Fisiología del ejercicio y pedagogía vocal: reflexiones calisténicas

Introducción: El método de calistenia gimnástica se configura como una modalidad de ejercicios específicos que involucra la adopción de posturas artificiales a través de movimientos particulares. Estos movimientos están diseñados para producir efectos higiénicos y educativos claramente definidos. Esta modalidad de ejercicio guarda notables similitudes con el modus operandi de los vocalise en la pedagogía vocal. Objetivo: El objetivo de este trabajo es investigar las relaciones potenciales entre los principios técnico-científicos que guían el sistema de calistenia gimnástica y los principios técnico-pedagógicos que rigen los ejercicios vocales realizados por cantantes durante su proceso de enseñanza-aprendizaje. Asimismo, se busca explorar las conexiones entre los objetivos y propósitos del sistema de calistenia gimnástica y los de los ejercicios vocales en dicho proceso. Método: Para abordar este objetivo, se llevó a cabo una investigación bibliográfica que implicó el análisis detallado de fuentes pertinentes. Se examinaron publicaciones académicas y literatura especializada relacionada con la calistenia gimnástica y la pedagogía vocal. Reflexión: La calistenia gimnástica y los ejercicios vocales comparten una estructura fundamental de ejercicios específicos que implican posturas artificiales y movimientos específicos. Ambos buscan un refinamiento en la higienización y educación, permitiendo a los individuos, ya sea en el ámbito físico o vocal, desarrollarse de manera adecuada y saludable. Conclusión: A partir de la investigación bibliográfica, se concluye que los ejercicios vocales en el proceso de enseñanza-aprendizaje de los cantantes pueden considerarse una suerte de calistenia vocal. Esta conclusión se fundamenta en las relaciones intrínsecas observadas entre los principios y objetivos del sistema de calistenia gimnástica y el modus operandi de los ejercicios vocales. Esta reflexión aporta perspectivas valiosas a la pedagogía vocal, con el fin de ofrecer una comprensión más específicamente fisiológica y biomecánica de los ejercicios vocales, orientando mejor la aplicación de las vocalizaciones en el proceso de educación y entrenamiento vocal.

Introduction: The gymnastic calisthenics method is configured as a specific form of exercises involving the adoption of artificial postures through specific movements. These movements are designed to produce clearly defined hygienic and educational effects. This mode of exercise bears notable similarities to the modus operandi of vocalises in vocal pedagogy. Objective: The objective of this work is to investigate the potential relationships between the technical-scientific principles that guide the gymnastic calisthenics system and the technical-pedagogical principles governing vocal exercises practiced by singers during their teaching and learning process. Additionally, it aims to explore the connections between the objectives and purposes of the gymnastic calisthenics system and those of vocal exercises in this process. Method: To address this objective, a bibliographic research was conducted, involving a detailed analysis of relevant sources. Academic publications and specialized literature related to gymnastic calisthenics and vocal pedagogy were examined. Reflection: Gymnastic calisthenics and vocal exercises share a fundamental structure of specific exercises involving artificial postures and specific movements. Both seek refinement in hygiene and education, enabling individuals, either in the physical or vocal realm, to develop appropriately and healthily. Conclusion: Based on the bibliographic research, it is concluded that vocal exercises in the teaching and learning process of singers can be considered a form of vocal calisthenics. This conclusion is based on the intrinsic relationships observed between the principles and objectives of the gymnastic calisthenics system and the modus operandi of vocal exercises. This reflection provides valuable insights into vocal pedagogy, aiming to offer a more specifically physiological and biomechanical understanding of vocal exercises. This effectively guides the application of vocalizations in the process of vocal education and training.

Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Knee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA. METHODOLOGY: A randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee's functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests-the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05. RESULT: Of the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM - 4.15; TSE - 4.42; KSE - 3.78), during stair ascent (MWM - 3.89; TSE - 4.88; KSE - 3.56) and descent (MWM - 3.78; TSE - 4.05; KSE - 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM - 7.05; TSE - 7.16; KSE - 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05). CONCLUSION: In this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA. TRIAL NO: ClinicalTrials.gov = NCT04099017 23/9/2019.

The effects of kettlebell training versus resistance training using the own body mass on physical fitness and physiological adaptations in obese adults: a randomized controlled trial.

AIM OF STUDY: This study aimed to explore the effects of different types of resistance training using kettlebells versus the own body mass, in comparison to a passive control, on key physical fitness and physiological parameters in young, obese adults. METHODS: Data from 60 sedentary, obese male college students, aged 17-26, were used for final analyses. Participants were randomly assigned to one of three groups: a control group (CG, n = 20, no training), a kettlebell resistance training group (KRTG, n = 20), or a bodyweight resistance training group (BWRTG, n = 20). Selected measures of physical fitness were tested using the 12-minutes run test, the push-up test, the sit-up test, and the sit-and-reach test. Physiological measures included vital capacity, resting and maximum heart rate (HRmax), mean arterial blood pressure, breath holding time, and respiratory rate. Biochemical variables were measured in the morning, in a fasted state, and comprised high and low density lipoprotein, total cholesterol, and triglycerides. The 12-weeks progressive KRTG and BWRTG were specifically tailored using sets, repetitions, and intensity levels. RESULTS: Notable findings include significant body fat reductions in BWRTG (p < 0.001; d = 1.53) and KRTG (p < 0.001; d = 1.43), and a substantial increase in VO2max for BWRTG (p < 0.001; d = 1.32) and KRTG (p < 0.001; d = 1.34) compared to CG. KRTG also showed significant improvements in vital capacity (p < 0.001; d = 1.61) and reductions in resting heart rate (p = 0.024, d = 1.05) and respiratory rate (p = 0.001, d = 1.55), with BWRTG showing similar trends (resting heart rate: p = 0.041, d = 1.35; respiratory rate: p = 0.001, d = 1.98). Both intervention groups significantly improved breath holding time (KRTG: p = 0.001, d = 1.58; BWRTG: p < 0.001, d = 1.98) and reduced total cholesterol and low-density lipoprotein levels compared to CG. CONCLUSIONS: This study demonstrates that both KRTG and BWRTG are effective in improving body composition and selected fitness and physiological measures. Thus, resistance training using kettlebells or bodyweight training are recommended if the goal is to improve body composition and fitness in obese male adults. TRIAL REGISTRATION: OSF, September, 28th 2023. https://doi.org/10.17605/OSF.IO/Z6Y9Gosf.io/2mb98.

The effect of self-designed metabolic equivalent exercises on cancer-related fatigue in patients with gastric cancer: A randomized controlled trial.

AIMS: To investigate the effect of Self-designed Metabolic Equivalent Exercises (SMEE) on cancer-related fatigue in patients with gastric cancer. METHODS: 130 patients with gastric cancer admitted to Department of Oncology of a tertiary hospital in Shanghai were enrolled and assessed for eligibility. After excluding 1 patient who declined to participate, 129 eligible patients were randomly assigned into SMEE (n = 65) and control (n = 64) groups. The Revised Piper Fatigue Scale (RPFS) and EORTC QLQ-C30 Quality of Life Scale were used to measure cancer-caused fatigue and quality of life, respectively, in both groups at the first admission and after 3 months. RESULTS: After excluding patients who did not receive allocated intervention due to medical (n = 3) and personal (n = 2) reasons, those who were lost to follow-up (n = 3), and those who had discontinued intervention (n = 2), 119 patients (64 in the SMEE group and 55 in the control group) were included for analysis. There were no statistically significant differences in the RPFS or QLQ-C30 score between the two groups at baseline. After 3 months, the total RPFS score of the SMEE group was significantly lower than that of the control group (2.86 ± 1.75 vs. 4.65 ± 1.29, p = 0.009), with significant improvements in affective meaning (0.83 ± 0.92 vs. 1.13 ± 0.77, p = 0.044) and sensory (0.70 ± 0.71 vs. 1.00 ± 0.54, p < 0.001) subscales; in the SMEE group, QLQ-C30 scores in somatic (2.00 ± 0.27 vs. 1.31 ± 0.26, p < 0.001), emotional (2.67 ± 0.58 vs. 2.07 ± 0.48, p < 0.001), and social (3.23 ± 0.58 vs. 1.64 ± 0.51, p < 0.001) functioning were significantly higher than those in the control group, with significant improvements in fatigue (p < 0.001), nausea/vomiting (p = 0.014), shortness of breath (p < 0.001), constipation (p < 0.001), and diarrhea (p = 0.001) dimensions. CONCLUSION: The self-programmed metabolic equivalent manipulation as an exercise intervention could effectively reduce the degree of cancer-caused fatigue and improve quality of life in patients with gastric cancer.

The Impact of Baseline Pain Intensity on the Effectiveness of Whole-Body Electromyostimulation (WB-EMS) for Nonspecific Chronic Back Pain.

INTRODUCTION: Recent clinical studies confirmed that whole-body electromyostimulation (WB-EMS) training is a safe and time-efficient therapeutic method for patients with nonspecific chronic back pain (NSCBP). However, significant variations in initial pain intensity among subjects in these studies have been observed. This study aims to determine if patients with differing initial pain intensities experience varying degrees of benefit from WB-EMS and to assess the overall correlation between initial pain levels and pain reduction. METHODS: Pain intensity datasets from two studies were combined. The pooled data included 121 NSCBP patients (38 males and 83 females) with an average age of 55.1 years (±11.8 years). Data was categorized by baseline pain intensity on the numeric rating scale (NRS) into seven groups: 0 to 2, >2 to 3, >3 to 4, >4 to 5, >5 to 6, >6 to 7, and >7. Both absolute and relative changes were analyzed. Additionally, a Spearman rho correlation test was performed on the entire dataset to evaluate the relationship between initial pain level and pain reduction. RESULTS: Significant improvements were noted across all NRS11 categories, with strong effect sizes (p) in all classes above 2, ranging from 0.56 to 0.90. The >7 category exhibited the highest rate of clinically significant changes (80%) and an average improvement of 3.72 points. The overall group from >1 to 10 showed an average improvement of 1.33 points, with 37% of the participants experiencing clinically significant improvements. The Spearman rho correlation test revealed a moderate positive relationship between initial pain level and pain reduction (r_s = 0.531, p < 0.001), indicating that, generally, higher initial pain levels are associated with greater pain reduction. CONCLUSION: The findings support the hypothesis that NSCBP patients with higher baseline NRS values benefit more substantially from WB-EMS. Those with NRS values above 7 show the greatest improvement and highest rate of clinical significance. The overall positive correlation between initial pain intensity and pain reduction further underscores the efficacy of WB-EMS in managing NSCBP across different pain intensities.

Sleep Duration Irregularity is Associated with Elevated Blood Pressure During Submaximal Exercise in Young Adults.

Purpose: Irregularity in nightly sleep duration is reported to associate with elevated blood pressure (BP), but it is unclear whether this association can be observed with BP measured during exercise after controlling for factors known to influence the exercise pressor reflex. Methods: Twenty-nine young adults (22±4y; 19 men, 10 women) performed cycling exercise until volitional fatigue to assess peak oxygen uptake (VO2). Actigraphy was used to monitor sleep duration and daily physical activity for seven consecutive days after which participants completed two bouts of moderate-intensity cycling while BP and VO2 were measured using a Tango+ device and indirect calorimetry, respectively. Systolic BP was averaged from the two bouts of exercise and expressed as a change from seated rest (∆SBP). Sleep duration regularity was calculated as standard deviation (SD) and coefficient of variation (CV). Results: Systolic BP at seated rest, during exercise, and ∆SBP was 113±13, 152±21, and 38±13 mmHg, respectively. Sleep duration SD (range 10-146 min) and sleep duration CV (range 2-54%) when excluding weekend nights were significantly correlated with ∆SBP (r = 0.58 and r = 0.62, respectively; both p<0.01) after adjusting for age, sex, body mass index, peak VO2, physical activity, resting systolic BP, chronotype, and the VO2 response to exercise. Sleep duration regularity analyzed with weekend nights included (across all seven days) was also significantly correlated with ∆SBP (p≤0.01), but had weaker correlation coefficients. Conclusion: These results indicate that sleep regularity, especially when excluding weekend nights, is associated with the rise in systolic BP during moderate-intensity exercise in young adults. Sleep duration regularity may be a useful tool to capture the impact of intermittent nights of insufficient sleep on BP dysregulation.

Effects of weight loss on QTc in people with obesity: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Overweight and obesity have been found to exhibit a statistically significant increase in corrected QT interval (QTc), a major contributing factor to sudden death. However, the influence of widely used weight loss strategies including diet, exercise, anti-obesity drugs, and bariatric surgery on QTc remains inconsistent. Therefore, the present systematic review and meta-analysis aim to quantitatively analyse and evaluate the effect of weight loss on QTc in obese patients after diet control with exercise intervention and anti-obesity drugs, as well as bariatric surgery. METHODS: Twenty randomised controlled trials (RCT) and observational studies were included in the meta-analysis on the effects of weight loss on QTc. The fixed-effects model was employed in the RCTs, and the random-effects model was employed due to the presence of statistical heterogeneity among observational studies. Subgroup analysis was conducted to understand the differences in distinct weight loss methods and follow-up time. RESULTS: Overall, the QTc of people with obesity after weight loss was shorter than that before (mean difference (MD) = 21.97 ms, 95% confidence interval (CI) = 12.42, 31.52, p < .0001). Subgroup analysis restricted to seven included studies whose intervention was diet control with exercise showed a decrease of QTc with statistical significance (MD = 9.35 ms, 95%CI = 2.56, 37.54, p = .007). In the remaining 11 studies, bariatric surgery was the weight loss method. The results also showed a shortening of QTc after surgery, and the difference was statistically significant (MD = 29.04 ms, 95%CI = -16.46, 41.62, p < .00001). A statistically significant difference in QTc shortening at 6 months compared to pre-operation values was further observed (MD = -31.01 ms, 95%CI = -2.89, -59.12, p = .03). The shortening of QTc at 12 months of follow-up was also significantly different from that before surgery (MD = 36.47 ms, 95%CI = 14.17, 58.78, p < .00001). Moreover, the differences became more pronounced as the follow-up time extended. CONCLUSIONS: We demonstrate that weight loss links to a shortened QTc, without considering the means of weight loss. Bariatric surgery has been found to result in a greater reduction in QTc.

Exercise Therapy for Peripheral Artery Disease.

PURPOSE OF REVIEW: To summarize evidence regarding exercise treatments for lower extremity peripheral artery disease (PAD). RECENT FINDINGS: Supervised walking exercise is recommended by practice guidelines for PAD. Supervised treadmill exercise improves treadmill walking distance by approximately 180 m and 6-min walk distance by 30-35 m, compared to control. The Centers for Medicaid and Medicare Services covers 12 weeks of supervised exercise, but most people with PAD do not participate. Home-based walking exercise may be more convenient and accessible than supervised exercise. In randomized clinical trials, home-based walking exercise interventions incorporating behavioral methods, such as accountability to a coach, goal-setting, and self-monitoring, improved 6-min walk distance by 40-54 m, compared to control. Arm and leg ergometry also improved walking endurance for people with PAD, but efficacy compared to walking exercise remains unclear. Walking exercise is first-line therapy for PAD-related walking impairment and can be effective in either a supervised or a structured home-based setting.

Experimental validation of an advanced impedance pneumography for monitoring ventilation volume during programmed cycling exercise.

OBJECTIVE: Impedance pneumography (IP) has provided static assessments of subjects' breathing patterns in previous studies. Evaluating the feasibility and limitation of ambulatory IP based respiratory monitoring needs further investigation on clinically relevant exercise designs. The aim of this study was to evaluate the capacity of an advanced IP in ambulatory respiratory monitoring, and its predictive value in independent ventilatory capacity quantification during cardiopulmonary exercise testing (CPET). Approach: 35 volunteers were examined with the same calibration methodology and CPET exercise protocol comprising phases of rest, unloaded, incremental load, maximum load, recovery and further-recovery. In 3 or 4 deep breaths of calibration stage, thoracic impedance and criterion spirometric volume were simultaneously recorded to produce phase-specific prior calibration coefficients (CCs). The IP measurement during exercise protocol was converted by prior CCs to volume estimation curve and thus calculate minute ventilation (VE) independent from the spirometry approach. Main results: Across all measurements, the relative error of IP-derived VE (VER) and flowrate-derived VE (VEf) was less than 13.8%. In Bland-Altman plots, the aggregate VE estimation bias was statistically insignificant for all 3 phases with pedaling exercise and the discrepancy between VERand VEffell within the 95% limits of agreement (95% LoA) for 34 or all subjects in each of all CPET phases. Significance: This work reinforces the independent use of IP as an accurate and robust alternative to flowmeter for applications in cycle ergometry CPET, which could significantly encourage the clinical use of IP and improve the convenience and comfort of CPET.

Associations of accelerometer-estimated free-living daily activity impact intensities with 10-year probability of osteoporotic fractures in adults.

PURPOSE: Accelerometers are used to objectively measure physical activity; however, the relationship between accelerometer-based activity parameters and bone health is not well understood. This study examines the association between accelerometer-estimated daily activity impact intensities and future risk estimates of major osteoporotic fractures in a large population-based cohort. METHODS: Participants were 3165 adults 46 years of age from the Northern Finland Birth Cohort 1966 who agreed to wear a hip-worn accelerometer during all waking hours for 14 consecutive days. Raw accelerometer data were converted to resultant acceleration. Impact magnitude peaks were extracted and divided into 32 intensity bands, and the osteogenic index (OI) was calculated to assess the osteogenic effectiveness of various activities. Additionally, the impact peaks were categorized into three separate impact intensity categories (low, medium, and high). The 10-year probabilities of hip and all major osteoporotic fractures were estimated with FRAX-tool using clinical and questionnaire data in combination with body mass index collected at the age of 46 years. The associations of daily activity impact intensities with 10-year fracture probabilities were examined using three statistical approaches: multiple linear regression, partial correlation, and partial least squares (PLS) regression. RESULTS: On average, participants' various levels of impact were 8331 (SD = 3478) low; 2032 (1248) medium; and 1295 (1468) high impacts per day. All three statistical approaches found a significant positive association between the daily number of low-intensity impacts and 10-year probability of hip and all major osteoporotic fractures. In contrast, increased number of moderate to very high daily activity impacts was associated with a lower probability of future osteoporotic fractures. A higher OI was also associated with a lower probability of future major osteoporotic fractures. CONCLUSION: Low-intensity impacts might not be sufficient for reducing fracture risk in middle-aged adults, while high-intensity impacts could be beneficial for preventing major osteoporotic fractures.

Body weight change during a smoking cessation intervention for individuals with overweight or obesity.

INTRODUCTION: A more comprehensive understanding of the factors regarding weight control in individuals with overweight or obesity after quitting smoking is needed. The study aimed to analyze the changes of in-treatment variables during a smoking cessation intervention and examine their impact on weight. METHODS: A total of 120 individuals who smoke with overweight or obesity (MBMI = 31.75 ± 4.31; 54.16 % female) participated in a cognitive-behavioral therapy for smoking cessation and weight control or the same treatment plus contingency management. Weight, smoking variables (cotinine and continuous abstinence), eating behaviors (appetite, grazing), exercise, and sleep were assessed weekly throughout the treatment. RESULTS: More participants gained weight over time with reduced nicotine use or abstinence. There was a tendency during treatment to increase appetite and exercise time, while grazing episodes and sleeping hours remained stable. Higher baseline weight (p < .001), greater cotinine reduction (p = .021) and time (p = .009) were associated with greater weight gain, while more hours of exercise (p = .003), no appetite changes (p = .003) and diminished appetite (p < .001) were associated with less gain over the treatment. Both treatment conditions showed similar results in all in-treatment variables. DISCUSSION: Individuals with overweight and obesity with higher baseline weight and higher baseline cotinine levels during smoking cessation interventions may require special attention to improve weight outcomes. Exercise and appetite regulation may be useful for mitigating weight gain in smoking cessation interventions for individuals with overweight or obesity.

Physical activity trajectories and all-cause mortality in type 1 diabetes: A nationwide longitudinal study.

AIMS: To identify physical activity trajectories, explore the factors associated with them and assess their relationship with all-cause mortality. METHODS: This was a population-based longitudinal cohort study, with data from all specialist care units for type 1 diabetes in Sweden. A total of 48.921 adult patients were included, each with at least 3 registrations of physical activity, and a maximum follow-up of 14 years. The main outcomes were the longitudinal physical activity trajectories and all-cause mortality. RESULTS: Of 48.921 patients, 55.9% were males and mean (SD) age was 39.7(16.7). Four physical activity trajectories were identified: Steady Low (10.8%), Decreaser (12.7%), Increaser (20.7%) and Steady High (55.8%). Female sex, higher education, higher income, normal BMI, fewer comorbidities and foot free from diabetic disease were significantly associated with sustained high physical activity. Compared to the steady low group, the decreaser, increaser, and steady high physical activity groups exhibited lower adjusted risk of all-cause mortality (53-73% reduction). CONCLUSIONS: Consistently low physical activity is associated with higher all-cause mortality. This study underscores the importance of identifying patients at risk of low physical activity and tailoring personalized approaches to promote sustained physical activity in type 1 diabetes, ultimately improving outcomes.

Effects of Detraining on Physical Capacity and Its Relationship With Depressive Symptoms, Quality of Life and Sedentary Behavior in Community-Dwelling Older Adults: A Longitudinal Study.

BACKGROUND: Detraining is the partial or complete loss of physical training-induced adaptations as a result of exercise interruption or reduction. The COVID-19 pandemic led to the discontinuation of many older adult exercise programs and led to increased depressive symptoms (DS), increased sedentary behavior (SB), and decreased quality of life (QoL). OBJECTIVE: To evaluate the effects of detraining, in the pandemic, on physical capacity and its relationship with DS, QoL, and SB of community-dwelling older adults. METHODS: The physical capacity (static balance, dynamic balance, and lower limb and handgrip strength) of 35 participants was assessed prepandemic and after 18 and 24 months of the pandemic. DS, QoL, and SB were evaluated only at 18-month period. The analysis of variance for repeated measures or the Friedman and Pearson or Spearman tests were used for statistical analysis. RESULTS: There was a decline in dynamic balance (p < .001) and strength in the lower limbs (p < .001) in the first 18 months, as well as maintenance in the following 6 months. The reduction in dynamic balance during the 18 months of the pandemic was associated with greater DS (p = .015; r = .414) and worse QoL (p = .024; r = -.381) in this period. More time spent on SB (p = .024; r = .386) in the 18th month was associated with worse dynamic balance in the following 6 months. CONCLUSION: Detraining in the pandemic setting led to long-lasting harmful effects, which can last for 2 years, on the physical capacity of community-dwelling older adults. IMPLICATION: Our findings highlight how periods of detraining can interfere in physical and mental health of older adults.

Cognitive-Behavioral Therapy Enhancement Strategies.

We review the literature on various strategies to augment cognitive-behavioral therapy (CBT). Although traditional pharmacotherapy has only a small additive effect, research demonstrates that it is possible to select interventions that potentiate known mechanisms of CBT. D-cycloserine appears to potentiate activity at the N-methyl D-ethyl aspartate receptor and thereby facilitates fear extinction. Exercise may increase neural plasticity and thereby increase the efficacy of CBT for depression and anxiety. Noninvasive brain stimulation is thought to target the specific cortical regions needed for CBT response, but results have been mixed. Several other compounds appear promising but await controlled research before their efficacy as an augmentation strategy can be determined.

Health and Community Care workers' Knowledge and Perceptions of Social Prescribing in Singapore.

Objectives: This study aimed to survey knowledge and perceptions of social prescribing (SP) amongst health and community care workers. Study design: Cross sectional online survey conducted in November 2023. Methods: The survey on basic demographics, awareness, knowledge, and practices of SP was completed by 123 health and community care workers. Results: The mean age of respondents was 39.0 years. Nearly two-thirds had heard of SP. A lower proportion of acute hospital doctors (55.6%) and nurses (56.8%) had heard of SP compared with primary and subacute care doctors (75.0%). The majority agreed that SP is beneficial for patients' mental health and reducing healthcare utilisation. Primary care physicians, community nurses and active ageing centres were the top three professionals selected as most responsible for SP by survey respondents. The most commonly cited barriers to SP were seniors' reluctance (63.4%), lacking knowledge on how to refer (59.3%), lack of time (44.7%) and cost to seniors (44.7%). Conclusion: Overall, health and community care workers demonstrated positive attitudes toward SP and were keen to refer patients for SP. However, additional efforts are needed to improve knowledge about how to refer for and provide training on SP.

Adverse Effect of Bundle Branch Block on Exercise Performance in Patients with Fontan Physiology: From the Pediatric Heart Network Fontan Public Data Set.

Patients with Fontan physiology have reduced exercise performance compared to their peers as well as a higher incidence of bundle branch block (BBB). This study aims to investigate the association between BBB and exercise performance in the Fontan population through a retrospective review of the Pediatric Heart Network Fontan study public use dataset. "Low Performers" were defined as ≤ 25th percentile (for Fontan patients) for each exercise parameter at anaerobic threshold (AT) for gender and age and "Normal Performers" were all other patients. A total of 303 patients with Fontan physiology who underwent exercise testing reached AT and had complete data for BBB. BBB occurred more frequently in Low Performers for VO2 [OR (95% CI): 2.6 (1.4, 4.8)] and Work [OR (95% CI): 2.7 (1.4, 5.1)], suggesting that BBB in the Fontan population is associated with reduced exercise performance. This data adds to the existing clinical evidence of the adverse effects of conduction abnormalities on single ventricle cardiac output and adds support for consideration of cardiac resynchronization and multi-site ventricular pacing in this patient population.