = 0.04) compared to the controls. CONCLUSION: This systematic review reveals that TCM-based exercises can effectively improve physical performance outcomes, balance outcomes, and muscle strength in the elderly population. While there is limited evidence on the efficacy of other TCM-based lifestyle interventions, more high-quality clinical trials on this topic are warranted.

The effects of visual cognitive tasks on landing stability and lower extremity injury risk in high-level soccer players.

BACKGROUND: Visual cognition plays a pivotal role in sports. It is widely recognized that there is an intriguing coupling that they could affect each other through interaction between visual cognition and motor control, but few studies linked the effects of visual cognitive tasks on landing stability to postural control and injury risk. RESEARCH QUESTION: Whether visual cognitive tasks affect the landing stability and lower limb injury risk of professional soccer players? METHODS: The current study used a three-dimensional Multiple Object Tracking (MOT) task to simulate visual cognitive difficulties experienced in soccer matches. Fifteen male high-level soccer athletes (height: 181.43 ± 7.36 cm, weight: 75.37 ± 10.67 kg, training years: 10.07 ± 2.98 yr) from our school team were recruited and completed a landing action from a high platform with and without MOT tasks. Vicon infrared high-speed motion capture system and three-dimensional force measuring platform were used to collect various outcomes simultaneously. RESULTS: The Time to Stabilization (TTS) during landing was significantly prolonged, while the Medial-Lateral Stability Index (MLSI), Anterior-Posterior Stability (APSI), Dynamic Postural Index Stability Index (DPSI), the trajectory lengths, and envelope area of COP during landing were also increased during MOT dual-task. DISCUSSION: The decline of these indicators reflected the deterioration in postural stability and greater requirements for maintaining balance which could increase the risk of injury in soccer athletes. We advocate that adequate visual attention and visual information processing might play critical roles in maintaining dynamic balance through the supraspinal neural network.

Exercise-Induced Benefits for Alzheimer's Disease by Stimulating Mitophagy and Improving Mitochondrial Function.

Neurons are highly specialized post-mitotic cells that are inherently dependent on mitochondria due to their higher bioenergetic demand. Mitochondrial dysfunction is closely associated with a variety of aging-related neurological disorders, such as Alzheimer's disease (AD), and the accumulation of dysfunctional and superfluous mitochondria has been reported as an early stage that significantly facilitates the progression of AD. Mitochondrial damage causes bioenergetic deficiency, intracellular calcium imbalance and oxidative stress, thereby aggravating ß-amyloid (Aß) accumulation and Tau hyperphosphorylation, and further leading to cognitive decline and memory loss. Although there is an intricate parallel relationship between mitochondrial dysfunction and AD, their triggering factors, such as Aß aggregation and hyperphosphorylated Tau protein and action time, are still unclear. Moreover, many studies have confirmed abnormal mitochondrial biosynthesis, dynamics and functions will present once the mitochondrial quality control is impaired, thus leading to aggravated AD pathological changes. Accumulating evidence shows beneficial effects of appropriate exercise on improved mitophagy and mitochondrial function to promote mitochondrial plasticity, reduce oxidative stress, enhance cognitive capacity and reduce the risks of cognitive impairment and dementia in later life. Therefore, stimulating mitophagy and optimizing mitochondrial function through exercise may forestall the neurodegenerative process of AD.

Effects of Attentional Control on Gait and Inter-Joint Coordination During Dual-Task Walking.

In the process of walking, attentional resources are flexibly allocated to deal with varying environmental constraints correlated with attentional control (AC). A dual-task paradigm was used to investigate the effects of AC on gait and inter-joint coordination. Fifty students volunteered to participate in this study. Based on the reaction time (RT) in the Stroop task, the top 15 participants were assigned to the High Attentional Control (HAC) group, while the last 15 participants were assigned to the Low Attentional Control (LAC) group. The participants in the two groups were randomly asked to perform three tasks: (i) single 2-back working memory task (ST 2-back); (ii) single walking task (ST walking); and (iii) dual task (DT). Cognitive outcomes and gait spatiotemporal parameters were measured. Continuous relative phase (CRP), derived from phase angles of two adjacent joints, was used to assess inter-joint coordination. The LAC group exhibited significant task effects regarding RT, correct rate (CR), step width, gait cycle, step time, forefoot contact times, heel-forefoot times, hip-knee mean absolute relative phase (MARP), and deviation phase (DP) in the stance and swing phases (p < 0.05). In the HAC group, significant task effects were only detected in RT and foot progression angle of the left foot (p < 0.05). Under the three task conditions, the LAC group exhibited a higher CR in ST, longer heel contact times, and longer heel-forefoot times when compared with the LAC group (p < 0.05). Compared with the LAC group, the HAC group exhibited significantly smaller (closer to zero) MARP and weaker hip-knee DP values in the swing phase across all gait conditions (p < 0.05). In the stance phase, the HAC group had smaller MARP (closer to zero) values when compared with the LAC group (p < 0.05). In conclusion, the ability to maintain gait control and modulate inter-joint coordination patterns in young adults is affected by the level of attentional control in accommodating gait disturbances. AC is correlated with the performance of motor control, which theoretically supports the competitive selection of athletes and fall prevention strategies for a specific population.

Lifelong Aerobic Exercise Alleviates Sarcopenia by Activating Autophagy and Inhibiting Protein Degradation via the AMPK/PGC-1α Signaling Pathway.

Sarcopenia is an aging-induced syndrome characterized by a progressive reduction of skeletal muscle mass and strength. Increasing evidence has attested that appropriate and scientific exercise could induce autophagy or optimize the functional status of autophagy, which plays a critical role in senescent muscular dystrophy. As a publicly recognized strategy for extending lifespan and improving the health of the elderly, the underlying mechanisms of lifelong regular aerobic exercise for the prevention of sarcopenia have not been fully elucidated. To explore the role of lifelong aerobic exercise in the beneficial regulation of autophagic signaling pathways in senescent skeletal muscle, the natural aging mice were used as the sarcopenia model and subjected to lifelong treadmill running to evaluate corresponding parameters related to skeletal muscle atrophy and autophagic signaling pathways. Compared with the young control mice, the aged mice showed a significant reduction in skeletal muscle mass, gastrocnemius muscle weight/body weight (GMW/BW) ratio, and cross-sectional areas (CSA) of skeletal muscle fibers (p < 0.01). In contrast, lifelong aerobic exercise effectively rescued these reduced biomarkers associated with muscle atrophy. Moreover, as shown in the activated AMPK/PGC-1α signaling pathway, lifelong aerobic exercise successfully prevented the aging-induced impairment of the ubiquitin-proteasome system (UPS), excessive apoptosis, defective autophagy, and mitochondrial dysfunction. The exercise-induced autophagy suppressed the key regulatory components of the UPS, inhibited excessive apoptosis, and optimized mitochondrial quality control, thereby preventing and delaying aging-induced skeletal muscle atrophy.

[Regulatory roles of microRNAs in sarcopenia and exercise intervention].

Sarcopenia is an age-related degenerative disease, in which skeletal muscle mass and function are reduced during aging process. Physical intervention is one of the most effective strategies available for the treatment of sarcopenia. Studies have shown that microRNAs (miRNAs), as important regulators of gene expression, play an important role in maintaining the homeostasis of senescent skeletal muscle cells by regulating skeletal muscle cell development (proliferation and differentiation), mitochondrial biogenesis, protein synthesis and degradation, inflammatory response and metabolic pathways. Furthermore, exercise can combat age-related changes in muscle mass, composition and function, which is associated with the changes in the expression and biological functions of miRNAs in skeletal muscle cells. In this article, we systematically review the regulatory mechanisms of miRNAs in skeletal muscle aging, and discuss the regulatory roles and molecular targets of exercise-mediated miRNAs in muscular atrophy during aging process, which may provide novel insights into the prevention and treatment of sarcopenia.

Tai Chi Chuan for Subjective Sleep Quality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: This review aims to investigate the efficacy of Tai Chi Chuan on subjective sleep quality among adults. METHODS: We systematically searched PubMed, Embase, Cochrane Library, Scopus, CNKI (China National Knowledge Infrastructure), and the Wanfang Database from their inception to August 2019 and identified 25 eligible studies that were published in both English and Chinese. RESULTS: 24 out of 25 studies were identified to be high-quality studies according to the PEDro scale. The pooled results confirmed that Tai Chi Chuan elicited moderate improvements in subjective sleep quality (SMD = -0.512, 95% CI [-0.767, -0.257], P < 0.001). Notably, Tai Chi Chuan yielded more significant effects on sleep quality among the healthy population (SMD = -0.684, 95% CI [-1.056, -0.311], P < 0.001) than the clinical population (SMD = -0.395, 95% CI [-0.742, -0.047], P=0.026) and more benefits among the Asian population (SMD = -0.977, 95% CI [-1.446, -0.508], P < 0.001) than the American population (SMD = -0.259, 95% CI [-0.624, 0.105], P=0.164). After controlling the methodological quality of studies, it has been noted that Asians could achieve the most significant sleep-promoting benefit when Tai Chi Chuan was practiced between 60 and 90 min per session. CONCLUSIONS: Available data implied that subjective sleep quality was improved via Tai Chi training, but more thorough studies must be executed to ascertain our findings and optimize Tai Chi practices accordingly toward various populations.

Prevalence of osteoporosis in patients with type 2 diabetes mellitus in the Chinese mainland: A protocol of systematic review and meta-analysis.

BACKGROUND: Osteoporosis, as a metabolic disease, has become one of the most rapidly growing complications of diabetes mellitus. Previously, we conducted a systematic review to report the estimated prevalence of osteoporosis among patients with type 2 diabetes mellitus (T2DM) from 2001 to 2016. However, some newer studies have been reported, and more potential risk factors for osteoporosis remain controversial and vague. Therefore, the presented review is tailored to synthesize available evidence regarding the pooled prevalence and related risk factors of osteoporosis among T2DM patients in mainland China. METHODS: Both cross-sectional study and cohort study reporting on the prevalence of osteoporosis among patients with T2DM in mainland China, published in Chinese or English, will be considered for inclusion. Records from 4 English databases and 2 Chinese databases will be retrieved from their inceptions to March 2020. The process of study selection, data extraction, and methodologic quality assessment will be independently executed by 2 reviewers. The pooled prevalence of osteoporosis and the prevalence in the exposed and unexposed groups for each potential risk factor will be calculated by the software Stata version 12.0. RESULTS: The current systematic review and meta-analysis will provide more precise prevalence rates and associated risk factors of osteoporosis among people with T2DM in mainland China. CONCLUSION: The study will offer high-quality and explicit evidence for assisting diabetic patients to prevent osteoporosis in mainland China. OSF REGISTRATION: DOI 10.17605/OSF.IO/5ZKJ6.

Tai Chi exercise for sleep problems in older adults: A protocol of systematic review and meta-analysis.

BACKGROUND: Sleep plays a crucial role in the general health of the human body. However, sleep problems become increasingly severe with age, and its incidence is on the rise. Notably, Tai Chi exercise may be an efficacious means to ameliorate sleep problems among older adults. This is especially since Tai Chi has been widely used to manage sleep problems in China for many years, but there is limited evidence regarding its effectiveness. We will conduct this study aiming to investigate the efficacy of Tai Chi as a complementary and alternative therapy for sleep problems in older adults. METHODS: We will systematically search Scopus, Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang database from their inceptions to August 2019. Only randomized controlled trials of Tai Chi for sleep problems among older adults will be considered for inclusion and the Pittsburgh sleep quality index will be the primary outcome measurement. Moreover, study selection, data extraction, and the evaluation of the methodological quality of trials will each be independently completed by at least 2 researchers. We will employ the software Stata version 12.0 to implement the statistical analysis. RESULTS: The current systematic review and meta-analysis will provide synthesized results of the effectiveness and safety of Tai Chi exercise for sleep problems among older adults. CONCLUSION: This systematic review and meta-analysis will provide high-quality evidence on the effectiveness and safety of Tai Chi exercise for sleep problems in older adults. REGISTRATION: PEROSPERO CRD42019129782.

Prevalence of Osteoporosis in Patients with Type 2 Diabetes Mellitus in the Chinese Mainland: A Systematic Review and Meta-Analysis.

BACKGROUND: Some studies have investigated the prevalence of osteoporosis in patients with type 2 diabetes mellitus (T2DM) in China. However, the results were inconsistent. This review was performed to estimate the prevalence of osteoporosis in T2DM patients in the Chinese mainland and to characterize its epidemiology. METHODS: A literature search was conducted utilizing PubMed, Scopus, Web of Science, Cochrane Library, CNKI, Wanfang database from their inception through June 2017. A total of 54 studies evaluating the prevalence rate of osteoporosis in T2DM patients were collected. Prevalence estimates from the individual study were combined utilizing random-effect models in Stata 12.0. RESULTS: The pooled prevalence rate of osteoporosis in T2DM patients was 37.8%. Notably, osteoporosis was more frequent in females than in males (44.8% vs. 37.0%) and was increased with ageing (over 60: 40.1% vs. below 60: 26.5%). Osteoporosis prevalence was higher in less developed areas than in developed areas (41.0% vs. 32.7%) and almost the same between the southern and northern regions (37.6% vs. 38.2%). The prevalence rate between 2010 and 2017 decreased compared with the period between 2001 and 2009 (42.3% vs. 35.6%). Additionally, the meta-regression suggested that gender and age could significantly influence the estimation of prevalence rates respectively (P = 0.011, P = 0.022). CONCLUSION: Osteoporosis affects more than one-third of T2DM patients in China mainland. Females and older adults more likely require clinical prevention due to a higher prevalence. Further studies are needed to be conducted to incorporate and verify previous results.