• A 1-h time interval between a meal containing iron and consumption of tea attenuates the inhibitory effects on iron absorption: a controlled trial in a cohort of healthy UK women using a stable iron isotope.

      Ahmad Fuzi, Salma F.; Koller, Dagmar; Brugrabber, Sylvaine; Pereira, Dora I. A.; Dainty, Jack R.; Mushtaq, Sohail; University of Chester; Elsie Widdowson Laboratory, Cambridge; University of East Anglia; University Putra Malaysia (American Society for Nutrition, 18/10/2017)
      Background: Tea has been shown to be a potent inhibitor of nonheme iron absorption, but it remains unclear whether the timing of tea consumption relative to a meal influences iron bioavailability. Objective: The aim of the study was to investigate the effect of a 1-h time interval of tea consumption on nonheme iron absorption in an iron-containing meal in a cohort of iron-replete, nonanemic female subjects with the use of a stable isotope (57Fe). Design: Twelve women (mean 6 SD age: 24.8 6 6.9 y) were administered a standardized porridge meal extrinsically labeled with 4 mg 57Fe as FeSO4 on 3 separate occasions, with a 14-d time interval between each test meal (TM). The TM was administered with water (TM-1), with tea administered simultaneously (TM-2), and with tea administered 1 h postmeal (TM-3). Fasted venous blood samples were collected for iron isotopic analysis and measurement of iron status biomarkers. Fractional iron absorption was estimated by the erythrocyte iron incorporation method. Results: Iron absorption was 5.7% 6 8.5% (TM-1), 3.6% 6 4.2% (TM-2), and 5.7% 6 5.4% (TM-3). Mean fractional iron absorption was found to be significantly higher (2.2%) when tea was administered 1 h postmeal (TM-3) than when tea was administered simultaneously with the meal (TM-2) (P = 0.046). An w50% reduction in the inhibitory effect of tea (relative to water) was observed, from 37.2% (TM-2) to 18.1% (TM-3). Conclusions: This study shows that tea consumed simultaneously with an iron-containing porridge meal leads to decreased nonheme iron absorption and that a 1-h time interval between a meal and tea consumption attenuates the inhibitory effect, resulting in increased nonheme iron absorption. These findings are not only important in relation to the management of iron deficiency but should also inform dietary advice, especially that given to those at risk of deficiency. This trial was registered at clinicaltrials.gov as NCT02365103.
    • A 12-week prospective randomized controlled trial to investigate the effects of aerobic training on type 2 diabetes patients

      Sykes, Kevin; Yeung, Tin L. V.; Ko, Gary T. C.; University College Chester (Weston Medical Publishing, 2004)
      This study was undertaken to investigate the effects of a 12-week aerobic exercise program in the management of patients with type 2 diabetes. A prospective randomized controlled trial with repeated measures was conducted. Thirty-six Hong Kong Chinese patients with type 2 diabetes (mean age, 58.1 yr) were randomized into Group 1 (exercise, n = 24) and Group 2 (controls, n = 16). Assessments at baseline and at three months included anthropometry, body fat measurement, biochemistry, six-minute walking distance (6MWD) assessment, exercise capacity, and SF-36® quality of life assessment (QualityMetric Inc., Lincoln, RI). Blood glucose was monitored before and after each exercise session. The immediate response to one hour of moderate aerobic exercise was a significant decrease in blood glucose (10.4 ± 3.5 mmol/L to 7.1 ± 2.7 mmol/L, p < 0.05). After 12 weeks, significant differences were noted between the groups in 6MWD (498 ± 128 m versus 299 ± 75 m, p = 0.000), exercise capacity in terms of metabolic equivalent units (5.1 ± 1.0 METs versus 2.8 ± 0.8 METs, p = 0.001), and insulin sensitivity (1.7 ± 1.0 S1 versus 4.3 ± 2.5 S1, p = 0.048). Group 1 also demonstrated an increase in HDL (1.16 ± 0.30 mmol/L to 1.27 ± 0.33 mmol/L, p = 0.002), lower body weight (67.3 ± 12.8 kg to 66.9 ± 12.8 kg, p = 0.045), lower body mass (26.5 ± 4.6 BMI to 26.3 ± 4.6 BMI), reduced glycosylated hemoglobin HbA1c) (8.1 ± 1.3 percent to 7.7 ± 1.0 percent), and improved quality of life. In contrast, participants in Group 2 showed a significant decrease in the SF-36 social functioning domain (p = 0.035), lowered scores in all eight quality of life domains, and no changes in other variables. We conclude that moderate aerobic exercise should be advocated in the management of patients with type 2 diabetes.
    • Abortion 'on the NHS': The National Health Service and abortion stigma

      Astbury-Ward, Edna; University of Chester (BMJ journals, 05/03/2015)
      Before the creation of the National Health Service (NHS), the health of the British nation was in a perilous state and hospitals survived on the philanthropy of rich benefactors. Following its introduction on 5 July 1948, the NHS was the biggest and most expensive social reform of the era.1 It was founded on three core principles: that it should meet the needs of everyone, that it should be free at the point of delivery, and that its use should be based on clinical need, not ability to pay. These principles govern the NHS today. The NHS should not discriminate against anyone who requires health care. Yet abortion care remains almost the only acute health need not comprehensively provided for within the NHS.2 In England and Wales in 2013, 98% (185 331) of all abortions were funded by the NHS,3 but only 34% of abortions took place in NHS settings. The majority were in the independent sector, funded by the NHS.4 This is in sharp contrast to Scotland, where in 2013 only 40 women out of 12 447 (0.3%) had their abortions in a non-NHS setting.5 The question is why?
    • Acculturation and Food Intake Among Ghanaian Migrants in Europe: Findings From the RODAM Study

      Osei-Kwasi, Hibbah Araba; email: h.a.osei-kwasi@sheffield.ac.uk; Boateng, Daniel; Danquah, Ina; Holdsworth, Michelle; Mejean, Caroline; Terragni, Laura; Powell, Katie; Schulze, Matthias B.; Owusu-Dabo, Ellis; Meeks, Karlijn; orcid: 0000-0003-3032-405X; et al.
      Abstract Objective This study examined the role of migration and acculturation in the diet of Ghanaian migrants in Europe by (1) comparing food intake of Ghanaian migrants in Europe with that of Ghanaians living in Ghana and (2) assessing the association between acculturation and food intake. Design Data from the cross-sectional multicenter study Research on Obesity and Diabetes among African Migrants were used. Food intake was assessed using a Ghana-specific food propensity questionnaire (134 items and 14 food groups); foods were grouped based on a model of dietary change proposed by Koctürk-Runefors. Setting Ghana, London, Amsterdam, and Berlin. Participants A total of 4,534 Ghanaian adults living in Ghana and Europe, with complete dietary data. Of these, 1,773 Ghanaian migrants had complete acculturation data. Main Outcome Measure Food intake (the weighted intake frequency per week of food categories). Analysis Linear regression. Results Food intake differed between Ghanaians living in Ghana and Europe. Among Ghanaian migrants in Europe, there were inconsistent and small associations between acculturation and food intake, except for ethnic identity, which was consistently associated with intake only of traditional staples. Conclusions and Implications Findings indicate that migration is associated with dietary changes that cannot be fully explained by ethnic, cultural, and social acculturation. The study provides limited support to the differential changes in diet suggested by the Koctürk-Runefors’ model of dietary change.
    • Accumulating aerobic exercise for effective weight control

      Sykes, Kevin; Leong, Lau; Cotterrell, Mary; Chester College of Higher Education (Royal Society of Health, 2003)
      The article discusses a study to compare the effects of different patterns of regular treadmill walking and cycle ergometry on body weight, body composition, waist and hip circumferences in overweight adult Singaporean females.
    • Adherence to exercise in later life: How can exercise on prescription programmes be made more effective?

      Thurston, Miranda; Green, Ken; University College Chester (Oxford University Press, 2004-09)
      A broad consensus has emerged in relation to the desirability of promoting exercise among a variety of ‘at risk’ groups via ‘exercise on prescription’ (EoP) schemes, as an alternative to orthodox, biomedical approaches to the management of health problems. Underpinning the rationale for such schemes is the notion that they can act as vehicles for encouraging long-term adherence to exercise. Whilst there is a common sense appeal to using EoP schemes to promote exercise, research to date suggests that evidence of their impact is limited. This paper attempts to make sense of these findings in the light of recent debates about adult lifestyles and exercise. More specifically, it brings work in the sociology of leisure to bear on the topic, on the premise that any study of adults' propensity towards sustainable physical activity needs to be viewed as an aspect of their lives ‘in the round’. Such an analysis points up the value of synthesizing perspectives from across the disciplinary divide in order to shed light on particular ‘problems’, which obviate the necessity for further empirical work. The paper concludes by identifying a number of implications for public health policy and practice with respect to the matter of encouraging lifelong participation in sport and exercise in general, and via EoP schemes in particular. One such implication is the development of a model for understanding participation that shifts the emphasis away from a focus on motivation and behaviour change per se towards satisfaction and enjoyment through the development of skills and relationships. Reconceptualizing the matter of participation in this way is likely to lead not only to a more realistic appreciation of what can be expected from EoP schemes, but also a more adequate understanding of adherence to exercise in later life.
    • Antibacterial activity of Manuka honey and its components: An overview

      Johnston, M; McBride, M; Dahiya, D; Owusu-Apenten, Richard K.; Nigam, Poonam S.; University of Chester, University of Ulster (AIMS Press, 27/11/2018)
      The importance of honey for medicinal purposes is well documented in some of the world’s oldest literature. Honey is well known and studied for its antimicrobial properties. The medicinal properties in honey originate from the floral source used by bees. Manuka honey is a dark monofloral honey rich in phenolic content, and currently it is gaining much attention for its antimicrobial activity. Researchers have found that honey is effective against a wide range of pathogens. The antibacterial potency of Manuka honey was found to be related to the Unique Manuka Factor (UMF) rating, which is correlated with the methylglyoxal and total phenols content. It is reported that different types of Manuka honey have differing effects and Gram-negative bacteria are more resistant than Gram-positive bacteria. Bacterial resistance to honey as antimicrobial agent has yet to be identified, possibly due to the presence of a complex mixture of methylglyoxal and other components. Honey is also reported to alter a bacterium’s shape and size through septal ring alteration, which affects cell morphology and growth. Research has shown that Manuka honey of different UMF values has medicinal properties of interest and it can be beneficial when used as a combination treatment with other antimicrobial agents
    • Antioxidant and genoprotective activity of selected cucurbitaceae seed extracts and LC–ESIMS/MS identification of phenolic components

      Yasir, Muhammad; Sultana, Bushra; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Agriculture, Faisalabad, Pakistan; University of California; Ulster University (Elsevier, 30/11/2015)
      Cucurbitaceae are one of most widely used plant species for human food but lesser known members have not been examined for bioactive components. The purpose of this study was to evaluate the antioxidant and genoprotective activities from three cucurbitaceae seeds extracts and to identify phenolic components by LC–ESIMS/MS analysis. From the results, the yield of seeds extract was 20–41% (w/w) and samples had 16–40% total phenols as gallic acid equivalents (GAE). Compared with methanol solvent, using acidified methanol led to increased extraction yield by 1.4 to 10-fold, higher phenolic content (149.5 ± 1.2 to 396.4 ± 1.9 mg GAE/g), higher DPPH radical quenching and enhanced enoprotective activity using the pBR322 plasmid assay. LC–ESI-MS/MS analysis led to identification of 14–17 components, based on authentic standards and comparison with literature reports, as mainly phenolic acids and esters, flavonol glycosides. This may be the first mass spectrometric profiling of polyphenol components from cucurbitaceae seeds.
    • Antioxidant, Anticancer and Antibacterial Activity of Withania somnifera Aqueous Root Extract

      Barnes, D. A.; Barlow, R.; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain international, 10/11/2015)
      Aims: To evaluate total antioxidant capacity, anticancer activity and antibacterial effects Withania somnifera aqueous-root extracts. Study Design: In vitro study. Place of Study: School of Biomedical Sciences, Ulster University, UK. Methodology: Total antioxidant capacity (TAC) of whole powder and freeze dried W. somnifera aqueous-root extracts was determined using FRAP, DPPH, Folin and ABTS assays. Anticancer activity was accessed using MDA-MB-231 breast cells and Sulforhodamine B staining for cell viability. Antibacterial activity was by disk diffusion assay with penicillin, amoxicillin and streptomycin as positive controls. Results: The TAC for W. somnifera extract was 86, 47, 195,or 443 gallic acid equivalents per 100g dry basis (mgGAE/ 100 g) using FRAP, DPPH, Folin or ABTS assays, respectively. Corresponding TAC values for freeze dried W. somnifera aqueous-root extract were, 418, 553, 1898 or, 1770 (mgGAE/100 g). W. somnifera aqueous-root extract inhibited MDA-MB-231 cell proliferation in a dose-dependent manner with IC50 = 0.19 mg/ml (21 µM GAE). Nil antibacterial effects were detected for freeze dried W. somnifera extract (0-1 mg/ml) across six species of bacteria tested. Conclusion: Withania somnifera root water extract showed significant antioxidant and anticancer activity for MDA-MB-231 breast cancer cells but no antibacterial activity under the conditions of this study.
    • Antioxidant, Anticancer and Antimicrobial, Effects of Rubia cordifolia Aqueous Root Extract

      Barlow, R.; Barnes, D. A.; Campbell, A.; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain international, 10/11/2015)
      Aims: To evaluate the total antioxidant capacity (TAC) of Rubia cordifolia root extracts, to test anticancer activity against MDA-MB-231 breast cancer cell lines, and to evaluate antimicrobial activity of the same extract versus six Gram-positive and negative bacteria. Study Design: In vitro. Place of Study and Duration: School of Biomedical Sciences, Ulster University, July 2014-Sept 2015. Methodology: TAC was tested using ABTS, DPPH, FRAP and Folin assays and values were expressed as mg-gallic acid equivalents per 100 g (GAE/100 g) of sample. Anticancer properties were examined against MDA-MB-231 breast cancer cell lines using Sulforhodamine B assay. Antimicrobial activity was examined using a disk diffusion assay with three Gram-positive (Staphylococcus epidermidis, Staphylococcus aureus and Bacillus cereus) and three Gram-negative (Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi) bacteria. Results: TAC of dry extracts of Rubia cordifolia ranged from 523±43 to 4513±208 (mg GAE mg/100 g) depending on the method of analysis, ABTS> FRAP> Folin > DPPH methods. R. cordifolia dry extract showed cytotoxicity against MDA-MB-231 with IC50 = 44 µg/ml or 5.1µM GAE. No antimicrobial activity was observed against the three Gram-positive, or three Gram-negative bacterial species using the water extract or R. cordifolia. Conclusion: R. cordifolia aqueous extract possess high total antioxidant capacity but values depend on the method of analysis. R. cordifolia extract inhibits MDA-MB-231 breast cancer cells proliferation but nil anti-bacterial activity was observed for three Gram-positive and three Gram-negative bacterial strains tested.
    • Arabinoxylans from rice bran and wheat immunomodulatory potentials: a review article

      Fadel, Abdulmannan; Plunkett, Andrew; Li, Weili; Ranneh, Yazan; Tessu Gyamfi, Vivian Elewosi; Salmon, Yasser; Nyaranga, Rosemarie Roma; Ashworth, Jason (Emerald, 2018-02-12)
    • Arabinoxylans: Bioactivities in Relation to Their Molecular Structure

      Li, Weili; Zhang, Zhengxiao; Smith, Christopher J.; University of Chester; Manchester Metropolitan University (Bentham Science, 09/03/2017)
      Arabinoxylans are a group of compounds with a basic structure consisting of a xylose backbone with arabinose side chains. Variations in structure occur as a result of variations in the xylose chain length, the ratio of arabinose to xylose and the introduction of alternative side-chains. This allows for an enormous potential range of structures. Arabinoxylans are major components of the cell walls of cereals. They have been reported to have numerous health benefits. This chapter presents a systematic description of the molecular features of arabinoxylans and relates these to the different extraction technologies used to obtain them. The proposal, that their immune modulation activity is related to their molecular weight and structure, is presented. Results demonstrating the effects of various arabinoxylans in various in vitro immunological tests are discussed.
    • Are urological patients at increased risks of developing haemostatic complications following shock wave lithotripsy (SWL) for solitary unilateral kidney stones?

      Hughes, Stephen; Thomas-Wright, S. J.; Banwell, J.; Mushtaq, Sohail; Williams, R.; Abdulmajed, I.; Shergill, Iqbal; University of Chester; Wrexham Maelor Hospital (Elsevier, 2014-04-01)
      INTRODUCTION & OBJECTIVES: During the past two years there has been an increase in the number of patients undergoing shock wave lithotripsy (SWL) in Welsh hospitals (United Kingdom) for solitary unilateral kidney stones. Serious complications of SWL include haematuria, acute kidney injury and sepsis. Currently, there are no simple blood tests available, which can predict complications following SWL. Here we have tested the hypothesis that SWL will result in changes to haemostatic function, increase endothelial and haemostatic involvement postoperatively. MATERIAL & METHODS: In this pilot study, ten patients undergoing SWL for solitary unilateral kidney stones, were recruited (n=10). From patients (6 male and 4 female) aged between 31-70 years (mean=50 years), venous blood samples were collected pre-operatively (baseline), at 30 minutes, 120 minutes and 240 minutes postoperatively. Specific haemostatic biomarkers [D-dimer, von Willebrand Factor (vWF), Prothrombin time and sE-selectin] were measured. RESULTS: D-dimer and vWF concentrations were significantly increased from baseline at 240 minutes postoperatively (p=0.05 and <0.01 respectively). Prothrombin time and sE-selectin parameters were not significantly changed following SWL. CONCLUSIONS: The observed increase in D-dimer and vWF concentrations suggests that these markers would provide a more clinically relevant assessment of the extent of haemostatic involvement due to surgery. Analysis of such markers, have the potential to improve the detection of complications occurring postoperatively, such as haematuria and acute kidney injury.
    • Aspartame in conjunction with carbohydrate reduces insulin levels during endurance exercise

      Siegler, Jason; Howell, Keith; Vince, Rebecca; Bray, James W.; Towlson, Chris; Peart, Daniel; Mellor, Duane; Atkin, Stephen; University of Western Sydney ; University of York ; University of Hull ; University of Hull ; University of Hull ; University of Hull ; University of Chester ; University of York (01/08/2012)
      As most sport drinks contain some form of non-nutritive sweetener (e.g. aspartame), and with the variation in blood glucose regulation and insulin secretion reportedly associated with aspartame, a further understanding of the effects on insulin and blood glucose regulation during exercise is warranted. Therefore, the aim of this preliminary study was to profile the insulin and blood glucose responses in healthy individuals after aspartame and carbohydrate ingestion during rest and exercise. Each participant completed four trials under the same conditions (45 min rest + 60 min self-paced intense exercise) differing only in their fluid intake: 1) carbohydrate (2% maltodextrin and 5% sucrose (C)); 2) 0.04% aspartame with 2% maltodextrin and 5% sucrose (CA)); 3) water (W); and 4) aspartame (0.04% aspartame with 2% maltodextrin (A)). Insulin levels dropped significantly for CA versus C alone (43%) between pre-exercise and 30 min, while W and A insulin levels did not differ between these time points. Aspartame with carbohydrate significantly lowered insulin levels during exercise versus carbohydrate alone.
    • The BACPR standards and core components for cardiovascular prevention and rehabilitation 2012

      Jones, Jenni; Buckley, John P.; Furze, Gill; Doherty, Patrick; Speck, Linda; Connolly, Susan; Hinton, Sally; British Association for Cardiovascular Prevention and Rehabilitation ; University of Chester ; British Association for Cardiovascular Prevention and Rehabilitation ; British Association for Cardiovascular Prevention and Rehabilitation (British Association for Cardiovascular Prevention and Rehabilitation, 2012)
      This booklet sets out the seven core standards that patients, health care professionals, and commissioners should expect from a high quality cardiac rehabilitation programme.
    • Blacon Sure Start parent satisfaction survey

      Barrow, Marjorie; Rouse, Julia; Thurston, Miranda; Chester College of Higher Education (Unversity College Chester, 2003-11)
      This report evaluates Sure Start in Blacon during 2003.
    • Borg's scales in strength training: From theory to practice in young and older adults

      Buckley, John P.; Borg, Gunnar A. V.; University of Chester ; University of Stockholm (Human Kinetics Publishers, 2011)
      This article discusses a study which applied Borg's psychophysical equation to measuring responses to strength training with weights machines.
    • Characterization of Nitric Oxide Modulatory Activities of Alkaline-Extracted and Enzymatic-Modified Arabinoxylans from Corn Bran in Cultured Human Monocytes

      Zhang, Zhengxiao; Smith, Christopher J.; Li, Weili; Ashworth, Jason J.; Manchester Metropolitan University; University of Chester (American Chemical Society, 10/10/2016)
      The ingestion of foods and food-derived substances that may mediate the immune system is widely studied. Evidence suggests cereal arabinoxylans (AXs) have immunomodulatory activities that may impart health benefits in terms of immune enhancement. This study extracted AXs from corn bran using alkali and developed a modification process using three endoxylanases to obtain fractions of lower molecular weight ranges. In vitro studies showed extracted and modified AXs significantly (P < 0.05) elevated nitric oxide (NO) synthesis by the human U937 monocytic cell line (ranging from 53.7 ± 1.1 to 62.9 ± 1.2 μM per million viable cells) at all concentrations tested (5–1000 μg/mL), indicative of immune enhancement compared to an untreated control (43.7 ± 1.9 μM per million viable cells). The study suggested the dose range and Mw distribution of AXs are key determinants of immune-modulatory activity. AXs in the low Mw range (0.1–10 KDa) were the most effective at inducing NO secretion by U937 macrophages at low AX concentration ranges (5–50 μg/mL), with NO production peaking at 62.9 ± 1.2 μM per million viable cells with 5 μg/mL of AX (P = 0.0009). In contrast, AXs in the high Mw range (100–794 kDa) were most effective at inducing NO at high AX concentration ranges (500–1000 μg/mL) with NO production reaching a maximum of 62.7 ± 1.3 μM per million viable cells at 1000 μg/mL of AX (P = 0.0011). The findings suggest that dietary AXs from corn bran may heighten innate immune responses in the absence of infection or disease.
    • Cheshire Children's Fund learning mentor service: An evaluation

      Davies, Sarah; Thurston, Miranda; Killey, Mona; University College Chester (University College Chester, 2004-11)
      This report describes a learning mentor service based in a number of Chester primary schools and assesses whether the service is benefiting users, meeting Children's Fund objectives, and how the service is performing.
    • Chester treadmill police tests as alternatives to 15-m shuttle running

      Morris, Michael; Deery, Elizabeth; Sykes, Kevin; Department of Clinical Sciences & Nutrition, University of Chester, Parkgate Road, Chester CH1 4BJ, UK (Oxford University Press, 2019-04-13)
      Background Police officers require a specific level of aerobic fitness to allow them to complete personal safety training and specialist roles. Officers’ aerobic fitness is assessed using the 15-m multi-stage fitness test (MSFT); however, due to the agility required and risk of injury, two alternative treadmill tests have been designed to predict four of the key minimum VO2 criteria of 35, 41, 46 and 51 ml·kg−1·min−1. Aims To investigate the validity and reliability of Chester Treadmill Police Walk Test (CTPWT) and Chester Treadmill Police Run Test (CTPRT). Methods Seventy-eight UK police officers (18 females) completed the CTPWT (n = 53) or CTPRT (n = 35), or both, generating a total of 88 data sets. To assess reliability, 43 participants returned for a second visit (T2), to repeat the treadmill test. Results Mean differences between predicted and actual VO2 at 35, 41, 46 and 51 ml·kg−1·min−1 were as follows −1.1, −2.1, −0.1 and −1.2 ml·kg−1·min−1. Despite a significant under prediction (p = 0.001), a minimum of 92% of participants were within 10% of target VO2 at all levels. There was no significant difference between actual and predicted VO2 in the CTPRT, at 46 ml·kg−1·min−1 (T1 46.0 ± 1.4 or T2 45.1 ± 1.3 ml·kg−1·min−1). Similarly, there was no significant difference at 51 ml·kg−1·min−1 (T2 50.5 ± 1.4 ml·kg−1·min−1). We observed no differences for gender or trial. Ninety-five per cent limits of agreement were at worst T1–T2 −0.25 ± 4.0 ml·kg−1·min−1. Conclusions The CTPWT and the CTPRT provide a valid and reliable alternative to the 15-m MSFT. Key words Exercise testing; fitness; fitness standards; occupational; police; predictive; treadmill test.