OBJECTIVE: To evaluate the effects of a multicomponent training protocol and detraining on frailty status, physical activity level, sedentary behavior patterns, and physical performance in pre-frail older adults.
METHODS: A randomized controlled blinded trial was conducted with pre-frail older adults (74.8 ± 6.4 years, 70.4% female), who were allocated to receive a multicomponent training (MulTI = 16) or control group (CG = 11), which received guidance to maintain their daily living habits. Assessments of the frailty phenotype, physical activity levels measured by accelerometer, and physical performance (gait speed, timed up and go, short physical performance battery) were conducted at pre-intervention, post-intervention (16 weeks), and follow-up (6 weeks). The effect of the intervention was analyzed using the marginal homogeneity test and the two-way ANOVA with repeated measures.
RESULTS: All older adults who received the MulTI reversed their frailty status to non-frail (p < 0.001), and after follow-up, 87.5% remained non-frail. In the CG, one older adult reversed their frailty status to non-frail and another became frail (p > 0.05), maintaining this status after the follow-up period. Furthermore, only the older adults in the MulTI showed an improvement in gait speed post-intervention, which was maintained through follow-up (p = 0.008). No changes were observed in the other variables.
CONCLUSIONS: The MulTI was efficient to reverse the process of frailty and improving gait speed in pre-frail older adults. However, receiving only the MulTI was not sufficient to increase physical activity levels and reduce sedentary behavior patterns, necessitating the implementation of behavioral change strategies.
BACKGROUND: ClinicalTrials.gov NCT03110419.

UNASSIGNED: To examine changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR).
UNASSIGNED: This prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 ± 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis.
UNASSIGNED: At start, service-users were sedentary for 12.6 ± 0.7 h · day-1 and accumulated most PA at a light-intensity (133.52 ± 28.57 min · day-1) - neither changed significantly during RDCR. Sleep efficiency significantly reduced from start (88.80 ± 4.2%) to the end (86.1 ± 4.76%) of CR, with values meeting health-based recommendations (≥85%). Barriers to RDCR exercise included exertional discomfort and cardiac symptoms, and reduced confidence when exercising alone. Setting meaningful PA goals, self-monitoring health targets, and having social support, facilitated PA and exercise during RDCR.
UNASSIGNED: Our RDCR programme failed to elicit significant changes in MB or sleep. To increase the likelihood of successful RDCR, it is important to promote a variety of exercise and PA options, target sedentary time, and apply theory to RDCR design, delivery, and support strategies.
Practitioners should work with service-users to understand how best to support them to maximise the benefit(s) of remotely/hybrid delivered services.Facilitating easy (and regular) access to health professionals during remotely/hybrid delivered cardiac rehabilitation (CR) will support the development of service-users’ physical activity (PA) and exercise self-efficacy (i.e., confidence).Remotely/hybrid delivered CR should be informed by theory and/or behaviour change techniques to support increased PA, reduced sedentary time and improved sleep during and after CR.It is important to include strategies to reduce sedentary time in addition to targeting PA and exercise in remotely-delivered CR.

OBJECTIVE: To compare the efficacy of interferential current (IFC) therapy combined with quadriceps strengthening exercise versus sham IFC plus exercise for pain relief and functional improvement in patients with knee osteoarthritis.
METHODS: Double-blind randomised controlled trial.
METHODS: Outpatient rehabilitation clinic.
METHODS: Knee osteoarthritis patients aged 50-85 years with a pain score ≥4/10.
METHODS: One hundred forty-four participants were randomly allocated into the study and control groups. The study group received 20 min of IFC therapy (carrier frequency: 4000 Hz, beat frequency: 100 Hz) five times per week for three weeks, while the control group received sham IFC following the same protocol, followed by 10 min of exercise in both groups. Outcome measures included Numeric Rating Scale for Pain, Western Ontario and McMaster Universities Index (WOMAC) score, gait speed, and EuroQol-Five Dimensions-Five Levels questionnaire assessed at baseline, Week 3, and Week 6. Adverse events and patient satisfaction were evaluated at Week 3.
RESULTS: At Week 3, the study group demonstrated statistical improvement compared to the control group for Numeric Rating Scale for Pain, WOMAC Total, WOMAC Pain, and WOMAC Stiffness. The mean difference (95% confidence interval) between groups was 0.76 (0.21-1.30), 0.49 (0.03-0.95), 0.63 (0.13-1.13), and 0.62 (0.04-1.20), respectively. However, the mean differences between groups were below the Minimally Clinically Important Difference values for each outcome. Additionally, there were no significant differences between groups at Week 6 for any outcome measure.
CONCLUSIONS: IFC had no effect on pain reduction and functional improvement in patients with mild to moderate knee osteoarthritis.

OBJECTIVE: This study aimed to explore perceptions regarding the sustainability of exercise following participation in a pre- and post-colorectal surgery exercise intervention trial (PREPARE-ABC).
METHODS: Qualitative interview study. Data were analysed using framework analysis and independently coded by two researchers.
METHODS: Six United Kingdom National Health Service Trusts.
METHODS: Eighteen interviews (hospital-based exercise n = 9, home-based exercise n = 3, standard care n = 6) were conducted with patients 12-15 months after being randomised in the trial, after their 12 month appointment.
METHODS: Individuals who participated in one of two exercise intervention groups (hospital-supervised or home-supported exercise) or a standard care control group of the PREPARE-ABC trial were invited to interview.
RESULTS: The exercise interventions were reported to influence participants\' recovery and future sustainability of exercise behaviour change. Several participants continued to engage in exercise over a year after their surgery. Reasons for this included being engaged with exercise prior to diagnosis, psychological benefits of exercise and wanting to be engaged with something to help recovery. Perceptions about the sustainability of active lifestyles were influenced by confidence to engage in structured exercise or physical activity and beliefs about its potential to promote future wellness.
CONCLUSIONS: Sustainability varies among individuals and early assessment of physical activity engagement could be beneficial. Physical activity interventions immediately following surgery may be important for future engagement.

BACKGROUND: Premenstrual syndrome affects many women in their reproductive years and often disrupts their social connections and work. This study aimed to compare the effects of positive psychology and physical activity on depression, anxiety, and stress among students with premenstrual syndrome.
METHODS: In this four-group parallel clinical trial with blinded data analysis, 120 eligible students who experienced premenstrual syndrome were recruited based on inclusion/exclusion criteria and randomly allocated to four groups (n = 30) including three experiment groups as positive psychology, physical activity, and positive psychology, physical activity, and control group, using a simple randomization method. All four groups completed premenstrual syndrome screening and the DASS-21 questionnaire before the intervention. Then, the positive psychology intervention group received eight sessions of 70-90 min weekly intervention, the second group received eight weeks of aerobic physical activity intervention, and the third group received positive psychology and physical activity intervention for eight weeks. The control group did not receive any interventions. The DASS-21 was completed immediately after the intervention and two months later by all four groups. In this study, the participants and investigators were not blinded; however, the analysts were. The recruitment process took place from September 2018 to March 2019. One hundred twenty participants fulfilled the study. The Data were collected and analyzed using SPSS (v18).
RESULTS: Before and immediately after the intervention, there was no statistically significant difference in depression, anxiety, and stress mean scores among the positive psychology, physical activity, positive psychology, and physical activity and control groups (p ≥ 0.05). However, two months after the intervention, a significant difference was observed between the four groups so there was a difference between the scores of the three intervention groups and the control group (p < 0.05). There was no significant difference between positive psychology, and physical activity groups. No significant adverse events or side effects were observed.
CONCLUSIONS: Our findings supported the use of aerobic physical activity and educational interventions based on positive psychology as non-pharmacologic interventions to reduce anxiety, depression, and stress. This research should be replicated in different settings.
UNASSIGNED: Iranian Registry of Clinical Trials; https://irct.behdasht.gov.ir/trial/32363 (IRCT20130812014333N97), registered (11/08/2018).

OBJECTIVE: To evaluate the effects of replacing time spent in sedentary behavior (SB) with moderate to vigorous physical activity on sleep quality in young adults.
METHODS: Multicenter cross-sectional study, carried out with students enrolled in undergraduate courses at universities in Brazil. Sleep quality was assessed using a question of the World Health Organization Quality of Life (WHOQOL-brief) and classified as good or poor sleep quality. SB was evaluated by self-reported total sitting time, and the level of leisure-time PA was classified according to the intensity of moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA), which were assessed using a self-reported questionnaire. An isotemporal replacement logistic model was used to evaluate the effects of different SB, MPA, and VPA sessions on sleep quality.
RESULTS: A total of 8,059 study participants were evaluated, the majority had poor sleep quality (64.79%), were physically inactive (48.28%, defined as practicing < 150 min of MPA or < 75 min of VPA per week), and spent ≥ 9 h/day in SB (55.08%). The multivariate model showed an association between non-adherence to wake-based movement guidelines and poor sleep quality, where those with one altered behavior were 43% more likely to have poor sleep quality (OR:1.43;95%CI:1.27 to 1.60), while individuals with two altered behaviors were 97% more likely (OR:1.97;95%CI:1.73 to 2.24). In the isotemporal analysis, replacing MPA and VPA with equivalent time in SB increased the odds of poor sleep at all times assessed, with peaks of 56% for MPA and 68% for VPA.
CONCLUSIONS: The results of the present study indicate that replacing SB with the same amount of MPA or VPA may reduce poor sleep quality.

BACKGROUND: Understanding the impact of environmental factors on physical activity (PA) and physical fitness (PF) is crucial for promoting a healthy lifestyle among children and adolescents. This study examines how awareness of sports policies, school, family, and community environments influence PA and PF in Chinese youth.
METHODS: A cross-sectional study was conducted with 2747 children and adolescents (mean age 12.90 ± 2.49; 48.2% male) from 17 schools across five Chinese cities. Environmental factors were assessed via questionnaires, and PA levels were measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). PF metrics, including BMI, waist-to-height ratio, grip strength, vertical jump, and 20-m shuttle run test (20-mSRT), were measured onsite. Structural Equation Modeling (SEM) was used to explore relationships between environmental factors and PA/PF outcomes.
RESULTS: The school environment scored highest (78.0 ± 9.5), while the community environment scored lowest (38.7 ± 18.0). Family environment positively influenced low-intensity PA (LPA) (β = 0.102, P < 0.001) but negatively affected moderate-to-vigorous PA (MVPA) (β = -0.055, P = 0.035). Community environment and awareness of sports policies positively impacted MVPA (β = 0.216, P < 0.001; β = 0.072, P = 0.009, respectively). Family environment positively influenced BMI reduction (β = -0.103, P < 0.001) but negatively affected grip strength (β = -0.063, P = 0.018). Community environment improved grip strength and 20-mSRT performance (β = 0.088, P = 0.002; β = 0.065, P = 0.027).
CONCLUSIONS: School environments, despite high scores, do not significantly impact PA and PF. Community environments, though scoring lower, positively affect MVPA, grip strength, and 20-mSRT. Awareness of sports policies boosts MVPA, while family environments support LPA and BMI but are inversely related to MVPA and grip strength. Integrated strategies involving community infrastructure, family support, and policy awareness are essential for promoting active lifestyles among children and adolescents.

People with end-stage kidney disease (ESKD) often exhibit impaired cardiac structure and function, which may contribute to poor exercise capacity. This study used multimodal exercise testing to investigate the central and peripheral mechanisms of exercise limitation in adults with ESKD, also comparing in-centre hemodialysis (ICHD) to home hemodialysis (HHD). Seventeen adults (55.5 ± 14.5 years; n = 14 male; n = 12 HHD) participated. Resting cardiac examinations, followed by submaximal cycling cardiopulmonary exercise testing (CPET) and functional exercise testing, revealed cardiac structural abnormalities (increased left ventricular mass) and cardiac injury. Aerobic fitness in adults with ESKD was low, with pulmonary oxygen uptake (V̇O2) at the gas exchange threshold (GET) occuring at 39 ± 8% predicted V̇O2peak. O2 pulse, an estimate of stroke volume (SV), was higher in HHD at rest (p = 0.05, ES = 0.58) and during unloaded cycling (p = 0.05, ES = 0.58) compared to ICHD. However, thoracic bioreactance derived SV at the GET was significantly higher in adults receiving ICHD versus HHD (p = 0.01, ES = 0.74). In adults with ESKD, cardiac output was positively associated with V̇O2 at the GET (r = 0.61, p = 0.04). This study highlights prevalent exercise dysfunction in adults with ESKD undergoing dialysis, with potential distinct differences between in-centre and home hemodialysis, mechanistically linked to underlying cardiac abnormalities.

BACKGROUND: Physical exercise and exposure to air pollution have counteracting effects on individuals\' health outcomes. Knowledge on individuals\' real-time exercise behavior response to different pollution information sources remains inadequate.
OBJECTIVE: This study aims to examine the extent to which individuals avoid polluted air during exercise activities in response to different air pollution information sources.
METHODS: We used data on individuals\' exercise behaviors captured by wearable and mobile devices in 83 Chinese cities over a 2-year time span. In our data set, 35.99% (5896/16,379) of individuals were female and 64% (10,483/16,379) were male, and their ages predominantly ranged from 18 to 50 years. We further augmented the exercise behavior data with air pollution information that included city-hourly level measures of the Air Quality Index and particulate matter 2.5 concentration (in µg/m3), and weather data that include city-hourly level measures of air temperature (ºC), dew point (ºC), wind speed (m/s), and wind direction (degrees). We used a linear panel fixed effect model to estimate individuals\' exercise-aversion behaviors (ie, running exercise distance at individual-hour, city-hour, or city-day levels) and conducted robustness checks using the endogenous treatment effect model and regression discontinuity method. We examined if alternative air pollution information sources could moderate (ie, substitute or complement) the role of mainstream air pollution indicators.
RESULTS: Our results show that individuals exhibit a reduction of running exercise behaviors by about 0.50 km (or 7.5%; P<.001) during instances of moderate to severe air pollution, and there is no evidence of reduced distances in instances of light air pollution. Furthermore, individuals\' exercise-aversion behaviors in response to mainstream air pollution information are heightened by different alternative information sources, such as social connections and social media user-generated content about air pollution.
CONCLUSIONS: Our results highlight the complementary role of different alternative information sources of air pollution in inducing individuals\' aversion behaviors and the importance of using different information channels to increase public awareness beyond official air pollution alerts.

UNASSIGNED: Although several important documents of education and health promotion on the international level favor practices geared toward physical literacy (PL), not all countries have yet gained experience with this holistic concept. Therefore, numerous stakeholders and practitioners who intend to align their interventional activities with PL will soon face the situation that there are no recommendations for their specific culture and language for how to design such programs. Given that such recommendations are also lacking for Germany, the goal of the present study within the uncontrolled pilot cycles of the PLACE study was (a) to describe the process of a female pedagogue (27 years old, previously unexperienced with PL) initially familiarizing herself with the PL concept and its implementation opportunities for the school setting, and (b) to retrace the process of developing and refining a PL-driven intervention for extracurricular physical education (60-90 min) of children in grades three and four at primary schools in Bremen.
UNASSIGNED: Adopting a self-study design, this endeavor emphasized continuous reflexivity involving: (a) session protocols; (b) biweekly discussions with another coach; (c) weekly discussions between scientists and stakeholders of youth development (\"multi-perspective panel\"); (d) weekly observations and impressions during field work; and (e) summative group interviews with children (n = 17, age range: 8-9 years, 17.6% boys). Written documents underwent qualitative content analysis with inductively generated categories.
UNASSIGNED: Despite explicit links between the theoretical PL domains and the intervention content, the character of how PL informed the intervention level was dominated by the stance and atmosphere implemented by the deliverer (e.g., participatory attitude, open mindset). Accordingly, the team revised the intervention primarily on the levels of organization (temporal schedule and sequences), instruction, and materials. After initial stages of didactically \"surviving\" within classes, the deliverer could increasingly integrate tasks of cognitive engagement and provide choice for students enabling individual autonomy for nurturing a person-centered approach.
UNASSIGNED: This study encourages teachers and stakeholders of physical education to seek exchange with scholars or other practitioners while simultaneously demonstrating patience in comprehensively internalizing PL and efficiently translating the concept into routines in line with individual\'s quality standards.