Search Results (1,906)

The relationship between exercise and immune function has been widely studied, yet findings remain inconsistent regarding how different exercise modalities and intensities influence acute and chronic immunological responses. Previous reviews have often focused on single exercise types or limited outcomes, leaving a gap for an integrated synthesis. This narrative review aims to address this gap by summarizing and comparing immunological effects across aerobic exercise, resistance training, high-intensity interval training (HIIT), blood flow restriction (BFR), isometric exercise, mind–body interventions, and hypoxic training. A structured narrative approach was adopted. Literature published between January 2000 and December 2024 was searched in PubMed, Scopus, and Web of Science. Experimental and observational studies on humans and animal models were included, with study selection and data extraction performed by two reviewers. Findings were synthesized thematically by exercise modality to capture both acute and chronic immune responses. Twenty-four eligible studies were identified. Aerobic and mind–body exercises consistently demonstrated anti-inflammatory and immunoprotective effects, including increased IL-10 production, improved T cell profiles, and reduced inflammatory markers. Isometric training showed favorable modulation of cytokines and T cell balance, while resistance training evidence was limited but suggested cortisol-lowering benefits. HIIT, BFR, and hypoxic exercise produced mixed results, often combining transient pro-inflammatory responses with immunological benefits. Acute and chronic immunological responses to exercise are highly modality- and intensity-dependent. Aerobic and mind–body interventions provide the most consistent benefits, whereas HIIT, BFR, and hypoxic training show variable effects. Further high-quality trials are needed to clarify mechanisms and guide exercise-based immune recommendations. Full article

Background/Aim of Study: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality globally. Cardiac rehabilitation (CR) plays a pivotal role in the recovery of post-acute myocardial infarction (AMI) patients. Despite evidence supporting its clinical benefits, CR remains underutilized, especially in middle-income countries like Kazakhstan. This study aimed to evaluate the clinical effectiveness and economic impact of phase II CR among patients with AMI treated at the Almaty City Cardiology Center between 2018 and 2022. Methods: A retrospective cohort study was conducted using data from 2672 AMI patients. Two cohorts were compared: those who participated in phase II CR and those who did not. Primary outcomes included changes in left ventricular ejection fraction (LVEF), rehospitalization rates, and return to active work. Results: Economic outcomes involved direct medical costs related to initial hospitalization and follow-up care. CR participants showed significant improvements in LVEF (53.7% vs. 49.0% in non-CR patients, p < 0.001). Despite these clinical benefits, there was no significant reduction in long-term treatment costs between the CR and non-CR groups. CR users had slightly higher initial treatment costs but similar cumulative costs for subsequent treatments over two years. Importantly, government funding limitations were found to hinder the full effectiveness of CR programs in Kazakhstan. Conclusions: Phase II CR improves cardiac function in AMI patients but does not reduce long-term treatment costs. The current insufficient government funding for CR limits its broader impact. Expanding CR services and increasing funding are essential to maximize its benefits within Kazakhstan’s healthcare system. Full article

Background: A comprehensive rehabilitation program is recommended following anterior cruciate ligament reconstruction (ACLR) to restore function, strength and lower limb stability. Despite advancements in surgical techniques, high reinjury rates highlight the need to refine rehabilitation strategies. This study investigates performance across various physically demanding tasks and compares outcomes between the injured and uninjured leg, using a modified Back in Action (BIA) test battery. It is hypothesized that due to test learning effects patients exhibit faster improvement in coordinatively demanding tasks compared to strength-related tasks. Methods: Thirty-two patients (aged 18–40) following primary unilateral ACLR participated in a prospective cross-sectional study within the context of a larger trial. Participants completed a modified BIA test battery, including stability, countermovement jump (CMJ), drop landing, speedy jumps, and quick-feet test (QFT). Each test was conducted in three sets, with three immediate repetitions. Self-reported outcomes were also collected. Results: Patients showed significant within-session improvements in coordinative tasks, with 32% in the injured and 26% in the uninjured limb during the speedy jumps [p < 0.05]. No significant learning effects were observed in strength-related tasks (drop landing, stability test, CMJ). Patients with lower baseline performance exhibited greater improvement than patients with higher performance level from baseline. Furthermore, a correlation between self-assessed abilities and actual performance was identified. Conclusions: This study showed that improvement of coordinative tasks after Return to Sport (RTS) testing of ACLR patients are rather affected by test learning effects. In contrast, this phenomenon is not seen in strength-related tasks. Rehabilitation programs should integrate both types of exercises while considering individual baseline abilities. Tailoring rehabilitation to individual needs, establishing sport-specific rehabilitation programs and incorporating self-assessment tools can enhance patient-centered care and reduce reinjury risks. Full article

Background: Diastasis recti abdominis (DRA) is a common postpartum condition typically managed with rehabilitation exercises. Given its high prevalence and postpartum barriers in attending in-person sessions, telerehabilitation may offer a feasible alternative. This small pilot study evaluates the preliminary effectiveness and user satisfaction of a 12-week telerehabilitation exercise program for women with postpartum DRA. Methods: Parous women with DRA participated in a 12-week trunk stabilization program, including synchronous and asynchronous sessions, from April 2024 to May 2025. The primary outcome was satisfaction (Telehealth Usability Questionnaire—TUQ_Greek and two additional custom-made questions). Secondary outcomes included inter-recti distance (IRD), trunk muscle endurance tests, body image (BISS_Greek), and adherence to exercise. Results: Thirteen participants aged 37.54 ± 5.49 completed the pilot intervention. Satisfaction was high (TUQ_Greek = 6.28 ± 0.60), with 84.62% (11/13 subjects) rating telerehabilitation as very satisfactory. Statistically significant reductions in IRD were observed at 2 cm (large effect, d = 1.00; 95% CI [0.12 to 0.47]) and 5 cm (large effect, d = 0.81; 95% CI [0.08 to 0.58]) above the umbilicus (p < 0.05). Post-intervention, most trunk muscle endurance tests improved significantly (p < 0.05) at 4 and 12 weeks (large effect, η² = 0.44 to–0.56). Body image (BISS_Greek) also improved post-intervention (p < 0.05, medium to large effect, d = −0.73; 95% CI [(–1.75 to –0.16]). Mean adherence reached 71.37%. Conclusions: This small pilot supports the feasibility and acceptability of a telerehabilitation program as well as its effectiveness in improving key clinical outcomes. However, since this was a small pilot, generalizability might be limited by the small sample size and should be confirmed in larger studies. Full article

Background/Objectives: This study presents Co.Ge. a Cognitive Generative digital platform for cognitive testing. We describe its architecture and report a pilot study. Methods: Co.Ge. is modular and web-based (Laravel-PHP, MySQL). It can be used to administer a variety of validated cognitive tests, facilitating administration and scoring while capturing Reaction Times (RTs), trial-level responses, audio, and other data. Co.Ge. includes a study-management dashboard, Application Programming Interfaces (APIs) for external integration, encryption, and customizable options. In this demonstrative pilot study, clinical and non-clinical participants completed an Auditory Verbal Learning Test (AVLT), which we analyzed using accuracy, number of recalled words, and reaction times as outcomes. We collected ratings of user experience with a standardized rating scale. Analyses included Frequentist and Bayesian Generalized Linear Mixed Models (GLMMs). Results: Mean ratings of user experience were all above 4/5, indicating high acceptability (n = 30). Pilot data from AVLT (n = 123, 60% clinical, 40% healthy) showed that Co.Ge. seamlessly provides standardized clinical ratings, accuracy, and RTs. Analyzing RTs with Bayesian GLMMs and Gamma distribution provided the best fit to data (Leave-One-Out Cross-Validation) and allowed to detect additional associations (e.g., education) otherwise unrecognized using simpler analyses. Conclusions: The prototype of Co.Ge. is technically robust and clinically precise, enabling the extraction of high-resolution behavioral data. Co.Ge. provides traditional clinical-oriented cognitive outcomes but also promotes complex generative models to explore individualized mechanisms of cognition. Thus, it will promote personalized profiling and digital phenotyping for precision psychiatry and rehabilitation. Full article

Multiple-hops performed horizontally in series effectively assess return-to-play readiness, as they mimic the propulsive and decelerative demands of sports. Movement strategy variables (kinetic variables) offer more insight into injury recovery than outcome-based measures (kinematic variables) like hop distance alone. This study focused on kinematic and kinetic variables to assess asymmetries during triple-hop (3-Hop) and quintuple-hop (5-Hop) tests with 44 male athletes from university sports clubs and teams. The aim was to determine the magnitude and potential direction of asymmetry and compare the sensitivity of kinematic and kinetic variables. Results showed mean kinematic asymmetries below 7.1% (range: 0.00 to 28.9%), while average kinetic asymmetries were as high as 38.8% (range: 0.0% to 95.4%). These findings suggest that kinetic variables are more sensitive in assessing movement strategy, providing more detailed insight into rehabilitation and return-to-play decisions. The study emphasizes the importance of considering both outcome and movement strategy variables in injury recovery. These results have practical applications for clinicians and coaches supporting those in return-to-play scenarios, as well as those addressing performance deficits, therefore offering valuable information to refine exercise prescriptions and athletic program design. Full article

Background: Return to work (RTW) is a fundamental aspect of recovery after stroke, importantly, for workers of working age. Evidence indicates there is little known about the clinical and systematic predictors of RTW in Hungary. We aimed to determine the independent predictors of RTW for stroke survivors using aggregate hospital data and expert opinion. Methods: A mixed-method study using aggregated national level administrative data from the Pulvita platform (the National Health Insurance Fund of Hungary) and expert interpretation from the physicians who treat stroke survivors. The data analyzed 13,572 inpatient records for stroke hospitalizations from 2015–2024 across Hungarian counties. Results: Stroke severity, cognitive and psychological recovery, and presence of comorbidities were important clinical predictors of RTW. Rehabilitation intensity was greater for people aged 51–65 years, and work-age men appeared to have slightly better access to rehabilitation compared to work-aged women. Patients accessed more medical rehabilitation services than they did occupational or psychosocial services. Access to rehabilitation services may have varied geographically, with patients in counties such as Budapest and Pest having better access due to higher provider availability and cross-county patient movement. In addition, economic extrapolations from the literature on post-stroke care costs may have introduced bias in estimating annual social productivity losses, reported as EUR 19,953 per patient. Conclusions: Clinical and economic factors both impact RTW potential among stroke survivors in Hungary. Although rehabilitation intensity can indicate likelihood of RTW, the lack of a national RTW program acts as a significant barrier to RTW for stroke survivors. This study suggests a need for integrated rehabilitation and RTW systems, with associated future research linking clinical, economic, and labor market status data to develop effective and efficient policy for stroke survivors. Full article

Background and Objectives: Osteoarthritis (OA) is a chronic, degenerative joint disease. The main symptoms include pain that can cause loss of function and stiffness, as well as swelling, reduced range of motion, crepitus, joint deformity, and muscle weakness. It leads to irreversible structural changes, that in advanced stages can require surgical interventions. The aim of this review was to summarize the current literature about the role of virtual reality (VR), exergames and digital technologies in patients with knee osteoarthritis before or after total knee arthroplasty, to understand if it is possible to prevent and reduce the symptoms and if these new technologies are more effective than conventional rehabilitation therapies. Materials and Methods: We conducted a systematic search of PubMed, Cochrane Library, Scopus, and PEDro from inception to November 2024. The review adhered to the PRISMA 2020 guidelines, and the protocol was prospectively registered in PROSPERO (registration number: CRD42024541890). We included randomized controlled trials (RCTs) enrolling participants aged 60 years or older, in which VR or telerehabilitation programs were compared with conventional rehabilitation approaches. Eligible studies had to report at least one of the following outcomes: pain, functionality, stability, or adherence. Two independent reviewers screened titles and abstracts, assessed full-text eligibility, extracted data, and evaluated the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Fourteen randomized controlled trails (RCTs) (1123 participants; mean age 68.2 years) were included. VR and telerehabilitation generally outperformed conventional rehabilitation for pain (8/13 studies, −0.9 to −2.3 VAS points) and functionality (7/13 studies, WOMAC improvement 8–15%, TUG −1.2 to −2.8 s). Compliance was higher in most technology-assisted programs (6/7 studies, 70–100% adherence). Stability outcomes were less consistent, with only 1/4 studies showing clear benefit. One study favored conventional rehabilitation for functionality. Overall risk of bias was low-to-moderate, with heterogeneity mainly driven by intervention duration, platform type, and supervision level. Conclusions: Structured telerehabilitation, non-immersive VR, and interactive online exercise programs, especially those offering real-time feedback, show comparable or superior benefits to conventional rehabilitation in older adults with knee OA or after TKA, particularly for pain reduction, functional gains, and adherence. These approaches enhance accessibility and home-based care, supporting their integration into clinical practice when in-person therapy is limited. Full article

Background: Current guidelines endorse the integration of exercise into cancer care. The diagnosis of cancer and its treatment, however, may introduce factors that make exercise engagement difficult, especially for individuals with advanced stages of disease. In this paper, we describe the baseline screening and triage process implemented for the Alberta Cancer Exercise (ACE) hybrid effectiveness-implementation study and share findings that highlight the multifaceted complexity of the process and the direct role of the clinical exercise physiologist (CEP). Methods: ACE was a hybrid effectiveness-implementation study examining the benefit of 12-week cancer-specific community-based exercise program. The ACE screening process was developed by integrating evidence-based guidelines with oncology rehabilitation expertise to ensure safe and standardized participation across cancer populations. The screening process involved four steps: (1) a pre-screen for high-risk cancers, (2) completion of a cancer-specific intake form and the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), (3) a CEP-led interview to further evaluate cancer status, cancer-related symptoms and other health issues (performed in-person or by phone), and (4) a baseline fitness assessment that included measurement of vital signs. Results: A total of 2596 individuals registered and underwent prescreening for ACE with 2570 (86.6%) consenting to participate. After full screening including the baseline fitness testing, 209 participants (8.1%) were identified as requiring further medical clearance. Of these, 191 (91.4%) had either a high-risk cancer, metastatic disease or were in the palliative end-stage of cancer, and 161 (84.3%) reported cancer-related symptoms potentially affecting their ability to exercise. In total, 806 (31.4%) participants were triaged to CEP-supervised in-person programming, 1754 (68.2%) participants to ACE community programming, and 8 (0.3%) specifically to virtual programming (post-COVID-19 option). Conclusions: The findings highlight the complexity and challenges of the screening and triage process, and the value of a highly trained CEP-led iterative approach that included the application of clinical reasoning. Full article

Acute transverse myelitis (ATM) is a rare, immune-mediated disorder of the spinal cord characterized by sensory, motor, and autonomic dysfunction. Although the human papillomavirus (HPV) vaccine is widely regarded as safe, isolated reports have suggested a potential temporal association with autoimmune neurological events, including ATM. We present a case of a 21-year-old woman who developed ATM two weeks following administration of the first dose of the HPV vaccine (Cervarix). The clinical presentation included rapid-onset paraparesis, sensory deficits, and sphincter dysfunction. An MRI revealed a T2-hyperintense lesion at the Th10–Th12 level. A cerebrospinal fluid analysis showed elevated protein levels. The patient underwent corticosteroid therapy, plasmapheresis, and IVIG, followed by a comprehensive, individualized rehabilitation program. This included balance and stability training, Redcord-based neuromuscular activation, electrostimulation, and pelvic floor therapy. Although no causal link between HPV vaccination and ATM has been established, this case emphasizes the importance of considering post-vaccinal autoimmune phenomena. More importantly, it illustrates the critical role of early, targeted rehabilitation—particularly pelvic floor re-education and neuromodulation—in improving outcomes in patients with significant motor and autonomic deficits. Full article

The effectiveness of breathing interventions on postural alignment, pain reduction, and functional improvement in patients with forward head posture (FHP) and chronic neck pain remains uncertain. Previously conducted randomized controlled trials (RCTs) that involved breathing interventions were identified through searches of the PubMed, Cochrane Library, Web of Science, and Scopus databases. Studies were included if they applied diaphragmatic breathing, breathing muscle training, or feedback breathing exercises for at least 2 weeks to chronic neck pain (duration ≥ 3 months) and/or forward head posture. The craniovertebral angle (CVA), the visual analog scale (VAS), and the neck disability index (NDI) were the primary outcome measures. The results showed that breathing interventions had a moderate effect size in terms of improving the CVA. Limited effects were observed for pain reduction, and improvements in neck disability approached statistical significance. However, despite these positive findings, the overall evidence was rated as ‘very low certainty’ in the GRADE assessment, primarily due to high heterogeneity among studies, limited sample sizes, and the potential for unit-of-analysis errors in diagnosis-based subgroup analyses. Consequently, their overall effectiveness in chronic neck pain was limited. Future research is needed to explore a multidisciplinary approach to neck pain using standardized protocols and larger samples. Full article

Objective: Head-to-head evidence comparing closed-kinetic-chain (CKC) and open-kinetic-chain (OKC) training on balance in middle-aged women with knee osteoarthritis (KOA) is limited. Purpose: To compare 10-week hip abduction/external rotation-focused CKC versus OKC on static and dynamic balance. Methods: Twenty-two women with KOA were randomized to CKC (n = 11) or OKC (n = 11) and trained twice weekly for 10 weeks. The primary outcome was the center of pressure (COP) during single-leg stance (AP/ML range, excursion, velocity, and RMS); the secondary outcome was the Y-Balance Test (YBT) composite score. Results: CKC produced significant within-group reductions across all COP variables and significant YBT increases for both affected and unaffected limbs (p < 0.05). OKC showed only small changes in select COP indices and no meaningful change in YBT. Post-intervention between-group comparisons consistently favored CKC for AP/ML and total COP excursion/velocity and for the YBT composite score (p < 0.05). Conclusions: Under weight-bearing conditions, a hip-focused CKC program that promotes multi-joint coordination and co-contraction yields broader and more consistent improvements in postural stability and dynamic balance than OKC in middle-aged women with KOA. These findings support prioritizing CKC when rehabilitation aims include gait and functional stability. Full article

Background: Minimally invasive direct coronary artery bypass (MIDCAB) surgery offers advantages over off-pump coronary artery bypass (OPCAB), including reduced trauma and faster recovery. However, differences in perioperative cardiac rehabilitation (CR) outcomes between MIDCAB and OPCAB remain unclear. This study compared perioperative clinical characteristics, surgical features, and CR outcomes in patients undergoing MIDCAB versus OPCAB. Methods: This retrospective cohort analysis included 304 patients (31.2% MIDCAB, 68.8% OPCAB) who participated in a CR program, including the 6-min walk test (6MWT), from November 2023 to December 2024. Results: MIDCAB patients had shorter surgery times, fewer grafted vessels, shorter ventilator-assisted time, less total intraoperative fluid, less bleeding, and shorter postoperative hospital stays (all p < 0.05). After cardiac rehabilitation, MIDCAB patients showed shorter time to 6MWT, longer six-minute walk distance (6MWD) (200 ± 125 vs. 178 ± 125 m), higher 6MWD relative to predicted values, and greater metabolic equivalents (all p < 0.05). The median LVEF of MIDCAB patients was the same as that of OPCAB patients (p < 0.05). Conclusions: Our study demonstrates that MIDCAB patients exhibit superior exercise capacity following cardiac rehabilitation. Full article

Background/Objectives: Balance, postural control, and functional independence are essential components for the autonomy of people with neurological conditions. Robotic technologies such as the Lokomat^® have emerged as promising tools in rehabilitation, but their effectiveness when integrated into functional programs requires further evidence. The objective of this study was to evaluate the impact of an intensive robotic intervention on these three functional variables. Methods: A single-group, quasi-experimental pretest–posttest study was conducted with 136 participants who received a robotic rehabilitation intervention using the Lokomat^® device, and focused on functional tasks over several weeks. Balance (using the Berg scale), postural control (using the PASS), and functional independence (using the Barthel index) were assessed, comparing pre- and post-intervention results using parametric and non-parametric tests. Results: The results showed statistically significant improvements in all three variables after the intervention. The mean Berg score increased from 11.76 to 21.91 points (p < 0.001), postural control increased from 15.53 to 21.90 points (p < 0.001), and the Barthel index increased from 24.71 to 41.76 points (p < 0.001). In all cases, the effect sizes were large (d > 0.90). Conclusions: A rehabilitation program including intensive, task-oriented Lokomat^® training was associated with improvements in balance, postural control, and functional independence. Given the single-group design without a control arm, these findings reflect associations and do not establish causality. Full article

Background: Soft tissue sarcomas (STSs) are rare and heterogeneous malignancies requiring a multidisciplinary approach to diagnosis and treatment. Advances in surgical techniques, chemotherapy, and radiotherapy have improved survival rates but often result in significant functional impairments, particularly in patients undergoing limb-sparing procedures. Rehabilitation is crucial for restoring mobility and independence, with recent studies emphasizing the importance of personalized rehabilitation protocols tailored to specific surgical interventions. Quantitative assessments, such as 3D motion capture and surface electromyography, provide objective insights into gait performance and motor function, enabling more precise rehabilitation strategies to optimize recovery. Methods: This study evaluated gait performance in 21 patients with lower-limb impairment following limb-sparing surgery for STS. Patients underwent two instrumented gait assessments using marker-based 3D motion capture and surface electromyography to measure spatiotemporal gait parameters, joint kinematics, and muscle activity. Independence in the activity of daily living was assessed with the modified Barthel Index in both timepoints. Results: Following rehabilitation, patients demonstrated significant improvements in functional independence, as reflected by an increase in the modified Barthel Index (p < 0.001). Gait analysis revealed increased walking speed, stride length, cadence, and improved joint range of motion at the hip, knee, and ankle, though electromyographic analysis showed no statistically significant differences in muscle activation patterns or co-contraction indices. Conclusions: These findings underscore the importance of a rehabilitation programs personalized on gait strategies. A deeper understanding of motor adaptations based on sarcoma location and surgical approach could further refine rehabilitation protocols, ultimately enhancing patient outcomes and quality of life. Full article