Military fitness of young South African adults : does it comply with requirements?

The fitness of today's young people is reported to be at a very low level, and this is disconcerting considering that some are needed as military recruits but will not be accepted if they do not pass the military fitness tests. The aims of this study were to investigate the pass rate of young adults (n=41) in the standard South African National Defence Force (SANDF) fitness test, and to establish whether the pass rate of the male (n=31) and female (n=10) participants differed significantly. A cross-sectional case report design was used as the research method. All participants aged 18.0 to 22.9 years underwent tests for body composition, handgrip strength, vertical jump and multistage shuttle run. After a 48-hour rest period the SANDF tests were carried out. For analysis the descriptive statistics and the non-parametric Mann-Whitney U-Test were used. The p-value was set at 0.05. The following results were obtained: 85.4% of the cohort failed the test, of that 90.6% of the males (m) failed and 60.0% of the females (f) failed. Significant differences (p<0,01) were found between the male and female participants in their height (m=171.9 m; f=164.2 m); weight (m=76.9 kg; f=63.6 kg); percentage body fat (m=19,2%; f=28.0%); explosive power (m= 1254.5 watt; f=947.1 watt); handgrip dynamometer strength (m=99.4 kg; f=67.9 kg); and SANDF passing scores (p≤0.05) (m=2 006; f=2 567). No significant differences were observed on the indirect relative Vo2max reading (m=41.7 ml/kg/min; f=38.2 ml/kg/min); body mass index (m=24.3 kg/m²; f=23.5 kg/m²); and the sit-and-reach test (m=33.6 cm; f=36.5 cm). It was concluded that female participants performed better than their male counterparts but that all the young people tested did not comply with the fitness requirements of the SANDF. As the majority of the cohort complied with the normal limits set for the general fitness tests, it was concluded that the level of fitness needed to pass the SANDF fitness test was higher than the level of fitness prescribed for the general population.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher

Comparison of physical fitness outcomes of young South African military recruits following different physical training programs during basic military training

Physical training (PT) is an integral part of developing operational fitness. The objective of the study was to compare the physical fitness outcomes of two groups of young South African military recruits completing 12 weeks of Basic Military Training (BMT) who followed different PT programs. A historical control group (NCPG: female n=115, male n=73) that followed a traditional PT program and an experimental group (CPG: female n=85, male n=100) that followed a new cyclic-progressive PT program participated. The standardised PT test was taken at the beginning, the fifth week and the end of the BMT period. The changes in the fitness components evaluated by the South African National Defence Force (SANDF) standardised PT test were compared. Although the new cyclic-progressive PT program elicited more change (p<0.05) in the fitness parameters measured, it only yielded superior performance at the final measurement in the men’s push-ups (p=0.0001). This may be attributed to the relatively greater amount of upper body exercises performed by the CPG and by the additional resistance offered by pole PT. The new cyclic-progressive PT program has been mandated for all BMT units across the SANDF.http://academic.sun.ac.za/sajrsper/am201

Flexibility as risk factor for stress-fracture development in South African male soldiers

BACKGROUND : Stress fractures are a common military training injury. Flexibility of muscles and joints may directly influence stress-fracture risk by way of altering the forces applied to bone. Hip external rotation and ankle plantar- and dorsiflexion have been inconsistently reported to pose a risk to stress fracture development in military soldiers. Thus this study aimed to present results that could help define the risk flexibility may pose in the development of stress fractures amongst military male soldiers. METHODS : An experimental one-group pretest–posttest study design assessing the injury incidence, bilateral hip external rotation, ankle plantar- and dorsiflexion of South African male military soldiers (n = 100) undergoing 12 weeks of basic military training (BMT) was undertaken. The parametric t-test for dependent samples (α = 0.05) and effect size (ES) was used to analyse the data. RESULTS : No stress fractures were diagnosed in the 100 operational military training injuries reported. BMT resulted in significant mean decreases of 10% (L) and 17% (R) in hip external rotation and 18% (L) and 14% (R) in ankle plantar flexion respectively, whilst a significant increase of 37% (L) and 39% (R) dorsiflexion was observed. CONCLUSIONS : Although normal ankle and limited hip external flexibility do not appear to predispose these male soldiers to stress fracture development these variables should not be excluded as possible intrinsic risk factors.http://medpharm.tandfonline.com/loi/ojfp20am201

Mechanical properties of the triceps surae : differences between football and non-football players

Please read abstract in the article.http://www.tandfonline.com/loi/rjsp20hb201

Heart rate variability assessment of the effect of physical training on autonomic cardiac control

BACKGROUND: The effect of exercise interventions on autonomic nervous system (ANS) control of the heart by heart rate variability (HRV) is often investigated in just one position. It was hypothesized that results of exercise-induced changes on ANS are dependent on body position and that it is possible to distinguish between exercise induced changes in vagal and sympathetic influence by taking measurements in different body positions. METHODS: One hundred eighty-three (male=100, female=83) healthy volunteers, between 18 and 22 years, participated in a prospective twelve week medium to high intensity exercise intervention study with a self-control design. The influence of the exercise intervention was investigated on supine, rising, and standing as well as on the orthostatic response. Time domain, frequency domain and nonlinear (Poincar´e) HRV analysis were performed. RESULTS: The exercise intervention lead to a significant increase (P < 0.05) in vagal influence during supine, rising, and standing. Sympathetic control in the supine position was decreased and increased during rising and standing. In the initial orthostatic response to rising from the supine position, the exercise intervention lead to increased (P < 0.05) vagal withdrawal as well as increased sympathetic control. The orthostatic response measured as the difference between standing and supine indicated only an exercise induced increase in sympathetic control. CONCLUSIONS: Exercise-induced changes in sympathetic and parasympathetic ANS control differ, depending on posture and period of measurement. Exercise induced changes in parasympathetic and sympathetic outflow, respectively, can be extracted from measurements from supine, through the orthostatic response, to standing, thereby detecting changes in ANS that are otherwise obscured.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1542-474

The effect of chronic low back pain on daily living and fear-avoidance beliefs in working adults

Low back pain (LBP) has become one of the most influential musculoskeletal diseases of modern society. Exercise has been shown to be very effective in the treatment of chronic low back pain (CLBP). The goal of the study was to test the effect of two exercise intervention programmes (conservative and progressive-aggressive programmes) for 12 weeks on CLBP and their impact on the activities of daily living, and fear avoidance beliefs about physical activities and workrelated activities. In total 22 participants were recruited for the study and randomly assigned to one of two exercise groups: 11 participants in the conservative exercise group and 11 in the progressive-aggressive group). The Oswestry Disability Index (ODI), the Functional Rating Index (FRI), and the Visual Analogue Scale (VAS) for pain measurement was completed by the participants pre- and post-test. There were no statistically significant differences at the 5% level between the conservative and progressive-aggressive programmes. In conclusion, the results from the present study indicate that both types of programmes have shown to be very effective in the improvement of daily living and fear avoidance beliefs. On the basis of the magnitude of improvement, an aggressive-progressive exercise programme may be a little more effective than a more conservative exercise programme.http://www.ajol.info/journal_index.php?jid=153&ab=ajpherd2017-03-31am201

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

BACKGROUND: In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. METHODS : We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. RESULTS : This intervention is an innovative, nurse-driven and app-enabled intervention called ‘the Tshwane Insulin Project intervention’. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. CONCLUSION : The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.The Lilly Global Health Partnershiphttps://journals.sagepub.com/home/taehj2022Family MedicineInternal MedicinePhysiologySchool of Health Systems and Public Health (SHSPH

Using a nurse-driven and home-based telehealth intervention to improve insulin therapy for people with type 2 diabetes in primary care : a feasibility study

OBJECTIVES : A study was undertaken to assess the feasibility and safety of the Tshwane Insulin Project (TIP) intervention, describe patients’ and healthcare professionals’ experiences with the intervention, and determine preliminary treatment effects on glycaemic control. DESIGN : This was a single-group feasibility study. SETTING : The study was carried out in the City of Tshwane, South Africa. SUBJECTS : People with type 2 diabetes on maximum oral drugs with suboptimal glycaemic control (HbA1c: 9–12%), and healthcare professionals who were involved in the implementation of the TIP intervention were included. OUTCOME MEASURES : Implementation outcome measures included satisfaction, acceptability, appropriateness and safety; and efficacy by assessing change in HbA1c levels. RESULTS : Healthcare professionals and patients were satisfied with the intervention. Healthcare professionals agreed that the intervention was acceptable and appropriate. No symptomatic or severe hypoglycaemic events were reported. Improved glycaemic control was recorded with 2.2% lowering of HbA1c values (95% CI, 1.6–2.8%). CONCLUSIONS : The TIP intervention was feasible and can be implemented with minor amendments. Most participants recommended scaling up the intervention. Lessons learned from this study include: (1) high rates of insulin refusal should be anticipated, and insulin resistance amongst people with type 2 diabetes in primary care should be addressed; and (2) the challenges of initiating and titrating insulin in primary care can be addressed through task sharing and by involving allied healthcare workers.Lilly Global Health Partnershiphttps://www.tandfonline.com/loi/oemd20hj2022Human NutritionInternal MedicinePhysiologySchool of Health Systems and Public Health (SHSPH

Attitudes and beliefs of South African primary healthcare practitioners on initiating insulin in people with type 2 diabetes : findings from the Tshwane Insulin Project (TIP)

AIMS : To investigate the attitudes and beliefs of primary healthcare practitioners (HCPs) towards initiating insulin therapy for people with type 2 diabetes (T2D) in South Africa. METHODS : A cross-sectional survey was conducted amongst HCPs from 23 clinics. The nurses’ questionnaire was administered by research nurses while doctors completed an online version about their attitudes, beliefs and perceived barriers to initiating insulin. RESULTS : Of the 73 HCPs surveyed, 68% were nurses and 84% were women. Only 24% of HCPs believed that most patients would eventually need to initiate insulin regardless of their adherence to treatment regimens and 86% preferred to delay insulin therapy. Doctors were reluctant to initiate insulin, citing patient-related reasons such as low socio-economic level (41%), inability to refrigerate insulin (77%) and inability to self-monitor blood glucose (55%). Doctors mentioned that patient behaviour including not adhering to treatment regimen and appointments (91%) and reluctance to start insulin therapy (82%) influenced their prescription practices. Doctors mentioned that health system factors, including the pressure to see patients quickly (68%) and lack of continuity of care (64%) were barriers to initiating insulin. CONCLUSIONS : Optimising insulin therapy in primary care requires health system changes including promoting person-centred care and continuing training for HCPs.The Lilly Global Health Partnershiphttp://www.elsevier.com/locate/pcd2022-09-18hj2022Human NutritionInternal MedicinePhysiologySchool of Health Systems and Public Health (SHSPH

An epidemiological study of physical activity patterns and weight gain in physically active and sedentary pregnant women in Tshwane, South Africa

Physical activity during pregnancy has been investigated for its potential benefits which includes weight control. Physical activity patterns of pregnant women in Tshwane, South Africa, were investigated using the EPIC–Norfolk Physical Activity Questionnaire (EPAQ-2) in an epidemiological cross-sectional study. Differences between recalled pre-pregnancy weight and pregnancy weight were used to determine weight gain. Weight gain was calculated to determine its association with the physical activity levels of pregnant women in their second and third trimesters and to assess how the progression of the pregnancy affects this variable. Of the 78 women who participated, 31 (39.7%) and 47 (60.3%) were in their second and third trimesters, respectively; 30.8%, 53.9% and 16.7% were classified as relatively inactive, active and very active respectively. The weight gain of 45.5% of the pregnant women was within the recommended range, while 28.6% and 26.0% were below and above the range respectively. Non-parametric statistics indicated no connection between the trimester and the women’s activity level. Very active and relatively inactive pregnant women fall below and above the recommended weight-gain ranges, respectively (p>0.10). Of the pregnant women, 35 (53.9%) were relatively active and 35 (45.5%) fall within the recommended weight-gain ranges. In conclusion, no connection was established between the pregnancy trimester and the level of physical activity, while physical activity effectively controlled weight gain during pregnancy. This study was limited by its cross-sectional nature, therefore further longitudinal research is recommended.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher