Search Results (134)

Background: Although early mobilization has been shown to improve clinical outcomes after intensive care unit (ICU)-acquired weakness, its implementation remains limited in routine clinical practice. This study aimed to evaluate the feasibility, safety, and preliminary clinical outcomes of a mobile application-based rehabilitation program in non-ambulatory patients during the early ward phase following ICU discharge. Methods: This prospective single-arm pilot trial included adult patients (≥19 years) who had received ICU care and demonstrated limited ambulatory function, defined as Functional Ambulatory Category (FAC) ≤3. Participants received an individualized, application-guided exercise program comprising two daily sessions over two weeks. Primary outcomes were programmatic feasibility, safety, and patient satisfaction. Rehabilitation compliance was quantified using application usage logs and categorized as high (≥50%) or low (<50%). Secondary functional outcomes, such as Medical Research Council Sum Score (MRC-SS), ICU Mobility Scale, FAC, muscle strength measures, health-related quality of life, and pain scores, were assessed at baseline, week 1, and week 2. Results: Of the 25 initially enrolled patients, 5 dropped out due to clinical status changes or transfers, yielding a retention rate of 80.0%. For the 20 analyzed patients (mean age 52.7 ± 13.9 years; 45% male), the overall mean rehabilitation compliance was 40.6%. No serious adverse events related to the intervention were reported, and overall patient satisfaction and application usability were high. Progressive increases in exercise intensity and training levels were observed throughout the intervention period. Significant improvements over time were found in MRC-SS, ICU Mobility Scale, FAC, grip strength, health-related quality of life, and pain scores (all p < 0.05). Although compliance-based recovery trajectories were confounded by small subgroup sizes and baseline clinical imbalance, exploratory analyses nonetheless identified statistically significant time × compliance interaction effects for MRC-SS and straight leg raise performance. Conclusions: This pilot study demonstrates that a mobile application-based rehabilitation program is a feasible and safe approach to implement in deconditioned patients after ICU discharge. These preliminary functional recovery trajectories provide encouraging signals, suggesting that this digital platform may serve as a potential adjunct to conventional care. Rigorous, randomized controlled trials are required to confirm its definitive clinical efficacy and scalability. Full article

Heart failure (HF) is a heterogeneous clinical syndrome with increasing prevalence among adults worldwide. It is characterized by complex central and peripheral alterations that contribute to exercise intolerance, fatigue, dyspnea, and reduced quality of life. Inspiratory muscle weakness (IMW) plays a key role in this vicious cycle by exacerbating symptoms and further limiting functional capacity. Inspiratory muscle training (IMT) has emerged as a potential adjuvant in comprehensive HF management and is a physiologically grounded and promising tool in the contemporary HF therapeutic toolkit. Its integration into multimodal rehabilitation programs may mitigate the cycle of dyspnea and deconditioning in patients with HF. On this basis, we provide an overview of the pathophysiological mechanisms underlying IMW and present the practical characteristics of IMT programs, synthesizing current evidence regarding its clinical efficacy and implementation challenges. Full article

Aerobic exercise capacity, best quantified by maximal oxygen uptake (VO_2max), varies between individuals and is dependent on cardiac output (CO) and oxygen uptake in the periphery (a-vO₂ diff). Environmental stressors like hypoxia, microgravity, and heat negatively impact these parameters, thereby reducing aerobic exercise capacity. However, in response to acute and chronic exposures to these environments, compensatory processes serve to counteract reductions in VO_2max. In hypoxic environments, reduced oxygen partial pressure (PO₂) leads to hypoxic pulmonary vasoconstriction (HPV) and a diffusion limitation at the level of the lungs and skeletal muscle, resulting in a reduction in VO_2max. Microgravity environments reduce VO_2max through cardiac and skeletal muscle deconditioning, as well as reductions in plasma volume (PV), resulting in an increase in sympathetic nerve activity through baroreceptor-mediated pathways. In heat stress environments, increases in skin perfusion upon acute exposure hinder exercise performance, whereas compensatory PV expansion mitigates further decreases in VO_2max. As humans are increasingly exposed to austere environments and environmental extremes, it is critical to understand how these environments impact cardiovascular exercise physiology so that effective strategies and protocols ensuring proper aerobic functioning may be implemented. Full article

Background: Critically ill children requiring extracorporeal membrane oxygenation (ECMO) support are at high risk of immobility, deconditioning, and muscle loss. There is a lack of screening and diagnostic tools to quantify muscle loss in this population. Objective: This study aims to evaluate the use of bedside ultrasound as a practical and effective method for detecting muscle loss in this high-risk group. Materials and Methods: This is a secondary analysis of a prospective observational clinical study conducted between January 2024 and January 2025 that used ultrasound to describe muscle loss in critically ill children aged 2 to 18 years. Results: The primary study enrolled 35 patients, five of whom required ECMO support. All patients who required ECMO showed significant muscle loss (>10%) in the quadriceps femoris, as measured by muscle thickness and cross-sectional area, compared with baseline measurements obtained before ECMO cannulation. Conclusions: Point-of-care muscle ultrasound could be a reliable, cost-effective tool for assessing muscle loss in pediatric patients on ECMO. Full article

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fluctuating skeletal muscle weakness and fatigue, leading to reduced functional independence and impaired quality of life (QoL). Although exercise has historically been discouraged due to concerns about symptom exacerbation, emerging evidence suggest that structured exercise programs may be safe and beneficial in clinically stable patients. This systematic review critically evaluates current evidence on exercise and physical activity interventions in MG, focusing on effectiveness, safety, and impact on functional outcomes, fatigue, and QoL. Materials and Methods: A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Web of Science, Google Scholar, Scopus and ScienceDirect for studies published between 2015 and 2025. Keywords included MG, physical activity, aerobic training, resistance training, and respiratory muscle training. Methodological quality was assessed using the Downs and Black checklist. Results: Eight controlled studies met the inclusion criteria, encompassing aerobic, resistance, combined, and respiratory muscle training interventions. Sample sizes ranged from small pilot studies to moderate-size randomized controlled trials. Overall, exercise interventions were well tolerated, with no evidence of sustained symptoms exacerbation. Aerobic and combined programs consistently improved functional capacity, muscle strength, and activities of daily living. Respiratory muscle training demonstrated improvements in pulmonary function and inspiratory muscle strength, although findings were more heterogeneous. Study quality ranged from poor to excellent, with common limitations including small sample size, short follow-up duration, and heterogeneity in exercise programs. Conclusions: Current evidence supports the safety and potential efficacy of individualized, symptom-guided exercise interventions in clinically stable MG. Regular physical activity exercise may reduce secondary deconditioning, improve functional outcomes, and enhance QoL. However, larger, high-quality randomized controlled trials with standardized programs and longer follow-up periods are required to strengthen clinical recommendations and clarify long-term effects. Full article

Despite advances in surgical technique and perioperative care, pancreatic ductal adenocarcinoma (PDAC) remains associated with poor survival. Sarcopenia is highly prevalent in PDAC and is consistently associated with inferior survival and reduced tolerance of systemic therapy. However, interventions primarily aimed at increasing muscle mass through nutritional supplementation and resistance-based exercise have yielded limited improvements in clinically meaningful postoperative outcomes. This has prompted increasing interest in sarcopenia as a marker of broader biological vulnerability rather than isolated physical deconditioning. Emerging clinical, translational, and experimental evidence demonstrates that skeletal muscle and adipose tissue function as active immunometabolic organs, and that cancer-associated inflammatory pathways drive early muscle loss, immune dysfunction, and impaired physiological recovery. Across multiple clinical cohorts, sarcopenia is reproducibly associated with worse overall survival and failure to complete adjuvant therapy, but not consistently with increased postoperative complications, suggesting that its prognostic relevance lies in impaired recovery and oncological fitness rather than immediate surgical risk. Translational studies further indicate that sarcopenia identifies patients with reduced antitumor immune competence, particularly in early-stage disease. This review synthesizes current evidence linking sarcopenia, immune dysfunction, and surgical outcomes in PDAC and examines implications for perioperative care. We propose that immunometabolic-informed prehabilitation, integrated with existing nutritional and exercise strategies, may represent a more effective approach to improving recovery, treatment tolerance, and durable oncological outcomes following PDAC resection. Full article

Background/Objectives: Institutionalized aging is associated with severe physical deconditioning, a high risk of falls, and a pervasive fear of falling. Physical exercise mitigates these factors, but the comparative efficacy of different training methodologies in this specific population remains unclear. The objective of this study was to compare the impact of a multicomponent exercise program versus a dual-task (cognitive-motor) training program on reducing fall risk, decreasing the fear of falling, and improving physical performance in institutionalized older adults. Methods: A randomized, parallel group controlled trial involving 21 older adults residing in a nursing home (Mean age = 83.67 ± 6.17 years). Participants were allocated to either a Multicomponent Group (n = 11) or a Dual-Task Group (n = 10) for a 12-week intervention (2 sessions/week). Fall risk, fear of falling, and global physical performance were assessed at baseline and post-intervention. Results: No significant improvements were observed in fall risk assessment execution time for either group. The Multicomponent Group showed a significant reduction in the fear of falling (−29.1%; 95% CI [−17.27, −1.27], p = 0.025) and a clinically significant improvement in physical performance (+40.9%; 95% CI [1.11, 3.43], p < 0.001), supported by large time effects (FES-I: F(1, 19) = 4.52, η²p = 0.192; SPPB: F(1, 19) = 13.68, η²p = 0.419). The Dual-Task Group achieved no significant changes in these dimensions. Furthermore, a marginally significant time-by-group interaction was observed for physical performance, favoring the multicomponent approach (F(1, 19) = 3.83, p = 0.065, η²p = 0.168 [large effect]). Conclusions: Multicomponent training proved superior in improving physical performance and reducing the fear of falling. In a frail, institutionalized population, the attentional cost demanded by dual-task training appears to limit the physical and psychological benefits of exercise. Full article

Acute type A aortic dissection is a life-threatening condition requiring emergency surgery and complex postoperative management. Although survival rates have improved, many patients experience long-term functional impairments, reduced quality of life, and an elevated risk of complications. Despite strong evidence supporting cardiac rehabilitation in other cardiovascular populations, structured programs remain underutilized in patients with surgically resolved acute type A aortic dissection. Exercise-based cardiac rehabilitation appears feasible and can be delivered safely in carefully selected patients when appropriately adapted to individual needs and conducted under close supervision. Postoperative patients are often physically deconditioned, prone to hospital-acquired disability, and may misjudge exercise intensity. Therefore, individualized exercise prescription, guided by exercise testing when available, is important to support safe training thresholds. Early and gradual introduction of physical activity may help prevent complications associated with immobility, support blood pressure control, and contribute to improvements in functional capacity. However, training volume should be purposefully lower than in conventional program settings to reduce hemodynamic stress. Education on safe exercise parameters and self-monitoring plays a central role in enabling long-term adherence and promoting patient autonomy. Cardiac rehabilitation programs should incorporate dietary, nutritional, and psychological support. Although evidence specific to this patient population remains limited, available data suggest the feasibility and potential benefits of cardiac rehabilitation when delivered with appropriate precautions. Our review underscores the need for a tailored, multidisciplinary CR approach aimed at enhancing physical recovery, supporting cardiovascular stability, and improving overall quality of life in patients following surgery. Further research is required to define optimal program protocols. Full article

NASA intends to return humans to the Moon, where partial gravity will put them at risk of musculoskeletal deconditioning. Resveratrol (RSV) is a promising nutritional countermeasure that may protect muscle health during disuse; however, its efficacy and mechanism in simulated lunar gravity are unknown. Forty adult male Wistar rats underwent 14 days of normal loading or partial weight-bearing at 20% of normal loading (PWB20). Unloaded animals received daily RSV supplementation with or without an ERα antagonist to test whether ERα was required to mediate RSV benefits. Muscle function was longitudinally assessed, and a Western blot was used to quantify key signaling proteins in the soleus muscle. PWB20 led to a significant reduction in grip strength (−14.2%) associated with marked changes in electrophysiological muscle properties. RSV-supplemented animals performed better throughout the study, but not when Erα was inhibited. RSV supplementation resulted in a greater ERα phosphorylation ratio compared to PWB20 alone (3.5 vs. 1.91). These results suggest that RSV can mitigate muscle deconditioning in a lunar gravity analog and that ERα signaling is required. Full article

Chronic obstructive pulmonary disease, interstitial lung disease, and post-lung trans-plantation are often accompanied by skeletal muscle dysfunction that worsens the quality of life. Such physiological changes are driven by physical inactivity, systemic inflammation, oxidative stress, anabolic and hormonal resistance, and medication effects. Structural changes include impaired capillarization, fiber-type shifts (slow-to-fast in limb muscle and fast-to-slow in respiratory muscles), mitochondrial dysfunction, reduced oxidative capacity, and early lactate accumulation. Electromyography and dynamometry, both isokinetic and isometric, quantify neuromuscular drive through measuring strength, power, and endurance and are associated with functional outcomes (6-min walk, sit-to-stand, stair climbing tests). Pulmonary rehabilitation (PR) improves neuromuscular efficiency, dyspnea, exercise tolerance, and quality of life by combining resistance, endurance, and eccentric training. The effects of PR generally plateau at three months, emphasizing the need for maintenance and the personalization of rehabilitation plans. While nutritional optimization is important, supplements have shown little benefit. Future priorities include defining EMG/dynamometry thresholds to allow standardized routine testing for comparable benchmarks and more precise PR protocols. Future research targeting mitochondrial remodeling, inflammatory signaling, and anabolic resistance offer potential pathways for preventing and reversing muscle wasting. Full article

Background: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a significant extra-articular manifestation of rheumatoid arthritis that contributes to morbidity, functional limitation, exertional dyspnea, fatigue and reduced quality of life. Current pharmacologic therapies address inflammatory and fibrotic pathways but do not target deconditioning, ventilatory inefficiency, skeletal muscle dysfunction or the high burden of anxiety, depression, impaired emotional well-being and reduced daily functioning. Objective: To synthesize the evidence supporting the use of structured exercise and pulmonary rehabilitation (PR) on functional, psychological and quality of life outcomes in RA-ILD patients by integrating findings from RA-ILD cohorts, interstitial lung disease (ILD) PR trials, and rheumatoid arthritis (RA) exercise interventions. Methods: A structured narrative review was conducted using PubMed, Scopus, and Web of Science (1990–2025). Of the 1240 identified records, 32 studies met inclusion criteria, comprising 4 RA-ILD observational cohorts, 17 ILD PR trials and 11 RA exercise trials. No randomized controlled trials specifically evaluating PR in RA-ILD were identified. Available evidence was extrapolated from studies in general ILD and RA populations. Mechanistic and physiological literature was included to contextualize findings. Results: RA and ILD cohorts demonstrated markedly reduced six-minute walk distance, impaired diffusing capacity, exertional desaturation, fatigue, high anxiety and depression, and diminished daily function. Across seventeen PR trials, patients with idiopathic, autoimmune-associated, and fibrotic ILD showed improvements in exercise capacity, ventilatory efficiency, dyspnea, fatigue, psychological distress, emotional well-being, and health-related quality of life. Eleven RA exercise studies demonstrated improved aerobic capacity, strength, lean mass, fatigue, psychological outcomes (including anxiety), and function, with no increase in disease activity. Conclusions: Evidence from ILD PR and RA exercise literature suggest that structured rehabilitation has the potential, alongside pharmacological therapy, to address functional limitation, dyspnea, fatigue and psychological distress and overall quality of life in RA-ILD, though disease-specific trials are needed. Full article

Background: Cardiorespiratory fitness is frequently impaired in survivors of pediatric acute lymphoblastic leukemia (ALL), limiting their functional performance. While aerobic exercise is recommended, evidence is needed to guide the prescription of specific training protocols in this population. Objective: This study sought to compare the efficacy of constant-load (CL-AEx) and graded aerobic exercise (G-AEx) protocols on cardiorespiratory fitness and functional capability in pediatric survivors of ALL. Methods: Seventy-two pediatric ALL survivors were allocated to CL-AEx, G-AEx, or a control group. Cardiopulmonary fitness [peak oxygen consumption (peak VO₂), peak minute ventilation (VE), ventilatory equivalent for oxygen (VE/VO₂), respiratory exchange ratio (RER), peak oxygen pulse (peak O₂P), maximum heart rate (max HR), and one-minute heart rate recovery (HHR₁)] and functional performance [six-minute walk test (6MWT), 4x10-m shuttle run test (4x10-mSRT), and timed up down stairs (TUDS)] were assessed at pre- and post-intervention. Results: The G-AEx group exhibited significantly enhanced cardiorespiratory and functional outcomes compared to both the CL-AEx and control groups (all p < 0.05). The G-AEx group demonstrated more pronounced improvements, showing significant increases in peak VO₂, VE, VE/VO₂, peak O₂P, and HHR1, alongside a more efficient RER. Functionally, the G-AEx intervention led to superior improvements in 6MWT distance, and significantly faster completion times in the 4x10-mSRT and TUDS, highlighting multi-domain functional gain. Conclusions: In pediatric survivors of ALL, G-AEx demonstrated superior improvements in cardiorespiratory fitness and functional performance compared to CL-AEx over 12 weeks. These findings suggest that G-AEx is an effective modality for addressing acute physical deconditioning in this population. Incorporating G-AEx into clinical rehabilitation may enhance immediate physiological and functional recovery during the survivorship phase. Full article

Background: Fragility fractures of the pelvis (FFPs) are increasingly prevalent given ageing populations. Conservative management is often primarily utilised due to its initial minimal displacement and the high risks of surgery in this vulnerable population. However, this can lead to rapid deconditioning, especially with non-weight-bearing protocols. Parathyroid hormone (PTH), as a bone anabolic agent, has the potential to improve clinical and radiological outcomes in FFPs, but the evidence remains limited. Methods: A systematic review and meta-analysis following PRISMA guidelines was undertaken. Database search results were independently screened by two authors, and data were extracted. The primary outcome measure was time to fracture healing as assessed by imaging, with the secondary outcome measure of pain levels (VAS/NRS). Results: There were 1230 articles screened, and 893 unique results identified. Six studies were included in the final analysis. These compared the use of PTH and its analogues with standard care, placebo, or sacroplasty. The findings suggest that PTH may accelerate fracture healing and reduce pain in this patient population, although evidence is limited and at high risk of bias. Conclusions: Treatment with PTH may improve bone healing and visual analogue pain scores, although the evidence is limited. There may be a benefit from adjunctive PTH treatment for patients with FFPs; however, larger methodologically robust studies are required to confirm this. Full article

Exposure to microgravity results in cardiovascular deconditioning, with endothelial cell apoptosis recognized as a pivotal initiating event. However, the mechanosensitive mechanisms underlying this process remain poorly understood. Here, we demonstrate that the expression of mechanosensitive ion channel protein PIEZO1 is upregulated in human umbilical vein endothelial cells (HUVECs) under simulated microgravity. Functional studies revealed that PIEZO1 activation promotes endothelial apoptosis under simulated microgravity conditions. Proteomic analysis following PIEZO1 knockdown revealed extensive alterations in biological processes associated with apoptosis. Furthermore, we found that PIEZO1 activation triggers calcium influx, leading to elevated expression of the HMGA2. Moreover, we identify that PIEZO1 activation induces calcium influx, which subsequently elevates the expression of HMGA2. The knockdown of HMGA2 significantly mitigated microgravity-induced endothelial apoptosis, indicating its role in PIEZO1-mediated apoptosis. These findings reveal a novel PIEZO1–Ca²⁺–HMGA2 axis critical for microgravity-induced endothelial apoptosis, providing mechanistic insight into cardiovascular adaptation to spaceflight and potential therapeutic targets for countermeasure development. Full article

Over the past decade, given safety, reduced heart failure-related hospitalizations, and, above all, 5-year mortality rates nearly identical to those of heart transplants, left ventricular assist devices (LVADs) have increasingly become a treatment option for patients with advanced heart failure. However, improvements in functional capacity after LVAD implantation are minimal or modest, depending on pre-implantation right ventricular function, the patient’s hemodynamic status, the optimization of guideline-directed medical therapy, and noncardiac factors (physical deconditioning, skeletal muscle alterations, anemia, and alterations in alveolar gas exchange). Therefore, cardiac rehabilitation (CR) is a fundamental element from the early stages after LVAD implantation, as it is not only safe but also highly effective, leading to improved functional capacity and fewer episodes of worsening heart failure, and may be associated with reduced mortality. To perform safe and effective CR in patients with LVADs, it is crucial to account for the unique issues in this group. This includes the difficulty of detecting an arterial pulse with standard tools during CPR and the importance of closely monitoring the transmission line and LVAD controller to prevent unintended damage. Overall, the clinical trial indicates that exercise-based CR has the potential to improve functional capacity. Furthermore, some data suggest that CR is associated with fewer HF-related hospitalizations and may be linked to lower mortality; however, there is no consensus on this matter, partly because most studies supporting this assertion are observational. Full article