Physical inactivity has led to an increase in the prevalence of lifestyle-related chronic diseases on a global scale. There is a need for more awareness surrounding the preventive and curative role of a physically active lifestyle in healthcare. The prescription of physical activity in clinical care has been advocated worldwide through the ‘exercise is medicine’ (E=M) paradigm. However, E=M currently has no position in general routine hospital care, which is hypothesized to be due to attitudinal and practical barriers to implementation. This study aims to create an E=M tool to reduce practical barriers to enforcing E=M in hospital care. Firstly, this project will perform qualitative research to study the current implementation status of E=M in clinical care as well as its facilitators and barriers to implementation among clinicians and hospital managers. Secondly, an E=M tool towards application of active lifestyle interventions will be developed, based on a prediction model of individual determinants of physical activity behavior and local big data, which will result in a tailored advice for patients on motivation and physical activity. Thirdly, the feasibility of implementing the E=M-tool, as designed within this project, will be investigated with a process evaluation, conducting a pilot-study which will integrate the tool in routine care in at least four clinical departments in two Dutch hospitals. This project will give insight in the current implementation status of E=M and in factors that influence the actual E=M implementation. Secondly, an E=M tool will be designed providing a tailored E=M prescription for patients as part of clinical care. Thirdly, an implementation strategy will be developed for implementation of the E=M tool in clinical practice. This project envisages an extensive continuation of research on the implementation of E=M, supports the mutual decision making process of lifestyle referral of clinicians and will provide insights which can be used to assist in implementing physically active lifestyle prescription in the medical curriculum.
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Background: Despite the importance of sports injury prevention in youth, no broad scale approaches that work in real-life situations with significant positive effects exist. Main reasons for this are poor uptake and maintenance of current sports injury prevention exercises.Objective: In order to improve uptake of sports injury prevention routines, this project set out to: 1. identify the specifics of current injury prevention programs within 6 European countries, and 2: to establish wishes and needs regarding injury prevention of the end-users (sport coaches, physical educators and youth) within 6 European countries.Design: Semi-structured interviews and focus group sessions.Setting: Youth sports teams and physical education (PE) classes.Patients (or Participants): Interviews and focus group sessions were performed within 6 participating countries (Belgium, Denmark, Lithuania, Romania, The Netherlands, United Kingdom). National stakeholders were interviewed to identify injury prevention programs. The program owners of the identified programs were then individually interviewed. The focus group sessions were organized with youth basketball and soccer players and PE pupils. Separate focus group sessions were organized for basketball/soccer coaches and physical educators.Interventions (or Assessment of Risk Factors): This qualitative study provided input for the development of a freely available ICT based platform with video material of routines designed to prevent sports injuries in youth.Main Outcome Measurements: Overview of country specific results of interviews and focus groups.Results: This study will describe the current availability of national injury prevention programs within 6 European countries. The results of the focus group sessions will establish the differences in beliefs regarding injury prevention in 6 European countries regarding injury prevention.Conclusions: In the coming year, the Move Healthy project will use the qualitative results of this study to develop a freely available ICT based platform with video material of routines developed to prevent sports injuries in youth.
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To evaluate the 5-year course of physical work capacity of participants with early symptomatic osteoarthritis (OA) of the hip and/or the knee; to identify trajectories and explore the relationship between trajectories and covariates. Methods In a prospective cohort study, physical work capacity was measured at baseline, using a test protocol (functional capacity evaluation) consisting of work-related physical activities. Participants were invited to participate in 1, 2 and 5 year follow-up measurements. Multilevel analysis and latent classes analysis were performed, in models with test performances as dependent variables and age, sex, work status, self-reported function (Western Ontario McMasters Arthritis Scale-WOMAC), body mass index (BMI) and time as independent variables. Multiple imputation was used to control for the influence of missing data. Results At baseline and after 1, 2 and 5 years there were 96, 64, 61 and 35 participants. Mean (SD) age at baseline was 56 (4.9) years, 84% were females. There was no statistically significant change in test performances (lifting low and high, carrying, static overhead work, repetitive bending, repetitive rotations) between the 4 measurements. Male sex, younger age and better self-reported function were statistically significant (p < 0.05) determinants of higher performance on most of the tests; having a paid job, BMI and progression of time were not. Three trajectories were identified: 'weak giving way', 'stable and able', and 'strong with decline'. Discussion In subgroups of participants with early symptomatic OA, determined by age, sex and self-reported function, physical work capacity seems to be a stable characteristic over 5 years.
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InleidingBlessures zijn een groot probleem voor hardlopers. Zo raakt jaarlijks 64% van de midden-lange afstandslopers, 32% van de lange afstandslopers en 52% van de marathonlopers geblesseerd (1). Blessures veroorzaken niet alleen persoonlijk leed, maar hierdoor kunnen hardlopers ook niet (goed) trainen om hun prestatiedoel te bereiken. Daarom is het van groot belang om te bepalen wat de risicofactoren zijn om een blessure te krijgen. Een van de risicofactoren waar sporters en coaches zelf invloed op hebben is de trainingsbelasting (2). Daarom is in deze studie onderzocht of er patronen zijn in de trainingsbelasting die voorafgaan aan een blessure. Daarnaast is uitgezocht in hoeverre de blessures te voorspellen zijn op basis van deze patronen. MethodeDe trainingsbelasting en blessures van 23 hardlopers is twee jaar lang bijgehouden. Deze gegevens zijn met verschillende datamining technieken onderzocht om patronen te herkennen. Er is gekozen om dagelijkse acute trainingsbelasting (over 7 dagen) te delen door dagelijkse chronische trainingsbelasting (over 28 dagen), genaamd acute:chronic ratio (2). Dit is per hardloper over 720 dagen bepaald. Daarbij is specifiek gekeken naar het patroon van verandering in acute:chronic ratio over vier weken voorafgaand aan elke blessure. ResultatenDe resultaten laten zien dat de hardlopers twee weken voorafgaand aan een blessure hun acute:chronic ratio met gemiddeld 11,5% verhoogden ten opzichte van de twee weken daarvoor. Met deze verhoging van 11,5% is het relatieve risico op een blessure significant verhoogd met 9,4. De sensitiviteit van voorspellingen is 0,51 en de specificiteit is 0,94.DiscussieDit betekent dat een toename van 11,5% of meer in trainingsbelasting gedurende twee weken een verhoogde kans geeft op blessures bij hardlopers. Ondanks het verhoogde risico is de voorspelling van een blessure nog niet goed mogelijk met alleen trainingsgegevens. Toch kunnen hardlopers het risico op blessures misschien verkleinen door individueel goed te kijken naar verhogingen in trainingsbelasting.(1) Kluitenberg B et al. (2015) What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis. Sport Med. 45(8):1143–61.(2) Gabbett, TJ. (2016) The training-injury prevention paradox: should athletes be training smarter and harder?. Br J Sports Med, bjsports-2015.
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Background Running-related injuries (RRIs) can be considered the primary enemy of runners. Most literature on injury prediction and prevention overlooks the mental aspects of overtraining and under-recovery, despite their potential role in injury prediction and prevention. Consequently, knowledge on the role of mental aspects in RRIs is lacking. Objective To investigate mental aspects of overtraining and under-recovery by means of an online injury prevention programme. Methods and analysis The ‘Take a Mental Break!’ study is a randomised controlled trial with a 12 month follow-up. After completing a web-based baseline survey, half and full marathon runners were randomly assigned to the intervention group or the control group. Participants of the intervention group obtained access to an online injury prevention programme, consisting of a running-related smartphone application. This app provided the participants of the intervention group with information on how to prevent overtraining and RRIs with special attention to mental aspects. The primary outcome measure is any self-reported RRI over the past 12 months. Secondary outcome measures include vigour, fatigue, sleep and perceived running performance. Regression analysis will be conducted to investigate whether the injury prevention programme has led to a lower prevalence of RRIs, better health and improved perceived running performance. Ethics and dissemination The Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands, has exempted the current study from ethical approval (reference number: NL64342.041.17). Results of the study will be communicated through scientific articles in peer-reviewed journals, scientific reports and presentations on scientific conferences.
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PURPOSE: It has been reported that there is no correlation between anterior tibia translation (ATT) in passive and dynamic situations. Passive ATT (ATTp) may be different to dynamic ATT (ATTd) due to muscle activation patterns. This study aimed to investigate whether muscle activation during jumping can control ATT in healthy participants.METHODS: ATTp of twenty-one healthy participants was measured using a KT-1000 arthrometer. All participants performed single leg hops for distance during which ATTd, knee flexion angles and knee flexion moments were measured using a 3D motion capture system. During both tests, sEMG signals were recorded.RESULTS: A negative correlation was found between ATTp and the maximal ATTd (r = - 0.47, p = 0.028). An N-Way ANOVA showed that larger semitendinosus activity was seen when ATTd was larger, while less biceps femoris activity and rectus femoris activity were seen. Moreover, larger knee extension moment, knee flexion angle and ground reaction force in the anterior-posterior direction were seen when ATTd was larger.CONCLUSION: Participants with more ATTp showed smaller ATTd during jump landing. Muscle activation did not contribute to reduce ATTd during impact of a jump-landing at the observed knee angles. However, subjects with large ATTp landed with less knee flexion and consequently showed less ATTd. The results of this study give information on how healthy people control knee laxity during jump-landing.LEVEL OF EVIDENCE: III.
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Injuries of runners reduce the ability to train and hinder competing. Literature shows that the relation between potential risk factors and injuries are not definitive, limited, and inconsistent. In team sports, workload derivatives were identified as risk factors. However, there is an absence of literature in running on workload derivatives. This study used the workload derivatives acute workload, chronic workload, and acute: chronic workload ratios to investigate the relation between workload and injury risk in running. Twenty-three competitive runners kept a daily training log for 24 months. The runners reported training duration, training intensity and injuries. One-week (acute) and 4-week (chronic) workloads were calculated as the average of training duration multiplied by training intensity. The acute:chronic workload ratio was determined dividing the acute and chronic workloads. Results show that a fortnightly low increase of the acute:chronic workload ratio (0.10-0.78) led to an increased risk of sustaining an injury (p<0.001). Besides, a low increase of the acute:chronic workload ratio (0.05-0.62) between the second week and third week before an injury showed an association with increased injury risk (p=0.013). These findings demonstrate that the acute:chronic workload ratio relates to injury risk.
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Purpose: The aim of this brief review was to present an overview of noninvasive markers in trained to professional endurance athletes that can reflect a state of functional overreaching. Methods: A systematic literature search was conducted in the PubMed, Scopus, and PsycINFO databases. After screening 380 articles, 12 research papers were included for the systematic review. Results: Good consensus was found between the different papers in which noninvasive parameters were able to reflect a state of functional overreaching. Changes in power output (PO), heart rate (HR; [sub]maximal and HR recovery), rating of perceived exertion, and scores in the Daily Analysis of Life Demands for Athletes (DALDA) and/or Profile of Mood States (POMS) were shown to be able to reflect functional overreaching, whereas changes in maximal oxygen uptake and HR-variability parameters were not. Conclusion: Functional overreaching within a maximal performance test was characterized by a decrease in peak PO and a lower maximum HR, whereas a lower mean PO and a lower HR were observed during time trials. Changes in parameters during a standardized submaximal test when functionally overreached were characterized by a higher PO at a fixed HR or a lower HR at a fixed intensity, higher rating of perceived exertion, and a faster HR recovery. Although both the DALDA and POMS were able to reflect functional overreaching, the POMS was not able to differentiate this response from acute fatigue, which makes it unsuitable for accurately monitoring functional overreaching.
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The Hospital Elder Life Program (HELP) has been shown to be highly efficient and (cost-)effective in reducing delirium incidence in the USA. HELP provides multicomponent protocols targeted at specific risk factors for delirium and introduces a different view on care organization, with trained volunteers playing a pivotal role. The primary aim of this study is the quantification of the (cost-)effectiveness of HELP in the Dutch health care system. The second aim is to investigate the experiences of patients, families, professionals and trained volunteers participating in HELP.
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