Objective: The concept of "breaks" in sedentary behavior has emerged as a potential modifier of detrimental effects on adiposity caused by sedentary behavior. The existing research investigating the relationship between breaks in sedentary behavior with adiposity and cardiometabolic health in adults was systematically reviewed and quantitatively synthesized by this study. Methods: Observational and experimental studies that examined the relationships between the frequency of interruptions of sedentary behavior and markers of adiposity and cardiometabolic health in adults were identified by a systematic search of the literature. A meta-analysis was conducted by using the inverse variance method for experimental trials and a Bayesian posterior probability of existence of an association between breaks with adiposity and cardiometabolic markers for observational studies. Results: It was revealed by the pooled results from nine experimental studies that breaks in sedentary periods of at least light intensity may have a positive effect on glycemia but not on lipidemia for adults. It is unclear whether this effect is independent of total sitting time. However, the 10 identified observational studies showed an association with breaks, which was independent of total sedentary time, but only for obesity metrics. Conclusions: The theory that interrupting bouts of sedentary behavior with light-intensity activity might help control adiposity and postprandial glycemia was supported by the evidence. Further investigations with better methods of measuring sedentary behavior patterns and improved study designs are necessary to confirm this preliminary evidence.

Conclusion. Although comparable improvements in clinical outcomes were observed with both neuromuscular and quadriceps strengthening exercise in patients with moderate varus malalignment and mostly moderate-to-severe medial knee OA, these forms of exercise did not affect the knee adduction moment, a key predictor of structural disease progression.Knee osteoarthritis (OA), predominantly affecting the medial tibiofemoral compartment, is a common chronic condition leading to pain, loss of function, and ANZCTR: 12610000660088.

PROSPERO (http://www.crd.york.ac.uk/PROSPERO) [4/11/2015, CRD42015027543].

anzctr.org.au Identifier: ACTRN12610000439044.

Objective. To investigate whether a 12-week physical therapist-delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA). Methods. This was an assessor-blinded, 3-arm randomized controlled trial in 222 people (73 PCST/exercise, 75 exercise, and 74 PCST) ages ‡50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills, exercise comprised strengthening exercises, and PCST/exercise integrated both. Primary outcomes were self-reported average knee pain (visual analog scale, range 0-100 mm) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-68) at week 12. Secondary outcomes included other pain measures, global change, physical performance, psychological health, physical activity, quality of life, and cost effectiveness. Analyses were by intent-totreat methodology with multiple imputation for missing data. Results. A total of 201 participants (91%), 181 participants (82%), and 186 participants (84%) completed week 12, 32, and 52 measurements, respectively. At week 12, there were no significant between-group differences for reductions in pain comparing PCST/exercise versus exercise (mean difference 5.8 mm [95% confidence interval (95% CI) 21.4, 13.0]) and PCST/exercise versus PCST (6.7 mm [95% CI 20.6, 14.1]). Significantly greater improvements in function were found for PCST/exercise versus exercise (3.7 units [95% CI 0.4, 7.0]) and PCST/exercise versus PCST (7.9 units [95% CI 4.7, 11.2]). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST/exercise were seen on several secondary outcomes. Cost effectiveness of PCST/exercise was not demonstrated. Conclusion. This model of care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA, although it did not appear to be cost effective.