To assess the effectiveness of two different neck strengthening protocols at increasing isometric neck strength in male and female rugby players. Cluster randomised controlled trial. The team training facility of 3 amateur clubs. 142 male and female amateur rugby players were recruited to take part in the study. Isometric neck strength in flexion, extension, left and right side flexion, left and right rotation and sum of strength scores. Changes in neck strength were analysed for within-group and between group differences. Relative to the control group the male Band resisted group recorded the largest strength gain with statistically significant increases in sum of strength scores (p = 0.002), extension (p = 0.034), right flexion (p = 0.004), left rotation (p < 0.001) and right rotation scores (p < 0.001). The male Partner resisted group recorded improvements in left rotation (p < 0.001) and right rotation (p = 0.006). In the female band resisted group significant improvements in neck strength were recorded for sum of strength scores (p = 0.042), right rotation (p = 0.003) and left rotation (p = 0.005) however in the Partner resisted group significant improvements were recorded in right rotation only (p = 0.015). We have developed two time efficient and low cost neck strengthening protocols that demonstrate efficacy at enhancing neck strengthen in a team setting.
Knee osteoarthritis (OA) is a leading cause of pain and disability worldwide, with cultural and lifestyle factors shaping its burden in different populations. In Saudi Arabia, the perspectives of both patients and healthcare professionals (HCPs) remain underexplored in understanding management approaches. This study aimed to explore patients' and HCPs' perspectives on management strategies for knee osteoarthritis in Saudi Arabia. A qualitative exploratory study was conducted using focus group discussions (FGDs). Participants included patients with knee OA and HCPs involved in knee OA management recruited from three hospitals within Riyadh's First Health Cluster. FGDs were conducted separately for patients and HCPs using a semi-structured interview guide. Discussions were audio-recorded, transcribed verbatim in Arabic, and translated into English using forward-backward translation. Data were analysed inductively using reflexive thematic analysis. A total of 58 participants (30 patients and 28 HCPs) were included. Five overarching themes were identified: (i) understanding and risk factors of knee OA, (ii) clinical versus lived experience, (iii) treatment and management priorities, (iv) education and self-management, and (v) barriers and facilitators to adherence. Healthcare professionals demonstrated a biomedical understanding of knee OA, whereas patients showed variable knowledge and uncertainty. Although both groups recognised obesity and physical inactivity as key risk factors, a gap existed between knowledge and behaviour. Patients reported broader impacts on daily life and psychological well-being, which HCPs emphasised less. Divergence in treatment priorities was observed, with HCPs emphasising exercise while patients relied more on pharmacological management. Barriers to adherence included limited understanding, low motivation, and constraints in the healthcare system, while facilitators included social support and perceived improvement. Knee OA management in Saudi Arabia is influenced by misalignment between clinical approaches and patient experiences, as well as cultural and system-level factors. Addressing these gaps through patient-centred, culturally tailored interventions and improved support for self-management may enhance adherence and outcomes.
BackgroundPhysical exercise is widely recognized for its cognitive benefits; however, the effect of menopausal status in modulating the cognitive effects of exercise is not definitively established.ObjectiveTo examine the cognitive benefits of two 6-month physical exercise programs in cognitively healthy older women across adulthood, and whether menopause status moderates these benefits.MethodsIn a post hoc analysis of a randomized controlled trial, 93 cognitively healthy women (aged 20-67; 43% at post-menopause) were assigned to either aerobic exercise (AE) or stretching/toning (ST) 4 days a week for six months. Neuropsychological assessment, cardiorespiratory exercise test, and blood draw were performed at baseline, 3-months, and 6-months. Linear mixed-effects regression models assessed whether menopausal status moderated the impact of exercise on executive functions and processing speed.ResultsSeventy-six participants (81.7%) completed the intervention. A time-by-group-by-menopause interaction emerged after 3 months (β = -0.89; p = 0.001) and 6 months (β = -0.67, p = 0.016). Post-menopausal women in the AE group showed greater improvement in executive functions compared to the ST group and pre-menopausal women. Models controlled for age, education, and baseline cognitive performance.ConclusionsOur results provide novel evidence that AE improves cognition with pronounced executive functions benefits in post-menopausal women, a population at higher risk for dementia. Since women are at a higher risk of developing Alzheimer's disease compared to men, these findings support AE as a relevant strategy to promote women's brain health. Although this is a secondary analysis, it may inform future exercise trials targeting women.
To investigate the effects of a high-dose probiotic-lactoferrin (LF)-milk fat globule membrane (MFGM)-nucleotide combined formula on reducing the incidence risk of common diseases and related symptoms and improving growth and hemoglobin level in neonates born via cesarean section. This trial was a prospective, multicenter, open-label, randomized, controlled 3-month intervention study. A total of 150 eligible neonates were enrolled. All participants completed the full intervention and provided clinical data. All enrolled formula-feeding neonates were randomly assigned to either the intervention group (IG, n = 50) or the control group (CG, n = 50), and 50 exclusively breastfed neonates were assigned to the breastfeeding control group (BCG). The formula used in the IG contained 2 × 109 CFU/100 g probiotics, 200 mg/100 g LF, added MFGM, and 55 mg/100 g nucleotides. In contrast, neonates in the CG were fed a formula containing 45-50 mg/100 g LF and 30-35 mg/100 g nucleotides, without probiotic or MFGM fortification. The primary outcome was the frequency of upper respiratory tract infections (URTIs). Secondary outcomes included the incidence of other respiratory, gastrointestinal, and allergic symptoms and diseases, as well as infant anthropometric indicators (including length, weight and head circumference) and the hemoglobin (Hb) concentration. The incidence of URTIs over the 3-month intervention showed no significant difference among the three groups [the incidences of URTIs in CG, IG, and BCG: 22% (11/50), 18% (9/50), and 14% (7/50), respectively, χ2 = 1.084, p = 0.582] according to both intention-to-treat (TT) and per protocol (PP) analyses [incidence of URTIs in CG, IG, and BCG: 22.9% (11/48), 19.6% (9/46), and 14.9% (7/47), respectively, χ2 = 0.680, p = 0.712]. After the 3-month intervention, compared with infants in the CG, infants in the IG showed a reduced risk ration (RR) for functional dyspepsia [RR = 0.756, 95% confidence interval (95% CI) = 0.587-0.974] and eczema (RR = 0.647, 95% CI = 0.449-0.933). Hb levels in the CG and IG were both significantly higher than those in the BCG (107.35 ± 9.26 vs. 105.99 ± 7.01 vs. 101.42 ± 7.07 g/L for CG, IG, and BCG, respectively; F = 9.629, p < 0.001), with no statistically significant difference between the CG and IG. No significant differences in anthropometric indicators were observed among the three groups (p > 0.05). This study found no adverse effects associated with 3-month supplementation of a high-dose probiotic-LF-MFGM-nucleotide combined formula, supporting its safety for term neonates delivered by cesarean section. The primary outcome, URTI incidence, did not differ significantly among groups. Exploratory analyses suggested lower risks of functional dyspepsia and eczema in the intervention group; however, these findings should be considered preliminary and require confirmation in larger adequately powered studies. The intervention was well tolerated and showed safety comparable to standard feeding practices.
Nutrition is a modifiable driver of morbidity and mortality in the UK, yet nutrition education remains marginal within medical curricula. Despite guidance from the General Medical Council (GMC) and the Association for Nutrition (AfN), evidence suggests persistent under-provision. We triangulated findings from: (1) a curriculum review and mapping exercise of UK medical schools; (2) a curriculum survey (n=31) of final-year or newly qualified students; and (3) a rapid review (2010-2025) of literature on nutrition education in UK medical programmes. Survey items mapped to AfN competencies and GMC Outcomes for Graduates. Across all data sources, nutrition education was inconsistently delivered, theoretical and rarely assessed. Most students (71%) reported receiving ≤10 hours of teaching. Although 84% rated nutrition as important, only 61% felt prepared to address nutrition issues. Confidence was lowest for practical skills (nutrition assessment, referral pathways and brief interventions). The rapid review identified longstanding barriers: low curricular legitimacy, limited assessment, insufficient faculty expertise and weak clinical integration. Enablers included nutrition leads, interprofessional learning and competency-aligned teaching. Despite national prevention ambitions, nutrition remains insufficiently integrated into UK medical education. Aligning curricula with AfN/GMC standards, strengthening assessment, embedding leadership and co-designing applied teaching with students represent practical high-impact opportunities to develop prevention.
This study aims to investigate the clinical effect of acupuncture combined with rehabilitation training in the treatment of knee osteoarthritis (KOA) under unified acupoint intervention. In this prospective, comparative study informed by systematic acupoint analysis, the literature related to acupuncture for KOA treatment was retrieved from public databases and the core acupoints were analyzed using the Traditional Chinese Medicine Inheritance Calculation System (TCMICS) software. Eighty-four patients were selected as the participants, and the clinical effect (total efficacy rate), Numeric Rating Scale (NRS) for pain score, American Knee Society Score (AKSS) for knee joint function and the self-care ability score for daily living activities were used to evaluate the treatment effect. The curative effect index was calculated using the AKSS scores. After analyzing the core acupoints, we selected the Dubi, Zusanli, Yanglingquan, Xuehai, Neixiyan and Liang Qiu acupoints for the acupuncture treatment. The patients were divided into a control group (n = 42 patients undergoing rehabilitation training) and an intervention group (n = 42 patients undergoing acupuncture combined with rehabilitation training). The control group consisted of 15 male and 27 female, with a mean age of 62.90 ± 11.531 (range, 40 to 78) years. The mean course of the disease was 4.07 ± 1.841 years. The intervention group consisted of 16 male and 26 female, with a mean age of 63.95 ± 10.613 (range, 41 to 79) years and a mean disease course of 4.76 ± 2.328 years. There was no significant difference between the groups before treatment (p > 0.05). After acupuncture treatment, the 92.85% total efficacy rate (n = 39) was significantly higher than the 73.80% (n = 31) in the control group. The mean AKSS of the control and intervention groups were 64.17 ± 11.148 and 66.67 ± 17.795, respectively, and the mean knee joint articulation scores were 57.40 ± 8.925 and 54.10 ± 10.150 in the two groups, respectively. Following treatment, the scores of knee joint function and knee joint articulation in the intervention group were higher than those in the control group (p < 0.05). For AKSS, the mean difference of the control group was 6.030, and the proportion of patients who reached the improvement of minimum clinically significant difference (MCID) standard was 80.95%. The mean difference of the intervention group was 10.98, and the proportion of patients who reached MCID was 100%. Following treatment, the self-care ability score in the intervention group were higher than those in the control group (p < 0.05). For modified Barthel Index (MBI), the mean difference of the control group and intervention group were 6.446 and 6.225, all accounting for 100%. The mean NRS scores were significantly decreased from 5.19 ± 1.042 to 1.93 ± 0.640 after one month of acupuncture treatment. Our study results suggest that acupuncture combined with rehabilitation training based on data mining can relieve patients' pain, accelerate the recovery of their knee joint function and improve their daily living ability, demonstrating high clinical value in practice.
Continuous monitoring of sweat pH and lactate is of great value for physiological assessment, yet existing sensors face two critical bottlenecks: prolonged response times that hinder real-time tracking, and signal decoding relying on simple linear calibration that fails to handle nonlinearities and dynamic hysteresis. Here, we report a synergistic "RF-materials-AI" dual-band biosensing platform integrating (1) a stub-loaded dual-resonance microstrip antenna at 2.61 GHz and 3.98 GHz for frequency-domain discrimination of pH and lactate responses; (2) ternary nanocomposite interfaces-rGO/TiO₂/MWCNTs for pH and rGO/CuO/NiCo-MOF for lactate-for dielectric modulation and redox-mediated charge transfer, respectively; and (3) a Physics-BiLSTM-Attention network embedding first-order temporal difference priors and a dual-branch attention mechanism for robust multiparameter regression. The sensor achieves response times of 55 s (pH) and 135 s (lactate) with good stability and selectivity. On human sweat data from 10 subjects under LOSO-CV evaluation, the model delivers lactate prediction with R = 0.98, R²=0.96, MAE = 0.87 mM, RMSE = 1.12 mM, and pH prediction with R = 0.94, R²=0.88, MAE = 0.12 pH units, RMSE = 0.15 pH units-substantially outperforming static calibration (29.8% and 31.4% MAE reduction, respectively). The model achieves 94.0% accuracy in health status classification and 91.2% in exercise intensity classification, with well-calibrated uncertainty [Formula: see text]. Ablation studies confirm that removing any core component degrades MAE by 27-73%, underscoring the indispensable synergy of the three design dimensions. This work establishes a materials-hardware-algorithm co-design framework for multiparameter sweat analysis, offering a conceptually new pathway toward intelligent, passive, and continuous biosensing.
The 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) is widely used to assess health-related quality of life (HRQoL) in HF patients covering key HF-related health status domains. This study validated the Arabic KCCQ version and looked into potential correlation between patients' HRQoL and their demographics/clinical characteristics, health literacy, medication adherence/knowledge. This was a multicenter validation study from Jordan including HF adult patients. Cronbach's alpha coefficient was employed to assess the scale internal consistency. Test-retest reliability evaluated stability of participants' responses overtime. Construct validity was examined through exploratory factor analysis (EFA), supported by Kaiser-Meyer-Olkin measure and Bartlett's sphericity test. Model fit was evaluated by confirmatory factor analysis (CFA). Associations between KCCQ scores and patient demographic/clinical characteristics, health literacy, medication adherence/knowledge were analyzed using linear regressions. A total of 331 participants were recruited from two centers. KCCQ domains' scores ranged from mean±SD of 42.90±25.43 for symptom stability to 76.80±30.63 for social limitation. The total symptom, clinical summary and overall summary scores were 70.96±29.13, 74.67±25.67 and 70.67±25.70, respectively. The scale demonstrated excellent internal consistency (Cronbach's alpha=0.937). Test-retest analysis showed strong significant intraclass correlation coefficients and Pearson's correlation indicating good reliability. EFA and CFA supported data suitability for factor analysis and good model fit. The multivariate regression showed being married, performing exercise, being adherent to medication and taking fewer medications to significantly correlate to better HRQoL. The Arabic KCCQ version is a reliable, valid tool for HRQoL assessment among Arabic-speaking communities. Implementing interventions targeting sedentary HF patients not adherent to treatment regimen can improve HRQoL.
Accumulating studies have investigated the combined effects of 24-h movement behaviors on physical and mental health. The 24-hour Movement Behaviors Questionnaire (24HMBQ) was recently developed to measure the 24-hour movement behaviors in college students. However, its criterion validity remains to be elucidated. This study aimed to investigate the criterion validity of the 24HMBQ against accelerometer-derived data among Chinese college students. Eighty-eight college students (age = 20.2 ± 2.2 years) participated in this study. The Axivity AX3 accelerometers were used to objectively measure physical activity (PA), sedentary behavior (SB), and sleep levels over a consecutive seven-day period. At the last day, participants completed the 24HMBQ to self-report their PA, SB, and sleep levels. Paired-sample t-test, Spearman's rank correlation test, and Bland-Altman plot were used to examine the degree of agreement between 24HMBQ and accelerometer data. Spearman's correlation coefficients indicated strong agreement for sleep metrics (Rho = 0.77, p < 0.001 for weekdays; Rho = 0.68, p < 0.001 for weekends) and moderate agreement for SB (Rho = 0.55, p < 0.001 for weekdays; Rho = 0.33, p < 0.01 for weekends) between 24HMBQ and accelerometer measurements. However, lower correlations were observed for physical activities including light PA (Rho = 0.30, p < 0.01) and moderate-to-vigorous PA (MVPA; Rho = 0.15, p > 0.05). The 24HMBQ showed good criterion validity for sleep and moderate validity for sedentary behavior, but limited validity for physical activity (especially MVPA).
Glioblastoma (GBM), isocitrate dehydrogenase (IDH)-wildtype, has a median overall survival of 11-14 months despite standard treatment. Ketogenic metabolic interventions that lower the glucose ketone index (GKI) may improve outcomes. We evaluated the feasibility, tolerability, and potential clinical benefit of integrating standard treatment with an intensive multimodal metabolic therapy program (MTP) in newly diagnosed IDH-wildtype GBM. Patients received standard chemoradiation and adjuvant chemotherapy alongside an MTP comprising prolonged fasting, time-restricted feeding, and a ketogenic diet. The primary outcome was the proportion sustaining a mean daily GKI ≤6 during chemoradiation. Secondary outcomes included GKI control throughout chemotherapy, body weight, body mass index, adverse events, performance, exercise, quality of life, and survival, compared with contemporary controls using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Among 32 eligible patients, 18 commenced chemoradiation with the MTP (intention-to-treat), and 15 completed it (per-protocol). In the intention-to-treat population, 15 of 18 patients (83%) sustained a mean daily GKI ≤6 during chemoradiation. Among per-protocol patients, the GKI was 1.88 ± 0.56 during chemoradiation and 2.53 ± 0.86 throughout chemotherapy. Intentional weight loss averaged 17%, normalizing body mass index. MTP-related adverse events were mild or moderate. Exercise activity and quality of life improved. Median overall survival was 21.5 months versus 14.7 months in controls (HR = 0.42, 95% CI 0.18-0.97, P = .027), with 3-year survival of 27% versus 7%. Intensive multimodal metabolic therapy was feasible, well-tolerated, and associated with improved exercise activity, quality of life, and survival outcomes, including higher 3-year survival.
Digital health technology has the potential to increase access to home-based reablement programmes for people living with dementia (PLwD) or mild cognitive impairment (MCI) to support everyday living. Digital Voice Assistants (DVAs) offer a possible solution to overcome usability issues with traditional technologies due to associated cognitive, motor and visual impairments. This paper describes the co-design of a personalised reablement programme to be delivered via DVA. PLwD or MCI (n = 9), their care partners (n = 9) and health professionals (n = 8) participated in the co-design via online workshops and semi-structured interviews. Phases 1-7 of the IDEAS (Integrate, Design, Assess and Share) framework guided this iterative process to develop a product for future feasibility testing. Consensus on essential functions and features was facilitated using the MoSCoW prioritisation method. Transcripts were analysed using a modified thematic framework to inform the reablement programme. Thematic requirements of a cognitive reablement program to be delivered via DVA included (1) Daily Living (self-care, household and cooking), (2) Activity Participation (leisure activities, home hobbies and ad hoc appointments), (3) Emotional Well-being (social connection and coping strategies) and (4) technical requirements (activation, adaptable content, adherence, auditory processing, awareness and training). The IDEAS framework successfully facilitated meaningful engagement from PLwD or MCI, their care partners, and health professionals to integrate user insights and feedback to co-design a personalised reablement program via DVA for subsequent pilot feasibility testing. PLwD and/or MCI, and their care partners contributed by sharing lived experiences for researchers to gain insights; collaboratively identifying behaviours requiring support; creating ideas for solutions; feeding back on prototypes and prioritising program features and functions. Health professionals fed back improvements on prototypes, identifying potential barriers and solutions to implementation of the program.
Syncope is a common clinical condition characterized by a transient loss of consciousness caused by temporary global cerebral hypoperfusion. Exercise-associated syncope is clinically important because it may reflect benign physiological mechanisms or represent the initial manifestation of a potentially life-threatening cardiovascular disorder. This narrative review examines current evidence on its epidemiology, pathophysiology, classification, diagnostic evaluation, differential diagnosis, and management. The reviewed evidence indicates that syncope occurring during exercise should be considered a high-risk presentation requiring prompt cardiovascular evaluation, whereas post-exercise episodes are more frequently associated with reflex mechanisms and impaired venous return. Initial assessment should include a detailed history, physical examination, orthostatic blood pressure measurement, and 12-lead electrocardiography, with echocardiography, exercise testing, ambulatory rhythm monitoring, or head-up tilt testing selected according to the suspected mechanism. Head-up tilt testing is most useful when reflex syncope remains suspected after the initial evaluation. A structured, risk-based diagnostic approach is therefore recommended to identify cardiac causes early while avoiding unnecessary testing in patients with likely benign syncope.
Diabetes mellitus is an important public health challenge worldwide, particularly in low-resource settings where health literacy may be limited. This study assessed perceptions regarding the causes, symptoms, complications, and prevention of diabetes among adult market vendors in Butembo, Democratic Republic of Congo. A descriptive cross-sectional survey was conducted between March and April 2025 among adult market vendors recruited from seven major markets in Butembo, Democratic Republic of Congo. Data were collected using a pre-tested structured questionnaire administered face-to-face in French or Swahili using KoboCollect software and analyzed using descriptive statistics in IBM SPSS version 20. A total of 433 adults participated in the study. Among them, 334 (77.1%) reported having previously heard of diabetes and were included in the perception analyses. Commonly perceived signs of diabetes included weight loss (64.4%) and chronic fatigue (49.4%). High blood pressure (50.3%) and death (48.5%) were frequently perceived as complications. Healthy diet (49.1%) and regular exercise (37.4%) were commonly identified as preventive measures; however, some respondents also reported spiritual or cultural beliefs such as prayer (28.4%) and poisoning-related beliefs. Most respondents (73.7%) reported knowing someone with diabetes, while 52.1% stated that consulting a doctor would be the preferred response if diabetes was suspected. Participants demonstrated mixed perceptions regarding diabetes, combining biomedical explanations with cultural and spiritual beliefs. These findings highlight the importance of culturally adapted community health education interventions in Butembo.
Multi-system impacts of long COVID remain unknown. We aimed to compare multi-system deficits between people with long COVID and controls. We conducted a case-control study and recruited participants from two UK population-based cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC) and TwinsUK. Participants provided samples for SARS-CoV-2 serology between 2020 and 2021 and were asked about duration of COVID-19 symptoms between July and December 2021. Cases had long COVID (evidence of COVID-19 infection and persistent symptoms ≥4 weeks post infection); controls comprised 3 groups: acute COVID-19 only (symptoms reported for <4 weeks) and serological evidence of infection; self-reported long COVID-like symptoms but without wild-type SARS-CoV-2 virus antibodies; no symptoms or history of COVID-19 infection. People who were severely unwell or pregnant were excluded. Participants attended a clinic follow-up visit between 2021 and 2023 and underwent multi-system MRI, (cardiac, brain, lung, kidney), measurement of blood pressure and autonomic function, spirometry, renal function, exercise tests, strength and physical capability. Severity of deficit was then scored for each system as 0 (none) to 3 (severe). Primary outcome was a single composite multi-domain score summing each of nine domains: autonomic, brain, exercise capacity, heart, lungs, physical, renal, strength and vascular, with a maximum score of 27. In total, 349 participants, 141 with long COVID (40%) and 208 (60%) controls were recruited. Overall deficit score in cases was 0.22 (95% CI -0.44, 0.88) units greater than controls, adjusted for age, sex, ethnicity, cohort membership and relatedness. This estimate was little changed (0.32 (-0.34, 0.98)) when additionally adjusted for educational status, index of multiple deprivation, physical activity, smoking and co-morbidity. Restricting cases to those reporting symptoms including fatigue (n = 46) increased the excess deficit score to 0.81 (-0.19, 1.81) units in the minimally adjusted model. A difference was only observed in the vascular domain, largely attributable to elevated blood pressure, showing a 1.76 (1.04, 2.97) multivariable adjusted odds ratio excess in cases, and 3.04 (1.36, 6.80) when restricted to cases with fatigue. There was no evidence of marked residual subclinical deficits in most systems in people with long-COVID, although there was evidence of persistent deficits in the vascular system, largely related to elevated blood pressure. Mechanisms unrelated to organ dysfunction may contribute to symptoms. Blood pressure measurement and control should be included in clinical follow-up. Jointly funded by the National Institute for Health and Care Research and UK Research and Innovation (CONVALESCENCE, COV-LT-0009, MC_PC_20051).
To investigate the effect of repeated-sprint exercise in hypoxia on sleep quality. Ten healthy young male adults performed three trials on different days: repeated-sprint exercise in normoxia (NOR, fraction of inspired oxygen [FiO2] 20.9%), repeated-sprint exercise in hypoxia (HYP, FiO2 14.5%), and no exercise in normoxia (REST, FiO2 20.9%). In NOR and HYP, trials were performed between 4:30 PM and 6:00 PM, consisting of 30 min of submaximal pedaling followed by two sets of repeated sprints (6 × 6-s with 30-s rest). During sleep, heart rate (HR), HR variability (e.g., the percentage of adjacent R-R intervals > 50 ms [pNN50]), skin temperature were monitored and sleep quality was assessed via electroencephalography. Total sleep time, sleep efficiency, sleep latency, duration of each sleep stage (non-REM [sleep stage without rapid eye movement] stages 1-3, REM) did not significantly differ among the three trials. During the first 90 min of sleep, HR was significantly higher in HYP (53 ± 2 bpm) than in REST (49 ± 1 bpm, P < 0.05). Furthermore, pNN50 was significantly lower in both HYP (48.8 ± 4.8%) and NOR (50.4 ± 4.9%) than in REST (58.3 ± 3.6%, P < 0.05). Performing repeated-sprint exercise in hypoxia in the early evening altered HRV-derived indices during the first 90 min of sleep, without markedly affecting sleep quality.
To investigate whether adding visuo-vestibular exercises to standard manual therapy and exercise produces superior improvements in sensorimotor function, pain, balance, and functional disability in adults with chronic neck pain. This prospective, randomized controlled trial enrolled 58 adults with chronic neck pain (≥3 months) allocated to a manual therapy and exercise group (MtE; n = 29) or MtE plus visuo-vestibular exercises (MtE-VVE; n = 29). Both groups completed 12 supervised sessions over six weeks with a daily home exercise programme. Outcomes were assessed at baseline, 6 weeks, and 12 weeks, and included pain intensity (Visual Analog Scale [VAS]), upper extremity reaction time, computerized posturography, the Neck Disability Index (NDI), and cervical muscle endurance. Fifty-four participants (27 per group) completed the study. Both groups improved significantly across all outcomes (p < 0.001). At 12-week follow-up, the MtE-VVE group demonstrated superior outcomes: activity-related pain was reduced by an additional 2.00 cm (95% CI: 0.75-3.25; p = 0.005), bilateral reaction time improved by 1.70 s (p = 0.001), eyes-open mediolateral sway decreased by 0.50 mm (p < 0.001), NDI score was 6.30 points lower (95% CI: 3.42-9.18; p < 0.001), and cervical flexion and extension endurance improved by 12.00 s and 27.70 s, respectively (p ≤ 0.020). Adding visuo-vestibular exercises to standard manual therapy and exercise produces clinically meaningful and sustained improvements in activity-related pain, sensorimotor function, postural control, and functional disability in adults with chronic neck pain, and may be recommended as an effective adjunctive intervention.
This study compared high-intensity interval training (HIIT) versus moderate continuous training (MCT) as preconditioning on hippocampal BDNF, TrkB, and TNF-α gene expression in rats exposed to acute noise stress. Forty-two male Wistar rats were randomised into seven groups (n = 6): control, time-control, stress, HIIT, MCT, HIIT+stress, and MCT+stress. Exercise groups underwent 8-week treadmill training (5 sessions/week). HIIT (6x2-min intervals, 85-90% Vmax) or MCT (22-min continuous, 65-70% Vmax). Stress groups received a single 4-hour noise exposure. Hippocampal mRNA was quantified via real-time PCR. Both HIIT and MCT significantly upregulated BDNF versus time-control, with HIIT eliciting greater increases. MCT significantly elevated TrkB versus time-control. Noise stress reduced BDNF and TrkB while increasing TNF-α. Both exercise protocols attenuated these alterations. Under stress, HIIT+stress exhibited significantly higher TrkB than MCT+stress. MCT elevated TNF-α versus time-control, but stress-induced increases were similarly mitigated in both preconditioned groups. Correlation analysis revealed strong positive correlations between BDNF and TrkB and moderate correlations between BDNF and TNF-α, and TrkB and TNF-α. HIIT and MCT differentially modulate hippocampal gene expression. While MCT effectively upregulates basal TrkB, HIIT provides superior protection against stress-induced TrkB suppression, highlighting intensity-specific neuroprotective adaptations and integrated pathway regulation among BDNF, TrkB, and TNF-α.
Artificial intelligence (AI) offers potential to automatically evaluate the burden of active arthritis on magnetic resonance imaging (MRI) but must be reliable and practical to see routine use. We sought to validate the reliability and feasibility of iKIMRISS, an AI-automated iteration of the Knee Inflammation MRI Scoring System (KIMRISS) for bone marrow lesions (BMLs), using both quantitative and qualitative methods. Eleven readers participated in a 3-part reading exercise evaluating 40 2-time-point knee MRI cases using manual KIMRISS and different levels of AI automation in iKIMRISS. BML scoring reliability between methods was assessed using agreement metrics. A subset of experts also participated in postexercise questionnaires and semistructured interviews to assess the usability, feasibility, and implementation potential of iKIMRISS. iKIMRISS' BML scores demonstrated moderate-to-strong agreement with human reader scoring, especially human readers who were experienced KIMRISS users (mean intraclass correlation coefficients of 0.76 for both baseline and time interval change scores). Thematic analysis of survey responses and semistructured interviews revealed an overall positive sentiment towards iKIMRISS as a research tool but indicated a need for further technical and logistical improvements to increase its value in clinical settings. iKIMRISS greatly improves the speed and accessibility of KIMRISS BML scoring while maintaining acceptable reliability for research and clinical trial applications. However, further refinement of the tool is recommended to improve its applicability in clinical settings.
Impaired balance is a common and debilitating sequela among stroke survivors. Tai chi (TC), a traditional mind-body exercise, has emerged as a promising rehabilitative intervention. This meta-analysis aimed to quantitatively evaluate the effects of TC on balance function in post-stroke patients. A systematic literature search was conducted across eight electronic databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang Data) from their inception until May 13, 2025, to identify relevant randomized controlled trials (RCTs). Eligible studies compared TC (as an adjunct or standalone therapy) with conventional rehabilitation therapy (CRT) in stroke patients, using balance-related outcomes as endpoints. Methodological quality was assessed using the Cochrane Risk of Bias tool. Statistical synthesis was performed using RevMan software (version 5.4). Twenty RCTs involving 1296 participants were included. The pooled results demonstrated that, compared to CRT alone, the integration of TC with CRT led to significantly greater improvements across multiple balance measures: the Berg Balance Scale (mean difference [MD] = 6.17, 95% confidence interval [CI]: 5.19 to 7.15), the Fugl-Meyer Assessment scale (MD = 7.18, 95% CI: 4.14 to 10.23), the Timed Up-and-Go test (MD = -2.03, 95% CI: -3.65 to -0.41), the Functional Reach Test (MD = 2.81, 95% CI: 0.29 to 5.33), the Modified Fall Efficacy Scale (MD = 8.70, 95% CI: 4.36 to 13.04), and the Fall Risk Index (MD = -0.78, 95% CI: -1.22 to -0.34). Current evidence suggests a beneficial effect of integrating TC with CRT for improving balance after stroke. However, due to methodological limitations and the overall quality of the included trials, these findings should be interpreted with caution. More rigorous and well-designed studies are needed before definitive clinical recommendations can be established.
This study aims to investigate the effect of a structured postoperative shoulder exercise program on shoulder range of motion (ROM) recovery and the development of postoperative shoulder stiffness following surgical fixation of distal radius fractures (DRFs). This non-randomized, time-based cohort study included a total of 64 patients who underwent volar plate fixation of DRF between October 2022 and March 2023. Patients were allocated into two groups based on calendar periods and basic demographic factors were evaluated. Group 1 (exercise group, n = 33) was educated on pre-designed shoulder exercise to prevent shoulder stiffness after surgical treatment. Group 2 (control group, n = 31) was instructed to use their shoulders freely without an arm sling. Shoulder ROM and Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores were evaluated and compared at postoperative Weeks 2, 4, 8, 12, and 24. Shoulder stiffness was defined as passive ROM restricted by 30° or more compared to the contralateral side (or difference of two or more Constant-Murley scores in internal rotation) in two or more planes of movement. Of the patients, 12 were male and 52 were female with a mean age of 65.7 ± 8.9 (range, 42 to 85) years. The mean follow-up was 6.8 ± 1.6 months. Shoulder ROM markedly decreased between postoperative Weeks 2 and 4, but continuously improved until the final follow-up in both groups. A transient improvement in internal rotation at postoperative Weeks 4 and 8 was observed in Group 1 compared to Group 2. No significant difference in internal rotation was observed at the other time points. At the final follow-up, 7.8% of all patients continued to experience shoulder stiffness. Structured shoulder exercise may facilitate earlier recovery of shoulder internal rotation after volar plate fixation of DRFs. However, this advantage can be transient and cannot be maintained beyond eight weeks postoperatively, suggesting that shoulder ROM often recovers spontaneously even in the absence of a routine rehabilitation protocol. Furthermore, secondary shoulder stiffness following DRF fixation peaks at approximately four weeks after surgery and subsequently resolves more rapidly than the typical natural history of primary frozen shoulder. These findings indicate that structured shoulder exercises may provide short-term benefits in postoperative recovery, while the long-term clinical significance of routine shoulder rehabilitation remains uncertain.