Journal articles on the topic 'Fitness Waist Trainer'

The aim: To model, to ground and to check experimentally the efficiency of the complex organized system of fitness trainings and system of health improving trainings; to discover their influence on the status of women’s somatic health of the first period mature age. Materials and methods: Analysis, systematization, pedagogical observation, modelling, pedagogical experiment, tests: Ruffier, Stange, Romberg’s, Harvard step test and tests of PWC170. Results: Complex organized system of fitness trainings (dosed, systematic, complex motive activity, managed by trainer) appeared more effective (11.68 %) in comparison with system of individual health improving trainings (6.54 %). Both systems contributed to reducing of weight (CG2 – 3.8 %, EG2 – 16.3 %),decrease in body’s parts sizes, in particular, of breast (CG2 – 0.5 %, EG2 – 1.3 %), waist (CG2 – 2.3 %; EG2 – 13.75 %), pelvis (CG2 – 3.6 %; EG2 – 5.3 %), formation of physical characteristics (strength – CG2 – 2.1 %, EG2 – 17.4 % and flexibility – CG2 – 4.5 % and EG2 – 9 %).Differences in the level of physical capacity are marked, mainly, in the control group (PWC170absolute – 12.2 %; PWC170relative – 19.3 %), in comparison with experimental (PWC170 absolute – 10.2 %; PWC170 relative – 17.5 %). Conclusions: In general both systems assisted the improvement of somatic health level that proves the efficiency of system approach to organization of trainings in this agerelated group.

Since 2020 there has been an increase in demand for home workouts. Therefore, different ways of delivering distance training have been proposed to promote “stay active at home.” This study aimed to compare the effectiveness of three different training programs consisting of a total of 15 workouts (three sessions per week): supervised livestreaming (LS), unsupervised following a video recording (VR), and unsupervised following a written program (WP). Changes in anthropometric and cardiovascular variables, muscle fitness, and physical activity levels were evaluated. To provide a meaningful analysis for significant comparisons between small groups, mean differences (∆), 95% confidence interval (95% C.I.), and Cohen’s effect sizes (E.S.) were also calculated. The three training modalities increased physical activity levels, with an adherence rate of LS = 93.3%, VR = 86%, and WP = 74%. Although there was no reduction in body weight, waist circumference decreased by 1.3 cm (95% C.I. = −2.1, −0.5; E.S. = 0.170; p < 0.004). Furthermore, where LS, VR, and WP resulted in improvements in muscle fitness, only LS showed changes in cardiovascular variables, such as resting heart rate (∆ = −7.3 bpm; 95% C.I. = −11.9, −2.7; E.S. = 1.296; p < 0.001) and Ruffier’s index (∆ = −2.1bpm; 95% C.I. = −3.5, −0.8; E.S. 1.099; p < 0.001). Remote online training proved its effectiveness over a short period of time. However, supervised training proved to be the most effective, highlighting the importance of an experienced trainer.

We tested the hypothesis that muscle sympathetic nerve activity (MSNA) would be higher in endurance-trained (ET) compared with sedentary (Sed) men with similar levels of total body and abdominal adiposity. We further hypothesized that sympathetic baroreflex gain would be augmented in ET compared with Sed men independent of the level of adiposity. To address this, we measured MSNA (via microneurography), sympathetic and vagal baroreflex responses (the modified Oxford technique), body composition (dual-energy X-ray absorptiometry), and waist circumference (Gulick tape) in Sed ( n = 22) and ET men ( n = 8). The ET men were also compared with a subgroup of Sed men ( n = 6) with similar levels of total body and abdominal adiposity. Basal MSNA was greater in the ET compared with Sed men with similar levels of total body and abdominal adiposity (28 ± 2.0 vs. 21 ± 2.0 bursts/min; P < 0.05) but similar to the larger group of Sed men ( n = 22) with higher total body and abdominal adiposity (vs. 26 ± 3 bursts/min; P > 0.05). In contrast to our hypothesis, sympathetic baroreflex gain was lower in the ET compared with Sed men (−6.4 ± 0.8 vs. −8.4 ± 0.4 arbitrary integrative units·beat−1·mmHg−1; P < 0.05) regardless of the level of adiposity. Taken together, the results of the present study suggest that MSNA is higher in ET compared with Sed men with similar levels of total body and abdominal adiposity. In addition, sympathetic baroreflex gain is lower in ET compared with Sed men. That sympathetic baroreflex gain was lower in ET compared with Sed men regardless of the level of adiposity suggests an influence of the ET state per se.

Objectives:To explore the effects of exercise training on body composition, cardiovascular function, and physical fitness in 5-year-old obese and lean children.Methods:42 obese and 62 lean children were randomly allocated into exercise and control groups separately. Body composition, cardiovascular function, and physical fitness were measured at baseline and the end of the intervention. The exercise groups participated in 10 weeks of supervised moderate intensity exercise training (at 50% of heart rate reserve), 50 training sessions in total.Results:The physical activity program was successfully completed and no sport injury occurred. Exercise training decreased BMI, waist circumference, body fat%, and fat mass; and slowed down the growth speed of body mass of both trained obese and lean children. Exercise training significantly decreased systolic blood pressure of obese children and decreased their heart rate responses during exercise. Trained obese children improved the performances of long jump, 10-m × 4 shuttle run, and 3-m balance beam walk; while trained lean children improved more items of physical fitness.Conclusions:10 weeks of moderate intensity exercise training is an effective and safe treatment for children aged 5 years, either obese or with normal body mass.

Abstract Study aim: The purpose of the study was to assess the level of physical fitness (PF) and somatic structure in children training a Korean martial art (ITF taekwondo) and untrained peers and to determine the associations of children’s BMI with that of their parents. Material and methods: The research material consisted of data from 135 individuals, representing 45 child-mother-father triplets, including 22 triplets with children practicing taekwondo and 23 triplets with untrained children. The children had an average chronological age of 10.08 ± 1.35 years, whereas the age of mothers and fathers was 38.09 ± 4.56 years and 40.57 ± 4.70 years, respectively. Traits analyzed included those evaluated by selected physical fitness tests from the Eurofit Physical Fitness Test battery, body mass index (BMI), and waist-to-height ratio (WHtR) in children, and BMI in parents. Statistical analyses included the chi-square test, Mann-Whitney U test, and Spearman’s correlations, with a significance level set at α = 0.05. Results: The results showed no significant differences in the somatic structure, physical fitness, BMI, and WHtR in the children studied. However, a tendency was observed for children attending ITF taekwondo classes to be characterized by higher levels of physical fitness. Higher BMI was found in the parents of the trained children and positive correlations were found between the BMI of the trained children and their parents. Conclusions: Identifying and studying the effect size of PA determinants in adolescents, with a particular focus on the influence of parents, may be the key to improving the health of future generations.

The purpose of this research was to investigate the effects of a physical training program and semester break periods on the chosen physical abilities and basic body composition indicators among police trainees. Body weight (BW), waist circumference (WC), push-ups (PU), sit-ups (SU) and 2.4 km run (RUN) times of 420 male trainees attending the Abu Dhabi Police College were collected. The testing was conducted by the police education centre during routine testing periods (June, September, December, May) which bracketed the semesters and could be used to investigate the impacts of the physical training program and any potential detraining occurring over the semester break. A repeated measure analysis of variance was performed to identify changes in results across the time periods with a Bonferroni post-hoc adjustment to identify where differences, if any, lay. The level of significance was set at 0.05 a priori. Following the semester break period from June to September, BW, WC and RUN increased significantly (p&lt;.01), while PU and SU decreased significantly (p&lt;.01). WC and RUN significantly decreased from September to December and December to May (p&lt;.01); BW significantly decreased from September to December (p&lt;.01), but did not change from December to May (p=.267); PU and SU significantly increased from September to December (p&lt;.01) and December to May (p=.018 and p&lt;.01, respectively).

Background: Zumba® Fitness is a popular aerobic exercise and sometimes due to its high-intensity is considered sufficient for weight management,, from both trainers and trainees,, regardless of the type of diet followed. Its effectiveness in weight and body fat loss,, with or without dietary intervention has been slightly studied.Subjects and Methods: In the current randomized controlled trial,, thirty two healthy adult overweight women who attended exclusively Zumba® fitness for three times per week,, were randomly divided into 3 subgroups and received parallel dietary advice for two months: Group A did not receive dietary intervention (control group),. Group B received general healthy eating guidelines based on the Mediterranean pyramid and the food plate model and Group C individualized diet plan according anthropometric characteristics,, lifestyle,, and dietary habits. A Food Frequency Questionnaire used at baseline to assess dietary habits before the study,, and three 24-hour recalls evaluated compliance upon dietary intervention.Results: Significant reductions in body weight,, fat,, hip and waist circumference revealed in Group C, and in body fat of Group B.Conclusions: Zumba® fitness is enjoyable and could be used to enhance weight loss with appropriate dietary individualized advice in overweight subjects. In parallel,. it could be effective when combined with healthy eating guidance for improving fat loss and general well being.

Developing the shape of human bodies is both one of the important tasks of the sports industry in each country in the world and the need of each individual, especially women. So, what body image is considered standard? We have researched and initially built a rating scale for each of the basic body standards indicators of women including 7/9 body standards indicators. At the same time, it also developed a standard to evaluate the body image of women's body shape through the ratio between waist measurement and indicators such as standing height, bust measurement, and hips measurement. During this study, we used common methods such as reference methods related to research objectives; expert interviews; anthropometric; Statistical mathematics. The study has developed a scale to evaluate the indicators of body beautiful image for each criterion of ideal body standards. This is the basis for them to be able to calculate the measurements of each fitness criterion to exercise in proportion to their height so that they have an ideal body standard, as well as a source of reference for other athletes, trainers, body image trainers, physical education teachers, or researchers on women's health in Vietnam. From there, it helps the practitioner know the correct rings needed have to work out based on his height. This is the basis for them to be able to calculate the measurements of each fitness criterion to exercise in proportion to their height so that they have an ideal body standard.

Abstract Human immunodeficiency virus-1(HIV-1) is associated with cardiovascular abnormalities and autonomic dysfunction. Exercise training is recommended to enhance functional capacity, as it is known that fitness is icommensurate with a improved autonomic profile and can reduce cardiovascular malfunctions. Although it is well established that physical activity in HIV-1 pts results in increased aerobic capacity, the effect of moderate exercise training on vascular mechanisms and autonomic modulations in HIV-1 disease is still unknown. The purpose of this investigation is to examine the effects of regular physical activity on arterial compliance, autonomic modulation and alterations in NK cell number and function in HIV-1 disease. Subjects were matched for age, body mass index, waist/hip ratio, and fitness. Arterial compliance (AC), heart rate variability (HRV), and baroreflex sensitivity (BRS) were collected and analyzed via traditional methods using power spectral analysis during seated rest. NK cell number was measured via flow cytometry. Four groups of men (N=12), mean age 38.8 ± 5.3) were studied. Trained subjects completed three weekly sessions of supervised aerobic exercised at 60–75% VO 2max for 10 weeks. Controls performed activities of daily living (ADL) with no formal exercise training. Subjects were categorized as follows: HIV negative untrained (HNU), HIV negative trained (HNT), HIV positive untrained (HPU), and HIV positive trained (HPT). HIV positive subjects were seropositive for HIV disease within 24 months of this investigation. Preliminary data demonstrate a strong trend toward augmented arterial compliance and a higher autonomic profile with increased NK cell number and activity [ HPU mean NK cell level, 160.42/cu mm(10.7%); and HPT was 251.8/cu mm (15.4%)] in response to moderate regular exercise. However, cessation of training exercises resulted in return to near baseline NK cell number, percentage (191.8/cu mm (11.2%). HNU HNT HPU HPT AC (mmHgxsec) 7.0±3.1 9.4±5.4 4.0±1.5 7.8±1.1 HRV (msec²) 6.1± 2.1 7.6±1.1 3.9±1.5 7.4±0.3 BRS (msec/mmHg) 7.9±6.6 13.9±7.5 8.1±2.9 19.2±8.7 CONCLUSIONS: Enhanced fitness and its effect on vascular compliance and autonomic modulation with moderate regular exercise induces alterations in NK cell number and activity may help improve quality of life, morbidity and mortality, survival and response to therapy in pts with HIV-1 disease.

We examined the impact of strength fitness and body weight on the redox properties of high-density lipoprotein (HDL) and associations with indices of vascular and metabolic health. Ninety young men were categorized into three groups: 1) overweight untrained (OU; n = 30; BMI 30.7 ± 2.1 kg/m2); 2) overweight trained [OT; n = 30; BMI 29.0 ± 1.9; ≥4 d/wk resistance training (RT)]; and 3) lean trained (LT; n = 30; BMI 23.7 ± 1.4; ≥4 d/wk RT). Using a novel assay on the basis of the HDL-mediated rate of oxidation of dihydrorhodamine (DOR), we determined the functional (redox) properties of HDL and examined correlations between DOR and indices of vascular and metabolic health in the cohort. DOR was significantly lower in both trained groups compared with the untrained group (LT, 1.04 ± 0.49; OT, 1.39 ± 0.57; OU, 1.80 ± 0.74; LT vs. OU P < 0.00001; OT vs. OU P = 0.02), however, DOR in the OT group was not significantly different from that of the LT group. DOR was negatively associated with HDL-cholesterol ( R = −0.64), relative strength ( R = −0.42), sex hormone-binding globulin ( R = −0.42), and testosterone ( R = −0.35) (all P ≤ 0.001); whereas DOR was positively associated with triglycerides ( R = 0.39, P = 0.002), oxidized low-density lipoprotein ( R = 0.32), body mass index ( R = 0.43), total mass ( R = 0.35), total fat mass ( R = 0.42), waist circumference ( R = 0.45), and trunk fat mass ( R = 0.42) (all P ≤ 0.001). Chronic RT is associated with improved HDL redox activity. This may contribute to the beneficial effects of RT on reducing cardiovascular disease risk, irrespective of body weight status.

IntroductionPreventive interventions to reduce overweight and obesity in childhood and adolescence are studied on their effectiveness worldwide. A number with positive results. However, long-term effects of these interventions and their potentially wider influence on well-being and health have been less studied. This study aims to evaluate the long-term effects of a multicomponent intervention in elementary school children targeting individual behaviour as well as environment (Lekker Fit!). The primary outcomeis body mass index and the secondary outcomes are waist circumference, weight status, physical fitness, lifestyle, psychosocial health and academic performance.Methods and analysisIn a naturalistic effect evaluation with a retrospective, controlled design adolescents in secondary schools, from intervention and non-intervention elementary schools, will be compared on a wide set of outcome variables. Data will be collected by questionnaires and through anthropometric and fitness measurements by trained physical education teachers and research assistants. Baseline data consist of measurements from the adolescents at the age of 5 years old and are gathered from preventive youth healthcare records, from before the intervention took place. Multilevel regression models will be used and adjusted for baseline measurements and potential confounding variables on the individual and environmental level. Furthermore, propensity scores will be applied.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the Erasmus Medical Centre, Rotterdam, The Netherlands (permission ID: MEC-2020-0644). Study findings will be disseminated in peer-reviewed journals and by conference presentations.Trial registration numberNL8799. Pre-results.

This study aimed to determine whether aerobic training could reduce lipid peroxidation and inflammation at rest and after maximal exhaustive exercise in overweight/obese adolescent girls. Thirty-nine adolescent girls (14-19 years old) were classified as nonobese or overweight/obese and then randomly assigned to either the nontrained or trained group (12-week multivariate aerobic training program). Measurements at the beginning of the experiment and at 3 months consisted of body composition, aerobic fitness (VO2peak) and the following blood assays: pre- and postexercise lipid peroxidation (15F2a-isoprostanes [F2-Isop], lipid hydroperoxide [ROOH], oxidized LDL [ox-LDL]) and inflammation (myeloperoxidase [MPO]) markers. In the overweight/obese group, the training program significantly increased their fat-free mass (FFM) and decreased their percentage of fat mass (%FM) and hip circumference but did not modify their VO2peak. Conversely, in the nontrained overweight/obese group, weight and %FM increased, and VO2peak decreased, during the same period. Training also prevented exercise-induced lipid peroxidation and/or inflammation in overweight/obese girls (F2-Isop, ROOH, ox-LDL, MPO). In addition, in the trained overweight/obese group, exercise-induced changes in ROOH, ox-LDL and F2-Isop were correlated with improvements in anthropometric parameters (waist-to-hip ratio, %FM and FFM). In conclusion aerobic training increased tolerance to exercise-induced oxidative stress in overweight/obese adolescent girls partly as a result of improved body composition.

Purpose:This study was designed to assess the feasibility and preliminary efficacy of a teacher-facilitated high-intensity interval training intervention for older adolescents (ie, 16–18 y).Methods:Two secondary schools from New South Wales, Australia were recruited, and participants (ie, grade 11 students; 16.2 [0.4] y) were randomized at the school level to the Burn 2 Learn intervention (n = 38), or a wait-list control group (n = 30). Teachers were trained to facilitate the delivery of the novel high-intensity interval training program, which involved 3 sessions per week (∼12–20 min) for 14 weeks. A range of process measures were used to assess intervention feasibility (ie, recruitment, retention, attendance, and program satisfaction). Primary (cardiorespiratory fitness, determined using the progressive aerobic cardiovascular endurance run shuttle run test) and secondary outcomes were assessed at baseline and posttest (14-wk).Results:Sixty-eight grade 11 students were recruited at baseline (85% of target sample), 61 participants completed posttest assessments (90% retention) and on average, participants performed 1.9 sessions per week. Overall, teachers (4.0/5) and students (4.0/5) were satisfied with the Burn 2 Learn program. Group by time effects were observed for cardiorespiratory fitness (8.9 laps; 95% confidence intervals, 1.7–16.2) and a selection of secondary outcomes.Conclusion:This study provides evidence for the feasibility and preliminary efficacy of a teacher-facilitated high-intensity interval training intervention for older adolescents.

Aim: Nowadays increasing blood pressure is the most important risk factor of coronary, cerebral and renal vessel diseases. Epidemiological studies indicate that Physical inactivity adversely affects the blood pressure in postmenopausal women. The purpose of this study was to determine the impact of aerobic on body composition and blood pressure in postmenopausal women. Methods: 20 healthy postmenopausal women with similar age and weight were randomly devided in intervention and control groups. Subjects completed an informed consent form and health history questionnaire. The intervention group was trained in an aerobic exercise program for 8 weeks (3 sessions weekly). Weight, body fat percentage (BF%), body mass index (BMI), waist to hip ratio (WHR), Lean body mass and blood pressure (BP) were measured in the beginning and the end of the study for all of the subjects. Data were analyzed by the Paired t-test and independent t- test. Results: The results showed that BF% , WHR, BMI decreased and Lean body mass increased significantly in training group after 8 weeks training (P0.05). Conclusions: It seems that a period of aerobic training for 8 weeks can be effective as a non-pharmacological treatment strategy for improvement some physical fitness and body composition indexes, blood pressure in postmenopausal women.

In this study, we aimed to investigate the effects of three months of aerobic exercise on physical fitness, body composition and some blood parameters in sedentary Female. 45 sedentary Female with an average age of 36.11±1.04 years, high of 158.9 ±0.76 cm and weight of 70.83 ±1.67 kg have been selected. Sedentary Females were trained through an aerobic exercises programmed one hour a day for three days a week. The aerobic exercise time was on 12 weeks. Setting-up exercises and training in each training session were arranged in such a way as to make each woman’s heart rate to between a levels of 130-140 beats per minute. Statistical analysis were done with Paired-t test, Variance analysis and Scheffe tests. At the end of the three months exercise programmed, a decrease of %9.06 in body weight, %9.96 in systolic blood pressure, %6.94 in diastolic blood pressure, %12.42 in total cholesterol, %22.44 in Triglyceride, %21.16 in low density lipoprotein and %21.4 in fat content ratio have been registered. However, there were increases of %26.22 in hand grip power, %63.83 in the maximum oxygen transfer, %6.2 in aerobic strength and %16.34 in high density lipoprotein. Even though the three months exercise has produced significant effect to on systolic blood pressure, jumping, high density lipoprotein cholesterol, Apo-B, Triglyceride, Hip circumference at .01 level. On number of heart beats, hand grip power, waist circumference, the maximum oxygen transfer, Low density lipoprotein cholesterol, Apo A I and fat contents, diastolic blood pressure and aerobic strength at .05 level. Conclusions: The result of three months low intensity aerobic exercises have shown the fact that such exercises could improve high density lipoprotein cholesterol values and physical fitness. Also by the changes of body fat, Triglyceride, total cholesterol and low density lipoprotein cholesterol values parameters it reduces body parameters. The risk for cardiovascular problems are reduced on sedentary females. Aerobic exercises programmers may be recommended to reduce hypertension, weight loss, diabetes, cardiovascular diseases or metabolic diseases on sedentary females between 130-140 heart rate.

Purpose: Intensive military training courses are among the programs and specialties of the police force. Musculoskeletal disorders in the military are one of the vital factors that keep people away from courses and shorten their service life. This research aims to measure the prevalence of musculoskeletal injuries in newly arrived students in the pre-service training course of the police force using the Oslo Sports Trauma Research Center (OSTRC) questionnaire. Methods: For this purpose, 124 soldiers with a mean age of 20.7 years, a mean height of 178.5 cm, a mean weight of 72.9 kg, and a mean activity per week for 3 hours and 19 minutes in one of the training barracks affiliated to the Tehran Police Force and were selected and completed the OSTRC questionnaire every month for 6 months. The research design of this study is epidemiology and the results are presented descriptively. Results: The results of the research related to prevalence measurement on a monthly mean showed that ankles at 2.8%, knees at 2.2%, and waist at 1.8% respectively have the highest prevalence rates among soldiers. Also, among the harmful factors, the parade had the largest share with 22.5% and during 6 months, the second month had the highest number of injuries, and the sixth month had the lowest number of injuries. In terms of participation in exercises, 86.6% of soldiers participated in practical classes without any physical injuries during the six months. A total of 9.1% of the soldiers could not perform optimally and properly despite their full attendance in the practical classes due to physical injuries and finally, 3.8% of the participants, despite attending the practical classes, had to leave the class halfway due to the severity of the injury. Conclusion: What is clear is that the most affected areas are the central area and the lower limbs, and the spine of the back, head, neck, and upper limbs were not among the most damaged areas. Finally, it seems that the prevalence rate among the soldiers in training courses is acceptable and close to the average of global statistics. However, it is required to take preventive measures as well as plan to add classes and specialized exercises to strengthen physical fitness and specialized exercises related to improving the conditions of damaged areas.

The aim of this study was to evaluate the effectiveness of various forms of physical activity (PA) among male students in physical education (PE) programs offered by universities in Poland, Hungary and the United Kingdom. The study involved 200 full-time male university students (mean age: 19.86±0.82), enrolled in nine different PA programs. The participants’ anthropometric traits and body composition parameters were determined with the InBody analyser. Based on the students’ physiological parameters, the effectiveness of various types of PA was measured with Suunto. Ambit3 peak heart rate monitors during 60 minutes of physical exertion. The average values of body mass, body mass index (BMI), body fat mass (BFM), percent body fat (PBF), waist hip ratio (WHR), and visceral fat (VFL) were significantly (p<0.05) lower in students who performed jogging, followed by sauna (JFBS) and martial arts than in the remaining PA groups. Minutes of difficult and very difficult intensities were highest in martial art students, followed by jogging students, and they were significantly (p<0.05) higher than the values noted in the remaining PA groups (golf, bodybuilding/fitness, swimming, general PE classes, cycling and individual training). Physiological parameters were significantly (p<0.05) lowest in golf players and students who trained individually. Martial arts and JFBS are the most effective types of PA among male university students. Students performing martial arts and JFBS were characterized by the lowest relative, body fat, whereas students who practiced swimming had the highest body fat levels in the population sample.

There is a positive relationship between children’s movement competence and physical activity, with a further relationship established between physical activity and childhood obesity. The Movement Oriented Games Based Assessment (MOGBA) is a delivery and assessment intervention designed to improve children’s complex movement skills, based on principles of motor development and assessment theories. MOGBA aims to improve children’s movement competence, physical fitness and self-perceptions (physical and game) and increase children’s moderate-to-vigorous physical activity (MVPA). MOGBA is to be used in the ‘Made to Play’ initiative, involving 105 sports and activity programs across 21 countries, involving over 25 million children. A multi-site cluster randomized controlled trial will take place across three global sites (UK, Ireland and Australia). Each site will recruit eight primary schools (four experiment, four control) with each school providing two separate classes of children from age ranges 8–12 years (Site n = ~300, total n = 904). After baseline assessments, schools will be randomly allocated to an experimental or wait-list control group. Following two half-day workshops, trained facilitators will deliver the MOGBA intervention for 9 weeks. The main intervention components include delivery of 14 games-based activities with associated assessments of children’s movement and differentiation to meet children’s needs by manipulating space, effort and relationships. The primary outcome of the trial is to improve children’s’ movement competence (The Dragon Challenge), with secondary outcomes of improving children’s’ in-activity and leisure-time MVPA (5-day accelerometer), physical fitness (standing long jump and push ups) and self-perceptions (physical and game). Data will be analysed using multilevel modelling approaches. The MOGBA intervention has been designed to improve children’s movement competence and scalable interventions based on MOGBA could be applied across programs within the Made to Play initiative, globally. The trial is registered at the Australia New Zealand Clinical Trial Registry (ACTRN12619001320145p, 27 Sep 2019).

Aerobics or strength exercise plus diet interventions have been shown to counteract childhood obesity. However, little is known with regard to periodized multicomponent exercise interventions combined with nutritional counselling, which might be less demanding but more enjoyable and respectful of children and adolescents’ nature. In order to analyze the impact of such a multimodal approach, 18 obese children (10.8 ± 1.6 years; 63% females; z Body Mass Index 3 ± 0.4) trained for 60 min, twice weekly and were measured for body composition, biochemical parameters and physical function. We found that 16 weeks of multimodal intervention (14 of training), based on fun-type skill-learning physical activities and physical conditioning with challenging circuits and games, together with nutritional counselling, led to an attendance > 80%, with significant overall health improvement. Body composition was enhanced (p < 0.01 for z BMI, mid-upper-arm-circumference, waist-to-height ratio, tricipital and subscapular skinfolds, body-fat % by Slaughter equation and Dual energy X-ray absorptiometry body fat% and trunk fat%), as well as metabolic profile (LDL cholesterol, gamma-glutamyl transferase , alanine aminotransferase ; p < 0.05), homeostatic model assessment of insulin resistance (HOMA-IR; p < 0.05) and inflammatory response (C-Reactive Protein; p < 0.05). Physical fitness was also improved (p < 0.01) through better cardiovascular test scores and fundamental movement patterns (Functional Movement Screen-7, FMS-4). Tailoring multimodal supervised strategies ensured attendance, active participation and enjoyment, compensating for the lack of strict caloric restrictions and the low volume and training frequency compared to the exercise prescription guidelines for obesity. Nutritional counselling reinforced exercise benefits and turned the intervention into a powerful educational strategy. Teamwork and professionals’ specificity may also be key factors.

Background: Pharmacists are currently providing comprehensive medication management in the outpatient setting. However, there is little documented evidence demonstrating pharmacists are generating further improved health outcomes utilizing non-pharmacologic support, such as fitness and nutrition counseling. The objective of this study is to determine if a pharmacist-led wellness program with medication management and lifestyle modifications through fitness and nutrition coaching can lead to improved biometric markers. Methods: The wellness program targeted corporate employees and was offered in a corporate headquarters' setting with an on-site workout facility. The program was expected to recruit approximately 15 patients into the wellness program consisting of two treatment arms. The standard group featured nutrition-based classes, medication therapy management and fitness education. The intervention group performed the standard group's activities plus direct, supervised fitness training once weekly. Measured biometric markers were assessed at baseline, 3.5 months, and 7 months and included body mass index (BMI), waist circumference (WC), fasting blood glucose (FBG), systolic and diastolic blood pressure (SBP and DBP), and full lipid panel (TC, TG, HDL, and LDL). Results: Seventeen patients were enrolled in the study. The standard group (n = 11) and intervention group (n = 6) had relatively similar biometric markers at baseline. Seven total patients completed the study (4 from standard group, 3 from intervention group). The majority of biometric markers improved in both groups, and BP and LDL control was maintained for all who completed the study. Conclusion: These data suggest that a licensed pharmacist with certified personal trainer credentials may be capable of maintaining biometric markers at healthy levels and improving where necessary in an employee wellness program through one-on-one medication, fitness and nutrition support. Additional, large-scale research is needed to verify the clinical outcomes and feasibility in a larger group setting. Type: Clinical Experience

Background: Culturally relevant approaches that address low physical activity rates among Black girls are increasing, yet opportunities to engage in physical activity (PA) remain minimal. Coupled with deficit approaches to school-based PA programming, positioning Black adolescent girls as PA leaders is missing from practice. BLinG-Health aims to develop peer leaders to participate in and deliver group fitness sessions in an after-school PA program. Methods: Black adolescent girls engaged in a culturally relevant, 8-week pretest and posttest quasi-experimental pilot study examining the impact of a peer-led school-based PA intervention program in a Baltimore, Maryland, public school. After peer leaders engaged in a 12-hr fitness education, training, and certification program using the Interactive Fitness Trainers of America’s Tabata group fitness instruction and certification series, peer leaders led classmates in group fitness 2–3 days a week for 8 weeks. Peer leaders and participants completed two assessment rounds at baseline and Week 9, including height and weight, to compute body mass index, waist circumference, hip circumference, hip-to-waist ratio, a 12-min run/walk, and push-up test. Results: Participants (n = 7; Mage = 16.43 years) significantly improved in cardiovascular endurance (p = .025) and muscular endurance (p = .013) with modest, nonsignificant changes in anthropometric measures. Discussion: Challenging deficit narratives on Black girls’ PA engagement, participants consistently attended weekly group fitness sessions and improved cardiovascular and muscular fitness. Empowering Black adolescent girls to lead group fitness sessions among peers may enhance PA engagement. Schools should consider culturally relevant programming to increase Black girls’ opportunities to engage in PA.

IntroductionPhysical fitness is regarded as a significant indicator of sarcopenia. This study aimed to develop and evaluate a deep-learning model for predicting the decline in physical fitness due to sarcopenia in individuals with potential sarcopenia.MethodsThis study used the 2010–2023 Korean National Physical Fitness Award data. The data comprised exercise- and health-related measurements in Koreans aged &gt;65 years and included body composition and physical fitness variables. Appendicular muscle mass (ASM) was calculated as ASM/height2 to define normal and possible sarcopenia. The deep-learning model was created with EarlyStopping and ModelCheckpoint to prevent overfitting and was evaluated using stratified k-fold cross-validation (k = 5). The model was trained and tested using training data and validation data from each fold. The model’s performance was assessed using a confusion matrix, receiver operating characteristic curve, and area under the curve. The average performance metrics obtained from each cross-validation were determined. For the analysis of feature importance, SHAP, permutation feature importance, and LIME were employed as model-agnostic explanation methods.ResultsThe deep-learning model proved effective in distinguishing from sarcopenia, with an accuracy of 87.55%, precision of 85.57%, recall of 90.34%, and F1 score of 87.89%. Waist circumference (WC, cm), absolute grip strength (kg), and body fat (BF, %) had an influence on the model output. SHAP, LIME, and permutation feature importance analyses revealed that WC and absolute grip strength were the most important variables. WC, figure-of-8 walk, BF, timed up-and-go, and sit-and-reach emerged as key factors for predicting possible sarcopenia.ConclusionThe deep-learning model showed high accuracy and recall with respect to possible sarcopenia prediction. Considering the need for the development of a more detailed and accurate sarcopenia prediction model, the study findings hold promise for enhancing sarcopenia prediction using deep learning.

Aims: One third of the U.S. adult population is estimated to have obesity-associated prediabetes. Hispanics have a 50% higher type 2 diabetes death rate compared to non-Hispanic whites, yet low participation in lifestyle change programs, making this subgroup an important target for prevention. Our objective was to determine the feasibility and the effects of an intervention implementing the Center for Disease Control and Prevention National Diabetes Prevention Program (NDPP) plus recreational soccer (RS) in Hispanic men.Methods: Overweight and obese Hispanic men, aged 30–57 years with prediabetes at screening were recruited (n = 41). Trained soccer coaches led 30-min facilitated discussion of the NDPP modules after each RS session, with two sessions per week for 12 weeks and once per week for the following 12 weeks. The 1-h RS sessions followed the Football Fitness curriculum. Assessments included body mass index, waist circumference, bioelectrical impedance analysis (InBody 270), blood pressure, glycated hemoglobin (HbA1c), and validated physical fitness tests. Multilevel mixed models assessed the outcomes as a function of time and cohort and incorporated an unstructured covariance structure to examine the changes from baseline to 24 weeks. All analyses were conducted as intent-to-treat using SAS v 9.4.Results: Hispanic males (n = 41; mean age 41.7 [0.1] years) were obese at baseline (mean BMI 32.7, standard error of mean [0.7], mean weight 93.9 [2.2] kg). Attendance rate was 65% overall at 12 weeks but differed between cohorts. Five mild injuries occurred over the trial. After 24 weeks of the NDPP+RS intervention, there were significant decreases in systolic and diastolic blood pressure (%change −4.7[SE 2.4]; 95% CI [−11.5, −1.7] and −6.1 [1.7] mmHg; [−9.6, −2.6], respectively), HbA1c (−0.2 [0.1]; [−0.3, −0.1]), Despite significant reductions in weight (−3.8 [0.7]; [−5.2, −2.5]), waist circumference (−6.6 [0.7] cm; [−8.0, −5.1]), body fat % (−1.9 [0.5]; [−2.8, −1.0]), lean body mass was preserved (−0.9 [0.3]; [−1.6, −0.2]).Conclusion: A 24-week soccer-based adaptation of the Diabetes Prevention Program is safe and feasible among middle-aged Latino men.

Purpose: One third of the U.S. adult population is estimated to have prediabetes. Hispanics have a 50% higher type 2 diabetes (T2DM) death rate compared to non-Hispanic whites, yet low participation in lifestyle change programs, making this subgroup an important target for prevention efforts. The purpose of this study was to determine the effects of an intervention implementing the Center for Disease Control and Prevention (CDC) National Diabetes Prevention Program (NDPP) plus recreational soccer (RS) in Hispanic men. Methods: Overweight and obese Hispanic men, aged 30-57 years with prediabetes at screening were recruited from the community. Enrolled participants were divided into three cohorts. Trained soccer coaches led 30-minute facilitated discussion of the NDPP modules after each RS session, with two sessions per week for 3 months and once per week for the following 3 months. The 1-hour RS sessions followed the Football Fitness curriculum structure. Standardized study assessments included body mass index, waist circumference, multi-frequency bioelectrical impedance analysis (InBody 270), blood pressure, hemoglobin A1c, and validated field physical fitness tests (figure of 8 run, handgrip strength, vertical jump, modified sit-ups, dynamic push-ups, one leg stand and Yo-Yo intermittent sprint test). Mixed models assessed the outcomes as a function of time and cohort and incorporated an unstructured covariance structure to examine the difference between baseline and 6 months. All analyses were conducted as intent-to-treat and generated using SAS v 9.4. Results: Hispanic males (n=41; mean age 41.7 [0.1] years) were obese at baseline (mean BMI 32.7, standard error [0.7], mean weight 93.9 [2.2] kg). After 6 months of the NDPP+RS intervention, there were significant changes in systolic and diastolic blood pressure (-6.6 [2.4]; p=0.01 and -6.1 [1.7] mmHg; p<0.001, respectively), HbA1c -0.2 [0.1]; p=0.005, figure of 8-agility run (-0.5 [0.1] sec; p<0.0001), number of modified push-ups in 40 seconds (3.9 [0.6]; p<0.0001), dynamic sit-ups (1.9 [0.4]; p<0.0001), and predicted VO 2 (ml/kg/min) (0.4 [0.2]; p=0.04. Despite significant reductions in weight (-3.8 kg [0.7]; p<0.0001), waist circumference (-6.6 [0.7] cm; p<0.0001), body fat % (-1.9 kg [0.5]; p=0.0002), lean body mass was mostly preserved [-0.9 [0.3]; p=0.009]. Conclusion: Among middle-aged Latino men, broad-ranging significant improvements in body composition, physical fitness, HbA1c and blood pressure were observed after 6 months of participating in lifestyle education plus RS.

OBJECTIVES: The purpose of this study was to investigate the effects of 6 weeks of resistance training (RT) combined with aerobic training (AT) and Tirzepatide supplementation on lipid profiles, insulin resistance, anthropometric characteristics and physical fitness in prediabetic obese soldiers. METHODS: 61 obese men were randomly divided into six groups: Placebo; Tirzepatide 5 mg (T5); Tirzepatide 2.5 mg (T2.5); Hypertrophy, Strength, Power-Circuit Training+Placebo (Ex+P); Hypertrophy, Strength, Power-Circuit Training+Tirzepatide 5 mg (Ex+T5); Hypertrophy, Strength, Power-Circuit Training+Tirzepatide 2.5 mg (Ex+T2.5). All training groups performed aerobic training (AT) after resistance training. Subjects trained for six weeks, three sessions per week. Before and after the intervention period, the participants were evaluated for anthropometric measures, body composition [body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and fat mass (FM)], cardiorespiratory fitness (VO2max), and muscle strength (chest press 1RM and leg press 1RM). Blood biochemistry evaluations included triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), insulin level and insulin resistance (HOMA-IR). To evaluate the differences between the groups, ANCOVA statistical method was used along with Bonferroni’s post hoc test, and the significance level was P < 0.05. RESULTS: Body weight, BMI, WC, FM, FBG, LDL-C, TC, TG and HOMA-IR were significantly decreased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo, T5 and T2.5 groups. WHR significantly decreased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo group. HDL-C, chest press and leg press significantly increased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo, T5 and T2.5 groups. VO2max significantly increased and insulin significantly decreased in Ex+P group compared to Placebo, T5 and T2.5 groups. FM, FBG and TG were significantly decreased in both the T2.5 and T5 groups compared to Placebo group. HOMA-IR, LDL-C and TC significantly decreased in the T5 group compared to Placebo group. Also, leg press significantly increased in Ex+P group compared to all other groups. CONCLUSIONS: Performing six weeks of combined resistance and aerobic training in the form of RT+AT alone is more effective than the simultaneous use of Tirzepatide on cardiorespiratory fitness, strength, and modulating insulin levels. Taking Tirzepatide in doses of 5 mg and 2.5 mg in combination with exercise training did not have a significant advantage over exercise training alone. Finally, taking Tirzepatide in doses of 5 mg or 2.5 mg in combination with exercise training is not significantly superior to each other.

This study aimed to understand the effects of adopting peer support in physical education (PE) class on university students’ body composition and circumference. Two university PE classes were recruited and assigned randomly to class with peer support (CWP; n=41; 8 underweight, 23 normal weight, 5 overweight, and 5 obesity; mean age=19.6±1.3yrs; height=169.5±8.0 cm) or class without peer support (CWOP; n=41; 9 underweight, 23 normal weight, 4 overweight, 5 obesity; mean age=19.3±1.1yrs; height=169.1±6.7 cm). Both classes adopted 16 weeks the same bodyweight management program for fitness promotion for 90 min/session/week (15 min warm-up, 60 min main training, 15 min cool-down). Students in CWP were asked to group with 2-3 students and required to train in the same group throughout the program, while students in CWOP were asked to train individually. The two classes were coached by the same teacher and held in the same semester. Body composition (InBody320, South Korea) and circumference metrics (waist and hip circumferences, waist-to-hip ratio [WHR], body adiposity index [BAI]) were obtained before and after the program and statistically analyzed using repeated measures ANOVA. Weekly training frequency and duration after class were obtained using questionnaire and compared using t-tests. Results showed that the proportion of students in abnormal weight is significantly reduced only in CWP (χ²=10.7, P=0.013). Body mass (F=5.96, P=0.017) and body mass index (F=4.40, P=0.039) significantly reduced in both classes, and changes in muscle mass and body fat percentage were greater in CWP (45.1±8.9kg vs. 46.0±9.1kg, P<0.001, Cohen’s d=0.10; 19.8%±8.0% vs. 18.4%±8.3%, P=0.002, Cohen’s d=0.18) than CWOP (45.8±7.8kg vs. 45.6±8.0kg, P=0.42; 19.9%±7.3% vs. 19.6%±7.3%, P=0.23). Further, waist circumference, WHR, and BAI were significantly reduced in both groups, and BAI changes were greater in CWP (25.01±3.44 vs. 24.06±3.08, P<0.001, Cohen’s d=0.29) than CWOP (24.29±3.53 vs. 24.08±3.34, P=0.42). Finally, CWP group trained longer (3.2±0.9hrs vs. 1.6±0.8hrs, P=0.003, Cohen’s d=1.88) and more frequently (2.6±1.3 vs. 1.3±2.1, P<0.001, Cohen’s d=0.74) than their counterparts. University students benefited from the 16-week PE class with reduced body composition and circumference. However, CWP group showed greater changes. Accordingly, social support from a peer can enhance motivation, such as elders with a partner would more likely be active. Meanwhile, students with a peer would have longer training duration and higher training frequency. Thus, peer support affects training habits and benefits students in body composition and circumference. PE teachers are encouraged to adopt peer support in their classes for fitness promotion.

Introduction: Studies have demonstrated that higher cardiorespiratory fitness (CRF) is associated with a lower risk of cardiovascular disease (CVD) and mortality. However, exercise CRF test is not routinely performed in clinical settings because it requires specialized equipment and trained personnel. Therefore, non-exercise estimated CRF (eCRF) using easily accessible health indicators in clinical practice may be a time- and cost-effective alternative for evaluating fitness. Hypothesis: We hypothesized that higher eCRF in midlife will be associated with a lower risk of CVD and all-cause mortality in later life. Methods: We evaluated 2,501 Framingham Offspring cohort participants (mean age 65 yrs., 52% women). We used a longitudinal non-exercise algorithm that includes age, sex, body mass index, waist circumference, resting heart rate, physical activity, and smoking status. We then used SAS PROC TRAJ to identify sex-specific latent patterns of eCRF (low, moderate, and high eCRF categories) between exam 2 and 8 (1979-2008). Multivariable Cox proportional hazards regression models were used to relate the long-term trajectories of eCRF to incident CVD and all-cause mortality on follow-up. Results: We identified three distinct trajectories of eCRF (Low [n=268, 10.7%] vs. moderate [n=1,273, 50.9%] vs. high [n=960, 38.4%]). Overall, 265 participants developed CVD and 429 died during 10 years of median follow-up. Participants in the “high eCRF” group were at lower risk of CVD and all-cause mortality compared to those in the “low eCRF” group, after adjustment for potential confounders ( Table ). Conclusions: Our findings suggest that lower eCRF during midlife may be a marker of risk of CVD and mortality in older adulthood.

Abstract Helén, J, Kyröläinen, H, Ojanen, T, Pihlainen, K, Santtila, M, Heikkinen, R, and Vaara, JP. High-intensity functional training induces superior training adaptations compared with traditional military physical training. J Strength Cond Res XX(X): 000–000, 2023—This study examined the effectiveness of concurrent strength and endurance training with an emphasis on high-intensity functional training (HIFT) during military service. Voluntary male conscripts (aged 18–28 years) were placed in either an experimental (EXP: n = 50–66) or a control (CON: n = 50–67) group. The training for the EXP group included HIFT using body mass, sandbags, and kettlebells. The CON group trained according to the current practice. Physical performance and body composition were assessed at baseline (PRE), at week 10 (MID), and after (POST) the 19-week training period. Significance was set at p < 0.05. The total distance covered in a 12-minute running test increased in both groups, but the change in EXP was superior to the change in CON (11.6%, ES: 0.79 vs. 5.7%, ES: 0.33; p = 0.027). Maximal strength and power characteristics increased in EXP (3.1–5.0%), whereas no improvements were observed in CON. Conscripts with the highest initial fitness showed no improvements in physical performance in either group. Body mass and waist circumference decreased in EXP, whereas CON showed an increase in muscle mass. These findings suggest that HIFT is an effective and time-efficient approach to improve soldiers' aerobic fitness during military service. For the optimal development of strength, the training equipment used may not have provided sufficient and progressive loading to yield considerable strength adaptations. More focus should be placed on sufficient intensity and volume in both strength and endurance training, especially for the most fit soldiers.

Introduction: Non-exercise estimated cardiorespiratory fitness (eCRF) algorithms have shown similar accuracy to CRF estimated from submaximal and maximal exercise tests in healthy adults. Using easily accessible health indicators, eCRF measurement does not involve in-person exercise testing, trained personnel, or specialized equipment for measuring CRF. Thus, eCRF may be a cost-effective alternative for heart disease risk stratification. The relation between eCRF and Heart failure (HF) remains unclear. Hypothesis: We hypothesized that higher midlife eCRF is associated with a lower risk of incident HF in later life. Methods: We evaluated 2,226 Framingham Offspring cohort participants attending examination cycles 2 and 7 (mean age of 42- 61years; 53% women). We used a validated longitudinal non-exercise algorithm for eCRF including age, sex, body mass index, waist circumference, resting heart rate, physical activity, and smoking status. Midlife eCRF was defined as a sex-specific standardized average of eCRF (z-score of the average eCRF with mean=0 and a standard deviation [SD]=1) between cycles 2 and 7. The sex-specific midlife eCRF were then categorized into three groups based on tertiles and was also analyzed as a continuous variable (per 1 SD increment). We used multivariable Cox proportional hazards regression models for pooled sexes to relate the midlife eCRF to incident HF after examination cycle 7. Results: Overall, 189 participants developed HF during a median of 17 years of follow-up. Participants in either moderate or high eCRF group experienced a 52% lower risk of HF compared to those in the low eCRF group, after adjustment for potential confounders. Additionally, each SD increment in midlife eCRF was associated with a 40% lower risk of HF in later life. The associations remained significant after excluding participants on antihypertensive treatment (Table). Conclusions: Lower eCRF during midlife may be a marker of higher HF risk in later life.

Purpose The research aims to explore the interaction effect of consumer social class and service type on consumers' preference for robot services, as well as the mediating role of risk aversion in this interaction effect. Design/methodology/approach Experiment 1 is a field experiment with service type being the independent variable. The participants were divided into two groups based on the services they received (diagnostic dental services vs. hotel room services). 93 consumers participated voluntarily in the blind experiment and were asked if they would choose to allow a robot to perform the focal services. Experiment 2 employs a 2 × 2 factorial design: personal fitness trainer services at the gym vs wait staff services in a casual dining restaurant × higher- vs lower-social class, with 196 participants. Findings Results from the two experiments show that participants in the higher-social classes were more willing than participants in the lower-social classes to choose robot services in credence-based service settings. More significantly, risk aversion mediated the interaction effect of social class and service type on participants' preference for robot services. Originality/value Based on the credence-experience typology, this research is the first to discuss the weight of social class in consumer decision-making regarding preference for different types of robot services. Furthermore, by extending risk aversion to the robot services field, the current research sheds new light on this underlying mechanism that can inform future studies.

Abstract Background Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course. Methods Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants. Results Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p <.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course. Conclusion We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI.

AbstractBackgroundImprovements in cardiorespiratory fitness (CRF) have been shown to largely attenuate the negative health risks associated with obesity. To date, literature on women with obesity has focused upon the evaluation of aerobic‐based exercise interventions. Hence, there is a need to evaluate resistance and combined interventions with this cohort.ObjectiveThis study aimed to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for improving CRF, strength, body composition and other health outcomes.MethodsSixty‐seven women with obesity were randomly assigned to the control (CON) or one of three exercise groups (aerobic [AE], resistance [RE], COM). Exercise groups were trained x3 times/week for 12 weeks (up to 150‐min/week). Feasibility outcomes included adherence, attendance, recruitment and retention rates and adverse events. Secondary outcomes were CRF (predicted VO2 max), body composition (body weight [BW], waist circumference [WC], body fat percentage [%BF], fat mass [FM] and lean mass) and strength (5RM bench press, leg dynamometry, grip strength) and self‐reported measures of physical activity, mood, sleep, pain and quality of life.ResultsFindings support the feasibility of all three exercise modalities in terms of adherence, attendance, and retention. Interventions with a resistance component (COM and RE) were associated with the greatest improvements across the broad range of health outcomes measured. Combined was the most promising for body composition outcomes including body mass index (Effect size [ES] = 0.79, p = 0.04), BW (ES = 0.75, p = 0.05), %BF (ES = 0.77, p = 0.04), FM (ES = 0.83, p = 0.03) and WC (ES = 0.90, p = 0.02), physical activity (i.e., moderate physical activity [ES = 0.69, p = 0.07), mood (ES = 0.83, p = 0.03) and sleep (ES = 0.78, p = 0.04). Resistance was most promising for CRF (ES = 1.47, p = 0.002), strength (i.e., bench press [ES = 2.88, p=<0.001]) and pain (i.e., pain severity [ES = 0.40, p = 0.31]).ConclusionsFor health outcomes, these results indicate the importance of including a resistance component when prescribing exercise for women with obesity to achieve meaningful improvements.CLINICAL TRIAL REGISTRATIONISRCTN13517067

Abstract Objectives Given that the prevalence of obesity in the military is a growing national security concern, we sought to determine: 1) the level of agreement between body mass index (BMI), circumference-based equation (CBE), waist circumference (WC), and bioelectrical impedance analysis (BIA) measures, and 2) if BMI, CBE, or WC measures alone or in combination adequately reflect adiposity in military personnel compared to BIA measures. Methods Measurements taken by trained personnel were used to estimate BMI (using overweight cut-offs in males from the military (BMI, ≥27.5 kg/m2) and World Health Organization (WHO BMI, ≥25.0 kg/m2)), BMI % body fat (BF%), WC, CBE BF%, and BIA BF%. Respondents were categorized as normal vs. overweight/obese or overfat. Anthropometric measures were compared to BIA to examine levels of agreement and standard screening performance measures. Results Among the 389 participants (78% male), WHO BMI and BIA BF% classified the most males (61.1% and 42.6%, respectively) and females (both 51.2%) as overweight/obese, whereas WC with BMI (BMI + WC) and WC alone were the least likely to classify males (10.9% and 11.6%, respectively) and females (both 9.3%) as overweight/obese. The levels of agreement were all statistically significant and highest for BMI (males Cohen's kappa (Ck) = 0.711, females Ck = 0.814) and WHO BMI (males Ck = 0.578, females Ck = 0.814); moderate for BMI + CBE (males Ck = 0.447, females Ck = 0.676); and lowest for WC and WC + BMI (all Ck ≤ 0.270). To maximize sensitivity and minimize false discovery rate, BMI + CBE performed best overall (sensitivity = 50.9%, false discovery rate = 5.4%). Conclusions Valid measures of adiposity are needed to ensure that military recruitment and job security are not jeopardized by inaccurate body fat standards. Our findings support BMI + CBE as an easy-to-implement combination to assess adiposity in the military. Future studies need to consider overall goals, including associated health risks, before expanding on these findings. Funding Sources All authors contributed their efforts without receiving funding or salary support. The research study was supported by a Grant to the Consortium for Health and Military Performance at the Uniformed Services University from the US Army's Comprehensive Soldier and Family Fitness program.

Photo by 187929822 © Victor Moussa | Dreamstime.com INTRODUCTION The nonconsensual taking of a human organ to use in transplantation medicine violates ethical principles, including autonomy, informed consent, and human rights, as well as criminal laws. When such an organ harvesting is not just nonconsensual, but performed in a way that causes a death or uses the pretense of brain death without meeting the criteria, it also violates the dead donor[1] rule.[2] The dead donor rule is both ethical and legal. It prevents organ retrieval that would predictably cause the death of the organ donor.[3] Retrieval of a vital organ is permissible only after a declaration of death.[4] Forced organ harvesting may breach the dead donor rule as it stands. A reimagined, broader dead donor rule could consider a larger timeframe in the forced organ harvesting context. In doing so, the broad dead donor rule could cover intent, premeditation, aiding and abetting, and due diligence failures. A broad definition of forced organ harvesting is ‘‘the removal of one or more organs from a person by means of coercion, abduction, deception, fraud, or abuse of power. . .’’[5] A more targeted definition is “[t]he killing of a person so that their organs may be removed without their free, voluntary and informed consent and transplanted into another person.”[6] In the global organ harvesting context, forced organ harvesting violates the World Health Organization (WHO) Guiding Principle 3, which says “live organ donors should be acting willingly, free of any undue influence or coercion.”[7] Furthermore, WHO states live donors should be “genetically, legally, or emotionally” attached to the recipient. Guiding Principle 1 applies to deceased donors, covers consent, and permits donation absent any known objections by the deceased.[8] Principle 7 says, “Physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures if the cells, tissues or organs concerned have been obtained through exploitation or coercion of, or payment to, the donor or the next of kin of a deceased donor.”[9] There are underground markets in which organ hunters prey on the local poor in countries with low wages and widespread poverty[10] and human trafficking that targets migrants for the purpose of organ harvesting.[11] This paper explores forced harvesting under the backdrop of the dead donor rule, arguing that a human rights violation so egregious requires holding even distant participants in the chain of events accountable. By interfering with resources necessary to carry out bad acts, legislation and corporate and institutional policies can act as powerful deterrents. A broader dead donor rule would highlight the premeditation and intent evidenced well before the act of organ retrieval. I. Background and Evidence In China, there is evidence that people incarcerated for religious beliefs and practices (Falun Gong) and ethnic minorities (Uyghurs) have been subjects of forced organ harvesting. A tribunal (the China Tribunal) found beyond a reasonable doubt that China engaged in forced organ harvesting.[12] Additionally, eight UN Special Rapporteurs found a system of subjecting political prisoners and prisoners of conscience to blood tests and radiological examinations to determine the fitness of their organs.[13] As early as 2006, investigators found evidence of forced organ harvesting from Falun Gong practitioners. [14] Over a million Uyghurs are in custody there, and there is ample evidence of biometric data collection.[15] An Uyghur tribunal found evidence of genocide.[16] “China is the only country in the world to have an industrial-scale organ trafficking practice that harvests organs from executed prisoners of conscience.”[17] Witnesses testified to the removal of organs from live people without ample anesthesia,[18] summonses to the execution grounds for organ removal,[19] methods of causing death for the purpose of organ procurement,[20] removing eyes from prisoners who were alive,[21] and forcing live prisoners into operating rooms.[22] The current extent of executions to harvest organs from prisoners of conscience in China is unknown. The Chinese press has suggested surgeons in China will perform 50,000 organ transplants this year.[23] Doctors Against Forced Organ Harvesting (DAFOR) concluded, “[f]orced organ harvesting from living people has occurred and continues to occur unabated in China.”[24] China continues to advertise in multiple languages to attract transplant tourists.[25] Wait times for organs seem to remain in the weeks.[26] In the United States, it is common to wait three to five years.[27] II. The Nascent System of Voluntary Organ Donation in China In China, throughout the 1990s and early 2000s, the supply of organs for transplant was low, and there was not a national system to register as a donor. A 1984 act permitted death row prisoners to donate organs.[28] In 2005, a Vice Minister acknowledged that 95 percent of all organ transplants used organs from death row prisoners.[29] In 2007 the planning of a voluntary system to harvest organs after cardiac death emerged. According to a Chinese publication, China adopted brain death criteria in 2013.[30] There had been public opposition due partly to cultural unfamiliarity with it.[31] Cultural values about death made it more difficult to adopt a universal brain death definition. Both Buddhist and Confucian beliefs contradicted brain death.[32] Circulatory death was traditionally culturally accepted.[33] The Ministry of Health announced that by 2015 organ harvesting would be purely voluntary and that prisoners would not be the source of organs.[34] There are cultural barriers to voluntary donation partly due to a Confucian belief that bodies return to ancestors intact and other cultural and religious beliefs about respect for the dead.[35] An emphasis on family and community over the individual posed another barrier to the Western approach to organ donation. Public awareness and insufficient healthcare professional knowledge about the process of organ donation are also barriers to voluntary donation.[36] Although the Chinese government claims its current system is voluntary and no longer exploits prisoners,[37] vast evidence contradicts the credibility of the voluntary transplant program in China.[38] III. Dead Donor Rule: A Source of Bioethical Debate It seems tedious to apply this ethical foundation to something as glaring as forced organ harvesting. But the dead donor rule is a widely held recognition that it is not right to kill one person to save another.[39] It acts as a prohibition on killing for the sake of organ retrieval and imposes a technical requirement which influences laws on how death is declared. The dead donor rule prevents organ harvesting that causes death by prohibiting harvesting any organ which the donor agreed to donate only after death prior to an official declaration of death. There is an ongoing ethical debate about the dead donor rule. Many in bioethics and transplant medicine would justify removing organs in specific situations prior to a declaration of death, abandoning the rule.[40] Some use utilitarian arguments to justify causing the death of someone who is unconscious and on life support irreversibly. Journal articles suggest that the discussion has moved to one of timing and organ retrieval.[41] Robert Truog and Franklin Miller are critics of the dead donor rule, arguing that, in practice, it is not strictly obeyed: removing organs while a brain-dead donor is still on mechanical ventilation and has a beating heart and removing organs right after life support is removed and cardio-pulmonary death is declared both might not truly meet the requirement of the dead donor rule, making following the rule “a dubious norm.”[42] Miller and Truog question the concept of brain death, citing evidence of whole body integrated functions that continue indefinitely. They challenge cardio-pulmonary death, asserting that the definition includes as dead, those who could be resuscitated. Their hearts could resume beating with medical intervention. Stopping life support causes death only in those whose lives are sustained by it. Some stipulate that the organ retrieval must not itself cause the death. Some would rejigger the cause of death: Daniel Callahan suggests that the underlying condition causes the death despite removal of life support.[43] But logically, a person could continue life support and be alive, so clearly, removing life support does cause death. Something else would have caused brain death or the circumstance that landed the person on mechanical ventilation. To be more accurate, one could say X caused the irreversible coma and removing life support caused the death itself. Miller and Truog take the position that because withdrawal of life support does cause death, the dead donor rule should be defunct as insincere. To them, retrieving vital organs from a technically alive donor should be permissible under limited conditions. They look to the autonomous choices of the donor or the surrogate (an autonomy-based argument). They appreciate the demand for organs and the ability to save lives, drawing attention to those in need of organs. Live donor organ retrieval arguably presents a slippery slope, especially if a potential donor is close to death, but not so close to label it imminent. They say physicians would not be obligated to follow the orders of a healthy person wishing to have vital organs removed, perhaps to save a close friend or relative. Similarly, Radcliffe-Richards, et al. argue that there is no reason to worry about the slippery slope of people choosing death so they can sell their vital organs, whether for money for their decedents or their creditors.[44] The movement toward permissibility and increased acceptance of medical aid in dying also influence the organ donation arena. The slippery slope toward the end of life has potential to become a realistic concern. Older adults or other people close to death may want to donate a vital organ, like their heart, to a young relative in need. That could greatly influence the timing of a decision to end one’s life. IV. Relating the Dead Donor Rule to Forced Organ Harvesting There is well documented evidence that in China organs have been removed before a declaration of death.[45] But one thing the dead donor rule does not explicitly cover is intent and the period prior to the events leading to death. It tends to apply to a near-death situation and is primarily studied in its relationship to organ donation. It is about death more than it is about life. Robertson and Lavee investigated data on transplantation of vital organs in China and they document cases where the declaration of death was a pretense, insincere, and incorrect. Their aim was to investigate whether the prisoners were in fact dead prior to organ harvesting.[46] (The China Tribunal found that organs have been removed from live prisoners and that organ harvesting has been the cause of death.) They are further concerned with the possible role of doctors as executioners, or at least as complicit in the execution as the organ harvesting so closely follows it. V. A Broader Dead Donor Rule A presumed ethical precursor to the dead donor rule may also be an important ethical extension of the rule: the dead donor rule must also prohibit killing a person who is not otherwise near death for the purpose of post-death organ harvesting. In China, extra-judicial killings of prisoners of conscience are premeditated ― there is ample evidence of blood tests and radiology to ensure organ compatibility and health.[47] To have effective ethical force, the dead donor rule should have an obvious application in preventing intentional killing for an organ retrieval, not just killing by way of organ retrieval. When we picture the dead donor rule, bioethicists tend to envision a person on life support who will either be taken off it and stop breathing or who will be declared brain dead. But the dead donor rule should apply to healthy people subject to persecution at the point when the perpetrator lays the ground for the later killing. At that point, many organizations and people may be complicit or unknowingly contributing to forced organ harvesting. In this iteration of the dead donor rule, complicity in its violations would be widespread. The dead donor rule could address the initial action of ordering a blood or radiology test or collecting any biometric data. Trained physicians and healthcare technicians perform such tests. Under my proposed stretch of the dead donor rule, they too would be complicit in the very early steps that eventually lead to killing a person for their organs. I argue these steps are part of forced organ harvesting and violate the dead donor rule. The donor is very much alive in the months and years preceding the killing. A conspiracy of indifference toward life, religious persecution, ethnic discrimination, a desire to expand organ transplant tourism, and intent to kill can violate this broader dead donor rule. The dead donor rule does not usually apply to the timing of the thought of organ removal, nor the beginning of the chain of events that leads to it. It is usually saved for the very detailed determination of what may count as death so that physicians may remove vital and other organs, with the consent of the donor.[48] But I argue that declaring death at the time of retrieval may not be enough. Contributing to the death, even by actions months or years in advance, matter too. Perhaps being on the deathbed awaiting a certain death must be distinguished from going about one’s business only to wind up a victim of forced organ harvesting. Both may well be declared dead before organ retrieval, but the likeness stops there. The person targeted for future organ retrieval to satisfy a growing transplant tourism business or local demand is unlike the altruistic person on his deathbed. While it may seem like the dead donor rule is merely a bioethics rule, it does inform the law. And it has ethical heft. It may be worth expanding it to the arena of human trafficking for the sake of organ removal and forced organ harvesting.[49] The dead donor rule is really meant to ensure that death was properly declared to protect life, something that must be protected from an earlier point. VI. Complicity: Meaning and Application Human rights due diligence refers to actions that people or institutions must take to ensure they are not contributing to a human rights violation. To advise on how to mitigate risk of involvement or contribution to human rights violations, Global Rights Compliance published an advisory that describes human rights due diligence as “[t]he proactive conduct of a medical institution and transplant-associated entity to identify and manage human rights risks and adverse human rights impacts along their entire value and supply chain.”[50] Many people and organizations enable forced organ harvesting. They may be unwittingly complicit or knowingly aiding and abetting criminal activity. For example, some suppliers of medical equipment and immunosuppressants may inadvertently contribute to human rights abuses in transplantation in China, or in other countries where organs were harvested without consent, under duress, or during human trafficking. According to Global Rights Compliance, “China in the first half of 2021 alone imported ‘a total value of about 24 billion U.S. dollars’ worth of medical technology equipment’, with the United States and Germany among the top import sources.”[51] The companies supplying the equipment may be able to slow or stop the harm by failing to supply necessary equipment and drugs. Internal due diligence policies would help companies analyze their suppliers and purchasers. Corporations, educational institutions, and other entities in the transplantation supply chain, medical education, insurance, or publishing must engage in human rights due diligence. The Global Rights Compliance advisory suggests that journals should not include any ill-gotten research. Laws should regulate corporations and target the supply chain also. All actors in the chain of supply, etc. are leading to the death of the nonconsenting victim. They are doing so while the victim is alive. The Stop Forced Organ Harvesting Act of 2023, pending in the United States, would hold any person or entity that “funds, sponsors, or otherwise facilitates forced organ harvesting or trafficking in persons for purposes of the removal of organs” responsible. The pending legislation states that: It shall be the policy of the United States—(1) to combat international trafficking in persons for purposes of the removal of organs;(2) to promote the establishment of voluntary organ donation systems with effective enforcement mechanisms in bilateral diplomatic meetings and in international health forums;(3) to promote the dignity and security of human life in accordance with the Universal Declaration of Human Rights, adopted on December 10, 1948; and(4) to hold accountable persons implicated, including members of the Chinese Communist Party, in forced organ harvesting and trafficking in persons for purposes of the removal of organs.[52] The Act calls on the President to provide Congress a list of such people or entities and to sanction them by property blocking, and, in the case of non-US citizens, passport and visa denial or revocation. The Act includes a reporting requirement under the Foreign Assistance Act of 1961 that includes an assessment of entities engaged in or supporting forced organ harvesting.[53] The law may have a meaningful impact on forced organ harvesting. Other countries have taken or are in the process of legal approaches as well.[54] Countries should consider legislation to prevent transplant tourism, criminalize complicity, and require human rights due diligence. An expanded dead donor rule supports legal and policy remedies to prevent enabling people to carry out forced organ harvesting. VII. Do Bioethicists Mention Human Rights Abuses and Forced Organ Harvesting Enough? As a field, bioethics literature often focuses on the need for more organs, the pain and suffering of those on organ transplant waitlists, and fairness in allocating organs or deciding who belongs on which waitlist and why. However, some bioethicists have drawn attention to forced organ harvesting in China. Notably, several articles noted the ethical breaches and called on academic journals to turn away articles on transplantation from China as they are based on the unethical practice of executing prisoners of conscience for their organs.[55] The call for such a boycott was originally published in a Lancet article in 2011.[56] There is some acknowledgement that China cares about how other countries perceive it,[57] which could lead to either improvements in human rights or cover-ups of violations. Ill-gotten research has long been in the bioethics purview with significant commentary on abuses in Tuskegee and the Holocaust.[58] Human research subjects are protected by the Declaration of Helsinki, which requires acting in the best interests of research subjects and informed consent among other protections.[59] The Declaration of Helsinki is directed at physicians and requires subjects enroll in medical research voluntarily. The Declaration does not explicitly cover other healthcare professionals, but its requirements are well accepted broadly in health care. CONCLUSION The dead donor rule in its current form really does not cover the life of a non-injured healthy person at an earlier point. If it could be reimagined, we could highlight the link between persecution for being a member of a group like Falun Gong practitioners or Uyghurs as the start of the process that leads to a nonconsensual organ retrieval whether after a proper declaration of death or not. It is obviously not ethically enough to ensure an execution is complete before the organs are harvested. It is abuse of the dead donor rule to have such a circumstance meet its ethical requirement. And obviously killing people for their beliefs or ethnicity (and extra-judicial killings generally) is not an ethically acceptable action for many reasons. The deaths are intentionally orchestrated, but people and companies who may have no knowledge of their role or the role of physicians they train or equipment they sell are enablers. An expanded dead donor rule helps highlight a longer timeframe and expanded scope of complicity. The organ perfusion equipment or pharmaceuticals manufactured in the United States today must not end up enabling forced organ harvesting. With an expanded ethical rule, the “donor is not dead” may become “the donor would not be dead if not for. . .” the host of illegal acts, arrests without cause, forced detention in labor camps, extra-judicial killings, lacking human rights due diligence, and inattention to this important topic. The expanded dead donor rule may also appeal to the bioethics community and justify more attention to laws and policies like the Stop Forced Organ Harvesting Act of 2023. - [1] The word “donor” in this paper describes any person from whom organs are retrieved regardless of compensation, force, or exploitation in keeping with the bioethics literature and the phrase “dead donor rule.” [2] Robertson, M.P., Lavee J. (2022). Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [3] Robertson, J. A. (1999). Delimiting the donor: the dead donor rule. Hastings Center Report, 29(6), 6-14. [4] Retrieval of non-vital organs which the donor consents to donate post-death (whether opt-in, opt-out, presumed, or explicit according to local law) also trigger the dead donor rule. [5] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023), https://www.congress.gov/bill/118th-congress/house-bill/1154. [6] Do No Harm: Mitigating Human Rights Risks when Interacting with International Medical Institutions & Professionals in Transplantation Medicine, Global Rights Compliance, Legal Advisory Report, April 2022, https://globalrightscompliance.com/project/do-no-harm-policy-guidance-and-legal-advisory-report/. [7] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the sixty-third World Health Assembly in May 2010, in Resolution WHA63.22 https://apps.who.int/iris/bitstream/handle/10665/341814/WHO-HTP-EHT-CPR-2010.01-eng.pdf?sequence=1. [8] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (2010). [9] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (2010). [10] Promchertchoo, Pichayada (Oct. 19, 2019). Kidney for sale: Inside Philippines’ illegal organ trade. https://www.channelnewsasia.com/asia/kidney-for-sale-philippines-illegal-organ-trade-857551; Widodo, W. and Wiwik Utami (2021), The Causes of Indonesian People Selling Covered Kidneys from a Criminology and Economic Perspective: Analysis Based on Rational Choice Theory. European Journal of Political Science Studies, Vol 5, Issue 1. [11] Van Reisen, M., & Mawere, M. (Eds.). (2017). Human trafficking and trauma in the digital era: The ongoing tragedy of the trade in refugees from Eritrea. African Books Collective. [12] The Independent Tribunal into Forced Organ Harvesting from Prisoners of Conscience in China (China Tribunal) (2020). https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf [13] UN Office of the High Commissioner, Press Release, China: UN human Rights experts alarmed by ‘organ harvesting’ allegations (UN OTHCHR, 14 June 2021), https://www.ohchr.org/en/press-releases/2021/06/china-un-human-rights-experts-alarmed-organ-harvesting-allegations. [14] David Matas and David Kilgour, Bloody Harvest. The killing of Falun Gong for their organs (Seraphim Editions 2009). [15] How China is crushing the Uyghurs, The Economist, video documentary, July 9, 2019, https://youtu.be/GRBcP5BrffI. [16] Uyghur Tribunal, Judgment (9 December 2021) (Uyghur Tribunal Judgment) para 1, https://uyghurtribunal.com/wp-content/uploads/2022/01/Uyghur-Tribunal-Judgment-9th-Dec-21.pdf. [17] Ali Iqbal and Aliya Khan, Killing prisoners for transplants: Forced organ harvesting in China, The Conversation Published: July 28, 2022. https://theconversation.com/killing-prisoners-for-transplants-forced-organ-harvesting-in-china-161999 [18] Testimony demonstrated surgeries to remove vital organs from live people, killing them, sometimes without ample anesthesia to prevent wakefulness and pain. China Tribunal (2020), p. 416-417. https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf; Robertson MP, Lavee J. (2022), Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [19] Doctors reported being summoned to execution grounds and told to harvest organs amid uncertainty that the prisoner was in fact dead. China Tribunal (2020), p. 52-53. [20]In testimony to the China Tribunal, Dr. Huige Li noted four methods of organ harvesting from live prisoners: incomplete execution by shooting, after lethal injection prior to death, execution by removal of the heart, and after a determination of brain death prior to an intubation (pretense of brain death). China Tribunal (2020), pp. 54-55. https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf [21] A former military medical student described removing organs from a live prisoner in the late 1990s. He further described his inability to remove the eyes of a live man and his witnessing another doctor forcefully remove the man’s eyes. China Tribunal (2020), p. 330. [22] In 2006, a nurse testified that her ex-husband, a surgeon, removed the eyes of 2,000 Falun Gong practitioners in one hospital between 2001 and 2003. She described the Falun Gong labor-camp prisoners as being forced into operating rooms where they were given a shot to stop their hearts. Other doctors removed other organs. DAFOH Special Report, 2022. https://epochpage.com/wp-content/uploads/sites/3/2022/12/DAFOH-Special-Report-2022.pdf [23] Robertson MP, Lavee J. (2022), Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [24] DAFOH Special Report, 2022. https://epochpage.com/wp-content/uploads/sites/3/2022/12/DAFOH-Special-Report-2022.pdf; DAFOH’s physicians were nominated for a Nobel Prize for their work to stop forced organ harvesting. Šućur, A., & Gajović, S. (2016). Nobel Peace Prize nomination for Doctors Against Forced Organ Harvesting (DAFOH) - a recognition of upholding ethical practices in medicine. Croatian medical journal, 57(3), 219–222. https://doi.org/10.3325/cmj.2016.57.219 [25] Robertson and Lavee (2022). [26] Stop Organ Harvesting in China, website (organization of the Falun Dafa). https://www.stoporganharvesting.org/short-waiting-times/ [27] National Kidney Foundation, The Kidney Transplant Waitlist – What You Need to Know, https://www.kidney.org/atoz/content/transplant-waitlist [28] Wu, Y., Elliott, R., Li, L., Yang, T., Bai, Y., & Ma, W. (2018). Cadaveric organ donation in China: a crossroads for ethics and sociocultural factors. Medicine, 97(10). [29] Wu, Elliott, et al., (2018). [30] Su, Y. Y., Chen, W. B., Liu, G., Fan, L. L., Zhang, Y., Ye, H., ... & Jiang, M. D. (2018). An investigation and suggestions for the improvement of brain death determination in China. Chinese Medical Journal, 131(24), 2910-2914. [31] Huang, J., Millis, J. M., Mao, Y., Millis, M. A., Sang, X., & Zhong, S. (2012). A pilot programme of organ donation after cardiac death in China. The Lancet, 379(9818), 862-865. [32] Yang, Q., & Miller, G. (2015). East–west differences in perception of brain death: Review of history, current understandings, and directions for future research. Journal of bioethical inquiry, 12, 211-225. [33] Huang, J., Millis, J. M., Mao, Y., Millis, M. A., Sang, X., & Zhong, S. (2015). Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transplantation, 21(4), 419-422. [34] Huang, Millis, et al. (2015). [35] Wu, X., & Fang, Q. (2013). Financial compensation for deceased organ donation in China. Journal of Medical Ethics, 39(6), 378-379. [36] An, N., Shi, Y., Jiang, Y., & Zhao, L. (2016). Organ donation in China: the major progress and the continuing problem. Journal of biomedical research, 30(2), 81. [37] Shi, B. Y., Liu, Z. J., & Yu, T. (2020). Development of the organ donation and transplantation system in China. Chinese medical journal, 133(07), 760-765. [38] Robertson, M. P., Hinde, R. L., & Lavee, J. (2019). Analysis of official deceased organ donation data casts doubt on the credibility of China’s organ transplant reform. BMC Medical Ethics, 20(1), 1-20. [39] Miller, F.G. and Sade, R. M. (2014). Consequences of the Dead Donor Rule. The Annals of thoracic surgery, 97(4), 1131–1132. https://doi.org/10.1016/j.athoracsur.2014.01.003 [40] For example, Miller and Sade (2014) and Miller and Truog (2008). [41] Omelianchuk, A. How (not) to think of the ‘dead-donor’ rule. Theor Med Bioeth 39, 1–25 (2018). https://doi-org.ezproxy.cul.columbia.edu/10.1007/s11017-018-9432-5 [42] Miller, F.G. and Truog, R.D. (2008), Rethinking the Ethics of Vital Organ Donations. Hastings Center Report. 38: 38-46. [43] Miller and Truog, (2008), p. 40, citing Callahan, D., The Troubled Dream of Life, p. 77. [44] Radcliffe-Richards, J., Daar, A.S., Guttman, R.D., Hoffenberg, R., Kennedy, I., Lock, M., Sells, R.A., Tilney, N. (1998), The Case for Allowing Kidney Sales, The Lancet, Vol 351, p. 279. (Authored by members of the International Forum for Transplant Ethics.) [45] Robertson and Lavee, (2022). [46] Robertson and Lavee, (2022). [47] China Tribunal (2020). [48] Consent varies by local law and may be explicit or presumed and use an opt-in or opt-out system and may or may not require the signoff by a close family member. [49] Bain, Christina, Mari, Joseph. June 26, 2018, Organ Trafficking: The Unseen Form of Human Trafficking, ACAMS Today, https://www.acamstoday.org/organ-trafficking-the-unseen-form-of-human-trafficking/; Stammers, T. (2022), "2: Organ trafficking: a neglected aspect of modern slavery", Modern Slavery and Human Trafficking, Bristol, UK: Policy Press. https://bristoluniversitypressdigital.com/view/book/978144736. [50] Do No Harm: Mitigating Human Rights Risks when Interacting with International Medical Institutions & Professionals in Transplantation Medicine, Global Rights Compliance, Legal Advisory Report, April 2022, https://globalrightscompliance.com/project/do-no-harm-policy-guidance-and-legal-advisory-report/. [51] Global Rights Compliance, p. 22. [52] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023). https://www.congress.gov/bill/118th-congress/house-bill/1154. [53] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023), https://www.congress.gov/bill/118th-congress/house-bill/1154. [54] Global Rights Compliance notes that Belgium, France (passed law on human rights due diligence in the value supply chain), United Kingdom, United States, Canada, Australia, and New Zealand have legal approaches, resolutions, and pending laws. p. 45. [55] For example, Caplan, A.L. (2020), The ethics of the unmentionable Journal of Medical Ethics 2020;46:687-688. [56] Caplan, A.L. , Danovitch, G., Shapiro M., et al. (2011) Time for a boycott of Chinese science and medicine pertaining to organ transplantation. Lancet, 378(9798):1218. doi:10.1016/S0140-6736(11)61536-5 [57] Robertson and Lavee. [58] Smolin, D. M. (2011). The Tuskegee syphilis experiment, social change, and the future of bioethics. Faulkner L. Rev., 3, 229; Gallin, S., & Bedzow, I. (2020). Holocaust as an inflection point in the development of bioethics and research ethics. Handbook of research ethics and scientific integrity, 1071-1090. [59] World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended multiple times, most recently by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/