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Objective
osteoporosis
OSTEOPOROSIS
To evaluate three Tai Chi (TC) exercise programs as intervention measures to compare their effects on improving rate of change in bone mineral density (BMD) in elderly individuals with osteoporosis (OP) and to propose the optimal exercise duration.
PMC10712169
Methods
A randomized controlled trial (RCT) was conducted to identify study participants based on inclusion and exclusion criteria. Due to subject attrition, the number of participants analyzed decreased from 60 to 49. These participants were divided into four groups: 24-style TC Chuan group (24TCCG) (
PMC10712169
Results
Compared with CG, all three TC groups showed significant improvements in BMD changes (
PMC10712169
Conclusion
These three TC exercise programs have similar positive effects on the BMD of the femoral neck and greater trochanter. However, compared with other exercise schemes, 24TCC showed a more significant improvement in BMD of the L2-L4 lumbar vertebrae region after just 8 weeks, as well as a more pronounced improvement in BMD...
PMC10712169
Supplementary Information
The online version contains supplementary material available at 10.1186/s13018-023-04324-0.
PMC10712169
Keywords
PMC10712169
Introduction
TC, osteoporosis
OSTEOPOROSIS
Aging is associated with decreased bone health and an increased risk of osteoporosis (OP) [In recent years, there has been growing interest in the potential benefits of Tai Chi (TC) exercise in improving BMD in this population. TC is a unique Chinese exercise method that combines gentle, flowing movements with rhythmic...
PMC10712169
Methods
PMC10712169
Research design
This investigation was structured as a randomized, double-blind controlled trial, executed with strict adherence to the ethical tenets delineated in the Declaration of Helsinki of the World Medical Association [
PMC10712169
Research subjects
PMC10712169
Inclusion and exclusion criteria
OSTEOPOROSIS RISK
This study recruited middle-aged and older individuals engaged in teaching activities in TC societies through random selection. Inclusion and exclusion criteria were established to limit variability and maintain subject baseline characteristics. Inclusion criteria included being between 55 and 65 years of age, voluntar...
PMC10712169
Power analysis and sample size estimation
We conducted a power analysis and estimated the sample size using G*Power software (version 3.1.9.7) [
PMC10712169
Subjects grouping
This study employed randomization for coding subjects who met inclusion criteria, utilizing stratified random grouping with SPSS 26.0 software. Personnel not involved in the study were responsible for coding subjects to four different groups, including 24TCCG (
PMC10712169
TC exercise program and protocols
PMC10712169
TC exercise program
In this study, we selected 24TCC, TCKFF, and TCSB as interventions for the participants, which are all related to Tai Chi (TC) but involve different exercise methods:(i) 24TCC: It consists of 24 movements, including the basic actions and postures of TC, focusing primarily on the smoothness and coherence of movements, w...
PMC10712169
Exercise protocols
Baseline characteristics of each subject group were recorded prior to experimentation, and homogeneity of the data was tested to ensure scientific and effective subsequent study. Mean and standard deviation data are presented in Table Baseline characteristics of the included subjects and data of each index before TC ex...
PMC10712169
Indicator measurements
L2-L4 lumbar vertebrae
This study utilized dual-energy X-ray absorptiometry (DXA) to measure BMD at four anatomical sites (L2-L4 lumbar vertebrae, Ward's triangle, femoral neck, and greater trochanter) over five consecutive noncardiac rate scans in g/cm
PMC10712169
Statistical analysis
PMC10712169
Data entry
All BMD data and intervention results were subject to meticulous two-person cross-entry and verification. The intervention effect was assessed via the formula of (after intervention-before intervention)/before intervention × 100%, with percentages before and after intervention systematically observed. Given that BMD is...
PMC10712169
Statistical analysis
Statistical analysis of data processing was performed using SPSS 26.0 software. Abnormal data and normal distribution were detected using the Shapiro–Wilk test in Explore, and any such data were systematically verified and eliminated. To determine the change rate of a given index between groups before and after the int...
PMC10712169
Image rendering
GraphPad Prism 8.0.2 software was utilized to generate graphical representations of BMD change rates in L2-L4, Ward's triangle, femoral neck, and greater trochanter regions before and after intervention in each group.
PMC10712169
Results
PMC10712169
Subjects were included in the completion condition
RECRUITMENT
From February to April in 2023, 64 subjects were recruited for this study, with 60 subjects identified as "positive" by OMOST after excluding 4 subjects who did not meet the inclusion criteria. These subjects were randomly allocated to 24TCCG, TCKFFG, TCSBG, and CG, each consisting of 15 cases. A total of 49 cases comp...
PMC10712169
Baseline data and data after 16-week TC exercise intervention
PMC10712169
Baseline data
Baseline data for each group are given in Table
PMC10712169
Data of BMD changes
The recorded data on BMD changes are given in Table Data of BMD changes after 16-week TC exercise intervention in each group
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Results of statistical analysis
Figure Trend plots that encapsulate the alterations in BMD subsequent to sixteen weeks of structured TC intervention across every study group. Note: The horizontal axis of each plot represents intervention duration (in weeks), whereas the vertical axis depicts the percentage rate of change in BMD (in %)
PMC10712169
L2-L4 lumbar vertebrae
During week 4, the comparison between 24TCCG and TCKFFG resulted in insignificant difference (
PMC10712169
Ward's triangle
At weeks 4, 12, and 16, no significant difference was observed between 24TCCG, TCKFFG, and TCSBG (
PMC10712169
Femoral neck
At the 4th week, no significant difference was observed among 24TCCG, TCKFFG, and TCSBG (
PMC10712169
Greater trochanter
Following the assessments at the 4th, 8th, 12th, and 16th week intervals, there was no significant difference observed between 24TCCG, TCKFFG, and TCSBG (
PMC10712169
Discussion
PMC10712169
Differences in the use of statistical methods between this study and other studies
Presently, considerable research is being conducted to investigate the influence of TC exercise on BMD in middle-aged and older populations. However, the employed statistical methodologies in these studies are diverse. For example, Chan et al. implemented the independent samples t-test to assess the impact of TC boxing...
PMC10712169
Analysis of the results of this study
PMC10712169
Controversial results on the effect of TC exercise on BMD
L2-L4 lumbar vertebrae BMD
A comparative analysis of data from 24TCCG and CG demonstrated a significant enhancement in BMD at Ward's triangle and the femoral neck regions over time, paralleling findings for L2-L4 lumbar vertebrae and femoral neck BMD in TCKFFG and CG, along with L2-L4 lumbar vertebrae BMD and femoral neck BMD in TCSB and CG comp...
PMC10712169
Differences in the effects of different TC exercise programs and times on BMD improvement
skeletal muscle contraction, BMD loss
The present study revealed that each TC exercise program exhibited significant disparities in BMD changes across several skeletal regions including the L2-L4 lumbar vertebrae, Ward's triangle, femoral neck, and greater trochanter in comparison to CG, at various time points. These differences were particularly pronounce...
PMC10712169
The potential impact of gender disparities on the trend in BMD changes
In this study, the number of males and females varies among different groups. Based on the existing research, females are more susceptible to OP due to hormonal differences, changes in menopausal hormones, and variations in peak bone mass [
PMC10712169
Potential reasons for the decreasing trend in the rate of change of BMD in the subjects of this study
The present study utilized Plot trend analysis of BMD data by site to reveal a decrease in BMD in subjects, possibly due to the risk of OP. It has been suggested that a negative correlation exists between BMI and the risk of OP prevalence, with a higher risk of OP prevalence in subjects with lower BMI [
PMC10712169
Potential reasons for better improvement in BMD with 24TCC compared to other TC exercise programs
In our study, we observed a better effect of 24TCC on BMD improvement, which may be attributed to a combination of biomechanical, physiological, and potential biochemical factors. Several potential mechanisms can be proposed:
PMC10712169
Advantage of movement characteristics
The superior effect of 24TCC and other TC exercise programs on BMD improvement may be attributed to their movement characteristics. Firstly, the 24TCC program consists of 24 different movements, focusing on the smoothness and continuity of the overall movements. These movements involve various joint motions and provide...
PMC10712169
Biomechanical characteristics
The superiority of 24TCC in improving BMD can be attributed to specific movements and biomechanical characteristics inherent in the program. The 24TCC training program consists of 24 different movements involving various joint motions, including weight shifting, rotations, and weighted postures. Some of these movements...
PMC10712169
Physiological and biochemical mechanisms:
RECRUITMENT
The superiority of 24TCC in improving BMD may involve physiological mechanisms. The execution of movements in 24TCC involves the integration of body alignment, breathing techniques, and mindful coordination. The precise execution of movements and the combination of mental focus may enhance the activation of neuromuscul...
PMC10712169
Potential mechanisms for TC exercise to improve BMD
PMC10712169
Physical mechanisms
This study employed a RCT to investigate the effects of TC exercise on the prevention and treatment of OP in middle-aged and elderly individuals. While the results provide insight into the impact of TC exercise on BMD improvement, it is imperative to elucidate the underlying mechanism, which potentially involves mechan...
PMC10712169
Biochemical mechanisms
PROLIFERATION
The engagement in TC exercise has been demonstrated to generate mechanical stress on the skeletal system, subsequently stabilizing bone metabolism and enhancing BMD. Notably, this exertion may also potentially elicit hormonal, cytokine, noncoding RNA, and signaling pathway responses, thereby fostering osteogenesis.TC e...
PMC10712169
Insights from TC exercise in traditional Chinese exercise control OP
Research has demonstrated the high prevalence of OP in our country [
PMC10712169
Advantages and limitations
There exist several advantages to the present study: (i) Subjects in this study underwent OMOST and tested positive, thereby mitigating the error in baseline characteristics and selection bias, resulting in increased credibility of the RCT outcomes. (ii) In the statistical analysis of this study's RCT data, the exclusi...
PMC10712169
Suggestions
(i) Larger sample size: Conduct studies with a larger sample size to increase statistical power and enhance the generalizability of the findings. (ii) Long-term interventions: Implement longer intervention periods to investigate the effects of TC exercise programs on BMD over extended durations. (iii) Stratification ba...
PMC10712169
Conclusion
In conclusion, all 3 TC exercise programs yielded comparable positive outcomes on BMD in the femoral neck and greater trochanter. Nevertheless, 24TCC, the long-term (≥ 8 weeks) TC exercise intervention, exhibited superior improvements in BMD at L2-L4 lumbar vertebrae when compared to the other programs. Furthermore, 24...
PMC10712169
Authors contributions
RECRUITMENT
JK was responsible for the framework design, subject recruitment, experimental manipulation, data entry, and writing of the manuscript; CT and LZ were responsible for proofreading the manuscript.
PMC10712169
Funding
This manuscript was sponsored by the Shandong Province Professional Degree Graduate Students Teaching Case Bank Program (SDYAL20103).
PMC10712169
Availability of data and materials
The datasets used in this study are available upon request from the first or corresponding author. Access to the data is subject to any applicable ethical and legal approvals.
PMC10712169
Declarations
PMC10712169
Ethics approval and consent to participate
The research in this manuscript was approved by the Biomedical Ethics Committee of Qufu Normal University, No. 2022075, and the ethical materials state that the research is consented for publication.
PMC10712169
Competing interests
All authors declare that they do not have any conflict of interest.
PMC10712169
References
PMC10712169
Background
TB
TUBERCULOSIS (TB)
Children under age five years, particularly those living with HIV (CLHIV), are at risk for rapid progression of tuberculosis (TB). We aimed to describe TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV compared to children without HIV in Cameroon and Kenya.
PMC10107571
Methods
TB, HIV infection
REGRESSION, MAY, HIV INFECTION
This sub-analysis of a cluster-randomized trial evaluating the integration of pediatric TB services from May 2019 to March 2021 enrolled children age < 5 years with TB. We estimated the HIV infection rate with 95% confidence interval (CI). We compared TB clinical presentations, diagnostic pathways and treatment outcome...
PMC10107571
Results
TB, co-infected with HIV, fatigue, night sweats, malnutrition
MALNUTRITION
We enrolled 157 children with TB (mean age was 1.5 years) and 22/157 (14.0% [9.0-20.4%]) were co-infected with HIV. CLHIV were more likely to initially present with acute malnutrition (AOR 3.16 [1.14–8.71], p = 0.027). Most TB diagnoses (140/157, 89%) were made clinically with pulmonary TB being the most common present...
PMC10107571
Conclusions
TB
These results altogether advocate for better integration of TB services into all pediatric entry points with a special focus on nutrition services, and illustrate the importance of non-sputum-based TB diagnostics especially in CLHIV.
PMC10107571
Trial registration
NCT03862261, first registration 05/03/2019.
PMC10107571
Supplementary Information
The online version contains supplementary material available at 10.1186/s12879-023-08216-w.
PMC10107571
Keywords
PMC10107571
Background
TB, death, ®, HIV infection, Tuberculosis
HIV INFECTION, DISEASE, TUBERCULOSIS
Tuberculosis is one of the top ten causes of death in children worldwide [In children, the laboratory-based diagnosis of TB is particularly challenging due to the paucibacillary nature of the disease and the difficulty to obtain respiratory samples for bacteriological confirmation [Major advances in the diagnosis of TB...
PMC10107571
Methods
PMC10107571
Study design and setting
TB
This is a sub-analysis of the INPUT study. The INPUT study is a multi-national, cluster-randomized, stepped-wedge trial, which evaluates the major components of the Catalyzing Pediatric TB (CaP-TB) project, integrating pediatric TB screening and diagnostics into non-TB child healthcare services at the hospital and prim...
PMC10107571
Study population
TB
MAY
From May 2019 to March 2021 (with a pause due to COVID-19 from April to July 2020), the INPUT study prospectively enrolled young children under the age of five years with a presumptive diagnosis of TB based on TB signs and symptoms, and followed them through TB diagnosis investigations and treatment where applicable. I...
PMC10107571
Data collection
TB, nasopharyngeal aspirate, pulmonary TB
MALNUTRITION
In the INPUT study, an electronic data capture system developed by CliniOps (Fremont, CA, USA) was used to standardize data collection across the study sites and to compile the data into one unified dataset. Research nurses entered data directly into a tablet via an electronic case report form. Data were synced regular...
PMC10107571
Statistical analysis
TB, HIV infection, HIV coinfection
REGRESSION, HIV INFECTION, HIV COINFECTION
The prevalence of HIV coinfection among children presumed and diagnosed with TB was estimated together with the associated 95% confidence interval (CI). Demographic and clinical characteristics of children diagnosed with TB at enrollment were summarized using means (standard deviations) or medians (interquartile range)...
PMC10107571
Power and sample size
No a priori power or sample size estimates were performed for this exploratory sub-analysis. We used the sample that was available from the INPUT study.
PMC10107571
Results
PMC10107571
Discussion
TB, death, fatigue, HIV infection, TB-HIV co-infection, sweats, malnutrition, Fatigue
HIV INFECTION, DISEASE TRANSMISSION, SEVERE MALNUTRITION, MALNUTRITION
The overall prevalence of TB-HIV co-infection was 14% among children under age five years diagnosed with TB in our study. Studies from Cameroon and Kenya have found estimates in children less than five years of age with TB-HIV co-infection to be between 41 and 52% [In this study, CLHIV did not necessarily have a wider ...
PMC10107571
Conclusions
TB, TB-HIV co-infection, malnutrition
MALNUTRITION
In this sub-analysis of the INPUT study comparing children under age five years with TB-HIV co-infection to those with TB living without HIV in Kenya and Cameroon, we identified a lower-than-expected proportion of TB-HIV co-infection. Children with TB and HIV presented with malnutrition more frequently compared to thos...
PMC10107571
Acknowledgements
ALBERT, GILCHRIST
We acknowledge contribution of the INPUT study group collaborators, in Cameroon: Anne Cecile Bissek, Desire A Cheugoue, Loic Feuzeu, Albert Kuate, Sandrine Kwedi, Muhamed Mbunka, Giscard N Nana, Ferdinand Ngong, Lucie Nguimbous, Bernadette Ngum, Pascal Nyamb, Pierrette Omgba, Patrice Tchendjou, Yanique B Tchouga. In Ke...
PMC10107571
Authors’ Contributions
LP, LD, NR and AT conceptualized the sub-study. MO, SJP, RMas, BT collected the data. NH, SS and LD validated the data. NH and RMac performed the statistical analysis. All authors contributed to the interpretation of data. LP prepared the original draft. All authors reviewed and edited the draft. RMas, BT, LD and AT ad...
PMC10107571
Funding
The INPUT study was funded by UNITAID. The funding body is not involved in the study design implementation and in writing the manuscript.
PMC10107571
Data Availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
PMC10107571
Declarations
PMC10107571
Ethics approval and consent to participate
TB
MINOR, NAIROBI
The protocol has been reviewed and approved by the Cameroon National Ethics Committee for Research in Human Health (CNERSH) (number 2018/12/ 1131/CE/CNERSH/SP dated 14 Dec 2018), the Kenyatta National Hospital University of Nairobi Ethical Review Committee (KNH UON-ERC) (number KNH-ERC/A/44 dated 07 Feb 2019), the WHO ...
PMC10107571
Consent for publication
Not applicable.
PMC10107571
Competing interests
The authors declare that they have no competing interests.
PMC10107571
Abbreviations
TB, Mycobacterium tuberculosis, MTB, ®
CORONAVIRUS, SEVERE ACUTE RESPIRATORY SYNDROME, PEDIATRIC AIDS, IMMUNODEFICIENCY
AntigenAdjusted odds ratioAntiretroviral therapyCatalyzing pediatric TB innovationsComprehensive care center for HIVChildren living with HIVCameroon national ethics committee for research in human healthConfidence intervalCoronavirus disease 2019Elizabeth Glaser Pediatric AIDS FoundationExtra-pulmonary TBEthics review ...
PMC10107571
References
PMC10107571
Background
TB, Tuberculosis
TUBERCULOSIS, TUBERCULOSIS (TB)
The authors have declared that no competing interests exist.Current address: Connect TB, Hague, the Netherlands‡ These authors are joint first-authors on this work.¶ Membership of the TREATS Study Team is provided in the Acknowledgements.Tuberculosis (TB) prevalence remains persistently high in many settings, with new ...
PMC10490889
Methods and findings
TB, fever, chest pain, cough, sweats, weight loss
The study population of the HPTN 071 (PopART) trial included individuals aged ≥15 years living in 21 urban and peri-urban communities in Zambia and South Africa, with a total population of approximately 1 million and an adult HIV prevalence of around 15% at the time of the trial. Two sputum samples for TB testing were ...
PMC10490889
Conclusions
TB
There was no evidence that the PopART intervention reduced TB prevalence. Systematic screening for TB that is based on symptom screening alone may not be sufficient to achieve a large reduction in TB prevalence over a period of several years. Including chest X-ray screening alongside TB symptom screening could substant...
PMC10490889
Trial registration
TB
The TREATS study was registered with In a population based cohort study, Eveline Klinkenberg and colleagues examine the impact of the PopART intervention on TB prevalence in Zambia and South Africa.
PMC10490889
Author summary
PMC10490889
Why was this study done?
TB, Tuberculosis
TRANSMISSION, TUBERCULOSIS, TUBERCULOSIS (TB)
Tuberculosis (TB) prevalence remains persistently high in many settings, with new or expanded interventions required to achieve substantial reductions.The HIV Prevention Trials Network (HPTN) 071 Population Effects of Antiretroviral Therapy to Reduce HIV Transmission (PopART) community-randomised trial, conducted in 21...
PMC10490889
What did the researchers do and find?
TB
We conducted a TB prevalence survey during 2019 to 2021, among around 50,000 randomly selected individuals aged ≥15 years in the 21 urban and peri-urban communities that were included in the HPTN 071 (PopART) trial.Overall, estimated TB prevalence was 0.92% (457/49,556). There was no evidence of a difference in TB prev...
PMC10490889
What do these findings mean?
TB
This study found no evidence that the PopART intervention reduced TB prevalence, compared with standard-of-care.Systematic screening for TB that is based on symptom screening alone may not be sufficient to achieve a large reduction in TB prevalence over a period of a few years.Including chest X-ray screening alongside ...
PMC10490889
Data Availability
The analysis dataset that was used to produce the results that are presented in this paper can be accessed from the LSHTM data repository, and the DOI is
PMC10490889
Introduction
TB, death, viral suppression
COVID-19 (CORONAVIRUS DISEASE 2019), TUBERCULOSIS, TUBERCULOSIS (TB)
Tuberculosis (TB) overtook HIV as the leading infectious cause of death worldwide, prior to the Coronavirus Disease 2019 (COVID-19) pandemic, requiring a major policy shift if it is to be controlled in line with the global commitment to “end TB” [Meanwhile, 4 community-randomised trials have shown that delivery of univ...
PMC10490889
Methods
PMC10490889
Ethics statement
The TREATS study was approved by the research ethics committees of the London School of Hygiene & Tropical Medicine, the University of Zambia (UNZABREC), and Pharma-Ethics (Pty) in South Africa. Individuals gave written informed consent to survey participation, and for individuals aged 15 to 17 years, assent and parent...
PMC10490889
HPTN 071 (PopART) community-randomised trial design, PopART intervention, and TREATS study design
TB, sweats, weight loss, cough
The HPTN 071 (PopART) community-randomised trial was conducted during 2013 to 2018. All communities were urban or peri-urban, 12 were in Zambia and 9 were in the Western Cape Province of South Africa, with a total population of around 1 million individuals and estimated adult HIV prevalence of around 15%. In the HPTN 0...
PMC10490889
TREATS TB prevalence survey design
PMC10490889
Sample size and survey timing
TB
The TREATS TB prevalence survey was conducted among a random sample of individuals aged ≥15 years during 2019 to 2021. The target sample size was 3,000 to 4,000 participants in each arm C community and 1,500 to 2,000 participants in each arm A and arm B community, with a total targeted sample size of around 50,000 part...
PMC10490889
Field procedures
TB
Within each community, random sampling was structured according to geographically defined blocks of around 200 households. For every randomly selected block, all households were visited by a research assistant. If an adult household member was found at home, permission was sought to enumerate (list) all household membe...
PMC10490889
Eligibility to provide 2 sputum samples (S1 and S2) for Xpert-Ultra testing
TB, chest pains, fever, cough, sweats, weight loss
“Sputum-eligible” individuals were identified based on TB screening using symptoms and chest X-ray. An individual was sputum-eligible based on TB symptoms if they had a cough for ≥2 weeks or if they had 2 or more among 5 “TB suggestive” symptoms (cough of any duration, unexpected weight loss for ≥4 weeks, night sweats ...
PMC10490889