BACKGROUND:This study aimed to investigate the independent and joint associations of sleep and 24-hour rest-activity rhythms with reduced kidney function among older adults in rural China. METHODS:Data from 1493 participants in the baseline survey of the Rural Physical Activity Behavior and Healthy Aging Cohort were analyzed. Sleep and 24-hour rest-activity rhythm parameters, including total sleep time (TST), wakefulness after sleep onset (WASO), interdaily stability (IS), intradaily variability (IV), Least active 5 h span (L5), Most active 10 h span (M10), and relative amplitude (RA). Multivariable logistic regression models were employed to examine the independent and joint associations of sleep and 24-hour rest-activity rhythms with reduced kidney function. RESULTS:Independent analyses revealed that IS, L5, and M10 were significantly inversely associated with reduced kidney function (IS: OR = 0.13, 95% CI: 0.04-0.49; L5: OR = 0.89, 95% CI: 0.82-0.97; M10: OR = 0.97, 95% CI: 0.96-0.99), whereas IV and TST were significantly positively associated with reduced kidney function (IV: OR = 2.90, 95% CI: 1.37-6.15; TST: OR = 1.35, 95% CI: 1.15-1.57). Joint analyses demonstrated that compared with the long sleep group, the moderate and short sleep groups exhibited significantly lower ORs. Regardless of sleep duration, the stable rest-activity rhythm group showed significantly lower ORs than the unstable group. CONCLUSION:These findings suggest that maintaining stability in rest-activity rhythms should be emphasized in older rural Chinese populations, as it may play an important role in the early prevention and management of reduced kidney function.

Abstract Alzheimer’s disease (AD) is the most prevalent type of dementia, and its pathophysiological mechanisms involve multiple factors, including genomic factors, metabolomic factors, and environmental factors. Lipid dysregulation occurs both centrally and peripherally in patients with AD, and the severity is closely associated with disease progression. Applied studies based on genome-wide association studies, genomic analyses, lipidomic analyses, mass spectrometry, and machine learning, have identified lipids as a key potential target for early diagnosis and intervention in AD. However, due to the complexity of AD pathogenesis and the considerable structural and functional diversities of lipids, pharmacological therapies that target lipid homeostasis have shown limited effectiveness in ameliorating AD pathology and are often accompanied by side effects. In contrast, exercise, a holistic intervention with multitarget effects, can modulate the levels of multiple lipids simultaneously and slow the progression of AD with minimal side effects. However, the mechanisms require further clarification. This review summarizes alterations and mechanisms of action of lipids—including fatty acids, triglycerides, glycerophospholipids, sphingolipids, and cholesterol—in AD and further outlines the possible molecular mechanisms through which exercise influences AD through modulation of lipid metabolism. We also review the recent clinical research on lipid-targeting drugs for AD, and propose a hypothesis that lipids may act as a mediator of the peripheral–central crosstalk between exercise and AD. Additionally, how different apolipoprotein E genotypes may affect the response to exercise in AD is explored. These insights provide a theoretical basis for nonpharmacological interventions for AD and offer an important reference for the development of lipid-related therapeutic targets.

OBJECTIVE:To explore the effects of brain-computer interactive (BCI) rehabilitation training combined with gait robot (GR) on gait recovery in patients with hemiplegia after stroke. DESIGN:Randomized controlled trial. SETTING:Hospital settings across the Shandong Provincial Third Hospital. PARTICIPANTS:A total of 120 eligible subjects were enrolled and randomly allocated, via random-number table, into 4 equal groups (n=30 each): control (routine training), BCI, GR, and BCI-GR (BCI combined with GR training). INTERVENTIONS:Each group received its designated training once daily, 6 d/wk, for 8 consecutive weeks. MAIN OUTCOME MEASURES:Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), integrated electromyography (IEMG), and stride parameters. Assessments were conducted at baseline, 4 wk, and 8 wk. RESULTS:After 8 wk, all interventions-BCI, GR, and BCI-GR-significantly improved lower-limb function, muscle activity, and gait compared with control (all P<.01). FMA-LE increased by +12.93 (BCI-GR), +12.16 (BCI), and +12.07 (GR) versus +8.20 in control; BBS improved by +14.53, +13.63, and +14.30 versus +9.53; FAC improved by +1.73, +1.73, and +1.77 versus +1.37. IEMG of tibialis anterior and gastrocnemius increased most in BCI-GR (+0.156 and +0.063), significantly higher than BCI and GR (P<.05), whereas co-contraction ratio decreased most in BCI-GR (-18.59%; P<.05). Stride parameters (step frequency, step length, step width, and walking speed) improved in all intervention groups, with BCI-GR showing greater gains in step frequency (+25.90) and step width reduction (-12.87) versus single interventions (P<.05). No other significant differences among intervention groups were observed at week 8. CONCLUSIONS:BCI and GR interventions significantly improve lower-limb motor function, muscle activation, and gait in poststroke patients. Combined BCI-GR training accelerates early functional recovery and more effectively enhances muscle activation patterns compared with single interventions, providing a promising strategy for poststroke rehabilitation.

Nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in the NAD+ salvage pathway, has emerged as an important regulatory node linking metabolic homeostasis to neuroinflammatory responses. However, although pharmacological inhibition of NAMPT may attenuate inflammatory activation, it may also reduce intracellular NAD+ availability, thereby exacerbating mitochondrial dysfunction and disturbances in energy metabolism. Here, we found that 6-month-old APP/PS1 mice exhibited an abnormal, cell type-specific distribution of NAMPT in the brain, characterized by reduced neuronal NAMPT and increased microglial NAMPT. This abnormality was accompanied by disrupted NAD+ homeostasis, marked neuroinflammatory activation, mitochondrial structural and functional impairment, increased β-amyloid (Aβ) burden, and impaired learning and memory ability. FK866 (1 mg/kg per injection, once every other day for 12 weeks) alone exerted limited effects and was insufficient to ameliorate the overall pathological phenotype. By comparison, a 12-week aerobic treadmill exercise program markedly ameliorated cognitive impairment, attenuated Aβ pathology, suppressed neuroinflammation, and improved mitochondrial integrity and bioenergetic function in APP/PS1 mice. More importantly, under NAMPT-inhibited conditions, exercise still preserved hippocampal NAD+ homeostasis and maintained significant neuroprotective effects. Compared with exercise alone, the combined intervention with exercise and FK866 further improved selected indices related to Aβ pathology, neuroinflammation, oxidative stress, and mitochondrial damage. These additional effects may be associated with increased NAD+ biosynthesis through the NMNAT3 pathway, as well as reduced NAD+ consumption and neuroinflammatory activation through the suppression of CD38 and PARP1 expression.

OBJECTIVE:The aim of this study is to examine the association between the daily steps, step intensity and physical fitness (PF) of community-dwelling older Chinese women. METHODS:Cross-sectional data were derived from baseline survey of the Physical Activity and Health in Older Women Study. Participants' daily steps and intensity were objectively measured using wGT3X-BT accelerometers. PF levels was determined through the National Physical Fitness Test (Elderly Section). To evaluate the associations of step counts and intensity with PF, logistic regression analyses were performed. Furthermore, receiver operating characteristic (ROC) curve analysis was employed to determine the optimal cut-off values of step counts and intensity for discriminating high PF levels. RESULTS:A total of 1122 participants were included in this study with a mean age of 64.9 ± 2.8 years. Logistic regression results showed that an increase of 1000 steps/day in incidental, purposeful, and moderate-vigorous steps, and an increase of 10 steps/min in peak cadence (defined as the highest average step rate over 1/5/10/30/60 min for Peak-1/5/10/30/60, respectively), were significantly associated with higher PF levels (P < 0.05). ROC analysis results showed that the AUC values for total daily steps, incidental steps, purposeful steps, and moderate-vigorous intensity steps are 0.62, 0.60, 0.60, and 0.67, respectively. In addition, the corresponding optimal cut-off values for distinguishing between high and low PF are 6882 steps/day, 3596 steps/day, 4395 steps/day, and 1537 steps/day, respectively. The AUC values for Peak-1, Peak-5, Peak-10, Peak-30, and Peak-60 are 0.61, 0.62, 0.62, 0.61 and 0.61, respectively. The areas under the curves are all greater than or equal to 0.60. In addition, the corresponding optimal cut-off values for distinguishing high vs. low PF are 116 steps/min, 108 steps/min, 101 steps/min, 82 steps/min, and 67 steps/min, respectively. CONCLUSIONS:Both higher step intensity and greater step accumulation were associated with better physical fitness in older women.

ObjectiveTo investigate the association among multidimensional (Digital engagement, DE; Digital devices, DD; and Digital purpose, DP) digital technology use and depression in older Chinese, considering social participation as a mediator and physical activity level (PAL) as a moderator.MethodsData on 5,744 participants (aged≥60) were extracted from the China Health and Retirement Longitudinal Study 2020 dataset. Depression was assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Logistic regression examined the association between digital technology use and depression. The PROCESS program’s Model 4 evaluated the mediating role of social participation, while Model 7 assessed the moderating role of PAL.ResultsDigital technology use was negatively associated with depression (DE, OR= 0.722, 95%CI: 0.609, 0.858; DD, OR= 0.739, 95%CI: 0.634, 0.860; DP, OR= 0.916, 95%CI: 0.881, 0.952). Various dimensions of digital technology use exerted direct effects on depression scores of 85.87% (DE, OR= -0.638, 95%CI: -1.036, -0.240), 86.09% (DD, OR= -0.526, 95%CI: -0.844, -0.208), and 87.82% (DP, OR= -0.173, 95%CI: -0.259, -0.087), respectively, and social participation mediated 14.13%, 13.91%, 12.18%. PAL exerted a positive moderating effect on the first half path of mediation, especially with the vigorous PAL (DE, OR= 0.591, 95%CI: 0.230, 0.952; DD, OR= 0.515, 95%CI: 0.206, 0.824; DP, OR= 0.157, 95%CI: 0.075, 0.239).ConclusionsMultidimensional digital technology use showed an association with depression in older adults. Promoting social participation through digital technology use is associated with lower depressive symptom scores, and vigorous PAL further strengthens this association, leading to improved mental health.

Aims: This study aims to investigate the associations of objectively measured daily steps and step intensity with peripheral arterial disease (PAD) in Chinese community-dwelling older women. Methods: Cross-sectional data were derived from the baseline survey of the Physical Activity and Health in Older Women Study. Peripheral arterial disease was evaluated through ankle-brachial index (ABI), ABI <= 0.9 was defined as cut-off point. Daily steps and step intensity were measured via tri-axial accelerometers. Multivariate logistic regression was used to investigate associations of step variable with PAD. Receiver operating characteristic (ROC) analysis was applied to identify an optimal cut-off value for step variables to screen PAD. Results: After adjusting for confounding factors, it was found that daily steps was not independently associated with PAD, and brisk steps, peak 30 as well as peak 60, were significantly associated with PAD, with ORs of 0.68 (0.50-0.93), 0.71 (0.52-0.96) and 0.60 (0.40-0.90), respectively. The optimal cut-off values for brisk steps, peak 30 and 60 screening PAD were 952.3 steps, 76.7 steps/min and 51.8 steps/min, respectively. Conclusions: Step intensity rather than daily steps was independently associated with PAD in Chinese communitydwelling older women. Increasing the intensity during walking may be a viable strategy to reduce the risk of PAD in self-care and cardiovascular nursing.

Objective: This study aims to explore the independent and combined associations of physical activity (PA) in different domains and inflammatory diet with type 2 diabetes mellitus (T2DM). Methods: Data from 8736 American adults from the NHANES 2007-2016 were used. PA in different domains was assessed using the self-reported Global Physical Activity Questionnaire, and dietary inflammatory index was estimated based on 24 h dietary recalls. T2DM diagnosis was determined by a combination of self-report and laboratory data. A multivariate modified Poisson regression model was used to explore the independent and combined associations of moderate-vigorous intensity physical activity (MVPA) and inflammatory diet with T2DM. Results: PA in the Work MVPA, Recreational MVPA and Total MVPA domains was independently associated with reduced risk of T2DM, and an inflammatory diet was independently associated with elevated risk of T2DM. In the combined analysis, the combination of active and anti-inflammatory within the Work MVPA, Recreational MVPA and Total MVPA fields was associated with the greatest reduced risk of T2DM, and always associated with decreased risk of T2DM in the active group. Conclusions: Our study emphasizes that the combination of active PA and anti-inflammatory diet is closely associated with the reduced risk of T2DM, and suggests the combination of both for the prevention and treatment of T2DM.

Objective: This systematic review and meta-analysis evaluates how the flipped classroom model—considered as a neurocognitive training environment—affects cognitive–motor integration and brain-mediated motor skill performance in university students, providing scientific evidence for optimizing higher-education physical education pedagogy (a course related to physical literacy and the cultivation of physical and mental health, rather than a training program for professional physical education teachers). Methods: In order to compare the effects of flipped classroom and traditional teaching on the motor skill performance of university students, this study conducted a systematic review and meta-analysis according to PRISMA rules, whereby studies were screened according to specific inclusion criteria and data were extracted, assessed for quality, and then meta-analyzed to assess the effectiveness of the flipped classroom model in improving motor skill performance. Results: A total of 12 original randomized controlled trials (RCTs) were included in the study. The meta-analysis results indicated that the flipped classroom model significantly outperformed traditional teaching methods in improving university students’ motor skill scores (standardized mean difference (SMD) = 1.22, 95% CI = 0.64–1.79, p < 0.0001). Subgroup analysis showed significant effects in both general major students and sports science major students, with no significant difference between studies conducted in China and those conducted in non-China regions. Conclusions: The flipped classroom model demonstrates significant advantages over traditional PE teaching methods in improving motor skill performance. It enhances students’ skill acquisition and classroom engagement, showing promising potential for future implementation in university PE programs. Further research should explore the model’s applicability across different sports and student populations, as well as its long-term impact on skill retention and postgraduation sports participation.

To examine the associations between usual walking speed and the risk of mortality and major non-communicable diseases in general population by conducting a systematic review and meta-analysis. A total of 48 studies met the eligibility criteria. Compared with the participants with the fastest walking speed, the relative risk (RR) of all-cause mortality, cardiovascular disease (CVD) incidence, cancer incidence and type 2 diabetes (T2D) incidence of the participants with the slowest walking speed were 1.49, 1.20, 1.09 and 1.31, respectively. Furthermore, a non-linear dose-response relationship was identified between usual walking speed and the risk of all-cause mortality; a linear dose-response relationship was observed with the risk of CVD incidence and T2D incidence. For per 0.1 m/s increase in walking speed, there was a 4 % and 3 % reduction in the risk of CVD and T2D, respectively. Walking speed were inversely associated with the risk of all-cause mortality and major non-communicable diseases including CVD, cancer and T2D. In light of the favourable impact of increased walking speeds on numerous health indicators, we propose that that people incorporate brisk walking into their daily lives for greater health benefits.

To examine the associations of accelerometer-measured daily step counts and intensity with overweightness/obesity among older Chinese women. Data were collected from 1,085 women in the Physical Activity and Health in Older Women Study (PAHIOWS) in China. Multiple linear regression analyses were used to assess the association of total daily step counts, peak cadence and their joint association with overweightness/obesity indicators. Receiver operating characteristic curve (ROC) analysis was used to determine the optimal cut-off values of daily steps and peak cadence for distinguishing overweightness/obesity. Daily step counts, cadence or intensity were independently associated with lower overweightness/obesity indicators. Each 1,000 step increase in daily step counts was associated with lower body fat ratio (BFR) (β: -0.22, 95

OBJECTIVE:To examine the independent and joint associations between physical activity (PA) timing and volume patterns in relation to metabolic syndrome (MetS). METHODS:Data from the NHANES 2011-2014 cycles, involving 5065 participants, were used. PA was measured using triaxial accelerometers. PA timing patterns were determined using the K-means clustering algorithm, and PA volumes were categorized based on tertiles (low, moderate, and high). Logistic regression models were used to assess the associations between PA patterns and MetS and its components. We also used restricted cubic spline curves to fit the PA to the MetS and its component non-linear associations. RESULTS:Three distinct PA timing patterns were identified using K-means clustering (morning, midday-afternoon, and late afternoon-evening). Independent analyses indicated that engaging in PA during the morning or midday-afternoon PA was with lower odds of MetS compared to late afternoon-evening. The adjusted odds ratios (95% confidence intervals) were 0.79 (0.63-0.99) and 0.78 (0.62-0.98), respectively. In joint analyses, compared with the late afternoon-evening/low PA pattern, the morning and midday-afternoon PA timing patterns were associated with lower odds of MetS when combined with moderate or high PA volume. In contrast, the late afternoon-evening PA pattern was significantly associated with lower odds of MetS only at high PA volumes. Additionally, a nonlinear association with MetS was identified in the morning PA pattern, whereas dose-dependent associations with MetS were observed in the midday-afternoon and late afternoon-evening PA patterns. CONCLUSIONS:Our study shows that morning and midday-afternoon PA patterns are associated with lower odds of MetS compared to late afternoon-evening PA. Higher total PA volume is also linked with lower odds of MetS. Conversely, prolonged PA during the late evening or nighttime is associated with higher odds of poorer metabolic outcomes.

Abstract Background This study aimed to investigate the relationships between accelerometer-measured physical activity (PA) and sedentary behaviour (SB) with physical function (PF) among older Chinese women in the community. Methods The present study comprised 1,113 community-dwelling older females, with an average age of 65 ± 2 years. We employed a linear regression analysis to investigate the relationship between patterns of PA and SB with PF. PA variables consisted of total PA time, bouted PA time (a continuous PA that lasts equal to or more than 10 min), and sporadic PA time (a continuous PA that lasts less than 10 min). SB variables included total SB time, 30-min bout of SB (a continuous SB that lasts equal to or more than 30 min), and 60-min bout of SB (a continuous SB that lasts equal to or more than 60 min). PF variables comprised handgrip strength (HGS), one-legged stance test with eyes closed (OLSTEC), usual walking speed (UWS), maximum walking speed (MWS) and chair-stand time (CT). To explore the joint effects of moderate-to-vigorous-intensity PA (MVPA) and SB on PF, we divided the duration of SB and MVPA participation in older women into different combinations: low MVPA & high SB, low MVPA & low SB, high MVPA & high SB, high MVPA & low SB. Results The study revealed a significant association between 30-min bout of SB and CT, which remained after adjusting for total MVPA time (P = 0.021). Both total MVPA and bouted MVPA were found to be positively associated with better UWS, MWS, CT, and PF Z-score. When the combination of low MVPA & high SB was used as a reference, the regression coefficients for PF ascended by 1.32 (P < 0.001) in the high MVPA & high SB group and by 1.13 (P < 0.001) in the high MVPA & low SB group. Conclusions A significant association was observed between poorer lower limb function and prolonged, uninterrupted SB in older women, rather than with the total SB time. Concurrently, the insufficient engagement in MVPA may also be a crucial factor contributing to poorer PF in older women. Engaging in longer durations and higher intensity of PA, such as bouts of MVPA lasting a minimum of 10 min or longer, may contribute to better PF.

BackgroundDeveloping adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. ObjectiveThe purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. MethodsThe literature search was conducted in 6 electronic databases—PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus—from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. ResultsA total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD –0.23, 95% CI –0.33 to –0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. ConclusionseHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult–oriented research is needed to develop eHealth interventions that can change multiple behaviors. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418

Introduction: We examined the association between physical activity (PA) and sedentary behavior (SEB) time with bone health and whether it changes depending on different patterns. Materials and methods: Cross-sectional data were derived from the baseline of the Physical Activity and Health in Older Women Study. PA and SEB were measured using Actigraph wGT3X-BT accelerometers. Bone mineral density (BMD) was derived from the SONOST-2000 ultrasound bone densitometer, with unhealthy bone defined as a BMD T -score of <2.5 standard deviation a young adult reference population's mean. A 10 min-bouted SEB was defined as an SEB duration of >10 min (allow 2 min 0 counts), similar to 30 min-bouted and 60 min-bouted SEBs. Sporadic and bouted PAs were defined by PA duration of <10 min or >= 10 min. Multivariate logistic regression analysis investigated the associations between PA and SEB patterns with bone health. Results: Among 1111 female participants, 42.12 % had unhealthy bones. In a fully -adjusted model, increasing 30 min/day of SEB was associated with a higher odds ratio (OR) for an unhealthy bone (OR, 1.08; P = 0.005), similar to the 10 (OR, 1.06; P = 0.012), 30 (OR, 1.06; P = 0.043), and 60 min-bouted (OR 1.08, P = 0.032) SEBs. Total light PA (LPA) time (OR, 0.97; P = 0.005) had a lower OR for unhealthy bone. After adjusting for sporadic LPA time, bouted LPA (OR, 0.97; P = 0.005) retained this association. No association was observed between total moderate -to -vigorous PA (MVPA) and bone health, sporadic MVPA, and bouted MVPA. Conclusions: Performing bouted LPA and reducing 10 min-bouted SEB may maintain bone health.

As a neurodegenerative disease closely related to age-related changes, Alzheimer's disease (AD) is rapidly becoming one of the most resource-intensive and deadly diseases of this century. As a systemic neurotransmitter system with widespread distribution throughout the central and peripheral nervous systems, the 5-hydroxytryptamine (5-HT) system not only plays an important role in antidepressant therapy but also shows potential value in improving AD symptoms. The 5-HT system may facilitate the prevention and treatment of AD by impacting its pathological processes through various pathways, such as the regulation of Aβ deposition, hyperphosphorylation of Tau, central and peripheral neuroinflammation, and the interactions with the cholinergic and BDNF systems. In addition, regular exercise, as a non-pharmacological intervention, provides systemic and multi-level physical health benefits. Given the high sensitivity of the 5-HT system to exercise, this paper reviews its crucial role and potential mechanisms in alleviating AD through exercise. From perspective of the integrative biology of exercise, we propose several crosstalk mechanisms between the peripheral and central systems mediated by the 5-HT system. These mechanisms serve as a bridge for the treatment of AD and offer novel ideas and strategies for future therapeutic approaches.

Background: Physical activity (PA) and/or exercise improves postprandial cardiometabolic risk markers; however, the optimal exercise intensity, frequency, and dose remain unclear. We aimed to (1) compare the acute metabolic effects of interrupted prolonged sitting with PA bouts of different frequencies and durations on blood glucose, insulin, and triacylglycerol responses, and (2) compare the effects of the different types and different times of PA breaks on these measures. Methods: A literature search was carried out using four databases. Network meta-analysis (NMA) and paired meta-analysis were performed to estimate the total standardized mean differences (SMDs) with 95% confidence intervals (95%CI). Results: According to the NMA, compared to prolonged sitting, every 30 min interruption had the highest probability (SUCRA) of being the best intervention for improving blood glucose (SUCRA = 81.8%, SMD = −1.18, 95%CI: −1.72, −0.64) and insulin (SUCRA = 77.5%, SMD = −0.98, 95%CI: −1.36, −0.60). Additionally, every 20 min interruption also significantly lowered blood glucose (SMD = −0.89, 95%CI: −1.52, −0.27) and insulin (SMD = −0.94, 95%CI: −1.41, −0.46). Pairwise meta-analysis suggested that frequent breaks by light-intensity PA significantly lowered glucose (SMD = −1.45, 95%CI: −2.32, −0.57) and insulin (SMD = −1.04, 95%CI: −1.53, −0.55). The same was found for frequent breaks by moderate-to-vigorous PA, which also significantly lowered glucose (SMD = −0.6, 95%CI: −0.83, −0.37) and insulin (SMD = −0.53, 95%CI: −0.73, −0.32). Conclusions: According to the NMA, performing short bouts of PA every 30 min is the most effective prolonged sitting intervention for improving blood glucose and insulin. More evidence is needed to determine the optimal type and time of PA breaks for braking sedentary sitting. PROSPERO Registration: CRD42022340036.

OBJECTIVE: The current study aimed to assess and rank the comparative efficacy of different nonoperative treatments on Cobb angle, angle of trunk rotation, and quality of life for mild -to -moderate adolescent idiopathic scoliosis. METHODS: A comprehensive search of databases, including Medline, The Cochrane Library, PubMed, EMBASE, and Web of Science spanning all previous years up to January 1, 2024. The included studies were evaluated for literature quality according to Cochrane Handbook criteria, and a network meta -analysis was performed using STATA 14.0 statistical software. RESULTS: Twenty randomized controlled trials met all inclusion criteria and were analyzed. Schroth exercise and scoliosis-specific exercise combined with brace treatments had a significant positive effect on Cobb angle and quality of life. For angle of trunk rotation, Schroth exercise and Schroth exercise combined with brace treatments prove more effective compared to the control group. On surface-under-the-cumulative-ranking-curve analysis, Schroth exercise combined with brace treatment had the highest likelihood for reducing Cobb angle (P -score [ 0.899), angle of trunk rotation (0.82), and improving quality of life (0.828). CONCLUSIONS: Although most conservative treatments had benefits for mildto -moderate adolescent idiopathic scoliosis, the most optimal programs were those that included (1) at least 10 weeks of approximately 60 -minute Schroth exercise sessions twice a week and (2) wearing the brace for 23 hours every day throughout the treatment period.

Background Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults. Methods The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time. Results A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = −0.50, 95% CI: −0.87, −0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively. Conclusions In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.