Medicine and Health Sciences Commons^™

Statin Utilization And Cardiovascular Outcomes In A Real-World Primary Prevention Cohort Of Older Adults, Aaron J. Walker, Jianhui Zhu, Floyd Thoma, Oscar Marroquin, Amber Makani, Martha Gulati, Eugenia Gianos, Salim S. Virani, Fatima Rodriguez, Steven E. Reis, Christie Ballantyne

Office of the Provost

Background: Statins are a cost-effective therapy for prevention of atherosclerotic cardiovascular disease (ASCVD). Guidelines on statins for primary prevention are unclear for older adults (>75 years).
Objective: Investigate statin utility in older adults without ASCVD events, by risk stratifying in a large healthcare network.
Methods: We included 8,114 older adults, without CAD, PVD or ischemic stroke. Statin utilization based on ACC/AHA 10-year ASCVD risk calculation, was evaluated in intermediate (7.5%-19.9%) and high-risk patients (≥ 20%); and categorized using low and 'moderate or high' intensity statins with a follow up period of ∼7 years. Cox regression models were used to …

High All-Cause Mortality And Increasing Proportion Of Older Adults With Tuberculosis In Texas, 2008–2020, Belinda A. Medrano, Miryoung Lee, Gretchen L. Gemeinhardt, Lana Yamba, Blanca I. Restrepo

School of Medicine Publications and Presentations

Pulmonary tuberculosis (PTB) elimination efforts must consider the global growth of the ageing population. Here we used TB surveillance data from Texas, United States (2008–2020; total n = 10656) to identify unique characteristics and outcomes in older adults (OA, ≥65 years) with PTB, compared to young adults (YA, 18–39 years) or middle-aged adults (40–64 years). We found that the proportion of OA with PTB increased from 15% in 2008 to 24% in 2020 (trend p < 0.05). Diabetes was highly prevalent in OA (32%) but not associated with adverse outcomes. Death was 13-fold higher in OA compared to YA and was 7% at the time of diagnosis which suggests diagnostic delays. However, once TB was suspected, we found no differences in culture, smear, or nucleic acid detection of mycobacteria (although less lung cavitations) in OA. During treatment, OA had less drug-resistant TB, few adverse reactions and adhered with TB treatment. We recommend training healthcare workers to ‘think TB’ in OA, for prompt treatment initiation to diminish deaths. Furthermore, OA should be added as a priority group to the latent TB treatment guidelines by the World Health Organization, to prevent TB disease in this highly vulnerable group.

A Contextual Analysis Of Life Stories From Older Adults Participating In A Telephone Reminiscence Program, Eliana Likorama

Honors Scholar Theses

Life satisfaction, loneliness, and mental health & well-being are important factors to consider when working with the older adult population. This population is predisposed to many risk factors for mental health problems such as coping with a serious illness, losing a loved one, living alone, cognitive deficits, and more. Reminiscence is one simple, flexible, and cost-effective intervention that can be utilized to promote the mental health and well-being of older adults. Reminiscence is defined as the cognitive process of recalling the past. Numerous studies have shown beneficial effects of reminiscence in older adults: increased self-esteem, enhanced quality of life, increased …

The Differences In Covid-19 Infection Rates: An Examination Of Residential Care Communities (Rccs), Han Yang

Doctoral Dissertations and Projects

Infection control practices (ICPs) are crucial for maintaining the health and safety of residents in a residential care community (RCC). This paper examines the differences in COVID-19 infection rates and cases based on the characteristics of RCCs, such as ICPs, personal protective equipment (PPE) shortages, ownership type (for-profit vs. nonprofit), census regions, and RCC size. While ICPs contribute significantly to preventing and controlling the highly contagious virus, a comprehensive program is encouraged to provide a targeted intervention based on RCC’s environmental factors. The importance of the characteristics of the RCCs must be considered in combing with the ICPs to enhance …

The Effectiveness Of Dexmedetomidine In The Reduction Of Postoperative Delirium In Patients Over 65: A Scoping Review, Jacqueline Renee Breuer, Michael G. Callonas, Kathleen Chmelicek, Laura Elizabeth Denman, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Postoperative delirium impacts as many as 51% of surgical patients, resulting in increased mortality and morbidity, longer hospital stays, and increased healthcare costs. Adults ≥ 65 have a high risk for developing delirium. This scoping review examines the use of dexmedetomidine in the perioperative period in adults ≥ 65 years old to prevent and treat postoperative delirium.

Methods

Using relevant inclusion criteria, an extensive review of the literature was performed from September through November 2022, utilizing the Cochrane, CINAHL, ClinicalKey, PubMed, and Embase databases. Search phrases included: dexmedetomidine infusion, dexmedetomidine, intraoperative dexmedetomidine, postoperative delirium, older adults, and elderly delirium. …

Increased Nitrate Intake From Beetroot Juice Over 4 Weeks Affects Nitrate Metabolism, But Not Vascular Function Or Blood Pressure In Older Adults With Hypertension, Rebeka Fejes, Martin Lutnik, Stefan Weisshaar, Nina Pilat, Karl-Heinz Wagner, Hans-Peter Stüger, Jonathan M. Peake, Richard J. Woodman, Kevin D. Croft, Catherine P. Bondonno, Jonathan M. Hodgson, Michael Wolzt, Oliver Neubauer

Research outputs 2022 to 2026

The decline in vascular function and increase in blood pressure with aging contribute to an increased cardiovascular disease risk. In this randomized placebo-controlled crossover study, we evaluated whether previously reported cardiovascular benefits of plant-derived inorganic nitrate via nitric oxide (NO) translate into improved vascular function and blood pressure-lowering in 15 men and women (age range: 56-71 years) with treated hypertension. We investigated the effects of a single ∼400 mg-dose at 3 hours post-ingestion (3H POST) and the daily consumption of 2 × ∼400 mg of nitrate through nitrate-rich compared with nitrate-depleted (placebo) beetroot juice over 4 weeks (4WK POST). Measurements …

Multifactorial Exercise Intervention Decreases Falls Risk In High-Risk And Low-Risk Older Adults, Amanda Estep, Steven Morrison, Shane V. Caswell, Jatin P. Ambegaonkar, João R. Vaz, Nelson Cortes

Rehabilitation Sciences Faculty Publications

Background: Each year, 1 in 4 people over the age of 65 years of age will experience a fall. It is important to identify and address modifiable risk factors that are associated with falls in adults at high and low risk for falls.

Hypothesis: Falls risk improves in both high-risk and low-risk participants with the implementation of Stay Active and Independent for Life (SAIL).

Study Design: Cohort study.

Level of Evidence: Level 3.

Methods: Seventy-eight older adults (age, 70.9 ± 5.1 years) were included in this study and categorized into high risk and low risk for falling based on the …

Pain Is Underestimated In Older Adults With Risk Of Falls, Mustafa Atee

Research outputs 2022 to 2026

Dear Editor, I have read with great interest the Xiao et al. study examining ret-rospectively the incidence of falls and related factors in outpatient and inpatient elderly sample (n= 451) aged 65 years and above. . . .

Unveiling The Link Between Systemic Inflammation Markers And Cognitive Performance Among Older Adults In The Us: A Population-Based Study Using Nhanes 2011–2014 Data, Zheng Guo, Yulu Zheng, Jian Geng, Zhiyuan Wu, Tao Wei, Guangle Shan, Yahong Zhu, Yuanyuan Zheng, Xingang Li

Research outputs 2022 to 2026

Purpose: This study aimed to evaluate the association between systemic inflammation markers and cognitive performance among older US adults. Methods: This cross-sectional study assessed 3,632 older participants from the 2011–2014 National Health and Nutrition Examination Survey (NHANES). The main analysis included participants aged over 60 years. Systemic inflammation markers were quantified by calculating the composite inflammation indicators from the blood routine count, and cognitive performance was assessed using Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, Animal Fluency test (AFT), and Digit Symbol Substitution test (DSST). Results: There were 2,743 individuals enrolled in the current analysis. The overall …

Initiating A Skin-Care Bundle In The Emergency Department To Decrease Hospital-Acquired Pressure Injuries In Geriatric Patients, Suzanne Babcock, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Adults 65+ comprise 15.2% of the United States (U.S.) population and 17.9% of Emergency Department (ED) visits. Aging causes changes to skin, including thinning and loss of elasticity. Annually, in the U.S., 2.5 million individuals develop Pressure Injuries (PI), causing 60,000 deaths. Hospital acquired PIs in the U.S. cost $26.8 billion annually, over $10,000/patient and increase the length of stay by greater than four days.

LOCAL PROBLEM: This project occurred in a 27-bed Geriatric Accredited Emergency Department in a southeastern U.S. city where patients 65+ comprise 40% of the patient volume annually. PIs can begin developing within two hours. …

Tuberculosis Presentation And Outcomes In Older Hispanic Adults From Tamaulipas, Mexico, Belinda Medrano, Miryoung Lee, Gretchen L. Gemeinhardt, Javier E. Rodríguez-Herrera, Moncerrato García-Viveros, Blanca I. Restrepo

School of Medicine Publications and Presentations

Older people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but there are few studies among them, particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in older Hispanics by conducting a cross-sectional study of TB surveillance data from Tamaulipas, Mexico (2006–2013; n = 8381). Multivariable logistic regressions were assessed for older adults (OA ≥65 years) when compared to young (YA, 18–39 years) and middle-aged adults (40–64 years). We found that the OA had features associated with a less complicated TB (e.g., lower …

The Influence Of Baseline Sleep On Exercise-Induced Cognitive Change In Cognitively Unimpaired Older Adults: A Randomised Clinical Trial, Kelsey R. Sewell, Stephanie R. Rainey-Smith, Jeremiah Peiffer, Hamid R. Sohrabi, James Doecke, Natalie J. Frost, Shaun J. Markovic, Kirk Erickson, Belinda M. Brown

Research outputs 2022 to 2026

Objectives: Observational studies consistently demonstrate that physical activity is associated with elevated cognitive function, however, there remains significant heterogeneity in cognitive outcomes from randomized exercise interventions. Individual variation in sleep behaviours may be a source of variability in the effectiveness of exercise-induced cognitive change, however this has not yet been investigated. The current study aimed to (1) investigate the influence of a 6-month exercise intervention on sleep, assessed pre- and post-intervention and, (2) investigate whether baseline sleep measures moderate exercise-induced cognitive changes. Methods: We utilised data from the Intense Physical Activity and Cognition (IPAC) study (n = 89), a 6-month …

Supporting Vulnerable Older Adults With Telehealth Through Wellness Calls And Tablet Distribution During Covid-19: Quality Improvement Project, Sweta Tewary, Nicole J. Cook, Marie Dezine, Oksana Shnayder, Naushira Pandya

HPD Articles

BACKGROUND: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University's South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services.

OBJECTIVE: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population.

METHODS: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. …

Association Between Chronic Disease And Substance Use Among Older Adults In Tennessee, Manik Ahuja, Jessica Stamey, Johanna Cimilluca, Kawther Al Skir, Mary K. Herndon, Kathleen Baggett, Thiveya Sathiyasaleen, Praveen Fernandopulle

ETSU Faculty Works

Background:

Design and methods:

A Home Safety Program For Low-Income Community-Dwelling Older Adults: Using Meals On Wheels Volunteers, Erin Jeffords, Ms, Otr/L

Post-Professional Occupational Therapy Doctorate Culminating Presentations

Low-income older adults who reside in the community have fewer opportunities to access services and limited resources to obtain equipment that would enhance safety in their living environment. Through their “army” of volunteers, Meals on Wheels agencies have long been the eyes of the community to identify older adults who are socially isolated and disabled (Thomas et al., 2018). The purpose of this project was to evaluate the (1) delivery of the Midlands Modifiers Home Safety Program and (2) training program for the Meals on Wheels volunteers who will administer the home safety screen. The Midlands Modifiers Home Safety Program …

Outcomes Following Total Hip Arthroplasty For Hip Dysplasia In Older Adults. Are They Comparable To Those With Osteoarthritis?, Cesar A. Sevilla Jr, Vanessa Lopez, Ruthvik Allala, Isabella Amado, Yin Xi, Avneesh Chhabra, Nicholas Fey, Joel Wells

School of Medicine Publications and Presentations

Background: Total hip arthroplasty (THA) for the treatment of hip dysplasia, which disproportionately impacts the younger population, has been shown to be an effective intervention to restore functionality and improve quality of life. However, it is unclear whether these outcomes can be just as beneficial in treating hip dysplasia when it presents in older patients. Therefore, we sought to investigate and compare the pre-and postoperative outcomes of THA for hip dysplasia in older adults to those with end-stage osteoarthritis (OA).

Methods: A prospectively collected database from a single institution was queried from September 1st, 2016 to October 31st, 2021 …

Evaluating Non-Pharmacological Approaches To Nursing Home Dementia Care: A Protocol, Natalie E Leland, Victoria Shier, Catherine V. Piersol, Cara Lekovitch, Jenny Martínez, Yuna H Bae-Shaaw, Neeraj Sood, Claire Day, Paul Cass, Dominique Como, Carin Wong, Felicia Chew

Department of Occupational Therapy Faculty Papers

BACKGROUND: The COVID-19 pandemic has underscored the daily challenges nursing home (NH) staff face caring for the residents living with Alzheimer's Disease and Related Dementias (

METHODS: This clustered randomized trial will compare

CONCLUSION: This trial will be the first-ever evaluation of team- and problem-based approaches to ADRD care across multiple NHs and geographic regions. Results can provide health system leaders and policymakers with evidence on how to optimize ADRD training for staff in an effort to enhance ADRD care delivery.

Age-Related Differences In Kinematics, Kinetics, And Muscle Synergy Patterns Following A Sudden Gait Perturbation: Changes In Movement Strategies And Implications For Fall Prevention Rehabilitation, Woohyoung Jeon, Ahmed Ramadan, Jill Whitall, Nesreen Alissa, Kelly Westlake

Health and Kinesiology Faculty Publications and Presentations

Falls in older adults are leading causes of fatal and non-fatal injuries, negatively impacting quality of life among those in this demographic. Most elderly falls occur due to unrecoverable limb collapse during balance control in the single-limb support (SLS) phase. To understand why older adults are more susceptible to falls than younger adults, we investigated age-related differences in lower limb kinematics, kinetics, and muscle synergy patterns during SLS, as well as their relationship to postural control strategies. Thirteen older and thirteen younger healthy adults were compared during the SLS phase of balance recovery following an unexpected surface drop perturbation. Compared …

Integrating 4ms Assessment Through Medicare Annual Wellness Visits: Comparison Of Quality Improvement Strategies In Primary Care Clinics., Sweta Tewary, Nicole Cook, Desiree Simon, Elizabeth Philippe, Oksana Shnayder, Naushira Pandya

HPD Articles

The Medicare Annual Wellness Visit (AWV), which includes comprehensive preventative assessments and screenings, is associated with improved preventative services, including vaccination and cancer screenings. However, the AWV alone does not promote whole-person care. Integrating the AWV within an Age-Friendly Health System (AFHS) contextualizes AWV services within a comprehensive geriatric care framework that integrates the "4Ms" (mentation, medication, mobility, and what matters). This study describes and evaluates quality improvement initiatives to improve the completion of AWV within two different AFHS-recognized health systems (an academic university clinic and a Federally Qualified Health Center). The results from this evaluation present opportunities that other …

Navigating Life With Hiv As An Older Adult On The Kenyan Coast: Perceived Health Challenges Seen Through The Biopsychosocial Model, Patrick Mwangala, Ryan G. Wagner, Charles Newton, Amina Abubakar

Institute for Human Development

Objectives: This study explores the perceptions of adults living with HIV aged ≥50 years (recognized as older adults living with HIV—OALWH), primary caregivers and healthcare providers on the health challenges of ageing with HIV at Kilifi, a low literacy setting on the coast of Kenya.

Methods: We utilized the biopsychosocial model to explore views from 34 OALWH and 22 stakeholders on the physical, mental, and psychosocial health challenges of ageing with HIV in Kilifi in 2019. Data were drawn from semi-structured in-depth interviews, which were audio-recorded and transcribed. A framework approach was used to synthesize the data.

Results: Symptoms of …

Sarcopenia And Cardiovascular Diseases, Abdulla A Damluji, Maha Alfaraidhy, Noora Alhajri, Namit N Rohant, Manish Kumar, Christina Al Malouf, Samira Bahrainy, Min Ji Kwak, Wayne B Batchelor, Daniel E Forman, Michael W Rich, James Kirkpatrick, Ashok Krishnaswami, Karen P Alexander, Gary Gerstenblith, Peggy Cawthon, Christopher R Defilippi, Parag Goyal

Journal Articles

Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be …

A Structured Life Review Intervention To Improve Life Satisfaction In Home Health Service Patients: A Feasibility Study, Leah Graf

University Scholar Projects

Two million older adults in the U.S. suffer with depression. Adults who live with the difficulties of depression concurrently experience dissatisfaction with life. Life review is a systematic recollection of past events. Dr. Robert Butler postulated that, as the elderly and those with terminal illness approach the end of their lives, there is a resurgence of life experiences in the conscience (1963). A successful life review conducted by an active listener assists the individual to process unresolved conflicts and attain ego-integrity in the final stage of life. Home health services have become an increasingly accepted option for managing chronic illnesses …

Physical Therapy Consultation In The Emergency Department For Older Adults With Falls: A Qualitative Study, Anita Chary, Elise Brickhouse, Beatrice Torres, Lauren Cameron-Comasco, Sangil Lee, Brittany Punches, Rachel M Skains, Aanand D Naik, Catherine C Quatman-Yates, Maura Kennedy, Lauren T Southerland, Shan Liu

Journal Articles

OBJECTIVES: Little is known about current practices in consulting physical therapy (PT) in the emergency department (ED) for older adults with falls, a practice that can reduce fall-related ED revisits. This qualitative study aimed to understand perspectives of ED staff about ED PT consultation for older adults with falls and fall-related complaints, specifically regarding perceived value and associated challenges and strategies.

METHODS: We performed focus groups and key informant interviews with emergency physicians, advanced practice clinicians, nurses, physical therapists, occupational therapists, and technicians who perform ED geriatric screenings. We used rapid qualitative analysis to identify common themes related to decisions …

Comparing The Effectiveness Of Cannabis Use And Opioid Use In Palliative Care Patients, Olivia Grace Finley, Brooke Chalmers, Caroline Spencer, Katherine Lewis

Non-Thesis Student Work

This project aims to study the efficacy of the use of marijuana versus opioids for pain management in patients over 65 years old on palliative care. Palliative care is defined as an approach that focuses on improving the quality of care of seriously ill people and their families (Wallerstedt et. al., 2019). Opioids have been a reliable form of chronic pain relief in the past, but since the legalization of marijuana in some states, it has been presented as an alternative. A search was conducted using key words including marijuana, opioids, palliative care, and pain management. …

Age-Dependent Differences In Frequent Mental Distress (Fmd) Of Us Older Adults Living In Multigenerational Families Versus Living Alone, Debasree Das Gupta, David W.S. Wong

Kinesiology and Health Science Faculty Publications

Frequent mental distress (FMD) is prevalent among older Americans, but less is known about the disparities in the FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared the FMD (≥14 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (≥65 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, the findings indicate 23% lower odds of FMD among older adults living in multigenerational …

Accessibility Of Health Data Representations For Older Adults: Challenges And Opportunities For Design, Peterson Jean, Emma Murphy, Enda Bates

Books/Book Chapters

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations …

Serum 25-Hydroxyvitamin D Response To Vitamin D Supplementation Using Different Lipid Delivery Systems In Middle-Aged And Older Adults: A Randomised Controlled Trial, Aisling F. Mccourt, Steven L. Mulrooney, Graham O'Neill, E. Dolores O'Riordan, Aifric M. O'Sullivan

Articles

Food fortification improves vitamin D intakes but is not yet mandated in many countries. Combining vitamin D with different dietary lipids altered vitamin D absorption in in vitro and postprandial studies. This randomised, placebo-controlled trial examined the effect of the lipid composition of a vitamin D-fortified dairy drink on change in 25-hydroxyvitamin D (25(OH)D) concentrations. Sixty-three healthy adults aged 50+ years were randomised to one of the following for 4 weeks: vitamin D-fortified olive oil dairy drink, vitamin D-fortified coconut oil dairy drink, vitamin D supplement or placebo control dairy drink. All vitamin D groups received 20 µg of vitamin …

Crochet Connections: An Intergenerational Fibre Craft Project, Karen Lints, Ferzana Chaze, Kate Dupuis

Crochet Connections: An Intergenerational Fiber Craft Project

Crochet Connections: An Intergenerational Fibre Craft Project was a research study that brought together Sheridan students and older adults from the community to participate in a crochet group. The research team examined whether an intergenerational group, organized as an activity-based program, could positively benefit participant well-being. This report outlines results from an eight-week crochet program implemented in Fall 2022 at Sheridan College’s Davis Campus in Brampton, Ontario. As an outcome of the crochet group, seven handmade blankest were donated to charity. The study was approved by Sheridan’s Research Ethics Board and funded by a 2022 Sheridan Generator Growth Grant.

Barriers And Enablers Associated With Participation In A Home-Based Pragmatic Exercise Snacking Program In Older Adults Delivered And Monitored By Amazon Alexa: A Qualitative Study, Paul Jansons, Jackson J. Fyfe, Jack Dalla Via, Robin M. Daly, David Scott

Research outputs 2022 to 2026

Background: ‘Exercise snacking’, which is characterised by shorter and more frequent exercise bouts compared with traditional exercise guidelines, may be an acceptable strategy for increasing physical activity and reducing sedentary behaviour in older adults. Aim: The aim of this study was to evaluate the enablers and barriers for older adults associated with participation in a home-based exercise snacking program delivered and monitored using an Amazon Echo Show 5 device (Alexa). Methods: This study used an interpretive description qualitative design to conduct semi-structured interviews following a 12-week pilot study in 15 adults aged 60–89 years with at least one chronic condition. …

The Effect Of High-Speed Power Training On Physical Frailty In Older Adults: Effect Of A Visual-Guided Exercise Program In South Korean Rural Areas, Dong H. Yoon, Jin-Soo Kim, Su S. Hwang, Dong W. Lee, Wook Song

Research outputs 2022 to 2026

Objective. Exercise has been shown to be an effective intervention; the difficulty still lies in providing exercise programs to the older adults in rural areas. Therefore, this study aimed to examine the effects of a 12-week exercise program provided with visual guidelines (prerecorded video) on frailty among older adults in rural areas. Methods. Fifty participants (71.7 ± 4.9 years) from 5 different rural areas were recruited and divided into two groups: the exercise group (EX, n = 24 (male: 8, female: 18)) and the control group (CON, n = 26 (male: 7, female: 17)). With the commencement of the exercise …