Measurement, determinants, barriers, and interventions for exercise adherence: a scoping review

Background: Adherence to exercise interventions is the cornerstone of a successful rehabilitation program. However, there is limited evidence on multifaceted components of exercise adherence. Therefore, we aimed to summarize the existing literature on measurement, determinants, barriers, theoretical frameworks, and evidence-based interventions that support exercise adherence. Methods: We conducted a scoping review based on the PRISMA extension for scoping reviews guidelines and searched the literature in PubMed, Cochrane Databases of Systematic Reviews, ScienceDirect, and Web of Science. Two reviewers independently screened articles. The included articles were subjected to data extraction and qualitative synthesis. Results: A total of 72 articles were included for this review. Data synthesis showed that there are no gold standard methods of measuring exercise adherence; however, questionnaires and daily logs are commonly used tools. The determinants of adherence are personal, disease-related, therapy-related, provider-related, and health system-related. The common barriers to adherence are the absence of a caregiver, low health literacy, poor communication by healthcare providers, cost, and lack of access to health facilities. Few evidence-based interventions used for supporting adherence are behavioral strategies, improving self-efficacy, motivational therapy, and mHealth or multimedia. Conclusion: Non-adherence to exercises is a challenge for healthcare providers. There are no standard guidelines for the evaluation and management of non-adherence to exercises. Future studies should aim at developing objective measures of exercise adherence and investigate the long-term effects of adherence strategies in different disease populations. It is an under-researched area and requires multipronged strategies to improve adherence levels among patients

Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus

Objective To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies. Method We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK. Results In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains - (1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4. Conclusion We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies

Fermentation, Isolation, Structure, and antidiabetic activity of NFAT-133 produced by Streptomyces strain PM0324667

Type-2 diabetes is mediated by defects in either insulin secretion or insulin action. In an effort to identify extracts that may stimulate glucose uptake, similar to insulin, a high throughput-screening assay for measuring glucose uptake in skeletal muscle cells was established. During the screening studies to discover novel antidiabetic compounds from microbial resources a Streptomyces strain PM0324667 (MTCC 5543, the Strain accession number at Institute of Microbial Technology, Chandigarh, India), an isolate from arid soil was identified which expressed a secondary metabolite that induced glucose uptake in L6 skeletal muscle cells. By employing bioactivity guided fractionation techniques, a tri-substituted simple aromatic compound with anti-diabetic potential was isolated. It was characterized based on MS and 2D NMR spectral data and identified as NFAT-133 which is a known immunosuppressive agent that inhibits NFAT-dependent transcription in vitro. Our investigations revealed the antidiabetic potential of NFAT-133. The compound induced glucose uptake in differentiated L6 myotubes with an EC50 of 6.3 ± 1.8 μM without activating the peroxisome proliferator-activated receptor-γ. Further, NFAT-133 was also efficacious in vivo in diabetic animals and reduced systemic glucose levels. Thus it is a potential lead compound which can be considered for development as a therapeutic for the treatment of type-2 diabetes. We have reported herewith the isolation of the producer microbe, fermentation, purification, in vitro, and in vivo antidiabetic activity of the compound

Management of Palmo-Plantar Psoriasis by Classical Shodhan and Shaman Chikitsa- A Case Report

Background: Palmo-plantar psoriasis in a non-inflammatory skin condition in which it is capable to produce functional disability. It is the type of psoriasis which occurs in palms and soles together with features like scaling, erythema and itching, pustules cracked & pain, and is limited. Palmo-plantar is the disease which does not have a specific line of treatment, but can be assessed and treated with classical line of Ayurvedic management. This Palmo-plantar not only affects physically but also disturbs the mental health of patient In Ayurveda all the skin diseases are described under single topic; Kushtha (Skin disorders). As Palmo-Plantar psoriasis is compared with Vipadika Kshudra Kushta (cracked bilateral soles & palms) in Ayurveda, the predominant Dosha’s (fundamental bodily bio-elements) are Vata (governs movement of body & mind) & Kapha (controls immune system) in which Vaman Karma (Emesis) is useful. Aim: To evaluate the role of Ayurveda treatment modalities in Vipadika Kshudra Kushta. Materials & Methods: A case report of 56 year old male patient suffering from scaling of both palms and soles with severe pain since 16 years is presented in this article where the patient got satisfactory relief by adopting Shodhan Karma (purification treatment) followed by Shaman Chikitsa (pacifying treatment) with dietary and behavioral lifestyle modification. The symptoms were reduced by Vaman procedure. Result: Patient got about 80% relief after the treatment by which one can say that the palmo-plantar psoriasis can be treated by Ayurveda Medicine

Avoiding ecosystem and social impacts of hydropower, wind, and solar in Southern Africas low-carbon electricity system.

The scale at which low-carbon electricity will need to be deployed to meet economic growth, electrification, and climate goals in Africa is unprecedented, yet the potential land use and freshwater impacts from this massive build-out of energy infrastructure is poorly understood. In this study, we characterize low-impact onshore wind, solar photovoltaics, and hydropower potential in Southern Africa and identify the cost-optimal mix of electricity generation technologies under different sets of socio-environmental land use and freshwater constraints and carbon targets. We find substantial wind and solar potential after applying land use protections, but about 40% of planned or proposed hydropower projects face socio-environmental conflicts. Applying land and freshwater protections results in more wind, solar, and battery capacity and less hydropower capacity compared to scenarios without protections. While a carbon target favors hydropower, the amount of cost-competitively selected hydropower is at most 45% of planned or proposed hydropower capacity in any scenario-and is only 25% under socio-environmental protections. Achieving both carbon targets and socio-environmental protections results in system cost increases of 3-6%. In the absence of land and freshwater protections, environmental and social impacts from new hydropower development could be significant

Avoiding ecosystem and social impacts of hydropower, wind, and solar in Southern Africa’s low-carbon electricity system

Abstract The scale at which low-carbon electricity will need to be deployed to meet economic growth, electrification, and climate goals in Africa is unprecedented, yet the potential land use and freshwater impacts from this massive build-out of energy infrastructure is poorly understood. In this study, we characterize low-impact onshore wind, solar photovoltaics, and hydropower potential in Southern Africa and identify the cost-optimal mix of electricity generation technologies under different sets of socio-environmental land use and freshwater constraints and carbon targets. We find substantial wind and solar potential after applying land use protections, but about 40% of planned or proposed hydropower projects face socio-environmental conflicts. Applying land and freshwater protections results in more wind, solar, and battery capacity and less hydropower capacity compared to scenarios without protections. While a carbon target favors hydropower, the amount of cost-competitively selected hydropower is at most 45% of planned or proposed hydropower capacity in any scenario—and is only 25% under socio-environmental protections. Achieving both carbon targets and socio-environmental protections results in system cost increases of 3-6%. In the absence of land and freshwater protections, environmental and social impacts from new hydropower development could be significant

Equitable low-carbon transition pathways for California’s oil extraction

Oil supply-side policies—setbacks, excise taxes and carbon taxes—are increasingly considered for decarbonizing the transportation sector. Understanding not only how such policies reduce oil extraction and greenhouse gas (GHG) emissions but also which communities receive the resulting health benefits and labour-market impacts is crucial for designing effective and equitable decarbonization pathways. Here we combine an empirical field-level oil-production model, an air pollution model and an employment model to characterize spatially explicit 2020–2045 decarbonization scenarios from various policies applied to California, a major oil producer with ambitious decarbonization goals. We find setbacks generate the largest avoided mortality benefits from reduced air pollution and the largest lost worker compensation, followed by excise and carbon taxes. Setbacks also yield the highest share of health benefits and the lowest share of lost worker compensation borne by disadvantaged communities. However, currently proposed setbacks may fail to meet California’s GHG targets, requiring either longer setbacks or additional supply-side policies