Search Results (55)

Background: Simplified field tests have gained increasing interest for the assessment of functional capacity in patients with post-COVID-19 condition; however, direct comparisons of functional performance and physiological responses between the 1-min sit-to-stand test (1MSTST) and the 6-min walk test (6MWT) remain limited. This study aimed to examine the associations between the two tests by evaluating functional performance, cardiopulmonary responses, oxygen desaturation, perceived exertion, and peripheral muscle strength. Furthermore, we explored whether the 1MSTST can be used as a complementary assessment, particularly within telerehabilitation pathways and in contexts where resource-intensive testing is not feasible. Methods: We conducted a cross-sectional observational study of adults recovering from moderate to severe COVID-19 between May and July 2021. Participants performed both the 1MSTST and 6MWT on the same day. Functional performance, peak heart rate, nadir peripheral oxygen saturation (SpO₂), perceived exertion, and handgrip dynamometry were recorded. Associations between test performances were assessed using correlation and partial correlation analyses, including adjustment for peripheral muscle strength. Results: Fifty-four patients were included. A moderate correlation was observed between 1MSTST repetitions and 6MWT distance (Spearman’s ρ = 0.47, p < 0.001), which was attenuated after adjustment for muscle strength and demographic variables. Peak heart rate and nadir SpO₂ responses were strongly correlated between tests (r = 0.75 and ρ = 0.83, respectively; both p < 0.001), with no significant differences in magnitude. Exercise-induced oxygen desaturation (≥4% SpO₂ drop) occurred at similar frequencies during both tests. Perceived exertion increased similarly following the 1MSTST and the 6MWT. Conclusions: In post-COVID-19 patients, the 1 min sit-to-stand test shows moderate concordance with the 6 min walk test for functional performance and strong agreement in cardiopulmonary responses. These findings suggest that the two tests assess overlapping but distinct aspects of functional capacity. This supports the use of the 1MSTST as a pragmatic complementary assessment when standard walking tests are not feasible, particularly within telerehabilitation pathways, primary care, and resource-limited settings. Full article

Background/Objectives: This multicenter nonrandomized pragmatic trial (NCT04282616), offering different options for active support by an exercise facilitator (EF) in the dialysis unit, aims to explore the attitudes and preferences of end-stage kidney disease (ESKD) patients in relation to their characteristics, capabilities and barriers. Methods: In six European dialysis units, an EF was set to offer to each ESKD patient able to walk four simple low-cost three-month interventions: (i) advised physical activity increase (U-PA-I); (ii) structured home-based walking exercise (S-HB-LI); (iii) in-hospital (pre/postdialysis) supervised walking and resistance low-intensity training (S-SU-LI); and (iv) performance assessment only (PPA). After collecting attitudes and perceptions of patients, the EF was available for counseling about the choice. Outcome measures were the percentage of engaged patients among the total population, the percentage of active interventions versus PPA and their distribution among the available options, as well as the factors related to patients’ choices (anthropometry, clinical, exercise capacity, and others). Results: Of the 297 eligible patients, 221 met the inclusion criteria, 176 (59%) of whom chose to participate (males, n = 113; aged 68 ± 10 years). The patients’ choices were as follows: S-SU-LI, (n = 80), S-HB-LI (n = 66), PPA (n = 25) and U-PA-I (n = 5). Patients in the LI group were significantly older (p < 0.001) and had a lower exercise capacity, as measured by the 6 min walking distance (p < 0.001). No significant differences in sex, distance from the dialysis center, dialysis duration, or recruiting site were recorded. The main reasons for nonparticipation were not being interested (67%) or already active (22%). Conclusions: In this exploratory research, patients exhibited positive attitudes toward exercise training and abandoning a sedentary lifestyle when counseled by an EF and when offered the possibility to choose. As the patient profile becomes more comorbid and frail, supervised and/or lower-intensity programs are preferred. Full article

Background: Acute coronary syndrome (ACS) encompasses ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina. While optimal medical therapy (OMT) is central to secondary prevention, lifestyle interventions—particularly dietary modification—remain underutilised despite their potential impact on long-term outcomes. Objective: To review the current evidence regarding dietary interventions post-ACS, their implementation, adherence, and effects on cardiovascular risk factors and clinical outcomes. Methods: A narrative literature review was performed using PubMed, including studies published in English from 2000 onwards. Keywords included “acute coronary syndrome,” “diet,” “cardiovascular disease,” “outcomes,” “adherence,” “wine,” and “intermittent fasting,” combined with Boolean operators AND/OR. Animal studies were excluded. The latest search was conducted in October 2025. Results: Mediterranean-style diets, when combined with OMT and lifestyle interventions (exercise, smoking cessation, alcohol moderation), consistently improve cardiovascular risk factors and reduce recurrent ischemic events and mortality. Clinical trials and cohort studies demonstrate long-term benefits, including reductions in all-cause mortality and major adverse cardiovascular events, particularly in patients adhering to structured dietary programmes within cardiac rehabilitation. Evidence for other dietary modifications, including low-fat diets, increased fibre, antioxidant supplementation, and intermittent fasting, was more limited, often derived from small or short-term studies focusing on surrogate endpoints. Real-world adherence to dietary guidelines remains suboptimal, especially in high-risk and obese populations. Preliminary studies suggest intermittent fasting and moderate red wine consumption may confer additional cardiovascular benefits, though larger, long-term trials are needed. Conclusions: Dietary modification is a key, yet underutilised component of secondary prevention post-ACS. A Mediterranean-style, whole-food diet integrated with OMT and supported by structured cardiac rehabilitation programmes offers the most evidence-based strategy to improve risk factor control and long-term outcomes. Future research should focus on pragmatic, long-term trials assessing hard cardiovascular endpoints and implementation strategies to enhance adherence across diverse populations. Full article

The aim of this review was to harmonize major consensus statements (European Working Group on Sarcopenia in Older People 2; Asian Working Group for Sarcopenia 2019; Foundation for the National Institutes of Health Sarcopenia Project operational criteria) into a stage- and setting-stratified algorithm. It maps diagnostic strata to dose-defined resistance and combined training, integrates multimodal and technology-enabled options (whole-body electrical muscle stimulation, whole-body vibration, virtual reality, AI-assisted telerehabilitation) with safety cues, and embeds nutrition (≥1.2 g/kg/day protein, vitamin D, key micronutrients) and education to sustain adherence. Sarcopenia is a consequential geriatric syndrome linked to falls, loss of independence, hospitalization, mortality, and psychosocial burden, yet translation to practice is hindered by heterogeneous definitions, diagnostics, and treatment guidance. Literature searches via PubMed/MEDLINE, EBSCO, SciELO, and Google Scholar (January 2000 to August 2025) yielded 354 records; after screening and deduplication, 132 peer-reviewed studies were included. We summarize tools for screening, strength, muscle mass, and function (e.g., Sarcopenia Five-Item Questionnaire, grip strength, dual-energy X-ray absorptiometry, gait speed) and identify resistance exercise as the cornerstone, with aerobic, balance, and flexibility training adding functional and metabolic benefits. Clinic-ready tables and figures operationalize a stepwise program across primary to severe sarcopenia and across acute or iatrogenic to community settings. Early screening plus structured, exercise-centered care, augmented by targeted nutrition and education, offers pragmatic, scalable benefits. Full article

Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability issues among HF patients mean that the 6 min walk test (6MWT) is a cost-saving and well-tolerated complementary assessment. We aimed to systematically review the validity, reliability, and safety of the 6MWT compared to CPET for patients with HF. Methods: This study is a systematic review and meta-analysis. Embase, Medline, and Scopus were searched from inception to November 2023. We applied Fisher’s z-transformation to correlation coefficients and pooled effects under a random-effects model; heterogeneity (I²), leave-one-out sensitivity, and Egger’s test were reported. Results: Twenty studies were finally included, involving 5379 HF participants. A significant moderately strong positive correlation was shown between the 6MWT distance and CPET peak oxygen consumption: (r) = 0.62, 95% CI 0.58–0.66; I² = 56.95%; p < 0.001. The results showed an excellent test–retest reliability, with a pooled intraclass correlation coefficient of 0.93 (95% CI 0.89–0.95; I² = 92.06%; p < 0.001). A pooled weighted mean difference of 15.5 m (95% CI 10.2–20.8) was found for the learning effect between the first and second 6MWT. Although some patients required rest stops or reported symptoms such as fatigue or dyspnea, no 6MWTs were terminated due to serious adverse events. Conclusions: Compared with CPET, the 6MWT distance demonstrated a moderately strong correlation with peak VO₂, excellent test–retest reliability, and a small learning effect. The 6MWT can therefore complement CPET or serve as a pragmatic alternative when CPET is not feasible; it does not replace comprehensive CPET assessment. Full article

Generative artificial intelligence (AI) is reshaping higher education (HE) by reconfiguring how knowledge becomes visible, how judgment is exercised, and how recognition is distributed. These systems intervene in the pedagogical and democratic conditions under which plurality, critique, and participation can be sustained. This study examines how students and lecturers interpret and navigate these transformations and what they reveal about the possibilities of democratic education under algorithmic mediation. Drawing on n = 151 written articulations (122 students, 29 lecturers) to open-ended questions collected via LimeSurvey, analyzed through Grounded Theory in combination with biographical interpretation and oriented by education theory (Bildung) and democracy pedagogy, the research reconstructs five orientations that range from pragmatic coping to struggles over recognition. These orientations illuminate how systemic dynamics of acceleration, opacity, and infrastructural authority are refracted into everyday academic practice. They are further synthesized into three broader axes of temporal sovereignty, epistemic opacity and accountability, and recognition ecologies. The findings highlight how fragile orientations emerge as both risks and resources. The study contributes to HE didactics by outlining strategies to transform fragility into pedagogical occasions, emphasizing reflective delay, dialogical engagement with opacity, and diversification of recognition practices. It concludes that democratic education depends on cultivating spaces where algorithmic pressures become educable and fragile orientations can develop into dispositions of reflexivity, critique, and participation. Full article

Stroke survivors frequently experience long-term disability, post-stroke fatigue, frailty, sarcopenia, falls, and psychosocial distress, which together drive poorer functional recovery, rehospitalization, institutionalization, and caregiver burden. This narrative review synthesizes contemporary evidence on the prevalence, mechanisms, and clinical impact of post-stroke fatigue, frailty, sarcopenia, and falls and examines their links with palliative care needs, healthcare costs, and emerging telehealth models. A PubMed and Google Scholar search up to October 2025 identified studies on stroke and fatigue, frailty, sarcopenia, falls, palliative care, and telehealth, with an emphasis on clinical studies, trials, systematic reviews, and guidelines in adults. Frailty and sarcopenia are highly prevalent after stroke and predict mortality, poor functional outcome, reduced rehabilitation response, and higher care needs. Post-stroke fatigue is common, multifactorial, and associated with worse quality of life and reduced return-to-work rates. Falls are frequent and arise from the combined effects of focal neurological deficits and systemic frailty/sarcopenia. Despite substantial symptom burden, palliative care is often introduced late and inconsistently. We summarize brief, validated screening tools, such as the Clinical Frailty Scale, SARC-F plus grip strength, Malnutrition Universal Screening Tool, Fatigue Severity Scale/Neurological Fatigue Index for Stroke, Short Physical Performance Battery, and fall-risk instruments. We propose pragmatic timepoints and referral thresholds for their use in stroke services. Multicomponent interventions that integrate exercise, nutritional optimization, psychosocial support, and structured fall prevention can reduce frailty, sarcopenia, and falls and improve function and mood. Telemedicine and telerehabilitation may enhance access and continuity but risk widening digital inequities. Earlier, structured palliative approaches aligned with patient goals are needed across the frailty–sarcopenia–stroke continuum. Implementing integrated screening–intervention pathways and hybrid telehealth models could improve long-term outcomes for stroke survivors and their caregivers while supporting more efficient use of healthcare resources. Full article

Background/Objectives: Diabetes mellitus (DM) is a major global health concern, yet limited research has examined how sociodemographic factors and physical activity (PA) influence glycaemic control within specific national contexts. This pilot study explored associations between sociodemographic and behavioral factors and glycaemic regulation among adults with DM in Croatia. Methods: A cross-sectional study was conducted at a national reference center, including 95 adults with type 1 or type 2 diabetes. Data on demographics, clinical characteristics, and PA were obtained through questionnaires and medical records. Descriptive statistics, Welch’s t-tests, χ² tests, correlations, and regression analyses were applied to identify predictors of HbA1c and diabetes-related complications. Glycaemic control was categorized as optimal (HbA1c ≤ 7.5%) or suboptimal (>7.5%) according to the pragmatic clinical threshold commonly used in DM management. Results: Mean HbA1c was 6.9% (SD = 1.3), with 33.7% of participants above 7.5%. Higher education (β = −0.48, p = 0.013) and participation in strength or balance exercises (β = −0.32, p = 0.041) were associated with lower HbA1c, whereas longer disease duration (β = 0.03, p = 0.004) and type 2 diabetes (β = 0.38, p = 0.030) predicted higher HbA1c. In logistic regression, age predicted cardiovascular comorbidities (OR = 1.12, 95% CI 1.02–1.23, p = 0.019). The interaction between PA and place of residence (urban vs. rural) showed a non-significant trend (p = 0.061). Conclusions: Glycaemic control in Croatian adults with diabetes was associated with educational level and engagement in strength and balance exercises, while longer disease duration, older age, and type 2 diabetes were linked to poorer regulation and more complications. These findings underscore the importance of structured exercise and patient education in diabetes management, although larger, prospective studies with standardized PA-intensity measures are required to confirm and extend these results. Full article

Cancer survivors (CS) constitute an expanding population with underrecognized cardiometabolic risk. Despite substantial improvements in five-year survival rates, both childhood and adult survivors remain at high risk for premature morbidity and mortality. These risks are particularly pronounced following exposure to anthracyclines and/or chest radiotherapy, typically in a dose-dependent manner. In Chile, the establishment of the National Pediatric Antineoplastic Drug Program (PINDA) in 1998 marked a milestone in improving equitable access to high-quality pediatric oncology care through evidence-based treatment protocols across the public health system; the adult counterpart (PANDA) has developed diagnostic, treatment, and monitoring protocols for hematological neoplasms. Few prospective cohort or mechanistic studies have clarified risk stratification or surveillance strategies in survivor populations. The regulated, short-term activation of inflammation and innate immunity can be an adaptive and protective response to tissue injury, whereas persistent low-grade inflammation may trigger neutrophil extracellular traps formation (NETosis) and other maladaptive pathways that accelerate endothelial injury, thrombosis, and adverse cardiovascular remodeling. NETosis represents a putative immunomodulatory target for therapeutic immunomodulation in heart failure and maladaptive left ventricular remodeling in preclinical models. Concurrently, skeletal muscle-derived and hormonal mediators known as exerkines—together with increased NET activity—may modulate the pathophysiology of chronic cardiometabolic disease and contribute to cancer progression, particularly in the context of obesity, diabetes, and insulin resistance. Structured exercise is a promising non-pharmacological intervention that modulates inflammatory and metabolic pathways and may thereby help prevent non-communicable diseases, including cancer. We synthesize basic and clinical evidence to (1) define how cancer therapies promote low-grade inflammation and NETosis; (2) describe how exerkines and structured exercise influence cardiometabolic biology; and (3) evaluate exercise as a mechanistic and clinically pragmatic strategy to reduce long-term CVD risk in pediatric and adult CS. Full article

Background/Objectives: We aimed to test whether home-based low-intensity interval training (LIIT) could be equally or more effective than traditional continuous walking advice (TWA) in a population hospitalized and healed from severe COVID-19. Methods: This pragmatic nonrandomized controlled trial (NCT04615390) enrolled patients admitted to intensive care units due to COVID-19 who at discharge from the hospital were given a choice between either a home-based LIIT program or TWA. The former received a structured LIIT walking (1:1 walk:rest ratio per 10 times) to be performed at a prescribed progressively increasing speed maintained with a metronome. The latter received TWA according to the guidelines (30 min or moderate intensity activity, 5 days/week). Outcome measures, collected at baseline, at the end of the 3-month training and at the 6-month follow-up, included 6 min walking distance (primary), lower limb strength, quality of life, depression and cognitive status. Results: From a total of 85 enrolled patients, 69 of them (LIIT n = 32; TWA n = 37) completed the study. Home exercise was safely executed with an 82% adherence for the LIIT group and 64% adherence for TWA. After the 3-month program, both groups significantly improved the 6MWD (LIIT: +87 m vs. TWA +42 m; p < 0.001) with a significant difference that was also maintained at follow-up (LIIT: +138 m vs. TWA +69 m; p < 0.001). No other significant between-group differences were noted. However, patients in the LIIT group significantly improved in the majority of the outcomes, while patients of TWA improved in only the primary outcome and the physical component of quality of life. Conclusions: Compared with TWA, LIIT walking was feasible, safe and associated with more favorable multidimensional recovery in COVID-19 survivors after hospitalization for severe pneumonitis. Full article

In 1978, Brian Kernighan and Dennis Ritchie insisted that the first program to write in a new language is one to print the words “hello, world.” From then until now, “hello, world” has frequently been the first exercise in introductory programming courses. On one hand, this does seem like a good first program because it makes something familiar—a greeting—appear on the screen. On the other hand, it is extremely strange. How can it be understood as a greeting? Who is greeting whom? Unfortunately, the bulk of formal means for defining programming languages provides very little help for assigning a meaning to the “hello, world” program. It is argued that the weakness of older theories and methods of programming language semantics is due to the historical, disciplinary segregation (in logic, semiotics, and linguistics) of semantics as a study apart from syntax and pragmatics. Drawing from both more recent work in programming language semantics that addresses side effects and on speech-act-based programming language design, this paper proposes a possible reintegration of semantics and pragmatics in order to better define the meaning of “hello, world” and the programming languages used to produce speech acts more generally. Full article

Religion played a pivotal role in shaping the political and cultural landscape of early China, particularly through the practice of relocating capitals (遷都). The relocation of capitals is an outstanding theme in early Chinese historiography, setting it apart from many other world traditions. In particular, this practice contrasts sharply with the early Mediterranean context, where the city of Rome transitioned from a modest city-state to a world empire and was celebrated as the “eternal city.” By contrast, early Chinese capitals were deliberately transient, their impermanence rooted in strong religious sentiments and pragmatic considerations. Religious and ideological justifications were central to these relocations. The relocation was not merely a logistical or political exercise; it was imbued with symbolic meaning that reinforced the ruler’s legitimacy and divine mandate. Equally important was the way rulers communicated these decisions to the populace. The ability to garner mass support for such monumental undertakings reveals the intricate relationship between political authority and religious practice in early China. These critical moments of migration offer profound insights into the evolving religious landscape of early China, shedding light on how religion shaped early governance and public persuasion. “Capital relocation” served as a means to rearticulate belief, reaffirm the centrality of worship, and restore faith in the ruling order. Drawing on recent archeological discoveries and updated textual and inscriptional scholarship related to the events of Pan Geng and the Zhou relocation to Luoyi, this article re-examines the motif of “capital relocation” as both a historical and historiographical phenomenon unique to early China. Full article

This paper suggests a method of private internalization of externalities via the bundling of new fossil fuel automobile purchases. The bundle encourages and pursues a new quality of life entailing planting trees, a healthy body and mind, and efficient use of new energy usages for the joining of a grassroots environmental club. The work was motivated by the classic economics article by Ronald Coase, The Problem of Social Cost (1960). Marketing plays an important role in this internalization endeavor. Indeed, modern behavioral economics and psychology help inform how creative bundles of a new automobile purchase with sustainable lifestyle elements can effectively formulate some promotional propositions. The pragmatism we are demonstrating in this piece is to show the linkage between theories and marketable directions that can be experimented with via trial-and-error, as in many bundling exercises. Full article

Swearing, a highly emotive form of expression, has recently attracted growing interest from researchers. Yet, swearing is still largely unexamined as a form of self-talk among professional athletes, coaches, and casual exercisers. This study aims to fill that gap by creating and validating the Use of Swear Words in Sport and Exercise Questionnaire (USWSEQ), an innovative instrument intended to assess how often athletes, coaches, and recreational exercisers utilize common swear words. The questionnaire was administered to 513 participants and underwent exploratory (n = 333) and confirmatory (n = 180) factor analyses to evaluate its content structure, reliability, and validity. Results confirmed a robust two-factor model: (1) Self/Other Degradation, and (2) Situational Swearing. Notably, the study emphasizes the complexity involved in researching language, because swear words can be semantically ambiguous, pragmatically flexible, and deeply embedded in culture. These attributes present challenges for conventional psychometric methods and highlight the importance of function-based and context-aware frameworks. Full article

Background: Adolescent and young adult (AYA) cancer survivors have unique needs, yet few tailored rehabilitation programs exist. CaRE-AYA is an 8-week multidimensional rehabilitation program for AYAs that targets impairments, activity limitations and participation restrictions and comprises an individualized exercise prescription and weekly group-based exercise and self-management education. Methods: We conducted a single-arm multi-method pragmatic feasibility study evaluating CaRE-AYA’s feasibility, acceptability, and safety (primary outcomes) and assessed disability, physical functioning, mental health, and social functioning at baseline (T0), immediately post-intervention (T1), and 3 months post-intervention (T2). Results: Twenty-five participants (median age: 32.8, 76% female) were enrolled. Participation (60%), retention (84% at T1, 72% at T2), and program adherence (76% for education classes, 74% for exercise classes) supported feasibility. Qualitative interviews (n = 9) supported strong perceptions of feasibility and acceptability. No serious adverse events (≥grade 3) attributed to CaRE-AYA occurred. Conclusions: The results suggest CaRE-AYA is feasible, acceptable, and safe. A randomized controlled trial is needed to determine the effectiveness. Full article