Lara Allet

AIMS: This exploratory study aimed to assess the changes in functional capacity and patient-reported outcome measures (PROMs) experienced by outpatients undergoing cardiac rehabilitation; and factors associated with health-related quality of life. METHODS: We prospectively included all consecutive patients diagnosed with various cardiac conditions who had undergone a 10-week multidisciplinary cardiac rehabilitation programme from October 2020 to October 2022. The primary outcomes were functional capacity, including the 6-minute walk test, maximal short-term exercise capacity, estimated metabolic equivalent of task (eMET) and maximal quadriceps isometric strength at entry and discharge; and PROMs including the Hospital Anxiety and Depression Scale (HADS), quality of life (HeartQoL), and level of work, sport and leisure physical activity (Baecke) at entry, discharge and at 6 months. Secondarily, we assessed factors associated with heart-related quality of life over the 6-month period using multi-level mixed-effects generalised linear models adjusted for age, sex and time point. RESULTS: Among the 273 included patients, 81% were men and the median age was 63 years (range: 57–69). From programme entry to discharge, median values significantly increased for the 6-minute walk test (+60 m, 95% CI: 50–65), maximal short-term exercise capacity (+50 W, 95% CI: 50–50), eMET (+0.9, 95% CI: 0.7–1.1), maximal left quadriceps isometric strength (+3 Nm, 95% CI: 2–4) and maximal right quadriceps isometric strength (+4 Nm, 95% CI: 2.4–4.7). The median scores of depression, anxiety, physical and emotional heart-related quality of life and leisure activity were significantly improved from entry to the 6-month follow-up. The physical domain of quality of life was associated with the 6-minute walk test (coefficient: 1.001, 95% CI: 1.00–1.001) and anxiety score (coefficient: 0.97, 95% CI: 0.96–0.99) while the emotional domain was associated with level of depression (coefficient: 0.95, 95% CI: 0.94–0.97) and anxiety (coefficient: 0.98, 95% CI: 0.97–0.99). CONCLUSIONS: Our study showed that functional capacity significantly improved at discharge from the cardiac rehabilitation programme, as did the symptoms of anxiety and depression, quality of life and leisure-time physical activity at 6 months. The 6-minute walk test and symptoms of depression or anxiety were found to be significantly associated with quality of life. A cardiac rehabilitation programme could be proposed to eligible cardiac patients to improve their outcomes.

The experience of owning a body (body ownership, BO) and the perception of our body dimensions (metric body representation, mBR) depend on the integration of multisensory cues. As the human sensory system is subjected to a decline along the lifespan, encompassing all sensory modalities, we hypothesize that body perception may be different in older, as compared to young adults. Here, we investigate this hypothesis by comparing the multisensory processing underlying BO and mBR in healthy older (> 65 years) and young individuals. First, we applied rigorous computational and psychophysical methods to assess alterations in mBR and BO quantitatively. We then modeled the manifold relationship between the observed body misperceptions and the potential underlying sensory, motor, and cognitive factors. The results highlight significant differences between the two groups, with higher distortions in perceived arm dimensions and an increased tendency to experience BO towards a virtual hand in the aged group. These differences in both mBR and BO are explained by the reduced proprioceptive abilities of older adults, suggesting a crucial role of proprioception in driving age-dependent plasticity in body representations. Overall, our modeling and experimental approach provide new perspectives on altered body perception during aging, suggesting that they stem from the physiological proprioceptive decline occurring in older adults, and laying the groundwork to generate prevention and stimulation strategies to restore accurate body perception in aging.

Background: A ketogenic diet (KD) reduces daily carbohydrates (CHOs) ingestion by replacing most calories with fat. KD is of increasing interest among athletes because it may increase their maximal oxygen uptake (VO₂max), the principal performance limitation at high-altitudes (1500–3500 m). We examined the tolerance of a 4-week isocaloric KD (ICKD) under simulated hypoxia and the possibility of evaluating ICKD performance benefits with a maximal graded exercise bike test under hypoxia and collected data on the effect of the diet on performance markers and arterial blood gases. Methods: In a randomised single-blind cross-over model, 6 recreational mountaineers (age 24–44 years) completed a 4-week ICKD followed or preceded by a 4-week usual mixed Western-style diet (UD). Performance parameters (VO₂max, lactate threshold [LT], peak power [P_peak]) and arterial blood gases (PaO₂, PaCO₂, pH, HCO₃⁻) were measured at baseline under two conditions (normoxia and hypoxia) as well as after a 4-week UD and 4-week ICKD under the hypoxic condition. Results: We analysed data for all 6 participants (BMI 19.9–24.6 kg m⁻²). Mean VO₂max in the normoxic condition was 44.6 ml kg⁻¹ min⁻¹. Hypoxia led to decreased performance in all participants. With the ICKD diet, median values for PaO₂ decreased by − 14.5% and VO₂max by + 7.3% and P_peak by + 4.7%. Conclusion: All participants except one could complete the ICKD. VO₂max improved with the ICKD under the hypoxia condition. Therefore, an ICKD is an interesting alternative to CHOs dependency for endurance performance at high-altitudes, including high-altitude training and high-altitude races. Nevertheless, decreased PaO₂ with ICKD remains a significant limitation in very-high to extreme altitudes (> 3500 m). Trial registration Clinical trial registration Nr. NCT05603689 (Clinicaltrials.gov). Ethics approval CER-VD, trial Nr. 2020-00427, registered 18.08.2020—prospectively registered.

Objectives This project aims to assess opinions, attitudes, knowledge, beliefs, practices and perceived barriers and facilitators of injury prevention (IP) strategies in Swiss basketball teams. Methods An online survey was sent to athletes, coaches and medical staff of the three best basketball leagues in Switzerland. The survey was subdivided in four sections: (1) characteristic of participants, (2) knowledge, opinions, attitudes and beliefs, (3) practices and (4) barriers and facilitators. Results Among 105 persons (n=45 female, n=60 male) who answered the survey, more than 60% (n=68) considered the risk of injury for basketball athletes as being high to very high. The ankle, knee and the hand were considered as being the most at risk. More than 80% of participants considered that recovery, training load and the warm-up quality were very important factors for IP. More than 90% of participants considered IP as either important or very important with 53 (50.5%) of the participants indicating using exercise-based IP in their clubs. Athletes and coaches’ motivation and compliance were judged as either important or very important for successful IP implementation by more than 80% of participants, with the coach being reported as the most influential person. Environmental barriers towards human or infrastructural resources were also reported as factors influencing IP strategies, namely by female participants. Conclusion Good knowledge and positive attitude towards IP were reported by participants, but exercise-based IP strategies lack implementation. The coach was considered as the most influential person and was reported with the athletes as playing an important role towards successful implementation.

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Introduction: Home adaptation can be a key contributor to successfully aging at home, allowing older adults to remain in a familiar environment while maintaining their quality of life and well-being despite progressing functional difficulties. Although several theoretical studies on home adaptations exist, the benefits of custom home adaptations remain poorly evaluated. The present study's primary aims were to explore older adults' expectations and needs regarding home adaptations and evaluate the impact of individualized home adaptations on quality of life, fear of falling, independence, and difficulties using adapted rooms. Its secondary aim was to describe the barriers and facilitators of home adaptation. Method: The 15 homes in this case series were adapted using an inclusive, interdisciplinary approach. Adaptations' effects were assessed using a parallel mixed-methods design. Quantitative and qualitative data were collected using questionnaires and semi-structured interviews. An architect and a health professional visited each home twice to assess the older adult's expectations and needs, evaluate the home's technical aspects, and co-create an adaptation plan with that study participant. They assessed the older adult's perceived quality of life, fear of falling, independence, and difficulties using the rooms needing adaptations. Inhabitants received two more visits after the adaptations (one or two months and six months later) to assess their benefits. Results: Most homes had their bathroom adapted. Participants reported improved safety, independence, ease of use, positive feelings, and comfort. They also reported lower perceived levels of difficulties during the activities of daily living in the adapted rooms (reductions of 93.4% [SD = 12.7] of bathrooms and 100% of kitchens), an improvement in quality of life of 9.8% (SD = 27.6), and a reduction in fear of falling of 12.5% (SD = 9.7). Conclusion: Home adaptations are beneficial to older adults' activities of daily living and improve their quality of life; however, several factors hinder the implementation of those adaptations.

Background: Respiratory insufficiency is the most common cause of mortality among patients with a neuromuscular disease. Methods: We followed the PRISMA statement for systematic reviews. We explored the effects of high frequency wall compression and intrapulmonary percussive ventilation, compared to a control intervention, on the lung volume and capacity, and quality of life in patients with neuromuscular disease. We further assessed the effects of these two interventions on clinical value, complications, and survival. The literature search was performed on 30/06/2020 in Embase, MEDLINE, CENTRAL, PEDro and CINAHL on 6/07/2020. Inclusion criteria: patients with neuromuscular disease; interventions of interest mentioned above; randomised controlled trials comparing these interventions with a control intervention. Results: Five studies were included, and results were presented narratively. High frequency wall compression was not shown to be superior to standard care in terms of lung volume and capacity, quality of life, complications, and survival rate. Compared with standard care, intrapulmonary percussive ventilation showed non-significant differences in terms of lung volume and capacity, and the risk of respiratory infection. Standard care was nevertheless associated with a significantly higher risk of days of hospitalisation (Incidence Rate Ratio 8.5 [1.1-67]) and of antibiotic use than intrapulmonary percussive ventilation (Incidence Rate Ratio 43 [6-333]). The assessment with the risk of bias tool 2.0 showed a high risk of bias for all outcomes. Moreover, the evidence is of very low-quality for all outcomes. Conclusions: Due to large variety of reported outcomes, missing data and limited number of studies, no meta-analysis could be conducted. The results should be interpreted with caution as the results have a very low certainty of evidence and reported outcomes have a high risk of bias. The evidence for high frequency wall compression and intrapulmonary percussive ventilation is still insufficient to draw final conclusions. Registration: PROSPERO ID: CRD42017064703.