Weeks Of Intervention Research Articles

EVALUATING THE EFFICACY OF MUSCLE STIMULATION IN THE MANAGEMENT OF DEGENERATIVE-DYSTROPHIC CHANGES IN THE CERVICAL SPINE

Degenerative-dystrophic changes in the cervical spine are a common cause of chronic pain and functional impairment, affecting millions of individuals globally. These conditions often result in reduced mobility, muscle atrophy, and declining quality of life. In recent years, muscle stimulation has emerged as a promising adjunctive therapy to improve muscle function and alleviate symptoms. This study evaluates the effectiveness of muscle stimulator application during treating patients with dystrophic-degenerative changes in the cervical spine. A cohort of 10 patients, aged 40-50, diagnosed with cervical degenerative conditions, participated in this randomized controlled trial. Participants were divided into two groups: one receiving conventional physical therapy alone and the other receiving combined therapy using a muscle stimulator targeting the cervical musculature. Over a 12-week intervention period, both groups were assessed using the Visual Analog Scale (VAS) for pain, the Neck Disability Index (NDI), and electromyography (EMG) to measure muscle activity. These findings suggest that muscle stimulator application is a valuable adjunct to conventional therapies, offering a non-invasive and effective means of managing dystrophic-degenerative changes in the cervical spine. Future research should explore the long-term benefits of this intervention and its potential to prevent the progression of cervical spine degeneration.

Effects of Standard Tai Chi on Exercise Capacity and Mental Health in Exercise-Deprived Overweight/Obese Adults and Assessment of Participant Adherence.

To explore the effects of Tai Chi on body mass index (BMI), exercise capacity, and mental health of overweight/obese adults, and investigate factors influencing adherence to enhance adherence of Tai Chi as a sustainable exercise method. A randomized, controlled, exploratory clinical trial was conducted paired with a qualitative study of adherence management. A total of 20 overweight/obese participants were randomly assigned to a standard Tai Chi group (experimental) and a simplified Tai Chi group (control) for an 8-week intervention, 10 patients in each group, with a 12-month follow-up. BMI was calculated and exercise capacity including an isokinetic muscle strength and balance ability test were evaluated. Mental health was assessed using the General Well-Being Schedule (GWB), Pittsburgh Sleep Quality Index (PSQI), and Coping Self Efficacy Scale (CSES) at baseline, 4th week, and 8th week, respectively. The qualitative research included open-interviews with Tai Chi practitioners and semi-structured interviews with subjects. The intervention was conducted in Haidian Park, Beijing, China from October 6, 2022, to January 1, 2023, without dropouts. After an 8-week intervention, the participants in the experimental group exhibited a significant decrease in BMI (P<0.05). Both groups demonstrated significant improvements in exercise capacity (P<0.05). The experimental group exhibited a significant enhancement in the GWB, PSQI and CSES (P<0.05). Only GWB had significant difference in the control group (P<0.05). The experimental group surpassed the control group in GWB and CSES (P<0.05). The adherence rate was 87.5% in the experimental group and 57.9% in the control group after 8 weeks intervention. Analysis on adherence identified 15 themes, the top 3 themes mentioned were as follows: mind-body effects, online and on-site guidance, training schedule (for subjects); mind-body effects, difficulties in practicing, and understanding of Tai Chi (for practitioners). Both interventions were effective in improving exercise capacity. Tai Chi, integrating both physical and mental conditioning, reduced weight, improved exercise capacity and mental happiness, and increased adherence, providing a sustainable exercise program (ChiCTR2200063599).

Peak Flow Feedback Intervention Improves Under-Perception of Airflow Limitation in Pediatric Asthma: A Randomized Clinical Trial.

Under-perception of asthma symptoms is associated with poor asthma outcomes. We assessed the effects of a behavioral intervention for improving perception of airflow limitation and asthma outcomes. A two-arm randomized controlled trial compared peak expiratory flow (PEF) feedback versus supportive counseling. Latino and Black adolescents with asthma ages 10-17 years old and caregivers were recruited from hospitals in the Bronx, NY. PEF feedback sessions reviewed accuracy of PEF guesses and medication adherence data, and targeted behavior change using motivational interviewing and problem-solving skills training. Supportive counseling received emotional support related to asthma. Both groups received 3 sessions across 6 weeks. All participants were blinded to PEF while guessing PEF during pre-intervention, 1, 6, and 12-month follow-up. Children in PEF feedback saw actual PEF after guesses were locked in during the 6-week intervention. Participants and assessors were blinded to group assignment. The primary outcome was under-perception of airflow limitation (divergence between actual PEF and guesses) on home spirometers. Secondary outcomes included daily PEF and forced expiratory volume in 1 second (FEV1), inhaled corticosteroid adherence measured by electronic monitors, Asthma Control Test, and emergency healthcare use for asthma. The sample comprised 354 children (M = 13.2±2.2 years; 62% Latino, 38% Black) and caregivers. PEF feedback (N = 153 analyzed) demonstrated greater improvements at 1-month follow-up on under-perception of airflow limitation (difference-in-differences, -12.64; 95% CI, -17.54 to -7.74), % personal best PEF (9.89; 95% CI, 7.13 to 12.65), % predicted FEV1 (4.93; 95% CI, 0.95 to 8.90) and ICS adherence (16.02; 95% CI, 7.15 to 24.89) compared with supportive counseling (N = 152 analyzed). At 12-month follow-up PEF feedback maintained improvements on under-perception of airflow limitation (-13.87; 95% CI, -19.03 to -8.71), higher PEF (14.23; 95% CI, 11.37 to 17.08) and %FEV1 (5.62; 95% CI, 1.56 to 9.67), and had smaller declines in ICS adherence (17.51; 95% CI, 7.12 to 27.89) versus pre-intervention than supportive counseling. No between-group differences existed for asthma control or healthcare use. The efficacy and sustainability of PEF feedback was established in improving children's perception of airflow limitation, pulmonary function, and medication adherence. Clinical trial registration available at www. gov, ID: NCT02702687.

Healthy Dietary Pattern Cycling Affects Gut Microbiota and Cardiovascular Disease Risk Factors: Results from a Randomized Controlled Feeding Trial with Young, Healthy Adults.

Previous research demonstrates that adopting, abandoning, and re-adopting (i.e., cycling) a healthy dietary pattern (HDP) improved, reverted, and re-improved cardiovascular disease (CVD) risk factors. In addition, changes in CVD risk factors are associated with dietary modifications of gut microbiota. We sought to assess the effects of cycling an HDP on gut microbiota and CVD risk factors. Retrospectively, we used data from a randomized controlled, crossover trial with three 3-week controlled dietary interventions, each separated by a 5-week period of participant-chosen, uncontrolled food intake. Seventeen participants (10 males, 7 females, age 26 ± 4 years old, BMI 23 ± 3 kg/m2) all consumed intervention diets that followed healthy U.S.-style dietary patterns. Gut microbiota composition and cardiovascular risk factors were measured before and after each HDP. Repeatedly adopting and abandoning an HDP led to a cycling pattern of changes in the gut microbial community and taxonomic composition. During the HDP cycles, relative abundances of several bacterial taxa (e.g., Collinsella, Mediterraneibacter, Romboutsia, and Dorea) decreased and returned to baseline repeatedly. Similar HDP cycling occurred for multiple CVD risk factors (i.e., serum total cholesterol and LDL-C concentrations). Consistent negative associations were observed between changes in Mediterraneibacter or Collinsella and serum total cholesterol/HDL-C ratio. These results support previous findings that HDP cycling affected multiple CVD risk factors and expand the HDP cycling phenomenon to include several bacterial taxa. Young adults are encouraged to adopt and sustain a healthy dietary pattern to improve cardiovascular health, potentially through modifying gut microbiota composition.

High-intensity interval swimming improves cardiovascular endurance, while aquatic resistance training enhances muscular strength in older adults

The aim of this study was to examine the effects of free swimming (FS), aquatic resistance training (ART), and their combination (FS&ART) on the body composition, blood pressure, and physical fitness of older adults. The study employed a randomized controlled design, comparing three experimental groups with a control group. Eighty volunteers aged between sixty and seventy years (age: 66.2 ± 2.3 years; body mass index: 25.8 ± 4.3 kg/m²) participated in the 16-week intervention, consisting of two weekly sessions. Assessments were conducted at baseline and post-intervention, including anthropometric measurements, blood pressure readings, and the Senior Fitness Test. Significant differences were found between groups in post-intervention considering the chair stand test (p = 0.017; ES = 0.125), arm curl test (p = 0.029; ES = 0.111), 8-foot up and go test (p = 0.042; ES = 0.102), and walk test − 6 min (p = 0.005; ES = 0.156). Specifically, both ART (+ 20.1%; p < 0.05) and FS&ART (+ 19.5%; p < 0.05) showed significantly greater improvements in the chair stand test compared to the control group. Similarly, ART (+ 23.1%; p < 0.05) and FS&ART (+ 18.7%; p < 0.05) performed better than the control group. FS&ART also exhibited a significant improvement over the control group in the 8-foot up-and-go test (+ 14.6%; p < 0.05). In the 6-minute walk test, FS (+ 19.4%; p < 0.05) and FS&ART (+ 15.9%; p < 0.05) both significantly outperformed the control group. This study found that FS improves cardiovascular endurance, while ART enhances muscular strength and endurance in older adults, with combined benefits for agility, suggesting integration of combined modalities into community wellness initiatives for enhanced physical fitness and health outcomes.

Efficacy of a combined exercise and nutrition intervention study for outpatients with possible sarcopenia in community-based primary care clinics (ENdSarC): study protocol for a multicenter single-blinded randomized controlled trial

BackgroundSarcopenia is a geriatric disease characterized by loss of muscle mass and strength. Although combined exercise and nutrition intervention are known to be effective for sarcopenia, clinical trials involving outpatients with sarcopenia in primary care are scarce. We describe a protocol for a trial to examine the effects of a 12-week combined exercise and nutrition intervention in Korean older adults with possible sarcopenia in community-based primary care.MethodsThis multicenter, randomized, controlled trial will include 94 community-dwelling older outpatients aged 65–85 years with possible sarcopenia (47 participants in the intervention and control groups each). Resistance exercises, which incorporate concentric and eccentric exercises, will consist of an introductory phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; contraction exercises), an expanded phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; eccentric exercises), and a maintenance phase (6 weeks: once-weekly supervised exercise sessions and twice-weekly home exercises; power/eccentric exercises). Nutritional supplementation will be provided according to the nutritional status of the participants using a Mini-Nutritional Assessment. Participants will be assessed at baseline, 12 and 24 weeks, and the primary outcome will be the 5-times chair stand test results.DiscussionTo the best of our knowledge, this will be the first clinical trial to evaluate the efficacy of a combined exercise and nutritional supplementation intervention in older outpatients with possible sarcopenia in community-based primary care clinics. These findings will provide new insights to clinicians regarding the long-term usability for doctors and outpatients with possible sarcopenia in community-based primary care.Trial registrationThis trial was prospectively registered at ClinicalTrials.gov on September 16, 2023 (registration number: NCT06049914).

Effectiveness of a theory-underpinning exercise intervention among community-dwelling (pre)frail older adults: A stepped-wedge cluster-randomized trial

ObjectivesTo evaluate the effectiveness of a theory-underpinning exercise intervention among Chinese community-dwelling (pre)frail older adults, and the impacts of intervening late as opposed to intervening early. MethodsThis was a stepped-wedge cluster-randomized trial. Participants were enrolled from six communities in a county of central China from January to November in 2021 (n = 149). A 12-week exercise intervention based on the integration of Health Belief Model, Theory of Planned Behavior and Health Action Process Approach was implemented among 149 community-dwelling (pre)frail older adults during the study period. The primary outcomes were frailty and muscle mass, muscle strength and physical performance. Secondary outcomes included physical disability, fear of falling, cognitive function, depressive symptoms, social support and quality of life. Assessments were conducted at baseline and at 12, 24 and 36 weeks. A multilevel regression model was used for statistical analysis. ResultsThe positive effects were statistically significant on frailty (β = −1.166, p = 0.016), muscle mass (β = 1.499, p = 0.005), handgrip strength (β = 14.758, p < 0.001), physical performance (Short Physical Performance Battery, β = 6.043, p < 0.001), physical disability (Activities of Daily Living: β = 0.462, p = 0.043; Instrumental Activities of Daily Living: β = 0.693, p = 0.049;) and fear of falling (β = −1.490, p = 0.003), cognitive function (β = −0.466, p = 0.011), depressive symptoms (β = −0.541, p < 0.001), social support (β = 27.661, p < 0.001), physical (β = 2.413, p = 0.013) and mental (β = 7.837, p < 0.001) components of quality of life at 0-week postintervention, and most of them persisted at 12- and 24-week postintervention. The effectiveness significantly differed by the time of interventions on muscle mass (β = −1.217, p = 0.002), 5-time chair stand test (β = −1.172, p = 0.018), cognitive function (β = 0.600, p = 0.014) and mental component of quality of life (β = −12.679, p = 0.002). ConclusionThe theory-underpinning exercise intervention has positive immediate and persistent effects on frailty, frailty-related characteristics as well as physical, mental and social functioning among Chinese community-dwelling (pre)frail older adults. Late intervention attenuated the significant intervention effect. Trial registrationChinese Clinical Trial Registry ChiCTR2100041981.

The development and testing of a single-arm feasibility and acceptability study of a whole foods diet intervention for adults with prediabetes and their offspring

BackgroundDiet is considered a first-line treatment option for prediabetes, a condition that affects 96 million United States (U.S.) adults. Diet patterns that prioritize whole foods (e.g., Mediterranean) are currently recommended to treat prediabetes. However, no studies have tested whether a U.S.-style diet pattern that prioritizes whole foods can be used to treat prediabetes. The purpose of this study was to assess the feasibility and acceptability of a whole foods diet for adults with prediabetes and their offspring prior to conducting a larger clinical trial.MethodsA 2-week single-arm pre-post experimental controlled-feeding intervention of a 2020–2025 Dietary Guidelines for Americans adapted whole foods diet (e.g., primarily focused on foods that have undergone limited processing or refinement) was conducted in adults (25–59 years) with prediabetes and their biological offspring (6–17 years). Families received 2 weeks of menus and grocery delivery and weekly counseling by a registered dietitian. Families were invited to attend an optional focus group session. Feasibility was based on having a ≥ 50% family completion rate with ≥ 80% completion of study outcomes. Measures included adult–child anthropometrics (weight [kg], body mass index [BMI] including BMI% and Z-scores for offspring, waist circumference [cm]) and child diet quality estimated using the 2015 Healthy Eating Index (HEI) from a single random food record. Wilcoxon signed rank was used to compare differences between baseline and 2-week anthropometrics measures and offspring total HEI scores. Qualitative data were analyzed using thematic analysis to understand factors attributed to diet adherence and acceptability.ResultsEight families enrolled (n = 8 adults, n = 12 offspring), with 7 families completing the study (12% attrition) and completing 100% of study outcome measures. Adults experienced a median weight loss of − 1.0 kg from baseline to 2 weeks (79.5 kg to 78.5 kg). Offspring had a 24-point increase in total 2015 HEI scores (median difference 50 to 74). Focus group participants (n = 4 adults) reported being satisfied with the program and expressed a willingness to continue the diet despite identified barriers.ConclusionsA whole foods diet that provides dietary support was found to be feasible and acceptable for families at risk for T2D. Future studies are needed to test the effects of the diet on prediabetes outcomes, diet quality, and diet adherence in adults and families.Trial registrationNCT05483972 at ClinicalTrials.gov. Registered July 25, 2022. https://clinicaltrials.gov/study/NCT05483972?cond=prediabetes&term=whole%20foods%20&rank=1

Feasibility of the MIND+SOUL Culturally Tailored Brain Healthy Diet: A Pilot Study.

Alzheimer's disease (AD) disproportionately impacts Black Americans, who are three times more likely to develop AD. While heart-healthy diets have shown potential in reducing AD risk, research on adapted dietary interventions for Black American communities remains limited. This pilot study assessed the feasibility and acceptability of an adapted brain healthy diet intervention (MIND + SOUL) and explored changes in cardiometabolic risk and cognition. Twenty-nine participants completed the 12-week intervention, which included culturally tailored health education, cooking classes, health coaching, and groceries. Feasibility was assessed by attendance and retention rates, while acceptability was measured by two questionnaires. Participants had a mean age of 70.3, with 10.3% male. The intervention demonstrated high feasibility (89.3% retention) and acceptability (mean = 71.9, SD = 8.59), with meaningful improvements in body mass index (estimate = -0.54, P = 0.009), dietary intake (estimate = 28.39, P = 0.042), and executive function (estimate = 3.32, P < 0.001). However, no significant changes in blood-based biomarkers were observed. The MIND + SOUL intervention demonstrated high feasibility and acceptability, improvements in body composition, cognitive function, and dietary behaviors, despite no significant changes in blood-based biomarkers. Findings suggest potential benefits for reducing AD risk factors and promoting healthy aging. Clinical Trials Registry: ClinicalTrials.Gov; NCT05414682.

Artificial Intelligence Assistance and Cognitive Abilities: Harnessing AI-Assisted Heuristic Methods for Transitioning from Critical to Creative Thinking in English Language Learning

Transitioning from critical to creative thinking is an essential component of English language learning, fostering problem-solving abilities, innovative idea generation, and effective communication skills. Purpose. This study examines the potential of AI-assisted heuristic methods in facilitating this cognitive shift. Methodology. Three distinct AI-driven approaches are investigated: adaptive learning systems, intelligent tutoring, and data-driven feedback. A mixed-methods approach is employed to evaluate the effectiveness of the AI-assisted heuristic methods and learners' experiences during the intervention. The study involves 60 participants, divided into three groups of 20, each exposed to one of the three AI-driven methods. English language learning resources, including reading passages, audio recordings, and interactive exercises, are integrated with the AI-assisted techniques. The 8-week intervention commences with a pre-test assessing participants' initial critical and creative thinking skills. Post-tests and surveys are administered following the intervention to measure cognitive development and gather feedback on learners' experiences. Results. Results demonstrate significant improvements in problem-solving and originality of idea generation among participants. Furthermore, learners report positive experiences and recognize the value of AI-driven approaches in personalizing learning and promoting cognitive growth. However, challenges such as technological barriers and teacher training needs are highlighted. The current research underscores the potential of AI-assisted heuristic methods in English language learning, offering valuable insights into effective teaching strategies, learning tools, and platforms. Conclusion. Findings contribute to the development of innovative interventions supporting learners in acquiring essential thinking skills amidst rapid technological advancements, ultimately empowering them to succeed in today's interconnected and knowledge-driven world.

Comparison of active release technique and post-isometric relaxation in treatment of plantar fasciitis among traffic police wardens: a quasi-experimental study

BackgroundPlantar fasciitis (PF) is a common cause of chronic foot pain that leads to functional limitations in individuals. There has been recent research on plantar fasciitis, but no studies have compared the effects of the active release technique and post-isometric relaxation in patients to determine which manual therapy technique improves foot pain and function.ObjectiveThis study aimed to compare the effectiveness of the active release technique and post-isometric relaxation on proximal foot pain and functional status and to assess muscular tightness among patients with traffic police wards and plantar fasciitis.MethodsA quasi-experimental study (pre-test, post-test) was conducted in the Physiotherapy Department of Police Hospital, Gujranwala, Pakistan, between October 2022 and April 2023. We included 30 consecutively aged 25- to 60-year-old symptomatic police wardens diagnosed with planter fasciitis, who complained of pain on walking and standing for more than 3 months and met the inclusion criteria. They were equally assorted into two groups (n = 15 in each group) using convenient sampling. Group A received an active release exercise technique, group B received a post-isometric relaxation technique, and the participants in both groups received a similar baseline treatment protocol that consisted of calf stretching and stretching of the plantar fascia (5 repetitions and holding for 15 s). In the outcome measures, we included the Foot Function Index to assess the function of the foot and the Visual Analog Scale to examine the pain intensity measured during rest. The participants in both groups performed the selective protocol 3 days per week for 3 weeks, and we calculated the results at baseline and on the third day of the third week. We analyzed the data using SPSS software version 24 (IBM Corp., Armonk, NY). We compared within-group differences in the VAS score and FFI using paired t tests and analyzed between-group differences in the VAS score and FFI before and after performing the ART and PIR using independent t tests.ResultsThe 8-week intervention therapy revealed a demographic age mean and standard deviation of 36.60 ± 6.11 for group A and 35.60 ± 4.85 for group B. Within-group analysis demonstrated a significant decrease in VAS (pain) score following ART intervention (1.80 ± 0.862, p < 0.01) compared to PIR (6.07 ± 0.884). Between-group analysis indicated a significant reduction in FFI (disability) scores for group A (30.33 ± 3.200, p < 0.03) compared to group B (56.93 ± 4.773). Moreover, ART intervention exhibited significant improvement in VAS scores (p < 0.05), with 95% CI [1.49, 2.11]. The mean difference in FFI scores was substantially greater in the ART group (86.00 to 30.33) compared to the PIR group (p > 0.05), suggesting non-significant differences.ConclusionThe active release exercise intervention is more effective than post-isometric relaxation in improving pain and foot function disability in patients with plantar fasciitis. The present study aimed to help physical therapists choose the most efficient manual therapy exercise intervention to improve functional limitations.

The Role of Household Social Support and Undermining in Dietary Change.

US adults find it challenging to meet disease prevention dietary recommendations and may participate in interventions to improve dietary quality. Social influences outside of the intervention, including level of social support and undermining of healthy eating in the home, may affect an individual's dietary intake. This secondary analysis examined (1) changes in household social support and undermining of healthy eating across a dietary intervention with household member participation and (2) the relationship between changes in social influences and dietary intake. Adults (N = 62) with low adherence to cancer prevention dietary recommendations recruited from the Philadelphia area participated in a 20-week dietary intervention focused on psychoeducation about NCI dietary recommendations and skills for behavior change. Half of the participants were also randomized to have an adult household member participate in some intervention contacts with them. Participants completed measures of social support and undermining of healthy eating and dietary intake at baseline and post-treatment (20weeks). Fifty-two participants had available data for baseline and post-treatment (i.e., completers). Household social support of healthy eating increased more among participants randomized to have household involvement in the intervention with a medium effect (η2 = .11). Fruit and vegetable intake significantly increased among participants with meaningful increases in household social support with a large effect (η2 = .37). There were no significant interaction effects of change in household undermining and time on change in dietary intake. Dietary interventions with a household support component show promise for improving household social support and may impact magnitude of dietary change.

Effects of VR task-oriented training combined with rTMS on balance function and brain plasticity in stroke patients: a randomized controlled trial study protocol

BackgroundBalance dysfunction affects 70% of stroke patients. Emerging neurophysiological approaches, such as virtual reality therapy (VRT) and repetitive transcranial magnetic stimulation (rTMS), have been proven by clinical studies that the balance function of stroke patients can be improved when applied alone, but there are relatively few studies on the combined treatment of balance dysfunction after stroke. This study aimed to evaluate the impact of a 4-week intensive intervention combining VRT and rTMS on both balance function and brain plasticity among stroke patients.MethodsThis single-blind, randomized controlled trial was conducted at the Rehabilitation Medical Center of the Rehabilitation General Hospital of Ningxia Medical University. A cohort of 136 stroke patients, with durations of 2 to 24 weeks post-stroke, were enrolled in the study. Participants were randomly allocated in a 1:1:1:1 ratio to four groups: the VR group (n = 34), the rTMS group (n = 34), the combined treatment group receiving both VR and rTMS (n = 34), and the control group undergoing traditional balance training (n = 34). All patients underwent a standardized inpatient rehabilitation program over 4 weeks. The VR group received daily 30-min sessions of VR therapy for 20 days. The rTMS group underwent daily sessions of rTMS stimulation for 20 min, targeting the motor imagery region in the affected hemisphere. The combination group received VR therapy after completing their rTMS treatment. The control group received conventional balance training, with each session lasting 30 min. Additionally, all patients received an extra 60 min of standard rehabilitation therapy twice daily. Assessments were conducted at baseline, 2 weeks, and 4 weeks post-treatment, using the Berg Balance Scale (BBS) as the primary measure, and secondary measures including the Timed Up-and-Go Test (TUGT), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), and 6-m walking test (6MWT), as well as assessments for brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VGEF), tyrosine receptor kinase (TrκB), motor-evoked potential latency (PL), central motor conduction time (CMCT), and amplitude.DiscussionThe widespread application of VR technology and rTMS in clinical settings is well-established. However, the potential synergistic effects of combining these modalities on balance function and neuroplasticity in stroke patients remain uncertain. Our hypothesis suggests that the integration of VR with rTMS may result in more pronounced improvements in both balance function and neuroplasticity among stroke patients, surpassing the outcomes achievable with VR alone, rTMS alone, or traditional therapy. The possible mechanism is that VR-based training combined with rTMS plays a superimposed effect, promoting better repair of damaged neurons and ultimately improving balance function in stroke patients. The positive results anticipated from this trial could provide objective evidence advocating for the concurrent use of VR and rTMS in clinical interventions.Trial registrationThe study protocol underwent review and approval by the Medical Research Ethics Committee of the General Hospital of Ningxia Medical University on January 26, 2024 (No. KYLL-2024–0162). Subsequently, it was registered in the Chinese Clinical Trial Registry on March 11, 2024 (registration number: ChiCTR2400081775). Currently, the study is still ongoing.

Effect of Consuming Salmon Products on Vitamin D Status of Young Caucasian Women in Autumn-A Randomized 8-Week Dietary VISA 2 (Vitamin D in Salmon Part 2) Intervention Study.

Young women are often at risk of vitamin D deficiency, while fatty fish can provide significant amounts of it, which is especially important when no vitamin D skin synthesis is possible due to limited sunshine exposure. This study aimed to analyze the impact of increasing the intake of salmon in various forms (smoked salmon, salmon sausages) on vitamin D status of young women in autumn. The 8-week intervention involved 120 non-obese women, aged 20-25 years. Participants were randomly assigned to one of three groups: smoked salmon (25 g/day), salmon sausage (100 g/day), or a control group. Both intervention products provided approximately 5 µg of vitamin D daily. Serum concentrations of 25(OH)D as well as vitamin D intakes were assessed pre-, mid-, and post-intervention. The median vitamin D intake at baseline was 2.7-3.4 µg/day and did not differ between the groups (p > 0.05), while during the intervention, it was highest in the smoked salmon group (p < 0.001) and amounted to 7.3 µg/day. While all groups experienced a decrease in 25(OH)D serum concentrations, the decrease was significantly smaller in the salmon sausage group compared to the control group (-4.3 vs. -15.0 nmol/L, p < 0.05), and no significant difference was observed between the smoked salmon and control group after 8 weeks (p > 0.05). Moreover, in the salmon sausage group, the intervention was more effective among participants with an inadequate vitamin D status at baseline (25(OH)D change after the intervention: -3.0 vs. -5.4 nmol/L, p < 0.05; inadequate vs. adequate baseline vitamin D status). Increasing the intake of salmon, and hence of vitamin D, was not enough to maintain the vitamin D status of young women in autumn. It seems that other, not-yet-fully-understood factors, may influence vitamin D absorption and/or metabolism, thereby affecting the outcomes of such interventions indicating that further research is needed. Nevertheless, it may be concluded that increasing salmon sausage intake might aid slow down the natural decline of 25(OH)D in young women in autumn.

Training community members to deliver an intervention for substance use disorder: Overcoming implementation barriers in American Indian communities

IntroductionAlthough American Indian and Alaska Native (AI/AN) people have high rates of abstinence from alcohol and other drugs, there also is evidence of greater rates of substance use disorders (SUDs) in Native communities. Health disparities associated with substance use are compounded by inadequate access to evidence-based treatments (EBTs). Lack of mental health providers is one notable barrier to EBT implementation in rural AI reservation communities. Our Indigenous Recovery Planning (IRP) intervention merges cultural lessons and culturally adapted relapse prevention strategies to facilitate SUD recovery in the reservation environment. One key implementation strategy is training non-specialist community-based facilitators to deliver IRP, thereby increasing its acceptability and sustainability. This manuscript reports the facilitator training, supervision, and fidelity monitoring procedures used in our ongoing clinical trial of IRP. MethodThe study recruited four AI non-specialist providers from the community to serve as IRP facilitators. Initial training involved an introductory motivational interviewing workshop followed by a 2-day workshop in the IRP curriculum. Then we conducted an open trial of the 6-week intervention with weekly supervision meetings as part of the facilitator training process. During the open trial we also assessed participant and facilitator receptivity to the IRP intervention and pilot tested our fidelity monitoring protocol. ResultsThe initial training workshops provided facilitators with information they needed to understand the rationale behind IRP and determine whether the facilitator role was a good fit; however, additional training and supervision during the open trial was needed to ensure proper treatment delivery. Although participant and facilitator feedback ratings were positive, the open trial helped us identify revisions needed to improve our approach to facilitator training, supervision, and fidelity monitoring. We revised these procedures, and also developed a protocol to train new facilitators who join the study midstream. ConclusionThe open trial was an important aspect of the facilitator training process and helped our team identify several areas of improvement. Our approach to training, supervising, and monitoring community member facilitators may serve as an example of how to overcome one barrier to implementing evidence-based SUD treatments in rural reservation communities with few mental health professionals.

Urine Metabolomics during a Legume Diet Intervention Suggests Altered Metabolic Signatures and Potential New Intake Markers: First Insights.

Given the general increase in legume consumption worldwide, there is a need to characterize the resulting human metabolic adaptations in order to demonstrate potential legume diet/health relationships. A nuclear magnetic resonance (NMR) metabolomics urine study was carried out on a small cohort (n = 18) to characterize the excretory effects of a pilot longitudinal 8-week legume-based dietary intervention. Despite the expected high interindividual variability in the excreted metabolome, the results suggested a nonlinear metabolic response, with higher metabolic activity in the first 4 weeks and a tendency toward baseline at the end of the intervention. The excretion of isoleucine, leucine, and threonine increased, along with metabolite changes suggestive of activation of the tricarboxylic acid cycle (through anaplerosis), ketogenesis, fat catabolism, and glycoprotein biosynthesis. Gut microbiota adaptations were also suggested based on the increased excretion of 2-hydroxyisobutyrate, allantoin, and hippurate. Increased levels of trigonelline were consistent with its role as a legume intake marker, whereas malonate and pseudouridine were suggested as possible additional markers. Correlation of NMR data with nutritional parameters aided putative explanatory hypotheses to be advanced. Our results suggest a dynamic response to legume consumption, mainly through increased amino acid excretion and altered energy metabolism, while advancing potential new markers of legume intake. These results require confirmation in larger cohorts but pave the way for an informed interpretation of the effects of legume-based diets on human health.

Exergaming interventions for older adults: The effect of game characteristics on gameplay

PurposeExergames can be used to train physical and cognitive abilities and have been shown to be effective in reducing the risk of falls in older adults. However, there is limited evidence about how people play exergames and how gameplay is affected by game settings and, thus, the potential training effects. The aim of this study was to investigate the impact of repeated exergaming sessions over 4 weeks and two game settings (difficulty level and game speed) on gameplay (performance, physical activity and perceived exertion) in older adults over a four-week exergaming intervention. Methods28 independently living older adults (mean age 74.47 years; 14 females) played two different exergames (Puzzle and Fox) at two difficulty levels 3× per week for 4 weeks. Physical activity measures from an accelerometer at the lower back, performance as game scores from the exergaming system, and self-reported measures of physical and cognitive exertion were collected at sessions 1,2,3,6,9 and 12. ResultsFor the Puzzle game, performance and physical activity increased significantly across the 12 training sessions. For the Fox game, an increased game speed was associated with increased performance, physical activity, and exertion across the exergaming sessions. Across all exergaming sessions, increasing difficulty by adding cognitive elements decreased the performance and amount of physical activity. ConclusionGame characteristics significantly influence how the exergames are played during a 4-week exergaming intervention. Hence, individual tailoring of the difficulty level and game speed is important. This study highlights the importance of understanding the interplay between game characteristics and gameplay during an exergaming intervention, thereby adding critical information for interpreting intervention effects – or the lack thereof.

Feasibility of the Challenge Assessment, the Gait Outcomes Assessment List and ‘Moving Together’ (‘Sammen I Bevægelse’), a Group-Based Motor Skills Intervention for Independent School-Aged Children with Cerebral Palsy

ABSTRACT This single group pre and posttest study evaluated the feasibility of a new 10-week group-based motor skills enhancement intervention: “Moving Together,” and associated use of the Challenge assessment and Gait Outcomes Assessment List (GOAL). Participant attendance/completion and satisfaction with the assessments and intervention were evaluated, and a first estimate of associated motor skill-related changes obtained. Ten ambulatory children with cerebral palsy (7–14 years) and their parents participated. Ninety percent of Challenge sessions were attended and 82.5% of GOAL questionnaires completed. Program attendance was 83% overall. Satisfaction with assessments was high for the Challenge and moderate for the GOAL, and intervention satisfaction was high. Mean change scores (95% CI) post-intervention for the Challenge and GOAL were 4.2 (−11.4 to 3.1) and 3.6 (−14.4 to 4.0) points (/100) respectively. Challenge and GOAL use was feasible and appropriate for “MovingTogether” and associated with gains in motor skill performance and functional abilities.

Effectiveness of a 12-week combining tai chi and yoga program on pulmonary function and functional fitness in COPD patients

BackgroundChronic obstructive pulmonary disease (COPD) poses significant challenges to both patients and healthcare providers due to its progressive nature and adverse impact on respiratory function and quality of life (QoL). While pulmonary rehabilitation remains a cornerstone of non-pharmacological COPD management, additional interventions are needed to address patients' diverse needs and preferences. AimThis study investigated the feasibility and potential benefits of a 12-week combining Tai Chi and Yoga (TY combining) program on cardiorespiratory and lung functions, functional fitness, and QoL in older males diagnosed with COPD. MethodsTwenty-four male COPD patients (age: 70 ± 6 years) with moderate to severe disease were recruited and randomized into the TY combining group (n = 12) or control group (n = 12). Assessments were conducted at baseline and at week 12, including pulmonary function tests, quality of life measures, dyspnea, and fatigue. Functional fitness tests were assessed at baseline, week 4, week 8, and week 12. ResultsThe TY combining program significantly improved pulmonary functions, functional fitness, quality of life, and fatigue over the 12-week intervention period. Notably, improvements in functional fitness parameters were observed after just four weeks of training, emphasizing the rapid benefits of the intervention. Moreover, the program exhibited high safety and feasibility, with no reported complications. ConclusionThe 12-week TY combining program represents a safe, feasible, and effective adjunctive therapy for COPD management in older male patients. By addressing multiple dimensions of health and functioning, including pulmonary and cardiovascular health, functional fitness, and quality of life, this holistic approach holds promise for optimizing outcomes in COPD patients. Further research is warranted to validate these findings and explore optimal implementation strategies in clinical practice.

Effect of supplementation with lutein, zeaxanthin, and omega-3 fatty acids on macular pigment and visual function in young adults with long-term use of digital devices: study protocol for a randomized double-blind placebo-controlled study.

Growing evidence emphasizes the importance of xanthophyll carotenoids and omega-3 fatty acids in eye health. However, the beneficial effects of such supplementation have not been thoroughly discussed among adults with high screen exposure. Current trial evidence on lutein bioavailability is contradictory, and the interactions of dietary intervention with host-related factors remain elusive. This study aims to investigate the comparative effectiveness of supplementation with macular xanthophylls and omega-3 fatty acids on macular pigment optical density (MPOD) and visual function, access the bioavailability of free lutein and lutein ester, and explore the complex interplay between genetic variations, intestinal microbiota, and the dietary intervention in Chinese adults with long-term exposure to digital devices. The Lutein, Zeaxanthin, and Omega-3 (LZO) clinical trial is a 24-week multicenter, randomized, double-blind, placebo-controlled trial of 600 participants recruited from research centers, universities, and communities. Individuals are eligible to participate if they are aged over 18 years and use digital devices for over 8 h daily in the last 2 years, and will be randomized to six arms. A total of three visits will be scheduled at baseline, 12 and 24 weeks. The primary outcome is the change in MPOD over the 24-week intervention. The secondary outcomes are changes in visual function (visual acuity, best-corrected visual acuity, contrast and glare sensitivity, critical flicker fusion, reaction time, visuognosis persistence, symptoms and signs of dry eye, retinal thickness, and optical quality), and changes in serum lutein and zeaxanthin concentrations, and erythrocyte membrane omega-3 fatty acids. Genetic variations will be determined using genome-wide genotyping at baseline. 16S rRNA gene sequencing will be utilized to assess microbiome compositional changes before and after intervention. The trial is anticipated to establish early interventions to prevent photochemical ocular damage and delay the onset of vision impairment in young adults with long-term repeated exposure to screen-based electronic devices, and provide valuable insights for the development of precision nutrition strategies for maintaining eye health. www.clinicaltrials.in.th, Identifier, TCTR20220904002.