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Chronic obstructive pulmonary disease (COPD) costs EURO 1.4 billion annually in healthcare costs. Pulmonary rehabilitation (PR) is a vital aspect of care for patients with COPD, but despite the compelling evidence, it is delivered to less than 30%. Frequent transport to the center-based program is regularly reported as reasons for non-attendance. The effectiveness and feasibility of pulmonary tele-rehabilitation (PTR) and home-based pulmonary rehabilitation (HPR) have never been investigated in patients with COPD who are unable to attend conventional outpatient PR. This study is a multicenter randomized controlled trial consisting of three parallel groups; PTR, HPR and a control group. 180 patients with moderate to very severe COPD, who are unable to attend in center-based PR programs will be included. The PTR group receives group-based resistance- and endurance training and patient education 60 min. twice a week for 10-weeks. HPR comprises an individual self-initiated home-based PR program with online motivational and professional counseling. The goal is to achieve at least 20 min. of muscle-endurance based exercises three days weekly for 10-weeks. The PTR and HPR group use a tablet with a conference system. The control group receives usual care (no PR). After completion of the intervention, the PTR and HPR groups are offered 65-weeks groupbased maintance program supervised once a week online via tablet. The primary outcome is change in respiratory symptoms measured with the COPD Assessment Test after 10-weeks (primary endpoint). The study aims to test a possible equivalence between PTR and HPR and their superiority to controls on respiratory symptoms. The study will provide valuable insights into the effectiveness of new rehabilitation models and maintenance programs for patients with COPD. If the two new delivery models can reduce respiratory symptoms, patients with moderate to very severe COPD can participate in both home- or centerbased PR. The trial is registrered and approved by the Ethics Committee of The Capital Region of Denmark (H-22015777; 29.08.2022) and the Danish Data Protection Agency (P-2022-245-13101, 25.05.2022). The trial is registrered at ClinicalTrials.gov, identifier: NCT05664945 (23.12.2022).

ObjectivesThe aims of this study were to investigate the association between educational level and musculoskeletal pain and physical function, respectively, in persons 60–70 years old, and to investigate if the association changed from 2010 to 2017.Design and participantsThis is a sex-stratified, cross-sectional study based on data from the Danish Health and Morbidity Survey in 2010 (n=15 165) and in 2017 (n=14 022).Self-reported data from respondents who were 60–70 years old and reported data for pain or physical function, sociodemographic, education and behavioural factors were included.Primary outcome measuresPrevalence of pain and physical limitations.ResultsAmong men, a high educational level was associated with reduced odds of pain compared with low educational level (OR 0.56 (95% CI 0.41; 0.74)). Medium and high educational levels were associated with reduced odds of pain in women (0.74 (0.59; 0.92) and 0.64 (0.41; 1.00), respectively). High educational level was associated with reduced odds of physical limitations in men (0.35 (0.19; 0.65)) and women (0.33 (0.14; 0.78)). The interaction terms between time and education were not associated with pain and physical function, respectively.ConclusionHigh education was associated with reduced musculoskeletal pain and reduced limitations of physical function. The association between education and musculoskeletal pain and physical function did not change significantly over time. Musculoskeletal pain during the past 14 days and chronic pain among old men and women 60–70 years and their level of physical function contribute to important knowledge of a group near the retirement age. The future perspectives illustrate trends and importance of focusing on adapting job accommodations for senior workers.

Purpose Quality of life (QOL) and physical activity (PA) is reduced in patients with chronic kidney disease (CKD). The aim was to investigate the impact of marital status and educational level on QOL and PA in patients with CKD including dialysis treatment. Methods This cross-sectional study included ambulatory adult patients undergoing dialysis or CKD stage 4–5. Data for marital status, educational level and PA were obtained using the Danish health and Morbidity Survey. QOL was assessed using the Physical Component Scale and the Mental Component Scale scores from the Kidney Disease Quality of Life Instrument. Results Five hundred twelve participants were included: 316 (62%) were married/had a permanent partner, 119 (23%) had a low level of education, 327 (67%) were physically active. After confounder adjustments (age, sex, treatment), having a permanent partner was associated with greater scores in Mental Component Scale, β 2.88 [CI 95% 0.99; 4.77], p  = 0.003, and being physically active in women OR 2.237 [1.231; 4.066], p  = 0.008. A high vs low educational level was associated with greater scores in Physical Component Scale (3.79 [1.01; 6.58], p  = 0.008) and in Mental Component Scale (3.55 [0.82; 6.28], p  = 0.011). Conclusion In ambulatory patients with CKD stage 4–5, being married or having a permanent partner and a high educational level had positive impacts on mental QOL. Higher educational level was also associated with better physical QOL. The presented inequality in QOL should be considered in communications, care and treatments in clinical practice.

Background: Assessments of functional capacity require considerable time and space and are thus generally not suitable for home-based assessments. Reproducibility measures from tests evaluating functional capacity suitable for home-based assessment are warranted. The aim of this study was to investigate the intra- and inter-rater reproducibility of home-based assessments of the one-minute sit-to-stand test (1MSTS), handgrip strength (HGS), and short physical performance battery (SPPB) in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Methods: Fifty patients were recruited from an ongoing RCT study prior to the start of the intervention. All patients performed two 1MSTS attempts with 30 min intervals, three HGS attempts, and one SPPB attempt. The procedure was repeated after 7–10 days by a blinded assessor. Results: Fifty patients (29 females; mean (SD): age 71.3 (±7.7) years, FEV1% predicted 37.4 (±14.1), and COPD assessment test score 19.4 (±6.5) were assessed. The 1MSTS intra-rater reliability (intraclass correlation coefficient; ICC1.1) was 0.95 (lower limit 95% CI: 0.91) and classified as excellent; agreement (standard error of measurement, SEM) was 1.7 repetitions. The inter-rater reliability ICC1.1 for 1MSTS was 0.91 (lower limit 95% CI: 0.84) and SEM 2.5 repetitions; for HGS it was ICC1.1 of 0.84 (lower limit 95% CI: 0.74) and SEM 4.2 kg; for SPPB it was ICC1.1 of 0.86 (lower limit 95% CI: 0.77) and SEM 0.9 points, respectively. Conclusions: The reproducibility of home-based assessment with 1MSTS, HGS, and SPPB in patients with moderate to very severe COPD showed good to excellent intra- and inter-rater reliability and acceptable agreement below the established minimal important change. These findings support the utility and feasibility of these tests as reliable outcome measures in clinical practice and their applicability in home-based settings enabling functional assessments of patients with transportation challenges and mobility limitations.

Pain is a clinical complication to chronic obstructive pulmonary disease (COPD) that interferes negatively with physical activity level (PAL), quality of life (QOL) and pulmonary interventions. Yet, research in pain characteristics including prevalence, localization, and intensity in people with COPD are sparsely researched. To investigate self-reported pain prevalence, localization and intensity of pain in people with and without COPD, and to investigate the association between pain intensity and PAL among participants with COPD. Data were derived from the Danish Health and Morbidity Survey in 2017. The study population was restricted to individuals aged ≥35 years. Data included pain intensity assessed on the Numeric Rating Scale (NRS) and localization, PAL, QoL, sleep disturbance, comorbidities, sociodemographic and behavioral factors. In all, 528 participants with COPD and 8184 participants without COPD (51% females, mean ±SD age 67.1±11.4 years) were analyzed. Pain prevalence within the past 14 days was significantly higher in participants with COPD vs nonCOPD (72.7% vs 57.7%, <0.001) and mainly located in the limbs, thorax, and lower back. COPD was associated with the prevalence of chronic pain (≥6 months) (OR: 2.78, 95%CI: 2.32; 3.34, <0.001). Participants with COPD reported a higher pain intensity compared to those with nonCOPD with a mean difference of 1.04 points (95%CI: 0.75; 1.32, <0.001) on the NRS. In the adjusted multiple logistic regression analysis, pain intensity was negatively associated with odds of being physical active (OR: 0.72, 95%CI: 0.61; 0.85, <0.001). Pain is more prevalent in people with self-reported COPD. After adjustment for age and gender, COPD was associated with an elevated pain intensity. Sleep disturbance and multimorbidity had the most pronounced impacts on pain intensity in the multiple linear regression model. In participants with COPD, increased pain intensity was negatively associated with being physically active.

Postpartum physical activity (PA) is linked to improved mental health and sleep. Yet, many women do not return to pre-pregnancy PA levels, and sedentary behavior may increase. This study mapped PA, sedentary time, and sleep from early pregnancy to one year postpartum, and examined if prenatal PA interventions affect these outcomes postpartum. In the FitMum randomized controlled trial, 220 healthy, inactive pregnant women (< 15 + 0 weeks gestation) were assigned to standard care (CON), supervised exercise (EXE), or motivational PA counselling (MOT). Participants wore wrist-worn activity trackers from inclusion to one year postpartum and completed the Pregnancy Physical Activity Questionnaire and Pittsburgh Sleep Quality Index. We found that postpartum daily steps increased by ~ 2,000 compared to late pregnancy ( p  < 0.001), while moderate-to-vigorous-intensity PA (MVPA) declined ( p  < 0.001). Sedentary time remained similar. Sleep duration dropped postpartum in the first three months ( p  < 0.05), while sleep quality improved ( p  = 0.006). Prenatal PA interventions had minimal impact postpartum, however, EXE participants reported slightly better sleep than MOT at one year. In conclusion, PA patterns and sleep changed postpartum, with more daily steps, less MVPA, and reduced sleep duration. Prenatal PA interventions had limited effect. Longitudinal studies are needed to optimize timing of interventions for maternal health. The study is registered at ClinicalTrials.gov; NCT03679130;20/09/2018.

Background A physically active lifestyle is beneficial during pregnancy. However, little is known about physical activity (PA) behaviour and psychosocial factors in women during and after pregnancy. This study examined exercise behavioural regulation, exercise self-efficacy, health-related quality of life, sickness absence and musculoskeletal pain in pregnant women offered either structured supervised exercise training, motivational counselling on PA, or standard prenatal care in the FitMum randomised controlled trial. Methods Two hundred and eighteen healthy inactive pregnant women were randomised to structured supervised exercise training ( n  = 87), motivational counselling on PA ( n  = 86) or standard prenatal care ( n  = 45). The women answered the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2), the Pregnancy Exercise Self-Efficacy Scale (P-ESES-DK) and the Short Form 36 Health Survey Questionnaire (SF-36) at baseline (gestational age (GA) of max 15 weeks), GA 28 and 34 weeks, and one year after delivery. Sickness absence and low back and/or pelvic girdle pain were likewise reported in questionnaires at baseline and GA 28 weeks. Results Participants offered structured supervised exercise training or motivational counselling on PA had higher autonomous motivation for exercise during pregnancy compared with participants receiving standard prenatal care (e.g., difference in intrinsic regulation at GA 28 weeks, structured supervised exercise training vs. standard prenatal care: mean difference in score 0.39 [0.16; 0.64], p  < 0.001). Participants offered structured supervised exercise training also had higher exercise self-efficacy during pregnancy (e.g., GA 28 weeks, structured supervised exercise training vs. standard prenatal care: mean difference in score 6.97 [2.05; 12.02], p  = 0.005). All participants reported high exercise self-efficacy at baseline and medium exercise self-efficacy during pregnancy and one year after delivery. No differences were found between groups in health-related quality of life, sickness absence or low back and/or pelvic girdle pain during pregnancy. No group differences were found one year after delivery. Conclusion Structured supervised exercise training and motivational counselling on PA had important effects on autonomous exercise motivation during pregnancy. Exercise self-efficacy was also increased with structured supervised exercise training compared to standard prenatal care. No group differences in health-related quality of life, sickness absence, or pain were found during and after pregnancy. No effects were found one year post-delivery after intervention cessation. Trial registration The study was approved by the Danish National Committee on Health Research Ethics (#H-18011067) and the Danish Data Protection Agency (#P-2019–512). The study adheres to the principles of the Helsinki declaration. Written informed consent was obtained at inclusion.

Aim. To investigate the associations between diabetes and musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis. Methods. Self-reported data were provided by the nationwide Danish National Health Survey 2013. Inclusion criteria were age≥40 years and known diabetes status. The exposure variable was diabetes, and the outcome variables included musculoskeletal pain during the last 14 days in three body sites (back/lower back, limbs, and shoulder/neck), osteoarthritis, osteoporosis, and rheumatoid arthritis. Logistic regression analyses adjusted for age, gender, BMI, education, marital status, and physical activity were performed. Results. 9,238 participants with diabetes were 65.6±11.0 (mean±SD) years old; 55.6% were males. 99,980 participants without diabetes were 59.2±11.8 years old; 46.7% were males. Diabetes was associated with back/lower back pain (OR 1.2 (CI 95% 1.1-1.2), p<0.001), pain in the limbs (1.4 (1.3-1.4), p<0.001), shoulder/neck pain (1.2 (1.1-1.3), p<0.001), osteoarthritis (1.3 (1.2-1.4), p<0.001), osteoporosis (1.2 (1.1-1.4), p=0.010), and rheumatoid arthritis (1.6 (1.4-1.7), p<0.001). In participants with diabetes, physical activity was associated with reduced pain (e.g., back/lower back pain (0.7 (0.6-0.7), p<0.001)). Conclusion. Diabetes was associated with elevated odds of having musculoskeletal pain. Diabetes was also associated with elevated odds of having osteoarthritis, osteoporosis, and rheumatoid arthritis. The most frequent disease in individuals with diabetes was osteoarthritis. The reported pain may have negative impacts on the level of physical activity. Health-care professionals should remember to inform patients with diabetes that musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis are not contraindications to exercise training.

The main objective of the study was to investigate the effects of prenatal exercise interventions on maternal body composition at 28 weeks gestation and 7–14 days after delivery. We also explored associations between physical activity (PA) per se and body composition. This study presents secondary outcomes of the FitMum randomized controlled trial, which included healthy inactive pregnant women at gestational age ≤ 15+0 weeks. They were randomized to structured supervised exercise training, motivational counselling on PA, or standard care. Maternal body composition was measured by doubly labeled water at 28 weeks gestation ( n = 134) and by dual-energy X-ray absorptiometry scan 7–14 days after delivery ( n = 117). PA, including moderate-to-vigorous-intensity PA (MVPA), active kilocalories, and steps, were measured continuously from inclusion to delivery by a wrist-worn activity tracker. One hundred fifty pregnant women were included with a median pre-pregnancy body mass index (BMI) of 24.1 (21.6–27.9) kg/m 2 . We found no differences between groups in fat mass, fat percentage or fat-free mass at 28 weeks gestation or 7–14 days after delivery. Visceral adipose tissue mass and bone mineral density measured 7–14 days after delivery did not differ between groups either. Linear regression analyses adjusted for pre-pregnancy BMI showed that a higher number of daily steps was associated with lower fat mass, fat percentage, and visceral adipose tissue mass at 28 weeks gestation and 7–14 days after delivery. Active kilocalories during pregnancy was positively associated with fat-free mass 7–14 days after delivery. Neither structured supervised exercise training nor motivational counselling on PA during pregnancy affected maternal body composition at 28 weeks gestation or 7–14 days after delivery compared to standard care. Interestingly, when adjusted for pre-pregnancy BMI, higher number of daily steps was associated with lower fat content during pregnancy and after delivery, whereas MVPA and active kilocalories were not. Trial registration: ClinicalTrials.gov; NCT03679130 ; 20/09/2018.

Background: Physical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women. Objective: The purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored. Methods: A randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA. Results: The average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery (P=.04). Attendance was higher for online (due to COVID-19 restrictions) compared with physical exercise training (P=.03). Adverse events and serious adverse events did not differ between groups. Conclusions: Offering EXE was more effective than CON to increase MVPA among pregnant women, whereas offering MOT was not. MVPA in the intervention groups did not reach the recommended level in pregnancy. Changing the intervention to online due to COVID-19 restrictions did not affect MVPA level but increased exercise participation. Trial Registration: ClinicalTrials.gov NCT03679130; https://clinicaltrials.gov/ct2/show/NCT03679130 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043671