Background:Although the health benefits of regular physical activity and exercise are well established and have been incorporated into national public health recommendations, there is a relative lack of understanding pertaining to the harmful effects of physical inactivity. Experimental paradigms including complete immobilization and bed rest are not physiologically representative of sedentary living. A useful ‘real-world’ approach to contextualize the physiology of societal downward shifts in physical activity patterns is that of short-term daily step reduction.Results:Step-reduction studies have largely focused on musculoskeletal and metabolic health parameters, providing relevant disease models for metabolic syndrome, type 2 diabetes (T2D), nonalcoholic fatty liver disease (NAFLD), sarcopenia and osteopenia/osteoporosis. In untrained individuals, even a short-term reduction in physical activity has a significant impact on skeletal muscle protein and carbohydrate metabolism, causing anabolic resistance and peripheral insulin resistance, respectively. From a metabolic perspective, short-term inactivity-induced peripheral insulin resistance in skeletal muscle and adipose tissue, with consequent liver triglyceride accumulation, leads to hepatic insulin resistance and a characteristic dyslipidaemia. Concomitantly, various inactivity-related factors contribute to a decline in function; a reduction in cardiorespiratory fitness, muscle mass and muscle strength.Conclusions:Physical inactivity maybe particularly deleterious in certain patient populations, such as those at high risk of T2D or in the elderly, considering concomitant sarcopenia or osteoporosis. The effects of short-term physical inactivity (with step reduction) are reversible on resumption of habitual physical activity in younger people, but less so in older adults. Nutritional interventions and resistance training offer potential strategies to prevent these deleterious metabolic and musculoskeletal effects.Impact:Individuals at high risk of/with cardiometabolic disease and older adults may be more prone to these acute periods of inactivity due to acute illness or hospitalization. Understanding the risks is paramount to implementing countermeasures.
Background The National Institute for Health and Care Excellence recommends that weight loss and exercise are a core part of treatment for osteoarthritis. The delivery of these services within the National Health Service is by physiotherapists and dietitians in the secondary health-care setting. This feasibility study for obese patients with knee osteoarthritis was led by registered exercise professionals with the aim of assessing the potential for widespread use within the community.Methods 81 patients met the inclusion criteria (body-mass index [BMI] >30 kg/m² and radiological evidence of knee osteoarthritis) and were invited to participate through various routes (National Exercise Referral Scheme exclusion criteria were used). The intervention was a 16-week programme containing 1 h of exercise twice a week and 1 h a week of dietary advice. Primary outcome measures were Oxford knee score, quality of life (EQ-5D and EQ visual analogue scale [EQ-VAS]), and function (6-min walk test and 30 s sit to stand test). Outcome data were collected at week 16 and at 1 year after completion by the same exercise professionals. Student's t tests were used for statistical analysis. FindingsThe intervention started in January, 2013. 27 patients attended initial assessment and 18 fi nished the 16-week intervention. All 18 patients were white (nine men, mean age 59•7 years [SD 5•11], range 50-68), and had a starting BMI of 38•9 kg/m² (SD 8•01). 14 patients completed 1-year follow-up (seven men, mean age 62•6 years [3•74], 53-69) and had a BMI of 33•34 kg/m² (SD 5•08) at 1 year. At 1-year follow-up, signifi cant changes were seen in the 30 s sit to stand test (mean change 3•6 repetitions, 95% CI 1•2 -5•96; p<0•0001) compared with baseline. Non-signifi cant improvements were also seen in this time period for Oxford knee score (mean change 3•4, -4•97 to 11•7) and 6-min walk test (54•9 m, -51•4 to 161•3). Interpretation Statistically signifi cant changes in 30 s sit to stand scores require investigation on a larger scale. Limitations include small sample size and lack of a control group. Sessions were run during working hours and no clear referral pathway was set up. Evening classes would allow working patients to participate, and incorporation of referral pathways within existing National Health Service structures would allow the programme to run at capacity. A larger study should advertise exit routes from the programme to enable long term success.
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