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Effectiveness of lifestyle interventions to promote physical activity on glycated hemoglobin and physical activity in type 2 diabetes patients - Systematic review with meta-analysis
No full textIntroduction
An increase in Type 2 diabetes (T2D) cases worldwide can be attributed to the prevalence of an unhealthy lifestyle. Engaging in regular exercise can significantly benefit individuals with T2D (Colberg et al., 2016). A multitude of studies have explored this impact through controlled exercise interventions (Hou et al., 2023). Nevertheless, our understanding of how lifestyle interventions can effectively promote physical activity (PA) and positively influence the progression of T2D in practical, real-world scenarios remains limited. The objective of this systematic review with meta-analysis is to investigate the impact of lifestyle interventions targeting the promotion of PA on glycated hemoglobin (HbA1c) levels and PA outcomes. Furthermore, the aim is to examine whether lifestyle interventions influence PA and therefore HbA1c.
Methods
We searched three databases (MEDLINE via PubMed, PsycINFO, and SPORTdiscus) using the expanded search strategy of “Type 2 diabetes” AND “lifestyle intervention” AND “randomized controlled trial” AND “physical activity” AND “HEMOGLOBIN A1C”. In order to provide a comprehensive overview, we examine the design of the studies and the structure of the lifestyle interventions. To address the aim of this study, we conducted a meta-analysis with the outcomes PA and HbA1c. Moreover, we performed a multivariate meta-regression analysis to explore the impact of the moderator variable, PA, on the study effect sizes of HbA1c.
Results
This review incorporated 12 studies (n = 2513 patients), exploring multiple lifestyle interventions with heterogeneity in design, components, and duration. Regarding PA outcomes, we found an increase in PA (g = 0.33, 95% CI = 0.21,0.45), with no disparity between objective and self-reported measurements of PA. For HbA1c, the effect size was g = -0.07 (95% CI -0.17,0.04). In multivariate meta-regression, the intercept was 0.004 (SE = 0.06, 95% CI -0.11,0.12), and the PA coefficient as a moderator was -0.05 (SE = 0.06, 95% CI -0.18,0.07). These findings suggest that physical activity does not act as a moderator for changes in HbA1c in the examined studies.
Discussion/Conclusion
The studies showed a small effect in increasing PA. Lifestyle interventions had no relevant impact on HbA1c compared to control conditions, and the role of PA as a moderator was inconclusive. Further research is required to determine if structured exercise programs, known for positively affecting HbA1c, could be a better alternative to lifestyle interventions for individuals with T2D. Additionally, there is a need to investigate ways to enhance the efficacy of lifestyle interventions in influencing PA and HbA1c levels.
References
Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E. S., Castorino, K., & Tate, D. F. (2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065-2079. https://doi.org/10.2337/dc16-1728
Hou, L., Wang, Q., Pan, B., Li, R., Li, Y., He, J., Qin, T., Cao, L., Zhang, N., & Cao, C. (2023). Exercise modalities for type 2 diabetes: A systematic review and network meta‐analysis of randomized trials. Diabetes/Metabolism Research and Reviews, 39(1), Article e3591. https://doi.org/10.1002/dmrr.359
Evaluation of drying performance of sports bras
No full textIntroduction
Fabrics used for manufacturing sports bras have to be lightweight, breathable, have fast drying behaviour, and moisture management properties (Uttam, 2013). Therefore, thermo-physiological comfort is an important quality criterion for sports bras (Carneiro et al., 2017). In addition, sports bras have to provide support to stabilize breasts during various physical activities (Ancutiene et al., 2017). These requirements lead to challenges in finding the best sports bra fabric, as bra support (Norris et al., 2021) and thermo-physiological comfort require contrasting fabric properties (Carneiro et al., 2017).
This work aims to compare drying characteristics of different sports bras types (compression, encapsulation and combination) and fabrics used. A newly developed methodology to investigate the drying behaviour of sports bras in the lab has been taken for their examination.
Methods
The measurement set-up was built up in a climatic chamber (at 23°C and 50% RH). It consists of the upper body part of a female manikin, the air channel with fans and a balance to measure the weight change of the sports bra over time (indicative of the amount of moisture evaporated). The Infrared (IR) camera was used to record local surface temperature. Based on these measurements, the local and general drying performance of the sports bras were assessed based on dry fabric weight, moisture uptake, moisture absorption, drying time and drying rate.
Results
The results show that type of sports bra and material composition can have influence on better drying performance studied. The range of drying time for the different sport bra types was observed between 13 and 66 min for compression bras, 25 and 42 min for encapsulation bras, and between 35 and 43 min for combination bras. The moisture uptake was detected in a range between 6% and 15% for compression bras, 13% and 15% only for encapsulation bras, while between 7% and 19% for combination bras.
Discussion/Conclusion
We were able to show that there is a significant difference in drying performance between sports bras. In combination with additional data about sensorial comfort and breast support, these findings provide a scientific basis for developing sports bras meeting specific requirements for various sports.
References
Ancutiene, K., Koldinska, M., & Havelka, A. (2017). Investigation of tensile resilience properties of stretch denim fabrics. Indian Journal of Fibre & Textile Research, 42, 175-182.
Carneiro, L. P., Miranda, T. M. R., & Catarino, A. A. (2017). Comparative thermophysiological study in sport bras for running. IOP Conference Series: Materials Science and Engineering, 254(7), Article 072006. https://doi.org/10.1088/1757-899X/254/7/072006
Norris, M., Blackmore, T., Horler, B., & Wakefield-Scurr, J. (2021). How the characteristics of sports bras affect their performance. Ergonomics, 64(3), 410-425. https://doi.org/10.1080/00140139.2020.1829090
Uttam, D. (2013) Active sportswear fabrics. International Journal of IT, Engineering and Applied Sciences Research, 2(1), 34-40
Assessing the accuracy of photoplethysmography for wearable heart rate monitoring based on body location and body motion in uncontrolled outdoor environments
No full textIntroduction
Reflective photoplethysmography (PPG) is the dominant method for heart rate (HR) monitoring consumer wearables. However, motion artifacts and sensor placement impact the accuracy of these HR measurements. Here, we present a study on how these two factors affect the accuracy of PPG-based HR measurements and compare them to ground-truth measurements from electrocardiography (ECG). Our study investigated these measurements in outdoor environments outside controlled laboratory settings.
Methods
Our study collected a dataset of 16 participants, each for 13 hours wearing four reflective PPG sensing devices placed at the forehead, sternum, ankle (supramalleolar), and wrist. Participants traveled by train from downtown Zurich to the Jungfraujoch railway station at 3,460 m above sea level in the mountains. PPG measurements were obtained using a MAX86141 optical analog front-end coupled with a green LED and photodiode from an SFH7072 module. Motion was quantified using two accelerometers (LIS2DH, ADXL355). A Lead I ECG was obtained by the device at the sternum using a MAX30003 biopotential sensor connected to gel electrodes on the chest. All devices were synchronized by aligning recorded signals post-hoc (33ms accuracy, Meier & Holz, 2023). The HR was extracted from the ECG by time-domain peak detection. The HR extraction from PPG was both performed by time-domain peak detection and frequency-domain analysis. The HR was computed every 5 seconds (30 seconds window size) resulting in 152,000 HR measurements across the whole dataset.
Results
The forehead and chest locations exhibited the highest HR measurement accuracy (median error 7.1% and 7.7%, respectively), while lower accuracies were observed for ankle and wrist placements (9.9% and 18.4% error). At rest, all median errors were below 5% while movements influenced readings at all locations negatively. Adjusted for motion, the HR obtained from the forehead sensor was most accurate. In terms of processing method, time-domain analysis produced better accuracy during periods of low motion while frequency-domain analysis was more reliable during movements.
Discussion/Conclusion
The accuracy of PPG-based HR measurements in uncontrolled outdoor settings is affected both by body location and motion artifacts with a clear ranking of site suitability: forehead >> chest >> ankle >> wrist. This is consistent with prior studies in controlled environments, though our study found a higher impact of motion than body location on HR accuracy (Longmore et al., 2019). This may be because participants’ motions in uncontrolled environments are more irregular and diverse, resulting in deteriorated signal quality. Our study shows the importance of further investigations in everyday conditions on the path toward more reliable PPG-based HR monitoring in wearable devices.
References
Longmore, S. K., Lui, G. Y., Naik, G., Breen, P. P., Jalaludin, B., & Gargiulo, G. D. (2019). A comparison of reflective photoplethysmography for detection of heart rate, blood oxygen saturation, and respiration rate at various anatomical locations. Sensors, 19(8), Article 1874. https://doi.org/10.3390/s19081874
Meier, M., & Holz, C. (2023). BMAR: Barometric and Motion-based Alignment and Refinement for offline signal synchronization across devices. Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies, 7(2), Article 69. https://doi.org/10.1145/359626
Book Review. Balancing the Commons in Switzerland. Institutional Transformations and Sustainable Innovations. Haller, Tobias, Karina Liechti, Martin Stuber, François-Xavier Viallon, and Rahel Wunderli (eds.)
No full textBook review of "Haller, Tobias, Karina Liechti, Martin Stuber, François-Xavier Viallon, and Rahel Wunderli (eds.). Balancing the Commons in Switzerland. Institutional Transformations and Sustainable Innovations. 2021. London: Routledge.Book review of "Haller, Tobias, Karina Liechti, Martin Stuber, François-Xavier Viallon, and Rahel Wunderli (eds.). Balancing the Commons in Switzerland. Institutional Transformations and Sustainable Innovations. 2021. London: Routledge.Book review of "Haller, Tobias, Karina Liechti, Martin Stuber, François-Xavier Viallon, and Rahel Wunderli (eds.). Balancing the Commons in Switzerland. Institutional Transformations and Sustainable Innovations. 2021. London: Routledge
Evoluzione degli atteggiamenti degli insegnanti vodesi nei confronti dell\u27integrazione scolastica e del loro senso di autoefficacia tra il 2016 e il 2022
No full textIn der vorliegenden Querschnittsstudie werden Einstellungen von Waadtländer Lehrpersonen zur schulischen Integration sowie deren Selbstwirksamkeitsgefühl vor und nach der Inkraftsetzung des Gesetzes über die Sonderpädagogik und der Einführung des 360°-Konzepts im Jahr 2019 untersucht. Die 2022 gemessenen Einstellungen und das Selbstwirksamkeitsgefühl von 167 Lehrpersonen werden mit Daten von 306 Lehrpersonen von 2016 verglichen. Die Einstellungen der Lehrpersonen im Jahr 2022 sind signifikant weniger positiv als im Jahr 2016. Auf Sekundarstufe I ist zudem ein tendenzieller Rückgang des Selbstwirksamkeitsgefühls festzustellen. Basierend auf diesen Resultaten wird präsentiert, wie (zukünftige) Lehrpersonen bei der Umsetzung der inklusiv ausgerichteten Schule unterstützt werden können.This cross-sectional study’s aim is to examine changes in the attitudes of teachers in the canton of Vaud (Switzerland) towards inclusive education and in their sense of self-efficacy (SSE), before and after the entry into force of the law on special education and the introduction of the 360° concept in 2019. Attitudes and SSE measured among 167 teachers in 2022 were compared with data collected from 306 teachers in 2016. The results indicate that teachers\u27 attitudes are less positive in 2022 than in 2016 and that their level of SSE is lower, particularly in secondary education. These results provide food for thought on how to support (future) teachers in implementing inclusive education.La présente étude transversale propose d’examiner l’évolution des attitudes à l’égard de l’intégration scolaire et le sentiment d’auto-efficacité (SAE) d’enseignant·e·s vaudois·e·s, avant et après l’entrée en vigueur de la Loi sur la pédagogie spécialisée et l’introduction du concept 360° en 2019. Les attitudes et le SAE mesurés en 2022 chez 167 enseignant·e·s ont été comparés aux données recueillies auprès de 306 enseignant·e·s en 2016. Les résultats indiquent que les attitudes des enseignant·e·s sont moins positives en 2022 qu’en 2016 et que leur niveau de SAE est moins élevé, particulièrement au secondaire I. Ces résultats ouvrent des pistes de réflexion concernant l’accompagnement des (futur·e·s) enseignant·e·s dans la mise en œuvre de l’école à visée inclusive.Questo studio trasversale esamina i cambiamenti negli atteggiamenti degli o delle insegnanti verso l\u27educazione inclusiva e nel loro senso di autoefficacia prima e dopo l\u27entrata in vigore della legge sull\u27educazione ai bisogni speciali e l\u27introduzione del concetto di 360° nel 2019. Gli atteggiamenti e i sentimenti di autoefficacia misurati nel 2022 tra 167 insegnanti sono stati confrontati con i dati raccolti da 306 insegnanti nel 2016. I risultati indicano che gli atteggiamenti degli o delle insegnanti sono meno positivi nel 2022 rispetto al 2016 e che il loro senso di autoefficacia è più basso, in particolare al livello secondario I. Questi risultati forniscono spunti di riflessione su come sostenere i (futuri) insegnanti nell\u27implementazione della scuola inclusiva
Bürgi, L. & Amberg, L. (2023) (Hrsg.). Kompetenzorientierte Spielsituationen. Planen, gestalten, begleiten, dokumentieren. hep-Verlag. 273 S.
No full textThe Power of Personality: Exemplarity, Racial Alterity, & Abraham/Moses Stereotypes in Greco-Roman & Judeo-Christian Antiquity
No full textAbraham and Moses were perhaps the only two figures that non-Jewish authors of the ancient Mediterranean world would have known about and would have associated with the Jews (or Judeans). The Roman world in particular cared a great deal about famous ancestral paradigms – what they called exempla – and the ancient world writ large had a habit of correlating the defining characteristics of particular exempla and particular peoples. Thus Carthaginians, like Hannibal, were seen as perfidious and Romans, like Scipio, were understood to be brave and impassive. This essay explores a similar dynamic wherein exemplarity and racial (and/or ethnic/national) stereotypes coalesced in Greco-Roman presentations of Abraham and/or Moses as embodiments of Jewish traits. It argues that Greek and Roman authors tended to impute to Abraham and Moses a particular theurgic, magical essence, and that this came to be a stereotype used to categorize the Jewish people. By putting this discourse in the frame of symbolic or cultural power, this article seeks to contribute to our understanding of how exemplarity, the rhetoric of race, and discursive constructions of identity and alterity could function in Greco-Roman and Judeo-Christian antiquity
Coupling a finite element knee model with musculoskeletal multibody simulations. A case study of ACL force during a change-of-direction movement before and after injury prevention training
No full textIntroduction & Purpose
Change of direction (COD) movements are a common cause of injuries to the anterior cruciate ligament (ACL), especially in sports such as soccer, basketball, handball (Agel et al., 2016). In Mohr et al., (2024) an 8-week injury prevention training program including COD technique training was investigated. The movements during COD were recorded in an experimental setup with a marker-based system before and after the training program. While Mohr and colleagues observed training effects on the COD movement strategy, it remains unknown whether the ACL forces are actually reduced by the training program. The purpose of this project was to 1) develop a simulation-based approach to estimate ACL forces during COD movements using musculoskeletal simulations (OpenSim) and finite element (FE) knee simulations, and 2) use existing kinematics from a COD movement of one athlete before and after the 8-week injury prevention training program to investigate training effects on ACL force (Mohr et al., 2024).
Methods
The model OKS008 from the publicly-available collection of Open Knee(s) (OKS) FE models (2nd generation) of the Cleveland Clinic (Chokhandre et al., 2023) was implemented in the FE software Abaqus CAE.
In the original OKS008 model (Chokhandre et al., 2023) material parameters and pre-strains were taken from literature. However, the pre-strain of the ligaments is very individual (Lahkar et al., 2021). Therefore, in this study, the pre-strain of the ligaments and four material parameters of the OKS008 model were fit to in vitro kinetic testing data, using an optimization algorithm (interior-point algorithm). The kinetic data from in-vitro tests is available alongside with the OKS knee models, for which all donor knees were mechanically tested during passive flexion experiments (Chokhandre et al., 2023). The optimization was solved based on about 550 FE simulations over the course of one month (AMD Ryzen threadripper 3960 x 24-core processor x 48, 35 cores were used).
The effect of the knee kinematics from Mohr and colleagues (2024) on the loading of the anterior cruciate ligament (ACL) was then investigated with the optimized FE knee model in a post-processing step. Inverse kinematics in OpenSim was used to determine the 3D knee joint kinematics of one athlete during a maximum-speed 135° COD movement before and after the injury prevention training program. This athlete was selected because after the 8-week injury prevention training program, he showed a significant reduction in maximum knee adduction moment. The run-up velocity of the athlete on the COD was 3.97 m/s before the training program (baseline) and 4.09 m/s after the training program (follow-up). To simulate the COD movements in Abaqus, the FE knee model was driven by the measured knee kinematics of the COD, where the secondary kinematics (knee adduction and internal rotation) of the OpenSim model were added to the FE model’s secondary kinematics during passive flexion. The resulting force on the ACL was calculated by a free body cut in Abaqus CAE.
Results
The pre-strain optimized FE knee model closely reproduced the secondary kinematics (abduction, internal rotation) of the donor knee during passive flexion (mean error of 2.1687° before vs. 0.5799° after optimization).
The athlete’s maximum ACL force during the COD before the training program was 457 N, while after the training program a reduction in ACL force during the COD to 246 N was observed (46% reduction). The ACL force during the COD before and after the injury prevention training program is shown in Figure 1.
Discussion
A publicly available FE knee model was successfully optimized based on cadaveric mechanical testing data and implemented into a simulation-based approach to estimate ACL force. The plausibility of the model was checked by a mesh study and comparison with cadaver studies done in Wascher et al. (1993) and Hosseini Nasab et al. (2016). The timing of peak ACL force during a simulated COD movement, between 50 ms and 100 ms after initial contact, is physiologically plausible given that ACL injuries during CODs typically occur around 50 ms after initial contact (Krosshaug et al., 2007). The pre-strain optimization showed that it is necessary to estimate material parameters, e.g. ligament pre-strain, individually for each model to obtain realistic mechanical behaviour.
The case study demonstrated a reduction in ACL force during a COD by 46% following an injury prevention training program. The existing kinematic data from Mohr and colleagues (2024) show that the analyzed athlete performed the COD with decreased knee internal rotation and abduction after the 8-week injury prevention training. It is assumed that the ACL force was reduced due to the lower internal rotation and abduction. Figure 1 show further interesting observations that warrant investigation, e.g. the time-shifted peak ACL force following training. This will be done in future studies including more athletes.
Importantly, ACL forces during change of direction (COD) were calculated by applying only rotational kinematics to the FE model. The next step will be to implement joint reaction forces (JRF) into the FE simulations because they would have an effect on the ACL force (Esrafilian et al., 2022). It is therefore advisable to include the JRF in the subsequent simulations in order to obtain more physiologically relevant results.
Conclusion
We developed a FE simulation model in Abaqus CAE of the OKS008 knee to estimate and compare ACL forces based on the existing kinematics of a COD movement.
However, individual material parameter estimation is required for each model. The material parameter estimation increases the replicability of the specimen specific mechanical cadaver testing. This is an improvement to the original OKS008 model.
For the one analyzed athlete, after the 8-week injury prevention exercise program (Mohr et al., 2024) the ACL force caused by rotational kinematics of a COD is less than before the exercise program. The maximum ACL force during COD is reduced by 46% after the exercise program.
References
Agel, J., Rockwood, T., & Klossner, D. (2016). Collegiate ACL injury rates across 15 sports: National collegiate athletic association injury surveillance system data update (2004-2005 through 2012-2013). Clinical Journal of Sport Medicine, 26(6), 518-523. https://doi.org/10.1097/JSM.0000000000000290
Chokhandre, S., Schwartz, A., Klonowski, E., Landis, B., & Erdemir, A. (2023). Open knee(s): A free and open source library of specimen-specific models and related digital assets for finite element analysis of the knee joint. Annals of Biomedical Engineering, 51, 10-23. https://doi.org/10.1007/s10439-022-03074-0
Esrafilian, A., Stenroth, L., Mononen, M. E., Vartiainen, P., Tanska, P., Karjalainen, P. A., Suomalainen, J.-S., Arokoski, J. P. A., Saxby, D. J., Lloyd, D. G., & Korhonen, R. K. (2022). Toward tailored rehabilitation by implementation of a novel musculoskeletal finite element analysis pipeline. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 30, 789-802. https://doi.org/10.1109/TNSRE.2022.3159685
Hosseini Nasab, S. H., List, R., Oberhofer, K., Fucentese, S. F., Snedeker, J. G., & Taylor, W. R. (2016). Loading patterns of the posterior cruciate ligament in the healthy knee: A systematic review. PLoS One, 11(11), Article e0167106. https://doi.org/10.1371/journal.pone.0167106
Krosshaug, T., Nakamae, A., Boden, B. P., Engebretsen, L., Smith, G., Slauterbeck, J. R., Hewett, T. E., & Bahr, R. (2007). Mechanisms of anterior cruciate ligament injury in basketball: Video analysis of 39 cases. The American Journal of Sports Medicine, 35(3), 359-67. https://doi.org/10.1177/0363546506293899
Lahkar, B. K., Rohan, P.-Y., Pillet, H., Thoreux, P., & Skalli, W. (2021). Development and evaluation of a new procedure for subject-specific tensioning of finite element knee ligaments. Computer Methods in Biomechanics and Biomedical Engineering, 24(11), 1195-1205. https://doi.org/10.1080/10255842.2020.1870220
Mohr, M., Federolf, P., Heinrich, D., Nitschke, M., Raschner, C., Scharbert, J., & Koelewijn, A. D. (2024). An 8-week injury prevention exercise program combined with change-of-direction technique training limits movement patterns associated with anterior cruciate ligament injury risk. Scientific Reports, 14, Article 3115. https://doi.org/10.1038/s41598-024-53640-w
Wascher, D. C., Markolf, K. L., Shapiro, M. S., & Finerman, G. A. (1993). Direct in vitro measurement of forces in the cruciate ligaments. Part I: The effect of multiplane loading in the intact knee. The Journal of Bone and Joint Surgery, 75(3), 377-386. https://doi.org/10.2106/00004623-199303000-0000
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