BACKGROUND:Hypertension is the predominant risk factor for cardiovascular disease morbidity and mortality, with significant healthcare utilization and expenditure. Pharmaceutical management is habitually adopted; although its long-term effectiveness remains ambiguous, and accompanying adverse effects are disquieting. Peppermint owing to its abundance of menthol and flavonoids, possesses a range of potential hypertensive benefits. RATIONALE:Our previous trial has shown that peppermint is able to mediate significant improvements in systolic blood pressure in healthy individuals. But there has yet to be any randomized placebo-controlled studies, examining the efficacy of peppermint supplementation in hypertensive individuals. OBJECTIVE:This study proposes a placebo randomized controlled trial, exploring the effects of daily peppermint oil supplementation on outcomes pertinent to hypertensive disease in individuals with pre and stage 1 hypertension. METHODS AND ANALYSES:This 20-day, parallel randomized, placebo-controlled trial will recruit 40 individuals, assigned to receive either 100μL per day of either Peppermint oil or a peppermint flavoured placebo. The primary trial outcome will be the between-group difference in systolic blood pressure from baseline to post-intervention. Secondary outcome measurements will be between-group differences in anthropometric, haematological, diastolic blood pressure/ resting heart rate, psychological wellbeing, and sleep efficacy indices. Statistical analysis will be conducted on an intention-to-treat basis using linear mixed effects models to contrast differences in the changes from baseline to 20-days between the two trial arms. ETHICS AND DISSEMINATION:Ethical approval has been granted by the University of Central Lancashire (HEALTH 01074) and the study has formally been registered as a trial (NCT05561543). Dissemination of the trial findings will be through publication in a peer-reviewed journal. TRIAL REGISTRATION:ClinicalTrials.gov NCT05561543. ETHICS:HEALTH 01074.

OBJECTIVES:To monitor sleep patterns of elite swimmers and explore sleep as a potential risk factor for upper respiratory symptoms (URS) alongside salivary Immunoglobulin A (IgA) in elite swimmers, over an 8-month competitive season. DESIGN:Secondary analysis of an 8-month longitudinal study in elite international swimmers leading into either the Commonwealth Games 2018 or Swim Cup Eindhoven. METHODS:Fourteen elite swimmers (age ± SD = 19.9 ± 0.8 years, height = 178.9 ± 6.3 cm, and mass = 75.0 ± 7.7 kg) were recruited. Self-reported sleep quality, URS data and salivary IgA was obtained weekly on a standardised day. Quantitative sleep parameters were measured using wrist-worn actigraphy four times for two-week bouts; during low, moderate, high training loads and once leading into competition. RESULTS:Swimmers waking fatigued was positively associated with frequency (p < 0.001) and severity (p < 0.001) of URS, plus negatively associated with salivary IgA (p = 0.035). Perception of meeting 7-9 hour national sleep recommendations was positively associated with URS frequency (p < 0.001) and severity (p = 0.001). Average sleep duration was 06:30 hrs: mins and reduced significantly during high training loads (p = 0.001) and early morning training (5:00 hrs: mins, p = 0.001). Average sleep efficiency was 81% over the 8-month period. CONCLUSIONS:Perceived fatigue on waking was significantly associated with both frequency and severity of URS, and inversely associated with mucosal immunity (salivary IgA), providing novel insight into the relationship between sleep, fatigue and illness in this cohort. Although causality cannot be established, the high prevalence of inadequate sleep shown in elite swimmers highlights the importance of individual sleep monitoring to support recovery and inform strategies aimed at illness prevention.

Background: Osteoarthritis (OA) is a degenerative joint disease marked by pain, stiffness, and functional impairment, with inflammation central to its progression. Polyphenol-rich dark fruits, abundant in anthocyanins, possess antioxidant and anti-inflammatory properties that may mitigate OA-related mechanisms. This meta-analysis synthesized evidence from randomized controlled trials (RCTs) evaluating the effects of dark fruit supplementation on clinical symptoms and inflammatory biomarkers in individuals with OA. Methods: PubMed, Scopus, Web of Science, and three trial registries (ClinicalTrials.gov, WHO ICTRP, ISRCTN) were searched to September 2025 for RCTs comparing dark fruit supplementation with placebo, usual care, or no intervention. Two reviewers independently screened studies, assessed bias using Cochrane RoB, and evaluated certainty via GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Data were pooled using random-effects models, with Hedges’ g as the standardized mean difference. Results: Six RCTs (215 participants; 3–16 weeks) investigating knee OA met inclusion criteria. Pooled analyses showed significant improvements in overall symptom severity (Hedges’ g = –0.31; 95% CI –0.57 to –0.05; P = 0.02), physical function (g = –0.34; 95% CI –0.66 to –0.05; P = 0.02), and interleukin-6 (IL-6, g = –0.40; 95% CI –0.79 to –0.01; P = 0.047). Where reported, compliance was generally high, although adherence and adverse-event reporting were incomplete across trials. Evidence certainty was low, with moderate-to-high risk of bias. Discussion: In the available RCT evidence, which was restricted to knee OA, dark fruit supplementation was associated with small short-term improvements in selected OA symptoms and IL-6. However, findings are limited by low certainty of evidence, short intervention durations, incomplete adherence and adverse-event reporting, and the absence of long-term or structural outcomes; therefore, no conclusions can be drawn regarding disease-modifying effects or longer-term tolerability. Larger, high-quality trials are needed to determine whether polyphenol-rich fruits provide clinically meaningful benefits in OA management.

This study aimed to explore the impact attenuation efficacy of badminton shoes when lunging and to identify the effects of the vertical ground reaction force and the shoe-ground interface pressure. We examined the construction and functionality of badminton shoes to provide a theoretical basis for optimal badminton shoe design. Ten elite badminton players performed lunging trials in six pairs of professional badminton shoes. The pressure data were collected using a plantar pressure distribution measurement system. Three-dimensional reconstruction and simulation analysis of the badminton shoes were conducted using a three-dimensional scanner together with reverse engineering. Results indicated that the initial impact peak of YONEX-1 was significantly greater; the impulse of LI-NING was significantly greater. The pressure area of LI-NING, VICTOR and ASICS was significantly greater than that of other shoes. The mean pressure of MIZUNO and YONEX-2 was significantly greater than that of VICTOR and ASICS. Compared with other shoes, the centre of pressure of ASICS and LI-NING was closer to the centre at axis x and axis y, respectively. The loading rate of YONEX-1 and YONEX-2 was significantly greater than that of other shoes. The finite element analysis revealed that the peak of total deformation, stress and strain all concentrated at the heel centre. The shape and structure of the badminton shoe heel significantly influence the initial impact peak, impulse, pressure area and mean pressure in lunging. The MIZUNO footwear had the best impact attenuation effect; yet, VICTOR and ASICS demonstrated better pressure distribution. The smooth sole of VICTOR helped reduce stress and strain. A combination of kinetic and finite element analysis to optimise the design of badminton shoes should be a future research direction.

Despite growing evidence on the adaptive movement patterns that horses adopt during water treadmill (WT) exercise, underlying adaptations in muscle activity remain uninvestigated. This feasibility study aimed to develop a method for the synchronous measurement of muscle activity and movement of horses during WT exercise. Combined surface electromyography (sEMG) (2000 Hz) from selected hindlimb (biceps femoris, gluteus medius, tensor fasciae latae) and epaxial (longissimus dorsi) muscles, and three-dimensional kinematic (200 Hz) data from the back and pelvis of one (n = 1) horse were collected during overground (OG), dry treadmill (TM), and WT walking conditions. Statistical parametric mapping evaluated differences in time- and amplitude-normalised sEMG and thoracolumbar and pelvis kinematic waveforms between conditions. Distinct, significant (p < 0.05) adaptations in hindlimb and epaxial muscle activation patterns and axial and pelvic kinematics, were observed in this horse across exercise conditions. Adaptive muscle activity was most pronounced in this horse during WT, compared to OG walking. These findings demonstrate the feasibility of this method, which combines sEMG and motion capture technologies to synchronously quantify equine movement and muscle activation patterns during WT exercise. This justifies the replication of this work in a larger sample of horses to inform evidence-based training and rehabilitation programmes.

Crohn's disease (CD) is a long-term inflammatory gastrointestinal disorder, often adversely affecting physical, emotional, and psychological well-being. Pharmaceutical management is habitually adopted; although medicinal therapies require continuous administration, and are often associated with significant side effects and low adherence rates. Whole body vibration (WBV) represents a non-invasive technique, that provides vibration stimulation to the entire body. As WBV appears to target the physiological pathways and symptoms pertinent to CD epidemiology, it may have significant potential as a novel non-pharmaceutical intervention therapy in CD. This paper presents the study protocol for a randomised controlled trial investigating the impact of WBV on health outcomes in individuals with CD. This 6-week, parallel randomised controlled trial will recruit 168 individuals, assigned to receive WBV and lifestyle education 3 times per week compared to control, receiving lifestyle education only. The primary outcome of the trial will be the difference from baseline to post-intervention in health-related quality of life between the groups, assessed with the Inflammatory Bowel Disease Quality of Life Questionnaire. Secondary outcomes will include between-group differences in other questionnaires assessing fatigue, anxiety and pain, measures of physical fitness, and biological markers for disease activity and inflammation. Statistical analyses will follow an intention-to-treat approach, using linear mixed-effects models to compare changes between time points and both trial groups. Ethical approval was granted by the Nottingham Research Ethics Committee (REC: 24/EM/0106) and the study has been registered prospectively as a clinical trial (NTC06211400).

Poor bra fit is a global female health issue and is partially attributed to poor bra fit knowledge, with negative consequences combining physical, psychological, and social factors. This study determined women's ability to identify correct and incorrect bra fit as a direct measure of bra fit knowledge. Twenty-four female participants self-reported fit issues (subjective) and researchers carried out an assessment (objective) based on established professional bra-fitting criteria. All participants failed the objective assessment, with 77 bra fit issues identified in total. Large cups, the front band not being in contact with the sternum and loose straps were most frequently identified. Participants' subjective reports matched objective findings in only 51% of instances, highlighting the gross inability to identify correct and incorrect fit. Educational interventions to improve bra fit knowledge are warranted to enable correct size bra selection. Potential benefits may include improving bra fit, and physical, psychological, and social wellbeing.

Aims: Ulcerative colitis (UC) significantly impacts individuals’ self-perception, body image, and overall quality of life, while also imposing considerable economic costs. These challenges highlight the necessity for complementary therapeutic strategies with reduced adverse effects to support conventional pharmacological treatments. Among natural interventions, Montmorency tart cherries, noted for their high anthocyanin content have emerged as a natural anti-inflammatory agent for UC. The current trial aimed to investigate the effects of Montmorency tart cherries compared to placebo in patients with mild to moderate UC. Materials and methods: Thirty-five patients with UC were randomly assigned to receive either placebo or Montmorency tart cherry juice, of which they drank 60 mL per day for 6 weeks. The primary outcomes and health-related quality of life, measured via the Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ), and the secondary measures, including other health-related questionnaires, blood biomarkers, and faecal samples, were measured before and after the intervention. Linear mixed-effects models were adopted to contrast the changes from baseline to 6 weeks between trial arms. Effect sizes were calculated using Cohen’s d. Results: There were significantly greater improvements in the IBDQ (22.61 (95% CI = 5.24 to 39.99) d = 0.90) and simple clinical colitis activity index (−3.98 (95% CI = −6.69 to –1.28) d = −1.01) in the tart cherry trial arm compared to placebo. In addition, reductions in faecal calprotectin levels were significantly greater in the tart cherry trial arm compared to placebo (−136.17 µg/g (95% CI = −258.06 to –4.28) d = −1.14). Loss to follow-up (N = 1) and adverse events (N = 1) were low and compliance was very high in the tart cherry (95.8%) trial arm. Conclusions: Given the profoundly negative effects of UC on health-related quality of life and its fiscal implications for global healthcare systems, this trial indicates that twice-daily tart cherry supplementation can improve IBD-related quality of life as well as the severity of symptoms and therefore may be important in the management of UC.

This study examined lateral wedge insoles and altered foot progression angles on medial tibiofemoral loading and long-term cartilage failure risk. Fifteen healthy male participants walked under four conditions: neutral gait, lateral wedge insoles, toe-in and toe-out gait. Three-dimensional kinematics were captured using an eight-camera system, and ground reaction forces were measured via a piezoelectric force plate. Musculoskeletal simulation analysis quantified tibiofemoral compressive forces, cartilage stresses, strains, and whole-body metabolic power. Probabilistic modelling was employed to estimate the probability of cartilage failure. Comparisons across the four gait conditions employed linear mixed-effects models with repeated measures. Peak compressive forces, stresses and strains were significantly larger in the neutral (force = 2.68 BW, stress = 2.61 MPa & strain = 0.22), compared to toe-in (force = 2.51 BW, stress 2.47 MPa & strain = 0.21) and toe-out (force = 2.43 BW, stress 2.40 MPa & strain = 0.21) conditions. Medial tibiofemoral cartilage failure probability was also significantly larger in the neutral condition (14.04%) compared to toe-in (10.66%) and toe-out (7.89%) conditions. Whole-body metabolic power was also significantly greater in the toe-out (9.74 W/kg) condition compared to neutral (9.32 W/kg) and lateral insoles (9.36 W/kg). The findings suggest that toe-in or toe-out walking may reduce medial tibiofemoral osteoarthritis risk. However, the greater metabolic demand of toe-out walking may limit its long-term feasibility and practicality as a preventive intervention.

OBJECTIVE:The purpose of this study was to examine methods of pharmacologic and nonpharmacological pain management for people with bone-related diseases. METHODS:Bone-related disease incidence, treatment, and pain management strategies were assessed using an anonymous online survey in 2021. The survey included questions about demographics, disease characteristics, and pain coping. One-sample χ2 goodness of fit tests, 2-way Pearson χ2 tests of independence, and probability values were used for data analysis. RESULTS:Respondents were primarily postmenopausal females, aged 55-60 years old, with moderate disease activity, with osteoporosis most commonly reported. Responses suggest medical professionals' advice for pain management included multiple medications, especially analgesics. Dietary interventions also played an important role with vitamin D and calcium supplementation regularly being reported. Patients seek to use alternative methods of pain relief and disease management, with many respondents reporting nonpharmacological pain relief treatments playing a significant role in coping with their bone disease. Although respondents aged 46 to 50 opted against nonpharmacological relief, those aged 56 to 60 years reported they were willing to try nonpharmacological interventions that reduced pain, with the choice of treatment based on "how it made me feel." CONCLUSION:A substantial number of respondents believed that more research is required into pain relief for bone-related diseases, with those affected by these conditions seeking a more acute and analgesic approach to managing pain. Most respondents answered "yes" when asked if nonpharmacological pain relief treatments play a sufficient role in coping with their bone-related pain.

Background: Zinc-biofortified cereals are a promising strategy to combat zinc deficiency, though evidence on health outcomes is limited. This study assessed the effectiveness of consuming zinc-biofortified wheat flour on growth and zinc-related morbidity among adolescent girls (10–16 years; N = 517) and children (1–5 years; N = 517) living in rural north-west Pakistan. Methods: In this double-blind, cluster-randomised controlled effectiveness trial, 486 households received either zinc-biofortified or control wheat flour for 25 weeks. Anthropometric measurements and lung function tests (LFTs) were performed at the beginning, middle, and endline. Data on the incidence and duration of respiratory tract infection (RTI) and diarrhoea in the preceding two weeks were collected fortnightly. Analyses included baseline-adjusted linear mixed models for continuous outcomes and Pearson’s chi-square for categorical data. Results: At a zinc differential of 3.7 mg/kg for adolescent girls provided by zinc-biofortified wheat flour, the intervention had no significant effect on height or weight. For children, head circumference was significantly greater in the biofortified group at endline (control 48.47 ± 2.03 cm vs. intervention 48.76 ± 1.82 cm; p = 0.003), with no differences in other anthropometric parameters. Towards the end of the trial, a lower incidence of RTIs was reported in the intervention arm compared to the control arm for both children (week 26: control 27.4% vs. intervention 17.6%, p = 0.036) and adolescent girls (week 24: control 19.3% vs. intervention 11.5%, p = 0.037; week 26: control 14.5% vs. intervention 6.1%, p = 0.014). When the longitudinal prevalence (cumulative days of sickness as a percentage of total days) of RTI was considered, no treatment effects were observed. No benefits of treatment were reported for diarrhoea or LFT. Conclusions: The provision of zinc-biofortified wheat flour for 25 weeks did not have a significant effect on the growth of adolescent girls but modestly improved head circumference in children. Longer-term interventions are needed to monitor changes in functional outcomes with the national scale-up of zinc-biofortified wheat varieties.

Objectives To explore experts’ opinions and health care staff's experiences regarding challenges in patient manual handling and optimized approaches to promote patient safety and reduce the burden on health care staff. Design Two-phase study using a semistructured interview and online cross-sectional survey. Setting UK-based health care staff. Participants Nine manual handling expert interviews 70 UK-based health care workers participated in phase 2. Interventions Interviews were audio-recorded, transcribed, and analyzed thematically with NVivo software. The phase 2 survey elicited data on the practice areas and challenges for manual handling, analyzed using the inferential statistics of analysis of variance and 2-way Pearson chi-square tests using SPSS software. Main Outcome Measures Musculoskeletal Health Questionnaire and Nordic musculoskeletal questionnaire. Results Six overarching themes highlighted the major challenges in phase 1: (1) bed mobility; (2) Fowler's position; (3) postural care; (4) repositioning and turning, (5) side-lying; and (6) training issues. Health care staff often lacked adequate skills in these areas. Suggested optimized approaches included involving the patient in their care, time to build rapport, and ensuring realistic, comprehensive training. Findings from phase 2 revealed a high (56.30%) prevalence of work-related musculoskeletal disorders, with the majority occurring in the lower back (37.50%). Health care staff with work-related musculoskeletal disorders were not simplifying and splitting the movement/task (P<.001), had a majority caseload of patients with muscle tone issues (P=.043), did not consider supporting patients in symmetric postures (P=.020), and did not receive training on supporting patients in side-lying positions (P=.036). Conclusions Health care tasks in bed can be challenging due to the frequent need for being hands-on, more so with marked limitations in training, and poor practice of bed mobility, side-lying, and posture care. There are currently no safe approaches to rolling and turning a completely dependent patient. Optimized approaches were highlighted, including using low-tech and commonly available devices such as wedges, slide sheet systems, hoists, and firm support surfaces, as well as ergonomically safe handling techniques. Optimized positioning techniques currently lack empirical evidence, and UK-based health care staff showed low awareness of their practice. The future phase of this work will evaluate the ergonomics of these optimized approaches as single-handed care implementation with a 4-way slide sheet with hooks attached to mobile hoists for patient sliding, turning, and repositioning into side-lying. Findings from the study will aim toward improving manual handling training and practices, thereby reducing sick leaves, injury claims, staff turnovers, early retirement, and the consequent staff shortages with their effect on the quality of health care. Disclosures none.

Fencing has gained global popularity, with athletes often competing on hard surfaces, especially at United States national tournaments in convention centre with concrete floors. These surfaces may contribute to overuse injuries from high-impact movements like the fencing lunge. This study aimed to investigate tibial accelerations, a measure of impact shock, experienced by fencers during lunges on various surface materials placed beneath standard aluminium fencing pistes. The aim was to identify a material that could reduce injury risk by mitigating impact shock. Sixty-nine fencers (35 female) performed five lunges on six different surfaces (A–F: A–E composed of various materials placed between the aluminium piste and the concrete floor; F was only the concrete floor), during the 2024 US Senior National Championships. A triaxial accelerometer mounted on the tibia was used to measure tibial accelerations as a marker of impact shock. The accelerometer was aligned to measure acceleration along the longitudinal axis of the tibia and set to record at 1000 Hz with a sensitivity range of ± 100 g. Data acquisition was carried out via a logging system (Biometrics DL1001, Gwent, UK), which was attached to the participant using a tightly fitted backpack. The peak positive axial tibial acceleration was extracted for each lunge and the average was calculated from three lunges after discarding the highest and lowest values from each surface. Statistical analysis revealed that Surface E (a non-absorbent vinyl loop material; 12.7 ± 7.6g), significantly reduced tibial accelerations compared to the standard concrete setup (Surface F; 13.6 ± 8.4g). These findings suggest that modifying competition surfaces by incorporating cushioning materials may help reduce the impact shock of the fencing lunge, potentially lowering the risk of overuse injuries, such as tendonitis and tenosynovitis, commonly reported by fencers. Future research should investigate optimal material properties, including thickness and softness, for maximizing injury prevention while maintaining performance standards in competitive fencing environments.

ABSTRACT Background Breast screening uptake has improved nationally to 62% in the United Kingdom, though regionally, engagement challenges remain in northern regions such as Lancashire (54%–59%). It is important, therefore, to understand the barriers women face to enable appropriate person‐ and community‐centred engagement in health screening behaviours. Objectives This study aimed to be the first mixed‐method questionnaire exploration of women in Lancashire (the United Kingdom) to explore attitudes, behaviour, awareness, barriers and facilitators to breast screening. Design Cross‐sectional cohort study. Method The Breast Cancer Fear Scale, modified Mammography Self‐Efficacy Scale and the General Practice Physical Activity Questionnaire were included in the questionnaire alongside open‐ended elements on breast screening behaviour and awareness. Registered female participants (n = 50) were provided with digital assistance or language interpretation where requested. Results Ethnicity, faith and location all affected perceived levels of breast screening awareness, yet only age and faith influenced understanding of the process. Irrespective of protected characteristics, fear of breast cancer did not significantly vary between women. Racially minoritised women were less comfortable in removing clothing during screening. Participants reported barriers related to health awareness, patient experience, screening age and access to healthcare. Facilitators to address barriers were identified using a socioecological framework to identify key areas of development needed at an individual, interpersonal, organisational, community and public policy level. Conclusion Protected characteristics and geographical location significantly influence breast screening behaviour. Targeted person‐centred health awareness, cultural competency and inclusive practice are needed to promote awareness, remove taboos and open up dialogue and acceptance of breast cancer screening in communities. The use of the socioecological model highlighted that the responsibility to reduce barriers to breast screening in Lancashire is collective from an individual to public policy level. Further patient–public involvement would ensure adequate demographic representation and effectively investigate differences between ethnic subgroups. Patient or Public Contribution This article captures the viewpoints of individuals with and without experience of the breast screening process in the United Kingdom. A small group of individuals from white and racially minoritised backgrounds were involved in the design of the study to ensure the suitability and acceptability of the tool.

This study examined the effects of obesity on cartilage mechanics and longitudinal failure probability at the medial tibiofemoral compartment, using combined musculoskeletal simulation and probabilistic failure modelling approaches. The current investigation examined twenty obese females (BMI > 30.0 kg/m2) and 20 healthy weight (BMI < 25.0 kg/m2) females. Walking kinematics were obtained via an 8-camera optoelectric system, and a force plate was used to collect ground reaction forces. Musculoskeletal simulation and probabilistic failure modelling were utilized to explore medial tibiofemoral forces and cartilage probability. Comparisons between groups were undertaken using linear mixed-effects models. Net peak cartilage forces, stress and strain were significantly larger in the obese group (force = 2013.92 N, stress = 3.03 MPa & strain = 0.25), compared to health weight (force = 1493.21 N, stress 2.26 MPa & strain = 0.19). In addition, medial tibiofemoral cartilage failure probability was also significantly larger in the obese group (42.98%) compared to healthy weight (11.63%). The findings from the current investigation show that obesity has a profoundly negative influence on longitudinal medial knee cartilage health and strongly advocates for the implementation of effective weight management programs into long-term musculoskeletal management strategies.

Inflammatory bowel disease (IBD), a chronic disease affecting the digestive tract, has a significant impact on health-related quality of life. Pharmaceutical treatment is typically adopted, yet exercise is increasingly becoming recognized as an adjunct therapy. This study aimed to explore the perspectives, behaviours, and barriers of IBD patients in terms of their exercise habits. A 16-item closed-ended questionnaire was completed by 463 adult IBD patients (Ulcerative colitis = 57.02%, Crohn’s dis-ease = 40.60% and Other = 2.38%) (Female = 76.67%, Male = 22.46 and Non-binary = 0.86%). The questionnaire was divided into three sections: baseline/demographic characteristics, disease characteristics, and exercise perceptions, beliefs, and behaviours. Significantly (P<0.001) more participants (63.07%) reported that they engage regularly with exercise compared to those who do not; however, engagement was significantly lower in female patients (59.72%) compared to males (74.04%). Respondents also rated significantly (P<0.001) that a combination of factors prevents engagement in exercise (74.30%). Moderate intensity exercise was the predominant (P<0.001) aerobic modality (39.04%), the majority (P<0.001) response was that patients undertake no resistance training (27.74%), and significantly more (P<0.001) patients indicated that they don’t know whether resistance training can influence IBD either positively (57.53%) or negatively (62.33%). Whilst it is encouraging that IBD patients are engaging regularly with exercise, the reduced levels of engagement in females and lack of knowledge/ engagement with resistance training, indicate that future implementation and educational developments are necessary to enhance exercise in females and resistance training engagement in all IBD patients.

Introduction: The aim of this study was to undertake a randomized control trial examining the effects of a 10-week footstrike transition program on tibial stress fracture risk compared to control. Material and methods: Twenty habitual rearfoot strike runners were randomly assigned to either footstrike or control groups. The footstrike group undertook a graduated 10-week program which allowed them to convert their habitual rearfoot strike pattern, whereas the control group maintained their normal training regime without any alterations to their strike pattern. Running biomechanics were collected using an eight-camera motion capture system, and ground reaction forces using a force plate. Tibial strains were quantified using finite element modelling and stress fracture probability calculated via probabilistic modelling over 100 days of running. The primary outcome: tibial stress fracture probability, and secondary outcomes: running biomechanics, muscle forces, joint contact forces, and tibial strain indices were measured at baseline and after 10 weeks. Results: Intention-to-treat analyses revealed no significant alterations in the primary outcome (Footstrike: baseline = 12.82% & 10-weeks = 10.82%, Control: baseline = 15.43% & 10-weeks = 13.39%) between arms. However, alterations in the strike index (Footstrike: baseline = 21.79% & 10-weeks = 65.74%, Control: baseline = 13.61% & 10-weeks = 12.41%) and the loading rate (Footstrike: baseline = 165.85BW/s & 10-weeks = 100.01 BW/s, Control: baseline = 170.13 BW/s & 10-weeks = 197.87 BW/s) were significantly greater in the footstrike group compared to the control one. Conclusion: This trial concludes that the footstrike intervention adopted in this study was not effective in mediating improvements in tibial stress fracture risk, although future intervention trials could examine the efficacy of footstrike modification on other musculoskeletal injuries in runners.

Peripheral artery disease (PAD) is an atherosclerotic cardiovascular condition affecting the lower limbs. A classic symptom of PAD is intermittent claudication (IC), which precipitates on exertion and is relieved with rest. Supervised exercise programmes (SEPs) are first line treatments for patients with IC. Despite the benefits of exercise, there are inconsistencies between guidelines regarding the recommended level of prescribed claudication pain. The aim of this commentary is to highlight the limitations of current guidance which will lead to variability in care. The National Institute of Health and Care Excellence (NICE), American Heart Association and British Association of Sport and Exercise Sciences recommend exercising to maximal claudication pain. Supporting this, an early meta-analysis showed walking to near maximal pain to be most beneficial at improving maximal walking and pain-free walking distances. Indicating that greater amounts of ischaemia induced may produce greater haemodynamic and metabolic adaptations. Furthermore, high-intensity walking, eliciting moderate–severe ischaemic leg symptoms, was superior to low-intensity without ischaemic leg symptoms. Conversely, the American College of Sports Medicine and Exercise and Sports Science Australia suggest moderate pain is most beneficial. A systematic review suggested mild to moderate claudication pain yields optimal results in walking distance and cardiorespiratory fitness when compared to maximal pain. The conclusions were in line with the Vascular Disease Foundation and the American Association of Cardiovascular and Pulmonary Rehabilitation guidelines in that lower limb exercise should be performed to a threshold of mild–moderate pain. Despite the inconsistencies aforementioned, alarmingly several guidelines do not report a level of claudication pain to work towards, whilst others suggest working at a speed and gradient that induces claudication pain within 3–5 min, without specifying the intensity of the pain. As such, clinicians are not provided with clear guidance. A major issue is that guidelines are not fully inclusive of the evidence, as they do not consider pain-free exercise. A metaanalysis showed significant improvements in absolute and initial walking distance without inducing claudication pain. A recent systematic review also suggests pain-free SEPs elicit similar improvements in walking performance and functional outcomes compared to moderate pain. The missed consideration of pain-free SEPs and high claudication pain prescription may lead to poor uptake, as high claudication pain has been commonly cited as a barrier to exercise adherence and uptake of SEPs. Indeed patients taking part in a low pain SEP where 1.52 times more likely to complete the SEP than those in the high pain SEP. As SEPs are the first line of treatment for patients with PAD, guidelines must ensure greater participation occurs; consequently, patient ability and preference should be considered, so it is tolerable and beneficial for all patients. In conclusion, there are inconsistencies regarding the recommended level of claudication pain for clinicians to prescribe. Furthermore, there is no consideration for the evidence base regarding pain-free exercise. It is clear there is a need for a universal set of guidelines that consider optimising patient outcomes as well as uptake and adherence in relation to claudication pain. No research has directly compared maximal, pain-free and moderate claudication pain; however, trials are underway.

This study examined the efficacy of wide compared to self-selected stance width squats in terms of mediating performance improvements during an 8-week period of pre-season training in elite rugby league players. Participants (N = 26) were randomly separated into either wide (N = 13) (i.e. self-selected squat stance width increased by 20%) or self-selected (N = 13) squat stance width training groups, and they completed an 8-week pre-season training block. Measures of 505-agility test time (primary outcome), 3 repetition maximum (3RM) squat strength in participants self-selected stance position and counter movement jump height were measured at baseline and 8-weeks. There were no significant differences between training groups in terms of the improvements made during the intervention period for 505-agility test (wide: pre = 2.47 ± 0.08 & post = 2.34 ± 0.11’s and self-selected: pre = 2.46 ± 0.05 & post = 2.35 ± 0.08’s), counter movement jump (wide: pre = 42.68 ± 9.57 & post = 44.65 ± 9.04 cm, and self-selected: pre = 49.33 ± 6.70 & post = 50.33 ± 4.67 cm) or 3RM squat strength (wide: pre = 159.00 ± 15.24 & post = 178.00 ± 19.32 kg and self-selected: pre = 168.33 ± 11.73 & post = 185.56 ± 16.48kg). As such the findings from the current randomized controlled trial suggest that there is not sufficient evidence to suggest that wide stance width squats represent a more efficacious method of resistance training prescription in elite rugby league.

Purpose Research regarding the effect cold-water immersion (CWI) has on cognitive performance often uses excessive cooling protocols (>1-hour) to measure the detrimental impact prolonged cold exposure has on cognition. Previous studies have not considered shorter CWI protocols, similar to that used in recovery and wellness practices (∼10 min). Aims To investigate a more ecologically valid CWI protocol on cognition, well-being and sleep in an acute and chronic manner. It was hypothesised that a therapeutic CWI protocol would improve well-being, and sleep and have no detrimental effect on cognition. Methods Thirteen healthy participants (20.85±2.15 years), (169.96±7.77 cm), (72.03±14.92 kg), (27.67±9.55 BF%) volunteered to complete a 4-week CWI protocol. Participants were immersed in cold water (10.42±0.59°C) 3-times a week for 4-weeks. Cognitive performance (Stroop & TMT), well-being (WEMWBS, PSWQ, GAD-7, SHS) and sleep (PSQI) were measured acutely and chronically over the 4-week protocol along with thermoregulatory measures (Tsk, Tco, thermal comfort). Results Results show that CWI had no detrimental impact on cognitive performance, with Stroop performance & well-being seeing no differences acutely or chronically. Alternatively, the trail making test showed significant improvement from baseline (TMT-A 15.17±4.81-seconds, TMT-B 39.68±15.12-seconds) to week-3 (TMT-A 11.06±3.29-seconds, TMT-B 26.18±10.23-seconds). A reduction in sleep disturbances was seen from baseline scores of 7.85±3.44 AU to the end of week-3 measures 5.75±3.77 AU. Conclusion Therapeutic cooling can improve sleep quality when utilised in short frequent doses (3 times per week, for 4-weeks) and is not detrimental to cognitive performance, improving certain aspects of executive function.