BACKGROUND:People with COPD are more likely to be sedentary, a behaviour associated with reduced life expectancy. COPD is also associated with social isolation and socioeconomic deprivation. Therefore, this study aimed to examine the relationship between these determinants and sedentary time. METHODS:This study analysed 23,559 UK Biobank participants with COPD (recruited 2006-2010), with a follow-up accelerometer assessment (2013-2015). Primary analyses were performed on accelerometer participants (n = 1,558) with complete covariate and accelerometer data. Associations between sedentary time, social isolation, and deprivation were explored using multivariable linear regression, stratified by COPD severity (GOLD stages). RESULTS:Sedentary time rose stepwise with disease severity (p < 0.001); with GOLD 4 individuals spending 19% more of their day sedentary than GOLD 1. Social isolation interacted with severity (p = 0.033), predicting an extra 1.5 h of daily sedentary time in GOLD 3-4 (95% CI, 0.49-2.47; p = 0.004). Deprivation had the greatest impact on sedentary time in mild disease. CONCLUSIONS:This large observational study suggests sedentary behaviour is associated with social isolation in severe COPD and socioeconomic deprivation in mild disease severity. This highlights the need to consider individual social and environmental factors alongside a clinical focus to reduce sedentary behaviour.

Background Individuals with chronic obstructive pulmonary disease (COPD) often lead sedentary lives, which is linked to negative health outcomes. Understanding the causes of this behaviour is essential for designing effective interventions. In the time following a hospital discharge, people with COPD may be especially sedentary and develop habits that contribute to this behaviour. Therefore, this is an important point at which to evaluate the reasons behind sedentary behaviour.Methods From one acute hospital in England, 12 participants with a recent COPD exacerbation were recruited. Following discharge, semi-structured interviews were conducted to identify perceptions of and barriers and facilitators to reducing sedentary behaviour. Reflexive thematic analysis was employed.Findings Two themes developed: “Focusing on survival” and “Loneliness, social isolation and lack of purpose”. Factors contributing to sedentary behaviour include the need for rest, social isolation, symptom management, fear of dying or being readmitted to hospital from over-exertion, adherence to health professional advice, and lack of motivation and purpose. Concerns about socioeconomic disparities were noted. Participants were ready to embrace positive lifestyle changes.Conclusion Our study found some people with COPD, recently discharged from hospital, may adopt a sedentary lifestyle to manage symptoms and daily activities. Interviews highlight the need to tackle socioeconomic disparities, social support, and feelings of social disconnection. Misconceptions about sedentary behaviour being part of recovery underline the need for education for individuals with COPD and health professionals. The findings suggest strategies to reduce sedentary time, such as enjoyable activities, community involvement, and incorporating sedentary behaviour reduction into pulmonary rehabilitation.

BACKGROUND:Chronic obstructive pulmonary disease (COPD) affects over 300 million people and is the third leading cause of death. People with COPD spend a large amount of their day sedentary, which is associated with reduced life expectancy. METHODS:A systematic search was conducted across electronic databases, including Medline, CINAHL, PsycINFO, and Cochrane Library. Due to the heterogeneity of study design and siting of the activity monitor, a narrative synthesis was conducted. RESULTS:1086 studies were identified; six met inclusion criteria, and two reported a decreased sedentary time. Nordic walking reduced sedentary time by 128 minutes/day compared to baseline, significantly more than the control group (p < 0.01). Another study using a behaviour change intervention reduced sedentary behaviour by 64 minutes/day compared to baseline, significantly more than the control group (p = 0.018). Both studies were conducted for over 12 weeks, with a multi-modal approach incorporating behaviour change techniques, goal setting, education, self-monitoring and feedback. No studies focusing on reducing sedentary behaviour alone reported significant changes. CONCLUSIONS:Few interventional studies have focused on reducing sedentary behaviour in people with COPD. Interventions that have effectively reduced sedentary time primarily focused on physical activity and adopted a multi-modal strategy. This suggests that future interventions could consider a multi-modal approach, which includes behaviour change and the incorporation of enjoyable light physical activities into daily living. We cannot conclude from the available evidence that solely targeting sedentary time will reduce sedentary behaviour. Longer interventions may reduce sedentary behaviour, but there is a lack of studies on both short- and long-term approaches.PROSPERO registration number CRD 42024510434.

The purpose was to directly assess in-competition thermoregulatory responses in recreational runners during a city marathon conducted in cool, ambient conditions using a two-pill ingestion strategy.

Background People with chronic obstructive pulmonary disease (COPD) are more likely to adopt a sedentary lifestyle. Increased sedentary behaviour is associated with adverse health consequences and reduced life expectancy.Aim This mixed-methods systematic review aimed to report the factors contributing to sedentary behaviour in people with COPD.Methods A systematic search of electronic databases (Medline, CINAHL, PsycINFO and Cochrane Library) was conducted and supported by a clinician librarian in March 2023. Papers were identified and screened by two independent researchers against the inclusion and exclusion criteria, followed by data extraction and analysis of quality. Quantitative and qualitative data synthesis was performed.Results 1037 records were identified, 29 studies were included (26 quantitative and 3 qualitative studies) and most studies were conducted in high-income countries. The most common influencers of sedentary behaviour were associated with disease severity, dyspnoea, comorbidities, exercise capacity, use of supplemental oxygen and walking aids, and environmental factors. In-depth findings from qualitative studies included a lack of knowledge, self-perception and motivation. However, sedentarism in some was also a conscious approach, enabling enjoyment when participating in hobbies or activities.Conclusions Influencers of sedentary behaviour in people living with COPD are multifactorial. Identifying and understanding these factors should inform the design of future interventions and guidelines. A tailored, multimodal approach could have the potential to address sedentary behaviour.PROSPERO registration number CRD42023387335.

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Background The COVID-19 pandemic has been associated with an unprecedented number of critical care survivors. Their experiences through illness and recovery are likely to be complex, but little is known about how best to support them. This study aimed to explore experiences of illness and recovery from the perspective of survivors, their relatives and professionals involved in their care. Study design In-depth qualitative interviews were conducted with three stakeholder groups during the first wave of the pandemic. A total of 23 participants (12 professionals, 6 survivors and 5 relatives) were recruited from 5 acute hospitals in England and interviewed by telephone or video call. Data analysis followed the principles of Reflexive Thematic Analysis. Findings Three themes were generated from their interview data: (1) Deteriorating fast-a downhill journey from symptom onset to critical care; (2) Facing a new virus in a hospital-a remote place; and (3) Returning home as a survivor, maintaining normality and recovering slowly. Conclusions Our findings highlight challenges in accessing care and communication between patients, hospital staff and relatives. Following hospital discharge, patients adopted a reframed 'survivor identity' to cope with their experience of illness and slow recovery process. The concept of survivorship in this patient group may be beneficial to promote and explore further. Relevance to clinical practice All efforts should be made to continue to improve communication between patients, relatives and health professionals during critical care admissions, particularly while hospital visits are restricted. Adapting to life after critical illness may be more challenging while health services are restricted by the impacts of the pandemic. It may be beneficial to promote the concept of survivorship, following admission to critical care due to severe COVID-19.

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OBJECTIVES:To assess how biomarkers indicating central nervous system insult (neurobiomarkers) vary in peripheral blood with exertional-heat stress from prolonged endurance exercise. DESIGN:Observational study of changes in neuron specific enolase (NSE), S100 calcium-binding protein B (S100β), Glial Fibrillary Acid Protein (GFAP) and Ubiquitin carboxyl-terminal hydrolase isozyme L1 (UCHL1) at Brighton Marathon 2022. METHODS:In 38 marathoners with in-race core temperature (Tc) monitoring, exposure (High, Intermediate or Low) was classified by cumulative hyperthermia - calculated as area under curve of Time × Tc > 38 °C - and also by running duration (finishing time). Blood was sampled for neurobiomarkers, cortisol and fluid-regulatory stress surrogates, including copeptin and creatinine (at rested baseline; within 30 min of finishing; and at 24 h). RESULTS:Finishing in 236 ± 40 min, runners showed stable GFAP and UCH-L1 across the marathon and next-day. Significant (P < 0.05) increases from baseline were shown post-marathon and at 24 h for S100β (8.52 [3.65, 22.95] vs 39.0 [26.48, 52.33] vs 80.3 [49.1, 99.7] ng·L-1) and post-marathon only for NSE (3.73 [3.30, 4.32] vs 4.85 [4.45, 5.80] μg·L-1, P < 0.0001). Whilst differential response to hyperthermia was observed for cortisol, copeptin and creatinine, neurobiomarker responses did not vary. Post-marathon, only NSE differed by exercise duration (High vs Low, 5.81 ± 1.77 vs. 4.69 ± 0.73 μg·L-1, adjusted P = 0.0358). CONCLUSIONS:Successful marathon performance did not associate with evidence for substantial neuronal insult. To account for variation in neurobiomarkers with prolonged endurance exercise, factors additional to hyperthermia, such as exercise duration and intensity, should be further investigated.

Objectives: This study aimed to examine the impact of extreme heat exposure frequency on inflammation and well-being in UK Fire Service personnel.Methods: 136 Fire personnel and 14 controls (CON) were recruited [92 Firefighters (FF), 44 Breathing Apparatus Instructors (BAI)]. BAI were split into low (LBAI; <= 15 exposures per month) and high (HBAI; >= 20 exposures per month) categories. Measures of inflammation, mood and fatigue were collected at 0, 3 and 6 month times points. These variables were analysed for differences between groups and association with frequency of exposure.Results: HBAI exhibited raised IL-1 beta, IL-6, IL-10, IgE and lower IgM (p < 0.05). In addition, IL-1 beta, IL-6, IL-10 and IgM were associated with monthly exposure number, with exposures accounting for 15.4% of the variance in IL6, 11.8% of IL-1 beta and 25.2% of IL-10. No differences in mood or fatigue were reported (p > 0.05).Conclusion: High exposure firefighting consistently causes systemic inflammation without perceptual recognition of potential health risks.

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Objectives: Endurance exercise is known to cause a rise in serum creatinine. It is not known to what extent this rise reflects renal stress and a potential acute kidney injury (AKI). Increases in Insulin Like Growth Factor Binding Protein 7 (IGFBP7) and Tissue Inhibitor of Metalloprotinases-2 (TIMP-2), urinary biomarkers of cell cycle arrest and renal stress, are associated with the development of AKI in clinical populations.Design: Repeated measures study.Methods: Runners were recruited at the 2019 Brighton Marathon (UK) and provided urine and blood samples at baseline, immediately post-race and 24 h post-race. Serum creatinine, urinary creatinine and urinary IGFBP7 and TIMP-2 were analysed from the samples.Results: Seventy nine participants (23 females, 56 males), aged 43 +/- 10 yrs. (mean +/- SD), finish time 243 +/- 40mins were included for analysis. Serum creatinine increased over the race by 40 +/- 26% (p < 0.001), TIMP-2 increased by 555 +/- 697% (p < 0.001) and IGFBP7 increased by 1094 +/- 1491% (p < 0.001) over the race. A subset of twenty-two participants supplied samples 24 h post-race, reporting values similar to baseline for all variables.Conclusions: This study is the first to report large rises in IGFBP7 and TIMP-2 following marathon running. This suggests that rises in creatinine are not fully explained by changes in production and clearance and marathon running induces a state of kidney stress and potential injury.(c) 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

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Background As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site—the MDT site (n=19)—had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup’s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post–critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID) RR2-10.12968/ijtr.2020.0102

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