搜索结果：Physical activity and nutrition

Early childhood (0-5 years) is key for shaping health behaviors, yet optimal behaviors are rarely achieved. Digital health promotion interventions offer scalable support for families; however, most research has focused on childhood more broadly, leaving limited evidence for the early childhood period. The primary aim of this systematic review was to examine whether autonomously delivered digital interventions targeting parents are effective at increasing physical activity, reducing sedentary behavior, improving nutrition (breastfeeding, feeding practices), and/or optimizing sleep among children aged 0-5 years. The secondary aim was to review the reporting of co-design practices, user engagement, and process evaluation, and to assess how engagement influences intervention effectiveness. Seven databases were searched for randomized controlled trials (RCTs) evaluating autonomously delivered digital interventions targeting one or more of the following behaviors: physical activity, sedentary behavior, nutrition, or sleep among children (published to January 2026). Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Findings were narratively synthesized by target age-group and behavior, and the direction of effect was summarized in structured tables. Of the 14,352 identified records, 38 interventions (33 RCTs, 4 pilot RCTs, and 1 feasibility RCT) were included. Most studies focused on pregnancy to infancy (n=24; 0-1 y), followed by preschoolers (n=8; 3-5 y) and toddlers (n=6; 1-2 y). Intervention duration ranged from 2 weeks to 1000 days, and various digital formats were used (apps n=11, SMS text messaging n=10, web- or internet-based platforms n=6, WeChat [Tencent] n=3, tablet-based program n=2, a combination of app and SMS text messaging n=1, website and emails n=1, emails and SMS text messaging n=1, automated voice calls n=1, Facebook Messenger Chatbot [Meta] n=1, and online videos n=1). Interventions spanning pregnancy to infancy reported mixed findings for breastfeeding and feeding practices. Studies targeting toddlers showed improvements in sleep, mixed findings for diet and screen time, and no differences in physical activity. Most studies targeting preschoolers reported significant improvements for feeding practices and diet, but no differences in physical activity, sedentary behavior and sleep, and mixed findings for screen time. Most studies reported co-design or engagement (n=24), but few examined the impact of engagement on intervention effectiveness (n=6), and those that did reported mixed findings. Interpretation was limited by heterogeneous designs, inconsistent outcome measures, and mixed risk-of-bias ratings across studies. This review advances the field by synthesizing evidence on scalable digital interventions that support parents in promoting healthy lifestyle behaviors across the first 2000 days, together with key design and implementation factors that have rarely been reported in previous reviews. Unlike prior work, it focuses exclusively on autonomously delivered digital interventions in early childhood. Findings show heterogeneous designs and mixed effectiveness, and highlight 3 priority evidence gaps: limited studies in toddlers and preschoolers, incomplete reporting of engagement, and limited understanding of how engagement influences outcomes. These findings define priorities for future research to strengthen the evidence for scalable digital interventions in early childhood.

Background: Population ageing increases the burden of chronic diseases, multimorbidity, and functional limitations, making nutrition and lifestyle important modifiable determinants of healthy ageing. Universities of the Third Age (U3A) provide an educational and social environment for older adults, but multidimensional relationships between nutrition knowledge, diet quality, lifestyle, and health status in this population remain insufficiently characterized. This study aimed to assess these associations among older adults attending U3A in Poland. Methodology: A cross-sectional online survey was conducted between January and April 2026 among community-dwelling older adults participating in U3A programs. Of 700 distributed invitations and 520 returned questionnaires, 450 complete and eligible responses were included. The questionnaire was based on the KomPAN® framework and expanded with items on health, lifestyle, psychosocial resources, barriers to healthy eating, and sources of health information. Diet quality was assessed using the pro-Healthy Diet Index, non-Healthy Diet Index, and overall Diet Quality Index (DQI). Nutrition knowledge was measured using a 24-item scale. Analyses included distributional diagnostics, non-parametric group comparisons, FDR-corrected Spearman correlations, psychometric assessment, principal component analysis, multivariable regression with model diagnostics, and profile segmentation. Results: The mean age was 73.63 ± 5.73 years, and most participants were women. The median DQI was 15.59 [3.93-24.86], with a predominance of neutral diet quality. Nutrition knowledge was moderate, with a median score of 12.00 [9.00-15.00], and the scale showed very good internal consistency. PCA identified three dietary patterns: convenience/ultra-processed, prudent/health-promoting, and traditional meat-and-fat. Higher DQI was associated with better nutrition knowledge, greater physical activity, a more favorable sleep profile, regular meal timing, and lower disease burden. Participants with multimorbidity had significantly lower DQI. Segmentation distinguished a health-engaged/higher-resource profile and a lower-resource/nutritionally vulnerable profile. Conclusions: U3A participants in Poland are educationally and socially active but nutritionally heterogeneous. The predominance of neutral diet quality, moderate nutrition knowledge, and identifiable knowledge gaps indicates the need for targeted, practical, and behavior-oriented nutrition education supporting healthy ageing.

Background/Objectives: Maternal nutrition and physical activity are modifiable behaviours relevant to pregnancy outcomes, but higher activity may coexist with both favourable and unfavourable dietary patterns. This study examined associations between pregnancy physical activity, individualised fruit-vegetable adequacy, energy-dense, nutrient-poor (EDNP) food and beverage intake, and preterm birth. Methods: This cross-sectional study included 1048 postpartum women with singleton live births recruited consecutively at a tertiary maternity hospital in Romania. Physical activity during the last three months of pregnancy was assessed using the Pregnancy Physical Activity Questionnaire and categorised into quartiles of total MET-hours/week. Dietary intake was assessed using an adapted food frequency questionnaire. Fruit-vegetable adequacy was evaluated against individualised recommendations, and EDNP intake was summarised using a composite score derived from fast food, sweets, chocolate, and sugar-sweetened beverages. Preterm birth was defined as delivery before 37 completed weeks of gestation. Results: Preterm birth occurred in 118 cases (11.3%). Higher physical activity categories showed greater fruit-vegetable intake and adequacy, but also higher EDNP intake. After adjustment for maternal age, pregestational BMI, parity, education, and income, physical activity category remained associated with all modelled dietary outcomes. Category 4 had higher odds of fruit-vegetable adequacy than category 1 (OR 2.24, 95% CI 1.55-3.24). In diet-informed models, category 3 had the lowest odds of preterm birth (OR 0.38, 95% CI 0.21-0.68). Conclusions: Total physical activity during pregnancy was associated with a complex dietary profile rather than a uniformly favourable lifestyle pattern. The lowest odds of preterm birth were observed in the third activity category, suggesting a non-linear association.

This narrative review synthesizes magnetic resonance imaging (MRI) evidence of (i) the associations between physical activity and/or aerobic fitness and brain markers related to cognitive function in Parkinson's disease (PD); and (ii) MRI-derived brain markers linked to gait impairment in PD. We also propose a conceptual framework describing how physical activity or fitness may support the cognitive-motor networks associated with gait. PubMed and Web of Science were searched for MRI studies examining the relationships between physical activity/fitness and cognition-relevant brain markers as well as MRI studies linking brain markers to gait outcomes (including cognition-related gait measures and freezing of gait). Fourteen observational studies met our inclusion criteria. Higher physical activity and/or fitness were seen to be generally associated with better cognitive performance and MRI features suggestive of preserved brain integrity and connectivity within the cognitive-motor networks. Regarding gait, the reviewed evidence suggests a shift toward greater reliance on cognitive-motor control to compensate for impaired automatic motor control, which may occur when this compensatory cognitive control becomes insufficient under increased task demands. Physical activity and fitness may contribute to gait function in patients with Parkinson's disease by supporting the cognitive-motor integration required for walking. Longitudinal and interventional studies using ecologically valid paradigms that approximate real-world (including dual-task) walking, ideally combined with wearable neuroimaging approaches, are needed to clarify how changes in physical activity or fitness are related to neural markers of gait.

Gestational Weight Gain (GWG) affects maternal and fetal health. Vitamin D insufficiency, common during pregnancy, may impact weight control via metabolic, inflammatory, and endocrine pathways. However, the association between maternal vitamin D and GWG remain unclear. Therefore, this narrative review's objective is to integrate existing evidence on the correlations between maternal vitamin D and GWG, examine the effect of pre-pregnancy Body Mass Index (BMI), assess the cumulative effects of vitamin D deficiency and inadequate GWG on pregnancy outcomes, and assess the efficacy of vitamin D supplementation. A narrative review was conducted in accordance with SANRA 2.0 principles, with the search strategy reported in line with PRISMA-S guidance. A literature review was conducted in PubMed, Scopus, and Google Scholar to identify studies examining gestational weight gain (GWG) and serum 25-hydroxyvitamin D status published between January 2015 and November 2025. Observational and interventional studies were eligible for inclusion. After eliminating duplicates, reviewers independently evaluated 1,395 records; 14 studies were included. The prevalence of vitamin D deficiency and its bidirectional associations with maternal weight, gestational weight gain as a modifier of vitamin D's metabolic effects, combined effects on fetal and offspring outcomes, and supplementation trial evidence were narratively synthesized. Vitamin D insufficiency affected 30-85% of pregnant women worldwide. Bidirectional vitamin D-GWG relationships differed among studies, with prepregnancy BMI as a substantial effect modifier. In overweight women, low first trimester vitamin D levels were associated with 3.70 kg higher total GWG. Vitamin D's insulin resistance protection was greatly reduced by excessive GWG. High-dose supplementation (1600 IU/day) met biochemical needs but did not affect GWG. In one cohort, both low vitamin D and suboptimal GWG independently predicted small-for-gestational-age births. The association between maternal vitamin D status and gestational weight gain remains inconsistent across the current evidence base. Pre-pregnancy BMI may modify this relationship, with the strongest associations observed among overweight and obese women. Integrated strategies addressing both vitamin D adequacy and appropriate gestational weight gain, particularly among women with elevated pre-pregnancy BMI, should be explored in future research. Vitamin D supports skeletal health and also contributes to immune and metabolic function. In pregnancy, achieving recommended gestational weight gain is important because both inadequate and excessive gain are linked to adverse outcomes for mothers and infants. This narrative review summarises global evidence on whether maternal vitamin D status is associated with gestational weight gain and whether pre-pregnancy body weight influences this relationship. We searched major bibliographic databases for studies published between 2015 and 2025 that measured vitamin D during pregnancy and reported gestational weight gain. Across studies, results were inconsistent. Some reported associations between lower vitamin D status and higher or lower gestational weight gain, while others found no clear relationship. Methodological differences likely explain part of this variability, including timing of vitamin D assessment, definitions of deficiency, measurement of weight gain, and adjustment for key factors such as pre-pregnancy body mass index, season, diet, physical activity, and supplementation. Although evidence remains mixed, higher pre-pregnancy adiposity is frequently associated with lower circulating vitamin D and may also relate to a greater likelihood of non-recommended gestational weight gain and metabolic complications. These overlapping risks highlight the importance of considering baseline maternal weight status when interpreting the vitamin D and gestational weight gain literature. Overall, current evidence does not establish a consistent causal link between vitamin D status and gestational weight gain. Robust prospective studies and adequately powered trials are needed to clarify directionality and determine whether optimising vitamin D status, within comprehensive antenatal care, supports healthier gestational weight trajectories.

Physical activity is essential for reducing cardiovascular risk in children with congenital heart disease (CHD). However, evidence of this association in early childhood remains limited. This study aimed to examine the association between physical activity and health care use and burden in preschool-aged children with CHD using a nationwide, population-based cohort in Korea. We analyzed data from 44 349 children born between 2014 and 2016 who were diagnosed with CHD and enrolled in the National Health Insurance Service database. Participants were categorized as physically active or inactive based on their responses to a national infant health screening questionnaire. Health care use, including hospitalizations, intensive care unit days, tertiary hospital and emergency department visits, and total medical costs, was assessed over a 3-year follow-up period. Adjustments were made for CHD severity and surgical complexity using American Heart Association and Risk Adjustment for Congenital Heart Surgery-2. Stabilized inverse probability of treatment weighting was applied to ensure robustness. Physical inactivity was significantly associated with a higher risk of hospitalization, increased tertiary outpatient visits, and longer intensive care unit stays. Although no overall association was observed with emergency department visits or total medical costs in the overall cohort, significant effect modification by CHD severity was identified. These increased risks were specifically observed in children with moderate-to-severe CHD. Active participation in physical activities during preschool years was associated with reduced health care use among children with CHD, supporting the need for early, individualized physical activity guidelines.

Sleep-wake disturbances are frequently reported by patients with chronic pain. Physical activity, recommended as a first-line treatment for chronic pain, can be difficult to implement due to pain severity. This study aimed to assess the prevalence of insomnia and other sleep-wake disturbances in a cohort of patients with chronic pain and to explore the influence of physical activity, opioid use, reported pain, and symptoms of depression and anxiety. This clinical cross-sectional study included 100 patients with chronic pain attending a specialist-level pain clinic. Participants were consecutively enrolled, and sleep and physical activity were evaluated using accelerometers. Additional assessments included the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), symptoms of restless legs syndrome (RLS), STOP-Bang score, pain intensity assessed by Numeric Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and self-reported level of physical activity. Overall, nearly all participants experienced sleep-wake disturbances. Average sleep duration (hh:mm) was 5:30 (range, 1:46-9:52), and sleep efficiency was 64% (range, 28-81). Based on PSQI scores, 95% were classified as having poor sleep quality. Clinical insomnia (ISI ≥ 15p) was reported by 67%. A statistically significant correlation (rs = 0.31, 95% CI, 0.10-0.50) was found between sleep efficiency and level of physical activity and between ISI and HADS depression (rs = 0.41, 95% CI, 0.22-0.57). A wide range of sleep-wake disturbances were present in the examined cohort, highlighting the possible benefit of assessing sleep to optimise pain rehabilitation. In this cohort, nearly all patients with chronic pain experienced sleep-wake disturbances, and none reached 85% sleep efficiency indicating stable sleep. These findings emphasise the need for a comprehensive assessment of sleep problems to improve the understanding and management of severe pain. ClinicalTrials.gov: NCT04649281.

Physical activity (PA) is of great importance for peritoneal dialysis (PD) patients with sarcopenia. However, the optimal PA dose for sarcopenia in PD patients remains unclear. This study adopted a cross-sectional design and enrolled PD patients from two large general hospitals in China between March 2023 and February 2025. Sarcopenia was diagnosed in accordance with the 2019 criteria of the Asian Working Group for Sarcopenia. The Chinese Low Physical Activity Questionnaire was used to assess PA levels. Restricted cubic spline (RCS) models were applied to examine the dose-response relationships of total PA consumption, total walking time, leisure walking time, light physical activity&#xa0;time, and inactive time with sarcopenia and its three parameters in PD patients. A total of 881 participants were included in the final analysis. Non-linear dose-response relationships were observed between total PA consumption and the prevalence of sarcopenia (overall p&#x2009;<&#x2009;0.05, non-linear p&#x2009;<&#x2009;0.05), as well as the five-repetition sit-to-stand (5-STS) (overall p&#x2009;<&#x2009;0.01, non-linear p&#x2009;<&#x2009;0.05). Total PA consumption was associated with handgrip strength, but no significant non-linear relationship was detected (overall p&#x2009;<&#x2009;0.05, non-linear p&#x2009;>&#x2009;0.05). No significant association was found between PA consumption and skeletal muscle index (overall p&#x2009;>&#x2009;0.05, non-linear p&#x2009;>&#x2009;0.05). A protective effect against sarcopenia was observed when PA consumption exceeded 33&#x202f;MET-h/week, and its protective effect on 5-STS tended to plateau after reaching 43&#x202f;MET-h/week. These findings indicate that there may be an optimal range of PA for simultaneously reducing sarcopenia risk and improving physical function in PD patients.

Background: This study aimed to compare a limited set of predefined diet-, lifestyle-, knowledge-, and psychosocial indicators across school youth, students, and adults in Poland, and to examine their associations with three predefined outcomes: BMI &#x2265; 25 kg/m2, poorer mental well-being, and high stress/overload. Diet quality, daily health-related practices, psychosocial well-being, and stress/overload may co-occur across different life stages, but online survey data require a focused analytical framework to avoid overinterpretation. Methods: This cross-sectional anonymous online survey included 360 respondents: 154 school youth aged 15-19 years, 127 students aged 20-29 years, and 79 adults aged 30 years or older. Dietary assessment was based on the KomPAN questionnaire and included the pro-healthy diet index, non-healthy diet index, and Diet Quality Index. Study-specific scores were used for knowledge, healthy practices, psychosocial well-being, and stress/overload. Analyses were restricted to predefined group comparisons, selected correlations, and three whole-sample adjusted logistic regression models. Results: Adults had the highest BMI and waist/hip circumference, whereas school youth showed the highest non-healthy diet index and more frequent high processed-food intake. Among the knowledge and psychosocial indicators, only obesity knowledge differed significantly between groups, with the highest mean value among students. Stress/overload was inversely associated with psychosocial well-being, and DQI was positively associated with psychosocial well-being after adjustment for age, sex, and group. In adjusted whole-sample models, BMI &#x2265; 25 kg/m2 was positively associated with age and DQI and inversely associated with physical activity frequency and regular meals; the positive DQI-BMI association was interpreted cautiously as potentially reflecting reverse causality, reporting bias, or compensatory dietary modification among respondents with excess body weight. Poorer mental well-being was associated with higher stress/overload and inversely associated with DQI, physical activity frequency, and family meals. High stress/overload was positively associated with highly processed food intake and inversely associated with regular meals. Conclusions: The findings suggest that diet quality, behavioral regularity, and psychosocial burden may be more informative than knowledge alone when describing health-related profiles across age-defined groups. Because the study was cross-sectional, self-reported, anonymous, and based on a modest sample, the results should be interpreted as preliminary and hypothesis-generating rather than causal.

Background: Childhood obesity remains a major public health challenge worldwide, with increasing prevalence across Europe. Schools represent an important setting for promoting healthy lifestyles through physical activity and nutrition-related interventions. This systematic review aimed to evaluate the effectiveness of school-based interventions promoting physical activity and healthy eating behaviours among children and adolescents aged 6-18 years in European countries. Methods: A systematic literature review was conducted using PubMed and Scopus. Studies were eligible if they were conducted in school settings, targeted children and adolescents aged 6-18 years, were implemented in European countries, had a minimum duration of nine months, and assessed anthropometric and/or behavioural outcomes related to obesity prevention. Methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Results: Sixteen studies conducted across nine European countries met the inclusion criteria. Intervention duration ranged from nine months to five years, and most studies employed multicomponent approaches combining physical activity promotion, nutrition education, environmental modifications, and parental involvement. Seven studies were rated as strong quality, six as moderate quality, and three as weak quality. Among the fourteen studies assessing BMI or other anthropometric outcomes, eleven (78.6%) reported statistically significant improvements in at least one obesity-related measure, including BMI, BMI z-score, waist circumference, waist-to-height ratio, body fat percentage, or overweight/obesity prevalence. Evidence regarding physical activity and nutrition-related outcomes was more heterogeneous, although several studies reported improvements in dietary behaviours, nutrition knowledge, sedentary behaviour, and physical activity levels. Positive anthropometric effects were more commonly observed in interventions lasting at least one academic year and in multicomponent programmes. Some studies also reported differential effects according to sex and parental educational background. Conclusions: The findings of this review suggest that long-term, multicomponent school-based interventions can contribute to improving obesity-related anthropometric outcomes among children and adolescents in European countries. However, evidence regarding sustained changes in physical activity and dietary behaviours remains less consistent. Future research should focus on identifying the most effective intervention components and strategies for achieving long-term behavioural change across diverse populations and educational contexts.

Wijekulasuriya, GA, Woods, CT, Kittel, A, and Larkin, P. The association between athletic movement quality and physical fitness in athletic populations: A systematic review with multilevel meta-analysis. J Strength Cond Res XX(X): 000-000, 2026-Proficient athletic movement skill is purported to be foundational for the development of physical fitness qualities. Conducting a meta-analysis to determine the association between athletic movement quality and physical fitness in athletic populations would thus provide empirical evidence to substantiate or challenge this purportion. The aim of this study was to undertake a systematic review and meta-analysis to determine the association between athletic movement quality and physical fitness measures in athletic populations. Following our literature search, 62 studies were identified for inclusion. Multilevel meta-analyses were then conducted to determine the association between assessments of athletic movement quality and physical fitness measures, which included GRADE assessments for certainty of evidence. Subgroup analysis determined whether associations differed between movement quality assessments. There was high certainty of evidence for the association between athletic movement quality and balance, lower-body bilateral power, and speed. There were also associations between athletic movement quality and cardiorespiratory endurance, flexibility, and muscular strength. However, associations were negligible to low in magnitude and were assessment-dependent for some physical fitness measures. Bias due to nonreporting and limited control for confounding factors was identified, and moderate model and between-study heterogeneity was evident for most meta-analyses. Thus, the association between athletic movement quality and physical fitness seems small and assessment specific. These results may influence the selection of athletic movement quality assessments for athletes in addition to long-term athletic development strategies in youth populations.

Post COVID-19 condition (PCC) significantly affects health-related quality of life (HRQoL), but involvement and interconnectivity of different health dimensions is still underexplored. This study aims to characterize the multidimensional health status of individuals with and without PCC after at least one year follow-up. Hospitalized and non-hospitalized COVID-19 patients were included from three hospitals in the Netherlands. HRQoL, pulmonary and metabolic health, muscle strength, physical capability, symptoms, psychological- and social wellbeing, and cognitive function were measured using validated objective and subjective methodology. Presence of PCC was based on self-report. 139 participants were included, of which 87 with PCC and 52 without PCC. HRQoL was lower in the PCC group compared to the non-PCC group (EQ-5D: p&#x2009;=&#x2009;0.005; VAS: p&#x2009;<&#x2009;0.001). Individuals with PCC also more frequently reported fatigue, anxiety/depression, stress and loneliness, alongside lower subjective cognitive functioning and sleep quality (p&#x2009;<&#x2009;0.05). Inspiratory muscle strength and exercise capacity (p&#x2009;=&#x2009;0.024 and p&#x2009;=&#x2009;0.007) were lower in the PCC group than the non-PCC group. Pulmonary function and residual CT-abnormalities, body composition, cardiometabolic risk, expiratory- and peripheral muscle strength, mobility, physical activity, and cognitive function tests were not different between groups. Perceived health burden in PCC is reflected by lower health status, more frequently reported symptoms of fatigue and poor sleep quality, and lower psychological- and social wellbeing and subjective cognitive functioning compared to non-PCC. These differences are only partially reflected in objectively assessed dimensions of muscle strength and physical capability, but not in pulmonary/metabolic health and cognitive function. The findings indicate a discordance between subjective health burden and currently available objective assessments in individuals with PCC.

This study aimed to investigate changes in activity levels and health-related quality of life (HRQoL) in children with spastic cerebral palsy (CP) before and after botulinum toxin (BTX) injection, based on parental reports within the International Classification of Functioning Disability and Health (ICF) framework. This retrospective study included 60 children with spastic CP (20 girls, 40 boys) who underwent BTX injection for spasticity management. The age range was 2-11 years (mean age, 5.44 &#xc5;} 2.09 years). Gross motor function level was classified using the Gross Motor Function Classification System-Family Report. Activity was evaluated with the Pediatric Outcome Data Collection Instrumen (PODCI), and HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) before and after BTX injection. Parents completed all questionnaires 6-12 months after BTX injection; pre- and post-injection scores were compared. The PODCI scores improved significantly after BTX in upper extremity function (P = .001), transfers/basic mobility (P = .005), pain/comfort (P = .009), happiness/satisfaction (P < .001), and global score (P < .001), while the physical function/sports subscale did not change significantly (P = .136). The PedsQL total score improved (P < .001), with significant improvements in daily activities (P < .001), school (P = .034), activity/balance (P < .001), pain/ache (P = .015), fatigue/prostration (P = .002), and nutrition (P = .027); the speech/communication domain showed no significant change (P = .150). From a parental perspective, BTX injection was associated with improved activity and HRQoL in children with spastic CP, with gains seen across multiple functional and well-being domains. Clinically, these findings support counseling families that BTX within an ICF-oriented rehabilitation approach may translate into meaningful improvements in daily function and overall well-being, although speech-related outcomes may be less responsive. &#xa0; Cite this article as: Yavuz GK, Y&#x131;lmaz G, G&#xfc;nel MK. Parent-reported activity and health-related quality of life after botulinum toxin in spastic cerebral palsy. Acta Orthop Traumatol Turc., 2026; 60(2), 0612, doi: 10.5152/j.aott.2026.25612.

Metabolic syndrome (MetS) is a major risk factor for cardiovascular disease and diabetes. However, ecological evidence regarding the differential effects of exercise intensity remains limited. In this study, we examined the associations between three types of exercise (high-intensity, moderate-intensity, and strength training) and five MetS components at the population level and developed a decision tree-based model to identify high-risk groups. Age group-level aggregate data (N = 150) from the National Health Screening Statistical Yearbook (2014-2023) were analyzed. Pearson's and age-adjusted partial correlations were used to assess associations between exercise frequency and the prevalence of metabolic conditions. A CART-based decision tree model was developed and evaluated using five-fold stratified cross-validation. In simple correlation analyses, high-intensity exercise was negatively correlated with hypertension and hyperglycemia. After adjusting for age, moderate-intensity exercise was positively correlated with abdominal obesity, hypertension, and hyperglycemia, whereas strength training was positively correlated with hypertriglyceridemia and low HDL cholesterol (all p < 0.001). The decision tree model achieved an accuracy of 78.7% using high- and moderate-intensity exercise variables, which improved to 82.2% when all three exercise types were included. Under the MetS criterion (&#x2265; 3 risk factors), accuracy reached 85.6% with a precision of 0.94. Partial correlations differed in direction from findings at the individual level, indicating a potential ecological fallacy. Nevertheless, the decision tree model demonstrated acceptable predictive performance, suggesting that exercise frequency may be a useful population-level screening indicator.

To examine the efficacy of conservative (non-surgical) treatments, usual care, and no treatment for chronic radicular and non-specific back pain. Time course network meta-analysis. Six electronic databases (Medline, SPORTDiscus, CINAHL, PsycINFO, Embase, and CENTRAL), searched from inception to 24 July 2020, and 302 previous systematic reviews. Full peer reviewed publications in English or German of randomised controlled trials, randomised clinical trials, randomised controlled cluster trials, or randomised crossover trials in adults (aged &#x2265;18 years) receiving common conservative treatments for non-specific and radicular chronic low back pain. Treatments examined were acupuncture, education or advice, electrotherapy (including heat and ice electrotherapeutic modalities applied non-invasively), exercise training, manual treatments or manipulation, massage, the McKenzie method, pharmacotherapy, psychological treatments, traction, physical therapy (otherwise not falling into specific treatment combinations), placebo, multidisciplinary pain management, usual care (eg, management by a doctor), and no treatment (true control). Back pain intensity, leg pain intensity, disability, and mental health outcomes were reported immediately (<1 day), and at short term (&#x2265;1 day and &#x2264;3 months), intermediate term (>3 and <12 months), and long term (&#x2265;12 months) time points. 581 reports of 551 studies (71&#x2009;126&#x2009;patients) were included. 510 trials included people with non-specific chronic low back pain and 41 trials included those with radicular chronic low back pain. For back pain (0-100 scale), acupuncture (mean difference -20.91, 95% credible interval -24.00 to -11.95), electrotherapy (-18.98, -21.84 to-10.95), exercise (-15.59, -17.51 to -10.05), manual treatment (-19.48, -22.17 to -11.74), massage (-25.61, -30.42 to -10.91), and multidisciplinary pain management (-18.96, -22.26 to -9.58) exceeded the minimal clinically important difference (set at 0.5 standard deviation) in the short term. For disability (0-100 scale), acupuncture (mean difference -10.52, 95% credible intervals -11.84 to -6.59), massage (-9.95, -11.45 to -5.50), and multidisciplinary pain management (-12.56, -13.91 to -8.55) were clinically effective in the short term. In the immediate and intermediate term only, the McKenzie method and massage, respectively, exceeded the minimal clinically important difference. In the long term, although two of the 14 treatments for back pain and nine of 14 treatments for disability had statistically significant benefits compared with no treatment, the effects were not clinically significant. The certainty of the evidence based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was low (1.4%) to very low (98.6%) across interventions and time points. Findings for massage and the McKenzie method were not stable in the sensitivity analyses. Treatment effects for radicular chronic low back pain did not seem to differ from those for non-specific chronic low back pain. Some treatments were effective for pain and function in non-specific chronic low back pain, but improvements did not persist long term. Most of the evidence was for non-specific chronic low back pain; the evidence base for radicular chronic low back pain was limited. Although sensitivity analyses did not provide evidence for a different response in radicular chronic low back pain, an evidence gap remains for this subpopulation. Future work should explore strategies to establish the long term efficacy of modifications to lifestyle and behaviour. PROSPERO CRD42020182039.

This study examines awareness, perceived legitimacy, trust and readiness for the implementation of lifestyle medicine within National Health Service (NHS) prevention pathways among community-dwelling adults and healthcare professionals (HCPs) in England. A secondary objective was to assess how professional training and system factors relate to the provision and intended use of lifestyle medicine services within the NHS. Cross-sectional, self-administered online survey. UK; online survey administered in January 2026. Adults aged &#x2265;18 years living in the UK, recruited via a closed online panel using quota sampling to approximate national distributions by age, gender and ethnicity. A subgroup of respondents self-identified as HCPs. Primary outcomes were perceived legitimacy of lifestyle medicine as a healthcare approach and intention to use an NHS lifestyle medicine service if available. Secondary outcomes included awareness and familiarity with the term 'lifestyle medicine', trust in different providers of lifestyle advice, perceived self-efficacy across lifestyle domains and-among HCPs-training, confidence, barriers and current provision of lifestyle-related advice. A total of 733 participants completed the survey including 58 HCPs. Awareness of the term 'lifestyle medicine' was limited in the general population (26.3%) but substantially higher among HCPs (62.1%). Despite this, there was broad agreement across groups regarding core lifestyle medicine domains; particularly nutrition, physical activity, sleep and stress management. Higher perceived legitimacy of lifestyle medicine was strongly associated with stated intention to use an NHS service. Trust in lifestyle advice was highest when delivered by clinicians with formal lifestyle medicine training and lower for non-medical professionals, even when formally trained. Among HCPs, formal training and greater confidence were strongly associated with provision of lifestyle-related advice, whereas perceptions of NHS support for lifestyle-based approaches were consistently low regardless of training status. Lifestyle medicine is widely viewed as legitimate and potentially valuable when anchored within professional training and NHS delivery but its implementation is constrained by limited public familiarity, variable workforce capability and low perceived system readiness. Strengthening training pathways, clarifying professional standards and enhancing institutional support may be critical to embedding lifestyle medicine within NHS prevention and long-term condition strategies.

Non-communicable diseases are leading causes of morbidity and mortality worldwide. Lifestyle behaviors, such as poor diet, physical inactivity, and tobacco use, contribute substantially to this burden. Lifestyle medicine (LM) emphasizes evidence-based behavioral interventions to prevent and manage chronic diseases. However, little is known about LM education among family medicine residents in Saudi Arabia, particularly in the Jazan region. This study aimed to assess the effects of a structured LM educational intervention on the knowledge and attitudes of family medicine residents in the Jazan region. A pilot pre- and post-intervention design was implemented among 67 residents enrolled in a post-graduate family medicine program in the Jazan region during May 2025. A validated questionnaire covering eight knowledge domains and five attitude dimensions related to LM was administered before and after training. The intervention was performed in a single day. An 8-h intensive program provided a comprehensive introduction to LM and health coaching through a blended learning approach incorporating lectures, workshops, and case-based scenarios. Facilitated by International Board of Lifestyle Medicine-certified consultant family physicians, the curriculum leveraged expert instruction and multimedia tools to deliver evidence-based training on the Six Pillars of Lifestyle Medicine. Data were analyzed using descriptive and comparative statistics to evaluate the changes between pre- and post-intervention responses. The median total knowledge score increased from 23.0 (IQR 19.0-29.0) at baseline to 29.0 (IQR 27.0-31.0) following the intervention. Knowledge improved across the majority of domains, notably nutrition, physical activity, and health coaching. Knowledge improved among 82.1% of participants. A total of 56.7% demonstrated a positive shift in attitudes toward LM principles, which may translate into greater willingness to counsel patients on lifestyle modification and prioritize preventive care during routine clinical encounters. The educational intervention significantly improved residents' knowledge and moderately enhanced their attitudes toward LM. The findings of this pilot study underscore the importance of incorporating structured LM training into family medicine residency programs nationwide to strengthen preventive care competencies and support the goals of Saudi Vision 2030.