Artificial intelligence (AI) and machine learning (ML) are rapidly transforming the medical field. The aim of this review was to outline the current scientific state of AI and ML application in sports medicine, evaluate the level of clinical validation and readiness for implementation, and identify key priorities to guide future advancements and implementation into injury risk assessment, diagnosis, rehabilitation and clinical decision-making in sport medicine. A scoping review was conducted with a literature search performed on February 5, 2026, using the MEDLINE, EMBASE and Web of Science databases which targeted AI or ML application on individuals within a sports medicine context. Of 8,677 studies, 97 studies were included. Most research covered orthopaedics (70.1%) and neurology (18.6%), where AI was applied for injury prediction, diagnostic image analysis, and recovery estimation. Predictive and estimation models were the dominant application (57.7%). Reported discriminative performance was frequently high. However, the majority of studies relied on retrospective datasets and internal validation. Calibration reporting was uncommon, and prospective workflow integration was rare, with a single study attempting an interventional prevention strategy. Substantial heterogeneity in modelling approaches, data inputs, and outcomes definitions was observed. Although AI and ML applications in sports medicine frequently demonstrate strong within-sample performance, most remain in early-stage development. Currently, these tools should be viewed as supportive adjuncts rather than autonomous decision-making systems. AI, Predictive modeling, Diagnostic imaging, Rehabilitation, Deep learning, Return to sport.
BACKGROUND: This study aims to understand the perspectives of healthcare workers who are involved in the care of patients about the factors that impact access to and participation in rehabilitation services for people with amputation in Southern Ethiopia, with a particular focus on gender aspects of both persons with amputation and healthcare workers. METHODS: A qualitative study was conducted using semi-structured one-to-one, face-to-face interviews with 22 eligible healthcare workers from hospitals and rehabilitation centers in Southern Ethiopia. This study employed a Community-Based Participatory Research (CBPR) approach from 14 October 2022 to 16 January 2023 using consultative workshops with experts and engaged community members as Local Research Advisory Committees (LRACs). Two research assistants conducted interviews, which were recorded, transcribed, and securely stored in a password-protected cloud. The data were then analyzed using reflective thematic analysis. The research team reviewed and agreed upon the themes, sub-themes, and their meanings, using mind-maps to highlight interconnectivity. RESULTS: The study identified five themes with interconnecting sub-themes: Barriers to accessing rehabilitation services (knowledge and awareness of rehabilitation services, fear and violence, culture and belief, long distance, transportation challenges and financial constraints, physical environment and, acceptability and utilization of prosthesis and rehabilitation services related barriers), Resources (quality of materials and physical infrastructure, and workforce), Rehabilitation system (rehabilitation to support independent living, engagement, and service design), Perceptions of patient’s experiences (psychological/emotional, relationships and copings, and physical), and Health outcomes (pain, wound, and prosthetic discomfort). CONCLUSIONS: This study provides a unique contribution to understanding access (barriers/ issues) to rehabilitation, particularly highlighting the complex issues faced by women with amputations. The insights of health workers illustrate the multifaceted struggles of women and the reality of compromising their rights to equal and personalized rehabilitation services. It highlights the need for gender-inclusive programs, addressing financial constraints, limited decision-making capacity, and transportation issues. Community-based programs, cultural expectations, and innovative prosthetic design approaches are crucial for empowering women as well as promoting gender diversity in healthcare professionals.
BACKGROUND: Kinesio taping, as a non-invasive, non-pharmacological elastic taping technique, has become increasingly popular in sports injury management due to its safety, non-restrictive nature, and lack of interference with joint movement. This study aims to evaluate whether conventional comprehensive rehabilitation combined with kinesio taping can more effectively improve rehabilitation outcomes in military personnel following surgery for recurrent shoulder dislocation caused by training injuries. METHODS: Sixty military personnel with recurrent shoulder dislocation caused by training injury were selected and randomly divided into a study group and a control group, with 30 cases in each group.The control group received conventional rehabilitation therapy, including physical agent modalities (ultrasound), cryotherapy and exercise therapy. The study group received, in addition to all treatments administered to the control group, shoulder-specific kinesio taping (using I-strip, Y-strip, and fan-cut strips applied over the supraspinatus muscle, deltoid muscle, and glenohumeral joint area, changed daily). After 6 weeks of treatment, shoulder joint range of motion, UCLA(The university of California at Los Angeles shoulder rating scale)score, and Constant-Murley score were compared between the two groups. RESULTS: After treatment, the range of motion for shoulder flexion, abduction, internal rotation, external rotation, and extension increased in both groups compared to pre-treatment values (P < 0.05). Similarly, the UCLA and Constant-Murley scores also improved significantly in both groups (P < 0.05). The study group demonstrated significantly greater improvements in shoulder joint mobility (P < 0.05), UCLA score (P < 0.05), and Constant-Murley score (P < 0.05) compared to the control group. CONCLUSION: Conventional comprehensive rehabilitation therapy combined with kinesio taping can better improve the range of motion and activities of daily living in postoperative military personnel with recurrent shoulder dislocation caused by training injury.
Pulmonary arterial hypertension (PAH) and related pulmonary hypertension populations are associated with impaired exercise capacity and reduced quality of life. Supervised exercise rehabilitation is recommended for clinically stable patients, but the relative effects and certainty of evidence for different exercise components and combinations remain uncertain. We conducted a systematic review and Bayesian network meta-analysis of randomised controlled trials. The review was initiated on 1 July 2025 and registered in PROSPERO on 18 July 2025. PubMed, Embase, Web of Science, the Cochrane Library, CNKI, VIP and Wanfang were searched from database inception, defined as the earliest records indexed in each database, to 2 June 2026, together with reference lists and trial registries. Eligible interventions were aerobic exercise (AE), resistance exercise (RE), breathing training (BT), aerobic exercise plus resistance exercise (AE + RE), aerobic exercise plus breathing training (AE + BT), and usual care (UC). Analyses used change-from-baseline values when available and post-intervention endpoint values otherwise. Risk of bias was assessed with RoB 2. Network estimates were reported as mean differences (MDs) with 95% credible intervals (CrIs). Certainty of evidence was assessed using the GRADE approach adapted for network meta-analysis and the Confidence in Network Meta-Analysis (CINeMA) framework. Sixteen trials involving 644 participants were included. For health-related quality of life measured using the Short Form-36 (SF-36), AE + RE showed a favourable but imprecise signal, and the credible interval did not exclude no clear effect. For 6-min walk distance (6MWD), BT showed the largest estimated improvement versus UC; however, this finding was based on limited direct evidence and should be interpreted cautiously. AE + BT improved peak oxygen uptake compared with UC. Evidence for forced expiratory volume in 1 s percentage predicted (FEV1%) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was particularly sparse and imprecise, and no firm conclusions could be drawn for these outcomes. Overall, certainty of evidence was generally low or very low for many active-intervention comparisons because of sparse networks, wide credible intervals, risk of bias and clinical indirectness. Supervised exercise-based rehabilitation showed favourable signals for selected outcomes assessed mainly at the end of the intervention in adults with PAH and related pulmonary hypertension populations. However, the evidence remains uncertain because several networks were sparse, credible intervals were wide, direct active-versus-active comparisons were limited, and certainty of evidence was generally low or very low. SUCRA rankings should be interpreted only as exploratory signals and not as confirmatory evidence for choosing one exercise modality over another. In particular, the favourable ranking of AE + RE for SF-36 should not be considered clear superiority for quality of life. Larger, adequately powered and subtype-stratified trials with standardised exercise prescriptions, harmonised safety reporting and longer follow-up are needed. PROSPERO CRD420251107670.
The impact of preoperative rehabilitation on bone mineral density (BMD) and tendon-bone healing in anterior cruciate ligament reconstruction (ACLR) patients is unknown. A total of 53 ACL rupture patients were randomized into 2 groups (Control Group [CON, n = 27] and Exercise rehabilitation group [ER, n = 26]). The CON received conventional treatment, and the ER group received 6-week exercise on this basis. Subsequently, both groups underwent ACLR. At baseline, after 3, 6 and 12 months post-ACLR, the knee BMD, magnetic resonance imaging, and physical function were measured. The BMD of lateral femur condyle (LFC) in ER group was higher than CON group at 3 and 6 months post-ACLR (p = 0.004, 0.01). The signal/noise quotient (SNQ) of proximal and distal segments in ER group were lower than CON group at 6 and 12 months post-ACLR (p = 0.02, 0.03). The medial femoral condyle cartilage thickness in ER group was begun thicker than CON group at 3 months post-ACLR (p = 0.04). At 6 months post-ACLR, the relative peak torque of the quads and hamstrings, the balance composite score, the Lysholm and IKDC scores in the ER group were better than CON group (Quads p = 0.02; Hamstrings p = 0.01; balance p < 0.001; Lysholm p < 0.001; IKDC p < 0.001). The difference value of BMD from baseline to 3 months post-ACLR in medial femoral condyles (MFC) exhibited positive correlations with 6 and 12 months post-ACLR within distal autograft SNQ (p = 0.025; 0.011). ACLR patients who undergo preoperative rehabilitation can effectively delay the decline of BMD in the LFC, enhance the tendon-bone healing, improve the knee articular cartilage thickness and advance the physical function. The less the early BMD of MFC loss in early postoperative, the better the later tendon-bone healing within or near the tibial tunnel. PRS, NCT05924178. Registered 28 May 2023, www. gov.
Adolescent new psychoactive substance (NPS) users represent a high-risk population with complex psychological needs that remain insufficiently characterized, limiting the development of targeted rehabilitation interventions. This study aimed to (1) characterize the personality trait profiles and psychological symptom patterns of adolescent NPS users undergoing compulsory drug rehabilitation relative to normative standards; (2) identify empirically derived personality-based subgroups within this population; and (3) examine differential psychological symptom patterns across identified subgroups to inform precision intervention design. A cross-sectional study was conducted with 60 adolescent male participants (mean age = 17.2 ± 1.9 years) recruited from a compulsory drug rehabilitation facility in Shandong Province, China. Participants completed a multimodal assessment battery comprising Cattell's 16 Personality Factor Questionnaire (16PF), the Personality Diagnostic Questionnaire-4+ (PDQ-4+), and the Symptom Checklist-90-Revised (SCL-90-R). Personality-based subgroups were identified using a two-stage cluster analysis (Ward's method followed by K-means), with cluster quality evaluated via Average Silhouette Width and split-sample Adjusted Rand Index. Between-cluster differences in psychological symptom profiles were examined using one-way ANOVA with Tukey post-hoc comparisons. Hierarchical multiple regression identified independent personality predictors of overall psychological distress (SCL-90-R Global Severity Index, GSI). Fourteen of 16 personality factors deviated significantly from Chinese adolescent norms (all corrected p < .05), with the largest deviations observed for Tension (Q4; d = 1.38), Rule-Consciousness (G; d = 1.30↓), Apprehension (O; d = 1.24), and Emotional Stability (C; d = 1.13↓). Overall psychological distress was pervasive, with 81.7% of participants exceeding the GSI clinical significance threshold (GSI ≥ 1.0; mean GSI = 1.52 ± 0.43). Paranoid Ideation emerged as the most severely elevated SCL-90-R dimension (d = 1.39), followed by Interpersonal Sensitivity (d = 1.09) and Anxiety (d = 1.02). Cluster analysis identified three empirically stable personality-based subgroups: Dysregulated-Hostile (n = 22, 36.7%), Anxious-Withdrawn (n = 21, 35.0%), and Impulsive-Sensation-Seeking (n = 17, 28.3%; Average Silhouette Width = 0.58; split-sample ARI = 0.71). The three clusters demonstrated clinically meaningful differential symptom profiles: the Dysregulated-Hostile cluster was characterized by elevated Hostility and Paranoid Ideation; the Anxious-Withdrawn cluster by elevated Anxiety, Depression, and Obsessive-Compulsive symptoms; and the Impulsive-Sensation-Seeking cluster by relatively lower overall distress with elevated personality disorder tendencies. Hierarchical regression revealed that 16PF personality factors explained an additional 48.7% of variance in GSI beyond demographic covariates (ΔR² = 0.487, ΔF(6, 49) = 14.38, p < .001), with Tension (Q4; β = 0.318), Emotional Stability (C; β = -0.312), and Apprehension (O; β = 0.287) as the strongest independent predictors. Adolescent NPS users in compulsory rehabilitation present a distinctive high-risk personality configuration and a substantial psychological distress burden that is not uniformly distributed across the population. Three empirically derived personality-based subgroups with differential symptom profiles provide preliminary, hypothesis-generating evidence that should be validated in a larger, multisite cohort before informing the development of differentiated, precision intervention strategies. Personality assessment at treatment intake-particularly targeting Tension, Emotional Stability, and Apprehension-offers clinically meaningful predictive information for distress severity that substantially exceeds demographic screening alone. These findings complement the gut microbiota-exercise intervention framework being developed in our companion, currently in-press trial and represent a critical step toward a precision medicine model for adolescent NPS rehabilitation that integrates personality-based stratification with physiologically targeted exercise interventions.
In medicine and sports science, 'acute' denotes short-term or single-session effects, whereas 'non-acute' pertains to long-term, sustained training outcomes. Hypertensive patients need to exercise with caution, especially during isometric exercises, as such exercises may cause a sharp increase in blood pressure. However, long-term non-acute training may bring antihypertensive effects through mechanisms such as improving vascular function and reducing peripheral resistance, without causing acute risks. Therefore, long-term training may be safer than acute exercise. This article explores the cumulative effects of long-term training and quantifies the effects of long-term isometric contraction training on blood pressure (SBP, DBP) values in hypertensive patients, and provides evidence-based guidance for clinical doctors and rehabilitation therapists. This study was registered in the PROSPERO database, and qualified studies were identified through systematic searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Controlled Trial Center Registry, and EBSCO. The quality evaluation adopted the Cochrane Collaboration Network RCT bias assessment tool, using RevMan 5.4 software for data synthesis, forest plot creation, publication bias assessment, forest map creation, and publication bias assessment. This study has been registered at the National Institute for Health and Care Research (PROSPERO), ID: CRD42024602119. Five randomized controlled trials conducted in English were analyzed. The results showed modest changes in blood pressure relative to the control group: systolic blood pressure (SBP) decreased by an average of 2.31 mmHg (95% CI: -4.37 to 8.98), while diastolic blood pressure (DBP) saw a slight drop of 1.34 mmHg (95% CI: -6.31 to 3.44). As the confidence intervals include zero and show no statistical significance (p > 0.05), these reductions are not statistically significant but may suggest a potential effect worthy of further investigation. Although modest reductions in SBP and DBP were observed, the magnitude of change (mean SBP reduction: 2.31 mmHg) is below the clinically significant threshold of ≥ 5 mmHg recommended for hypertension management. Current evidence does not support isometric resistance training (IRT) as a standalone effective intervention. However, it may be considered a complementary approach within multimodal non-pharmacological strategies.
Upper limb impairment is a common consequence of stroke and can markedly limit independence in daily life. Virtual reality (VR) and motion-sensing games incorporating swing-based elements have increasingly been used in rehabilitation, but their effectiveness for post-stroke upper limb recovery remains unclear. This article aims to systematically evaluate the effectiveness of VR/motion-sensing games incorporating swing-based elements on upper limb function after stroke. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251141175). PubMed, Web of Science, Scopus, and the Cochrane Library were searched from January 1999 to September 2025 for randomized controlled trials. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic and Cochran's Q test. Sensitivity and subgroup analyses were performed, and publication bias was explored using funnel plots and Egger's test. Ten randomized controlled trials involving 426 participants were included. Compared with conventional therapy, virtual reality/motion-based games incorporating swing-like elements demonstrated significant improvement in upper limb functional recovery. The overall meta-analysis showed a merge standardized mean difference of 0.64 (95% CI: 0.44, 0.84) in favour of the intervention group. Substantial between-study heterogeneity was observed (I² = 82.2%, p < 0.001). Exploratory subgroup analyses suggested relatively larger effects in older participants and in those with longer stroke duration, although these findings should be interpreted cautiously. Sensitivity analysis showed that the pooled effect was stable, and Egger's test did not indicate significant publication bias (p = 0.454). VR/motion-sensing games incorporating swing-based elements may improve upper limb function after stroke and could serve as a useful adjunct to conventional rehabilitation. Further rigorously designed trials with standardized protocols are required to strengthen the evidence base and determine optimal intervention strategies.
To describe the handgrip strength, lifestyle patterns (i.e., physical activity), and body composition of Chilean adult divers of different blood pressure status. Secondly, to associate body fat (BF), fat-free mass (FFM), and bone mineral content (BMC) with blood pressure. A cross-sectional study was conducted in adult divers men. Participants were categorized into; hypertensive (HTN, n = 41), high blood pressure (HBP, n = 19), or normotensive (NT, n = 35). Primary outcomes were blood pressure, Total and segmental BF %, FFM, and BMC assessed by dual-X absorptiometry. Secondary outcomes comprised handgrip strength (HGSav), repetitions in Ruffier test and physical activity. Total and segmental BF % were consistently higher in HTN compared with HBP and NT divers, particularly in total BF (+ 2.8%), arms (BFA+2.8%), right arm (BFRA +1.4 to + 3.2%), left arm (BFLA +1.6 to + 2.5%), and trunk (BFT +3.4%; all P ≤ 0.05). Age (β = 0.4, [95%CI] 0.1; 0.6, P = 0.0004) and total BF % (β = 1.0, [95%CI] 0.1; 0.6, P = 0.0004) were significant predictors of SBP in Chilean divers. Total fat-free mass (FFM) does not significantly predict SBP or DBP. Total BMC shows a significant association with SBP (β = - 0.007, [95%CI] - 0.01; 0.0002, P = 0.050). Hypertensive Chilean divers show a linear trend to decrease HGSav, low cardiovascular fitness, and higher BF than NT peers. There was a significant association between Total BF and Total BMC parameters with both SBP, where segmentally FFM of legs and left leg was associated with both SBP and DBP.
OBJECTIVE: Compare neuromuscular alterations of the ankle joint between individuals with chronic ankle instability (CAI) and copers who both experienced lateral ankle sprain (LAS) to examine the functional differences and guide rehabilitation strategies. DESIGN: Systematic review and meta-analysis. DATA SOURCE: A comprehensive search of PubMed, Web of Science, Embase, SPORTDiscus, and Scopus databases from inception to 1 December, 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies and randomized controlled trials (RCTs) comparing neuromuscular function between copers and CAI patients were included. RESULTS: Fifteen studies including 627 participants were analyzed. Meta-analysis showed CAI individuals exhibited delayed peroneus longus (PL) latency (g = -1.17, 95% CI: -1.62 to -0.73), and increased tibialis anterior (TA) and medial gastrocnemius (MG) activation (g = -0.49 and g = -0.35, respectively) compared to copers. No significant differences were observed in PL activation or co-contraction indices. Muscle morphology and performance showed inconsistent outcomes across studies, preventing meta-analysis. CONCLUSION: Findings from meta-analyses indicate that copers exhibit different neuromuscular functional alterations compared to individuals with CAI. However, whether these alterations are compensations in response to LAS is still unclear. Clarifying this distinction may inform understanding of CAI development and generate hypotheses for future rehabilitation research. TRIAL REGISTRATION: CRD42024623852. Date of Registration 19.12.2024.
Pilates-based exercise has gained attention as a non-pharmacological rehabilitation strategy for people with multiple sclerosis (MS), yet the comparative effectiveness of different Pilates modalities remains uncertain. This systematic review and network meta-analysis evaluated and ranked Pilates-based interventions for functional mobility, balance, walking performance, fatigue, and health-related quality of life in adults with MS. PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to October 24, 2025. Eligible studies were randomized controlled trials of structured Pilates-based interventions lasting at least four weeks in adults with MS. The primary outcome was functional mobility measured by the Timed Up and Go test. Secondary outcomes included balance, walking endurance, fatigue, walking performance, and MS-specific quality of life. A frequentist random-effects network meta-analysis was performed; treatment ranking was summarized using SUCRA, risk of bias using RoB 2, and certainty of evidence using GRADE-NMA through CINeMA. Twenty-two randomized controlled trials involving 901 participants were included. Pilates ranked first for functional mobility and significantly improved Timed Up and Go performance versus control (MD: -5.23 s; 95% CI: -6.39 to -4.06). It also ranked first for balance, with a mean improvement of 8.58 points on the Berg Balance Scale (95% CI: 7.86 to 9.30). Pilates combined with Pilates-based telerehabilitation ranked highest for the 6-Minute Walk Test (MD: 50.81 m; 95% CI: 0.16 to 101.46) and significantly improved Fatigue Severity Scale scores. Home-based Pilates showed the largest reduction in Modified Fatigue Impact Scale scores. No comparison reached high certainty under GRADE-NMA. Pilates-based interventions may improve mobility, balance, walking endurance, fatigue, and quality of life in people with MS. Sparse networks, risk of bias, heterogeneity, imprecision, and limited follow-up warrant cautious interpretation. Adequately powered trials with standardized protocols are needed before routine implementation can be recommended.
Despite the high prevalence of knee osteoarthritis, the anatomical factors that characterize distinct deformity patterns remain unclear. This study aimed to compare the three-dimensional (3D) lower-limb musculature between varus and valgus knee osteoarthritis (OA) using an artificial intelligence (AI)-based computed tomography (CT) segmentation, evaluating whole-muscle volume, fatty degeneration, and morphological differences to inform targeted prevention, treatment, and rehabilitation strategies. This retrospective study included 75 patients who underwent CT imaging before total knee arthroplasty for end-stage knee OA. Patients were categorized into valgus (femorotibial angle [FTA] ≤ 176°) and varus (FTA > 176°) groups. A validated Bayesian U-Net-based AI segmentation model was used to reconstruct 3D musculature and quantify muscle volume and Hounsfield unit (HU) values. Twenty-three muscle compartments were analyzed. For the vastus medialis and tensor fasciae latae (TFL), intramuscular fat volume was additionally quantified using Mimics to calculate fat percentage. Between-group comparisons were performed using the Mann-Whitney U test, and false discovery rate correction was applied for multiple comparisons. The valgus group (n = 16) demonstrated significantly smaller muscle volumes in the biceps femoris, TFL, and superficial posterior compartment than the varus group (n = 59) after false discovery rate correction. The HU value of the TFL was significantly lower in the valgus group. The vastus medialis showed a lower HU value before correction; however, this difference did not remain significant after false discovery rate correction. Mimics-based fat quantification revealed no significant difference in the fat percentage of the vastus medialis, whereas the TFL showed significantly higher fat infiltration in valgus knees. Correlation analyses using FTA as a continuous variable showed that greater valgus alignment was associated with lower TFL muscle volume, lower TFL HU values, and greater TFL fat infiltration. AI-assisted CT-based 3D analysis revealed distinct muscle morphologies and fatty degeneration patterns in varus and valgus knees of patients with OA. Valgus knees exhibited characteristic reductions in the posterior and lateral muscle groups and increased fatty infiltration of the TFL. These deformity-specific muscular alterations may inform personalized rehabilitation strategies and help elucidate the factors contributing to the progression of OA. Not applicable.
Exercise interventions present advantageous outcomes for patients with Coronary Artery Disease (CAD). Nevertheless, there is a persistent discourse surrounding the optimal exercise modality, particularly in CTE. This research employed meta-analysis to identify the most effective exercises for improving cardiorespiratory fitness in CAD patients. This systematic review comprehensively searched databases like Web of Science, PubMed, Embase, SPORTDiscus, Cochrane Library, CNKI, and Wanfang for RCTs on exercise interventions in CAD patients published from January 1, 2010, to December 31, 2023. Two researchers screened the literature and extracted data using predefined criteria. The included studies were then assessed for quality, subgroup analysis, sensitivity analysis, and publication bias evaluation. This study included 23 literatures with a total of 1,730 CAD patients. The evaluated exercise modalities comprised aerobic exercise (AE), high-intensity interval training (HIIT), aerobic combined with resistance exercise (AE&RE), Chinese traditional exercise (CTE), and aerobic combined with Chinese traditional exercise (AE&CTE). The results demonstrated that exercise intervention had a significant impact on various physiological parameters, including oxygen consumption peak (VO2 peak) (MD = 2.86, 95%CI: 2.00 ~ 3.73, P < 0.001), oxygen pulse (O2 pulse) (MD = 1.55, 95%CI: 0.57 ~ 2.53, P < 0.01), left ventricular ejection fraction (LVEF) (MD = 3.56, 95%CI: 1.61 ~ 5.52, P < 0.01), and anaerobic threshold (AT) (MD = 2.00, 95%CI: 1.16 ~ 2.84, P < 0.01), with significant improvements observed. Subgroup analysis found that all exercise modalities (AE&CTE, HIIT, AE&RE, and AE) were associated with significant improvements in VO2 peak, with AE&CTE (MD = 3.62) and HIIT (MD = 3.60) showing numerically larger effect sizes, followed by AE&RE (MD = 2.67) and AE (MD = 2.59). LVEF improvements were observed across AE&RE (MD = 2.49) and AE subgroups (MD = 3.05), while O2 pulse showed increase in the AE&CTE (MD = 2.16) and AE&RE subgroups (MD = 1.03). For AT, AE&RE (MD = 2.03) demonstrated notable improvements. Exercise intervention significantly improves VO2 peak, O2 pulse, LVEF, and AT in patients with CAD. Numerically larger effect estimates were observed for AE&CTE and HIIT on VO2 peak, for AE&CTE and AE&RE on O2 pulse, and for AE&RE on LVEF and AT. In clinical or rehabilitation settings, exercise prescriptions should be tailored to the individual patient's specific functional deficits and therapeutic objectives.
Exercise is a core approach in stroke rehabilitation, yet updated evidence on its effects on the Berg balance scale (BBS), modified Barthel index (MBI), and Fugl-Meyer assessment of upper extremity motor function (FMA-UE) remains limited. This study systematically evaluated the effects of exercise interventions on these three outcomes. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from January 2015 to March 2025 for randomized controlled trials. Meta-analysis was performed using RevMan 5.4, and a meta-regression analysis was performed to explore the dose‒response relationship between exercise dose and improvements in FMA-UE scores. The minimal clinically important difference (MCID) was used to derive an optimal dose threshold. Nineteen RCTs involving 1,041 participants were included. Exercise significantly improved the MBI (SMD = 0.95, 95% CI: 0.42-1.49), BBS (SMD = 0.73, 95% CI: 0.24-1.22), and FMA-UE (SMD = 0.62, 95% CI: 0.16-1.07) scores. The meta-regression analysis revealed a linear relationship (MD = 1.5252 + 0.0003 × total dose). The optimal dose threshold for achieving an MCID of 5 points was approximately 11,580 min (193 h). Exercise improves balance, daily activities, and upper limb function in stroke patients. The proposed "193-hour concept" provides a preliminary cumulative dose target for clinically meaningful upper limb recovery, pending prospective validation. PROSPERO registration: CRD420251272336.
OBJECTIVE: The relationship between muscle function recovery and biomechanical alterations after anterior cruciate ligament reconstruction (ACLR) during high-risk movements remains unclear. This study aimed to investigate lower-limb muscle strength across multiple angular velocities (concentric and eccentric contractions) and knee biomechanics during side-cutting at 9 months post-ACLR, and to explore their association. METHODS: Thirty-six participants (21 males, 15 females) at 9 months post-ACLR completed three-dimensional motion analysis during side-cutting and isokinetic strength testing (concentric: 60, 180, 300°/s; eccentric: 60°/s). Paired t-tests analyzed interlimb differences; Spearman’s correlation assessed limb symmetry index (LSI) correlations. RESULTS: The reconstructed limb demonstrated reduced peak knee flexion angle (P < 0.001, Cohen’s d = 0.91), extension moment (P < 0.001, Cohen’s d = 1.05), and vertical ground reaction force (P = 0.011, Cohen’s d = 0.45), alongside increased external rotation angle (P = 0.035, Cohen’s d = 0.37). Concentric quadriceps strength was weaker at 60°/s (P = 0.010, Cohen’s d = 0.46), 180°/s (P = 0.001, Cohen’s d = 0.58) and 300°/s (P = 0.001, Cohen’s d = 0.62), concentric hamstring strength was also reduced at 300°/s (P = 0.037, Cohen’s d = 0.36). Knee flexion angles showed a strong positive correlation with concentric quadriceps strength at 180°/s (r = 0.512, P = 0.001), while external rotation angles correlated moderately negatively with both concentric quadriceps strength and concentric hamstring strength at 300°/s (r = -0.410, P = 0.013; r = །0.467, P = 0.004). At the vGRF peak, the extension moment correlated positively with eccentric quadriceps (r = 0.377, P = 0.023) and hamstring strength (r = 0.364, P = 0.029) at 60°/s. CONCLUSION: At nine months post ACLR, persistent interlimb asymmetries in side-cutting biomechanics and thigh muscle strength were observed, with moderate correlations between them, particularly at medium to high angular velocities. These findings suggest moving beyond maximal strength training in rehabilitation. Incorporating velocity-specific and eccentric training, together with isokinetic strength assessment at velocities such as 180°/s and 300°/s in return-to-sport criteria, may help reduce reinjury risk.
Sports injuries not only impose periods of physical rest, but they can also provoke negative psychological responses, particularly fear, that can delay return to sport (RTS) and elevate reinjury risk. Although various instruments, including the Athlete Fear Avoidance Questionnaire (AFAQ) and the Fear of Return to Sport Scale (FRESS), are available to assess such fear-related factors, validated Simplified-Chinese versions have not yet been developed. This study conducted a systematic cross-cultural translation and psychometric validation of the AFAQ and the FRESS into Chinese (AFAQ-Ch and FRESS-Ch), following established international guidelines. Phase 1, which involved 30 athletes who had sustained an injury within the previous year (age: M = 20.6, SD = 2.4), comprised forward-backward translation, an expert panel review, and a face validity evaluation. Phase 2 assessed internal consistency, test-retest reliability, structural validity, and convergent validity among a larger sample of 204 Chinese injured athletes (age: M = 21.4, SD = 3.2), using the Simplified-Chinese Tampa Scale for Kinesiophobia (SC-TSK) and the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS-Ch) as theoretically related comparison instruments. Both the AFAQ-Ch and the FRESS-Ch demonstrated acceptable internal consistency (Cronbach's α = 0.748 and 0.736, respectively) and acceptable test-retest reliability. The AFAQ-Ch showed good test-retest reliability, with an intraclass correlation coefficient (ICC) of 0.855 (95% CI [0.790, 0.900], F[96, 96] = 12.759, p < .001), whereas the FRESS-Ch demonstrated moderate test-retest reliability, with an ICC of 0.729 (95% CI [0.620, 0.810], F[96, 96] = 6.372, p < .001). Confirmatory factor analysis supported the structural validity of the AFAQ-Ch and FRESS-Ch, with acceptable model fit for the AFAQ-Ch and generally acceptable fit for the FRESS-Ch. Evidence of convergent validity was demonstrated through significant correlations. A significant moderate positive correlation was observed between the AFAQ-Ch and the FRESS-Ch (r = .484, p < .001). These findings indicate that the AFAQ-Ch and the FRESS-Ch can be reliably used in clinical and research settings to assess fear among Chinese-speaking athletes following injury.
Exercise-induced hypoalgesia (EIH) is vital for rehabilitation, but its efficacy in patients with knee pain remains controversial. Blood flow restriction (BFR) might augment analgesia through metabolic accumulation. This study aimed to investigate the acute analgesic impact of a low-intensity warm-up with or without BFR and to compare EIH responses between healthy individuals and patients with persistent knee pain. Forty-six participants (healthy controls: n = 26; participants with persistent knee pain: n = 20) were enrolled in a single-session, within-subject split-body protocol. BFR at 70% arterial occlusion pressure was applied to one limb during a 5-min low-intensity warm-up. The BFR-treated limb was randomized in healthy controls, whereas in participants with persistent knee pain, BFR was consistently applied to the symptomatic limb, with the contralateral asymptomatic limb serving as the within-subject comparison. Pressure pain thresholds (PPT) were measured at three peri-patellar sites pre- and post-condition using a Latin Square design. Data were analyzed via Linear Mixed Models. Healthy controls showed a robust increase in PPT after warm-up (+ 5.55 N, 95% CI, 4.20 to 6.90), whereas participants with persistent knee pain showed no clear increase (+ 0.15 N, 95% CI, -1.39 to 1.69). The between-group difference in EIH was significant (+ 5.40 N, 95% CI, 3.36 to 7.45, p < 0.001). The EIH response was markedly attenuated in participants with persistent knee pain, a finding consistent with altered endogenous pain modulation. However, the present data do not directly identify the central or peripheral mechanisms underlying this attenuation. The additional BFR effect was small and not statistically significant (-0.14 N; 95% CI, -2.18 to 1.91; p = 0.894), suggesting the tested BFR protocol did not demonstrate statistically superior additional hypoalgesic effects compared with the non-BFR condition. A brief low-intensity warm-up induced a clear EIH response in healthy controls, whereas participants with persistent knee pain showed a markedly attenuated response. The tested BFR protocol did not demonstrate statistically superior additional hypoalgesic effects compared with the non-BFR condition. These exploratory findings warrant further investigation using adequately powered, prespecified, and mechanistically informed studies. Chinese Clinical Trial Registry ChiCTR2300069386 (https://www.chictr.org.cn/, registered on 15 March 2023).
Pure Posteromedial tibiotalar dislocation unaccompanied by fractures represents an exceptionally rare orthopedic injury, accounting for approximately 0.065% of ankle injuries and 0.46% of ankle dislocations. Such injuries typically result from high-energy trauma, with limited reports involving low-energy mechanisms in athletic activities. This case illustrates the successful management of a closed posterior ankle dislocation in a young student, emphasizing the importance of prompt intervention and structured rehabilitation. A 17-year-old male student sustained a pure posterior tibiotalar dislocation during a recreational basketball game, following a forced inversion and plantarflexion mechanism. Immediate closed reduction was performed under local anesthesia combined with intravenous analgesia, followed by immobilization in a splint and subsequent transition to a controlled ankle motion (CAM) boot. Post-reduction CT confirmed anatomical reduction and excluded occult fracture, while CTA showed no evidence of vascular injury; serial clinical examinations revealed no sensory or motor deficit. At one-year follow-up, the patient achieved a full functional recovery and unrestricted return to academic and physical activities. This case underscores that early closed reduction and phased rehabilitation can yield excellent outcomes in pure posteromedial tibiotalar dislocation, even in adolescent populations. The report highlights the viability of non-operative management for such injuries and contributes to the sparse literature on low-energy mechanisms in young, non-professional athletes.
BACKGROUND: Chronic kidney disease (CKD) is a major global health challenge. Exercise is a key non-pharmacological therapy, but the most effective modality and dose for improving renal function in non-dialysis CKD is unclear. OBJECTIVE: To compare exercise modalities and quantify dose–response effects on estimated glomerular filtration rate (eGFR) in adults with non-dialysis CKD. METHODS: We searched PubMed, Web of Science, Cochrane Central, EBSCO, Embase, and CNKI from inception to July 2025 for randomized controlled trials (RCTs) involving adults with non-dialysis CKD. Exercise interventions were classified as aerobic training (AT), resistance training (RT), or mixed physical activity (MPA), which included combined training and other multicomponent interventions. Doses were converted to MET-min/week. A Bayesian dose–response network meta-analysis estimated effects and dose thresholds for eGFR. RESULTS: Twenty-five RCTs involving 1,827 adults with non-dialysis CKD were included. Studies were published between 2012 and 2024, with sample sizes 20–163 and intervention durations 12–52 weeks. Participants were mostly CKD stages 2–4, with common comorbidities including hypertension, diabetes and obesity. Exercise sessions lasted 30–90 min/week, with doses ranging 208–1,869 MET‑min. Compared with usual care, RT yielded the greatest improvement in eGFR (MD = 5.77 mL/min/1.73 m²; 95% CrI 3.27–8.25), followed by AT (MD = 3.66; 95% CrI 1.25–6.03), whereas MPA showed a smaller, non-significant effect (MD = 1.76; 95% CrI − 0.33–3.79). A non-linear dose–response was observed, with meaningful gains at ~ 264–1,302 MET‑min/week, peaking at ~ 1,200 MET‑min/week. Findings for MPA should be interpreted cautiously and should not be overgeneralized to all specific exercise forms within this category. CONCLUSIONS: RT and AT improve eGFR in adults with non-dialysis CKD, with RT showing the greatest effect. A non-linear dose–response indicates moderate weekly volumes offer the most benefit, beyond which gains plateau.
OBJECTIVE: Blood Flow Restriction Training (BFRT) has been shown to have similar benefits to high-intensity exercise conditions without high resistance loads. This training methodology is not included in traditional healthcare professional training, as it is an emerging training tool. Moreover, the attitudes and knowledge of healthcare professionals towards BFRT remain unknown in South Africa. The purpose of this exploratory study was to elucidate the attitudes and knowledge of selected healthcare professionals registered with the Health Professions Council of South Africa regarding BFRT. RESULTS: A total of 100 healthcare professionals completed an online questionnaire, including exercise physiologists (46%) and physiotherapists (13%), with medical practitioners (14%), occupational therapists (14%), and other professions (13%). Most had heard about BFRT. Exercise physiologists and physiotherapists agreed that BFRT is a feasible clinical tool and that they possess sufficient knowledge of BFRT methodology, whereas other practitioners were indifferent. Most healthcare professionals were significantly indifferent on the role of BFRT in post-surgical interventions and in improving physiological outcomes. Physiotherapists disagreed with the statement that BRFT improves health outcomes in older individuals. At the same time, all healthcare practitioners agreed that BFRT can be used in the healthy adult population, but is contraindicated for pregnant women. A very high proportion of health practitioners agreed on the need for more education and training in BFRT. CONCLUSION: Overall, health care providers demonstrated attitudes that were generally positive toward BFRT, but were indifferent regarding using the tool in rehabilitation and post-surgery. There was low confidence in the application of BFRT, and most participants desired more training and education. Our findings emphasise the need for the adoption and education of BFRT.