Search Results (1,264)

Early rehabilitation is essential for restoring functional recovery in patients with stroke, particularly during the early phase of post-acute care (PAC), or the subacute stage. We aimed to evaluate the effectiveness of a 7-week PAC rehabilitation program in improving muscle strength, physical performance, and functional recovery. A total of 219 inpatients with stroke in the subacute stage were initially recruited from the PAC ward of a regional teaching hospital in Northern Taiwan, with 79 eligible patients—within 1 month of an acute stroke—included in the analysis. The program was delivered 5 days per week, with 3–4 sessions daily (20–30 min each, up to 120 min daily), comprising physical, occupational, and speech–language therapies. Sociodemographic data, muscle strength, physical performance (Berg Balance Scale [BBS], gait speed, and 6-minute walk test [6MWT]), and functional recovery (modified Rankin Scale [mRS], Barthel Index [BI], Instrumental Activities of Daily Living [IADL], and Fugl–Meyer assessment: sensory and upper extremity) were collected at baseline, 3 weeks, and 7 weeks. Generalized estimating equations analyzed program effectiveness. Among the 56 patients (70.9%) who completed the program, significant improvements were observed in the muscle strength of both the affected upper (B = 0.93, p < 0.001) and lower limbs (B = 0.88, p < 0.001), as well as in their corresponding unaffected limbs; in physical performance, including balance (BBS score: B = 9.70, p = 0.003) and gait speed (B = 0.23, p = 0.024); and in functional recovery, including BI (B = 19.5, p < 0.001), IADL (B = 1.48, p < 0.001), and mRS (B = −0.13, p = 0.028). These findings highlight the 7-week PAC rehabilitation program as an effective strategy during the critical recovery phase for patients with stroke. Full article

China’s rapid urbanization has driven tremendous socioeconomic development while posing new forms of social–spatial inequalities that challenge environmental sustainability and spatial justice. This study investigates urban park-accessibility patterns across 10 s-tier provincial capital cities in China, examining how these patterns relate to housing-price dynamics to reveal diverse manifestations of social–spatial (in)justice. Using comprehensive spatial analysis grounded in distributive justice principles, we measure park accessibility through multiple metrics: distance to the nearest park, park size, and the number of parks within a 15 min walk from residential communities. Our findings reveal significant variation in park accessibility across these cities, with distinctive patterns emerging in the relationship between housing prices and park access that reflect different forms of social–spatial exclusion and inclusion. While most cities demonstrate an unbalanced spatial distribution of parks, they exhibit different forms of this disparity. Some cities show consistent park access across housing-price categories, while others display correlations between high housing prices and superior park accessibility. We argue that these divergent patterns reflect each city’s unique combination of economic development trajectory, politically strategic positioning within national urban hierarchies, and geographical constraints. Through this comparative analysis of second-tier cities, this study contributes to broader understandings of social–spatial (in)justice and urban environmental inequalities within China’s urbanization process, highlighting the need for place-specific approaches to achieving equitable access to urban amenities. Full article

Objectives: This study examined the impact of a low-sugar flavored beverage on total fluid intake and hydration biomarkers during intermittent exercise in a hot environment among healthy children. Methods: Twenty-one children (11 girls, 8–10 y) completed a randomized, crossover study with two trials. Each trial involved three bouts of 10 min walking, 5 min rest, 10 min walking, and 35 min rest for a total of 3 h in a hot (29.9 ± 0.6 °C) and dry environment (26 ± 7% relative humidity). Walking intensity was 69 ± 7% of age-predicted maximum heart rate. Participants consumed either plain water (W) or a low-sugar flavored beverage (FB). Body weight, fluid intake, urine samples, and perceptual ratings were collected. Results: Total ad libitum fluid intake was significantly higher with the FB (946 ± 535 mL) than with W (531 ± 267 mL; p < 0.05). This difference was 128% higher for FB compared to W, with 19 out of the 21 children ingesting more fluids in FB versus W. Children rated the FB as more likable across all time points (p < 0.05). Net fluid balance was better with FB at 60, 70, 85, 135, and 145 min (p < 0.05), though not different at the 3 h mark. Urine volume was higher with FB (727 ± 291 mL) than with W (400 ± 293 mL; p < 0.05). Urine osmolality was significantly higher in the W trial at 120 and 180 min (p < 0.05). Conclusions: A flavored, low-sugar beverage enhanced ad libitum fluid intake and improved hydration markers compared to water during exercise in the heat, supporting its potential as a practical rehydration strategy for children. Full article

Metabolic analysis systems require binary sex input, conflating biological sex with gender, limiting inclusivity. This study aimed to determine whether sex input altered metabolic or pulmonary variables during self-paced walking and running. Twenty adults completed two 5-min walking and running trials under both female (FC) and male (MC) input conditions in randomized order. Dependent t-tests determined differences between conditions; p-values < 0.05 were considered significant, and effect sizes were calculated. No significant within-participant differences were found between FC and MC for any variable. During walking, mean relative VO₂ (mL/kg/min) was 11.13 ± 2.73 (FC) and 10.81 ± 2.39 (MC), p = 0.08, R² = 0.93; mean energy expenditure (kcal) was 18.28 ± 4.74 (FC) and 17.86 ± 4.33 (MC), p = 0.12, R² = 0.94. During running, mean relative VO₂ was 28.80 ± 5.89 (FC) and 28.82 ± 6.06 (MC), p = 0.90, R² = 0.98; mean energy expenditure was 45.79 ± 13.08 (FC) and 45.55 ± 12.26 (MC), p = 0.99, R² = 0.98. Binary sex input in the TrueOne 2400 system did not affect variables, supporting inclusive sex and gender data collection to improve research ethics, accuracy, and representation of gender-diverse people without compromising integrity. Full article

Background/Objectives: Total knee arthroplasty (TKA) is commonly associated with postoperative muscle atrophy and weakness, while traditional rehabilitation is often limited by pain and patient compliance. Passive blood flow restriction (pBFR) training may offer a safe, low-threshold method to attenuate muscle loss in this early phase. This pilot study examined the feasibility, safety, and early effects of pBFR initiated during hospitalization on muscle mass, swelling, and functional recovery after TKA. Methods: In a prospective, single-blinded trial, 26 patients undergoing primary or aseptic revision TKA were randomized to either a control group (CON: sham BFR at 20 mmHg) or intervention group (INT: pBFR at 80% limb occlusion pressure). Both groups received 50 min daily in-hospital rehabilitation sessions for five consecutive days. Outcomes, including lean muscle mass (DXA), thigh/knee circumference, 6 min walk test (6 MWT), handgrip strength, and patient-reported outcomes, were assessed preoperatively and at discharge, six weeks, and three months postoperatively. Linear mixed models with Bonferroni correction were applied. Results: The INT group showed significant preservation of thigh circumference (p = 0.002), reduced knee swelling (p < 0.001), and maintenance of lean muscle mass (p < 0.01), compared with CON, which exhibited significant declines. Functional performance improved faster in INT (e.g., 6 MWT increase at T3: +23.7%, p < 0.001; CON: −7.2%, n.s.). Quality of life improved in both groups, with greater gains in INT (p < 0.05). No adverse events were reported. Conclusions: Initiating pBFR training on the first postoperative day is feasible, safe, and effective in preserving muscle mass and reducing swelling after TKA. These findings extend prior BFR research by demonstrating its applicability in older, surgical populations. Further research is warranted to evaluate its integration with standard rehabilitation programs and long-term functional benefits. Full article

Urban green spaces (UGS) are essential for residents’ well-being, environmental quality, and social cohesion. However, previous studies have typically employed undifferentiated analytical frameworks, overlooking UGS types and failing to adequately measure the structural disparities of different UGS types within residents’ walking distance. To address this, this study integrates Gaussian Two-Step Floating Catchment Area models, Simpson’s index, and the Gini coefficient to construct an accessibility–diversity–equality assessment framework for UGS. This study conducted an analysis of accessibility, diversity, and equity for various types of UGSs under pedestrian conditions, using the high-density city of Shenzhen, China as a case study. Results reveal high inequality in accessibility to most UGS types within 15 min to 30 min walking range, except residential green spaces, which show moderate-high inequality (Gini coefficient: 0.4–0.6). Encouragingly, UGS diversity performs well, with over 80% of residents able to access three or more UGS types within walking distance. These findings highlight the heterogeneous UGS supply and provide actionable insights for optimizing green space allocation to support healthy urban development. Full article

When people overextend their step length, it leads to an increase in vertical movement and braking force. The overextension elevates landing impacts, which may increase pain in the knees or lower back. The objective of this study was to examine the effects of soft-landing walking techniques in a 90 min, instructor-led group class for older adults. To evaluate a landing impact, an accelerometer measurement system (Descente LTD., Tokyo, Japan) was used to measure a participant 10 meter (m) of walking. Assessment outcomes included the average number of steps, step length, upward acceleration which reflects the landing impact, and survey questions. A total of 223 older adults (31 men, 192 women, mean age 74.4 ± 5.7 years) completed the walking lesson. Following the lesson, participants decreased their step lengths and reduced upward acceleration, along with an increased step count. The number of steps increased, and a positive correlation (r = 0.73, p < 0.01) was observed between the rate of change in step length and upward acceleration. Over 95% of participants gave high marks for practicality and understanding the accelerometer measurements. The information derived from this study will provide valuable insight into the effectiveness of soft-landing techniques as a promotion of a healthy walking program for older adults. Full article

This paper clarified the correlation among quality of life (QoL) indicators, exercise implementation level, and exercise habits in middle-aged and older adults under identical exercise intervention conditions. The survey items were anthropometric and physiologic measurements, physical strength measurements, and exercise habits. During the 3-month experimental period, a weekly “health exercise course” served as the primary intervention. For all participants, anthropometric and physiologic measurements, physical strength tests, questionnaire surveys, and other surveys were conducted before and after the experiment; then, the pre- and post-intervention effects were compared. After the exercise intervention, significant differences were observed among middle-aged and older adults in terms of various parameters, such as weight, fat rate, diastolic pressure, systolic pressure, sit-up, standing on one foot, lower limb extension force, activity of daily living (ADL), and subjective well-being (PGC). ADL and PGC changed significantly in the participants who engaged in exercise more than twice a week. However, the participants who engaged in exercise for less than twice a week showed no significant differences in any parameters except the life satisfaction (LSI) mean; the LSI increased in the “Less than twice a week” exercise group but decreased in the “More than twice a week” group. In terms of average walking time per session, the “More than 30 min” exercise group showed significant differences in ADL and PGC, whereas the “Less than 30 min” group showed significant differences only in the LSI. The influence of exercise on QoL indicators of middle-aged and older adults, under the same exercise intervention conditions, is related to their exercise habits. This study highlights the benefits of physical exercise in middle-aged and older adults, emphasizing the importance of regular and sustained exercise for this population. Furthermore, the study provides a scientific basis for improving QoL in middle-aged and older adults, thus, to some extent, addressing the concerns related to the growing population of older adults. Full article

Background/Objectives: Although public health organizations encourage family walking, no studies have examined children’s physical activity and enjoyment during outdoor parent–child walks. This study addresses those gaps by examining children’s moderate-to-vigorous physical activity (MVPA) and enjoyment during outdoor walks with their parents, along with parental barriers and their relationship with parent’s self-efficacy and co-activity minutes. Methods: Fifty parent–child dyads (children aged 6–12 years) completed 10 min, self-paced outdoor walks while wearing waist-worn ActiGraph monitors. Parents reported perceived barriers to walking outdoors with their child and self-efficacy for supporting their child’s daily physical activity. Results: Children reported high enjoyment (mean = 5.1 on a six-point scale) and attained high physical activity intensity (71.3% of time in MVPA, 22.0% in vigorous activity, mean step count = 1200). Parents reported an average of 2.6 barriers (SD = 1.0) to walking outdoors with their child, with poor weather (70%) and lack of time (70%) reported most frequently. Each additional barrier was associated with a 1.3-point reduction in parents’ self-efficacy (p = 0.007). Two barriers (‘diverse interests between parent and child’ and ‘other parent-suggested barriers’) were significantly associated with fewer co-activity minutes per week (p < 0.001). Conclusions: Our study highlights the benefits of parent–child outdoor walking for promoting MVPA and enjoyment in children. Because perceived barriers may lower parents’ self-efficacy in supporting their child’s physical activity, addressing these barriers may be essential for the success of family-based interventions that encourage walking together outdoors. Full article

Background: The perceived importance of physical practice and its contribution to students’ academic success have evolved considerably throughout the history of the modern educational system. Aim: The purpose of this study was to understand the relationship between physical fitness (measured as VO₂max) and cognitive abilities (attention and concentration) and academic performance in different subjects: sciences, letters, language, arts, and physical education. Method: Fifty Spanish male students who participated in extracurricular sports activities (mean age (SD): 11.59 ± 1.30; range: 9–15 years) were included in the analysis. The 6 min walk test was used to assess physical fitness (6MWT), while for selective attention and concentration, the students completed the D2 test, which is usually considered to analyse the visual ability to select the most relevant stimulus of an exercise and ignore precisely the most irrelevant stimuli. Results: Correlation the individual contribution analyses revealed no significant associations between VO₂max and academic performance in sciences (r = 0.04, p = 0.77), humanities (r = 0.00, p = 0.98), language (r = 0.03, p = 0.83), or arts (r = 0.04, p = 0.76). Similarly, no relationship was found between VO₂max and overall academic performance (r = 0.10, p = 0.46), or cognitive abilities. However, a small positive correlation was observed between VO₂max and physical education scores. Conclusions: Physical fitness showed no significant association with cognitive abilities or academic performance in most subjects, although a small positive correlation with physical education scores was observed. These findings emphasise the importance of promoting physical activity for its health and physical benefits. However, future research should explore broader cognitive outcomes and include more diverse and representative samples. Full article

Introduction: Home-based cardiac telerehabilitation (HBCTR) is a multidisciplinary intervention aimed at optimizing functional, psychological, and social recovery in patients undergoing percutaneous coronary intervention (PCI). This rehabilitation model serves as an effective alternative to traditional center-based rehabilitation, providing a cost-effective and clinically advantageous approach. Methods: Following PRISMA guidelines, we conducted a systematic literature search across multiple databases (PubMed, CINAHL, Cochrane, Scopus, Web of Science). We included randomized controlled trials (RCTs), cohort, and observational studies assessing telerehabilitation in post-PCI patients. Primary outcomes focused on health-related quality of life (HRQoL) and adherence, while secondary outcomes included functional capacity (6 min walk test, VO₂max), cardiovascular risk factor control, and psychological well-being. Risk of bias was assessed using the Cochrane RoB 2.0 and ROBINS-I tools. Results: A total of 3575 articles were identified after removing duplicates, of which 877 were selected based on title and abstract, and 17 met the inclusion criteria, with strong RCT representation ensuring robust evidence synthesis. HBCTR was associated with significant improvements in exercise capacity, with increases in VO₂max ranging from +1.6 to +3.5 mL/kg/min and in 6 min walk distance from +34.7 to +116.6 m. HRQoL scores improved significantly, with physical and mental component scores increasing by +6.75 to +14.18 and +4.27 to +11.39 points, respectively. Adherence to telerehabilitation programs was consistently high, often exceeding 80%, and some studies reported reductions in hospital readmissions of up to 40%. Wearable devices and smartphone applications facilitated self-monitoring, enhancing adherence and reducing readmissions. Several studies also highlighted improvements in anxiety and depression scores ranging from 10% to 35%. Conclusions: HBCTR is a promising strategy for rehabilitation and quality-of-life improvement after PCI. It offers a patient-centered solution that leverages technology to enhance long-term outcomes. By integrating structured telerehabilitation programs, healthcare systems can expand accessibility, promote adherence, and improve equity in cardiovascular care. Full article

Inhaled treprostinil is approved for the treatment of pulmonary hypertension-associated interstitial lung disease (PH-ILD); however, it has not shown significant benefit in patients with a pulmonary vascular resistance (PVR) < 4 WU. As such, treatment for non-severe PH-ILD remains controversial. A total of 16 patients with non-severe PH-ILD were divided into two groups based on changes in PVR during exercise: a dynamic PVR group (n = 10), characterized by an increase in PVR with exertion, and a static PVR group (n = 6), with no increase in PVR with exercise. The dynamic PVR group received inhaled treprostinil, while the static PVR group was monitored off therapy. Baseline and 16-week follow-up values were compared within each group. At 16 weeks, the dynamic PVR group demonstrated significant improvements in mean 6 min walk distance (6MWD) (+32.5 m, p < 0.05), resting PVR (−1.04 WU, p < 0.05), resting mean pulmonary arterial pressure (mPAP) (−5.8 mmHg, p < 0.05), exercise PVR (−1.7 WU, p < 0.05), exercise mPAP (−13 mmHg, p < 0.05), and estimated right ventricular systolic pressure (−9.2 mmHg, p < 0.05). In contrast, the static PVR group remained clinically stable. These observations suggest that an exercise-induced increase in PVR, identified through Level 3 CPET, may help select patients with non-severe PH-ILD who are more likely to benefit from early initiation of inhaled treprostinil. Full article

Background/Objectives: Lung function decline is influenced by metabolic risk factors (e.g., obesity, hyperglycemia, dyslipidemia) and environmental exposures (e.g., PM2.5), which may jointly contribute to airway inflammation and lung function impairment. This study aimed to investigate these associations in northern Thai adults and identify factors linked to lung function impairment. Methods: A cross-sectional study was conducted in San Pa Thong, Chiang Mai, Thailand, involving 137 adults. Data on metabolic indicators and spirometry were collected. Statistical analyses included Spearman’s correlation, multivariable linear regression, and logistic regression. Results: Higher triglyceride levels and shorter 6-min walk test (6MWT) distances were associated with reduced forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC). Only 6MWT distance remained a significant factor for lung function impairment in logistic regression (adjusted OR = 0.763, 95% CI: 0.588–0.990, p = 0.042). Conclusions: Combining metabolic and respiratory assessments may improve early detection of lung function impairment in high-risk populations, particularly given the dual burden of metabolic disorders and air pollution in northern Thailand. These findings support the integration of metabolic and respiratory screening in community health programs to enhance preventive strategies. Full article

Purpose: We aimed to evaluate the safety and feasibility of a remote electrocardiogram (ECG) monitoring-based cardiac rehabilitation (CR) program during an early postoperative period in patients who underwent cardiac surgery. Methods: Five days after cardiac surgery, patients were referred to a CR department and participated in a low-intensity inpatient CR program while wearing an ECG monitoring device. Prior to discharge, the patients underwent a cardiopulmonary exercise test (CPET) and squat endurance test to determine the suitable intensity and target heart rate (HR) for home-based CR (HBCR). During 2 weeks of the HBCR period after discharge, patients participated in aerobic and resistance exercises. Electrocardiogram data were transmitted to a cloud, where researchers closely monitored them through a website and provided feedback to the patients via telephone calls. Grip strength (GS), 6 min walk distance (6 MWD), EuroQol-5 dimension (EQ-5D), short-form 36-item health survey (SF-36), and Korean Activity Scale/Index (KASI) were measured at three different time points: 5 d post-surgery (T1), pre-discharge (T2), and 2 weeks after discharge (T3). Squat endurance tests and CPET were performed only at T2 and T3. Result: Sixteen patients completed the study, seven (44%) of whom underwent coronary artery bypass graft surgery (CABG). During the study period between T2 and T3, peak VO₂ improved from 12.39 ± 0.57 to 17.93 ± 1.25 mL/kg/min (p < 0.01). The squat endurance test improved from 16.69 ± 2.31 to 21.81 ± 2.31 (p < 0.01). In a comparison of values of time points between T1 and T3, the GS improved from 28.30 ± 1.66 to 30.40 ± 1.70 kg (p = 0.02) and 6 MWD increased from 249.33 ± 20.92 to 387.02 ± 22.77 m (p < 0.01). The EQ-5D and SF-36 improved from 0.59 ± 0.03 to 0.82 ± 0.03 (p < 0.01) and from 83.99 ± 3.40 to 122.82 ± 6.06 (p < 0.01), and KASI improved from 5.44 ± 0.58 to 26.11 ± 2.70 (p < 0.01). In a subgroup analysis, the CABG group demonstrated a greater increase in 6 MWD (102.29 m, p < 0.01) than the non-CABG group. At the end of the study, 75% of the patients expressed satisfaction with the early CR program guided by remote ECG monitoring. Conclusions: Our findings suggest that early remote ECG monitoring-based CR programs are safe and feasible for patients who have undergone cardiac surgery. Additionally, the program improved aerobic capacity, functional status, and quality of life. Full article

A lack of access to healthy food has been a problem for low-income residents in many developed urban areas. Due to travel time and additional transportation costs, these residents often opt for unhealthy food rather than nutritious alternatives. This study examines the spatial distribution of food deserts in Mississauga—one of Canada’s most populous cities and a city with one of the highest diabetes rates in the Province of Ontario. Network analysis was employed to map the geographic inaccessibility to essential nutritious food, defined as residential areas that are beyond a 15-min walking distance from grocery stores. Socioeconomic indicators were integrated to identify and compare the regions that are socioeconomically disadvantaged and, therefore, most affected by food inaccessibility. The results reveal the presence of several food deserts spatially dispersed in Mississauga. The implications of these findings are discussed, with a focus on the relationship between food desert locations and the socioeconomic conditions of the affected residents. This study provides a practical, replicable approach for identifying food deserts that can be easily applied in other regions. The model developed offers valuable tools for policymakers and urban planners to address food desert issues, improving access to healthy food and positively impacting the health and well-being of affected populations. Full article