Milk is nutritionally rich, but its production poses ethical and environmental concerns. Farming practices can influence milk’s nutritional quality and improve its sustainability, creating opportunities for innovation. This study explores consumer willingness to adopt improved products and the interrelationships of knowledge and attitudes towards the dairy industry in relation to purchasing and consumption. We conducted an online survey of UK adults from November 2021 to March 2022, covering knowledge and attitudes towards dairy, dairy consumption, likelihood to purchase improved milk, and socio-demographics. Participants were classified as low or high dairy consumers based on their intake: below or above 1.81 dairy portions per day. Of the 706 dairy consumers who completed the survey, 47% reported consuming ≥1.81 portions of dairy products daily. High dairy consumption predicted more positive attitudes towards dairy farmers than lower consumption. Conversely, low consumption was associated with greater concern for animal welfare and the environmental implications of dairy (p < 0.001). Price was the most important consideration when purchasing milk habitually; however, when presented with four different descriptions of milk, 41% of participants said they would definitely or very probably buy the product with improved trade, welfare, and sustainability standards, despite this product having the highest price per litre. Balancing the nutritional value of cows’ milk with the environmental consequences and ethical concerns of its production is a critical part of the debate to foster a food system that supports planetary and human health. Altering production methods and improving products can be part of the food system transformation.

Sarcopenia is associated with many adverse outcomes such as cardiac and respiratory diseases and mobility issues which in turn may lead to the decreased quality of life and loss of independence. Resistance exercise is recommended for older adults to both prevent and treat sarcopenia. However, very few older adults participate in such exercise. Thus, this study aims to explore enablers and barriers toward home-based resistance exercise (include both body weight and resistance band) for older adults. A subgroup of 10 participants aged 60 years and over (5 male and 5 female) from the 46 participants in the Krill Oil exeRcisE Ageing (KOREA) study were included. Semi-structured interviews were conducted in Glasgow, UK, following a 16-week study period during which participants performed home-based resistance exercises using both body weight and resistance bands. Interviews lasted between 7 and 25 min and were audio-recorded and transcribed verbatim. Reflexive thematic analysis, using an inductive approach, was employed to analyse the data. The analysis generated five themes: Flexibility and simplicity of home-based resistance exercise, navigating commitment (e.g., using an exercise log) and the perceived benefits of home-based exercise such as observing improvements in grip strength were identified as enablers for performing home-based resistance exercises. In contrast, learning home-based resistance along with indolence and procrastination were barriers. The current data indicate that to improve older adults’ engagement in home-based resistance exercise, programs should prioritise flexibility, simplicity, and opportunities for participants to monitor their own progress. Interventions should combine bodyweight and resistance band exercises with accessible tools such as grip strength monitors or exercise logs to enhance motivation, commitment, and adherence to home-based resistance exercise.

Introduction and Objective: Physical activity intensity may differentially influence body composition and skeletal health in people with type 1 diabetes (T1D). The aim of the current study was to examine the associations of objectively measured light, moderate, and vigorous physical activity with body composition and bone parameters. Methods: This cross-sectional analysis included 273 people with T1D (54.2% males, 45.8% females). Physical activity was assessed using a wrist-worn accelerometer over 7 consecutive days. Multivariable linear regression models adjusted for age, sex, and body mass index (BMI) were used to examine associations of light, moderate, and vigorous physical activity with total tissue fat, total fat mass, total lean mass, relative skeletal muscle index (RSMI). bone mineral content (BMC) and total bone mineral density (BMD). Results: Light physical activity was associated with lower total tissue fat (β-coefficient [95% CI] 2.22 [−4.28, −0.15], p=0.035) and total fat mass (−0.002 [−0.003, -0.00004], p=0.045). Moderate physical activity showed similar inverse associations with total tissue fat (−1.38 [−2.35, −0.41], p=0.005) and total fat mass (−0.001 [−0.002, -0.0004], p=0.003). Vigorous activity was also strongly associated with lower total tissue fat (−0.20 [-0.29, -0.11], p<0.001) and total fat mass (−0.0001, [-0.0002, -0.00005], p= 0.001). Light and moderate intensity physical activity were not associated with lean mass, BMD or BMC. In contrast, vigorous physical activity was positively associated with total total lean mass (0.0001 [0.00002, 0.0002], p= 0.015), RSMI (0.40 [0.10, 0.70], p= 0.008), BMD (4.99 [1.33, 8.65], p= 0.008) and BMC (0.001 [0.0001, 0.003], p=0.042). Conclusion: In people with T1D, all intensities of physical activity appear beneficial for adiposity, whereas only vigorous physical activity is beneficial for lean mass and bone health. These findings underscore the importance of physical activity intensity in optimizing musculoskeletal and body composition outcomes in people with T1D. Disclosure J. AlKandari: None. M. Irshad: None. S. Mourad: None. D. Alsaeed: None. A. Al-Ozairi: None. A.S. Mashankar: None. S.R. Gray: None. E. Alozairi: None. Funding The manpower used in this study has been funded by the Kuwait Foundation of Advancement of Science (KFAS) and the Ministry of Health, Kuwait.

AIMS:This study examined changes in body composition and bone mineral density (BMD) over 12 months in people with obesity and type 1 diabetes (T1D) treated with a GLP-1 receptor agonist alone (GLP-1RA) or a dual glucose-dependent insulinotropic polypeptide (GIP/GLP-1RA). MATERIALS AND METHODS:This real-world observational study included 70 people with obesity and T1D treated with GLP-1RA alone or dual GIP/GLP-1RA. Dual-energy X-ray absorptiometry (DEXA) was used to quantify regional and total fat mass, lean mass, bone mineral content (BMC) and BMD at baseline and after 12 months of treatment. Overall changes were quantified, and changes stratified by percentage weight loss using repeated measures analysis. RESULTS:Over 12 months body weight (-6.33%; 95% CI: -7.92, -4.73; p < 0.001), HbA1c (-0.48%; 95% CI: -0.74, -0.22; p < 0.001), total tissue fat (-1.42%; 95% CI: -2.47, -0.36; p = 0.009), fat mass (-5.90%; 95% CI: -10.50, -1.57; p = 0.001), and lean mass (-1.75%; 95% CI: -3.50, -0.48; p = 0.005) decreased, while total BMC and BMD remained unchanged. Total lean mass loss was associated with body weight loss (R2 = 0.36, p < 0.001). CONCLUSIONS:In people with obesity and T1D, 12-month GLP-1RA alone or dual GIP/GLP-1RA therapy resulted in clinically meaningful weight loss, improved glycaemic control, preferential fat mass reduction, modest lean mass loss, and preservation of total BMD. People achieving > 10% weight loss derived the greatest metabolic benefit without compromising bone health, although the loss of lean mass was greater.

Background. Medium-chain triglycerides (MCT) and medium-chain fatty acids (MCFA) have distinct metabolic properties and may influence skeletal muscle metabolism and function; however, evidence is fragmented and inconsistent. Aim. The aim of this systematic review and meta-analysis is to evaluate the clinically relevant and mechanistic effects of MCFA/MCT supplementation on skeletal muscle morphology, metabolism, and function in adult humans and adult animal models. Data Sources. Peer-reviewed studies will be identified through systematic searches of major electronic databases, and reference lists of included studies will be screened to identify additional relevant publications. Participants and Interventions. Eligible studies will include randomised controlled trials conducted in adult human and adult animal models, comparing the effects of oral MCFA/MCT supplementation with placebo oils, usual diet, or calorie-matched controls. Study Appraisal and Synthesis Methods. Risk of bias will be assessed using RoB 2 for human studies and the SYRCLE tool for animal studies. Where appropriate, random-effects meta-analyses will be conducted; otherwise, findings will be synthesised narratively. The certainty of evidence will be evaluated using the GRADE framework. Human and animal studies will be synthesised and analysed separately to distinguish clinically relevant outcomes from mechanistic evidence and to avoid inappropriate cross-species inference. Conclusions. This protocol outlines a transparent and rigorous approach to synthesising current evidence on MCFA/MCT supplementation and skeletal muscle-related outcomes. The findings are expected to clarify existing evidence gaps and inform future research in nutrition and muscle health. Keywords: Medium-chain fatty acids; skeletal muscle; muscle metabolism; muscle function; randomised controlled trials

Patients with takotsubo cardiomyopathy present acutely with symptoms indicative of an acute myocardial infarction. Despite apparent ‘normalisation’ of heart function, many patients develop heart failure with preserved ejection fraction, characterised by impaired cardiac energetic status and cardiac limitation on cardiopulmonary exercise testing. In heart failure of other aetiologies, patients’ functional status can be improved with exercise training. In addition, psychiatric disorders including anxiety or depression are more common in patients with takotsubo cardiomyopathy, suggesting that some patients might benefit from a combined psycho-cardiological rehabilitation. As there is no evidence base to inform the management of patients with takotsubo cardiomyopathy, in this randomised controlled trial we assessed the role of behavioural modifications after a recent index event. In a prospective multi-centre clinical trial conducted between February 2020 and August 2023, patients with acute takotsubo cardiomyopathy were randomised 1:1:1 to physical exercise training, cognitive behavioural therapy or standard care for 12 weeks after index presentation. The primary endpoint was resting phosphocreatine/gamma-adenosine triphosphate ratio (PCr/yATP) assessed by 31P-magnetic resonance spectroscopy. Secondary endpoints were peak oxygen consumption (peak VO2) on cardiopulmonary exercise testing, 6-minute walk distance, left ventricular global longitudinal strain and patient-reported symptoms. Between groups differences in post-to-pre intervention changes in end-points were compared. Seventy-six participants were recruited: median age was 66 years and 91% were women. As shown in Figure 1, compared with standard care, the primary endpoint of myocardial PCr/yATP ratio was improved by physical exercise training (0.4, 95% confidence interval [0.1–0.8]; p=0.016) and with cognitive behavioural therapy (0.3 [0.01 – 0.7]; p=0.043). Both physical exercise training and cognitive behavioural therapy also improved peak VO2 (4.2 [1.6–6.8] and 3.7 [1.1 – 6.2] mL/min/kg; p=0.003 and 0.007 respectively) and 6-minute walk distance (92.6 [24.7–160.6] and 73.3 [7.9–138.8] m; p=0.009 and 0.029, respectively) compared to standard care. There were no differences in global longitudinal strain or symptom burden. In this randomised controlled trial, a 12-week cardiac rehabilitation with behavioural modification (physical exercise training or cognitive behavioural therapy) delivered to patients with acute takotsubo cardiomyopathy led to improvements in resting left ventricular high energy phosphate metabolism and cardio-respiratory functional capacity. We have shown that behavioural modification strategies after takotsubo cardiomyopathy can enhance the metabolic and functional recovery of the heart, supporting the use of these cardiac rehabilitation strategies for these patients.Figure 1

BACKGROUND:Current sedentary behavior (SB) guidelines primarily emphasize total time spent sedentary. We explored differences between interrupted and prolonged SB in relation to a range of cancer outcomes. METHODS AND FINDINGS:This study included 91,292 UK Biobank participants with valid accelerometer data. Participants were followed for a median of 12.38 years (interquartile range 11.56-13.15 years). A two-step approach based on a random forest model was used to classify SB. Multivariable Cox proportional hazards models were applied to overall incident cancers and cancer deaths, plus obesity-related and type-2 diabetes-related cancers, and 23 site-specific cancers. Models were adjusted for demographic, socioeconomic, lifestyle, dietary, and health-status factors, including age, ethnicity, deprivation, education, smoking, alcohol intake, diet, and morbidity count. Isotemporal substitution models were used to estimate the associated cancer risk when replacing prolonged SB with intermittent SB, or physical activity (PA). After adjusting for sociodemographic and lifestyle factors, each additional hour of prolonged SB was associated with a higher risk of overall cancer mortality (hazard ratio [HR] HR1hour 1.09; 95% confidence interval [CI] [1.06, 1.11]; p < 0.001). Replacing 1 hour per day of prolonged SB with light PA (HRLPA 0.88; 95% CI [0.79, 0.99]; p = 0.033) was associated with lower risk of overall cancer mortality. Similarly, replacing 30 min per day of prolonged SB with moderate PA (HRMPA 0.92; 95% CI [0.86, 0.99]; p = 0.024) was associated with a lower risk of overall cancer mortality. The main methodological limitations were observational design, residual confounding, healthy volunteer bias, and measurement imprecision due to having only 7 days of accelerometer wear. CONCLUSION:Cancer risk associated with SB is specific to prolonged SB. Replacing prolonged SB physical activity is associated with lower cancer risk.

Purpose:This study aimed to investigate the association of timing of the most active five hours (M5 time) with markers of cardiometabolic health in people with type 1 diabetes (T1D) and type 2 diabetes (T2D). Patients and Methods:People with T1D or T2D were invited to participate in the study. Physical activity was measured over a 7-day period with a wrist worn accelerometer. The M5time (as a linear and circular (sin-cos) variable) and the amount of activity in these five hours (M5value) were calculated, and associations with glycaemic control, blood lipids and body composition were examined using multiple linear regression, with multiple testing controlled using false discovery rate (FDR) correction. Results:A total of 891 people with T1D and 1381 people with T2D were included. In people with T1D, M5time (linear) was associated with waist circumference after full adjustment (model 3) (B = -0.32, SE = 0.15, FRD p = 0.047). Similarly, in people with T1D M5 time (circular) was also significantly associated with BMI (p = 0.004) and waist circumference (p = 0.001), with amplitudes of BMI: 1.32 kg/m2 and Waist: 4.28 cm, and phases of BMI: 12:51h and Waist: 13:06h. In people with T2D, M5 time was not associated with any cardiometabolic markers after FDR correction in any adjusted models. Conclusion:In people with T1D, the time of day at which people were most active was associated with some cardiometabolic markers. However, in people with T2D, there was no association with any cardiometabolic markers. Overall, our data indicates little effect of time of and physical activity at any time of day should be promoted.

Purpose: Vitamin K2 supplementation has emerged as a strategy to enhance recovery and modulate post-exercise physiological responses. This study aimed to assess the effects of vitamin K2 on recovery from muscle-damaging exercise in young and older adults. Methods: Healthy young (18-40 years) and older (65+ years) adults were randomly assigned to either vitamin K2 (menaquinone 7, MK-7, 240 μg/day) or placebo (cellulose) for 12 weeks in this double-blind randomised controlled trial. Before and after supplementation, knee extensor maximal torque, functional ability, muscle soreness, and systemic blood markers of muscle damage and inflammation were measured before (0h) and 3h, 24h, 48h, and 72h post-exercise. Data were analysed using regression and mixed models. Results: Seventy-one participants (35 young and 36 older) completed the study, with 12 weeks of vitamin K2 supplementation increasing circulating MK-7 levels (p-value <0.001). There were no supplement*time effects for any variables. Significant supplement*time*older age interaction effects were noted for electromechanical delay (EMD) (p-value = 0.03), electromyography root mean square (RMS) (p-value = 0.01), IL-6 concentrations (p-value <0.001), and creatine kinase (CK) levels (p-values = 0.02). In older adults, after 12 weeks, EMD appeared lower at all time points and RMS higher post exercise in the vitamin K2 group. No clear pattern in IL-6 or CK were observed, but at 72h post-exercise CK was lower in older adults in the Vitamin K2 group. Conclusions: Vitamin K2 supplementation had no effect on muscle strength, physical function, muscle soreness or inflammatory responses in the recovery period after a bout of resistance exercise. Effects of supplementation were observed on EMD, RMS, IL-6 and CK by age, and warrant further investigation. Trial registration: Prospectively registered on 21st December 2020, trial registration clinicaltrials.gov ID NCT04676958 https://clinicaltrials.gov/ct2/show/NCT04676958.

Background Multimorbidity – the co-existence of two or more long-term conditions in an individual – is a growing problem in Malawi, as the population transitions from predominantly young and rural to older and more urban. People living with multimorbidity experience lower quality of life and shorter life expectancies. Managing multiple long-term conditions also poses a significant challenge for Malawi’s health system. Both physical activity (PA) and sleep have been shown, in other settings, to influence the development of multimorbidity, and health of people living with multimorbidity, but no large-scale objective measurement of these behaviours has yet been carried out in Malawi. Objectives To describe 24-hour free-living movement behaviour, comprising PA, inactivity, and sleep in an urban and a rural population in Malawi, and quantify associations of these behaviours with multimorbidity prevalence. Methods This will be a cross-sectional study, nested within a larger study of long-term conditions in an urban and a rural Health and Demographic Surveillance System in Malawi. A random sample of 4,000 pre-selected participants will be invited to wear an Axivity AX3 accelerometer on their dominant wrist for one week. Raw accelerometery data will be processed to produce 24-hour movement behaviour metrics of PA and sleep. Inverse probability weighting will be applied to account for selection procedures. Multimorbidity will be assessed through a combination of self-reported physical and mental long-term conditions and objective measurements, including blood pressure and fasting blood glucose. In addition, this study will add hand-held spirometry to assess for obstructive airways disease. Patterns and associations of accelerometer-derived metrics among people living with multimorbidity will be established through multivariable regression and compositional data analysis. Discussion This study will provide the largest description of device-measured 24-hour movement behaviours in Malawi to date, and the first description of the associations of these behaviours with multimorbidity in this population.

AIM:The purpose of this paper is to examine the acute and nocturnal glycaemic response to morning fasted, fed or afternoon fed resistance exercise in people with type 1 diabetes. METHODS:In a crossover RCT, people with type 1 diabetes performed three acute bouts of resistance exercise in (1) morning (8 AM-10:30 AM) in a fed state, (2) morning (8 AM-10:30 AM) in a fasted state and (3) afternoon (3-8 PM) in a fed state, with interstitial glucose levels measured 6-h post-exercise and in the nocturnal period (11 PM-6 AM). RESULTS:In all participants (n = 66), mean glucose levels were lower in the 6-h period after afternoon fed versus morning fasted resistance exercise (9.46 ± 2.56 vs. 8.65 ± 2.04 mmol/L, P = 0.04), with no other differences noted. In multiple daily injections (MDI), users (n = 47), but not insulin pump users (n = 19), in the 6-h period post-exercise mean glucose levels were higher (9.63 ± 2.58 vs. 8.44 ± 1.93 mmol/L, P = 0.007), time-in-range (3.9-10.0 mmol/L) lower (50.9 ± 29.5% vs. 67.0 ± 27.6%, P = 0.007) and time above range (> 10.0 mmol/L) higher (44.4 ± 32.1% vs. 26.3 ± 25.3%, P = 0.003) in morning fasted versus afternoon fed state; no other differences were noted. CONCLUSION:Resistance exercise timing and feeding status (fed vs. fasted) independently influence post-exercise glycaemic responses in people with type 1 diabetes. Performing resistance exercise in the afternoon under fed conditions was associated with a more favourable glucose profile, particularly among MDI users. These findings indicate that consideration of both time of day and feeding status is important when optimising resistance exercise prescription in this population. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT05884814 (Registered on 10 May 2023).

Background and Aims Maintenance of weight loss is a major challenge. Continuous glucose monitoring (CGM) could provide biofeedback to support lifestyle changes to facilitate weight maintenance. This randomised controlled trial evaluated the feasibility of incorporating CGM into a personalised, dietitian-led, weight loss maintenance programme (PWM), and whether CGM use led to greater improvements in dietary intake, physical activity, body weight, body composition, and cardiometabolic risk biomarkers over 24 weeks. Methods Adults who lost >5kg bodyweight in the past six months were eligible. Of 131 individuals who expressed interest, 99 met eligibility criteria. Forty-nine participants (17 men, 32 women) consented and were randomised to either PWM (n=25) or PWM/CGM (n=24) groups. Average recruitment rate was five participants/month. All participants received five one-to-one personalised dietitian consultations in weeks 1, 2, 4, 8 and 12; the PWM/CGM group also received a CGM for the 24-week intervention period and education on its use to support diet and physical activity behaviours. Results 19 PWM and 22 PWM/CGM participants completed the study (83.7% of randomised participants). All completers attended all dietitian consultations, and PWM/CGM participants wore their CGMs on 92.6% of intervention days. In completers, weight loss at 24-weeks was greater for PWM/CGM than PWM (-2.7±1.1 kg vs +0.5±0.8 kg, p=0.032). This difference remained significant in an intention-to-treat sensitivity analysis (-2.5±1.0 kg vs +0.4±0.6 kg, p=0.012). Change in energy intake from baseline to 24-weeks was greater in PWM/CGM than PWM (-235.0±123.0 kcal.day-1 vs +23.3±201.6 kcal.day-1, p=0.007). There were no differences in changes in physical activity or cardiometabolic risk biomarkers except triglycerides between groups. Conclusions These findings indicate that CGM is a feasible addition to an intensive weight loss maintenance programme and support a future fully-powered randomised controlled trial to determine long-term effectiveness. ClinicalTrials.gov (NCT05890209)

BACKGROUND: While the benefits of muscle-strengthening activities are well established, national surveillance data suggest that women do fewer muscle-strengthening activities than men. The study aimed to understand the barriers and facilitators to participation in muscle-strengthening exercise among women aged 18 to 64 who are currently meeting the muscle-strengthening guidelines, and to identify strategies to improve involvement in these activities. METHODS: 24 women, aged 18 to 64, from the United Kingdom who participated in muscle-strengthening exercises at least two days per week were invited to an online or in-person interview. A qualitative study using reflexive thematic analysis was used to identify key themes related to the barriers and facilitators of participation, as well as potential strategies to improve participation. RESULTS: Qualitative findings revealed four overarching themes: (1) reason for participating in muscle-strengthening exercises (health concerns and sports performance), (2) barriers to muscle-strengthening exercise participation (perceived time constraint, low motivation, cultural stigma and societal perceptions, confidence in ability and accessibility), (3) facilitators to participating in muscle-strengthening exercises (resources or information, accountability, social support, ability to choose and positive changes) and (4) strategies to improve women’s participation in muscle-strengthening exercises (what an individual and others can do). CONCLUSION: This study enhances understanding of women’s engagement in muscle-strengthening exercises by highlighting how individual, social, and physical environments interact to influence participation. Findings suggest that strategies are needed that target all levels of influence to help increase participation in muscle-strengthening exercises.

Background:Diabetic foot ulceration (DFU) is the leading cause of nontraumatic amputations in people with diabetes. Research shows that improving patient awareness can result in short-term improvements, but Cochrane reviews report insufficient high-quality evidence. Objective:This study aims to investigate the effects of multimedia presentation and smartphone alerts to enhance long-term knowledge and foot care behaviors in individuals at moderate-to-high risk of DFU. Methods:Participants were randomized to a control group, receiving usual diabetic foot care advice (n=40), or an intervention group, receiving a multimedia diabetic foot care presentation and regular "foot alerts" through the MyU smartphone app on top of usual care (n=37). Patient's knowledge and behaviors related to diabetic foot care were assessed at baseline and after 12 months. Repeated measures ANOVA was conducted in both intention-to-treat and per-protocol analyses to evaluate the intervention's effectiveness. Results:The findings were consistent across intention-to-treat and per-protocol analyses. In the intervention group, the number of podiatry visits was positively correlated with improved foot care behavior (r=0.408; P=.02), while the control group showed a negative correlation (r=-0.402; P=.02). No significant correlations were observed with knowledge scores. Although no significant time×group interactions were seen, the main effects of time were found for both knowledge (η²=0.12; P=.004) and behavior scores (η²=0.31; P<.001). Post hoc analysis showed a decline in knowledge scores in the control group (Cohen d=-0.24; P=.007) and improvements in behavior scores in both groups (Cohen d: intervention=0.61, control=0.63; all P<.001). Conclusions:The MyU app-based multimedia intervention was associated with improved foot care behaviors over 12 months, indicating potential benefits as an adjunct to usual diabetic foot care. However, no significant changes in diabetic foot care knowledge were observed. These findings suggest that while the applied digital multimedia tool may support behavior change, further research is needed to enhance knowledge retention and clinical impact. The study revealed that multimedia education alone may not be effective for long-term improvement in foot self-care knowledge and behavior among individuals at moderate-high DFU risk, but the reinforcement of educational material during follow-up podiatry visits could be effective.

Background Multimorbidity – the co-existence of two or more long-term conditions in an individual – is a growing problem in Malawi, as the population transitions from predominantly young and rural to older and more urban. People living with multimorbidity experience lower quality of life and shorter life expectancies. Managing multiple long-term conditions also poses a significant challenge for Malawi’s health system. Both physical activity and sleep have been shown, in other settings, to influence the development of multimorbidity, but no large-scale objective measurement of these behavioural determinants has yet been carried out in Malawi. Objectives To describe 24-hour free-living movement behaviour, comprising physical activity, inactivity, and sleep in an urban and a rural population in Malawi, and quantify the associations of these behaviours with multimorbidity prevalence. Methods This will be a cross-sectional study, nested within a larger cross-sectional study of long-term conditions in an urban and a rural Health and Demographic Surveillance System in Malawi. A random sample of 4,000 pre-selected participants will be invited to wear an Axivity AX3 accelerometer on their dominant wrist for one week. Raw accelerometery data will be processed to produce 24-hour movement behaviour metrics of physical activity, inactivity, and sleep. Inverse probability weighting will be applied to account for selection procedures. Multimorbidity will be assessed through a combination of self-reported physical and mental long-term conditions and objective measurements, including blood pressure and fasting blood glucose. In addition, this study will add hand-held spirometry to assess for obstructive airways disease. Associations between accelerometer-derived metrics and multimorbidity will be established through multivariable regression, compositional data analysis, and latent class analysis. Discussion This study will provide the largest description of device-measured 24-hour movement behaviours in Malawi to date, and the first description of the associations of these behaviours with multimorbidity in this population.

Importance Long COVID presents an unmet therapeutic need. Objective To determine the effects of a resistance exercise intervention on exercise capacity, health status, and safety among adults after COVID-19 infection. Design, Setting, and Participants A 2-arm, multicenter, randomized clinical trial including 233 adults with a hospital or community diagnosis of COVID-19 infection in the preceding 12 months was undertaken from June 1, 2021, to April 26, 2024. The intervention group comprised 117 individuals, and the control group comprised 116 individuals. A total of 224 individuals at baseline and 193 individuals at 3 months completed Incremental Shuttle Walk Tests. Exposures The intervention group received the personalized resistance exercise intervention for 3 months, and the control group received treatment as usual. Main Outcomes and Measures The primary outcome was the distance achieved (in meters) in the Incremental Shuttle Walk Test undertaken 3 months after randomization. Secondary outcome measures included health-related quality of life (measured by the European Quality of Life 5-Dimension 5-Level Instrument [EQ-5D-5L]), anxiety and depression (measured by the Patient Health Questionnaire), and grip strength. Results A total of 233 adults (median age, 53.6 years [IQR, 43.8-60.8 years]; 146 women [62.7%]; 91 [39.1%] hospitalized with COVID-19 infection) were randomized (117 [50.2%] to the intervention group and 116 [49.8%] to the control group). The median percentage adherence with the exercise intervention was 71.0% (IQR, 47.8%-96.8%), equivalent to performing the exercises 5 days per week. The mean (SD) distance achieved in the Incremental Shuttle Walk Test was 328 (225) m for 224 individuals at baseline and 389 (249) m for 193 individuals at follow-up. The mean (SD) change in Incremental Shuttle Walk Test distance at 3 months compared with baseline was 83 (118) m in the intervention group (n = 94) and 47 (95) m in the control group (n = 98) (adjusted mean difference, 36.5 m [95% CI, 6.6-66.3 m]; P = .02). By 3 months, compared with the control group, greater improvements in the intervention group were also observed for the health-related quality of life utility score (EQ-5D-5L) (0.06 [95% CI, 0.01-0.11]; P = .02), Patient Health Questionnaire category (0.5 [95% CI, 0.2-0.8]; P = .01), and handgrip strength (2.6 kg [95% CI, 0.9-4.2 kg]; P = .002). Conclusions and Relevance In this randomized clinical trial, a 3-month program of resistance exercise among adults after COVID-19 infection appeared to improve walking distance, health-related quality of life, anxiety, depression, and grip strength. This pragmatic intervention may be a generalizable therapy for individuals with persisting physical symptoms after COVID-19 infection. Trial Registration ClinicalTrials.gov Identifier: NCT04900961

Obesity continues to grow as a public health concern and although dietary interventions can be effective at reducing body mass and improving cardiovascular risk factors, they also result in undesirable losses of lean tissue. The aim of this randomised controlled pilot trial was to investigate the effects of a home-based resistance training exercise programme on body composition and muscle function in people living with overweight or obesity undergoing dietary weight loss. Participants (n = 48) from Glasgow were randomly assigned to either a diet-induced weight loss group (WL) or a diet plus home-based resistance training exercise group (RT + WL) for 12-weeks. Body composition, muscle strength, and physical function were assessed at baseline and post-intervention. There was no effect of the resistance exercise training programme (all p > 0.05) on body composition including body mass index, total body mass, fat mass, fat free mass or muscle thickness during weight loss. However, the resistance training group showed improvements in muscle and physical function compared to the weight loss only group, resulting in higher grip strength (RT + WL: Δ2.65, 95% CI: 0.44, 4.86; WL: Δ-0.26, 95% CI: -2.04, 1.51:p = 0.046), maximal voluntary contraction force (RT + WL:Δ23.61, 95% CI: 3.39, 43.84 WL: Δ-11.95, 95% CI: -35.37, 11.48;p = 0.019), and sit-to-stand test scores (RT + WL:Δ5.9, 95% CI: 4.27, 7.53 WL: Δ1.47, 95% CI: 0.13, 2.82; p < 0.001). These findings suggest that incorporating home-based resistance training into weight loss programmes can preserve, or even enhance, muscle function without negatively impacting the effectiveness of dietary weight loss interventions, highlighting its potential to mitigate muscle function losses during weight loss in people living with overweight or obese. Name of the registry: ClinicalTrials.gov. The registration number: NCT05702840. Date of Registry: 18/01/2023. The registration title: EXerCise wEight Loss (EXCEL).

OBJECTIVES:The main aim was to investigate the association of n-3 fatty acid intake and the n-6/n-3 fatty acid intake ratio with muscle mass and strength in older adults. METHODS:This study included 61,381 individuals (28,187 men and 33,194 women) aged ≥60 years. Grip strength and muscle mass index were assessed and n-3 and n-6 fatty acid intake were determined. Regression models adjusted for age, deprivation index, ethnicity, month of assessment, total energy intake, multimorbidity, lifestyle factors and physical activity. A sensitivity analysis was conducted in participants aged ≥65 years and in people with sarcopenia. RESULTS:Data are presented as trend for quintiles from fully adjusted models. Higher n-3 fatty acid intake was associated with a higher grip strength in both men (0.114 kg; 95% CI: 0.02 to 0.21) and women (0.115 kg; 95% CI: 0.05 to 0.18). Similar results were reported for grip strength index, with no associations observed for muscle mass index. No associations were seen in people ≥65 years. In people with sarcopenia no associations of n-3 fatty acid intake with grip strength or grip strength index were seen, but a positive association with muscle mass index was noted in men (0.197 kg/m²; 95% CI: 0.05 to 0.33). The n-6/n-3 fatty acid intake ratio was associated with grip strength in women (0.081 kg; 95% CI: -0.16 to 0.000) and with muscle mass index in men (-0.016 kg/m²; 95% CI: -0.02 to 0.00), no other associations were observed. No associations were seen in people with sarcopenia or people ≥65 years. CONCLUSION:Higher n-3 fatty acid intake, with no consistent association with the n-6/n-3 fatty acid intake, was modestly associated with grip strength, with effects varying by sex and age, suggesting limited benefit for sarcopenia prevention at typical intake levels in older adults.