Search Results (666)

Post-COVID condition is frequently associated with persistent fatigue, reduced functional capacity, and loss of independence in activities of daily living. Exercise intolerance and post-exertional symptom exacerbation limit participation in conventional rehabilitation programs, highlighting the need for safe and scalable home-based interventions. The REACT-COVID project aims to evaluate the feasibility, safety, and potential effects of a home-based intervention combining whole-body electromyostimulation (WB-EMS) with functional activities of daily living in individuals with post-COVID condition. This study will be a randomized, placebo-controlled, participant-blinded pilot trial including 30 participants allocated to either an experimental group receiving active WB-EMS or a control group receiving sham stimulation over a 12-week period. The primary aim is to assess feasibility, safety, and acceptability. As exploratory clinical outcomes, fatigue severity (Chalder Fatigue Questionnaire, CFQ-11) and functional capacity (Six-Minute Walk Test, 6 MWT) will also be evaluated. Secondary outcomes include handgrip strength and independence in activities of daily living (ADLQ). Assessments will be conducted at baseline (week 0), post-intervention (week 12), and three-month follow-up (week 24). This intervention is designed to provide a low-mechanical-load, accessible alternative for individuals unable to tolerate conventional exercise programs. This study’s findings will inform larger multicenter trials and contribute to scalable rehabilitation models for post-COVID care. Trial registration number: ClinicalTrials.gov (NCT07312357). Full article

Background: Frailty impacts the prognosis of respiratory diseases but lacks standardized evaluation criteria. This pilot study aimed to develop a frailty assessment method using unsupervised clustering of various physical function tests. Methods: Clinical data, handgrip strength (HS), lower limb strength (LLS), the 6 min walk test (6 min WT), the 5 m walk test (5 m WT), body composition, such as skeletal muscle mass index (SMI), whole-body phase angle (WBPhA), and pulmonary function variables were measured. Frailty status was evaluated in three groups (frail, pre-frail, and robust) using the J-CHS and Kihon Checklist. Unsupervised hierarchical clustering was performed, followed by dimensionality reduction using Principal Component Analysis. Results: Ninety-eight patients and healthy volunteers (70 males, 28 females; mean age, 57.5 years) were divided into four clusters, ranging from robust to pronounced frailty. On the 2-principal component plane, data points formed clusters across the four regions. The biplot showed variables aggregating in two directions: one including %FEV₁, FEV₁%, 6 min WT, and 5 m WT speed (exercise tolerance), and the other including HS, LLS, SMI, and WBPhA (physical elements). Tracking 39 participants (mean, 636 days later) showed cluster shifts that were broadly reproducible, although the small follow-up sample warrants cautious interpretation. Conclusions: As an exploratory, hypothesis-generating pilot study with a small single-center sample, this novel frailty model may offer a more granular assessment to help guide management; however, external validation in larger cohorts is required before clinical application. Full article

Background/Objectives: Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a rare neurometabolic disorder with an expanding clinical spectrum, including mild and non-classical presentations. We report a boy with severe transient neonatal hyperkalemia, bilateral congenital cataracts, and later subtle neurological and neurocognitive symptoms, in whom genomic testing supported the diagnosis of mild GLUT1DS. Methods: This single-patient case report describes clinical follow-up from birth to nine years of age, including neurological, metabolic, neuropsychological, imaging, and genetic investigations. Whole-exome sequencing using next-generation sequencing technology was performed. Results: The patient required intensive care immediately after birth because of severe transient hyperkalemia of unclear etiology. Bilateral congenital cataracts were surgically corrected during infancy. Later, he developed two brief seizure episodes, reduced exercise tolerance, episodic fatigue, attentional difficulties, motor restlessness, and mild graphomotor impairment. Neuropsychological assessment showed overall average intellectual functioning, below-average verbal abilities, low-average non-verbal abilities, and attention-deficit/hyperactivity disorder. Repeated metabolic investigations, electroencephalography, and brain magnetic resonance imaging were unrevealing. Whole-exome sequencing identified an apparently de novo heterozygous SLC2A1 variant, NM_006516.4.1333_1335del, p.(Phe445del), supporting the diagnosis of mild GLUT1DS. Because of the mild phenotype and preserved everyday functioning, ketogenic diet therapy was not initiated. Conclusions: This case highlights the diagnostic challenges of mild GLUT1DS and the value of genomic testing in children with unexplained neurological or neurocognitive symptoms despite normal routine investigations. Although neonatal hyperkalemia and GLUT1DS coexisted in this patient, current evidence is insufficient to establish a causal relationship. Full article

This narrative review explores sauna exposure as an emerging adjunctive intervention with potential relevance to physiotherapy practice. The physiological effects of sauna exposure are presented as related to neuromusculoskeletal performance, cardiorespiratory function, exercise recovery, and systemic health domains relevant to advanced physiotherapy care. The key benefits, owing to hyperthermia and upregulation of heat shock proteins, include thermoregulatory, cardiovascular, neuroendocrine, and cytoprotective responses that support homeostasis and adaptive stress tolerance. From a clinical perspective, frequent sauna use is linked to improved aerobic capacity and blood pressure regulation, particularly when combined with exercise. Furthermore, sauna exposure may support post-exercise and post-intervention recovery through attenuation of muscle soreness and modulation of inflammatory and hormonal responses, contributing to tissue repair and a timely return of neuromuscular function. Despite these potential benefits, substantial variability in evidence-informed dosing parameters exists, underscoring the need for appropriate patient selection and safety considerations. Despite inconsistent dosing parameters, sauna exposure represents a physiologically plausible and increasingly evidence-informed intervention that may complement established physiotherapy interventions. Further clinical research is needed to define optimal dosing, safety guidelines, and its targeted role within rehabilitation populations. Moreover, studies comparing sauna exposure to other physiotherapy thermal modalities are needed to determine efficacy. This manuscript is classified as level 5 evidence based on the Oxford Centre for Evidence-Based Medicine guidelines. Thus, no indication of the superiority of sauna over other interventions is being established. Full article

Background: Intermittent Hypoxic–Hyperoxic Training (IHHT) induces physiological adaptations. While its efficacy in athletic performance remains debated, IHHT improves health markers in pathological and geriatric populations. This Exploratory Pilot Study aimed to explore the safety and feasibility of two IHHT protocols through preliminary responses. Methods: Twelve healthy volunteers completed a 4-week intervention (two sessions/week, 45 min/session) combining IHHT simultaneously during low-intensity exercise. The study compared a Training Group (TG: 30 min hypoxia, 7.5 min normoxia, 7.5 min hyperoxia) with a Conditioning Group (CG: 15 min hypoxia, 22.5 min normoxia, 7.5 min hyperoxia). Outcomes assessed included cardiorespiratory parameters, Acute Mountain Sickness symptoms, Perceived Exertion, a comprehensive biochemical panel, systemic inflammation, oxidative stress, and renal status. Results: Both protocols were well-tolerated. The TG exhibited significantly greater oxygen desaturation than the CG (p = 0.048). Moreover, the CG demonstrated a significantly attenuated increase in Interleukin-6 (p = 0.021) compared to the TG. Additionally, preliminary variations highlighted an interesting reduction in lipid parameters (TC, LDL, and Apo A1/B ratios) in both groups, although these did not reach statistical significance after FDR correction. Conclusions: While both protocols proved feasible and safe, a more balanced hyperoxic-to-hypoxic exposure (CG) showed better acute physiological tolerability, attenuating cardiovascular strain and mitigating systemic pro-inflammatory responses compared to the unbalanced exposure (TG). Finally, the preliminary variations observed in lipid parameters provide a rationale that warrants further controlled investigations. Full article

Background: Sarcopenia and frailty are highly prevalent extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) and are strongly associated with reduced exercise tolerance, exacerbation risk, hospitalizations, and mortality. Beyond inflammation, oxidative stress, and physical inactivity, emerging evidence highlights nutrition as a major modifiable driver of muscle deterioration in COPD. Nutritional deficits impair anabolic signaling, exacerbate proteolysis, worsen mitochondrial dysfunction, and contribute to frailty progression. Methods: This narrative review synthesizes evidence from PubMed, Embase, Scopus, and Web of Science up to 2025, integrating mechanistic, metabolic, nutritional, and biomarker-related pathways underlying muscle dysfunction in COPD. Studies examining inflammation, hypoxemia, oxidative stress, hormonal imbalance, nutrition, and emerging biomarkers were included. Results: COPD-related sarcopenia results from converging inflammatory (TNF-α, IL-6), catabolic (FOXO, UPS), metabolic, and vascular mechanisms, compounded by energy deficiency, protein insufficiency, and micronutrient deficits. Inadequate intake of protein, vitamin D, antioxidants, and omega-3 fatty acids increase anabolic resistance, enhance muscle catabolism, and worsen frailty. Nutritional interventions, particularly high-protein supplementation, leucine-enriched formulas, vitamin D repletion, omega-3 fatty acids, and multimodal nutrition–exercise programs, demonstrate benefits in muscle mass, strength, and physical performance. Biomarkers such as GDF-15, CAF22, and specific microRNAs reflect nutritional status and correlate with muscle health in COPD. Conclusions: Sarcopenia and frailty in COPD arise from a complex interplay of inflammatory, metabolic, nutritional, and lifestyle-related factors. Integrating nutritional assessment and targeted dietary interventions with exercise and pulmonary rehabilitation is essential to counteract anabolic resistance and improve functional outcomes. Advances in biomarker research may support earlier diagnosis and personalized nutrition-based therapeutic strategies. Full article

Background: Both neuromodulation and physical therapy have been shown to mitigate motor and non-motor symptoms of Parkinson’s disease. To date, no studies have examined the integration of transcutaneous auricular vagus nerve stimulation (taVNS) with physical therapy approaches for improving Parkinsonian symptoms. The purpose of this study was to investigate the safety, tolerability, and feasibility of combining taVNS with physical therapy to enhance the therapeutic benefits of exercise as medicine in a clinical setting. Methods: Participants were randomly assigned to receive active or sham bilateral taVNS in combination with PT for 12 visits over 6 weeks. Safety, tolerability, and feasibility outcomes were primary. Secondly, exploratory analyses of changes in cardiovascular and motor function over time were also performed. Results: Overall, taVNS was safe and well-tolerated prior to PT. Cardiovascular analyses suggest that active taVNS may augment HR response to exercise compared to sham. For motor outcomes, both groups showed significant overall improvements; however, no significant between-group differences were found. Conclusions: The preliminary results obtained in this pilot trial confirm that taVNS combined with physical therapy for individuals with PD is safe and feasible. The exploratory cardiovascular and motor findings support the need for larger, adequately powered clinical trials investigating the integration of taVNS into PT and exercise methods for improving PD symptomology. Trial registration: ClinicalTrials.gov NCT05871151. Full article

Advances in screening, surgical techniques, perioperative care, and multimodality treatment have progressively expanded the population of long-term survivors with early-stage non-small cell lung cancer (NSCLC). However, disease-free survival does not necessarily correspond to complete functional recovery after curative-intent treatment. Many patients continue to experience persistent fatigue, dyspnea, reduced physical activity, impaired exercise tolerance, muscle loss, and deterioration in health-related quality of life despite adequate oncologic control. This narrative review discusses functional recovery as a survivorship endpoint in early-stage NSCLC, focusing on recovery trajectories, physiologic vulnerability, frailty, sarcopenia, rehabilitation, symptom burden, and emerging biologic frameworks such as allostatic load. Increasing evidence suggests that survivorship after NSCLC should not be interpreted exclusively according to recurrence or survival metrics, but also according to the ability to recover physiologic reserve, autonomy, and daily functioning after treatment. Functional recovery appears heterogeneous and influenced by multiple interacting factors, including baseline reserve, systemic inflammation, physical inactivity, behavioral adaptation, and cumulative stress burden. Rehabilitation strategies, structured symptom surveillance, and patient-reported outcomes may help identify vulnerable patients and improve long-term survivorship trajectories. Future survivorship models should probably integrate oncologic outcomes with longitudinal functional assessment to better characterize recovery patterns after treatment. Full article

Background: New Zealand blackcurrant (NZBC) is an anthocyanin-rich supplement with reported ergogenic effects in endurance exercise; however, its effects in resistance-trained adults remain largely unexplored. Objective: This study aimed to examine whether seven days of low- or high-dose NZBC supplementation improves resistance exercise performance, anaerobic capacity, and cognitive function in resistance-trained adults. Methods: Twenty resistance-trained adults completed a randomized, double-blind, placebo-controlled crossover trial with four conditions: no-capsule control (CON), placebo (PL), low-dose blackcurrant (LDBC; 250 mg·day⁻¹), and high-dose blackcurrant (HDBC; 600 mg·day⁻¹), each for seven days. Outcomes included bench press and leg press 1RM, total lifting volume, Tendo-derived bench press power, 30 s Wingate performance, Stroop Color–Word Test scores, readiness, perceived exertion, hemodynamic responses, and adverse events. Results: LDBC and HDBC increased bench press 1RM versus CON and PL, with increases versus CON of +3.33 kg (ES = 0.72; p = 0.005) and +2.34 kg (ES = 0.49; p = 0.041), respectively. Leg press 1RM was higher in PL, LDBC, and HDBC versus CON, with the largest effects observed for LDBC (+37.2 kg, ES = 1.33; p < 0.001) and HDBC (+25.8 kg, ES = 1.11; p < 0.001). Leg press total lifting volume was substantially higher with LDBC (+2627 kg, ES = 1.56; p < 0.001) and HDBC (+1025 kg, ES = 0.74; p = 0.004) versus CON. Bench press volume showed no significant overall treatment effect (p > 0.05). For Tendo-derived power, HDBC exceeded PL for peak (+79.5 W; p = 0.006) and mean power (+46.2 W; p = 0.026). Wingate outcomes did not differ across conditions (all p > 0.05). LDBC exceeded PL on Stroop Color, Color–Word, and total scores (all p < 0.05); HDBC exceeded PL on Color–Word only. Hemodynamic responses and adverse events were comparable across all conditions. Conclusions: Short-term NZBC supplementation improved selected resistance-exercise and cognitive outcomes, with the strongest evidence observed for outcomes that exceeded both CON and PL. The PL response relative to CON suggests that non-specific capsule, expectancy, repeated testing, or period effects may have contributed to some of the lower-body improvements; therefore, placebo-controlled contrasts should be emphasized when interpreting NZBC-specific efficacy. Wingate performance was unaffected, and both doses were well tolerated over the short-term supplementation period. Full article

Background/Objectives: Exercise is pivotal for glycemic control in type 2 diabetes mellitus (T2DM), yet the relative efficacy of various exercise modalities remains inconclusive. This network meta-analysis aimed to evaluate and provide a preliminary ranking of exercise interventions on HbA1c levels in adults with type 2 diabetes mellitus, to facilitate clinically relevant network comparisons and to generate evidence for future large-scale comparative trials. Methods: A systematic review and network meta-analysis were conducted in accordance with PRISMA guidelines. Electronic databases (PubMed, MEDLINE, Cochrane Library, CINAHL, and ProQuest) were searched from inception to Dec 2024. Randomized controlled trials evaluating exercise interventions in adults with T2DM were included. Risk of bias was assessed independently by two reviewers using the JBI critical appraisal tool. The primary outcome was the change in HbA1c level. Results: Six randomized controlled trials involving a total of 511 participants (256 in the treatment group and 255 in the control group) were included in the final analysis. Both high-intensity interval training (MD = −0.322; 95% CI: −0.559 to −0.084; p = 0.008) and yoga (MD = −0.366; 95% CI: −0.534 to −0.198; p < 0.001) significantly reduced HbA1c compared with the active control. Although the preliminary ranking analysis suggested a higher probability of effectiveness for yoga (SUCRA 1) than for HIIT (SUCRA 0.5), the indirect comparison revealed no statistically significant difference in HbA1c reduction between the two interventions (MD = −0.044; 95% CI: −0.335 to 0.247; p = 0.766). Conclusions: These findings provide preliminary, evidence-generating; however, given the sparse network and absence of head-to-head trials, the treatment hierarchy should be interpreted with extreme caution and selected based on patients’ preferences and tolerance. Registration: PROSPERO [CRD42025650162]. Full article

Background: Mixed martial arts (MMA) involve repeated high-intensity, explosive actions that cause substantial fatigue, underscoring the importance of effective recovery strategies. Purpose: This pilot study investigated short-term performance responses to different post-exercise recovery interventions in Polish MMA athletes. Methods: Sixteen athletes (14 males and 2 females) were randomly assigned to cryosauna (CRYO), cold-water immersion (CWI), foam rolling (FR), or passive recovery (CON), with 4 participants per group. The intervention lasted two weeks, with the assigned recovery intervention applied after each training session. Performance was evaluated before and after the intervention using the countermovement jump (CMJ), isokinetic knee peak torque (flexion and extension), and reactive stress tolerance of the determination test (DT). Data were analyzed using mixed-design ANOVA. Results: CMJ performance improved over time across groups. FR significantly increased knee extension (from 228.67 ± 26.49 N.m to 250.50 ± 22.41 N.m), whereas DT scores significantly increased in the CRYO group (from 247.50 ± 12.50 AU to 291.50 ± 15.61 AU) and significantly decreased in the CON group (from 290.25 ± 24.45 AU to 255.50 ± 24.18 AU). Significant Time × Group interactions were observed for DT (p < 0.001) and knee extension torque (p = 0.008). Conclusions: FR appeared beneficial for knee extension performance, whereas CRYO was associated with improved DT performance. Findings are exploratory and need confirmation in larger, controlled studies. Full article

Sports nutrition products are increasingly expected to deliver bioactive compounds that aid in recovery, reduce fatigue, and support physiological regulation, going beyond merely providing energy and nutrients. However, many bioactive compounds face challenges such as poor aqueous dispersibility, limited stability, low bioaccessibility, or inefficient absorption, which hinder their practical use in real food products. This review critically examines food-grade, gel-based delivery systems for bioactive compounds in sports nutrition from a design-driven perspective. It focuses on hydrogels, microgels, emulsion gels, protein gel matrices, and multicomponent gel architectures that prioritize structural stability, digestion-triggered responsiveness, and compatibility with food. Key design principles are discussed, including the need to maintain stability during processing and storage, balance protection with release, and tailor delivery structures to sports-specific constraints such as gastrointestinal tolerance, osmotic load, nutrient timing, and changes in digestion related to exercise. The review also analyzes the effectiveness of gel-based and hybrid systems in liquid, solid, and semi-solid sports nutrition products, emphasizing how the product format and consumption scenario can influence delivery performance. A design decision framework is proposed to align bioactive properties, food format, target release profile, and exercise-stage requirements with appropriate delivery architectures. Current challenges are also addressed, including difficulties in predicting structure–function relationships, limited robustness during scale-up processes, and inadequate functional evaluation. Overall, gel-based food delivery systems provide a promising solution for improving the stability, release behavior, and practical functionality of bioactives in sports nutrition. Full article

Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving tolerance of active rehabilitation. Osteoarthritis (OA) is a heterogeneous whole-joint disorder in which cartilage degeneration, subchondral bone remodeling, synovitis, peri-articular tissue dysfunction, neuromuscular impairment, and pain sensitization may interact to produce pain, stiffness, and activity restriction. As conservative therapy for OA, education, progressive therapeutic exercise, weight management when indicated, and self-management remain the core of care. Nevertheless, some patients cannot fully participate in exercise because of pain, fear of movement, load intolerance, comorbidity, or limited access to supervised rehabilitation. This narrative review synthesizes evidence published mainly between 2016 and 2026 for extracorporeal shock wave therapy (ESWT), photobiomodulation/low-level laser therapy (PBMT/LLLT), pulsed electromagnetic field therapy (PEMF), transfer energy capacitive and resistive/capacitive–resistive electric transfer (TECAR/CRET) therapy, body weight support and aquatic unloading strategies, and mechanosonic vibration therapies. The available literature suggests that ESWT and PBMT/LLLT may provide short- to mid-term pain and function benefits in selected patients with knee OA when parameters are aligned with evidence-supported dosing windows. PEMF and vibration therapies show promising but less consistent effects because protocols, devices, sham conditions, and populations vary. TECAR/CRET and unloading approaches are best interpreted as enabling tools that may reduce guarding, improve walking tolerance, or increase the quality of therapeutic exercise, rather than stand-alone disease-modifying treatments. Current national and society guidelines consistently prioritize exercise, education, and weight management; most of the modalities reviewed here are absent from guidelines or are supported only indirectly, which justifies cautious wording and individualized use. A practical application model is, therefore, time-limited and goal-oriented: identify the barrier to rehabilitation, select a modality with a plausible mechanism and published protocol, monitor pain and functional response, and discontinue the modality if it does not improve participation in active care. Full article

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual incretin-based therapies has fundamentally transformed obesity pharmacotherapy, enabling magnitudes of non-surgical weight loss that were previously unattainable. Yet, the clinical success of these treatments cannot be measured in kilograms alone. Total body weight is a composite, tissue-nonspecific endpoint that fails to distinguish between adipose reduction and losses in skeletal muscle mass, strength, and physical function—compartments of direct relevance to metabolic health, functional independence, and long-term resilience. This narrative review builds on and extends existing conceptualizations of weight loss quality by proposing a clinically oriented, multidimensional framework of high-quality weight loss. Within this framework, preferential adiposity reduction is achieved while preserving skeletal muscle mass, neuromuscular function, dietary adequacy, and cardiometabolic health. We examine the physiological and clinical consequences of lean tissue loss during pharmacological energy restriction, with specific attention to phenotypes at greatest risk (i.e., older adults, individuals with sarcopenic obesity, and those with type 2 diabetes). We then evaluate the evidence supporting precision protein nutrition, dietary fiber adequacy, and gastrointestinal tolerability management as nutritional countermeasures, followed by a mechanistic and clinical analysis of resistance training as the primary exercise strategy for preserving lean mass and function. Finally, we discuss body composition monitoring, integrated multidisciplinary care, and unresolved research gaps. The future of obesity treatment lies not in greater weight loss per se, but in achieving better weight loss—defined as metabolically favorable, functionally responsible, and clinically sustainable. Bone health is treated as a further dimension of high-quality weight loss, since pharmacologically driven energy restriction can adversely affect areal bone mineral density and microarchitecture, and adequate protein intake combined with mechanical loading is required to preserve skeletal integrity alongside lean mass. Full article

Allostatic load (AL) is a multisystemic indicator of the cumulative “wear and tear” on the body caused by chronic stress. In oncology, high AL is associated with a poorer prognosis, a higher number of postoperative complications, and lower treatment tolerance. Patients with head and neck cancer (HNC)—due to frequent smoking, alcohol abuse, low socioeconomic status, and high psychological and functional burden—belong to a group particularly vulnerable to high AL; however, its role in this population remains poorly understood. This narrative review includes publications from 2015 to 2026 from the PubMed/MEDLINE, Embase, and Scopus databases. We analyzed original studies, systematic reviews, and narrative reviews concerning AL in oncology, prehabilitation, and HNC. Additionally, we employed the snowballing method and included studies from key research groups. The results reveal a clear research gap—the lack of direct studies evaluating AL in HNC patients. In other cancers (breast, colorectal, lung), high AL is an independent risk factor for complications, longer hospital stays, and poorer survival. Multimodal prehabilitation (exercise, nutritional, and psychological support) shows potential for reducing AL, but no prospective studies evaluating this effect have been conducted in the HNC population. Assessment of AL may serve as a valuable tool for preoperative risk stratification and monitoring the effects of prehabilitation in patients with head and neck cancer. Prospective cohort and randomized trials are needed to integrate AL into precision medicine for this patient group. Full article