Behaviour change interventions to improve physical activity in adults: a systematic review of economic evaluations.

BACKGROUND: Behaviour change interventions can result in lasting improvements in physical activity (PA). A broad implementation of behaviour change interventions are likely to be associated with considerable additional costs, and the evidence is unclear whether they represent good value for money. The aim of this study was to investigate costs and cost-effectiveness of behaviour change interventions to increase PA in community-dwelling adults. METHODS: A search for trial-based economic evaluations investigating behaviour change interventions versus usual care or alternative intervention for adults living in the community was conducted (September 2023). Studies that reported intervention costs and incremental cost-effectiveness ratios (ICERs) for PA or quality-adjusted life years (QALYs) were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC-list). A Grading of Recommendations Assessment, Development and Evaluation style approach was used to assess the certainty of evidence (low, moderate or high certainty). RESULTS: Sixteen studies were included using a variety of economic perspectives. The behaviour change interventions were heterogeneous with 62% of interventions being informed by a theoretical framework. The median CHEC-list score was 15 (range 11 to 19). Median intervention cost was US$313 per person (range US$83 to US$1,298). In 75% of studies the interventions were reported as cost-effective for changes in PA (moderate certainty of evidence). For cost per QALY/gained, 45% of the interventions were found to be cost-effective (moderate certainty of evidence). No specific type of behaviour change intervention was found to be more effective. CONCLUSIONS: There is moderate certainty that behaviour change interventions are cost-effective approaches for increasing PA. The heterogeneity in economic perspectives, intervention costs and measurement should be considered when interpreting results. There is a need for increased clarity when reporting the functional components of behaviour change interventions, as well as the costs to implement them.

Assessment, diagnosis and management characteristics of people with acute Charcot neuro-osteoarthropathy in a regional Australian health service: A 3-year retrospective audit.

OBJECTIVE: Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service. DESIGN: Three-year retrospective medical record audit. SETTING: Large regional health service with catchment area of >250 000 people in regional Australia. PARTICIPANTS: People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC). MAIN OUTCOME MEASURES: Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale. RESULTS: Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14-47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases. CONCLUSIONS: Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.

Coagulation activity and thrombotic risk following high-volume endurance exercise in recreationally active cyclists.

Despite the prognostic effect of physical activity, acute bouts of high-volume endurance exercise can induce cardiac stress and postexercise hypercoagulation associated with increased thrombotic risk. The aim of this study was to explore the effect of high-volume endurance exercise on coagulation and thrombotic activity in recreational cyclists. Thirty-four recreational cyclists completed 4.8 ± 0.3 h of cycling at 45 ± 5% of maximal power output on a bicycle ergometer. Intravenous blood samples were collected preexercise, immediately postexercise, 24 and 48 h postexercise, and analyzed for brain natriuretic peptide (BNP), cardiac troponin (cTn), C-reactive protein (CRP), D-dimer, thrombin-antithrombin (TAT) complex, tissue factor (TF), tissue factor pathway inhibitor (TFPI), and TF-to-TFPI ratio (TF:TFPI). An increase in cTn was observed postexercise (P < 0.001). CRP concentrations were increased at 24 and 48 h postexercise compared with preexercise concentrations (P ≤ 0.001). TF was elevated at 24 h postexercise (P < 0.031) and TFPI was higher immediately postexercise (P < 0.044) compared with all other time points. TF:TFPI was increased at 24 and 48 h postexercise compared with preexercise (P < 0.025). TAT complex was reduced at 48 h postexercise compared with preexercise (P = 0.015), D-dimer was higher immediately postexercise compared with all other time points (P ≤ 0.013). No significant differences were observed in BNP (P > 0.05). High-volume endurance cycling induced markers of cardiac stress among recreational cyclists. However, plasma coagulation and fibrinolytic activity suggest no increase in thrombotic risk after high-volume endurance exercise.NEW & NOTEWORTHY In this study, a high-volume endurance exercise protocol induced markers of cardiac stress and altered plasma coagulation and fibrinolytic activity for up to 48 h in recreationally active cyclists. However, analysis of coagulation biomarkers indicates no increase in thrombotic risk when appropriate hydration and rest protocols are implemented.

Predicting successful draft outcome in Australian Rules football: Model sensitivity is superior in neural networks when compared to logistic regression.

Using logistic regression and neural networks, the aim of this study was to compare model performance when predicting player draft outcome during the 2021 AFL National Draft. Physical testing, in-game movement and technical involvements were collected from 708 elite-junior Australian Rules football players during consecutive seasons. Predictive models were generated using data from 465 players (2017 to 2020). Data from 243 players were then used to prospectively predict the 2021 AFL National Draft. Logistic regression and neural network models were compared for specificity, sensitivity and accuracy using relative cut-off thresholds from 5% to 50%. Using factored and unfactored data, and a range of relative cut-off thresholds, neural networks accounted for 73% of the 40 best performing models across positional groups and data configurations. Neural networks correctly classified more drafted players than logistic regression in 88% of cases at draft rate (15%) and convergence threshold (35%). Using individual variables across thresholds, neural networks (specificity = 79 ± 13%, sensitivity = 61 ± 24%, accuracy = 76 ± 8%) were consistently superior to logistic regression (specificity = 73 ± 15%, sensitivity = 29 ± 14%, accuracy = 66 ± 11%). Where the goal is to identify talented players with draft potential, model sensitivity is paramount, and neural networks were superior to logistic regression.

A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics.

BACKGROUND: Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer's disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive. OBJECTIVE: The MedWalk trial's primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment. METHODS: MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60-90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community. TRIAL REGISTRATION: Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au).

Habitual Physical Activity of People with or at Risk of Diabetes-Related Foot Complications.

Regular physical activity is an important component of diabetes management. However, there are limited data on the habitual physical activity of people with or at risk of diabetes-related foot complications. The aim of this study was to describe the habitual physical activity of people with or at risk of diabetes-related foot complications in regional Australia. Twenty-three participants with diabetes from regional Australia were recruited with twenty-two participants included in subsequent analyses: no history of ulcer (N = 11) and history of ulcer (N = 11). Each participant wore a triaxial accelerometer (GT3X+; ActiGraph LLC, Pensacola, FL, USA) on their non-dominant wrist for 14 days. There were no significant differences between groups according to both participant characteristics and physical activity outcomes. Median minutes per day of moderate-to-vigorous physical activity (MVPA) were 9.7 (IQR: 1.6-15.7) while participants recorded an average of 280 ± 78 min of low-intensity physical activity and 689 ± 114 min of sedentary behaviour. The sample accumulated on average 30 min of slow walking and 2 min of fast walking per day, respectively. Overall, participants spent very little time performing MVPA and were largely sedentary. It is important that strategies are put in place for people with or at risk of diabetes-related foot complications in order that they increase their physical activity significantly in accordance with established guidelines.

Comparison of telehealth and supervised phase III cardiac rehabilitation in regional Australia: protocol for a non-inferiority trial.

INTRODUCTION: Exercise-based cardiac rehabilitation programmes (ExCRP) promote recovery and secondary prevention for individuals with cardiovascular disease (CVD). Despite this, enrolment and adherence to ExCRP in rural locations is low. Telehealth programmes provide a convenient, home-based intervention, but concerns remain about compliance to exercise prescription. This paper presents the rationale and protocol design to determine if telehealth delivered ExCRP is not inferior to supervised ExCRP for improving cardiovascular function and exercise fidelity. METHOD AND ANALYSIS: A non-inferiority, parallel (1:1), single-blinded randomised clinical trial will be conducted. Fifty patients with CVD will be recruited from a rural phase II ExCRP. Participants will be randomly assigned to telehealth or supervised ExCRP and prescribed three weekly exercise sessions for 6 weeks. Exercise sessions will include a 10 min warm up, up to 30 min of continuous aerobic exercise at a workload equivalent to the ventilatory anaerobic threshold and a 10 min cool down. The primary outcome will be change in cardiorespiratory fitness as measured by cardiopulmonary exercise test. Secondary outcome measures will include change in blood lipid profile, heart rate variability, pulse wave velocity, actigraphy measured sleep quality and training fidelity. Non-inferiority will be confirmed if intention-to-treat and per-protocol analyses conclude the same outcome following independent samples t-test with p<0.025. ETHICS AND DISSEMINATION: Research ethics committees at La Trobe University, St John of God Health Care and Bendigo Health approved the study protocol and informed consent. Findings will be published in peer-reviewed journals and disseminated among stakeholders. TRIAL REGISTRATION NUMBER: ACTRN12622000872730p; pre-results.

The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis.

BACKGROUND: Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain. METHODS: This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS: Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m2. CONCLUSION: Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain. TRIAL REGISTRATION: The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).

Including a Technical Factor with Physical and In-Game Movement Factors Improves Model Sensitivity When Evaluating Draft Outcome in Elite-Junior Australian Rules Football.

Determining characteristics that define talent is critical for recruitment and player development. When developing predictive models, sensitivity is important, as it describes the ability of models to identify players with draft potential (true positives). In the current literature, modelling is limited to a small number of selected variables, and model sensitivity is often poor or unreported. The aim of this study was to determine how a technical factor combined with physical and in-game movement factors affects position-specific model sensitivity when evaluating draft outcome in an elite-junior National Australia Bank (NAB) League population. Physical, in-game movement, and technical involvement data were collated from draft-eligible (18th year) participants in the under 18 boys NAB League competition (n = 465). Factors identified through parallel analysis were used in binomial regression analyses. Models using factor combinations were developed to predict draft success for all-position, nomadic, fixed-position, and fixed&ruck players. Models that best characterised draft success were all-position (physical and technical: specificity = 97.2%, sensitivity = 36.6%, and accuracy = 86.3%), nomadic (physical and technical: specificity = 95.5%, sensitivity = 40.7%, and accuracy = 85.5%), fixed (physical: specificity = 96.4%, sensitivity = 41.7%, and accuracy = 86.6%), and fixed&ruck (physical and in-game movement: specificity = 96.3%, sensitivity = 41.2%, and accuracy = 86.7%). Including a technical factor improved sensitivity in the all-position and nomadic models. Physical factors and physical and in-game movement yielded the best models for fixed-position and fixed&ruck players, respectively. Models with improved sensitivity should be sought to assist practitioners to more confidently identify the players with draft potential.

Position-Specific Running and Technical Demands During Male Elite-Junior and Elite-Senior Australian Rules Football Match-Play.

ABSTRACT: Jennings, J, Staka, Z, Wundersitz, DW, Sullivan, CJ, Cousins, SD, Custovic, E, and Kingsley, MI. Position-specific running and technical demands during male elite-junior and elite-senior Australian rules football match-play. J Strength Cond Res 37(7): 1449-1455, 2023-The aim of this study was to compare position-specific running and technical demands of elite-junior and elite-senior Australian rules football match-play to better inform practice and assist transition between the levels. Global positioning system and technical involvement data were collated from 12 Victorian U18 male NAB League ( n = 553) and 18 Australian Football League ( n = 702) teams competing in their respective 2019 seasons. Players were grouped by position as nomadic, fixed, or ruck, and data subsets were used for specific analyses. Relative total distance ( p = 0.635, trivial effect), high-speed running (HSR) distance ( p = 0.433, trivial effect), acceleration efforts ( p = 0.830, trivial effect), deceleration efforts ( p = 0.983, trivial effect), and efforts at >150 m·min -1 ( p = 0.229, trivial effect) and >200 m·min -1 ( p = 0.962, trivial effect) did not differ between elite-junior and elite-senior match-play. Elite juniors covered less total and HSR distance during peak periods (5 seconds-10 minutes) of demand ( p ≤ 0.022, small-moderate effects). Within both leagues, nomadic players had the greatest running demands followed by fixed position and then rucks. Relative disposals ( p = 0.330, trivial effect) and possessions ( p = 0.084, trivial effect) were comparable between the leagues. During peak periods (10 seconds to 2 minutes), elite juniors had less technical involvements than elite seniors ( p ≤ 0.001, small effects). Although relative running demands and positional differences were comparable between the leagues, elite juniors perform less running, HSR, and technical involvements during peak periods when compared with elite seniors. Therefore, coaching staff in elite-senior clubs should maintain intensity while progressively increasing the volume of training that recently drafted players undertake when they have transitioned from elite-junior leagues.

Moderate continuous- and high-intensity interval training elicit comparable cardiovascular effect among middle-aged men regardless of recovery mode.

To assess the effect of active and passive intra-interval recovery modes in time-efficient high-intensity interval training (HIT) on cardiorespiratory fitness, autonomic function, and endothelial function in sedentary middle-aged men.Participants (n = 62; age: 49.5 ± 5.8 y; BMI: 29.7 ± 3.7 kg·m-2) completed the assessments of cardiorespiratory fitness, flow-mediated dilation (FMD) and heart rate variability before being randomly allocated to control (CON; n = 14), moderate intensity continuous training (MICT; n = 15), HIT with passive (P-HIT; n-15), or active recovery (A-HIT; n = 15). Participants performed thrice weekly exercise sessions for 12 weeks. MICT completed 50-60 min of continuous cycling at 60-70% heart rate (HR) maximum. HIT completed 30-s work intervals (∼85% HR) interspaced with 2.5 min of active or passive recovery.All exercise modalities increased oxygen uptake (V̇O2) (MD: ≥ 3.1 ml·kg-1·min-1, 95%CI: 1.5-4.7 ml·kg-1·min-1; P < 0.001), power output (MD: ≥ 26 W, 95%CI: 15-37 W; P < 0.001) and cycle duration (MD: ≥ 62 s, 95%CI: 36-88 s; P < 0.001) at 85% HRM. Significant pre-to-post differences were observed among all exercise groups for FMD (MD: ≥ 3.4%, 95%CI: 0.3-6.5%; P < 0.05), while MICT and P-HIT significantly increased the standard deviation of all NN intervals (SDNN) pre-to-post intervention (MD: ≥ 7 ms, 2-13 ms; P ≤ 0.05).Time-efficient HIT elicits significant improvements in cardiorespiratory fitness, FMD and autonomic modulation following a thrice weekly 12-week exercise intervention among sedentary middle-aged men. Active recovery between successive high-intensity intervals provided no additional benefit among this deconditioned cohort.

Residual neuromuscular fatigue influences subsequent on-court activity in basketball.

The aim of this study was to determine if residual neuromuscular fatigue influenced subsequent match and training activity in professional women's basketball. Prior to matches and training sessions throughout a season, players performed countermovement jumps while wearing a magnetic, angular rate and gravity (acceleration) sensor on their upper back. Flight time to contraction time ratio was used to determine neuromuscular performance and to identify neuromuscular fatigue. Average session intensity and volume, the proportion of live time spent in different intensity bands (matches), and absolute and relative time spent in different intensity bands (training) were quantified using accelerometry. Residual neuromuscular fatigue was deemed to be present when the decrement in neuromuscular performance relative to pre-season baseline was greater than the smallest worthwhile change. Players displayed residual neuromuscular fatigue before 16% of matches and 33% of training sessions. When players were fatigued prior to matches, the proportion of live time undertaking supramaximal activity was 5.7% less (p = 0.02) and moderate-vigorous activity was 3.7% more than when not fatigued (p = 0.02). When fatigued prior to training, the players displayed a 2.6% decrement in average intensity (p = 0.02), 2.8% decrement in absolute (p = 0.01) and 5.0% decrement in relative (p = 0.01) maximal activity, as well as 13.3% decrement in absolute (p < 0.01) and 6.8% decrement in relative (p < 0.01) supramaximal activity when compared to not being fatigued. These findings suggest that residual neuromuscular fatigue influences players' ability to perform supramaximal activity, which highlights the importance of monitoring neuromuscular performance throughout a professional season.Highlights Residual neuromuscular fatigue can influence the amount of supramaximal activity players perform in a subsequent training session or match.Practices should be implemented to minimise residual neuromuscular fatigue carried into matches while maintaining a sufficient training volume to elicit physiological adaptations.MARG sensors can be used as an affordable and time-efficient tool for regularly monitoring countermovement jump-derived neuromuscular fatigue.

Comparison between a targeted exercise program and a sham intervention on gluteal muscle activity in people with hip osteoarthritis: Analysis of secondary outcomes from a randomised clinical trial.

BACKGROUND: People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA. RESEARCH QUESTION: Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA? METHODS: This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention. RESULTS: Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population. SIGNIFICANCE: A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention.

Increased soluble urokinase plasminogen activator levels modulate monocyte function to promote atherosclerosis.

People with kidney disease are disproportionately affected by atherosclerosis for unclear reasons. Soluble urokinase plasminogen activator receptor (suPAR) is an immune-derived mediator of kidney disease, levels of which are strongly associated with cardiovascular outcomes. We assessed suPAR's pathogenic involvement in atherosclerosis using epidemiologic, genetic, and experimental approaches. We found serum suPAR levels to be predictive of coronary artery calcification and cardiovascular events in 5,406 participants without known coronary disease. In a genome-wide association meta-analysis including over 25,000 individuals, we identified a missense variant in the plasminogen activator, urokinase receptor (PLAUR) gene (rs4760), confirmed experimentally to lead to higher suPAR levels. Mendelian randomization analysis in the UK Biobank using rs4760 indicated a causal association between genetically predicted suPAR levels and atherosclerotic phenotypes. In an experimental model of atherosclerosis, proprotein convertase subtilisin/kexin-9 (Pcsk9) transfection in mice overexpressing suPAR (suPARTg) led to substantially increased atherosclerotic plaques with necrotic cores and macrophage infiltration compared with those in WT mice, despite similar cholesterol levels. Prior to induction of atherosclerosis, aortas of suPARTg mice excreted higher levels of CCL2 and had higher monocyte counts compared with WT aortas. Aortic and circulating suPARTg monocytes exhibited a proinflammatory profile and enhanced chemotaxis. These findings characterize suPAR as a pathogenic factor for atherosclerosis acting at least partially through modulation of monocyte function.

Effects of a targeted resistance intervention compared to a sham intervention on gluteal muscle hypertrophy, fatty infiltration and strength in people with hip osteoarthritis: analysis of secondary outcomes from a randomised clinical trial.

BACKGROUND: People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis. METHODS: Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time. RESULTS: In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm3/kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention. CONCLUSION: Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017.

Training and match demands differ between the regular season and finals in semi-professional basketball.

Basketball competitions often include a scheduled regular season followed by knock-out finals. Understanding training and match demands through the season can help optimize performance and reduce injury risk. This study investigated whether training and/or match demands differed between the regular season and finals, and whether these differences were dependent on player role. Average session intensity and volume and durations of relative exercise intensities (inactive, light, moderate-vigorous, maximal, supramaximal) were quantified during training sessions and matches using accelerometry in two semi-professional basketball teams (n = 23; 10 women, 13 men). Training and match demands were compared between the regular season (training: 445 observations; matches: 387 observations) and finals (training: 113 observations, matches: 75 observations) with consideration of player role (starters, in-rotation bench, out-rotation bench). During finals matches, starters received 4.4 min more playing time (p = 0.03), performed 14% more absolute maximal activity (p < 0.01) and had 8% less relative inactive time (p = 0.02) when compared to the regular season. Out-rotation bench players received 2.1 min less playing time (p < 0.01), performed 33% less absolute maximal activity (p = 0.01) and 57% less absolute supramaximal activity (p < 0.01) in finals when compared to the regular season. During finals training sessions, average training intensity was 5% higher (p = 0.02), absolute moderate-vigorous activity was 3% higher (p = 0.04), relative maximal activity was 12% higher (p < 0.01), and relative inactive time was 5% lower (p = 0.03) when compared to the regular season. These findings suggest starters need to be physically prepared for greater match demands during finals, while out-rotation bench players should supplement their training during finals with extra supramaximal activity to maintain their conditioning levels for matches.

External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff.

Background and study aims N95-filtering facepiece respirators (FFR) use is associated with physiological changes and symptoms due to impaired nasal airflow and increased breathing resistance. We prospectively studied the effect of using an external nasal dilator (END) in gastroenterology laboratory (gastrointestinal lab) staff using N95FFR. Patients and methods N95FFR qualitative saccharine fit testing was performed on study participants with and without an END. Prospective data collection and comparisons included: 1) survey of perceived symptoms and difficulty of performing one day of gastrointestinal procedures with N95FFR and 1 day of gastrointestinal procedures with END plus N95FFR in random sequence; and 2) vitals and respiratory belt plethysmography in ten gastroenterologists performing simulated colonoscopy while wearing a surgical mask (SM), N95FFR plus SM, END plus N95FFR plus SM for 20 minutes each in random sequence and rapid succession. Results Twenty-nine of 31 participants passed the N95FFR and the END plus N95FFR fit test. Twenty-two participants (12 physicians; 11 males; mean age 44.1 years, range 31-61) performed 1 day of gastrointestinal procedures with an N95FFR and 1 day of gastrointestinal procedures with an END plus N95FFR. Significantly less difficulty with nasal breathing and severity of symptoms including breathing difficulty, headache, fatigue and frustration, occurred while using an END plus N95FFR. Respiratory plethysmography peak-to-trough measurement showed an increase during the N95FFR stage compared to the END plus N95FFR stage and the SM stage. Conclusions N95FFR related respiratory changes and symptom development may be mitigated by END use.

Soluble Urokinase Plasminogen Activator Receptor and Venous Thromboembolism in COVID-19.

Background Venous thromboembolism (VTE) contributes significantly to COVID-19 morbidity and mortality. The urokinase receptor system is involved in the regulation of coagulation. Levels of soluble urokinase plasminogen activator receptor (suPAR) reflect hyperinflammation and are strongly predictive of outcomes in COVID-19. Whether suPAR levels identify patients with COVID-19 at risk for VTE is unclear. Methods and Results We leveraged a multinational observational study of patients hospitalized for COVID-19 with suPAR and D-dimer levels measured on admission. In 1960 patients (mean age, 58 years; 57% men; 20% Black race), we assessed the association between suPAR and incident VTE (defined as pulmonary embolism or deep vein thrombosis) using logistic regression and Fine-Gray modeling, accounting for the competing risk of death. VTE occurred in 163 (8%) patients and was associated with higher suPAR and D-dimer levels. There was a positive association between suPAR and D-dimer (ß=7.34; P=0.002). Adjusted for clinical covariables, including D-dimer, the odds of VTE were 168% higher comparing the third with first suPAR tertiles (adjusted odds ratio, 2.68 [95% CI, 1.51-4.75]; P<0.001). Findings were consistent when stratified by D-dimer levels and in survival analysis accounting for death as a competing risk. On the basis of predicted probabilities from random forest, a decision tree found the combined D-dimer <1 mg/L and suPAR <11 ng/mL cutoffs, identifying 41% of patients with only 3.6% VTE probability. Conclusions Higher suPAR was associated with incident VTE independently of D-dimer in patients hospitalized for COVID-19. Combining suPAR and D-dimer identified patients at low VTE risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04818866.

Factors influencing adults who participate in a physical activity coaching intervention: a theoretically informed qualitative study.

OBJECTIVE: Behaviour change interventions targeting changes in physical activity (PA) can benefit by examining the underlying mechanisms that promote change. This study explored the use of the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to code and contextualise the experiences of participants who completed a PA coaching intervention underpinned by motivational interviewing and cognitive-behavioural therapy. DESIGN: Semistructured interviews were conducted with a purposive sample of participants. SETTING: Interviews were conducted in a tertiary hospital in regional Victoria, Australia. PARTICIPANTS: Eighteen participants who completed a PA coaching intervention were interviewed. The participants were recruited into the coaching intervention because they were insufficiently physically active at the time of recruitment. RESULTS: Thirteen (72%) participants were women and the average age of participants was 54 (±5) years. Four participant themes mapped directly onto five components of the COM-B model, and ten of the TDF domains. Increases in PA were influenced by changes in motivation and psychological capability. The autonomy-supportive PA coaching intervention helped to evoke participants' own reasons (and motives) for change and influenced PA behaviours. Participants reflected on their own social and/or professional strengths, and used these skills to set appropriate PA goals and action plans. The structure of the PA coaching intervention provided clarity on session determinants and a framework from which to set an appropriate agenda. Relational components (eg, non-judgemental listening, collaboration) were continually highlighted as influential for change, and should be considered in future behaviour change intervention design. CONCLUSIONS: We demonstrate the beneficial effect of using theory-informed behaviour change techniques, and delivering them in a style that promotes autonomy and relatedness. The views of participants should be a key consideration in the design and implementation of PA coaching interventions TRIAL REGISTRATION NUMBER: ACTRN12619000036112. Post-results analysis.

On-Court Activity and Game-Related Statistics during Scoring Streaks in Basketball: Applied Use of Accelerometers.

The aim of this observational study was to determine if on-court activity and match statistics differed between periods of scoring streaks and regular play in basketball. Thirty-seven basketballers including professional women, semi-professional women and semi-professional men wore accelerometers during competitive matches throughout a season. Accelerometry-derived live-time individual on-court exercise intensity and team game-related statistics were compared between scoring streaks (periods of play where the teams participating in the study scored at least three times in a row), streaks against (periods of play where the opposition teams scored at least three times in a row) and regular play. Few differences existed in the average exercise intensity between streak types. During streaks against, there was a 5-15% lower proportion of 2-point attempts, 0.8-1.3 fewer defensive rebounds per minute and 0.3-1.6 fewer shot attempts per minute compared to regular play and scoring streaks, and there were 0.3 fewer offensive rebounds per minute compared to regular play. During scoring streaks, there were 0.5 more defensive rebounds per minute, 1.3 more shot attempts per minute, a 43% greater shooting percentage and a 10% lower proportion of 3-point attempts compared to regular play. To reduce the chances of streaks against, teams should focus on facilitating 2-point shot attempts and consider implementing a 3:1 ratio of 2-point to 3-point attempts to maximize scoring success, and they should focus on winning rebounds to facilitate more shot attempts.