Exercise is the Most Important Medicine for COVID-19.

ABSTRACT: COVID-19 infection and long COVID affect multiple organ systems, including the respiratory, cardiovascular, renal, digestive, neuroendocrine, musculoskeletal systems, and sensory organs. Exerkines, released during exercise, have a potent crosstalk effect between multiple body systems. This review describes the evidence of how exerkines can mitigate the effects of COVID-19 in each organ system that the virus affects. The evidence presented in the review suggests that exercise should be considered a first-line strategy in the prevention and treatment of COVID-19 infection and long COVID disease.

Development and validation of the body shape scale (BOSHAS) for assessing body shape perception in African populations.

BACKGROUND: As a consequence of 'Western' acculturation, eating disorders and body image disturbances, such as fatness phobia and body dysmorphic disorders towards musculature and body shape, are emerging in Africa, with young people the most affected. It is therefore important to accurately assess perceptions of body shape. However, the existing body image assessment scales lack sufficient accuracy and validity testing to compare body shape perception across different African populations. The purpose of this study was to develop and validate the Body Shape Scale (BOSHAS) to evaluate body shape perceptions related body image disorders in African populations. METHODS: To develop the BOSHAS, anthropometric measures of 80 Cameroonians and 81 Senegalese (both sexes included; 40.1% females overall) were taken for three body shape criteria: somatotype components, body mass index (BMI) and waist-to-hip ratio. Subjects were selected to cover a wide variability in body shape and were photographed in full face and profile positions. To validate the BOSHAS, the scale was administered twice (2 weeks apart) to 106 participants (aged 31.2 ± 12.6 years) to assess its reliability. In addition, a questionnaire measuring different aspects of body shape (e.g. musculature) was also administered (n = 597; aged 36.7 ± 15.6 years) to assess its convergent validity. RESULTS: The BOSHAS includes two sex-specific subscales of 10 photographs each. Most participants were able to repeat their BOSHAS preference order. Test-retest reliability was also consistent in estimating Current Body Shape (CBS), Desired Body Shape and Ideal Body Shape for participants and their partners. CBS was correlated with BMI, and different BOSHAS indices were consistent with declarations obtained by questionnaire. CONCLUSIONS: The BOSHAS is the first sex-specific scale of real African models photographed in face and profile, including large body shape variability. The validation protocol showed good validity and reliability for evaluating body shape perceptions and dissatisfaction of Africans.

Relationship Between Body Mass Index and Body Image Disturbances Among South African Mothers and Their Daughters Living in Soweto, Johannesburg.

In South African families, a phenomenon of mothers' acceptance of stoutness coexists with their daughters' appreciation for thinness. A sample of N = 615 mother-and-daughter pairs was recruited to conjointly identify the relationships toward body image and body mass index between both groups by assessing body weight satisfaction, body esteem, and eating disorders risk. We observed higher prevalence of obesity in mothers and higher eating disorders risk in daughters, while mother-daughter relationships were identified for body mass index and psychometric dimensions. The high prevalence of obesity in mothers and their tolerance for stoutness could expose their daughters to eating disorders and obesity.

Biocultural determinants of overweight and obesity in the context of nutrition transition in Senegal: a holistic anthropological approach.

Senegal is experiencing a rising obesity epidemic, due to the nutrition transition occurring in most African countries, and driven by sedentary behaviour and high-calorie dietary intake. In addition, the anthropological local drivers of the social valorization of processed high-calorie food and large body sizes could expose the population to obesity risk. This study aimed to determine the impact of these biocultural factors on the nutritional status of Senegalese adults. A mixed methods approach was used, including qualitative and quantitative studies. Between 2011 and 2013, fourteen focus group discussions (n=84) and a cross-sectional quantitative survey (n=313 women; n=284 men) of adults in three different socio-ecological areas of Senegal (rural: n=204; suburban: n=206; urban: n=187) were conducted. Dietary intake (Dietary Diversity Scores), physical activity (International Physical Activity Questionnaire), body weight norms (Body Size Scale), weight and health statuses (anthropometric measures and blood pressure) were measured. Middle-aged and older Senegalese women were found to value overweight/obesity more than younger Senegalese in all regions. In addition, young urban/suburban adults had a tendency for daily snacking whilst urban/suburban adults tended to be less physically active and had higher anthropometric means. A binary logistic regression model showed that being female, older, living in urban/suburban areas and valuing larger body size were independently associated with being overweight/obese, but not high-calorie diet. Univariate analyses showed that lower physical activity and higher socioeconomic status were associated with being overweight/obese. Finally, overweight/obesity, which is low in men, is associated with hypertension in the total sample. The nutrition transition is currently underway in Senegal's urban/suburban areas, with older women being more affected. Since several specific biocultural factors jointly contribute to this phenomenon, the study's findings suggest the need for local public health interventions that target women and which account for the anthropological specificities of the Senegalese population.

Review: Metabolic Syndrome in Black South African Women.

The prevalence of metabolic syndrome is increasing in African populations, and is particularly high in Black South African women (42%) vs women in the United Kingdom (23%) and the United States of America (36%). This population group is also known to have the highest prevalence of obesity in the sub-Saharan African region (42%), and consequently, a high risk of non-communicable diseases. In this article, we discuss factors (abdominal subcutaneous fat, visceral fat, lean mass, adiponectin, leptin, vitamin D, smoking and menopausal status) that have been investigated for their possible association with metabolic syndrome in African women, and discuss some recommendations for management of the syndrome. In particular, the infrastructural development of HIV/AIDS clinics in South Africa provides an ideal integrated platform to cater to the treatment needs of patients with multiple chronic morbidities.

The relationships of eccentric strength and power with dynamic balance in male footballers.

Unilateral balance is critical to kicking accuracy in football. In order to design interventions to improve dynamic balance, knowledge of the relationships between dynamic balance and specific neuromuscular factors such as eccentric strength and power is essential. Therefore, the aim was to determine the relationships of eccentric strength and power with dynamic balance in male footballers. The Y-balance test, eccentric isokinetic strength testing (knee extensors and flexors) and the countermovement jump were assessed in fifty male footballers (university (n = 27, mean age = 20.7 ± 1.84 years) and professional (n = 23, mean age = 23.0 ± 3.08 years). Spearman Rank Order correlations were used to determine the relationships of eccentric strength and power with dynamic balance. Multiple linear regression, adjusting for age, mass, stature, playing experience and competitive level was performed on significant relationships. Normalised reach score in the Y-balance test using the non-dominant leg for stance correlated with (1) eccentric strength of the non-dominant leg knee extensors in the university group (r = 0.50, P = 0.008) and (2) countermovement jump height in the university (r = 0.40, P = 0.04) and professional (r = 0.56, P = 0.006) football groups, respectively. No relationships were observed between eccentric strength (knee flexors) and normalised reach scores. Despite the addition of potential confounders, the relationship of power and dynamic balance was significant (r = 0.52, P < 0.0002). The ability to generate power correlates moderately with dynamic balance on the non-dominant leg in male footballers.

Patterns, levels and correlates of self-reported physical activity in urban black Soweto women.

BACKGROUND: Urban black South African women have a high prevalence of non-communicable diseases such as obesity and type 2 diabetes. The aim of this study was to assess the physical activity patterns of a cohort of middle-aged urban-dwelling black African women and to determine if physical activity is associated with anthropometric measures and metabolic outcomes in this population. METHODS: Physical activity and sitting time were assessed using the Global Physical Activity Questionnaire (GPAQ) in a cross-sectional study of 977 black African women (mean age 41.0 ± 7.84 years) from the Birth to Twenty study based in Soweto, Johannesburg. Anthropometric outcomes were measured and fasting blood glucose, insulin and lipid profile were analysed to determine metabolic disease risk and prevalence. RESULTS: Sixty-seven percent of the population were classified as active according to GPAQ criteria, and the domain that contributed most to overall weekly physical activity was walking for travel. Only 45.0% of women participated in leisure time activity. The prevalence of metabolic syndrome in this sample was 40.0%, and the prevalence of overweight and obesity was 29.2% and 48.0%, respectively. Women who reported owning a motor vehicle walked for travel less, and participated in more leisure-time activity (both p < 0.01), while women who owned a television reported significantly lower moderate-vigorous physical activity (MVPA), and walking for travel (both p < 0.01). Sitting time (mins/wk) was not different between the activity groups, but was associated with triglycerides and diastolic blood pressure. Total physical activity was inversely associated with fasting insulin, and physical activity in the work domain was associated with fat free soft tissue mass. CONCLUSIONS: The findings of this study show that the majority of urban dwelling black South African women are classified as physically active despite a high prevalence of obesity and metabolic disease risk factors. Sitting time had detrimental effects on both triglyceride levels and diastolic blood pressure whilst total physical activity attenuated fasting insulin levels. As walking for travel is a major contributor to physical activity, future research should attempt to determine whether the intensity of this activity plays a role in the prevention of cardiometabolic diseases.

A qualitative analysis of workers perceptions on the role of management in promoting health behaviour, informed by the COM-B model.

BACKGROUND: The primary objective of this study was to explore the viewpoints held by employees at a pharmaceutical manufacturing workplace in a middle-income country regarding management's role in promoting health behaviours in the workplace. METHODS: This study used transcripts of focus group discussion from an original study that investigated employee perceptions of factors associated with healthy behaviours among South African pharmaceutical manufacturing factory workers. RESULTS: Participants felt that workplace managers could improve capability through health promotion strategies, supportive leadership and promoting a culture of health. They could provide opportunity through employee engagement programs and resources, and physical activity opportunities were specifically identified. CONCLUSIONS: This study demonstrates that managers in a middle-income country have the potential to contribute to workplace health in a range of ways that include addressing capability, opportunity and motivation of their workers.

Obesity, beverage consumption and sleep patterns in rural African women in relation to advertising of these beverages.

BACKGROUND: The burden of obesity-related, non-communicable diseases in South Africa is persistent, with poor and black South African women particularly vulnerable. The purpose of the present study was to determine relationships between obesity, physical activity, sleep patterns and beverage consumption among black South African women in a rural village in the Limpopo province. METHODS: A cross-sectional study was conducted among 200 rural-dwelling African women. Data were collected on beverage consumption, sociodemographic information, sleep patterns and anthropometry using self-reported questionnaires. RESULTS: The mean body mass index (BMI) was 28.5±7.3 kg/m2, with 40% being classified as obese (BMI ≥30 kg/m2) and the mean sleep score was 4.68±2.51. Participants with very bad habitual sleeping patterns consumed significantly more sugar-sweetened beverages and alcohol than those with very good sleeping patterns. We also observed that when total coffee with sugar, fruit juice, total sugar-sweetened beverages and weight decreased the number of hours participants slept increased. CONCLUSIONS: The study identified significant associations between body weight, sleep duration and sugar-sweetened beverage consumption among rural black South African women. This underscores a need to address unhealthy lifestyle behaviours to lower incidences of non-communicable diseases in rural-dwelling women.

Results From South Africa's 2022 Healthy Active Kids' Report Card on Physical Activity, Body Composition Proxies, and Nutritional Status in Children and Adolescents.

BACKGROUND: Physical activity (PA) and nutrition in children have an impact on overall physical and mental well-being, cognitive, and social development. This study aims to report on the best current available evidence on PA, body composition proxies, and nutritional status of South African children and adolescents, based on the published findings between 2018 and 2022, which comprise the 2022 Healthy Active Kids South Africa Report Card. METHODS: A comprehensive literature search of online databases, along with hand searching and a gray literature search, was conducted based on PA, body composition proxies, and nutrition indicators defined, in part, by the Active Healthy Kids Global Alliance. RESULTS: Compared with the 2018 report card, there was an improvement in the majority of PA indicators which include overall PA (B-), active transportation (B-), physical fitness (B-), and government policy and programs (C). Body composition proxies and most of the nutrition indicators remained unchanged. The indicators that regressed from 2018 to 2022 included community and environmental influences (D), as well as participation in organized sport (D-). CONCLUSIONS: Despite the apparent improvement in overall PA levels in children and adolescents, there is a lack of tangible evidence of actual implementation of policies and programs. There was also a lack of nationally representative data for most indicators. Overall, there is a need to identify intersectoral, equitable approaches for promoting PA and healthy eating in South African children and adolescents and ongoing monitoring and surveillance.

Ukumela impilo randomised trial: preliminary findings of height-adjustable sit-to-stand workstations on health outcomes of South African office workers.

BACKGROUND: The prevalence of sedentary behaviour has concurrently risen with multiple cardiometabolic risk markers independent of physical activity levels. Office-based workers accumulate the highest levels of sitting time during occupational times. This study aims to investigate the short-term effects of using height-adjustable sit-to-stand workstations on cardiometabolic risk markers of office-based workers in South Africa. RESULTS: Sixty-two office-based workers were randomized into intervention (n = 44), and the control group (n = 18). Small improvements were observed in BMI, blood pressure, and cholesterol levels in this cohort. CONCLUSION: This preliminary investigation confirms that short-term height-adjustable sit-stand interventions are effective in reducing workplace sitting time and selected health outcomes. South Africa has been attributed with the highest burden of obesity in Sub-Saharan Africa, as a result, there is a need to implement long-term workplace intervention to reverse these implications. TRIAL REGISTRATION: Pan African Clinical Trial Registry, PACTR201911656014962 on the 12th of November 2019.

Employee Perceptions of an Established Health and Wellness Coaching Program to Improve Behavior.

OBJECTIVE: There is limited evidence, particularly qualitative analysis, of health and wellness interventions within the South African workplace. The purpose of this study is to explore whether health and wellness coaching when offered as part of an employee wellness program has potential for developing lifestyle change in a South African workplace. METHODS: There were four, 45-minute focus group discussions, where employees discussed their experiences of the workplace health and wellness intervention program. RESULTS: Main categories identified from the coding of the transcripts were purpose of the health and wellness coaching program, as well as employees' program experience and improvement to the program. Common barriers to engagement, positive and negative experiences, and suggested improvements were defined by the employees. CONCLUSIONS: The study highlighted the need of understanding employee perceptions in the development and implementation of a workplace health and wellness program.

Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa.

Background: Low-middle-income countries (LMICs) face increasing burdens from non-communicable disease (NCDs) requiring primary care task shifting to community health workers (CHWs). This study explored community members' perceptions of NCD-focused, CHW-led home visits in a historically disadvantaged township of South Africa. Methods: Trained CHWs visited community member homes, performing blood pressure and physical activity (PA) screenings, followed by brief counselling and a satisfaction survey. Semi-structured interviews were conducted within 3 days of the visit to learn about their experiences. Results: CHWs visited 173 households, with 153 adult community members consenting to participate (88.4%). Participants reported that it was easy to understand CHW-delivered information (97%), their questions were answered well (100%), and they would request home service again (93%). Twenty-eight follow-up interviews revealed four main themes: 1) acceptance of CHW visits, 2) openness to counselling, 3) satisfaction with screening and a basic understanding of the results, and 4) receptiveness to the PA advice. Conclusion: Community members viewed CHW-led home visits as an acceptable and feasible method for providing NCD-focused healthcare services in an under-resourced community. Expanding primary care reach through CHWs offers more accessible and individualized care, reducing barriers for individuals in under-resourced communities to access support for NCD risk reduction.

Factors Associated with Improved Knowledge of Metabolic Syndrome in Female Market Traders.

Metabolic syndrome (MetS) is considered to be a clustering of cardiometabolic diseases and is emerging as a public health concern. There is little evidence of this disease in market traders, and so the aim of this study was to determine the prevalence and knowledge of MetS. In this cross-sectional study, anthropometry, blood pressure and bloods were collected using standardized methods to detect the prevalence of MetS using the harmonized method in a cohort of female Ghanaian market traders (n = 338). A questionnaire documented the knowledge of MetS. Linear regression was used to investigate the factors associated with knowledge and was reported as adjusted ß values. Forty-two percent (n = 142) had MetS. The overall knowledge of MetS was low, driven by education (ß = 0.22, p = 0.0001), low levels of high-density lipoprotein-cholesterol (ß = -0.15, p = 0.018) and affiliation with the Ewe cultural group (ß = -0.19, p = 0.0004). As females working in a sedentary occupation, market traders are vulnerable to MetS. Our findings indicate the urgent need for culturally sensitive education to promote healthy behaviours.

The Effect of Obesity on the Waist Circumference Cut-Point Used for the Diagnosis of the Metabolic Syndrome in African Women: Results from the SWEET Study.

Waist circumference (WC) is one of the diagnostic criteria for metabolic syndrome (MetS). However, studies have shown that the waist cut-point may be influenced by BMI. The aim of this study was to, therefore, determine whether the presence of obesity influences the WC cut-point used to diagnose MetS in sub-Saharan African women. The second aim was to determine whether calculated cut-points of other waist-related and dual-energy X-ray absorptiometry (DXA)-determined anthropometric measures used for the diagnosis of MetS were also influenced by BMI. Biochemical, simple anthropometric and dual-energy X-ray absorptiometry-derived anthropometric data were collected in 702 black South African women from the Study of Women Entering and in Endocrine Transition (SWEET). A receiver operating characteristic curve analysis was used to determine waist, waist-to-hip (WHR) and waist-to-height ratios, body shape index (ABSI), total body fat, trunk fat, and peripheral (arm + leg) fat cut-points for MetS (without waist) in subjects with BMI above or below the median value. The estimated WC cut-points (107 cm, 93.5 cm) for women with high BMI and low BMI, respectively, and the cut-points for the other anthropometric variables for the diagnosis of MetS were greater in high BMI women compared to low BMI women. The exceptions were WHR and ABSI, for which the cut-points were very similar in both BMI groups, and peripheral fat, where the cut-point was lower in the high BMI group. Logistic regression analysis demonstrated that WC was associated with a higher risk (odds ratio [95% CIs]: 1.07 [1.04, 1.10]; p < 0.0001), whilst hip was associated with a lower risk (0.97 [0.94, 0.99]; p = 0.02) for MetS. These data suggest that with increasing BMI, the higher levels of protective gluteofemoral fat lead to the requirement for higher WC cut-points for MetS diagnosis. The opposing associations of waist and hip with MetS risk make WHR a more appropriate variable for diagnosing MetS among African women as the WHR cut-point is less influenced by increasing BMI than is WC, which was also observed for ABSI.

Employee perceptions of non-communicable diseases health risks, absenteeism and the role of organisational support in a South African pharmaceutical manufacturing company.

BACKGROUND: The growing prevalence of non-communicable diseases (NCDs) in South African workers has been shown to be associated with absenteeism and increased risk of morbidity. Low-income workers living in urban settings are particularly vulnerable. Consultation with workers is crucial for understanding risks and identifying opportunities for intervention to promote health in the workplace. The purpose of this study was to examine South African pharmaceutical manufacturing workers' perspectives of health risk factors and absenteeism, and to identify how they perceived a role for the organisation to initiate interventions to improve their health. MATERIALS AND METHODS: Five focus groups were conducted to capture 27 employees' perspectives. The semi-structured focus group discussions were recorded and analysed using a thematic content analysis approach. RESULTS: Participants indicated that they were aware of behavioural health risks such as prolonged sitting. They showed insight into strategies to prevent injuries and stay healthy, but also expressed dissatisfaction about the lack of organisational support, leading to stress and consequently absenteeism. Participants emphasized the responsibility of the organisation to support a range of health promoting strategies. CONCLUSIONS: The findings of this study are important for cultivating a tailored workplace intervention to reduce NCD risk factors in the pharmaceutical manufacturing workforce. It is vital that these be supported by leadership of the company through the provision of funding and the development of internal healthcare services.

The negative association of lower body fat mass with cardiometabolic disease risk factors is partially mediated by adiponectin.

Gluteofemoral fat correlates negatively with a number of cardiometabolic disease risk factors, but the mechanisms involved in these relationships are unknown. The aim of this study was to test the hypothesis that gluteofemoral fat attenuates the risk of cardiometabolic disease by increasing blood adiponectin levels. This was a cross-sectional study in which arm, leg, gluteofemoral, abdominal s.c. and visceral fat levels were measured by dual-energy X-ray absorptiometry in 648 African females. Fasting serum adiponectin, lipid, insulin and plasma glucose levels and blood pressure were measured. Relationships between variables were analysed using multivariable linear regression and structural equation modelling. Adiponectin correlated positively (ß = 0.45, P < 0.0001) with gluteofemoral fat in a multivariable regression model that included age, height, and arm, s.c. and visceral fat levels. In further regression models, there was a negative correlation of gluteofemoral fat with fasting glucose (ß = -0.28; P < 0.0001) and triglyceride levels (ß = -0.29; P < 0.0001) and insulin resistance (HOMA; ß = -0.26; P < 0.0001). Structural equation modelling demonstrated that adiponectin mediated 20.7% (P < 0.01) of the association of gluteofemoral fat with insulin resistance and 16.1% (P < 0.01) of the association with triglyceride levels but only 6.67% (P = 0.31) of the association with glucose levels. These results demonstrate that gluteofemoral and leg fat are positively associated with adiponectin levels and that the negative association of lower body fat with insulin resistance and triglyceride levels may partially be mediated by this adipokine. Further studies are required to determine other factors that mediate the effect of lower body fat on cardiometabolic disease risk factors.

Association of Longitudinal Nutrient Patterns with Body Composition in Black Middle-Aged South African Women: A Five-Year Follow-Up Study.

This study aimed to evaluate the association of longitudinal nutrient patterns with body composition in a cohort of 132 black South African middle-aged women over five years. Nutrient patterns were identified using principal component analysis at baseline and follow-up 5 years later. Associations between nutrient patterns and repeated body composition measures were evaluated using generalized estimating equations, before and after adjusting for baseline education and repeated measures of age, socio-economic status, physical activity and employment. The animal-driven nutrient pattern was associated with increases in repeated measures of visceral adipose tissue (VAT) (ß coefficient, 5.79 [95% CI, 0.01-11.57] cm2), fat mass index (FMI) (0.47 [0.01-0.93] kg·m-2) and lean mass index (LMI) (0.50 [0.18-1.17] kg·m-2) (p < 0.05) after adjustment. Vitamin C, sugar, and potassium-driven nutrient pattern was associated with higher FMI (0.50 [0.12-0.88] kg·m-2) and LMI (0.58 [0.07-1.10] kg·m-2) before and after adjustment (p < 0.05). These findings suggest that dietary interventions to curb obesity in black middle-aged South African women should focus on attenuation of nutrient patterns centred on added sugar, animal fat and animal protein.