A Preliminary Investigation into the Effect of Continuous Vigorous Exercise and Lifestyle-embedded Physical Activity upon Acute Glycaemic Regulation

Background and Purpose Continuous glucose monitoring (CGM) has recently emerged as a new tool for patients with diabetes mellitus to monitor glucose levels and aid maintainenance of euglycaemia. CGM provides information on ambulatory, postprandial and nocturnal glucose excursions. Extant research has thus far focused upon charting glucose excursions in diabetic patients, with limited normoglycaemic comparative data available. Additionally little is known upon how physical activity affects acute blood glucose regulation. The purpose of this study was to investigate the effect of continuous exercise and lifestyle-embedded physical activity upon glucose regulation, and assess the feasibility of prolonged CGM data collection in a normoglycaemic individual. Method One physically active non-diabetic male [age: 22 y; mass: 71.5 kg; height: 181 cm] underwent 7 days CGM, performing 3 trial conditions: a sedentary control (< 2500 steps, pedometer controlled), a continuous exercise condition (2 x 30 min treadmill running at 70% HRmax), and a lifestyle-embedded physical activity condition (100 min fractionalized moderate activity). Diet was standardised and physical activity levels were monitored via accelerometry throughout. Results Descriptive results displayed lower whole day mean blood glucose levels in both the continuous (Mean ± SD: 5.2 ± 0.3 mmol.L-1) and lifestyle conditions (5.3 ± 1.1 mmol.L-1), compared to sedentary control (5.6 ± 0.5 mmol.L-1). A post exercise decrease in glucose levels (2 h pre-6 h post (5.3 – 5.1 mmol.L-1)) with a carryover effect for the following day (reduced mean glucose 24 h pre-post (5.5 ± 0.5 - 5.2 ± 0.3 mmol.L-1)) was identified in the continuous exercise condition. In addition a significant correlation (R= 0.75, P = 0.02) was found between physical activity counts and CGM glucose values (mmol.L-1) during the continuous bout of vigorous exercise. Discussion and Conclusions It was concluded that day to day glucose homeostasis may be optimised through bouts of continuous vigorous exercise. The utilisation of CGM in exercise protocols and prolonged data collection is deemed a feasible proposition; however larger scale studies may pose logistical problems. This study was limited by its single subject design and specificity to normoglycaemic populations, future studies should look to include a greater sample size and characterise glycaemic regulation in pre-diabetic and diabetic populations

Accelerometer counts and raw acceleration output in relation to mechanical loading

AbstractThe purpose of this study was to assess the relationship of accelerometer output, in counts (ActiGraph GT1M) and as raw accelerations (ActiGraph GT3X+ and GENEA), with ground reaction force (GRF) in adults. Ten participants (age: 29.4±8.2yr, mass: 74.3±9.8kg, height: 1.76±0.09m) performed eight trials each of: slow walking, brisk walking, slow running, faster running and box drops. GRF data were collected for one step per trial (walking and running) using a force plate. Low jumps and higher jumps (one per second) were performed for 20s each on the force plate. For box drops, participants dropped from a 35cm box onto the force plate. Throughout, three accelerometers were worn at the hip: GT1M, GT3X+ and GENEA. A further GT3X+ and GENEA were worn on the left and right wrist, respectively. GT1M counts correlated with peak impact force (r=0.85, p<0.05), average resultant force (r=0.73, p<0.05) and peak loading rate (r=0.76, p<0.05). Accelerations from the GT3X+ and GENEA correlated with average resultant force and peak loading rate irrespective of whether monitors were worn at the hip or wrist (r>0.82, p<0.05, r>0.63 p<0.05, respectively). In conclusion, accelerometer count and raw acceleration output correlate positively with GRF and thus may be appropriate for the quantification of activity beneficial to bone. Wrist-worn monitors show a similar relationship with GRF as hip-worn monitors, suggesting that wrist-worn monitors may be a viable option for future studies looking at bone health

Epstein-Barr virus: clinical and epidemiological revisits and genetic basis of oncogenesis

Epstein-Barr virus (EBV) is classified as a member in the order herpesvirales, family herpesviridae, subfamily gammaherpesvirinae and the genus lymphocytovirus. The virus is an exclusively human pathogen and thus also termed as human herpesvirus 4 (HHV4). It was the first oncogenic virus recognized and has been incriminated in the causation of tumors of both lymphatic and epithelial nature. It was reported in some previous studies that 95% of the population worldwide are serologically positive to the virus. Clinically, EBV primary infection is almost silent, persisting as a life-long asymptomatic latent infection in B cells although it may be responsible for a transient clinical syndrome called infectious mononucleosis. Following reactivation of the virus from latency due to immunocompromised status, EBV was found to be associated with several tumors. EBV linked to oncogenesis as detected in lymphoid tumors such as Burkitt's lymphoma (BL), Hodgkin's disease (HD), post-transplant lymphoproliferative disorders (PTLD) and T-cell lymphomas (e.g. Peripheral T-cell lymphomas; PTCL and Anaplastic large cell lymphomas; ALCL). It is also linked to epithelial tumors such as nasopharyngeal carcinoma (NPC), gastric carcinomas and oral hairy leukoplakia (OHL). In vitro, EBV many studies have demonstrated its ability to transform B cells into lymphoblastoid cell lines (LCLs). Despite these malignancies showing different clinical and epidemiological patterns when studied, genetic studies have suggested that these EBV- associated transformations were characterized generally by low level of virus gene expression with only the latent virus proteins (LVPs) upregulated in both tumors and LCLs. In this review, we summarize some clinical and epidemiological features of EBV- associated tumors. We also discuss how EBV latent genes may lead to oncogenesis in the different clinical malignancie

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study

Background: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. Methods: CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2–7 months after hospital discharge and a later time point 10–14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). Findings: 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4–6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5–8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (–19%; 95% CI –20 to –16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18–39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27–41% of this effect. Interpretation: Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. Funding: UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council

The measurement of physical activity in children

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN024387 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Association of working shifts, inside and outside of healthcare, with severe COVID-19: an observational study.

Background: Health and key workers have elevated odds of developing severe COVID-19; it is not known, however, if this is exacerbated in those with irregular work patterns. We aimed to investigate the odds of developing severe COVID-19 in health and shift workers. Methods: We included UK Biobank participants in employment or self-employed at baseline (2006–2010) and with linked COVID-19 data to 31st August 2020. Participants were grouped as neither a health worker nor shift worker (reference category) at baseline, health worker only, shift worker only, or both, and associations with severe COVID19 investigated in logistic regressions. Results: Of 235,685 participants (81·5% neither health nor shift worker, 1·4% health worker only, 16·9% shift worker only, and 0·3% both), there were 580 (0·25%) cases of severe COVID-19. The odds of severe COVID-19 was higher in health workers (adjusted odds ratio: 2·32 [95% CI: 1·33, 4·05]; shift workers (2·06 [1·72, 2·47]); and in health workers who worked shifts (7·56 [3·86, 14·79]). Being both a health worker and a shift worker had a possible greater impact on the odds of severe COVID-19 in South Asian and Black and African Caribbean ethnicities compared to White individuals. Conclusions: Both health and shift work (measured at baseline, 2006–2010) were independently associated with over twice the odds of severe COVID-19 in 2020; the odds were over seven times higher in health workers who work shifts. Vaccinations, therapeutic and preventative options should take into consideration not only health and key worker status but also shift worker status. </p