Search Results (329)

Background: Early childhood is crucial for motor and cognitive development, with physical activity playing a key role. Mini-trampoline exercises may offer an effective approach to enhance these domains. Methods: This study assessed the effects of a mini-trampoline program on executive functions and motor skills in Tunisian preschoolers. Fifty-four children (age 3.87 ± 0.47 years) participated in a 12-week intervention, divided into a control group (n = 27), following standard activities, and an experimental group (n = 27), engaging in mini-trampoline exercises. Pre- and post-tests measured motor skills like postural steadiness, balance, and coordination, as well as cognitive functions, including working memory (WM) and inhibition. Results: Significant improvements were observed in the experimental group for functional mobility, postural steadiness, lower body strength, and inhibition (p < 0.001), whereas the control group showed minimal changes. ANOVA revealed no significant group × time effects, except for a trend in postural steadiness (p = 0.062), suggesting a potential benefit of the intervention. Conclusions: These findings highlight the potential of mini-trampoline exercises to enhance motor skills and specific executive functions in preschoolers, supporting their overall development. Full article

Background: Parkinson’s disease (PD) is a neurodegenerative condition that affects quality of life due to motor (gait, balance) and cognitive alterations, raising the risk of falling. Virtual reality (RV) and dancing have shown benefits for speed of walking, balance, and postural stability, as well as decreased risk of falls. Objective: The goal of this study was to analyze the effectiveness of RV and dancing using a Kinect Xbox 360 video game to improve walking speed and motor performance and reduce the risk of falls in patients with PD. Method: This is a pre-experimental study with a simple pre-post design, involving a single group of 14 patients diagnosed with PD in stages 1 to 4 of the Hoehn and Yahr (H and Y) scale, from the National Institute of Neurology (INNN). Before and after the intervention, motor tests, the Unified Parkinson’s Disease Rating Scale (UPDRS-III), the Timed Up and Go (TUG) test, and the Tinetti were applied. The intervention consisted of 16 bi-weekly sessions, which included warm-up, coordination exercises, 10 songs, and cool-down. Results: Effects of the RV intervention were observed on improvements in motor tests (z = −2.640, p = 0.008), gait (z = −3.316, p = 0.001), balance (TUG) (z = −2.966, p = 0.001), and on the UPDRS-III scale (total index) (z = −3.048, p = 0.002). An increase in the difficulty level of dancing was also observed (X² = 144.13, p < 0.01). Conclusions: The virtual reality intervention with dancing improved motor performance, including increased walking speed, enhanced postural stability, reduced stiffness and bradykinesia, and a decreased risk of falls Full article

Advancements in targeted therapies and immunotherapies have improved survival for individuals with metastatic non-small-cell lung cancer (mNSCLC), creating a growing population of Canadians living long-term with the disease. These individuals face ongoing physical, emotional, and practical challenges, yet existing supportive care services are often designed for patients receiving curative intent treatment and may not adequately address the challenges of those undergoing continuous treatment. To explore these experiences and inform the development of supports tailored to their needs, eight participants with mNSCLC completed one-on-one virtual interviews. They described limited support for managing side effects and psychosocial concerns despite general satisfaction with oncology care. Fatigue and cognitive challenges impacted daily functioning, and emotional challenges (e.g., fear of progression, stigma, and difficulty finding meaning) impacted quality of life. Financial burden, including unexpected costs and loss of income, further affected their well-being. Existing supports, such as exercise programs, were viewed positively but were often difficult to access, were offered only short-term, and required patients to find them independently. Recommendations included improved coordination and communication across the healthcare system, alongside tailored interventions such as navigation services, resource directories, health promotion supports, and expanded peer support. Overall, people living long term with mNSCLC face distinct challenges and unmet supportive care needs, highlighting the importance of integrating supportive services into routine oncology care. Full article

This study investigated the effects of eye exercises on eye-hand coordination, cognitive function, and balance in sixty elderly participants aged 60–70 years who were randomly assigned to an experimental or control group. The experimental group performed Gaze Stability Exercises (GSE) for 50 min per session, while the control group performed eyeball exercises for 10 min. Both groups trained twice a week for four weeks. Assessments of eye-hand coordination, cognitive function, and balance were conducted before and after the intervention. An Analysis of Covariance (ANCOVA), adjusting for baseline scores and gender, was used for between-group comparisons. ANCOVA revealed that the GSE group showed significantly greater improvements in cognitive function and dynamic balance compared to the control group (p < 0.05). However, no significant difference was found between the groups for eye-hand coordination. Within-group comparisons showed that both groups improved in eye-hand coordination and cognitive function (p < 0.05). These findings suggest that eye exercises, including GSEs and eyeball exercises, can enhance eye-hand coordination and cognitive function in elderly individuals. The dynamic balance improvements observed only in the experimental group highlight the potential of GSEs in balance training. Preliminary findings indicate that consistent eye exercise help improve motor and cognitive skills in the elderly, which requires further study. Full article

Background: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC), often arising after surgery or radiotherapy. Despite the key role physiotherapists play in rehabilitation, little is known about their perspectives and clinical approaches. This study aimed to explore physiotherapists’ experiences, perceptions, and treatment strategies in the management of treatment-induced trismus in HNC. Methods: A qualitative, cross-sectional study was conducted via a web-based self-administered questionnaire, developed in accordance with the CHERRIES guidelines. The survey combined closed- and open-ended questions across five thematic areas: sociodemographic, clinical experience, treatment practices, barriers, and medical devices. An inclusion algorithm ensured participation of physiotherapists with expertise in trismus. Quantitative data were analyzed descriptively; open responses underwent inductive thematic analysis. Results: Of 72 invited physiotherapists, 31 responded and 18 met inclusion criteria. Participants reported integrating manual therapy (100%) and therapeutic exercise (100%) into treatment, with more selective use of medical devices (77%). Barriers to implementation included lack of functional tools, dental status limitations, patient adherence issues, and socioeconomic constraints. Many highlighted that current devices often fail to mimic functional mastication, potentially overloading central incisors and limiting functional carryover. Conclusions: This qualitative study reveals limited device use, perceived design shortcomings, and the influence of dental status on functional recovery. Findings highlight the need for device innovation, interdisciplinary coordination, and protocols tailored to patient-specific barriers. Future research should explore combined approaches and include patient perspectives. Full article

Background/Objectives: Cerebral palsy (CP) is one of the most common causes of permanent motor disability in children, and its consequences for upper limb function have a significant impact on the patient’s independence and quality of life. Virtual reality is attracting increasing interest as a modern, engaging and effective method of physiotherapy for children with cerebral palsy. This systematic literature review aimed to synthesize current scientific data on the impact of virtual-reality-based physiotherapy on upper limb function in children with cerebral palsy. Methods: The review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Science Direct, Scopus, Web of Science, Research Gate and Google Scholar databases were searched for studies published between 2010 and 2025. Six original studies meeting the following criteria were included in the analysis: virtual reality therapy, population of children with cerebral palsy, physiotherapy goals related to the upper limb and availability of full text. Results: All included studies demonstrated a positive impact of virtual reality on at least one functional parameter of the upper limb, including range of motion, muscle strength, coordination and manual precision. Task-oriented training, immersive virtual reality environments and home-based therapy supported by remote monitoring proved to be the most effective. The effects were particularly noticeable in children with moderate impairment at GMFCS I–III. Conclusions: Virtual reality represents a safe and promising technology to support upper limb physiotherapy in children with cerebral palsy. It can be used both in clinical and home settings, contributing to increased exercise intensity and motivation. Further long-term studies using high-quality methodology are needed to determine the sustainability of the effects and their impact on everyday living. Full article

Background: Type 2 diabetes (T2D) is associated with reduced cardiorespiratory fitness (CRF), a critical predictor of cardiovascular disease and all-cause mortality. CRF relies upon the coordinated action of multiple systems including the skeletal muscle where the mitochondria metabolize oxygen and substrates to sustain ATP production. Yet, previous studies have shown that impairments in muscle bioenergetics in T2D are not solely due to mitochondrial deficits. This finding indicates that factors outside the mitochondria, particularly within the local tissue microenvironment, may contribute to reduced CRF. One such factor is the extracellular matrix (ECM), which plays structural and regulatory roles in metabolic processes. Despite its potential regulatory role, the contribution of ECM remodeling to metabolic impairment in T2D remains poorly understood. We hypothesize that pathological remodeling of the skeletal muscle ECM in overweight individuals with and without T2D impairs bioenergetics and insulin sensitivity, and that exercise may help to ameliorate these effects. Methods: Participants with T2D (n = 21) and overweight controls (n = 24) completed a 10-day single-leg exercise training (SLET) intervention. Muscle samples obtained before and after the intervention were analyzed for ECM components, including collagen, elastin, hyaluronic acid, dystrophin, and proteoglycans, using second harmonic generation imaging and immunohistochemistry. Results: Positive correlations were observed with elastin content and both glucose infusion rate (p = 0.0010) and CRF (0.0363). The collagen area was elevated in participants with T2D at baseline (p = 0.0443) and showed a trend toward reduction following a 10-day SLET (p = 0.0867). Collagen mass remained unchanged, suggesting differences in density. Dystrophin levels were increased with SLET (p = 0.0256). Conclusions: These findings identify that structural proteins contribute to aerobic capacity and identify elastin as an ECM component linked to insulin sensitivity and CRF. Full article

Background: Exercise duration at maximum oxygen uptake ($\dot{\mathrm{V}}$O₂max) appears to be influenced not only by metabolic factors but also by the interplay between brain dynamics and ventilatory regulation. This study examined how cortical activity, assessed via electroencephalography (EEG), relates to performance and acute fatigue regulation during a constant-load cycling test. We hypothesized that oscillatory activity in the theta, alpha, and beta bands would be associated with ventilatory coordination and endurance capacity. Methods: Thirty trained participants performed a cycling test to exhaustion at 90% maximal aerobic power. EEG and gas exchange were continuously recorded; ratings of perceived exertion were assessed immediately after exhaustion. Results: Beta power was negatively correlated with time spent at $\dot{\mathrm{V}}$O₂max (r = −0.542, p = 0.002). Theta and Alpha power alone showed no direct associations with endurance, but EEG–metabolic ratios revealed significant correlations. Specifically, the time to reach $\dot{\mathrm{V}}$O₂max correlated with Alpha/$\dot{\mathrm{V}}$O₂ (p < 0.001), Alpha/$\dot{\mathrm{V}}$CO₂ (p < 0.001), and Beta/$\dot{\mathrm{V}}$CO₂ (p = 0.002). The time spent at $\dot{\mathrm{V}}$O₂max correlated with Theta/$\dot{\mathrm{V}}$O₂ (p = 0.002) and Theta/$\dot{\mathrm{V}}$CO₂ (p < 0.001). The time-to-exhaustion was correlated with Theta/$\dot{\mathrm{V}}$CO₂ (p < 0.001) and Alpha/$\dot{\mathrm{V}}$CO₂ (p < 0.001). Conclusions: These findings indicate that cortical oscillations were associated with different aspects of acute fatigue regulation. Beta activity was associated with fatigue-related neural strain, whereas Theta and Alpha bands, when normalized to metabolic load, were consistent with a role in ventilatory coordination and motor control. EEG–metabolic ratios may provide exploratory indicators of brain–metabolism interplay during high-intensity exercise and could help guide future brain-body interactions in endurance performance. Full article

Critical Infrastructures (CIs) are the backbone of modern societies, providing essential services whose disruption can have severe consequences. The interdependencies among the CIs, across sectors and national borders, add significant complexity to risk and resilience management. While various EU Directives and EU-funded projects have addressed CI risk management, most efforts have focused on individual infrastructures rather than systemic cross-sector and cross-border approaches. In the EU-funded project ATLANTIS, we address this gap by advancing CI risk and resilience assessment towards a fully integrated European protection framework. We emphasise a holistic, multi-level approach that transcends individual assets, enabling coordination across operators, sectors, and national borders. To this end, we introduce a comprehensive risk assessment methodology that explicitly accounts for interdependencies among CIs and evaluates potential impacts and probabilities of disruptive events. This methodology is underpinned by the tailored data management framework, structured across three integrated layers. To validate the approach, novel tools and methods were implemented and tested in three large-scale pilot exercises, conducted through a series of stakeholder workshops. Results indicated measurable improvements in CI preparedness and awareness, ranging from approximately 5% to 55%, depending on the threat scenario and stakeholder group. The findings demonstrate that our approach delivers added value by supporting enhanced decision-making and fostering consistent, cross-CI communication through a shared platform. This paper presents the key components, cross-CI and multi-threat risk assessment methodology, and testing outcomes of the ATLANTIS project, highlighting its contribution to advancing European CI resilience. Full article

Appropriate subcontracting strategy optimizes large-scale engineering project organization, enhancing implementation efficiency. However, numerous subcontractors increase the transaction costs of project subcontracting management. This study classifies subcontracting costs into coordination, monitoring, and negotiation costs based on transaction cost economics (TCE), and divides contractor management control into behavior and outcome control. This study aims to examine the causal mechanisms between subcontractor dispersion and the three types of transaction costs, plus the moderating effects of behavior and outcome control. Data is collected through a survey questionnaire and is analyzed by Partial Least Squares (PLS) analysis. Results show that the extent to which work is distributed among multiple subcontractors is positively related to transaction costs. Behavior control exercised by general contractors significantly suppresses the increase in transaction costs (especially the monitoring costs) resulting from subcontractor dispersion. However, outcome control does not exhibit a significant moderating effect on the relationship between subcontractor dispersion and transaction costs. The findings contribute to the theory of TCE and fill the gap in the research on the effective application of different management control modes. The findings help project managers choose an appropriate mode of management control to effectively manage subcontracting. Full article

Background: Sustainable, dual-action ergogenic strategies are underexplored; most products target a single pathway and rarely upcycle seafood sidestreams. We therefore tested an upcycled formulation combining grouper bone hydrolysate and Undaria pinnatifida extract (GU) for ergogenic and microbiota effects in mice. We tested the ergogenic and microbiota modulating effects of GU in mice versus a vehicle and a BCAA control. Methods: GU was prepared via enzymatic hydrolysis of marine by-products and administered to male ICR mice for 4 weeks. Mice were divided into five groups (n = 7/group), receiving a vehicle control, a branched-chain amino acid (BCAA) supplement, or GU at three dose levels (1X, 2X, 3X) based on human-equivalent conversion. Exercise performance was assessed via grip strength and treadmill tests. Biochemical markers of fatigue, body composition, and safety indicators were also analyzed. Gut microbiota was evaluated using 16S rRNA sequencing and constrained principal coordinates analysis (CPCoA). Results: Four weeks of GU supplementation significantly enhanced exercise performance [(treadmill time ↑ Δ = 10.2–11.7 min versus vehicle (q ≤ 0.0002), grip strength ↑ Δ = 40.4–48.5 g (q ≤ 0.05)] and lean body mass [FFM ↑ at GU-1X (Δ = +0.80%, q = 0.0123)], surpassing the commercial BCAA control. Biochemical analyses indicated reduced exercise-induced lactate accumulation [(post-exercise lactate ↓ Δ = −2.71/−2.18 mmol·L⁻¹, q = 0.0006)]. Gut microbiota profiling revealed distinct shifts in community composition in GU-treated groups, notably with an increased abundance of beneficial taxa such as Lactobacillus and Muribaculum. These alterations reflect the prebiotic activity of seaweed-derived polysaccharides, promoting a healthier gut microbial profile. Notably, GU improved metabolic markers (aspartate aminotransferase, [AST]; lactate dehydrogenase, [LDH]) without inducing toxicity. Conclusions: These findings indicate that GU functions as a dual-action supplement, coupling amino acid-mediated muscle anabolism with microbiome modulation to enhance physical performance and metabolic health. As an upcycled marine product, it presents a sustainable and effective strategy for exercise support. Future studies should include 90-day safety, mechanistic assays, and a preregistered human pilot. Full article

Greece faces increasing exposure to natural hazards—particularly wildfires, floods, and earthquakes—driven by climatic, environmental, and spatial factors. This study systematically reviews 108 peer-reviewed publications and official reports, applying PRISMA methodology to evaluate the effectiveness of the national civil protection system. The analysis reveals localized progress, notably in earthquake preparedness due to strict building codes and centralized oversight, but also persistent systemic weaknesses. These include fragmented governance, coordination gaps across agencies, insufficient integration of spatial planning, limited local preparedness, and reactive approaches to disaster management. Case studies of major events, such as the 2018 Mati wildfires and 2023 Thessaly floods, underscore how communication breakdowns and delayed evacuations contribute to substantial human and economic losses. Promising developments—such as SMS-based early warning systems, joint training exercises, and pilot GIS risk-mapping tools—illustrate potential pathways for improvement, though their application remains uneven. Future priorities include strengthening unified command structures, enhancing prevention-oriented planning, investing in interoperable communication systems, and fostering community engagement. The findings position Greece’s civil protection as structurally capable of progress but in need of sustained, systemic reforms to build a resilient, prevention-focused framework for increasing disaster risks. Full article

Background: Fontan circulation is associated with impaired cardiac output, reduced exercise capacity, and systemic metabolic stress. However, the underlying lipidomic alterations remain poorly defined. Methods: Using targeted mass spectrometry, we analyzed 291 lipid species in fasting plasma samples from 20 adults with Fontan circulation and 20 age- and sex-matched healthy controls. Results: Forty-eight lipids were significantly altered between groups (p < 0.05), including reductions in total lysophosphatidylcholines (LPC) and total ether-linked LPC [LPC(O)] and elevations in total phosphatidylserines (PS). Notably, LPC(O-22:1) and LPC(O-20:0) were decreased, while PS 40:5 was elevated, with several of these species demonstrating strong correlations (|r| > 0.5, p < 0.001) with the stroke index, cardiac index, and VO₂max. These three lipid species also showed excellent capability in discriminating Fontan patients from healthy controls (AUC > 0.78). Correlation network and pathway enrichment analyses revealed tightly coordinated lipid clusters containing LPC/LPC(O), PE, and PS species as central features of dysregulated Fontan metabolism. Conclusions: These exploratory findings highlight coordinated lipid alterations associated with impaired cardiovascular reserve in Fontan patients. While based on unadjusted p-values and therefore being hypothesis-generating, they provide novel insight into the metabolic landscape of Fontan physiology and warrant validation in larger, independent cohorts. Full article

Background: A comprehensive rehabilitation program is recommended following anterior cruciate ligament reconstruction (ACLR) to restore function, strength and lower limb stability. Despite advancements in surgical techniques, high reinjury rates highlight the need to refine rehabilitation strategies. This study investigates performance across various physically demanding tasks and compares outcomes between the injured and uninjured leg, using a modified Back in Action (BIA) test battery. It is hypothesized that due to test learning effects patients exhibit faster improvement in coordinatively demanding tasks compared to strength-related tasks. Methods: Thirty-two patients (aged 18–40) following primary unilateral ACLR participated in a prospective cross-sectional study within the context of a larger trial. Participants completed a modified BIA test battery, including stability, countermovement jump (CMJ), drop landing, speedy jumps, and quick-feet test (QFT). Each test was conducted in three sets, with three immediate repetitions. Self-reported outcomes were also collected. Results: Patients showed significant within-session improvements in coordinative tasks, with 32% in the injured and 26% in the uninjured limb during the speedy jumps [p < 0.05]. No significant learning effects were observed in strength-related tasks (drop landing, stability test, CMJ). Patients with lower baseline performance exhibited greater improvement than patients with higher performance level from baseline. Furthermore, a correlation between self-assessed abilities and actual performance was identified. Conclusions: This study showed that improvement of coordinative tasks after Return to Sport (RTS) testing of ACLR patients are rather affected by test learning effects. In contrast, this phenomenon is not seen in strength-related tasks. Rehabilitation programs should integrate both types of exercises while considering individual baseline abilities. Tailoring rehabilitation to individual needs, establishing sport-specific rehabilitation programs and incorporating self-assessment tools can enhance patient-centered care and reduce reinjury risks. Full article

Tubular aggregate myopathy (TAM) is an inherited skeletal muscle disease associated with progressive muscle weakness, cramps, and myalgia. Tubular aggregates (TAs) are regular arrays of highly ordered and densely packed straight-tubules observed in muscle biopsies; the extensive presence of TAs represent a key histopathological hallmark of this disease in TAM patients. TAM is caused by gain-of-function mutations in proteins that coordinate store-operated Ca²⁺ entry (SOCE): STIM1 Ca²⁺ sensor proteins in the sarcoplasmic reticulum (SR) and Ca²⁺-permeable ORAI1 channels in the surface membrane. Here, we assessed the therapeutic potential of endurance exercise in the form of voluntary wheel running (VWR) in mitigating TAs and muscle weakness in Orai1^G100S/+ (GS) mice harboring a gain-of-function mutation in the ORAI1 pore. Six months of VWR exercise significantly increased specific force production, upregulated biosynthetic and protein translation pathways, and normalized both mitochondrial protein expression and morphology in the soleus of GS mice. VWR also restored Ca²⁺ store content, reduced the incidence of TAs, and normalized pathways involving the formation of supramolecular complexes in fast twitch muscles of GS mice. In summary, sustained voluntary endurance exercise improved multiple skeletal muscle phenotypes observed in the GS mouse model of TAM. Full article