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Objectives: Corporate executive job demands may lead to poor sleep habits, increasing their risk for cardiometabolic disease. This study aimed to describe and explore associations between objectively measured habitual sleep characteristics and cardiometabolic disease risk of corporate executives, while accounting for occupational, psychological, and lifestyle factors., Methods: Habitual sleep was measured using wrist-worn actigraphy and a sleep diary over seven consecutive days in 61 (68.3% men) corporate executives aged 46.4 ± 8.7years. A composite cardiometabolic disease risk score was determined using body mass index, waist circumference, blood pressure and fasting glucose and lipid concentrations. Prediction models were built using a backward stepwise selection approach to explore associations between sleep characteristics and cardiometabolic disease risk factors adjusting for occupational, psychological, and lifestyle covariates., Results: Average total sleep time was 6.60 ± 0.75 hours, with 51.7% of participants reporting poor sleep quality and 26.2% extending their weekend sleep. Adjusted models showed that lower sleep efficiency (β = -0.25, 95%CI: -0.43; -0.08, P = .006), shorter weekday total sleep time (β = -1.37, 95% CI: -2.41, -0.32; P = .011) and catch-up sleep (β = 0.84, 95%CI: 0.08, 1.60, P = .002) were associated with higher cardiometabolic disease risk scores. Adjusted models also found that shorter average time-in-bed (ß=-2.00, 95%CI: -3.76; -0.18, P = .031), average total sleep time (ß=1.98, 95%CI: -3.70; -0.25, P = .025) and weekday total sleep time (β = -2.13, 95%CI: -3.56; -0.69, P = .025) as well as catch-up sleep (β = 1.67, 95% CI: 0.52; 2.83; P = .012) were all associated with a higher body mass index., Conclusion: Corporate executives who compromise sleep duration during the working week may increase their risk for obesity and future cardiometabolic disease., Competing Interests: Declaration of conflicts of interest This was not an industry supported study. However, PRP was employed by Life Healthcare (SA), Life Health Solutions, of which corporate HRA data was used for this study. There are no other potential competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics., Methods: IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention- and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline., Results: Minimal significant beneficial exercise effects on self-reported CF (β=-0.09 [-0.16; -0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=-0.13 [-0.24; -0.02]), and no significant effect during cancer treatment (n=1,162, β=-0.08 [-0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=-0.14 [-0.25; -0.04]) or 24 weeks or longer (β=-0.18 [-0.32; -0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [-0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=-0.10 [-0.19; -0.02]) or after completion of treatment in patients with cognitive problems (β=-0.19 [-0.31; -0.06]). No other significant moderators were identified., Conclusions: This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline., Implications for Cancer Survivors: This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors., (© 2023. The Author(s).)

Background: There is insufficient evidence to provide recommendations for leisure-time physical activity among workers across various occupational physical activity levels. This study aimed to assess the association of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels., Methods: This study utilized individual participant data from 21 cohort studies, comprising both published and unpublished data. Eligibility criteria included individual-level data on leisure-time and occupational physical activity (categorized as sedentary, low, moderate, and high) along with data on all-cause and/or cardiovascular mortality. A 2-stage individual participant data meta-analysis was conducted, with separate analysis of each study using Cox proportional hazards models (Stage 1). These results were combined using random-effects models (Stage 2)., Results: Higher leisure-time physical activity levels were associated with lower all-cause and cardiovascular mortality risk across most occupational physical activity levels, for both males and females. Among males with sedentary work, high compared to sedentary leisure-time physical activity was associated with lower all-cause (hazard ratios (HR) = 0.77, 95% Confidence interval(95%CI): 0.70-0.85) and cardiovascular mortality (HR = 0.76, 95%CI: 0.66-0.87) risk. Among males with high levels of occupational physical activity, high compared to sedentary leisure-time physical activity was associated with lower all-cause (HR = 0.84, 95%CI: 0.74-0.97) and cardiovascular mortality (HR = 0.79, 95%CI: 0.60-1.04) risk, while HRs for low and moderate levels of leisure-time physical activity ranged between 0.87 and 0.97 and were not statistically significant. Among females, most effects were similar but more imprecise, especially in the higher occupational physical activity levels., Conclusion: Higher levels of leisure-time physical activity were generally associated with lower mortality risks. However, results for workers with moderate and high occupational physical activity levels, especially women, were more imprecise. Our findings suggests that workers may benefit from engaging in high levels of leisure-time physical activity, irrespective of their level of occupational physical activity., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Background: Although the prescription of physical activity in clinical care has been advocated worldwide, in the Netherlands, "Exercise is Medicine" (E = M) is not yet routinely implemented in clinical care., Methods: A set of implementation strategies was pilot implemented to test its feasibility for use in routine care by clinicians in 2 departments of a university medical center. An extensive learning process evaluation was performed, using structured mixed methods methodology, in accordance with the Reach, Effect, Adoption, Implementation, and Maintenance framework., Results: From 5 implementation strategies employed (education, E = M tool embedded in the electronic medical records, lifestyle coach situated within the department, overviews of referral options, and project support), the presence of adequate project support was a strong facilitator of the implementation of E = M. Also, the presence of the lifestyle coach within the department seemed essential for referral rate. Although clinicians appreciated the E = M tool, barriers hampered its use in practice., Conclusions: Specific implementation strategies, tailored to the setting, are effective in facilitating the implementation of E = M with specific regard to education for clinicians on E = M, deployment of a lifestyle coach within a department, and project coordination. Care providers do see a future for lifestyle coaches who are structurally embedded in the hospital, to whom they can easily refer.

Purpose: A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers., Methods: We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC)., Results: Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow., Conclusions: In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 te Loo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: To better understand physical activity behavior and its health benefits in people living with health conditions, we studied people with and without 20 different self-reported health conditions with regard to (1) their physical activity levels, (2) factors correlated with these physical activity levels, and (3) the association between physical activity and all-cause mortality., Methods: We used a subsample (n = 88,659) of the Lifelines cohort study from the Netherlands. For people living with and without 20 different self-reported health conditions, we studied the aforementioned factors in relation to physical activity. Physical activity was assessed with the Short Questionnaire to Assess Health-Enhancing Physical Activity Questionnaire, and mortality data were obtained from the Dutch death register., Results: People with a reported health condition were less likely to meet physical activity guidelines than people without a reported health condition (odds ratios ranging from 0.55 to 0.89). Higher body mass index and sitting time, and lower self-rated health, physical functioning, and education levels were associated with lower odds of meeting physical activity guidelines across most health conditions. Finally, we found a protective association between physical activity and all-cause mortality in both people living with and without different health conditions., Conclusion: People living with different health conditions are generally less physically active compared with people living without a health condition. Both people living with and without self-reported health conditions share a number of key factors associated with physical activity levels. We also observed the expected protective association between physical activity and all-cause mortality.

Introduction: The number of randomized controlled trials (RCTs) investigating the effects of exercise among cancer survivors has increased in recent years; however, participants dropping out of the trials are rarely described. The objective of the present study was to assess which combinations of participant and exercise program characteristics were associated with dropout from the exercise arms of RCTs among cancer survivors., Methods: This study used data collected in the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) study, an international database of RCTs investigating the effects of exercise among cancer survivors. Thirty-four exercise trials, with a total of 2467 patients without metastatic disease randomized to an exercise arm were included. Harmonized studies included a pre and a posttest, and participants were classified as dropouts when missing all assessments at the post-intervention test. Subgroups were identified with a conditional inference tree., Results: Overall, 9.6% of the participants dropped out. Five subgroups were identified in the conditional inference tree based on four significant associations with dropout. Most dropout was observed for participants with BMI >28.4 kg/m 2 , performing supervised resistance or unsupervised mixed exercise (19.8% dropout) or had low-medium education and performed aerobic or supervised mixed exercise (13.5%). The lowest dropout was found for participants with BMI >28.4 kg/m 2 and high education performing aerobic or supervised mixed exercise (5.1%), and participants with BMI ≤28.4 kg/m 2 exercising during (5.2%) or post (9.5%) treatment., Conclusions: There are several systematic differences between cancer survivors completing and dropping out from exercise trials, possibly affecting the external validity of exercise effects., (© 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Objective: The aim of the study is to explore the barriers and facilitators of participation and key components for sleep health programs designed for corporate work environments., Methods: Semistructured interviews with corporate executives and occupational medicine specialists in the decision making and management of workplace health promotion programs (WHPP) within their companies were held before and during COVID-19. Interviews were transcribed verbatim and analyzed using thematic content analysis to identify themes., Results: Barrier and facilitator themes emerging from the data include sleep health awareness, work culture, work-family balance, and confidentiality. Key components for sleep health programs included the following: identifying the need for a program, incorporating sleep health risk screening to WHPP, and promoting sleep health by raising awareness thereof., Conclusions: The identified barriers and facilitators to employee participation and key components of an ideal sleep health program provide guidance for further WHPP., Competing Interests: Conflict of interest: P.P. declared that she was employed by Health Partners during the study; A.B. declared that she was employed by CAOP during the study; W.v.M. declared that he was shareholder of company Evalua during the study. All three organizations Health Partners, CAOP, and Evalua were not involved in this study and were not involved in this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Objective: This study aimed to determine the longitudinal associations between self-reported sleep duration and cardiometabolic disease (CMD) risk in corporate executives., Methods: Self-reported sleep duration and lifestyle, occupational, psychological, and anthropometrical, blood pressure and blood marker variables were obtained from 1512 employees at annual health risk assessments in South Africa between 2016 and 2019. Gender-stratified linear mixed models, adjusting for age, lifestyle, occupational and psychological covariates were used to explore these longitudinal associations., Results: Among women, shorter sleep duration was associated with higher body mass index (BMI) covarying for age only (ß with 95% confidence intervals: -0.19 [-0.36, -0.03]), age and occupational factors (-0.20 [-0.36, -0.03]) and age and psychological factors (-0.20 [-0.37, -0.03]). Among men, shorter sleep was associated with both BMI and waist circumference (WC) covarying for age only (BMI: -0.15 [-0.22; -0.08]; WC: -0.62 [-0.88; -0.37]); age and lifestyle factors (BMI: -0.12 [-0.21; -0.04]); WC: -0.016 [-0.92; -0.29], age and occupational factors (BMI: -0.20 [-0.22; 0.08]; WC: -0.62 [-0.88; -0.36]), and age and psychological factors (BMI: -0.15 [-0.22; -0.07]; WC: -0.59 [-0.86; -0.33]). Among men, shorter sleep was also longitudinally associated with higher CMD risk scores in models adjusted for age and lifestyle factors (CMD: -0.12 [-0.20; -0.04]) and age and psychological factors (CMD: -0.08 [-0.15; -0.01])., Conclusion: Corporate executives who report shorter sleep durations may present with poorer CMD risk profiles, independent of age, lifestyle, occupational and psychological factors. Addressing sleep health in workplace health programmes may help mitigate the development of CMD in such employees., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings., Competing Interests: Competing interests: EV is Editor in Chief of BMJ Open Sports & Exercise Medicine., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This paper investigated facilitators and barriers to implementing the European Football Fans in Training program (EuroFIT) in professional sports clubs in England, the Netherlands, Norway, and Portugal. We analyzed qualitative data collected at clubs that delivered EuroFIT, based on semi-structured interviews with coordinating staff (n = 15), coaches (n = 16), and focus group interviews with participants (n = 108), as well as data from clubs that considered delivering EuroFIT in the future, based on interviews with staff (n = 7) and stakeholders (n = 8). Facilitators for implementation related to the content and structure of the program, its evidence-base, and the context for delivery in the football stadia. Financial and human resources were both facilitators and barriers. Further barriers were mostly practical, relating to human resources and infrastructure. Major differences between countries related to experience and commitment to running community projects, and differences in infrastructure, financing, and human resources. Professional football clubs' ability to support health promotion efforts depended on their ethos and the financial and human resources available to them. Overall, the EuroFIT program was well received by clubs, coaches, participants, and stakeholders, which was reflected by the many facilitators supporting sustained implementation. For sustainable implementation, it is crucial that clubs and their stakeholders engage fully with the EuroFIT program and understand that for an adequate program delivery their views (ethos) and ways of working influence the implementation and thereby the effectiveness of EuroFIT. An important prerequisite for future roll out of EuroFIT would be a strong EuroFIT delivery partner organization to ensure financial and human resources while overseeing and guiding the quality of delivery in clubs., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Abstract: Mukherjee, S, Fok, JR, and van Mechelen, W. Electrical stimulation and muscle strength gains in healthy adults: A systematic review. J Strength Cond Res 37(4): 938-950, 2023-Electrical muscle stimulation (EMS) is a popular method for strength gains among athletes and fitness enthusiasts. This review investigated the literature from 2008 to 2020 on EMS application protocols, strength adaptations, neural adaptations, and its use as an independent and combined training tool for strength gain in healthy adults. The investigation was modeled after the 2020 PRISMA guidelines. The eligibility criteria included studies that assessed the effect of EMS, either alone or in combination with voluntary resistance training (VRT) in healthy adult populations, involving a control group performing either usual or sham training, with at least 1 performance outcome measure assessed during experimental randomized controlled trials (RCTs), cluster RCT, randomized crossover trials, or nonrandomized studies. Ten studies met the eligibility criteria with a total of 174 subjects. Eight studies investigated the effect of EMS on lower limb muscles and 2 on elbow flexors. Five studies used concurrent VRT. Studies were heterogenous in methods, subject characteristics, intervention, and EMS protocols. All 10 studies reported significant strength gains as an outcome of EMS treatment, but there were no improvements in strength-related functional outcome measures. The optimal threshold for treatment duration, EMS intensity, pulse, and frequency could not be determined due to methodological differences and EMS application protocol inconsistency between studies. Protocol variations also existed between the studies that combined EMS with VRT. Standardized protocols are needed for electrode placement location, motor point identification, positioning of the body part being investigated, impulse type, intensity, and duration of stimulus., (Copyright © 2022 National Strength and Conditioning Association.)

Background: A randomised trial of European Fans in Training (EuroFIT), a 12-week healthy lifestyle program delivered in 15 professional football clubs in the Netherlands, Norway, Portugal, and the United Kingdom, successfully increased physical activity and improved diet but did not reduce sedentary time. To guide future implementation, this paper investigates how those effects were achieved. We ask: 1) how was EuroFIT implemented? 2) what were the processes through which outcomes were achieved?, Methods: We analysed qualitative data implementation notes, observations of 29 of 180 weekly EuroFIT deliveries, semi-structured interviews with 16 coaches and 15 club representatives, and 30 focus group discussions with participants (15 post-program and 15 after 12 months). We descriptively analysed quantitative data on recruitment, attendance at sessions and logs of use of the technologies and survey data on the views of participants at baseline, post program and after 12 months. We used a triangulation protocol to investigate agreement between data from difference sources, organised around meeting 15 objectives within the two research questions., Results: We successfully recruited clubs, coaches and men to EuroFIT though the draw of the football club seemed stronger in the UK and Portugal. Advertising that emphasized getting fitter, club-based deliveries, and not 'standing out' worked and attendance and fidelity were good, so that coaches in all countries were able to deliver EuroFIT flexibly as intended. Coaches in all 15 clubs facilitated the use of behaviour change techniques and interaction between men, which together enhanced motivation. Participants found it harder to change sedentary time than physical activity and diet. Fitting changes into daily routines, planning for setbacks and recognising the personal benefit of behaviour change were important to maintain changes. Bespoke technologies were valued, but technological hitches frustrated participants., Conclusion: EuroFIT was delivered as planned by trained club coaches working flexibly in all countries. It worked as expected to attract men and support initiation and maintenance of changes in physical activity and diet but the use of bespoke, unstable, technologies was frustrating. Future deliveries should eliminate the focus on sedentary time and should use only proven technologies to support self-monitoring and social interaction., Trial Registration: ISRCTN81935608, registered 16/06/2015., (© 2023. The Author(s).)

Background: A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO., Methods: Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m 2 ) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up., Discussion: This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle., Trial Registration: ISRCTN ISRCTN13046877 . Registered 21 April 2022., (© 2023. The Author(s).)

Background: Injury risk is high in Physical Education Teacher Education (PETE) students. Insights into specific injury locations per sex, setting, sports, and curriculum year are needed to develop preventive measures., Purpose: To compare injury distributions by body locations in PETE students and how these distributions differ by sex, type, onset, curriculum year, settings, or sports., Methods: In a historical cohort study over 14 years, data from 2899 students (male 76.2%, n  = 1947) enlisted in the first three years of a PETE curriculum were analysed. Injuries reported at the institution's medical facility were categorised per sex, body location, onset, type, setting, sports, and curriculum year., Results: Forty-three percent ( n  = 1247) of all students (female 54.9%, n  = 523, male 37.2%, and n  = 429) reported a total of 2129 injuries (freshmen 56.4%; 2 nd year 28.2%; 3 rd year 15.5%). The most prevalent sudden onset injury locations (63.4% of all injuries) were the ankle (32.5%) and knee (16.6). The most prevalent gradual onset injuries were the lower leg (27.8%) and knee (25.2%). Joint/ligament injuries (45.8%) and muscle/tendon injuries (23.4%) were the most prevalent injury types. Proportions for injury locations and injury types differed significantly between curriculum years. Injury prevalence per setting and sport differed significantly between the sexes. Injury locations differed significantly between sports and between the sexes per sport., Conclusion: A differential approach per injury location, onset, type, sex, setting, sports, and curriculum year is needed to develop adequate preventive measures in PETE studies. The engagement of precurricular, intracurricular, and extracurricular stakeholders is needed in the development of these measures., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Maarten Barendrecht et al.)

Objective: To investigate the construct validity of the Steep Ramp Test (SRT) by longitudinally comparing the correlation between maximum short exercise capacity of the SRT and direct measurements of peak oxygen consumption (Vo 2 peak) during or shortly after treatment in patients with breast cancer and the potential effect of chemotherapy-induced symptom burden., Design: Cross-sectional., Setting: Multicenter., Participants: We used data from 2 studies that included women with breast cancer treated with chemotherapy, resulting in 274 observations. A total of 161 patients (N=161) performed the cardiopulmonary exercise test and the SRT in 2 test sessions on different time points around chemotherapy treatment., Interventions: Not applicable., Main Outcome Measures: Fatigue was assessed with the Multidimensional Fatigue Inventory, and nausea and vomiting and pain by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. The longitudinal correlation between the maximum short exercise capacity and Vo 2 peak was investigated using a linear mixed model. Interaction terms were added to the model to investigate whether the correlation varied by symptom burden., Results: We found a statistically significant moderate correlation between Vo 2 peak and maximum short exercise capacity (0.61; 95% confidence interval, 0.51-0.70; P<.01) over time. This correlation was slightly attenuated (-0.07; 95% confidence interval, -0.13 to 0.00; P=.04) in patients with chemotherapy-related nausea and vomiting, indicating smaller correlations of Vo 2 peak with the maximum short exercise capacity with increasing symptom burden. Pain and fatigue did not significantly modify the correlation., Conclusions: The SRT can only be used as a proxy for changes in aerobic capacity with great caution and with attention for the level of nausea and vomiting., (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Rugby carries a risk for serious injuries, including acute spinal cord injuries. The lifetime health consequences of these injuries may be far-reaching., Purpose: In this study, we aimed to describe barriers and facilitators to healthcare and rehabilitation, in individuals with rugby-related spinal cord injuries in South Africa., Methods: This study adopted a pragmatic qualitative approach. Stratified purposive sampling was used to select interviews from players from a variety of socio-economic status and geographical areas for inclusion in this study. The final sample consisted of thirty-one (n = 31) participants. Thematic analysis was used to analyze the data., Results: Participants described long-term, accessible, affordable, quality healthcare and rehabilitation as important contributors to their quality of life. Even though public healthcare is accessible from a cost point of view, quality of care, availability of rehabilitation services and factors such as affordability and availability of adequate transport remain a barrier for lower socio-economic groups., Conclusion: This population was unique, as the support from a dedicated organization enabled participants to overcome some barriers, highlighting the challenges of the healthcare system in maintaining the health of people with spinal cord injuries. Every effort should be made to create equitable access to healthcare and rehabilitation for persons with spinal cord injuries in South Africa.

Objective: To develop a trail running injury screening instrument (TRISI) for utilisation as clinical decision aid in determining if a trail runner is at an increased risk for injury., Design: Multiple methods approach., Methods: The study utilised five phases 1) identification of injury risk factors 2) determining the relevance of each identified risk factor in a trail running context, 3) creating the content of the Likert scale points from 0 to 4, 4) rescaling the Likert scale points to determine numerical values for the content of each Likert scale point, and 5) determining a weighted score for each injury risk factor that contributes to the overall combined composite score., Results: Of the 77 identified injury risk factors, 26 were deemed relevant in trail running. The weighted score for each injury risk factor ranged from 2.21 to 5.53 with the highest calculated score being 5.53. The final TRISI includes risk categories of training, running equipment, demographics, previous injury, behavioural, psychological, nutrition, chronic disease, physiological, and biomechanical factors., Conclusion: The developed TRISI aims to assist the clinician during pre-race injury screening or during a training season to identify meaningful areas to target in designing injury risk management strategies and/or continuous health education., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running., Design: Living systematic review. Updated searches will be done every 6 months for a minimum period of 5 years., Data Sources: Eight electronic databases were searched from inception to 18 March 2021., Eligibility Criteria: Studies that investigated injury risk factors and/or reported the epidemiology of injury in trail running., Results: Nineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7-61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe., Conclusion: Limited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.PROSPERO registration numberCRD42021240832., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Despite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres., Design: A mixed methodologies study, using both online questionnaires and semi-structured interviews., Setting: Dutch university medical centres., Participants: Clinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres., Results: Forty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints)., Conclusions: Our study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality., Methods: A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality., Results: We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87-1.15] and females (HR 0.95, 95% CI 0.82-1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88-1.49)., Conclusions: While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.

Background: Increased physical activity (PA), reduced time spent sedentary (SED), healthier diet and reduced body weight may all have a positive impact on cardiometabolic risk. The relative importance of change in each of these variables on cardiometabolic risk, however, is unclear. We therefore sought to investigate the relative contributions of changes in PA, SED, diet and body weight on cardiometabolic risk., Methods: This is a secondary analysis of data collected from the EuroFIT randomised controlled trial, which was a 12-week group-based lifestyle intervention for overweight middle-aged men delivered by coaches in football club stadia aiming to improve PA, SED, diet, and body weight. PA and SED were assessed by accelerometry, diet using the Dietary Instrument for Nutrition Education (DINE). An overall cardiometabolic risk score was derived from combining z-scores for glucose, HbA1c, insulin, lipids and blood pressure. In total, 707 men (from the overall cohort of 1113) with complete data for these variables at baseline and 12-month follow-up were included in the multivariable linear regression analyses., Results: In multivariable analyses, change in number of steps (explaining 5.1% of R 2 ) and dietary factors (less alcohol, fatty and sugary food, and more fruit and vegetables) (together explaining 4.5% of R 2 ), but not changes in standing time or SED, were significantly associated with change in body weight. Changes in number of steps (R 2 = 1.7%), fatty food score (R 2 = 2.4%), and sugary food score (R 2 = 0.4%) were significantly associated with change in cardiometabolic risk score in univariable models. However, in multivariable models which included changes in weight as well as changes in steps and dietary variables, change in weight explained a substantially larger proportion of the change in cardiometabolic risk score, explaining 14.1% of R 2 (out of an overall model R 2 of 19.0%). When baseline (as well as change) values were also included in the model, 38.8% of R 2 for change in cardiometabolic risk score was explained overall, with 14.1% of R 2 still explained by change in weight., Conclusion: Change in body weight, together with baseline cardiometabolic risk explained most of the change in cardiometabolic risk. Thus, the benefits of increasing physical activity and improving diet on cardiometabolic risk appear to act largely via an effect on changes in body weight., Trial Registration: International Standard Randomised Controlled Trials, ISRCTN-81935608. Registered 06052015. https://www.isrctn.com/ISRCTN81935608?q=&filters=recruitmentCountry:Portugal&sort=&offset=7&totalResults=92&page=1&pageSize=10&searchType=basic-search., (© 2021. The Author(s).)

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months ( p = 0.0032) and having a chronic disease ( p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.

Objective: To investigate the association between the acute:chronic workload ratio (ACWR) and running-related injuries (RRI)., Methods: This is a secondary analysis using a database composed of data from three studies conducted with the same RRI surveillance system. Longitudinal data comprising running exposure (workload) and RRI were collected biweekly during the respective cohorts' follow-up (18-65 weeks). ACWR was calculated as the most recent (i.e., acute) external workload (last 2 weeks) divided by the average external (i.e., chronic) workload of the last 4, 6, 8, 10 and 12 weeks. Three methods were used to calculate the ACWR: uncoupled, coupled and exponentially weighted moving averages (EWMA). Bayesian logistic mixed models were used to analyse the data., Results: The sample was composed of 435 runners. Runners whose ACWR was under 0.70 had about 10% predicted probability of sustaining RRI (9.6%; 95% credible interval [CrI] 7.5-12.4), while those whose ACWR was higher than 1.38 had about 1% predicted probability of sustaining RRI (1.3%; 95% CrI 0.7-1.7). The association between the ACWR and RRI was significant, varying from a small to a moderate association (1-10%). The higher the ACWR, the lower the RRI risk., Conclusions: The ACWR showed an inversely proportional association with RRI risk that can be represented by a smooth L-shaped, second-order, polynomial decay curve. The ACWR using hours or kilometres yielded similar results. The coupled and uncoupled methods revealed similar associations with RRIs. The uncoupled method presented the best discrimination for ACWR strata. The EWMA method yielded sparse and non-significant results., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: This cross-sectional study aimed to compare the association between self-reported sleep duration and cardiometabolic risk among men and women corporate executives and investigate potential lifestyle, work- and stress-related mediators thereof., Methods: Self-reported sleep duration and lifestyle, occupational, psychological and measured anthropometrical, blood pressure (BP) and blood marker variables were obtained from health risk assessment data of 3583 corporate executives. Sex-stratified regression analyses investigated the relationships between occupational and psychological variables with self-reported sleep duration, and sleep duration with individual cardiometabolic risk factors. Mediation analyses investigated the effects of work, psychological and lifestyle factors on the relationships between self-reported sleep duration and cardiometabolic risk factors, as well as a continuous cardiometabolic risk score calculated from the sum of sex-stratified z-standardized scores of negative fasting serum HDL, and positive plasma Glu, serum TG, body mass index (BMI), waist circumference, systolic and diastolic BP., Results: Longer work hours and work commute time, depression, anxiety and stress were associated with shorter sleep duration in both men and women (all p < 0.05). Shorter sleep duration was associated with higher BMI, larger waist circumference and greater cardiometabolic risk scores in both men and women (all p < 0.05), higher diastolic BP in men (p < 0.05) and lower HDL cholesterol in women (p < 0.05). Physical activity, working hours and stress significantly mediated the relationships between self-reported sleep duration and BMI, waist circumference, diastolic BP and cardiometabolic risk score in men only., Conclusion: In these corporate executives, shorter self-reported sleep duration is associated with poorer psychological, occupational and cardiometabolic risk outcomes in both men and women. Given that physical activity, working hours and stress mediate this association among the men, the case for sleep health interventions in workplace health programmes is warranted., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)