To assess the effectiveness of two different neck strengthening protocols at increasing isometric neck strength in male and female rugby players. Cluster randomised controlled trial. The team training facility of 3 amateur clubs. 142 male and female amateur rugby players were recruited to take part in the study. Isometric neck strength in flexion, extension, left and right side flexion, left and right rotation and sum of strength scores. Changes in neck strength were analysed for within-group and between group differences. Relative to the control group the male Band resisted group recorded the largest strength gain with statistically significant increases in sum of strength scores (p = 0.002), extension (p = 0.034), right flexion (p = 0.004), left rotation (p < 0.001) and right rotation scores (p < 0.001). The male Partner resisted group recorded improvements in left rotation (p < 0.001) and right rotation (p = 0.006). In the female band resisted group significant improvements in neck strength were recorded for sum of strength scores (p = 0.042), right rotation (p = 0.003) and left rotation (p = 0.005) however in the Partner resisted group significant improvements were recorded in right rotation only (p = 0.015). We have developed two time efficient and low cost neck strengthening protocols that demonstrate efficacy at enhancing neck strengthen in a team setting.
This systematic review investigated the effect of protein intake on anthropometric and body composition markers in pre- to postmenopausal women. Understanding these effects may contribute to the development of nutritional strategies to improve body composition and prevent changes associated with this phase. Searches were conducted in the PubMed, EMBASE, and Cochrane Library databases, following the PRISMA guidelines, and the risk of bias was assessed using the Joanna Briggs Institute (JBI) tool (PROSPERO: CRD420251156313). Fifteen randomized clinical trials, involving 1161 pre- and postmenopausal women, were included. Interventions with animal-based protein (n = 8) showed more consistent effects on weight and body fat reduction, especially when combined with calorie restriction and supervised exercise. Protocols using whey protein, meat, or milk protein demonstrated reductions in body fat over 8-16 weeks, with increases in lean mass in longer interventions. However, these effects are strongly influenced by the use of other strategies, such as energy restriction and physical exercise. Studies with soy protein isolate (n = 7) showed more heterogeneous results, with few changes in short-term interventions and more favorable results when combined with exercise. When analyzed independently of energy restriction and physical exercise, the effects of consuming both proteins on body composition were less consistent, making it impossible to confirm benefits from an isolated increase in protein intake. Animal proteins have more consistent effects on anthropometric markers and body composition in women during the climacteric period, particularly when combined with energy restriction and physical exercise. In contrast, plant-based proteins have more heterogeneous effects, with greater benefits observed when associated with exercise. The findings of this review reinforce the importance of considering protein type, dose, duration of intervention, and other combined strategies when developing nutritional recommendations for changes in body composition.
Accumulating studies have investigated the combined effects of 24-h movement behaviors on physical and mental health. The 24-hour Movement Behaviors Questionnaire (24HMBQ) was recently developed to measure the 24-hour movement behaviors in college students. However, its criterion validity remains to be elucidated. This study aimed to investigate the criterion validity of the 24HMBQ against accelerometer-derived data among Chinese college students. Eighty-eight college students (age = 20.2 ± 2.2 years) participated in this study. The Axivity AX3 accelerometers were used to objectively measure physical activity (PA), sedentary behavior (SB), and sleep levels over a consecutive seven-day period. At the last day, participants completed the 24HMBQ to self-report their PA, SB, and sleep levels. Paired-sample t-test, Spearman's rank correlation test, and Bland-Altman plot were used to examine the degree of agreement between 24HMBQ and accelerometer data. Spearman's correlation coefficients indicated strong agreement for sleep metrics (Rho = 0.77, p < 0.001 for weekdays; Rho = 0.68, p < 0.001 for weekends) and moderate agreement for SB (Rho = 0.55, p < 0.001 for weekdays; Rho = 0.33, p < 0.01 for weekends) between 24HMBQ and accelerometer measurements. However, lower correlations were observed for physical activities including light PA (Rho = 0.30, p < 0.01) and moderate-to-vigorous PA (MVPA; Rho = 0.15, p > 0.05). The 24HMBQ showed good criterion validity for sleep and moderate validity for sedentary behavior, but limited validity for physical activity (especially MVPA).
This study aims to investigate the effect of a structured postoperative shoulder exercise program on shoulder range of motion (ROM) recovery and the development of postoperative shoulder stiffness following surgical fixation of distal radius fractures (DRFs). This non-randomized, time-based cohort study included a total of 64 patients who underwent volar plate fixation of DRF between October 2022 and March 2023. Patients were allocated into two groups based on calendar periods and basic demographic factors were evaluated. Group 1 (exercise group, n = 33) was educated on pre-designed shoulder exercise to prevent shoulder stiffness after surgical treatment. Group 2 (control group, n = 31) was instructed to use their shoulders freely without an arm sling. Shoulder ROM and Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores were evaluated and compared at postoperative Weeks 2, 4, 8, 12, and 24. Shoulder stiffness was defined as passive ROM restricted by 30° or more compared to the contralateral side (or difference of two or more Constant-Murley scores in internal rotation) in two or more planes of movement. Of the patients, 12 were male and 52 were female with a mean age of 65.7 ± 8.9 (range, 42 to 85) years. The mean follow-up was 6.8 ± 1.6 months. Shoulder ROM markedly decreased between postoperative Weeks 2 and 4, but continuously improved until the final follow-up in both groups. A transient improvement in internal rotation at postoperative Weeks 4 and 8 was observed in Group 1 compared to Group 2. No significant difference in internal rotation was observed at the other time points. At the final follow-up, 7.8% of all patients continued to experience shoulder stiffness. Structured shoulder exercise may facilitate earlier recovery of shoulder internal rotation after volar plate fixation of DRFs. However, this advantage can be transient and cannot be maintained beyond eight weeks postoperatively, suggesting that shoulder ROM often recovers spontaneously even in the absence of a routine rehabilitation protocol. Furthermore, secondary shoulder stiffness following DRF fixation peaks at approximately four weeks after surgery and subsequently resolves more rapidly than the typical natural history of primary frozen shoulder. These findings indicate that structured shoulder exercises may provide short-term benefits in postoperative recovery, while the long-term clinical significance of routine shoulder rehabilitation remains uncertain.
This study aims to compare the efficacy of conventional rehabilitation alone, conventional rehabilitation combined with balance acupuncture (BA) and conventional rehabilitation plus BA and unconscious proprioception training in chronic ankle instability (CAI) patients. This single-center, parallel-group, assessor-blinded randomized-controlled trial included a total of 120 CAI patients between October 2022 and October 2024. The patients were randomly assigned to control (n = 40), BA (n = 40), and combination therapy (CT, (n = 40) groups. All groups received six weeks of intervention (6 days/week): the control group received conventional rehabilitation, the BA group received conventional rehabilitation + BA and the CT group received conventional rehabilitation + BA + unconscious proprioception training. Unconscious proprioception training was defined as dual-task training using the MOTOmed system with cognitive distraction to shift focus away from conscious movement control. Assessments were conducted before and after treatment using a three-dimensional gait analysis system, a balance function testing and training system, and the Star Excursion Balance Test (SEBT). There was no statistically significant difference in age and sex among the groups (p > 0.05). In addition, disease duration and number of previous sprains were comparable among the groups (p > 0.05). Following the six-week intervention, all three groups showed significant improvements in gait parameters, balance function and SEBT scores compared to baseline (p < 0.05). The CT group exhibited significantly greater improvements in gait speed, cadence, movement length, movement ellipse area and SEBT scores than the BA group (p < 0.05), whereas the BA group outperformed the control group in all outcome measures (p < 0.05). No adverse reactions were reported in any group. The integration of BA and unconscious proprioception training may offer additional benefits for improving gait and balance in CAI patients compared to conventional rehabilitation plus BA or conventional rehabilitation alone. Based on these preliminary findings, the combined approach shows potential clinical value for targeted populations with CAI.
Functional assessment in wheelchair basketball (WB) has three evaluation stages: analysis of isolated functions, combined functional measures, and the observation of volume of action (VoA) in a sporting context. Sport class allocation relies on VoA assessed in controlled conditions (VoA-capacity), which corresponds to combined functional measures, and during game observation (VoA-performance). However, the contribution of each assessment phase to sport class allocation remains insufficiently understood. This study examines how trunk and hip muscle strength influences VoA-capacity and evaluates the extent to which VoA-capacity is associated with sport class. Additionally, it compares trunk muscle strength and VoA-capacity across sport classes to characterize functional differences between groups. A cross-sectional observational study was conducted with 40 officially classified WB players (sport classes 1.0-4.5). Trunk and hip muscle strength were assessed using the Manual Muscle Test (MMT). VoA-capacity was calculated as the sum of maximal trunk reaches in six directions (flexion, extension, rotation for both sides and lateral flexion for both sides) using an Inertial Measurement Unit (IMU) positioned at C7 (seventh cervical vertebra). Multiple linear regression, ordinal regression, Kruskal-Wallis, and Dunn's post-hoc tests were applied. Total Trunk-Hip muscle strength significantly predicted VoA-capacity (p < 0.001), explaining 80% of its variance (R 2 = 0.80). When analyzed separately, both trunk strength (p < 0.001) and hip strength (p = 0.006,) were significantly associated of VoA-capacity. VoA-capacity was a significant predictor of sport class (p < 0.001). Significant differences were found between sport classes for VoA-capacity (p < 0.001) and for total Trunk-Hip muscle strength (p < 0.001), with post-hoc comparisons showing the largest contrasts between lower (1.0-2.0) and higher (4.0-4.5) sport classes. Trunk and hip muscle strength showed associations with VoA capacity, suggesting their relevance for understanding players' ability to perform dynamic seated movements. VoA-capacity, was also associated with sport class allocation. Although muscle strength is not a classification criterion in WB, profiling players' muscular strength may offer complementary insights in complex classification scenarios. These findings provide preliminary functional evidence of WB classification and support future investigations integrating VoA-performance to refine assessment models.
Global increases in occupational heat exposure are raising concerns about worker safety and cognitive performance during prolonged and repeated shifts. At present, the cumulative effects of repeated heat exposure on cognitive performance remain unclear. This exploratory study examined cognitive performance and perceived workload across three consecutive days of simulated occupational heat stress. Twenty physically active adults (age: 27 ± 6 years [5 female]) completed two randomized crossover trials comprising three consecutive 8-h workdays under hot (35°C; 63% RH; WBGT 31°C) and control (18°C; 53% RH; WBGT 14°C) conditions wearing minimal clothing (< 1 Clo). Participants performed moderate-intensity physical work (~4.3 METs) using a 30-min work:30-min rest schedule. Cognitive performance was assessed at start-of-day, midday, and end-of-day using the Joggle Research battery, evaluating sensorimotor speed, processing speed, and attention, visuospatial perception, sustained attention, and visual memory. Perceived workload was assessed at start-of-day and end-of-day using the NASA Task Load Index. Cognitive performance was largely preserved across domains within and across repeated workdays, with no evidence of cumulative impairment (p ≥ 0.170). Unexpectedly, sustained attention improved in the heat. Perceived physical workload was higher in the heat, while perceived mental workload was unchanged. Under prescribed work-rest conditions, cognitive performance appears to be maintained across consecutive days of occupational heat exposure in young, physically active adults. Future work should explore the relationship between heat and cognition in larger, more diverse work populations and in more challenging conditions.
In collaboration with the Schools Health Research Network in Scotland (SHINE), Generation Scotland (GS) developed a free schools resource to educate students about health data and the value of taking part in research, supporting the recruitment of young people to the GS cohort. A scoping exercise with SHINE helped identify needs, and teachers and young people were engaged through their national conference and online focus groups to shape core content. In April 2025, funding from Research Data Scotland enabled revision and expansion of the resource based on teacher feedback. The resulting pack comprises three 45-minute lessons focused on "What is Big Data?" and introduces key concepts in health research, including big data, data linkage and data ethics. The resource was distributed to more than 50 interested schools via various newsletters and partner organisations, reaching schools in 22 of Scotland's 32 local authorities. Three schools have provided detailed feedback after delivering the lessons to approximately 150-250 pupils each. Offering these lesson plans created a reciprocal relationship that enabled recruitment of young people through schools. Teachers reported that the resource filled a gap in the curriculum, and delivering the lessons alongside GS recruitment materials provided a scalable, sustainable approach by leveraging existing school infrastructure. This not only supported recruitment but also contributed to lasting improvements in students' health research literacy and understanding of the value of data in research. The resource was developed with input from the SHINE network, extensive teacher feedback and contributions from the GS Young Persons Advisory Group.
24h movement behavior, including physical activity (PA), sedentary behavior (SB), and sleep(SLP), is independently associated with health after stroke. Few studies have explored the trajectory of 24h movement behavior and its effect on functional recovery in stroke survivors. We conducted a prospective longitudinal study from November 2023 to June 2025. This study was conducted in five hospitals in Henan province. The ActiGraph GT3X+ accelerometer was used to collect 24h movement behavior of 353 stroke survivors at acute phase(T0), 3-month recovery phase (T1), and 6-month sequelae phase (T2) after stroke onset, and functional recovery was evaluated at 12 months (T3) post-stroke. Patients' demographic information, disease-related data, psychological-related indicators and environment-related indicators were collected. The modified Rankin Scale (mRS) was used to assess their functional recovery 12 months after the onset of the disease. Through a prospective longitudinal study, Parallel-Process Latent Class Growth Model(PP-LCGM) was applied to determine the trajectories of 24h movement behavior, logistic regression was used to explore the effects of different trajectories on functional recovery. 298 stroke survivors completed three follow-up visits. Four potential categories of the 24h movement behavior change trajectory were finally identified. Multivariate logistic regression analysis showed that, after adjusting for age, gender, BMI, NRS grade, NIHSS score, BI index, social support, exercise self-efficacy, anxiety, and depression, there was an increased risk of poor prognosis in the 24h movement behavior imbalance group(OR:5.237,95%CI:1.848-14.835) or long-SLP increased-SB decreased-PA group(OR:4.160,95%CI:1.589-10.891) compared with the 24h movement behavior balance group. The results showed that stroke survivors had different 24h movement behavior trajectories after acute stroke, and there was an increased risk of poor prognosis in the 24h movement behavior imbalance group or long-SLP increased-SB decreased-PA group. 24h movement behavior interventions can be developed accordingly.
暂无摘要（点击查看详情）
Swimming-induced pulmonary oedema (SIPO) has predominantly been reported in swimmers. However, to date, no review has specifically explored the scientific literature concerning the occurrence and characteristics of SIPO in triathletes. Therefore, this review aims to summarize and discuss the current evidence on SIPO in the context of triathlon. We conducted a narrative review to summarize the current scientific literature on SIPO in triathletes. A structured search of two major databases-PubMed and Scopus-was conducted using free-text terms related to SIPO and triathlon. The search included articles published up to January 2025, with no language restrictions. After removing duplicates and excluding animal or in vitro studies, as well as unrelated articles based on title and abstract screening, a total of 48 relevant publications were included for analysis. The reports on SIPO in triathletes are mainly case reports or case studies on a single athlete or a small number (case series) of triathletes. Most reported cases involved middle-aged women (30-60 years) participating in IRONMAN® 70.3 and IRONMAN® triathlons. The prevalence of SIPO in triathletes is reported to be less than 1.5%. Risk factors for SIPO in triathletes are female sex, age over 50 years, hypertension, fish oil consumption, highly trained individuals, competitive exercise, wet suit compression, longer race distances (i.e. IRONMAN® 70.3 or IRONMAN®) and a cold (water) environment. The symptoms and outcome are similar to those observed in swimmers and other aquatic athletes. In summary, the results regarding the prevalence, symptoms and risk factors of SIPO in triathletes are comparable to those in other aquatic athletes. SIPO occurs only in IRONMAN® 70.3 and IRONMAN® races, but has not been reported in the Olympic distance triathlon or triathlons longer than the IRONMAN® race distance.
Across the delivery of oral health care, whether in the halls of learning environments or the operatories of individualized clinicians, corporations, or even unverifiable private equity led acquisitions, ethics is largely seen as a theoretical exercise separate from the day-to-day realities of clinical practice. A call for relational ethics, not merely traditions' ethical principlism, is more than theoretical exercise or an intellectual inquiry. This call is quite literally coming from both inside and outside of the proverbial oral health house. In examining the absence of holistic community-centered commitments of principles such as veracity and justice, this article provides a framework for conceptualizing a reimagined professionalism across various domains of oral health care delivery. Anchored by truth-telling and anti-oppressive justice, the author explores educational practice and pathways, models of care delivery, barriers to optimal learning and clinical environments, while providing individualized and systemic recommendations for change, While the goals are robust, [re]building trust and shifting dentistry and oral health toward outcomes advancing real health equity is imperative for this hour. True ethical dental education and practice must move beyond individual behavior of patients and providers alike, toward systems of accountability, truth-telling, and community engaged partnership.
Competing at high altitude (HA) poses major physiological challenges for sea-level athletes and can markedly impair performance. Normobaric hypoxia has emerged as a practical training and acclimation strategy, yet real-world evidence in elite sports remains limited. We report the preparation of the Chilean men's national football team ahead of a World Cup qualifying match in El Alto, Bolivia (4150 m.a.s.l.). Thirteen players completed 4-10 normobaric hypoxia sessions simulating altitudes of 3250-4480 m.a.s.l. Physiological responses were evaluated, and performance at HA was compared with that at sea-level. SpO2 remained stable during sessions 1-4 followed by progressive increases in sessions 5-6. Mixed-effects modeling identified an association between session number and SpO2 with effects independently influenced by exercise type, simulated altitude, and number of sessions completed. Although the acclimation protocol improved physiological responses, it did not fully offset the demands of HA, and high-speed running per minute (HSR/min) and average speed (m/min) remained lower at HA than at sea level. This case report describes the implementation of short-term normobaric hypoxia training in elite football and suggests potential benefits for acclimation. The heterogeneous responses observed highlight the importance of individualized monitoring to optimize performance at altitude.
The COVID-19 pandemic drastically changed lifestyles and reduced opportunities to exercise, leading to physical inactivity in all populations, especially the obese cohort. Luckily, telehealth may positively help people engage in physical activity. This study aimed to determine the efficacy of telehealth in increasing physical activity among people with obesity. This study is a literature review. Articles were sought from the CiNAHL, Proquest, MEDLINE, and PUBMED databases from August to September 2021 following predetermined strategies, inclusion, and exclusion criteria. The quality of the studies was appraised using the JBI Critical Appraisal Checklist Tools. Data Extraction was conducted using the JBI Data Extraction From for Observational/Experimental Studies. Five studies were included in this literature review. Due to the heterogeneity of study designs and outcome measures, a narrative synthesis was conducted. Most of the studies used mobile apps to deliver health programs to adults with obesity. Overall, studies reported the medium to large positive effects of telehealth in improving physical activity outcomes favoring the telehealth group (Fitbit d = 0.509, 95% CI= -0.36-0.427; Pedometer d = 0.918, 95% CI= 1.467-2.464), while one study found small positive effects on energy expenditure (SenseWear d = 0.446). This study supports the use of mobile applications to bring a significant increase in physical activity levels in adults with obesity. Further studies evaluating telehealth with video conferences and hybrid formats are needed.
The 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) is widely used to assess health-related quality of life (HRQoL) in HF patients covering key HF-related health status domains. This study validated the Arabic KCCQ version and looked into potential correlation between patients' HRQoL and their demographics/clinical characteristics, health literacy, medication adherence/knowledge. This was a multicenter validation study from Jordan including HF adult patients. Cronbach's alpha coefficient was employed to assess the scale internal consistency. Test-retest reliability evaluated stability of participants' responses overtime. Construct validity was examined through exploratory factor analysis (EFA), supported by Kaiser-Meyer-Olkin measure and Bartlett's sphericity test. Model fit was evaluated by confirmatory factor analysis (CFA). Associations between KCCQ scores and patient demographic/clinical characteristics, health literacy, medication adherence/knowledge were analyzed using linear regressions. A total of 331 participants were recruited from two centers. KCCQ domains' scores ranged from mean±SD of 42.90±25.43 for symptom stability to 76.80±30.63 for social limitation. The total symptom, clinical summary and overall summary scores were 70.96±29.13, 74.67±25.67 and 70.67±25.70, respectively. The scale demonstrated excellent internal consistency (Cronbach's alpha=0.937). Test-retest analysis showed strong significant intraclass correlation coefficients and Pearson's correlation indicating good reliability. EFA and CFA supported data suitability for factor analysis and good model fit. The multivariate regression showed being married, performing exercise, being adherent to medication and taking fewer medications to significantly correlate to better HRQoL. The Arabic KCCQ version is a reliable, valid tool for HRQoL assessment among Arabic-speaking communities. Implementing interventions targeting sedentary HF patients not adherent to treatment regimen can improve HRQoL.
Nutrition is a modifiable driver of morbidity and mortality in the UK, yet nutrition education remains marginal within medical curricula. Despite guidance from the General Medical Council (GMC) and the Association for Nutrition (AfN), evidence suggests persistent under-provision. We triangulated findings from: (1) a curriculum review and mapping exercise of UK medical schools; (2) a curriculum survey (n=31) of final-year or newly qualified students; and (3) a rapid review (2010-2025) of literature on nutrition education in UK medical programmes. Survey items mapped to AfN competencies and GMC Outcomes for Graduates. Across all data sources, nutrition education was inconsistently delivered, theoretical and rarely assessed. Most students (71%) reported receiving ≤10 hours of teaching. Although 84% rated nutrition as important, only 61% felt prepared to address nutrition issues. Confidence was lowest for practical skills (nutrition assessment, referral pathways and brief interventions). The rapid review identified longstanding barriers: low curricular legitimacy, limited assessment, insufficient faculty expertise and weak clinical integration. Enablers included nutrition leads, interprofessional learning and competency-aligned teaching. Despite national prevention ambitions, nutrition remains insufficiently integrated into UK medical education. Aligning curricula with AfN/GMC standards, strengthening assessment, embedding leadership and co-designing applied teaching with students represent practical high-impact opportunities to develop prevention.
Wearable fabrics embedding crystalline semiconductor materials (e.g. germanium, silicon) are promising biomedical devices for their therapeutic potential in musculoskeletal disorders, including osteoarthritis, tendinopathies, and chronic pain, and for supporting tissue healing and regeneration. These fabrics exert their bioactive functions without applying mechanical pressure or drug delivery systems, offering a non-invasive and comfortable therapeutic alternative that operates through mild thermal stimuli at body temperature. Recent peer-reviewed literature on semiconductor-based wearable textiles, far-infrared-emitting biomaterials, bioelectric signalling in tissue repair, and their clinical application in musculoskeletal disorders. At body temperature, semiconductor-containing fabrics consistently emit far-infrared radiation, experimentally associated with improved microcirculation and modulation of inflammation. Limited clinical studies report improvements in pain and functional outcomes in chronic musculoskeletal conditions, with good tolerability during prolonged wear. Proposed mechanisms include thermally induced electron release, ion generation, and piezoelectric or piezoresistive activity during movement, but direct biological evidence remains limited. The specific contribution of far-infrared emission is difficult to distinguish from thermal or placebo effects. Advances in bioelectric signalling research and textile engineering provide a framework to investigate electroactive interactions between semiconductor fabrics and biological tissues. Well-designed randomized trials, quantitative characterization of emitted physical stimuli, and mechanistic cellular studies are needed to establish clinical efficacy and inform regulatory classification.
Multi-system impacts of long COVID remain unknown. We aimed to compare multi-system deficits between people with long COVID and controls. We conducted a case-control study and recruited participants from two UK population-based cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC) and TwinsUK. Participants provided samples for SARS-CoV-2 serology between 2020 and 2021 and were asked about duration of COVID-19 symptoms between July and December 2021. Cases had long COVID (evidence of COVID-19 infection and persistent symptoms ≥4 weeks post infection); controls comprised 3 groups: acute COVID-19 only (symptoms reported for <4 weeks) and serological evidence of infection; self-reported long COVID-like symptoms but without wild-type SARS-CoV-2 virus antibodies; no symptoms or history of COVID-19 infection. People who were severely unwell or pregnant were excluded. Participants attended a clinic follow-up visit between 2021 and 2023 and underwent multi-system MRI, (cardiac, brain, lung, kidney), measurement of blood pressure and autonomic function, spirometry, renal function, exercise tests, strength and physical capability. Severity of deficit was then scored for each system as 0 (none) to 3 (severe). Primary outcome was a single composite multi-domain score summing each of nine domains: autonomic, brain, exercise capacity, heart, lungs, physical, renal, strength and vascular, with a maximum score of 27. In total, 349 participants, 141 with long COVID (40%) and 208 (60%) controls were recruited. Overall deficit score in cases was 0.22 (95% CI -0.44, 0.88) units greater than controls, adjusted for age, sex, ethnicity, cohort membership and relatedness. This estimate was little changed (0.32 (-0.34, 0.98)) when additionally adjusted for educational status, index of multiple deprivation, physical activity, smoking and co-morbidity. Restricting cases to those reporting symptoms including fatigue (n = 46) increased the excess deficit score to 0.81 (-0.19, 1.81) units in the minimally adjusted model. A difference was only observed in the vascular domain, largely attributable to elevated blood pressure, showing a 1.76 (1.04, 2.97) multivariable adjusted odds ratio excess in cases, and 3.04 (1.36, 6.80) when restricted to cases with fatigue. There was no evidence of marked residual subclinical deficits in most systems in people with long-COVID, although there was evidence of persistent deficits in the vascular system, largely related to elevated blood pressure. Mechanisms unrelated to organ dysfunction may contribute to symptoms. Blood pressure measurement and control should be included in clinical follow-up. Jointly funded by the National Institute for Health and Care Research and UK Research and Innovation (CONVALESCENCE, COV-LT-0009, MC_PC_20051).
Noncommunicable diseases (NCDs) remain the leading causes of morbidity and mortality in the United States, yet adherence to recommended physical activity and dietary behaviors remains suboptimal. Authors of this study examined associations between physical activity, diet, and selected NCDs among United States adults. Data were drawn from the 2024 Health Information National Trends Survey, a nationally representative cross-sectional sample of United States adults aged ≥18 years. Survey-weighted analyses examined self-reported diagnoses of diabetes, hypertension, heart disease, and lung disease in relation to aerobic activity, strength training, and fruit and vegetable intake. Bivariate analyses assessed sociodemographic differences, and multivariable logistic regression models estimated adjusted odds of not being diagnosed with each condition. Mean body mass index was 28.8 kg/m2, with 35.8% of respondents classified as obese. Few respondents met guidelines for moderate-intensity exercise (36.3%), strength training (38.4%), fruit intake (19.9%), or vegetable intake (28.0%). Meeting aerobic activity guidelines was associated with higher odds of not being diagnosed with diabetes (adjusted odds ratio [aOR] 1.33; 95% CI, 1.04-1.69) and hypertension (aOR 1.49; 95% CI, 1.15-1.93). Strength training was inversely associated with lung disease (aOR 0.66; 95% CI, 0.49-0.89). Fruit intake also was associated with lower odds of lung disease (aOR 1.97; 95% CI, 1.17-3.30). Younger age, healthy weight, and higher income were consistently associated with lower odds of NCD diagnoses. Aerobic physical activity demonstrated the most consistent protective associations with diabetes and hypertension, while diet and strength training showed condition-specific relationships. Improving adherence to lifestyle guidelines may reduce NCD burden and persistent disparities.
Physical activity (PA) is a modifiable lifestyle behaviour associated with lower dementia risk; however, molecular pathways bridging PA-related dementia prevention are poorly understood. We leveraged large-scale plasma proteomics to identify biological signatures of objectively monitored PA and cognitive ageing in functionally intact older adults, cross-validated these signatures in independent exercise cohorts and tested associations with both symptomatic and presymptomatic stages of neurodegeneration across multiple Alzheimer's disease and related dementias (ADRD) cohorts. We analysed large-scale plasma proteomics data (SomaScan 7k) across three cohorts including naturalistic, objective PA monitoring (University of California, San Francisco Brain Aging Network for Cognitive Health cohort, n = 65), self-reported PA (Atherosclerosis Risk In Communities study, n = 10 644) and PA intervention (Health Risk Factors, Exercise Training and Genetics study, n = 654). Differential regression models examined individual protein correlates of PA, adjusting for age and sex. Weighted gene co-expression network analysis assembled proteins into unbiased modules of protein co-expression, which were annotated for gene ontology and cell-type enrichment. To test clinical relevance to ADRD, we examined PA-related protein levels across-cohorts of symptomatic Alzheimer's disease and Parkinson's disease (Stanford Alzheimer's Disease Research Center), as well as frontotemporal dementia-spectrum disorders (ARTFL/LEFFTDS Longitudinal Frontotemporal Lobar Degeneration consortium). PA-related plasma proteins were also tested as predictors of antemortem cognitive change and post-mortem brain tissue mass spectrometry proteomic signatures in brain donors from the Religious Orders Study and Rush Memory and Aging Project (ROSMAP) cohort. Differential regression and network analyses identified PA plasma proteomic signatures linked to cell adhesion/extracellular matrix (ECM), immune response and lipid metabolism. Protein co-expression module M12 ECM/neurodevelopment harboured growth factor, cell adhesion and vascular remodelling proteins that (i) were positively associated with PA across exercise cohorts, (ii) positively associated with cognitive function and (iii) negatively associated with Alzheimer's disease, Parkinson's disease and frontotemporal dementia. Furthermore, M12 was enriched for proteins from Alzheimer's disease risk genes and antemortem plasma abundance of anthrax toxin receptor cell adhesion molecule 2 (ANTXR2), an M12 'hub' protein and top PA hit across-cohorts, forecasted longitudinal global cognitive decline and post-mortem brain tissue signatures of synaptic function and proteolysis in ROSMAP. Collectively, our integrated systems biology analysis of six independent plasma proteomic datasets facilitated discovery and validation of blood-detectable molecular signatures of PA and neurodegenerative disease, including PA-related proteins with clinical and biological relevance to early stages of disease. Circulating levels of PA-related proteins reflecting ECM biology (e.g. ANTXR2) may represent key molecular targets for dementia prevention.