Search Results (1,285)

The aim of this study was to propose the use of metaverse technology as an effective educational method for fall prevention in older adults. A theoretical review was conducted by analyzing publications from PubMed/MEDLINE, EBSCO, SciELO, and Google Scholar using the search terms “metaverse,” “falls,” “older adults,” “virtual reality,” and “exercise.” From 133 identified articles published between 2000 and July 2025, and one seminal pre-2000 study included due to its foundational relevance, 52 were examined in depth. Traditional face-to-face or one-way online education often fails to meet the diverse needs and physical limitations of older adults. Metaverse-based platforms, which employ virtual avatars and immersive environments, may enhance accessibility, motivation, and social connectedness. Potential applications include personalized fall prevention training, virtual community centers, and gamified group exercise environments. Augmented and mixed reality technologies may further improve realism and usability compared with traditional virtual reality. However, challenges remain, including digital literacy gaps, device costs, and infrastructure requirements. Metaverse technology therefore offers a promising platform to bridge the gap between face-to-face and remote interventions. This review is novel in that it systematically synthesizes fragmented evidence on metaverse-based fall prevention, conceptualizes its educational potential for older adults, and provides a foundation for future clinical and policy applications. Full article

Background: Hypertrophic cardiomyopathy (HCM) is a heterogeneous myocardial disease in which conventional prognostic models, primarily focused on sudden cardiac death, often fail to identify patients at risk of clinically relevant events such as heart failure progression or rehospitalization. Cardiopulmonary exercise testing (CPET) quantifies functional capacity, while stress echocardiography (SE) provides mechanistic insights into exercise-induced hemodynamic changes. Their combined application (CPET–SE) may enhance risk stratification in patients with HCM. Methods: In this retrospective study, 388 patients with obstructive and non-obstructive HCM (mean age 48 ± 15 years, 63.1% male) underwent baseline CPET–SE between 2010 and 2022 and were followed for a median of 7.4 years [IQR 4.3–10.2]. Echocardiographic parameters were assessed at rest and peak exercise, and CPET indices included peak oxygen consumption (pVO₂), ventilatory efficiency, and anaerobic threshold. The primary outcome was a composite of heart failure hospitalization or progression to end-stage HCM. Results: Over a median follow-up of 7.4 years, 63 patients (16.2%) experienced an event of the primary outcome. Patients who developed a primary outcome had greater left atrial diameter (45.0 vs. 41.0 mm, p < 0.001) and indexed volume at rest (36.4 vs. 29.0 mL/m², p < 0.001), with further dilation during stress (p = 0.046); increased LV wall thickness (p = 0.001); higher average E/e′ at rest and during stress (p ≤ 0.004); and higher pulmonary artery systolic pressure at rest (p = 0.027) and during stress (p = 0.044). CPET findings included lower pVO₂ (16.0 vs. 19.5 mL/kg/min, p = 0.001), reduced % predicted pVO₂ (p = 0.006), earlier anaerobic threshold (p = 0.032), impaired ventilatory efficiency (p = 0.048), and chronotropic incompetence (p < 0.001) in patients who experienced a primary outcome. Multivariable analysis identified dyslipidemia (OR 2.58), higher E/e′ (OR 1.06), and lower pVO₂ (OR 0.92) as independently associated with the primary outcome. Conclusions: CPET–SE provided a comprehensive evaluation of patients with HCM, associating aerobic capacity to its hemodynamic determinants. Reduced pVO₂ showed the strongest association with adverse outcomes, while exercise-induced diastolic dysfunction and elevated pulmonary pressures identified a high-risk phenotype. Incorporating CPET–SE into longitudinal management of patients with HCM may enable earlier detection of physiological decompensation and guide personalized therapeutic strategies. Full article

Background: The rapid aging of China’s population poses significant challenges, particularly in public health and medical services. Frailty, a reversible geriatric syndrome, is a critical intervention target for disability prevention among older adults. Objective: We hypothesize that both intervention groups will demonstrate significant improvements in Short Physical Performance Battery (SPPB) scores compared to the control group, and that these improvements will be accompanied by parallel reductions in inflammatory markers and beneficial alterations in the gut microbiota. Methods: The MultIfaceted NUtrition inTervention for frail Elderly (MINUTE) trial is a randomized, parallel-group controlled trial. In Beijing, China, 315 frail older adults were recruited and randomly assigned to 3 groups: a control group receiving routine community health management only, multifaceted nutrition intervention group, and a multifaceted nutrition and exercise combined intervention group, each comprising 105 participants. The study consists of a three-month intervention period followed by a nine-month follow-up. During the three-month intervention period, the control group receives routine community health management, while the multifaceted nutrition intervention group receives daily dietary guidance, personalized nutrition consultations, and health education. Additionally, the combined intervention group receives exercise interventions in addition to the nutritional components. After the three-month intervention, all three groups will be followed up for nine months to assess the sustainability of the study. Results: The primary outcomes are the changes in the SPPB scores. The secondary outcomes include frailty scores, intrinsic capacity, malnutrition risk, frailty recovery rates, serum differential metabolites, inflammatory factors, and gut microbiota changes. This study aims to establish a scalable and sustainable pathway for frailty prevention among community-dwelling older adults in China and provide valuable insights to inform strategies for healthy aging. Trial registration: This study is conducted in accordance with the Declaration of Helsinki and approved by the Peking University Institutional Review Board (IRB00001052-23178) on February 3, 2024, with all amendments subject to prior review and approval. Informed consent is obtained from participants, and findings will be disseminated through peer-reviewed publications, conference presentations, and summaries for school staff and participants. ClinicalTrials.gov (NCT06547593) registered 30 July 2024. Full article

Incomplete spinal cord injury (iSCI) results in impaired postural control and walking ability. Visual over-reliance may occur in iSCI individuals to maintain postural control. This can challenge their postural stability in various contexts of daily life activities. The present study assessed the feasibility, acceptability, and preliminary outcomes of balance training with intermittent visual deprivation using stroboscopic glasses on postural control and visual reliance during quiet standing in iSCI individuals. Training impact on walking performance was also evaluated. Seven chronic iSCI individuals participated in a 6-week home-based balance training program, three times weekly, using stroboscopic glasses. Postural and walking abilities were assessed pre- and post-training using a bipedal stance test (BST) and 10 m walking test (10 MWT). BST was performed, with open-eyes (OE) and closed-eyes (CE), on a force plate for three 30 s trials. The center of pressure (CoP) variables included were CoP area (A-CoP) and CoP mean velocity (MV-CoP). Romberg ratios (CE/OE) for two CoP variables were calculated. Duration and speed were measured in 10 MWT. Intervention feasibility was assessed using the feasibility and acceptability questionnaire. Data from able-bodied individuals were recorded and used as references of physiological performance. iSCI individuals were significantly less stable and showed visual over-reliance for postural steadiness compared to controls. Also, their walking ability was impaired. All iSCI individuals completed the training (adherence rate: 84%) and rated it highly feasible. A-CoP and MV-CoP significantly reduced after training in CE condition (p = 0.018, respectively) but not in OE condition (p > 0.05). The Romberg ratio of A-CoP was significantly lower (p = 0.018), but the Romberg ratio of MV-CoP was not (p > 0.05). A significant reduction in duration and increase in speed (p = 0.018, respectively) in performing the 10 MWT were observed. Preliminary findings from this explorative study indicated that 6-week home-based balance training with intermittent visual deprivation was feasible, acceptable, and had promising potential benefits in improving postural control with a reduction in visual over-reliance in iSCI individuals. The training enhanced also their walking performance. Full article

Introduction: Multiple sclerosis (MS) is a chronic neurodegenerative disease that entails high costs, progressive disability, and reduced quality of life (QoL). Telerehabilitation (TR), supported by new technologies, is emerging as an alternative or complement to in-person rehabilitation, potentially lowering socioeconomic impact and improving QoL. Aim: The objective of this study was to evaluate the effect of TR on the QoL of people with MS compared with in-person rehabilitation or no intervention. Materials and methods: A systematic review of randomized clinical trials was conducted (March–May 2025) following PRISMA guidelines. Searches were run in the PubMed-Medline, EMBASE, PEDro, Web of Science, and Dialnet databases. Methodological quality was assessed with the CASP scale, risk of bias with the Risk of Bias 2 tool, and evidence level and grade of recommendation with the Oxford Classification. The protocol was registered in PROSPERO (CRD420251110353). Results: Of the 151 articles initially found, 12 RCTs (598 total patients) met the inclusion criteria. Interventions included (a) four studies employing video-controlled exercise (one involving Pilates to improve fitness, another involving exercise to improve fatigue and general health, and two using exercises focused on the pelvic floor muscles); (b) three studies using a monitoring app to improve manual dexterity, symptom control, and increased physical activity; (c) two studies implementing an augmented reality system to treat cognitive deficits and sexual disorders, respectively; (d) one platform with a virtual reality headset for motor and cognitive training; (e) one study focusing on video-controlled motor imagery, along with the use of a pain management app; (f) a final study addressing cognitive training and pain reduction. Studies used eight different scales to assess QoL, finding similar improvements between groups in eight of the trials and statistically significant improvements in favor of TR in four. The included trials were of good methodological quality, with a moderate-to-low risk of bias and good levels of evidence and grades of recommendation. Conclusions: TR was more effective in improving the QoL of people with MS than no intervention, was as effective as in-person treatment in patients with EDSS ≤ 6, and appeared to be more effective than in-person intervention in patients with EDSS between 5.5 and 7.5 in terms of QoL. It may also eliminate some common barriers to accessing such treatments. Full article

(1) Background: Working from home is becoming increasingly common and has many advantages, but also negative consequences such as reduced physical activity, poor ergonomics and stress. Many people find it difficult to attend in-person rehabilitation sessions due to transportation barriers and limited access to rehabilitation facilities. Therefore, the aim of our study was to investigate whether our online preventive exercise programme effectively improves the musculoskeletal and mental health of sedentary workers. (2) Methods: The study participants worked from home on a long-term basis. Our research group consisted of 30 people, 16 in the intervention group and 14 in the control group. The intervention group members participated in a complex preventive exercise programme three times a week for 10 weeks. The training took place online. Before and after the exercise programme, various tests were used to assess the functional status of the participants’ spine, the strength and flexibility of their core muscles (Core, Kempf and Kraus–Weber tests) and their mental state (Beck Depression Inventory). (3) Results: Significant improvement was observed in the intervention group in the Core, Kempf, Kraus–Weber and Beck tests. (4) Conclusions: Our online complex training programme proved to be effective during the evaluation. It is crucial to tailor remote rehabilitation services to the individual needs and preferences of patients and healthcare professionals. Full article

Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction and adherence. Across non-surgical and surgical contexts, telemedicine shows feasibility and cost benefits, with mixed superiority but consistent non-inferiority for functional outcomes versus in-person care. In hip fracture populations, randomized and non-randomized studies indicate improvements in functional independence measure (FIM), Timed Up and Go test (TUG), Activities of Daily Living/Instrumental Activities of Daily Living (ADLs/IADLs), and quality of life, with some evidence for reduced anxiety and depression, while effects on mobility, pain, and adverse events remain uncertain overall. In patients with upper-limb fractures, telerehabilitation appears to improve function and pain, though strength gains may lag compared with in-person therapy in some trials; adjuncts like motor imagery and virtual reality may enhance outcomes and motivation. Application is facilitated by user-friendly platforms, caregiver involvement, and simple modalities such as structured phone follow-up. Limitations include small samples, heterogeneous protocols, scarce long-term data, and a predominance of non-inferiority or complementary designs, warranting larger, definitive trials. This technology can lead to improved patient management at home, effortlessly verifying treatment compliance, efficacy, and safety, while simultaneously reducing the need for hospitalization, promoting a more peaceful recovery. Here, we have undertaken a narrative review of the medical–scientific literature in this field. Full article

Purpose: Despite significant attention being paid to compression garments (CG) in the sports field, there remains ongoing debate regarding their actual effectiveness in enhancing athletic performance and expediting post-exercise recovery. This article examines their various aspects, with a focus on CG design and the materials they are made of, aiming to analyze the importance of personalized compression strategies based on individual anthropometric measurements and non-linear compression designs. Methods: Using anthropometric analysis of 40 healthy participants, this study examines the morphological characteristics of the lower limb and their implications for CG design. Results: Measurements of limb length and circumferences revealed complex interactions among anatomical variables, emphasizing the need for customized and adaptable device design. Finite element simulations clarified the challenges in achieving uniform pressure gradients along the lower limb, highlighting the limitations of one-piece devices and suggesting tailored segmented designs for individual limb segments. Conclusion: The results demonstrate that one-piece devices often fail to provide optimal compression due to non-linear variations in limb dimensions. Conversely, segmented devices, particularly those with bilinear progression, exhibited superior performance in applying targeted compression across different limb segments. This more detailed approach to customization could significantly contribute to optimizing outcomes and user comfort. Full article

This study developed and validated simplified, individualized heart rate (HR)-based regression models to predict energy expenditure (EE) during treadmill exercise without direct VO2 calibration, addressing the need for more practical and accurate methods that overcome limitations of existing predictions and facilitate precise EE estimation outside specialized laboratory conditions. Energy expenditure was measured by assessing oxygen uptake (VO₂) using a portable gas analyzer and predicted across three treadmill protocols: Bruce, Modified Bruce, and Progressive Speed. These protocols were selected to capture a wide range of exercise intensities and improve the accuracy of heart rate-based EE predictions. The six models combined heart rate, heart rate reserve (HRres), and demographic variables (sex, age, BMI, resting HR) using the Enter method of multiple regression, where all variables were included simultaneously to enhance the real-world applicability of the energy expenditure predictions. All models showed high accuracy with R² values between 0.80 and 0.89, and there were no significant differences between measured and predicted energy expenditure (p ≥ 0.05). HRres-based models outperformed others at submaximal intensities and remained consistent across sex, weight, BMI, and resting HR variations. By incorporating individual resting and maximal HR values, HRres models offer a personalized, physiologically relevant estimation method. These results support integrating HRres-based EE prediction into wearable devices to improve accessible and precise monitoring of physiological energy metabolism. Full article

Fibromyalgia is a chronic syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, and cognitive impairment. Its pathogenesis reflects a complex interplay between central and peripheral mechanisms, including altered pain modulation, neuroinflammation, mitochondrial dysfunction, autonomic imbalance, and genetic and epigenetic factors. Evidence from neuroimaging, omics studies, and neurophysiology supports this multifactorial model. Epidemiological updates confirm a global prevalence of 2–8%, with a strong female predominance and a significant impact on quality of life and healthcare costs. Diagnostic criteria have evolved from the 1990 American College of Rheumatology tender points to the 2010/2011 revisions and the 2016 update, improving case ascertainment but still lacking objective biomarkers. Recent omics and systems biology approaches have revealed transcriptional, proteomic, and metabolic signatures that may enable molecularly informed stratification. Therapeutic management remains multidisciplinary, combining pharmacological interventions (e.g., duloxetine, pregabalin, milnacipran) with non-pharmacological strategies such as graded aerobic exercise and cognitive behavioral therapy. Emerging approaches include drug repurposing to target neuroinflammation, mitochondrial dysfunction, and nociceptive pathways. Despite promising advances, progress is limited by small sample sizes, heterogeneous cohorts, and lack of standardization across studies. Future priorities include large-scale validation of biomarkers, integration of multi-omics with clinical phenotyping, and the design of precision-guided trials. By synthesizing mechanistic insights with clinical evidence, this review provides an updated framework for the diagnosis and management of fibromyalgia, highlighting pathways toward biomarker-guided, personalized medicine. Full article

Exercise has been found to be safe and beneficial for people with advanced cancers, but more research is needed to understand how best to design and implement exercise programming. The Alberta Cancer Exercise (ACE) study examines the effectiveness and implementation of a 12-week community-based exercise program in Alberta, Canada, for people diagnosed with cancer. Here, we describe the characteristics of individuals with metastatic cancer enrolled in the ACE program and report 12-week changes in self-reported and objective outcomes. Of 306 participants, 274 (89.5%) completed the 12-week study. Many participants were female (65.4%), with ≥1 comorbidity (71.9%), and on active cancer treatment (74.8%). Common cancer types included breast (33.7%), genitourinary (16.7%), and digestive (15.0%). Frequent sites of metastasis were bone (44.8%), liver (28.8%), and lung (25.8%). The mean exercise attendance rate was 73.6%. One exercise-related adverse event (0.3%) and one non-exercise-related adverse event (0.3%) occurred, both in individuals with brain metastases. Participants demonstrated strong interest and engagement in exercise, with significant improvements in weekly physical activity, symptoms, quality of life, and physical fitness. Greater benefits were found among subgroups of male participants, those not undergoing chemotherapy, and those receiving group personal training or virtual circuit training. A low rate of adverse events is anticipated. Full article

Background: Mild cognitive impairment (MCI) affects up to 40% of patients with Parkinson’s disease (PD), yet conventional rehabilitation often lacks engagement. The OPERA project developed a novel Bio-cooperative Robotic Platform (PRoBio), integrating a service robot and a virtual reality-based rehabilitation for personalized cognitive training. This work presents two preliminary user-centred studies aimed to assess PRoBio usability and acceptability. Methods: to gather qualitative feedback on robotic and virtual reality technologies, through ad hoc questionnaires, developed according to participatory design principles and user-centered evaluation literature, Study 1 (Focus group) involved 23 participants: 10 PD patients (F = 6; mean age = 68.9 ± 8.2 years), 5 caregivers (F = 3; mean age = 49.0 ± 15.5), 8 healthcare professionals (F = 6; mean age = 40.0 ± 12.0). Study 2 (Living Lab) tested the final version of PRoBio platform with 6 healthy volunteers (F = 3; mean age = 50.3 ± 11.0) and 8 rehabilitation professionals (F = 3; mean age = 32.8 ± 9.9), assessing usability and acceptability through validated questionnaires. Results: The focus group revealed common priorities across the three groups, including ease of use, emotional engagement, and personalization of exercises. Living Lab unveiled PRoBio as user-friendly, with high usability, hedonic quality, technology acceptance and low workload. No significant differences were found between groups, except for minor concerns on system responsiveness. Discussion: These preliminary findings support the feasibility, usability, and emotional appeal of PRoBio as a cognitive rehabilitation tool. The positive convergence among the groups suggests its potential for clinical integration. Conclusions: These preliminary results support the feasibility and user-centred design of the PRoBio platform for cognitive rehabilitation in PD. The upcoming usability evaluation in a pilot study with patients will provide critical insights into its suitability for clinical implementation and guide further development. Full article

Metabolic syndrome (MetS) is a multifactorial clinical condition characterized by the co-occurrence of abdominal obesity, impaired glucose metabolism, high blood pressure, and dyslipidemia. Non-pharmacological strategies, such as hypocaloric diets (HD) and structured physical training (PT), have shown promise in improving metabolic and functional outcomes in this population. The aim of this prospective interventional study was to evaluate the effects of a 16-week program combining HD with PT on ventilatory efficiency and cardiometabolic risk markers in women with MetS. Forty-one sedentary women (aged 45–55 years) with clinically diagnosed MetS underwent anthropometric, metabolic, nutritional, and cardiopulmonary assessments before and after the intervention. Participants engaged in 60 min exercise sessions three times per week and followed a personalized hypocaloric diet targeting 5–10% weight loss. Post-intervention analyses revealed significant reductions (p ≤ 0.05) in body weight (from 86.6 kg ± 3.3 kg to 78.2 kg ± 3.3 kg), body fat percentage (40.1% ± 0.6% to 33.4% ± 1.6%), and waist circumference (105.1 cm ± 1.2 cm to 95.7 cm ± 1.9 cm). Improvements were also observed in fasting glucose (from 117.1 mg/dL to 95.1 mg/dL) and triglycerides (158.8 mg/dL ± 9.1 mg/dL to 111.8 mg/dL ± 9.1 mg/dL), and in lean mass percentage (59.9% ± 6.5% to 66.6% ± 1.7%). Cardiopulmonary variables showed enhanced ventilatory function, with increased VO₂peak (1.59 L/min ± 0.1 L/min to 1.74 ± 0.1 L/min), improved oxygen uptake efficiency slope (OUES), and a steeper VO₂/workload relationship. Resting heart rate and blood pressure declined significantly (69.9 bpm ± 2.0 bpm to 64.9 ± 1.8 bpm; 145.4 mmHg ± 3.9/80.2 ± 3.0 mmHg to 140.1 mmHg ± 2.7/75.2 ± 1.6 mmHg). In conclusion, the 16-week intervention combining HD with PT proved effective for reducing cardiometabolic risk factors and enhancing ventilatory efficiency, suggesting improved integration of oxygen uptake, transport, and utilization in the women with MetS assessed. Full article

Advances in geroscience suggest that aging is modulated by molecular pathways that are amenable to dietary and pharmacological intervention. We conducted an integrative critical review of caloric restriction (CR), intermittent fasting (IF), and caloric restriction mimetics (CR-mimetics) to compare shared mechanisms, clinical evidence, limitations, and translational potential. Across modalities, CR and IF consistently activate AMP-activated protein kinase and sirtuins, inhibit mTOR (mechanistic target of rapamycin) signaling, and enhance autophagy, aligning with improvements in insulin sensitivity, lipid profile, low-grade inflammation, and selected epigenetic aging measures in humans. CR-mimetics, such as metformin, resveratrol, rapamycin, and spermidine, partially reproduce these effects; however, long-term safety and efficacy in healthy populations remain incompletely defined. Methodological constraints—short trial duration, selective samples, intermediate (nonclinical) endpoints, and limited adherence monitoring—impede definitive conclusions on hard outcomes (frailty, disability, hospitalization, mortality). We propose the Active Management of Aging and Longevity (AMAL) model, a three-level biomarker-guided framework that integrates personalized diet, chrono-nutrition, exercise, and the selective use of CR-mimetics, along with digital monitoring and decision support. AMAL emphasizes epigenetic clocks, multi-omics profiling, inflammatory and microbiome metrics, and adaptive protocols to enhance adherence and clinical relevance. Overall, CR, IF, and CR mimetics constitute promising, complementary strategies to modulate biological aging; rigorous long-term trials with standardized biomarkers and clinically meaningful endpoints are needed to enable their scalable implementation. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), have become the leading causes of chronic liver disease worldwide, with increasing rates of cirrhosis, hepatocellular carcinoma, and cardiovascular complications. Pathogenesis involves a complex interplay of dietary excess, sedentary lifestyle, insulin resistance, adipose tissue dysfunction, and alterations in the gut microbiome, which collectively lead to hepatocellular stress, inflammation, and fibrogenesis. Despite ongoing advances in pharmacotherapy, lifestyle intervention remains the cornerstone of management. Evidence shows that sustained weight loss of ≥5% reduces hepatic steatosis, ≥7% improves necroinflammation, and ≥10% stabilizes or reverses fibrosis. Dietary strategies, including Mediterranean-style patterns, high-protein approaches, and intermittent fasting, have been shown to be effective in improving insulin sensitivity and reducing intrahepatic triglycerides. Exercise interventions, focusing on both aerobic fitness and resistance training, enhance metabolic flexibility and combat sarcopenia, thereby improving hepatic and systemic outcomes. Equally important are behavioral support, digital health tools, and multidisciplinary approaches that enhance adherence and address barriers such as socioeconomic disparities, limited access, and patient engagement issues. Personalized nutrition plans, integrating physical activity, and ongoing support for behavioral change are essential for long-term disease management. This review synthesizes current evidence on the roles of macronutrients, micronutrients, dietary quality, physical activity, and adjunctive behavioral strategies in managing MASLD. By translating mechanistic insights into practical, evidence-based recommendations, we aim to provide clinicians, dietitians, and exercise professionals with effective frameworks to slow disease progression and improve outcomes across diverse patient populations. Full article