BACKGROUND: People with plantar heel pain (PHP) have reduced foot and ankle muscle function, strength and size, which is frequently treated by muscle strengthening exercises. However, there has been little investigation of what exercises are used and there is no sound evidence base to guide practice. This study aimed to develop a consensus-driven progressive muscle strengthening program for PHP.
METHODS: Thirty-eight experts were invited to participate in the study over three rounds. Round 1 was an open-ended questionnaire that provided the core characteristics of progressive strengthening programs designed for three different adult patient types with PHP (younger athletic, overweight middle-aged, older), which were presented as vignettes. In Round 2, experts indicated their agreement to the proposed exercises and training variables. In Round 3, experts were presented with amendments to the exercises based on responses from Round 2 and indicated their agreement to those changes. Consensus was achieved when > 70% of experts agreed.
RESULTS: Two experts were ineligible and 12 declined, leaving 24 (67%) who participated in Round 1. Eighteen (75%) completed all three rounds. From Round 1, progressive strengthening programs were developed for the three vignettes, which included 10 different exercises and three training variables (sets / repetitions, weight, and frequency). In Round 2, 68% (n = 17) of exercises and 96% (n = 72) of training variables reached consensus. In Round 3, only exercise changes were presented and 100% of exercises reached consensus.
CONCLUSIONS: This study provides three progressive strengthening programs agreed to by experts that can be used in future clinical trials to determine the effectiveness of muscle strengthening for PHP. In addition, clinicians could use the programs as part of a rehabilitation strategy with the caveat that they may change as more research is conducted.

Purpose to evaluate the prevalence and temporal trends in adherence to muscle-strengthening activity (MSA) guidelines among the US population from 1997 to 2018 (pre-Covid 19).
We used nationally representative data from the National Health Interview Survey of the US (NHIS; a cross-sectional household interview survey). We pooled data from 22 consecutive cycles (1997 to 2018) and estimated prevalence and trends of adherence to MSA guidelines among adults aged 18-24 years, 25-34 years, 35-44 years, 45-64 years, and ≥ 65 years.
A total of 651,682 participants (mean age 47.7 years [SD = 18.0], 55.8% women) were included. The overall prevalence of adherence to MSA guidelines significantly increased (p < .001) from 1997 to 2018 (19.8% to 27.2%, respectively). Adherence levels significantly increased (p < .001) for all age groups from 1997 to 2018. Compared with their white non-Hispanic counterparts, the odds ratio for Hispanic females was 0.5 (95% CI = 0.4-0.6).
It is over a 20-year span, adherence to MSA guidelines increased across all age groups, although the overall prevalence remained below 30%. Future intervention strategies to promote MSA are required with a particular focus on older adults, women, Hispanic women, current smokers, those with low educational levels, and those with functional limitations or chronic conditions.

UNASSIGNED: Despite functional and cognitive benefits, few adults and older adults do strength training twice per week with sufficient intensity. Exercise-based active video games (exergaming) may amplify the cognitive benefits of exercise and increase adherence and motivation toward training. However, the benefits of a well-defined and monitored dose of strength training, executed simultaneously or sequentially with a cognitive element, has received little attention. In this study we have two aims: First, to systematically gather the available evidence; second, to suggest possible ways to promote strength exergaming innovations.
UNASSIGNED: We systematically reviewed randomized controlled trials using simultaneous or sequent combined strength and cognitive training or strength exergaming to improve cognitive or functional outcomes in adults and older adults.
UNASSIGNED: After screening 1,785 studies (Google Scholar, ACM Digital Library, IEEE Xplore Library, PsycARTICLES, Scopus, Cochrane Library and PubMed) we found three eligible studies. Of the two studies using sequent strength and cognitive training, one showed improved functionality, but the other showed negative effects on cognition. The third study using simultaneous intervention, reported a positive influence on both cognition and function, when compared with either strength training alone or a control group. Moderate level of evidence was showed on GRADE analysis.
UNASSIGNED: The existing little evidence suggests that strength and cognitive training improves cognition and function in adults and older adults. The following suggestions may help to promote further innovation: (1) ensure minimal dosage of strength training (30-60 min, 2 × /week), (2) use machine-based strength training devices to control volume and intensity (to prevent cognitive components from interfering with strength training), (3) include power training by using cognitive tasks requiring rapid reactions, and (4) add cognitive memory tasks (to extend the cognitive benefits of strength training per se), and (5) include motivational exergame elements to increase adherence.

OBJECTIVE: Muscle-strengthening activity (MSE e.g. push-ups, sit-ups, use of weight machines) is linked to multiple health benefits for youth, and is part of the global physical activity guidelines for children and adolescents (5-17 years). However, MSE is rarely assessed in youth health surveillance. This study describes the longitudinal trends and predictors of MSE among a cohort of Canadian youths.
METHODS: Longitudinal.
METHODS: Data were drawn from a cohort of 3366 youths who participated in three waves of COMPASS, a longitudinal study of secondary school students across Canada [Wave 1 (T1) 2015/16, Wave 2 (T2) 2016/17, Wave 3 (T3) 2018/19]. The prevalence of the sample meeting the MSE guideline (≥3 days/week) was calculated for each wave. A multivariable logistic regression assessed the odds of meeting the MSE guideline for each wave (T1 and T2 and T3) across sociodemographic/lifestyle characteristics (e.g. sex, race, regionally, Body Mass Index, and aerobic physical activity).
RESULTS: For the total sample, MSE guideline adherence significantly declined across each study wave (T1 = 57.0%; T2 = 52.0%; T3 = 48.5%; p < 0.001 for linear trend). Population sub-groups less likely to meet the guideline at each wave included females, youth who were underweight or obese, those reporting insufficient aerobic physical activity, those from large urban settings, and youth who identify as Asian.
CONCLUSIONS: Among a large sample of Canadian youths, approximately half met the MSE guideline, with this prevalence declining over time. Large-scale MSE interventions are needed to address the low and decreasing adherence to this key modifiable health-related behavior among Canadian youths.

BACKGROUND: Compared with engaging in aerobic physical activity (aerobic PA; eg, walking, running, cycling) or muscle-strengthening exercise (MSE; eg, weight/resistance training) alone, epidemiological evidence suggests that combining both is linked to better health. However, the assessment of both PA modes is rare in health surveillance. This article provides the first multicountry study on the descriptive epidemiology of combined moderate to vigorous PA-MSE guideline adherence.
METHODS: Data were drawn from the European Health Interview Survey wave 2 (2013-2014), comprising samples from 28 European countries (n = 280,605). Self-reported aerobic PA and MSE were assessed using the validated European Health Interview Survey Physical Activity Questionnaire. The authors calculated the weighted proportions meeting the health-enhancing PA guideline (aerobic PA ≥ 150 min/wk and MSE ≥ 2 sessions/wk). Poisson regression assessed the prevalence ratios for meeting the combined guideline across sociodemographic factors and by country.
RESULTS: A total of 15.0% met the health-enhancing PA guideline. The lowest prevalence was from respondents from Southern and Central European countries (Romania, Poland, and Croatia, range: 0.5%-5.7%). Poorer self-rated health, older age, lower income, being female, and being obese had a lower likelihood of meeting the combined guideline.
CONCLUSIONS: Most European adults do not meet the health-enhancing PA guideline that includes both aerobic PA and MSE.

Despite the 2016 German \"National Recommendations for Physical Activity and Physical Activity Promotion\" stating that adults (≥18 years) should engage in: [a] ≥150 minutes of aerobic moderate-to-vigorous-intensity physical activity/week (MVPA); and [b] ≥2 days/week of muscle-strengthening exercise (MSE), there is limited research on the descriptive epidemiology on the adherence to these guidelines among German adults. This study describes the prevalence and correlates of physical activity guideline adherence among a nationally representative sample of German adults. Data were drawn from the 2014 German Health Update survey, collected via a combination of web-based and mail surveys. Self-reported physical activity levels were assessed using the previously validated European Health Interview Survey Physical Activity Questionnaire. Weighted prevalence levels of the sample meeting the aerobic MVPA (≥150 minutes/week), MSE (≥2 times/week), and combined MVPA-MSE guidelines were calculated. Poisson regressions were used to assess prevalence ratios for physical activity guideline adherence categories across sociodemographic and lifestyle-related variables. Out of 24,016 participants (response rate = 27.6%), aged ≥ 18 years, 45.3% (95% CI: 44.5%-46.0%), 29.4% (95% CI: 28.7%-30.1%), and 22.6% (95% CI: 21.9%-23.2%) met the aerobic MVPA, MSE, and combined guidelines, respectively. Population sub-groups less likely to meet the combined guidelines included those with poor self-rated health, being unemployed, low socioeconomic status, being a current smoker, and those being overweight or obese. Since ~ 80% of German adults do not meet the nationally recommended combined aerobic MVPA-MSE physical activity guidelines, there is a necessity for large-scale public health interventions promoting both aerobic MVPA and MSE.

OBJECTIVE: Guidelines for cancer survivors recommend both aerobic physical activity (PA) and strength training (ST). Few kidney cancer survivors (KCS) are meeting single-activity or combined guidelines; therefore, examining factors influencing PA participation is warranted. The purpose of this study is to examine demographic, medical, social-cognitive, and environmental correlates of meeting independent (i.e., aerobic-only, strength training (ST)-only) and combined guidelines (i.e., aerobic and ST) in KCS.
METHODS: KCS (N = 651) completed self-reported measures of PA and demographic, medical, social-cognitive, and perceived environmental factors. Built environment was assessed using the geographic information systems (GIS). Multinomial logistic regressions were conducted to determine the correlates of meeting the combined versus independent guidelines.
RESULTS: Compared with meeting neither guideline, meeting aerobic-only guidelines was associated with higher intentions (p < .01) and planning (p < .01); meeting ST-only guidelines was associated with higher intentions (p = .02) and planning (p < .01), lower perceived behavioral control (PBC) (p = .03), healthy weight (p = .01), and older age (p < .01); and meeting the combined guidelines were associated with higher intentions (p < .01), planning (p = .02), higher instrumental attitudes (p < .01), higher education (p = .04), better health (p < .01), and localized cancer (p = .05). Additionally, compared with neither guideline, meeting aerobic-only (p < .01) and combined (p < .01) guidelines was significantly associated with access to workout attire. Compared with neither guideline, meeting aerobic-only guidelines was associated with proximity to retail (p = .02).
CONCLUSIONS: PA participation correlates may vary based on the modality of interest. Interventions may differ depending on the modality promoted and whether KCS are already meeting single-modality guidelines.

BACKGROUND: We report on the correlation between the proportion of people who fulfil the recommended amount of aerobic physical activity in the general population and the prevalence of frailty or prefrailty in the population ≥65 years in 11 European countries (Austria, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, Slovenia, Spain and Sweden). In a subgroup analysis, it was assessed if people who do aerobic physical activity also do strength training.
METHODS: Aggregated physical activity data were taken from the European Health Interview Survey with the minimum effective sample size of 90,036 participants. Data on frailty status were taken from the Survey of Health Ageing and Retirement in Europe (SHARE) study (N = 24,590). For the subgroup analysis, data of the Austrian Health Interview Survey (ATHIS) (N = 15,770) were included.
RESULTS: The results indicate a significant negative correlation between the proportion of people fulfilling the minimal aerobic physical activity recommendations (≥150 min/week) and the proportion of prefrail or frail people (R = -0.745; p = 0.008). The correlation between the optimal aerobic physical activity recommendations (≥300 min/week) and the proportion of prefrail or frail individuals was R = -0.691 (p = 0.019). In both data sets a north-south gradient was seen. Austrian data showed that 52.0% of the participants fulfilled the minimal aerobic physical activity recommendations and conducted strength training, whereas 18.4% did not fulfil the aerobic recommendations but performed strength training (p < 0.001).
CONCLUSIONS: By taking into account that the number of people ≥65 years will increase in the future these results may be relevant in planning public health interventions for the whole population with the goal of reducing frailty in the elderly.

Purpose Obesity and excessive weight gain during pregnancy is a growing problem, conferring severe health risks for both mother and fetus. Exercise can help combat this epidemic. However, many pregnant women are not meeting the American Congress of Obstetricians and Gynecologists\' (ACOG\'s) 2015 guidelines for exercise during pregnancy. The objective of this study was to evaluate obstetricians\' beliefs and recommendations regarding exercise during pregnancy compared to ACOG\'s 2015 recommendations. Method Obstetricians were recruited via three different forums to complete a twenty-question survey: at a regional conference for Alabama and Mississippi ACOG members, at the University of Alabama at Birmingham\'s Obstetrics and Gynecology Department\'s Grand Rounds, and via telephone. Univariate statistical analysis was conducted with RedCap. Results  Seventy-one surveys were completed: 33 from the ACOG conference, 27 from Grand Rounds, and 11 from those recruited by telephone. Eighty-eight percent (n=60) of respondents correctly identified ACOG\'s recommendation of unrestricted exercise for women with uncomplicated pregnancies. One-fourth (24%; n=16) regularly discuss exercise with most (76%-100%) pregnant patients. Most (57%; n=59) do not consistently (\"never,\" \"rarely,\" or \"sometimes\") recommend sedentary patients begin exercising during pregnancy. Nearly all (97%; n=66) advise first-trimester patients to perform aerobic exercise two to five days per week, but the recommended duration varies. One-fourth (24%; n=16) do not recommend strength-training exercise during the first trimester. Twenty-five percent (n=17) and 32% (n=22) recommend decreased aerobic or strength-training exercise, respectively, in the third trimester. More than half (54%; n=37) recommend pregnant patients limit exercise by heart rate, most commonly 121-140 bpm (25%; n=17) or 141-160 bpm (24%; n=16). Sixty-eight percent (n=46) feel \"comfortable\" or \"very comfortable\" providing advice on exercise during pregnancy. Conclusion Despite believing exercise benefits pregnant women, knowing ACOG\'s 2015 guidelines endorse unrestricted exercise for women with uncomplicated pregnancies, and feeling comfortable discussing this topic with patients, obstetricians are not consistently counseling their pregnant patients on exercise. Notably, physicians are not instructing their sedentary pregnant patients to exercise. While most physicians provide appropriate advice on aerobic exercise, their advice on resistance training, maximum heart rate during exercise and third-trimester exercise are often discordant with ACOG\'s guidelines.

OBJECTIVE: To determine the association between meeting strength training guidelines (≥2 times per week) and the presence of functional limitations among older adults.
METHODS: This cross-sectional study used data from older adult participants (N=6763) of the National Health Interview Survey conducted in 2011 in the United States.
RESULTS: Overall, 16.1% of older adults reported meeting strength training guidelines. For each of nine functional limitations, those with the limitation were less likely to meet strength training recommendations than those without the limitation. For example, 20.0% of those who reported no difficulty walking one-quarter mile met strength training guidelines, versus only 10.1% of those who reported difficulty (p<.001). In sum, 21.7% of those with no limitations (33.7% of sample) met strength training guidelines, versus only 15.9% of those reporting 1-4 limitations (38.5% of sample) and 9.8% of those reporting 5-9 limitations (27.8% of sample) (p<.001).
CONCLUSIONS: Strength training is uncommon among older adults and even less common among those who need it the most. The potential for strength training to improve the public\'s health is therefore substantial, as those who have the most to gain from strength training participate the least.