Search Results (128)

Diabetic foot ulcers (DFUs) are a serious complication of diabetes, associated with high recurrence and amputation rates. Adherence to offloading devices is critical for wound healing but remains inadequately monitored in real-world settings. This study evaluates the SmartBoot edge-computing system—a wearable, real-time remote monitoring solution integrating an inertial measurement unit (Sensoria Core) and smartwatch—for its validity in quantifying cadence and step count as digital biomarkers of frailty, and for detecting adherence. Twelve healthy adults wore two types of removable offloading boots (Össur and Foot Defender) during walking tasks at varied speeds; system outputs were validated against a gold-standard wearable and compared with staff-recorded adherence logs. Additionally, user experience was assessed using the Technology Acceptance Model (TAM) in healthy participants (n = 12) and patients with DFU (n = 81). The SmartBoot demonstrated high accuracy in cadence and step count across conditions (bias < 5.5%), with an adherence detection accuracy of 96% (Össur) and 97% (Foot Defender). TAM results indicated strong user acceptance and perceived ease of use across both cohorts. These findings support the SmartBoot system’s potential as a valid, scalable solution for real-time remote monitoring of adherence and mobility in DFU management. Further clinical validation in ongoing studies involving DFU patients is underway. 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

As modern generative models advance rapidly, AI-generated images exhibit higher resolution and lifelike details. However, the generated images may not adhere to world knowledge and common sense, as there is no such awareness and supervision in the generative models. For instance, the generated images could feature a penguin walking in the desert or a man with three arms, scenarios that are highly unlikely to occur in real life. Current AI-generated image detection methods mainly focus on low-level features, such as detailed texture patterns and frequency domain inconsistency, which are specific to certain generative models, making it challenging to identify the above-mentioned general semantic fakes. In this work, (1) we propose a new task, reasoning AI-generated image detection, which focuses on identifying semantic fakes in generative images that violate world knowledge and common sense. (2) To benchmark the new task, we collect a new dataset Spot the Semantic Fake (STSF). STSF contains 358 images with clear semantic fakes generated by three different modern diffusion models and provides bounding boxes as well as text annotations to locate the fakes. (3) We propose RADAR, a reasoning AI-generated image detection assistor, to locate semantic fakes in the generative images and output corresponding text explanations. Specifically, RADAR contains a specialized multimodal LLM to process given images and detect semantic fakes. To improve the generalization ability, we further incorporate ChatGPT as an assistor to detect unrealistic components in grounded text descriptions. The experiments on the STSF dataset show that RADAR effectively detects semantic fakes in modern generative images. Full article

Background/Objectives: This study aims to investigate the influence of demographic, behavioral, anthropometric, and comorbid factors on brain atrophy in people living with HIV (PLWH). Methods: We conducted a cross-sectional study involving 121 HIV-positive patients, stratified into two groups, those with and without brain atrophy (BA). For each participant, we recorded demographic data, smoking status, physical activity levels, disease and treatment duration, and comorbidities. BA was quantitatively assessed using MRI-derived volumetric measurements of 47 cerebral substructures. Results: Patients with BA exhibited significantly reduced gray matter (GM) and white matter (WM) volumes alongside increased cerebrospinal fluid volumes, both in absolute and percentage measurements. WM atrophy was most pronounced in the frontal, parietal, and temporal lobes, with relative sparing of the occipital lobe. GM atrophy predominantly affected the basal ganglia (notably, the thalamus and putamen) and cortical regions, including the hippocampus, frontal, and parietal lobes. Significant positive correlations were observed between BA and both smoking status (pack–years) and disease duration, while physical activity demonstrated an inverse relationship (higher atrophy risk in those with less than 30 min of daily continuous walking). Non-adherence to antiretroviral therapy (ART) was also associated with BA. Among comorbidities, type 2 diabetes and HIV-associated neurocognitive disorders (HAND) showed the strongest associations with BA. Conclusions: Brain atrophy in PWH is correlated with smoking, physical inactivity, and the duration of HIV infection. Comorbid conditions, such as type II diabetes and HAND, amplify the risk for BA. We consider that early lifestyle interventions and optimized ART may mitigate the neurodegeneration process. Full article

This pilot study aimed to assess the feasibility and preliminary effects of a supervised, home-based exercise program in patients recovering from laparoscopic colorectal cancer surgery. A total of 23 patients were included, with 13 participating in the exercise intervention and 10 receiving standard postoperative care. The exercise group (intervention group) followed a two-month structured program, while the control group received no structured exercise. Feasibility was demonstrated by 98% adherence in the intervention group and no reported adverse events. At T1, the intervention group showed significant improvements in role function, cognitive function, and reduced fatigue compared to the control group. At T2, a significant difference was observed in physical function. Functional capacity, assessed by the Six-Minute Walk Test, was significantly better in the intervention group at T1, T2, and T3, as was physical performance measured by the Short Physical Performance Battery (SPPB) at T1, T2, and T3. No significant differences were observed between the groups in anxiety, depression, sleep quality, or body composition parameters. This study highlights the feasibility of a supervised home-based exercise program in the early postoperative phase, demonstrating positive effects on Quality of Life, functional recovery, and fatigue in colorectal cancer patients. Full article

Background/Objectives: In cardiac rehabilitation, the 6-minute walk test (6-MWT) is a standard assessment of initial evaluation. It measures walking distance as a surrogate of submaximal physical performance. Thereby, a subjective rating of perceived exertion, assessed by the Borg Scale, plays an important role. It has been observed that patients with coronary heart disease often rate themselves lower than the person supervising the test. Since this discrepancy might lead to inadequate exercise prescription, this study aims to explore reasons for low self-rating. Methods: In a qualitative study, influencing factors for low self-rating were collected from patients using interviews and questionnaires and from a focus group of physiotherapists. The evaluation was based on the grounded theory. Results: Self-image after retirement emerged as the central factor, as it shaped patients’ behavior during the 6-MWT and their subsequent self-assessment. Additionally, five different categories of causal conditions were detected from ten patients and five therapists: fears, physical limitations, test instruction, testing conditions, and therapists’ expectations. Conclusions: Patients with coronary heart disease had poor self-perception of exercise intensity and limited understanding of the meaning of the Borg Scale and the 6-MWT. Physiotherapists should place greater emphasis on patients’ perceived exertion to be able to effectively tailor exercise prescription and, therefore, improve attainment of cardiac rehabilitation goals and long-term adherence. Full article

One emerging method in home stroke rehabilitation is digital technology. However, existing approaches typically target one domain (e.g., upper limb). Moreover, existing interventions do not cater to older adults with stroke (OAwS), especially those with high motor impairment, who require adjunct therapeutic agents to independently perform challenging exercises. We examined the feasibility of Smartphone-based Exercise Training after Stroke (SETS) with Functional Electrical Stimulation (FES). A total of 12 participants (67 ± 5 years) with stroke (onset > 6 months) exhibiting moderate-to-high motor impairment (Chedoke McMaster Leg ≤ 4/7) underwent 6 weeks of multicomponent (gait, functional strength, dynamic balance) training integrated with FES to paretic lower limb muscles. Primary measures included safety and adherence. Secondary measures included motivation, acceptability and attitude, usability, and clinical measures of gait and balance function like the 10-Meter Walk Test and Mini-BESTest. Participants reported no adverse events and moderate-to-high adherence (84.17 ± 11.24%) and improvement (up to 40%) in motivation, acceptability, and attitude and system usability. Participants also showed pre-post improvements in all measures of gait and balance function (p < 0.05). Integrating SETS and FES is feasible and yields short-term gains in gait and balance function among OAwS. Future studies could validate our findings by examining its efficacy with control groups to identify the differential effects of SETS and FES. Full article

(1) Left ventricular assist device (LVAD) implantation is increasingly used as a treatment option for patients with advanced heart failure (HF). There is a need to provide patients with LVAD with long-term care, preferably at home. The implementation of home-based telerehabilitation (HTR) and telecare offers new opportunities in this field. Purpose: The purpose of this study was to assess the feasibility and safety of HTR and telecare in HF patients with implanted LVAD and evaluate patients’ acceptance of and adherence to HTR. (2) The study enrolled 30 HF patients with recently implanted LVAD (21 Heart Mate III, 9 Heart Ware) (29 males, mean 59 years) who underwent a 12-week telecare and HTR program based on walking, respiratory, and resistance training, five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recordings and to transmit data via a mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise. The influence on physical capacity was assessed by comparing changes in peak oxygen consumption (pVO₂; [mL/kg/min]) and workload duration (t; [s]) during the cardiopulmonary exercise test. (3) HTR resulted in a significant physical capacity improvement in pVO₂ 12.5 ± 2.9 vs. 15.1 ± 3.0 (p < 0.001), and workload duration t 628 ± 204 vs. 728 ± 222 (p < 0.001) during the cardiopulmonary exercise test. There were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the medical team. All patients completed HTR. (4) HTR is a feasible and safe form of rehabilitation that is well-accepted by patients. The adherence to HTCR was high. Full article

Background: Home-based pulmonary rehabilitation (PR) is an effective alternative to center-based PR. However, not all participants exhibit sufficient therapeutic improvement, highlighting the need to identify appropriate candidates to maximize cost-effectiveness. This study aimed to identify the factors associated with favorable outcomes in home-based PR, focusing on the role of digital therapeutics (DTx). Methods: This secondary analysis used data from a randomized controlled trial. Participants with chronic respiratory disease (CRD) were divided into responders and non-responders based on a change in 6 min walk distance (6MWD) and patient-reported outcome measures (PROM) representing dyspnea and health-related quality of life. Factors such as baseline 6MWD, DTx use, and pulmonary function were analyzed for their predictive value in improving 6MWD and PROM scores. Results: Responders, particularly those using DTx, showed significantly greater improvements in 6MWD than non-responders. Participants with a baseline 6MWD under 500 m demonstrated a higher likelihood of exceeding the minimum clinically important difference in 6MWD. DTx use strongly predicted improvements in both 6MWD and PROM scores. The baseline diffusing capacity of the lungs for carbon monoxide was also a significant factor influencing improvements in the modified Medical Research Council scale. Conclusions: Responders to 8-week program of home-based PR exhibited a relatively lower baseline health status. Encouraging participants with poorer baseline health could improve adherence to PR and enhance cost-effectiveness. Additionally, improvements in 6MWD and PROM scores were associated with the use of DTx. Considering the functions of DTx, proper supervision for home-based exercise may be crucial for achieving optimal outcomes. Full article

Pedestrian safety is a growing global concern, particularly in urban areas, where rapid urbanization and increased mobile device usage have led to an increase in distracted walking. This study investigates the impact of technological distractions, specifically mobile usage (MU), on pedestrian behavior and safety at signalized urban intersections. Data were collected from 11 signalized intersections in New Delhi, India, using video recordings. Key inputs to the modeling process include pedestrian demographics (age, gender, group size) and behavioral variables (crossing speed, waiting time, compliance behaviors). The outputs of the models focus on predicting mobile usage behavior and its association with compliance behaviors such as crosswalk and signal adherence. The results show that 6.9% of the pedestrians used mobile phones while crossing the road. Advanced machine learning models, including Convolutional Neural Networks (CNN), Long Short-Term Memory networks (LSTM), and Recurrent Neural Networks (RNN), have been applied to analyze and predict MU behavior. Key findings reveal that younger pedestrians and females are more likely to exhibit distracted behavior, with pedestrians crossing alone being the most prone to mobile usage. MU was significantly associated with increased levels of crosswalk violation. Among the machine learning models, the CNN demonstrated the highest prediction accuracy (94.93%). The findings of this study have a practical application in urban planning, traffic management, and policy formulation. Recommendations include infrastructure improvements, public awareness campaigns, and technology-based interventions to mitigate pedestrian distractions and to enhance road safety. These findings contribute to the development of data-driven strategies to improve pedestrian safety in rapidly urbanizing regions. Full article

Background: Frailty is a geriatric syndrome of significant public health concern that causes vulnerability to physiologic stressors and an increased risk of mortality and hospitalizations. Dietary intake and quality are contributing factors to the development of frailty. The Mediterranean diet is known to be one of the healthiest eating patterns with promising health impacts for prevention. We evaluated the association between Mediterranean diet patterns and frailty status. Methods: We conducted a cross-sectional study using National Health and Nutrition Examination Survey data from 2007 to 2017. We included 7300 participants aged > 60 years who completed the first day of a 24 h diet recall and had full covariate data. We constructed an alternate Mediterranean diet (aMED) score based on the quantity of specific food-group intake and categorized participants to low-, moderate-, and high-adherence groups (aMED adherence scores of 0–2, 3–4, and 5–9, respectively). Using a modified Fried Frailty phenotype (weakness, low physical activity, exhaustion, slow walking speed, and weight loss), participants were categorized as robust (met no criteria), pre-frail (met one or two criteria), and frail (met three or more criteria). Logistic regression evaluated the association of frailty (prefrail/robust as referent) and aMED adherence. Results: Included participants were mainly female (54.5%) and non-Hispanic White (80.0%). The mean (SD) aMED score was 3.6 (1.6) with 45% of participants falling into moderate aMED adherence (26% low adherence, 30% high adherence). Frailty prevalence among participants was 7.1%, with most participants classified as robust (51.0%) or pre-frail (41.9%). Fully adjusted models showed significantly reduced odds of frailty with moderate-adherence and high-adherence groups (odds ratio (95%CI) of 0.71 (0.55, 0.92) and 0.52 (0.36, 0.75), respectively). Conclusions: Mediterranean diet adherence is associated with decreased odds of frailty in older adults. These findings suggest that adherence to a Mediterranean diet may play a critical role in mitigating frailty and its associated conditions. Future research should include longitudinal and interventional studies that can definitively determine the effect of a Mediterranean diet on frailty and what food components provide the greatest benefit. Full article

Objective: In this study, the objective is to analyze the efficacy of different aquatic physical exercise programs in the treatment of osteoarthritis in older people. Material and Methods: The systematic review was conducted until April 2024 and updated in November 2024 in five electronic databases. Randomized controlled studies in people over 60 years of age with a diagnosis of osteoarthritis were included. Water-based exercise interventions were assessed for their impact on osteoarthritis symptoms, walking ability, muscle strength, depressive symptoms, range of motion, body composition, fear of falling, fall risk, quality of life, range of motion, and dual task function. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database. Results: A total of 12 studies were included, with sample sizes ranging from 35 to 312 participants. The presence of osteoarthritis in the sample was manifested in different joints. The methodological quality of the included studies varied from fair to good. Based on the results of this review, aquatic exercise significantly improved balance, stiffness, pain, and walking ability compared to non-exercise controls (p < 0.05). Compared with land-based exercise groups, only one study found significant differences between the two groups. Conclusions: Water-based exercise programs do not provide significantly superior benefits compared to other exercise modalities and appear to have limited effectiveness in the management of OA. However, the feasibility and high adherence make these programs a recommendable option for older people with OA. Future studies should investigate the impact of exercise intensity on the short- and long-term efficacy of aquatic therapy. Full article

Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of exercise training (ET) on HFpEF and HFrEF patients as well as exercise modality recommendations in frail and sarcopenic subpopulations. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF) and aids improved survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation (CR) and ET can play an important role in both HFrEF and HFpEF. Preliminary findings suggest that CR significantly improves functional capacity, exercise duration, and quality of life. ET has shown beneficial effects on peak oxygen consumption (pVO₂) and 6 min walk test distance in HFrEF and HFpEF patients, as well as a reduction in hospitalisation and mortality rates; however, the limited scope of larger trials reporting on this underscores the need for further research. ET also has been shown to have beneficial effects on depression and anxiety levels. High-intensity training (HIT) and moderate continuous training (MCT) have both shown benefits, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme, but prescription rates remain low worldwide. Larger robust trials are required to determine ET’s effects on HF, as well as the most efficacious and personalised exercise prescriptions in HF subtypes. Full article

Background/Objectives: Prehabilitation is a low-cost, safe procedure with no side effects, and it may have a positive impact on postoperative outcomes. However, it is not widely implemented. Our study aimed to assess the impact of prehabilitation on postoperative outcomes in patients with ovarian cancer within the field of gynecological oncology. Methods: We analyzed 110 patients with ovarian cancer who participated in a prehabilitation program before cytoreductive surgery. Based on the results of a 6-min walk test (6MWT), patients were divided into two groups: Group A (patients who improved their 6MWT results) and Group B (patients who did not improve their 6MWT results). Results: Patients in Group A demonstrated better postoperative outcomes. The length of hospital stay was significantly shorter in Group A compared to Group B (median 7 [5, 9] vs. 9 [6, 17], p = 0.032). Group A also had a lower overall number of complications and also fewer complications, as summarized by the Clavien–Dindo classification, compared to Group B. Conclusions: Patient adherence to prehabilitation recommendations was adequate. Prehabilitation was associated with improved postoperative outcomes, including shorter hospital stays and fewer complications. These benefits were more pronounced with higher patient compliance with the prehabilitation program and improvements were recorded in preoperative physical capacity. Full article

Background/Objectives: Individuals with subjective cognitive decline (SCD) have an increased risk of developing dementia, while non-pharmacological multicomponent lifestyle interventions are recommended for prevention/management. The Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) is such a multicomponent approach, encompassing simultaneous interventions (cognitive training, depression and sleep management, etc.). Exercise/Physical activity (PA) is suggested as one such intervention. This study (i) presents the exercise protocol developed for GINGER and (ii) explores its feasibility (acceptability, applicability, adherence, users’ satisfaction and reliability). Methods: Exercise/PA protocol development, targeting SCD individuals aged > 55 years, utilized relevant guidelines/literature followed by focus group involving exercise specialists. Data were synthesized through consensus to design optimal exercise interventions prescribed on participant’s physical capacity (heart rate, exertion, etc.), comprising 6-month combined aerobic, strengthening, balance and dual-task exercises, delivered 3 times/weekly in two group-based supervised sessions (in-person and online) and one home-based session. Physical outcomes include balance, aerobic capacity [2-Minute Walk Test (2 MWT), IPAQ-7], strength [Hand Grip Strength (HGS), Sit-to-Stand], fear of falling. Eligibility for entering intervention is low IPAQ-7, 2 MWT or HGS scoring. Feasibility was explored with adherence (exercise diaries and Exercise Adherence Rating Scale) and satisfaction (Patient Satisfaction Questionnaire) Results: Intervention was easily delivered with good reliability across testers’ assessments on 13 SCD participants (ICCs = 0.62–0.99), and improved physical outcomes, whereas users’ adherence and satisfaction scored highly. Conclusions: The exercise protocol for SCD was feasible, acceptable, applicable, reliable, demonstrating adherence and satisfaction, while improving physical parameters. It is thus integrated in the GINGER study, where multiple simultaneous interventions will take place to prevent/enhance cognitive function. Full article