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Recent Advances in Exercise-Based Rehabilitation

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Biomedical Engineering".

Deadline for manuscript submissions: closed (10 July 2025) | Viewed by 35470

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Prof. Dr. Elias Tsepis

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Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Rio, Greece
Interests: exercise prescription; prevention; biomechanics; physiotherapy assessment methods; rehabilitation
Special Issues, Collections and Topics in MDPI journals

Dr. Maria Tsekoura

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Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
Interests: exercise science; movement analysis; sarcopenia; geriatric assessmen; musculoskeletal rehabilitation
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Physical exercise has evolved from its traditional domain of sports performance enhancement and health promotion into a keystone method for preventive and therapeutic purposes across various pathological conditions. Increasing evidence supports exercise-based rehabilitation (EBR) for acute and chronic injuries, as well as pathologies beyond the traditional musculoskeletal, neurological, and cardiorespiratory focus. Those include cancer, hemodialysis, gynecology, gerontology, mental health, etc. Sophisticated exercise programs keep evolving in light of recent scientific advances and technological novelties, with new methods and equipment being introduced for physical performance monitoring and enhancement. Those novel means and methods comprise the context of the current Special Issue addressed to the modern multidisciplinary rehabilitation team.

Prof. Dr. Elias Tsepis
Dr. Maria Tsekoura
Guest Editors

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Keywords

exercise therapy
therapeutic exercise
kinesiotherapy
tele-rehab
rehabilitation technology

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Related Special Issue

Recent Advances in Exercise-Based Rehabilitation, 2nd Edition in Applied Sciences

Published Papers (10 papers)

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Research

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12 pages, 249 KB

Open AccessArticle

Effects of an 8-Week Abdominal Hypopressive Technique Program on Pelvic Floor Muscle Contractility: An Assessor-Blinded Randomized Controlled Trial

by Olga López-Torres, Miriam Álvarez-Sáez, Jorge Lorenzo Calvo, Loreto Carmona and Lidón Soriano

Appl. Sci. 2025, 15(11), 5844; https://doi.org/10.3390/app15115844 - 22 May 2025

Viewed by 2243

Abstract

Background: Pelvic floor muscle (PFM) dysfunctions, such as urinary incontinence (UI), significantly impact women’s quality of life. The abdominal hypopressive technique (AHT), a breathing and posture-based intervention, has emerged as a promising approach to improve PFM function. Despite growing evidence on its efficacy, limited research explores its effect on PFM contractility. Objective: This study aimed to evaluate the effects of an 8-week AHT program on pelvic floor muscle (PFM) strength in adult women with no prior experience with AHT. Methods: A randomized controlled trial was conducted with 42 females (mean age 43 ± 9 years) assigned to an experimental group (EG, n = 21) or a control group (CG, n = 21). The EG completed 24 AHT sessions (30 min/session, 3 sessions/week) over 8 weeks. PFM strength, measured via maximum voluntary contraction (MVC), was assessed pre- and post-intervention using the Phenix Biofeedback Kit. Secondary outcomes included load absorption and muscle efficiency. Muscle efficiency and load absorption were also registered. Results: After the 8-week intervention, significant improvements were observed in the EG for maximal voluntary contraction (MVC1 (from 672.2 ± 344.1 g/cm² to 890.3 ± 435.8 g/cm², p = 0.002) and load absorption (from 83.9 ± 36.8 to 103.1 ± 37.3, p = 0.001), with no significant changes in the CG. Between-group differences for MVC1 (p = 0.001), MVC2 (p = 0.016), and load absorption (p = 0.008) were statistically significant. High adherence (96%) and no adverse events were recorded. Conclusions: An 8-week AHT program significantly improved PFM strength, load absorption, and muscle efficiency in women from the present study comparing with the CG. AHT could be considered a safe, non-invasive, and effective intervention for pelvic floor rehabilitation, with potential benefits for addressing UI and enhancing pelvic floor functionality. Future research should focus on long-term outcomes and comparisons with alternative therapies. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

18 pages, 5123 KB

Open AccessArticle

MScope: A Reliable Battery for Functional Status Assessment in Multiple Sclerosis

by Daniel Lisardo, Susana López-Ortiz, Irati Jauregui-Fajardo, José Pinto-Fraga, Celia García-Chico, Alba Chavarría-Miranda, Nieves Téllez and Sergio Maroto-Izquierdo

Appl. Sci. 2025, 15(1), 11; https://doi.org/10.3390/app15010011 - 24 Dec 2024

Viewed by 1618

Abstract

Multiple sclerosis (MS) is a neurodegenerative disease that often leads to severe disability. Although exercise, particularly strength training, improves health outcomes in MS, no standardized, reliable tool exists for functional assessment to inform tailored exercise prescriptions and patients’ categorization. This study aimed to validate the reliability of the MScope battery, a comprehensive tool incorporating structural, functional, and neuromuscular assessments to objectively evaluate patients with MS. A reproducibility study was conducted with 40 MS patients who completed the MScope battery twice, 72 h apart. Tests included structural (muscle thickness of the vastus lateralis and rectus femoris), functional (sit-to-stand, timed up-and-go, 10 m and six-minute walking test), and neuromuscular tests (isometric strength during the squat and leg extension exercises and handgrip strength). Intraclass correlation coefficients (ICCs), Bland–Altman plots, and the coefficient of variation (CV) were used to evaluate intra- and inter-day reliability. The MScope battery showed high intra- and inter-day reliability, with ICC values ranging from 0.79 to 0.99. Muscle thickness measurements, along with handgrip strength, demonstrated excellent reliability (ICC > 0.9, CV < 5%). Functional tests, including the timed up-and-go, 10 m walk, and sit-to-stand variations, maintained consistent scores (ICC > 0.85, CV < 10%). The six-minute walking test exhibited excellent inter-day reliability (ICC = 0.94, CV < 4%). Neuromuscular assessments showed strong reliability with minor day-to-day variability (ICC = 0.75–0.95, CV < 8%). The battery’s overall consistency supports its use as a reliable tool for assessing functional status in MS patients. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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15 pages, 582 KB

Open AccessArticle

Barriers and Facilitators for Therapeutic Green Exercise in Patients with Chronic Conditions: A Qualitative Focus Group Study

by Aristi Tsokani, Theodoros Dimopoulos, Evangelos Vourazanis, Nikolaos Strimpakos, Evdokia Billis, Garyfallia Pepera and Eleni Kapreli

Appl. Sci. 2023, 13(18), 10077; https://doi.org/10.3390/app131810077 - 7 Sep 2023

Cited by 3 | Viewed by 3698

Abstract

Background: Exercise has indisputable advantages for people with chronic conditions. Engaging in physical activity within natural environments, known as green exercise, contributes to both physical and mental well-being. The aim of this study was to investigate the perceptions of people with chronic conditions and health professionals and the perceived facilitators and barriers to therapeutic green exercise. Methods: This was a qualitative study based on two focus groups. Ethical approval was received, and a thematic analysis was used to analyze the discussions. Results: Seven patients and eight health professionals participated in the study. The thematic analysis yielded thirteen main themes. Safety concerns and inadequate infrastructures were key barriers. Core facilitators were socialization, and multisensory exposure. Conclusions: Patients with chronic conditions and health professionals believe that green exercise improves physical activity engagement, and it would be beneficial if incorporated in the rehabilitation process. There are challenges to overcome to make therapeutic green exercise for people with chronic conditions more accessible. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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18 pages, 913 KB

Open AccessArticle

Impact of Exercise Guidance Timing on Physical and Cognitive Function in Older Adults: A Pilot Study

by Sofia Lampropoulou, Anthi Kellari and Vasiliki Sakellari

Appl. Sci. 2023, 13(17), 9526; https://doi.org/10.3390/app13179526 - 23 Aug 2023

Viewed by 2392

Abstract

Guidance through an exercise program improves balance and gait in older adults, but the efficacy of the timing these are given is unclear. The objective of this study is to evaluate the effects of guidance delivery time on balance, gait, falls, and cognitive functions. In a single (participants)-blinded clinical trial, a convenient sample of 24 older adults (aged 74 ± 6 years) were separated in two age-matched groups, both of which received a progressive 12-week Otago Exercise Program (OEP) for strength and balance. Group 1 received visual and verbal guidance before the performance of each of the exercises, while group 2 received the visual and verbal guidance only synchronously with the exercises. Balance, gait, fear of falling, and cognitive function were evaluated at baseline, week 6, and week 12 of the program. Fall incidence and exercise adherence were also documented. Significant improvements (p < 0.05) were revealed in all assessed variables post intervention, regardless of the guidance delivery time. Only the mental function and the adherence to the exercise tended to be better when the guidance was given in advance of the exercise execution, but further studies of a bigger sample size and with a control group should be conducted before safe conclusions are extracted. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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Review

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28 pages, 1543 KB

Open AccessReview

The Current State of Virtual Reality in the Management of Musculoskeletal Conditions and Associated Chronic Pain: Terminology, Technology, and Associations

by Manca Opara Zupančič and Nejc Šarabon

Appl. Sci. 2025, 15(5), 2564; https://doi.org/10.3390/app15052564 - 27 Feb 2025

Cited by 3 | Viewed by 2595

Abstract

Virtual reality (VR) demonstrates significant potential to improve rehabilitation outcomes for musculoskeletal conditions and associated chronic pain. However, the field faces notable challenges, including inconsistent terminology, a lack of specialized/comprehensive software solutions, and an overwhelming variety of hardware options, which can make it difficult for healthcare professionals without technical expertise to identify the most suitable tools for clinical use. This article explores the current state of VR in the rehabilitation of musculoskeletal conditions and chronic pain, focusing on terminology discrepancies, available hardware and software solutions, and key professional associations shaping the field. A review of the current state of terminology is essential to address inconsistencies that risk perpetuating misuse and to facilitate clearer communication. Building on this review, we propose a conceptual framework for understanding VR that aligns more closely with the capabilities of current VR technology. A comprehensive overview of VR hardware and software can assist healthcare professionals in selecting appropriate technologies for clinical practice, guide researchers in designing interventions, and inform developers on unmet needs in the field. Furthermore, understanding key professional associations provides valuable direction for those engaged in virtual rehabilitation, enabling them to access resources, foster collaboration, and stay informed about the latest advancements in the domain. This review addresses the significant confusion regarding the understanding of VR, particularly in relation to its classification based on levels of immersion. Accordingly, it proposes a framework that contributes to a standardized approach to understanding VR. Additionally, it highlights the lack of VR solutions tailored to the needs of patients with musculoskeletal conditions and associated chronic pain, emphasizing the necessity for further development in this area. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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24 pages, 689 KB

Open AccessReview

Effects of Physical Exercise on Substance Use Disorder: A Comprehensive Review

by Roberto Montón-Martínez, Ismael Castellano-Galvañ, Alba Roldán, Alejandro Javaloyes, Iván Peña-González, José Manuel Sarabia, Diego Pastor and Manuel Moya-Ramón

Appl. Sci. 2025, 15(3), 1481; https://doi.org/10.3390/app15031481 - 31 Jan 2025

Viewed by 4464

Abstract

Physical exercise has emerged as a promising complementary intervention for individuals with substance use disorders (SUD). This comprehensive review examines the neurobiological, psychological, and social benefits of exercise in improving quality of life (QOL), mental health, sleep quality, craving, physical fitness, and cognitive function among individuals with SUD. Aerobic exercises, particularly those of moderate intensity, demonstrate a consistent efficacy in reducing anxiety, depression, and cravings, while also enhancing cardiovascular health and psychosocial well-being. Strength training and concurrent programs provide additional benefits for muscular and cognitive function, although their effects on mental health are less consistent. Mind–body disciplines like yoga and Tai Chi offer accessible entry points for individuals with low baseline fitness but exhibit variable outcomes, especially in sleep and craving management. High-intensity interval training (HIIT) shows potential for craving reduction and cardiovascular improvements but may pose challenges for individuals with low initial fitness. This review underscores the importance of tailored, well-structured programs that align with participants’ needs and capabilities. Future research should prioritize standardizing protocols, incorporating technological tools, and exploring hybrid intervention models to maximize adherence and therapeutic impact. Physical exercise remains a vital, multifaceted tool in comprehensive SUD rehabilitation strategies. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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30 pages, 1105 KB

Open AccessReview

A Strong Core for a Strong Recovery: A Scoping Review of Methods to Improve Trunk Control and Core Stability of People with Different Neurological Conditions

by Giorgia Marchesi, Greta Arena, Alice Parey, Alice De Luca, Maura Casadio, Camilla Pierella and Valentina Squeri

Appl. Sci. 2024, 14(11), 4889; https://doi.org/10.3390/app14114889 - 5 Jun 2024

Cited by 2 | Viewed by 6923

Abstract

Objective: The purpose of this scoping review is to provide valuable insights for clinicians and researchers for designing rehabilitative interventions targeting the trunk and core for individuals who have experienced traumatic events, such as stroke or spinal cord injury, or are grappling with neurological diseases such as multiple sclerosis and Parkinson’s disease. We investigated training methods used to enhance balance, trunk control, and core stability. Methods: We conducted an extensive literature search across several electronic databases, including Web of Science, PubMed, SCOPUS, Google Scholar, and IEEE Xplore. Results: A total of 109 articles met the inclusion criteria and were included in this review. The results shed light on the diversity of rehabilitation methods that target the trunk and core. These methods have demonstrated effectiveness in improving various outcomes, including balance, trunk control, gait, the management of trunk muscles, overall independence, and individuals’ quality of life. Conclusions: Our scoping review provides an overview on the methods and technologies employed in trunk rehabilitation and core strengthening, offering insights into the added value of core training and specific robotic training, focusing on the importance of different types of feedback to enhance training effectiveness. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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Other

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20 pages, 1859 KB

Open AccessSystematic Review

From Evidence to Practice: A Systematic Review and Meta-Analysis on the Effects of Supervised Exercise on Fatigue in Breast and Prostate Cancer Survivors

by Arturo Cano-Uceda, Pablo García-Fernández, Blanca Peuyadé-Rueda, Ana María Cañuelo-Marquez, Cristian Solís-Mencía, Carmen Lucio-Allende, Luis De Sousa-De Sousa and José Luis Maté-Muñoz

Appl. Sci. 2025, 15(15), 8399; https://doi.org/10.3390/app15158399 - 29 Jul 2025

Viewed by 759

Abstract

Background: Breast and prostate cancer represent a significant global public health burden. Among the adverse effects of oncological treatments, fatigue is one of the most prevalent, persistent, and disabling symptoms. Therapeutic exercise has been shown to be effective for its management, with supervision identified as a key factor that may enhance adherence, safety, and intensity control. This systematic review and meta-analysis aimed to compare the effects of supervised exercise programs versus usual care on cancer-related fatigue in patients with breast or prostate cancer. Methods: A systematic search (September–December 2024) was conducted in six databases (PubMed, Web of Science, Scopus, Cochrane, PEDro, Scielo), selecting RCTs from the past 10 years in English or Spanish. Studies compared supervised exercise with unsupervised exercise or usual care in stage I–III breast or prostate cancer patients within five years post-treatment. Methodological quality was assessed with the PEDro scale and risk of bias with Cochrane’s RoB 2.0. A random-effects model was used to calculate pooled effect sizes (ES, 95% CI), with heterogeneity (I²), sensitivity, subgroup, and publication bias analyses. Results: A total of 25 interventions from 19 randomized controlled trials involving over 2200 participants were included. Supervised exercise significantly reduced cancer-related fatigue compared to usual care (effect size = 0.34; 95% CI: 0.22–0.47; p < 0.001; I² = 56%). Sensitivity analyses supported the robustness of the findings. Subgroup analyses revealed greater effects in combined exercise programs, in men, and in patients with prostate cancer. No evidence of publication bias was observed. While 73.7% of studies were rated as having good methodological quality, the risk of bias was often unclear or high. Conclusions: Supervised therapeutic exercise programs are effective and safe for reducing fatigue in breast and prostate cancer survivors. These interventions should be incorporated into comprehensive care plans, with individualization based on patients’ clinical and demographic characteristics. Further research is needed to identify the most effective and sustainable strategies for different patient subgroups. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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23 pages, 1711 KB

Open AccessCase Report

Effect of Individualized Whole-Body Vibration Exercise on Locomotion and Postural Control in a Person with Multiple Sclerosis: A 5-Year Case Report

by Stefano La Greca, Stefano Marinelli, Rocco Totaro, Francesca Pistoia and Riccardo Di Giminiani

Appl. Sci. 2025, 15(15), 8351; https://doi.org/10.3390/app15158351 - 27 Jul 2025

Viewed by 788

Abstract

The present study aims to investigate the multi-year effects (5 years) of individualized whole-body vibration (WBV) on locomotion, postural control, and handgrip strength in a 68-year-old man with relapse remitting multiple sclerosis (PwRRMS). The dose–response relationship induced by a single session was quantified by determining the surface electromyographic activity (sEMG) of the participant. The participant wore an orthosis to limit the lack of foot dorsiflexion in the weakest limb during walking in daily life. The gait alteration during walking was assessed at 1, 2 and 3 km/h (without the orthosis) through angle–angle diagrams by quantifying the area, perimeter and shape of the loops, and the sEMG of leg muscles was recorded in both limbs. The evaluation of postural control was conducted during upright standing by quantifying the displacement of the center of pressure (CoP). The handgrip strength was assessed by measuring the force–time profile synchronized with the sEMG activity of upper arm muscles. The participant improved his ability to walk at higher speeds (2–3 km/h) without the orthosis. There were greater improvements in the area and perimeter of angle–angle diagrams for the weakest limb (Δ = 36–51%). The sEMG activity of the shank muscles increased at all speeds, particularly in the tibialis anterior of weakest limbs (Δ = 10–68%). The CoP displacement during upright standing decreased (Δ = 40–60%), whereas the handgrip strength increased (Δ = 32% average). Over the 5-year period of intervention, the individualized WBV improved locomotion, postural control and handgrip strength without side effects. Future studies should consider the possibility of implementing an individualized WBV in PwRRMS. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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22 pages, 738 KB

Open AccessSystematic Review

The Effectiveness of Pelvic Floor Muscle Exercise with Biofeedback in Women with Urinary Incontinence: A Systematic Review

by Aikaterini Evangelia Matsi, Evdokia Billis, Sofia Lampropoulou, Sofia A. Xergia, Maria Tsekoura and Konstantinos Fousekis

Appl. Sci. 2023, 13(23), 12743; https://doi.org/10.3390/app132312743 - 28 Nov 2023

Cited by 2 | Viewed by 8348

Abstract

Urinary incontinence affects approximately 200 million people worldwide. The objective of this study was to investigate the effect of pelvic floor muscle (PFM) training with biofeedback (BF) in women with urinary incontinence in comparison to PFM training alone. The primary outcome was PFM strength with secondary outcomes being the severity of incontinence, other PFM parameters, quality of life (QoL), social life, satisfaction and adherence to treatment. Randomized controlled trials (RCTs) published from 2005 to 2023 in PubMed, MEDLINE, Scopus and Google Scholar were searched and evaluated with the PEDro scale. Nine moderate and two high methodological quality RCTs were selected. There was a statistically significant improvement in all parameters. In five studies, muscle strength and the severity of incontinence were statistically better in the BF group compared to the non-BF group. In most studies, no differences were found for QoL and social life between the groups. For adherence to treatment, the results were ambiguous. Τhe remaining variables (endurance, precontraction, function, adherence and satisfaction) had few studies to support the results. There was moderate level evidence that the group utilizing PFM exercises with BF showed significant improvements in the management of urinary incontinence. Concerning muscle strength and the severity of incontinence, findings were inconclusive, as only in some studies the results were statistically better in the BF group compared to the non-BF group. Full article

(This article belongs to the Special Issue Recent Advances in Exercise-Based Rehabilitation)

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