Search Results (815)

Air pollution is one of the major environmental challenges threatening global sustainable development and human health. The World Health Organization identifies it as a critical factor contributing to non-communicable diseases and inequality, especially in vulnerable populations such as children. The findings highlight the negative effects of environmental degradation on physical health and underline the urgent need to incorporate health metrics, such as children’s fitness, into sustainability monitoring frameworks and public policies aiming at cleaner and healthier urban environments. The aim of this study was to examine the association between ambient particulate pollution and cardiorespiratory fitness in school-aged children from two rural villages in southern Spain characterised by relatively higher and lower levels of particulate matter. A total of 938 children (primary and secondary school levels) participated in a naturalistic pre–post study design. Cardiorespiratory fitness was assessed using the 6 min walk test, where maximal oxygen uptake (VO₂max) was estimated. Assessments were conducted before and after a period characterised by unfavourable air-quality conditions in the higher-pollution village. The students were assigned by convenience into an experimental [n = 476 (EG)] and a control group [n = 462 (CG)]. The t-test, repeated measures analysis and MANOVA test were used in order to report differences within and between groups, as well as time-points and academic levels. The significance level was set at p < 0.05. Significant differences between groups were reported within the pre-test period, showing elevated pre-test values in the CG compared to the EG. The EG showed a higher pre–post difference in estimated VO₂max compared to the CG for primary education level (16.19%, ES(d) = 0.91 vs. 3.07%, ES(d) = 0.26; p < 0.001, respectively); secondary education (EG: 12.29%, ES = 0.91 vs. CG: 1.69, ES(d) = 0.16); and the whole population (EG: 14.72%, ES = 0.91 vs. CG: 2.84, ES = 0.25). It seems that the environmental context, and specifically the air pollution in the area of residence, may be an important factor to consider in relation to the assessment of physical fitness in the school-aged youth population. Full article

Background: Identifying multimodal interventions to counteract age-related physiological decline is a critical public health priority. This study investigated the impact of an 8-week Mat Pilates intervention (MPT) on the interplay between core stability, pulmonary function, and cardiorespiratory fitness in older adults, specifically examining the mechanistic link between trunk stabilization and respiratory mechanics. Methods: Twenty older adults (18 females, 2 males; age 60—77 years) were randomized (stratified by sex, age, and baseline stability) into an MPT group (n = 10; 60-min sessions, 3×/week) or a control group (CON, n = 10). Primary outcomes included core stability (plank test), functional flexibility (sit-and-reach; back-scratch), pulmonary function (FVC, FEV₁, FEV₁/FVC, FEF_25–75%, MVV), and cardiorespiratory fitness (6-min walk test; 6MWT). Results: Post-intervention, the MPT group demonstrated significant improvements in core stability, flexibility, and all pulmonary variables (FVC, FEV₁, FEF_25–75%, MVV) compared to the CON group (p < 0.001). A significant reduction in body weight was also observed (p < 0.001). Notably, MPT participants achieved superior 6MWT distances and reduced perceived exertion (p = 0.006). Correlation analysis revealed strong positive associations between core stability gains and pulmonary function (r = 0.892, p < 0.01), supporting the mechanistic link between trunk stabilization, enhanced ventilatory mechanics, and functional aerobic capacity. Conclusions: Mat Pilates is a potent intervention for older adults, facilitating a physiological synergy where core strengthening optimizes pulmonary function and cardiorespiratory endurance. These findings suggest MPT is a comprehensive modality for maintaining musculoskeletal and respiratory health, proving superior to habitual activity alone in promoting functional independence. Full article

Background: Stroke-related impairments in balance and gait are among the most common and disabling sequelae, significantly limiting functional independence and increasing fall risk. This study investigated the effects of short-term dynamic balance training on balance and gait in post-stroke hemiplegic patients. Methods: In this randomized controlled pilot trial, 16 post-stroke hemiplegic patients (intervention group, n = 8; control group, n = 8; mean age ≈ 58 years; predominantly male) were assigned to either a control group receiving conventional rehabilitation or an intervention group receiving additional daily dynamic balance training using the Prokin-252 system (30 min/day, 5 days/week, 3 weeks). Primary outcome measures included balance performance (Berg Balance Scale, mini-BESTest, single-leg stance), center-of-pressure (COP) parameters, gait performance (Timed Up and Go Test), and surface electromyography (sEMG) activity. Results: Following the intervention, both groups demonstrated improvements; however, the intervention group showed significantly greater gains in balance and gait outcomes. Specifically, Berg Balance Scale scores improved significantly (p = 0.012), as did mini-BESTest scores (p = 0.004). Eyes-closed single-leg stance time increased significantly on both sides (p < 0.05). COP analysis revealed reductions in sway area and trajectory length under challenging conditions. sEMG analysis indicated increased activation of the affected-side gluteus medius. In terms of gait performance, the intervention group demonstrated greater improvements in Timed Up and Go Test performance (p = 0.002), dual-task walking, and gait phase symmetry. Conclusions: Supplementing conventional rehabilitation with dynamic balance training effectively enhances balance and gait function in post-stroke patients, potentially through improved neuromuscular control. The integration of sensor-based COP analysis and sEMG provides additional mechanistic insight into rehabilitation outcomes. Full article

Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male finswimmers and sedentary age-matched non-athletes. Methods: Thirty-two boys aged 8 to 12 years old were stratified into the finswimmers group (FSG, n = 16) and the non-athletes group (NAG, n = 16). Assessments included pulmonary function (spirometry) and respiratory muscle strength (Maximum Inspiratory Pressure, MIP/Maximum Expiratory Pressure, MEP). Exercise capacity was evaluated using the modified shuttle walk test (MSWT). Results: The FSG exhibited significantly higher pulmonary function (Forced Vital Capacity, Forced Expiratory Volume in 1 s, Maximum Voluntary Ventilation; p < 0.05) and superior MIP compared to the NAG (105.3 ± 24.8 versus 87.3 ± 24.7 cmH₂O; p = 0.022). During the MSWT, FSG covered substantially greater distances (746.6 ± 97.2 versus 591.1 ± 86.4 m; p < 0.001) with lower levels of leg fatigue (Borg 0–10) (0.53 ± 0.39 versus 2.13 ± 1.93; p = 0.004) and demonstrated lower heart rate recovery time (4.47 ± 0.68 versus 5.75 ± 0.68 min; p < 0.001) compared to NAG. At the iso-level (8th level of MSWT), FSG scored lower levels of leg fatigue (0.13 ± 0.12 versus 2.02 ± 2.0; p = 0.001) compared to NAG, indicating better peripheral oxygen % saturation (100 ± 0.0 versus 98.14 ± 1.16; p < 0.001). Conclusions: Systematic exercise training enhances profound cardiorespiratory and peripheral muscle adaptations in children. Enhanced cardiorespiratory function allows young athletes to achieve higher workloads and recover faster than sedentary peers, highlighting the sport’s role in establishing a robust cardiorespiratory fitness. Full article

Introduction: Optimization of guideline-directed medical therapy in chronic heart failure remains challenging in real-world practice, particularly outside settings with routine cardiopulmonary exercise testing. In this context, cardiovascular rehabilitation can improve functional capacity, symptoms, and quality of life, while structured follow-up may also facilitate treatment adjustment. We therefore evaluated whether exposure to a structured multimodal functional assessment pathway, embedded within a more intensive follow-up model, was associated with pharmacological optimization and functional change in chronic heart failure. Methods: We conducted a retrospective, single-center cohort study including adults with chronic heart failure with reduced or mildly reduced ejection fraction managed in a tertiary university clinic. Patients were classified according to documented exposure to an integrated pathway that combined standardized 6 min walk testing, heart rate dynamics, oxygen saturation response, perceived exertion, validated quality-of-life assessment, and prespecified interim reassessment, versus usual care. The integrated pathway involved more frequent clinical contact than usual care. The primary outcome was change in 6 min walk distance over 6 months. Secondary outcomes included changes in heart rate recovery, oxygen saturation nadir, Borg perceived exertion score, quality-of-life score, intensity of guideline-directed medical therapy, treatment intensification rates, and heart failure hospitalization. Results: The study included 250 patients with comparable baseline demographic and clinical characteristics. Patients managed within the structured pathway showed greater improvement in 6 min walk distance at 6 months than those receiving usual care, together with more pronounced improvement in secondary functional parameters and quality-of-life scores. Pharmacological optimization, reflected by higher uptake and intensification of guideline-directed medical therapy, also occurred more frequently in the structured pathway group. The integrated group, however, also had higher follow-up intensity, which limits causal interpretation of the observed between-group differences. Conclusions: In this real-world heart failure cohort, exposure to a structured care pathway combining repeated multimodal functional profiling with closer follow-up was associated with greater functional improvement and more intensive pharmacological optimization. These findings should be interpreted as pathway-level associations rather than proof that functional assessment alone drove benefit, and they require prospective validation. Full article

Background: Habitual physical activity (PhA) may contribute to overall physiological reserve, yet its relevance for lung transplantation (LTx) remains unclear, as existing studies almost exclusively explore short-term exercise interventions. This study evaluates whether life-course PhA before LTx influences postoperative outcomes: functional capacity measured by 6 min walk test (6MWT), chronic lung allograft dysfunction (CLAD), and length of hospital stay (LOS). Methods: In this retrospective study, ninety-seven LTx recipients completed the Historical Adulthood Physical Activity Questionnaire (HAPAQ), assessing PhA from age 20 to transplantation. All participants were assessed within the same time frame, with varying time intervals since transplantation. Patients were classified into no/recreational/intensive sport groups based on regular participation. Statistical analyses examined sport group differences in 6MWT, CLAD, and LOS and interactions with sex, pulmonary disease type, and secondary pulmonary hypertension (PH). Results: Lifelong PhA did not significantly differentiate quantitative 6MWT, CLAD, or LOS, and no interaction effects were observed. A modest trend was noted in patients without secondary PH, among whom intensive PhA corresponded to more frequent within-norm qualitative 6MWT results. Outcomes were comparable between single- and double-lung (DLTx) recipients, although a moderate effect between sports groups suggested a possible DLTx compensatory advantage. Conclusions: This study provides the very first life-course assessment of PhA in LTx recipients, highlighting the value of HAPAQ for estimating pre-transplant physiological reserve. Despite postoperative outcomes being largely independent of lifelong PhA, and recovery appearing multifactorial, habitual PhA should not be overlooked in developing individualized prehabilitation strategies in transplant medicine. Full article

Background/Objectives: Cirrhosis is associated with increased mortality. In this study, we aimed to investigate the prognostic relevance of 6-min-walk-distance- and cardiopulmonary exercise testing (CPET)-derived peak oxygen uptake (VO₂) as estimates of exercise capacity in outpatients with cirrhosis. Methods: Patients underwent a comprehensive clinical characterization including cardiopulmonary exercise testing, six-minute-walking-test-derived distance, and echocardiography. We stratified the cohort using established prognostic thresholds for the six-minute-walking-test-derived distance (440 m) and peak VO₂ (65% predicted) and Child–Pugh class (A vs. B/C). Competing risk analyses were performed using cumulative incidence functions and subdistribution hazard models to assess the impact of baseline variables on mortality, accounting for liver transplantation (LT) as a competing event and for age and sex. The prognostic value of exercise performance was analyzed first, followed by the stepwise inclusion of additional variables; multicollinearity precluded a full multivariable model. Results: We enrolled 197 patients in Child–Pugh Class A, B, and C (N = 92, N = 80, N = 25 patients; male N = 146, age: 56 ± 9 years). During the observation time of 85 (25–105) months, 48 patients underwent a liver transplant, and 88 died. Both the six-minute-walking-test-derived distance ≤ 440 m (p = 0.002, sHR: 0.996 95% CI: 0.993–0.998) and peak VO₂ ≤ 65% predicted (p = 0.023, sHR: 0.987 95% CI: 0.976–0.998) were strong independent predictors of mortality. While the six-minute-walking-test-derived distance consistently remained significant across most models, the peak VO₂ retained significance only when adjusted for creatinine. Combining exercise capacity and the Child–Pugh classification identified patients at a particularly high mortality risk. Conclusions: In patients with liver cirrhosis outside the liver transplant setting, the impaired six-minute-walking-test-derived distance and peak VO₂ serve as predictors of mortality and may help to identify patients at a particularly high mortality risk. These results suggest that functional capacity provides complementary information to established liver disease severity scores and could be considered in a multidimensional risk assessment approach in patients with liver cirrhosis. Full article

Background: Atrial fibrillation (AF) is a common arrythmia in post-myocardial infarction (MI) cardiac rehabilitation (CR) cohorts, and beta-adrenergic signaling remodeling and rate-control pharmacotherapy may influence functional capacity. Methods: We retrospectively studied 117 consecutive male post-MI patients referred to outpatient CR. Functional capacity was assessed with a 6 min walk test (6MWT). AF was identified from clinical records, and beta-blocker exposure was unified as carvedilol-equivalent daily dose. Results: Beta-blockers were used in 94.1% of patients and AF was present in 10.3%. Patients with AF were older (72.7 ± 6.6 vs 58.1 ± 9.3 years) and walked shorter distances (430.0 [375.0–497.5] vs. 540.0 [480.0–570.0] m). In the prespecified interaction model, age remained independently associated with lower 6MWT (−4.29 m/year; p < 0.001), AF was associated with lower 6MWT (−137.21 m; p = 0.01), and the beta-blocker dose × AF interaction was positive (+6.78; p = 0.02; R² = 0.44). Importantly, the beta-blocker dose was not associated with 6MWT in patients without AF, whereas a positive association was observed in AF (B = 7.55, p = 0.04). Conclusions: In this exploratory analysis, AF identified a subgroup with markedly reduced functional capacity in early post-MI CR, supporting the potential of phenotype-informed assessment. Additionally, the association between beta-blocker dose and 6MWT distance differed by rhythm status. These preliminary findings require confirmation in larger prospective cohorts. Full article

Background: The Cystic Fibrosis Foundation (CFF) recognizes exercise as a critical part of managing cystic fibrosis (CF). This becomes even more important in the era of highly effective modulator therapy (HEMT) due to many people with cystic fibrosis (pwCF) having decreased symptom burden and a newfound ability to tolerate exercise better. Our single-center pilot study was designed to assess the implementation of a remotely delivered, individualized, and comprehensive exercise program for pwCF. We aimed to determine the feasibility, safety and acceptance of this intervention. Methods: PwCF ≥ 18 years old were recruited and consented at the University of Alabama in Birmingham in 2022 and 2023. Basic fitness was assessed for each participant, and an individualized exercise prescription was prepared for each participant, who was expected to exercise three times weekly on a remote basis with the exercise physiologist for 12 consecutive weeks. Subjects were reassessed at 4 and 7 months for post-exercise evaluation. Patient demographics and clinical parameters, including exacerbation rate, FEV₁ percent predicted, 6-min walk test (6MWT), and modified shuttle test (MST) were collected. Questionnaire data from the CFQ-R, PRAISE, and IPAQ were also recorded. The study was registered with ClinicalTrials.gov (NCT04680403) and was submitted on 17 December 2020. Results: Our goal was to enroll 12 participants over the 2-year study period. We were able to recruit nine people for the study, with four participants finishing the program. From the 36 sessions offered over the 12-week program, participants completed an average of 15 sessions. Clinical outcome data was observed, including lung function and exacerbation frequency, but not statistically analyzed due to the small sample size. Conclusions: Implementation of an individualized telehealth-based exercise program for pwCF was well received by participants, safe, and appreciated by the participants. Recruitment and adherence were challenging, which was partially due to the ongoing pandemic. Follow-up studies are needed to assess whether improvements in reducing the amount or supervision of weekly exercise sessions and/or extending the total time might help with adherence. Full article

(1) Background: The local divergence exponent (LDE) is a sensitive measure of walking stability deterioration and risk of falling in older adults. We aim to determine the validity the LDE measured using a mobile phone and to assess its ability to discriminate between healthy young and older adults; (2) Methods: 20 older adults (76.4 ± 4.6 years) and 20 young adults (29.1 ± 6.5 yrs) walked for 6 min on a 20-m walkway while wearing a research-grade inertial measurement unit (IMU) and a mobile phone placed on the sternum to record 3D acceleration data. The LDE was calculated using data from both devices for 3D, vertical (VT), mediolateral (ML), anteroposterior (AP), and norm (N) accelerations. ICC (3,1) was used to determine the validity of the mobile phone’s LDE. Mann–Whitney U tests were used to determine age-group discriminability of LDE measures; (3) Results: LDEs demonstrated excellent absolute agreement between the wearable IMU and mobile phone (ICC = 0.844). Mobile phone-derived LDEs demonstrated excellent validity relative to the wearable IMU (ICC > 0.75). No significant age-related differences in LDE were observed; wearable or mobile sensors (both p > 0.05); (4) Conclusions: LDEs measures obtained with a mobile phone are valid. No age group differences were identified. Full article

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: Recent guidelines have emphasized the importance of early mobilization and rehabilitation of patients following cardiac surgery. However, studies on the optimal targets and prescription methods for phase I cardiac rehabilitation (CR) are lacking. This study aimed to evaluate the feasibility and utility of an early phase 1 submaximal cardiopulmonary exercise test (CPET) using a recumbent ergometer in patients who have undergone cardiac surgery. Methods: Twenty ambulatory patients who underwent cardiac surgery between December 2021 and February 2023 were referred to the CR department on the fifth postoperative day, and a CR program was initiated. The program was conducted five times a week, with hour-long sessions consisting of warm-up exercises, resistance training, aerobic exercises, and a cool-down period. A recumbent ergometer-based submaximal CPET was performed approximately nine days after the surgery, prior to discharge. Participants initiated the test at 0 W, and the workload was increased by 20 W after 2 min. During the test, researchers evaluated parameters including submaximal peak values of oxygen consumption (VO₂), metabolic equivalents of task, respiratory exchange ratio (RER), blood pressure, heart rate (HR), and rating of perceived exertion (RPE). The grip strength test, 6 min walk test (6MWT), Korean Activity Scale/Index (KASI), EuroQol-5 dimension (EQ-5D), and short-form 36-item health survey (SF-36) values were also measured prior to discharge. Results: Twenty patients (75% male, average age 62.50 ± 1.99 years) underwent CPET at a median of 9.0 (8.0; 12.5) days postoperative. The average exercise duration of the CPET was 411.75 ± 168.25 s. During the test, their submaximal peak VO₂ was 12.32 ± 0.75 mL/kg/min (corresponding to 46.65 ± 2.08% of VO₂ max). The submaximal peak RER was 1.01 (0.98–1.12), and the submaximal peak RPE was 15.00 ± 0.51. Furthermore, the submaximal peak HR was 111.8 ± 3.76 beats/min (equivalent to 70.95 ± 2.09% of age-predicted maximal HR). After adjustment for age and sex, statistically significant positive correlations were observed between the submaximal peak VO₂ and 6MWT, squat endurance test, KASI, EQ-5D, and the physical component summary (PCS) of the SF-36 questionnaire. The 6MWT, squat endurance test, KASI, and PCS of SF-36 showed a correlation coefficient (r) of 0.522 (p = 0.026), 0.628 (p = 0.005), 0.586 (p = 0.011), and 0.546 (p = 0.019), respectively. No significant cardiac events, such as ST elevation/depression or hemodynamic instability, were observed during the test. Conclusions: Our findings suggest that performing recumbent ergometer-based CPET during early phase 1 CR is safe and feasible. These results highlight the potential of recumbent ergometer-based CPET as a valuable tool for guiding the appropriate prescription of early CR programs following hospital discharge in patients undergoing cardiac surgery. Full article

Japan is a super-aged society where community group multicomponent exercise is widely implemented, yet the age at which a fixed, low-frequency exercise dose no longer offsets functional decline is unclear. We examined 6-year trainability and explored “zero-change” ages in frail older women. Twenty community-dwelling frail women (80–86 years) participated in a once-weekly 90 min multicomponent exercise program for 6 years. Nine physical tests were assessed at baseline (Pre), 6 months, and annually. Overall time effects were tested using repeated-measures ANOVA and generalized estimating equations, with planned paired t-tests versus Pre. Age-specific annual percent changes (%/year) from Pre to each follow-up were annualized, grouped by age at follow-up (81–91 years), and tested against 0%/year. Separately, regression analyses related age to annual percent change across seven consecutive intervals to estimate “zero-change age” (predicted change = 0%). Time effects were significant for all nine measures (all p ≤ 0.032). Chair stand, 10 m fast/zigzag walk, supine-to-stand, maximal 5-step length, and 10-times knee lift generally improved in the early follow-up, whereas handgrip strength and sit-and-reach declined over time. In 6/9 tests, annual percent change diminished with advancing age; estimated zero-change ages ranged from ≈82 years (maximal 5-step length) to ≈88 years (chair stand and one-leg stance). Attendance remained high (≈90%). In this single-arm community program, several mobility-related functions improved or were maintained in frail women in their early 80s, whereas reduced trainability beyond the mid-80s may limit further protection. Threshold ages are exploratory statistical estimates; controlled trials are warranted. Full article

Background/Objectives: Youths with cerebral palsy (CP) have reduced levels of physical activity (PA) due to motor impairments and functional difficulties. Few studies have observed its link with various factors and none in young adults with CP. This study aimed to investigate the relationships between PA and various factors in young adults with CP, such as gait function, endurance, participation, and personal/environmental influences. Methods: Participants over 15 years old with CP who underwent Clinical Gait Analysis (CGA), the 6 min walk test, and wore an actimeter (ActiGraph GT3X+) for seven days were included. PA was assessed by daily step count (NbSteps/day). Explanatory factors included the Gait Profile Score (GPS), walking speed, subjective walking perception, joint pain, fatigue, 6 min walk distance, SF-36 questionnaire scores, and lifestyle habits. Correlations, univariate, and multivariate regression models were used for the analysis. Results: Forty-seven CP patients (28 males, 19 females, mean age 23.6 years) were included, with 82% classified as GMFCS I and 18% as GMFCS II. The average NbSteps/day was 5685. Significant correlations were found between NbSteps/day and subjective perception, pain, GMFCS level, and walking speed. Multivariate regression identified walking speed and physiotherapy (PT) sessions as significant predictors of PA. Conclusions: PA in young adults with CP is linked to walking speed, GMFCS level, joint pain, fatigue, and PT. No differences have been observed between patient unilateral or bilateral CP. However, individual behaviors vary and are not fully explained by linear regression analysis. 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