Supervised exercise training and increased physical activity to reduce cardiovascular disease risk in women with polycystic ovary syndrome: Study protocol for a randomized controlled feasibility trial

Background: Polycystic ovary syndrome (PCOS) affects up to 20% of women and is characterised by higher amounts of visceral fat, obesity, insulin resistance, dyslipidemia and reproductive and cardiometabolic complications. Increased oxidised low-density lipoprotein (LDL) concentrations have been associated with an increased risk of cardiovascular disease (CVD)-related events. Oxidised LDL is rarely used as a marker for CVD risk in PCOS-related studies despite its widely accepted role in atherogenesis and the increased risk factors associated with PCOS. Additionally, prolonged periods of sedentary behaviour can negatively affect metabolic health. No studies have specifically examined the effects of reducing sedentary behaviour on CVD risk in PCOS with a lifestyle physical activity intervention. The aim of the current study is to measure the feasibility of a randomised controlled trial (RCT) examining the effects of supervised exercise and reducing sedentary behaviour in women with PCOS on CVD risk. Methods/design: A feasibility, exploratory RCT will be conducted. Fifty-one pre-menopausal females will be randomly allocated between an exercise group (EG), a lifestyle physical activity group (LPAG) and a control group. Participants in the EG will undertake a 12-week supervised aerobic exercise programme. The LPAG will aim to increase daily physical activity and reduce sedentary behaviour for 12 weeks. The control group will not take part in any intervention. Primary outcomes are feasibility and acceptability of the intervention and procedures. Secondary outcomes are oxidised LDL, aerobic fitness, blood lipid profile, fasting glucose and insulin, testosterone and inflammatory markers. Discussion: PCOS is associated with various increased risk factors for CVD, including hypertension, dyslipidemia, abdominal obesity, insulin resistance, and inflammation. Whether oxidised LDL has a role in this increased risk is not yet known. The present study aims to measure the feasibility of implementing structured exercise training and/or increased lifestyle physical activity in women with PCOS, so that a subsequent adequately powered RCT can be designed. The results from the study will be used to refine the interventions and determine the acceptability of the study design. A limitation is that some self-monitoring in the lifestyle physical activity group may not be reliable or replicable, for example inputting information about time spent cleaning/gardening

Eating behaviours and food cravings; influence of age, sex, BMI and FTO genotype

Previous studies indicate that eating behaviours and food cravings are associated with increased BMI and obesity. However, the interaction between these behaviours and other variables such as age, sex, BMI and genetics is complex. This study aimed to investigate the relationships between eating behaviours and food cravings, and to examine the influence of age, sex, body mass index (BMI) and fat mass and obesity-associated (FTO) genotype on these relationships. A total of 475 participants (252 female, 223 male, BMI: 25.82 ± 6.14 kg/m², age: 30.65 ± 14.20 years) completed the revised 18-question version of the Three Factor Eating Questionnaire (TFEQ-R18) to assess cognitive restraint, uncontrolled eating and emotional eating, and the Food Cravings Inventory (FCI) to assess cravings for fatty food, sweet food, carbohydrates and fast food. DNA samples were genotyped for the rs9939609 polymorphism in the obesity-linked gene FTO. Questionnaire data was analysed for associations between the TFEQ-R18 and FCI subscales for the whole study group, and the group divided by sex, genotype and age (≤25 years versus >25 years). Finally, mediation analysis was used to explore the relationships between BMI, cognitive restraint and food cravings. FTO AA + AT genotype was associated with increased BMI, but not with differences in eating behavior scores or food craving scores; age was associated with increased BMI and decreases in food craving scores in which this effect was stronger in women compared to men. Increased cognitive restraint was associated with decreased food craving scores in the ≤25 years group. Mediation analysis demonstrated that in this group the association between BMI and reduced food cravings was mediated by cognitive restraint indicating that in this age group individuals use cognitive restraint to control their food cravings. The positive correlation between age and BMI confirms previous results but the findings of this study show that age, sex, FTO genotype and BMI have an influence on the relationships between eating behaviours and food cravings and that these variables interact

An acute bout of cycling does not induce compensatory responses in pre-menopausal women not using hormonal contraceptives

There is a clear need to improve understanding of the effects of physical activity and exercise on appetite control. Therefore, the acute and short-term effects (three days) of a single bout of cycling on energy intake and energy expenditure were examined in women not using hormonal contraceptives. Sixteen active (n = 8) and inactive (n = 8) healthy pre-menopausal women completed a randomised crossover design study with two conditions (exercise and control). The exercise day involved cycling for 1 h (50% of maximum oxygen uptake) and resting for 2 h, whilst the control day comprised 3 h of rest. On each experimental day participants arrived at the laboratory fasted, consumed a standardised breakfast and an ad libitum pasta lunch. Food diaries and combined heart rate-accelerometer monitors were used to assess free-living food intake and energy expenditure, respectively, over the subsequent three days. There were no main effects or condition (exercise vs control) by group (active vs inactive) interaction for absolute energy intake (P > 0.05) at the ad libitum laboratory lunch meal, but there was a condition effect for relative energy intake (P = 0.004, ηp2 = 0.46) that was lower in the exercise condition (1417 ± 926 kJ vs. 2120 ± 923 kJ). Furthermore, post-breakfast satiety was higher in the active than in the inactive group (P = 0.005, ηp2 = 0.44). There were no main effects or interactions (P > 0.05) for mean daily energy intake, but both active and inactive groups consumed less energy from protein (14 ± 3% vs. 16 ± 4%, P = 0.016, ηp2 = 0.37) and more from carbohydrate (53 ± 5% vs. 49 ± 7%, P = 0.031, ηp2 = 0.31) following the exercise condition. This study suggests that an acute bout of cycling does not induce compensatory responses in active and inactive women not using hormonal contraceptives, while the stronger satiety response to the standardised breakfast meal in active individuals adds to the growing literature that physical activity helps improve the sensitivity of short-term appetite control

Smart technology for healthcare: Exploring the antecedents of adoption intention of healthcare wearable technology

© The Author(s), 2019. Technological advancement and personalized health information has led to an increase in people using and responding to wearable technology in the last decade. These changes are often perceived to be beneficial, providing greater information and insights about health for users, organizations and healthcare and government. However, to date, understanding the antecedents of its adoption is limited. Seeking to address this gap, this cross-sectional study examined what factors influence users’ adoption intention of healthcare wearable technology. We used self-administrated online survey to explore adoption intentions of healthcare wearable devices in 171 adults residing in Hong Kong. We analyzed the data by Partial least squares – structural equation modelling (PLS-SEM). The results reveal that perceived convenience and perceived irreplaceability are key predictors of perceived useful ness, which in turn strengthens users’ adoption intention. Additionally, the results also reveal that health belief is one of the key predictors of adoption intention. This paper contributes to the extant literature by providing understanding of how to strengthen users’ intention to adopt healthcare wearable technology. This includes the strengthening of perceived convenience and perceived irreplaceability to enhance the perceived usefulness, incorporating the extensive communication in the area of healthcare messages, which is useful in strengthening consumers’ adoption intention in healthcare wearable technology

Effects of pre-meal whey protein consumption on acute food intake and energy balance over a 48-hour period

The effects of pre-meal whey protein consumption on acute food intake and subsequent energy balance measured over 48-h was investigated in males of healthy-weight (HW) or living with overweight and obesity (OV/OB). On two separate trial days, following a controlled breakfast (09:00) and lunch (13:00), 12 HW and 12 OV/OB males consumed either whey protein (20 g) or flavoured water beverages (16:40), and ad libitum test meal (17:00). A controlled 48-h assessment of energy intake and expenditure was used to determine any compensatory behaviour. Test meal energy intake reduced 15.9 % in HW (P = 0.003), and 17.8 % in OV/OB (P = 0.005) following whey protein, compared to placebo. We report no between-group differences and no changes in compensatory behaviour. A small dose of whey protein reduces energy intake at the next meal, without upregulating compensatory behaviours in both HW and OV/OB males. However, chronic effects on body composition and weight loss remain to be elucidated

Co-Designing and Refining a Home-Based Exercise Programme for Adults Living with Overweight and Obesity:Insight from People with Lived Experience

Undertaking a home-based exercise programme should be a positive, health-enhancing lifestyle behaviour, particularly for adults living with overweight and obesity. However, exercise programmes are seldom designed in collaboration with people with lived experience, limiting adherence, efficacy, and effectiveness. Two focus groups (in-person n = 6 and virtual n = 7) were undertaken in the United Kingdom, to glean feedback and further refine a home-based exercise programme, developed from previously conducted semi-structured interviews with adults living with overweight and obesity. Both focus groups provided an opportunity for participants to discuss the proposed programme, highlighting strengths and areas for further improvement. Three key priorities were identified for consideration throughout the design process, specifically for adults living with overweight and obesity: (1) individualisation—a person-centred programme was non-negotiable; (2) motivation—integration of motivational features affected adherence and engagement; (3) more than just weight loss—consideration of other outcomes aside from solely numerical weight loss. These priorities provide direction for further refinement of the proposed home-based exercise programme, in an effort to ensure the final intervention is truly population-specific and needs-sensitive. Following completion, the programme will be assessed using a feasibility randomised controlled trial design

“I Was Having My Midlife Fat Crisis”: Exploring the Experiences and Preferences of Home-Based Exercise Programmes for Adults Living with Overweight and Obesity

The involvement of people with lived experience in the design of exercise programmes is more likely to lead to a more needs-sensitive and population-specific intervention. There is limited evidence of the integration of people with lived experience, particularly regarding home-based exercise programmes for adults living with overweight and obesity, despite this being a population that would significantly benefit from a suitably tailored programme. Semi-structured interviews were virtually conducted to explore 20 participants’ experiences of exercising at home and their preferences for the design of future home-based exercise programmes. Codes were generated through thematic analysis, highlighting considerations such as comfort within a home-based environment, a desire for social connection, and the integration of technology. Four corresponding themes were generated, encapsulating participants’ choice reasoning for home-based exercise, difficulties of engaging in home-based exercise, undertaking and adhering to home-based exercise, and factors that constitute the perfect programme. Although the involvement of people with lived experience in research can be time-consuming, this process is fundamental to the design of an effective and efficacious programme. These findings will inform the design and development of a home-based exercise programme for adults living with overweight and obesity

A Manifesto for exercise science–a vision for improving the health of the public and planet

In this manifesto, we make the case that Exercise Science can and must do more to improve the health of the public and the planet. Post pandemic, our vision for Exercise Science is one of a maturing scientific discipline reaching outwards from a base of strong empirical evidence to have a profound and sustained positive global impact on health. In each of the three main areas of the discipline–research, teaching, and professional practice–a new and distinctive approach is needed. We propose 12 points of action, in no particular order, for a). quality, rigour, and professional standing, and b). reach, relevance, and public engagement and make numerous suggestions for action and change. We encourage the teachers, researchers and practitioners of Exercise Science to consider and act on these recommendations. We hope that this manifesto can help create a shared sense of purpose amongst the global Exercise Science community and further the principles of equality, diversity and inclusion. To act on these principles, we need to cultivate a discipline that encourages more women, people who experience racism and other forms of discrimination, and people with a disability to become involved in the discipline

The Four Regions in Settlement Space: A Game-Theoretical Approach to Investment Treaty Arbitration Part II: Cases

Following from Part I of this paper, which introduced the notion of decision-modelling for investor-state arbitration, Part II of the paper uses the game theoretic notions developed in Part I to explore the question of why a relatively large fraction of investor-state disputes proceed to arbitration tribunals. Likely explanations are advanced. The detailed mathematical model derived in Part I of the paper is then used to analyse 31 cases where an investor-state dispute has been judged by an arbitration tribunal. Auxiliary mathematics are developed to identify the relevant averages and variances, which are then calculated from the full data set. Three sample cases are analysed in greater detail, with the model results being compared against the actual awards. It is concluded that applying the mathematical model of the international arbitration process developed in Part I together with the data analysis laid out in Part II will provide useful insight and guidance to both parties involved or likely to be involved in a dispute between investor and state