Exercise-based Rehabilitation Research Articles

Pulmo-protection of long-term swimming exercise via improving insulin sensitivity in monocrotaline-induced pulmonary hypertensive rats

Exercise has been recognized as an effective intervention in the treatment of pulmonary arterial hypertension (PAH), supported by numerous studies. However, the precise effects of exercise on pulmonary function remain to be fully elucidated. In this study, using a rat model of swimming exercise training and monocrotaline-induced PAH, we aimed to explore its impact on pulmonary morphology and function. Our investigations revealed that MCT-treated rats exhibited augmented mean pulmonary arterial pressure (MPAP) and pulmonary vascular remodeling, which can be attenuated by 4 weeks of swimming exercise training (60 min/day, 5 days/week). Notably, MCT-treated rats showed impaired pulmonary function, as manifested by decreased tidal volume and dynamic compliance, which were reversed by exercise training. Assessment of pulmonary substrate in PAH rats indicated a prominent pro-inflammatory substrate, evidenced by macrophage accumulation through quantitative immunohistological analysis of macrophage-like cell expression (CD68), and extracellular matrix remodeling, evaluated by Masson staining. Importantly, both the pro-inflammatory substrate and extracellular matrix remodeling were ameliorated by swimming exercise training. Additionally, serum biochemical analysis demonstrated elevated levels of low-density lipoprotein cholesterol and Apolipoprotein B following MCT treatment, which were reduced with exercise intervention. Moreover, exercise enhanced systemic insulin sensitivity in both MCT-treated and untreated rats. Notably, MCT and exercise treatment both decreased fasting blood glucose (FBG) levels in rats, whereas exercise training reinstated FBG levels to normal in MCT-treated rats. In summary, our study suggests that swimming exercise confers a pulmonary protective effect in MCT-induced PAH rats, highlighting the potential importance of exercise-based rehabilitation in the management of PAH.

Changes in fatigue symptoms following an exercise-based rehabilitation programme for patients with Long-COVID

BackgroundThere is evidence to support COVID-19 rehabilitation programmes improving persistent COVID-19 symptoms; however, there is concern that therapies that include an exercise component may increase fatigue and post-exertional symptom exacerbation (PESE).ObjectivesTo determine the effect of a 6 week COVID-19 rehabilitation programme on fatigue and PESE in individuals with on-going COVID-19 symptoms.MethodsAfter a routine medical assessment, individuals with persistent COVID-19 symptoms were enrolled on a 6-week COVID-19 specific rehabilitation programme. The programme included symptom-titrated exercise, education, and self-management advice. Fatigue was assessed pre- and post-programme using the Functional Assessment Chronic Illness Therapy-Fatigue questionnaire (FACIT). Exercise capacity (Incremental and Endurance Shuttle Walking Test; ISWT/ESWT) and PESE (DePaul Symptom Questionnaire; DSQ) were also assessed pre- and post-programme. Composite scores were calculated for the frequency and severity domains of the DSQ.Results148 patients (median [IQR] age 59[49–72] years, 82 (60%) female, 81(54%) hospitalised) completed the COVID-19 rehabilitation programme. FACIT score reduced pre- to post-programme by a mean[CI] change of −5[−7, −4];p<0.01. Exercise capacity increased by 82[65, 99] m for the ISWT and 398[333, 462]seconds for the ESWT (n=148). PESE was assessed in 44 patients. The DSQ frequency and severity composite score improved by 20[13, 28] and 19[13, 26] points, respectively (p<0.01, n=44).ConclusionThis data demonstrates the potential benefits of a COVID-19 rehabilitation programme on improving fatigue, exercise capacity, and symptom exacerbation, in those with persistent COVID-19 symptoms.

Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM): protocol for a randomised feasibility trial

IntroductionPersonalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM) is a research programme that seeks to develop and evaluate a comprehensive exercise-based rehabilitation intervention designed for people with multimorbidity, the...

The Effectiveness of Exercise-based Rehabilitation in People with Hand Osteoarthritis: A Systematic Review with Meta-analysis.

OBJECTIVE: To investigate the effectiveness of exercise-based rehabilitation programs compared with non-exercise intervention or no intervention for people with hand osteoarthritis (OA). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched five databases on 23/07/2023. STUDY SELECTION CRITERIA: We included randomized controlled trials that compared the effectiveness of rehabilitation programs that included an exercise component, with non-exercise intervention or no intervention for people with hand OA. DATA SYNTHESIS: Standardized mean differences (SMD) were pooled using a random effects model. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The certainty of the evidence was evaluated using the GRADE approach. RESULTS: Fourteen trials were included in the meta-analysis (n = 1341 participants). In the immediate-term (<24 weeks) there was low-certainty evidence of an effect of exercise-based rehabilitation on improving pain (13 trials; SMD -0.65, 95%CI: -1.06, -0.25), function (11 trials; SMD -0.35, 95%CI: -0.54, -0.15), and grip strength (14 trials; SMD 0.21, 95%CI: 0.03, 0.38). There was moderate-certainty evidence of an effect on reducing stiffness (7 trials; SMD -0.33, 95%CI: -0.51, -0.16). There was low-certainty evidence of no effect on improving pinch strength and quality of life. For the long-term ⩾24 weeks), there was low-certainty evidence that exercise-based rehabilitation had no additional effect on improving pain, function, and stiffness. CONCLUSION: Exercise-based rehabilitation improved pain, function, stiffness, and grip strength in people with hand OA in the immediate-term; the benefits were not maintained in the long-term.

A Review of High-Intensity Interval Training in Heart Transplant Recipients: Current Knowledge and Future Perspectives.

This review reports how exercise-based rehabilitation strategies have developed over the past decades, and it specifically focuses on the effectiveness, safety, and implementation of high-intensity interval training (HIIT). It provides an overview of the historical progression, main research findings, and considerations surrounding HIIT as the preferred exercise modality for recipients of heart transplant (HTx). The review includes a timeline of studies spanning from 1976-2023. The 2017 Cochrane systematic review on exercise-based cardiac rehabilitation in recipients of HTx serves as the main knowledge base (≥2015). Additionally, literature searches in PubMed/Medline and ClinicalTrials.gov have been performed, and all reviews and studies reporting the effects of moderate- to high-intensity exercise in recipients of HTx, published in 2015 or later have been screened. High-intensity interval training has gained prominence as an effective exercise intervention for recipients of HTx, demonstrated by an accumulation of performed studies in the past decade, although implementation in clinical practice remains limited. Early restrictions on HIIT in HTx recipients lacked evidence-based support, and recent research challenges these previous restrictions. High-intensity interval training results in greater improvements and benefits compared with moderate-intensity continuous training in the majority of studies. While HIIT is now regarded as generally suitable on a group level, individual assessment is still advised. The impact of HIIT involves reinnervation and central and peripheral adaptations to exercise, with variations in recipent responses, especially between de novo and maintenance recipients, and also between younger and older recipients. Long-term effects and mechanisms behind the HIIT effect warrant further investigation, as well as a focus on optimized HIIT protocols and exercise benefits.

Effect of exercise-based rehabilitation on functional capacity and renal function in type 2 diabetes mellitus with nephropathy: a randomized controlled trial.

Diabetic nephropathy is a growing public health challenge with implications on health. Renal function decline impacts the functional ability and overall health and well-being of individuals with diabetic nephropathy due to development of several renal manifestations. The objective of the study was to determine the effect of an exercise-based rehabilitation program on functional capacity and renal function among individuals with type 2 diabetic nephropathy. A total of 283 individuals were screened and 60 eligible participants aged 45-70years with diabetic nephropathy were randomly allocated (n = 30 each) to the intervention group (IG) and control group (CG), respectively. The study outcome measures comprised of functional capacity (6-min walk test) and renal function assessed at baseline, 12th week and 24th week. Participants allocated to IG received 12weeks of exercise based rehabilitation (comprising of supervised + home-based exercises) along with standard care and followed-up till 24th week. The repeated measures ANOVA with Greenhouse-Geisser correction indicated significant timepoint*group interaction effect for 6-min walk distance F (1.71, 90.59) = 619, p < 0.001, serum creatinine F (1.23, 65.14) = 174.8, p < 0.001, estimated glomerular filtration rate F (1.15, 60.88) = 105.2, p < 0.001, serum urea F (1.48, 78.45) = 261.4, p < 0.001 and urine protein F (1.13, 59.82) = 4.58, p < 0.328. The study found that exercise based rehabilitation improved both functional capacity and renal function among individuals with type 2 diabetic nephropathy.

Exercise-based Rehabilitation to Improve Exercise Tolerance of Severe COVID-19 Survivors: A Review Paper

Exercise-based Rehabilitation to Improve Exercise Tolerance of Severe COVID-19 Survivors: A Review Paper

Virtual Physical Therapy Practices in Canadian Exercise-Based Pulmonary Rehabilitation Programs

Purpose: To understand the current physical therapy virtual care practices in Canadian pulmonary rehabilitation programs. Methods: Exercise-based pulmonary rehabilitation programs were identified through Canadian pulmonary associations available on public websites. Physiotherapists at eligible sites were emailed a web-based survey (REDCap) between March and June 2023. Results: 31/61 survey recipients from 56 programs completed the survey (response rate = 51%). A majority of participants ( n = 20, 65%) reported using a hybrid (mix of virtual and in-person) delivery model in the preceding 6 months. Assessments of exercise capacity, respiratory status, exertional oxygen requirements, and physical function were primarily conducted in-person, whereas exercise prescription and progression, respiratory treatment, psychosocial support, vital sign monitoring, and education were conducted both in-person and virtually. Commonly reported enablers to virtual care were patient preference, medical stability, and availability of technological equipment. Clinical practice guidelines alongside continuing education and training opportunities were identified as important resources needed to optimize virtual or hybrid rehabilitation delivery. Conclusions: Following the COVID-19 pandemic there has been a shift towards a hybrid model of exercise-based pulmonary rehabilitation delivered by physiotherapists. Expanding the evidence base particularly around the clinical utility of virtual assessment may further inform virtual care practices.

Exercise-based cardio-oncology rehabilitation for cardiotoxicity prevention during breast Cancer chemotherapy: The ONCORE randomized controlled trial

BackgroundBreast cancer (BC) treatment with anthracyclines and/or anti-human epidermal growth factor receptor-2 (HER2) antibodies is associated with an increased risk of cardiovascular disease complications, including cancer therapy-related cardiac dysfunction (CTRCD). While Cardio-Oncology Rehabilitation (CORe) programs including exercise have emerged to minimize these risks, its role in preventing CTRCD is unclear. ObjectivesWe investigated the effectiveness of an exercise-based CORe program in preventing CTRCD [left ventricular ejection fraction (LVEF) drop ≥10% to a value <53% or a decrease >15% in global longitudinal strain (GLS)]. Secondary outcomes examined changes in cardiac biomarkers, physical performance including peak oxygen consumption, psychometric and lifestyle outcomes. Safety, adherence, and patient satisfaction were also assessed. MethodsThis is a randomized controlled trial including 122 early-stage BC women receiving anthracyclines and/or anti-HER2 antibodies, randomized to CORe (n = 60) or usual care with exercise recommendation (n = 62). Comprehensive assessments were performed at baseline and after cardiotoxic treatment completion. The average duration of the intervention was 5.8 months. ResultsNo cases of CTRCD were identified during the study. LVEF decreased in both groups, but was significantly attenuated in the CORe group [−1.5% (−2.9, −0.1); p = 0.006], with no changes detected in GLS or cardiac biomarkers. The CORe intervention led to significant body mass index (BMI) reduction (p = 0.037), especially in obese patients [3.1 kg/m2 (1.3, 4.8)]. Physical performance and quality-of-life remained stable, while physical activity level increased in both groups. No adverse events were detected. ConclusionsThis study suggests that CORe programs are safe and may help attenuate LVEF decline in BC women receiving cardiotoxic therapy and reduce BMI in obese patients.

“Standing out like a sore thumb”: exploring socio-cultural influences on adherence to cardiac rehabilitation

ABSTRACT Exercise-based rehabilitation forms a key part of the UK National Health Service patient-care pathway for cardiac rehabilitation (CR). Only around half of all eligible patients attend core CR, however, with social inequalities affecting participation. Few qualitative studies have explored in-depth the key factors influencing engagement with CR, specifically from a sociological theoretical, and ethnographic perspective. Utilising an ethnographic approach allowed us to get a sense of the embodied experiences of 10 participants attending or declining core CR, together with a further seven family members/significant others. This provided in-depth appreciation of participants’ lifeworld contexts as key influences on CR participation. The article draws on these qualitative data and focuses on 1) participants’ initial thoughts about CR; and 2) navigating the field of CR, analysed via thematic analysis. We utilise a Bourdieusian theoretical perspective to theorise the findings, including salient socio-cultural factors influencing attendance/non-attendance and (non)adherence. The article findings highlight how perceptions of CR and the ability to navigate the field are strongly influenced by habitus and capital, and how personal biographies and socio-material conditions affect adherence to CR programmes. The study provides original insights into embodied experiences of exercise-based CR, and novel understandings of the reasons for drop-out/poor adherence, theorised from a Bourdieusian perspective.

Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patients with Underlying Alpha-1 Antitrypsin Deficiency: A Systematic Review and Practical Recommendations.

Alpha-1 antitrypsin deficiency (AATD) is an often-overlooked genetic condition that makes individuals susceptible to early onset of chronic obstructive pulmonary disease (COPD). The established benefits of exercise-based pulmonary rehabilitation (PR) for usual COPD patients are unclear for those with underlying AATD, especially given potentially differing muscle adaptations to exercise. This review seeks to compare PR outcomes between AATD and usual COPD patients and to consolidate current knowledge on exercise intervention outcomes for the AATD population. A thorough search of 4 databases (Ovid, Medline, CINAHL, CENTRAL) was conducted based on 3 search concepts: (1) alpha-1 antitrypsin deficiency, (2) pulmonary rehabilitation OR exercise, and (3) muscle morphology. A dual review process and quality assessment were independently implemented throughout all stages of the review. Four studies highlighted modest exercise capacity and quality of life in AATD patients undergoing PR. However, one study reported unique muscle and mitochondrial responses compared to usual COPD patients. Additionally, a moderate exercise session did not alter pro-inflammatory cytokine levels in AATD patients, despite higher levels of tumor necrosis factor-α levels in muscle biopsies compared to usual COPD patients. The current literature base insufficiently addresses the efficacy of PR on AATD, with indications that exercise adaptation may deviate from that of usual COPD patients. Further research is needed to optimize PR, particularly in identifying the most suitable exercise intensity, and delivery setting, and addressing specific educational needs for individuals with AATD.

Handheld Devices Utilization for Cognitive Rehabilitation and Medical Assessment Based on Navstar Global Positioning System: Towards Brain-Rehabilitation

There is less than a third of clinically competent brain patients in developed and developing countries utilizing brain rehabilitation through exercise. The lack of hospital-based rehabilitation services and long travel times impede participation. As a consequence, calls have been made for the creation of more adaptable substitutes. The creation of a system that enables the transmission of a patient's unique EEG, sample rate, N-GPS based speed, and position, as well as walking-based brain rehabilitation. A programmed handheld mobile device (HMD) transmits these data to a secure server where an exercise scientist can view them in real-time. To evaluate the viability of this approach, 134 brain patients who were unable to engage in hospital-based rehabilitation underwent remotely supervised exercise assessment and exercise sessions. Completion rates, technical participation, the ability to spot EEG changes, and the six-minute walk test conducted both before and after the participation. The device's efficiency and speed were praised. The participants were able to finish a six-week exercise-based rehabilitation program while they were on the go or close to their homes or places of employment. The bulk of sessions went off without a hitch or technical issues, however sporadic signal loss in underserved areas occasionally caused issues. There were many post-workout and exercise-related EEG abnormalities found. In all countries with data available, less than a third of clinically competent patients use exercise-based brain rehabilitation.

The impact of an aerobic exercise rehabilitation program on stroke patients' ability to walk more comfortably and some physiological indicators

Since stroke is the third leading cause of mortality worldwide, numerous studies must be done to attempt and determine what causes it, how to diagnose it quickly, and how to treat it properly to prevent advanced stages or total disability. The list of most frequent neurological system injuries includes stroke, which leaves victims with motor disabilities. Walking is one of the most frequently used motor skills since it is so integral to daily living, and a stroke frequently results in issues with how the body moves generally, such as the ability to walk. As we know, physical exercises, including aerobic exercises, are nothing more than operations to subject the vital systems of the body under the influence of physical exercises that lead to the occurrence of physiological and morphological changes that result in an increase in body efficiency and his ability. The injured person is treated by taking care of the manifestations of weakness of some muscles, ligaments, and joints. The current study sought to determine how an aerobic exercise-based rehabilitation program affected stroke patients' ability to walk and several physiological parameters. The study's findings showed that the rehabilitation program using aerobic exercises affects the improvement of walking skill and some physiological variables among stroke patients. The researchers used the experimental approach in a one group design, and the sample size was ten patients with stroke who were referred to a physiotherapy center in Koya city.

Supplementation with β-hydroxy-β-methylbutyrate after resistance training in post-acute care patients with sarcopenia: A randomized, double-blind placebo-controlled trial

ObjectivesThis study aimed to evaluate the efficacy of adding β-hydroxy-β- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit. Study designA randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program. Main outcome measuresThe primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up. ResultsAfter completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up. ConclusionsOur findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.

Balancing the value and risk of exercise-based therapy post-COVID-19: a narrative review.

Coronavirus disease 2019 (COVID-19) can lead to ongoing symptoms such as breathlessness, fatigue and muscle pain, which can have a substantial impact on an individual. Exercise-based rehabilitation programmes have proven beneficial in many long-term conditions that share similar symptoms. These programmes have favourably influenced breathlessness, fatigue and pain, while also increasing functional capacity. Exercise-based rehabilitation may benefit those with ongoing symptoms following COVID-19. However, some precautions may be necessary prior to embarking on an exercise programme. Areas of concern include ongoing complex lung pathologies, such as fibrosis, cardiovascular abnormalities and fatigue, and concerns regarding post-exertional symptom exacerbation. This article addresses these concerns and proposes that an individually prescribed, symptom-titrated exercise-based intervention may be of value to individuals following infection with severe acute respiratory syndrome coronavirus 2.

Changes in functional health status following open abdominal aortic aneurysm repair and the role of exercise-based rehabilitation: a systematic review

Background: Physical domains of quality of life measures are negatively impacted following abdominal aortic aneurysm (AAA) repair. This is likely to reflect a reduction in objective measures of functional status, although this is yet to be established. These reductions can be targeted via exercise-based rehabilitation. This review aims to systematically evaluate the current evidence quantifying changes in functional status following open AAA repair and to consider the role of exercise-based rehabilitation for these patients. Methods: The Medline, EMBASE and Cochrane CENTRAL databases were searched using two distinct search strategies. We included all prospective randomised and non-randomised trials that considered the impact of open AAA repair on functional status and/or the effect of exercise-based rehabilitation following open AAA repair. The primary outcomes were changes in objective measures of functional status following AAA repair and changes in these measures following exercise-based rehabilitation. Risk of bias was independently assessed by two review authors using the criteria outlined in the revised Cochrane tool (ROB 2.0) or the risk of bias in non-randomised studies of interventions (ROBINS-I) tool. Results: No studies were identified that quantified changes in functional status following open AAA repair. One study considered exercise-based rehabilitation. This three-arm randomised trial compared two walking-based exercise programmes with routine care physiotherapy.Patients who underwent backward walking-based rehabilitation had a significantly lesser decline in functional status than the other groups, based on the 6-minute walk test and standard metabolic equivalents. There were no significant differences in length of stay or pulmonary function. Discussion: This is the first systematic review to explore the objective decline in functional status and the role of exercise-based rehabilitation following open AAA repair. There is no evidence to quantify functional decline following AAA repair and limited low quality evidence to support exercise-based rehabilitation. The ideal next step for future research would be a feasibility or observational before-and-after cohort study using direct measures of physical function such as the short physical performance battery or the 6-minute walk test.

Paraspinal muscles in individuals undergoing surgery for lumbar spine pathology lack a myogenic response to an acute bout of resistance exercise.

Lumbar spine pathology (LSP) is a common source of low back or leg pain, and paraspinal muscle in these patients demonstrates fatty and fibrotic infiltration, and cellular degeneration that do not reverse with exercise-based rehabilitation. However, it is unclear of this lack of response is due to insufficient exercise stimulus, or an inability to mount a growth response. The purpose of this study was to compare paraspinal muscle gene expression between individuals with LSP who do and do not undergo an acute bout of resistance exercise. Paraspinal muscle biopsies were obtained from 64 individuals with LSP undergoing spinal surgery. Eight participants performed an acute bout of machine-based lumbar extension resistance exercise preoperatively. Gene expression for 42 genes associated with adipogenic/metabolic, atrophic, fibrogenic, inflammatory, and myogenic pathways was measured, and differential expression between exercised and non-exercised groups was evaluated for (a) the full cohort, and (b) an age, gender, acuity, and etiology matched sub-cohort. Principal components analyses were used to identify gene expression clustering across clinical phenotypes. The exercised cohort demonstrated upregulation of inflammatory gene IL1B, inhibition of extracellular matrix components (increased MMP3&9, decreased TIMP1&3, COL1A1) and metabolic/adipogenic genes (FABP4, PPARD, WNT10B), and downregulation of myogenic (MYOD, ANKRD2B) and atrophic (FOXO3) genes compared to the non-exercised cohort, with similar patterns in the matched sub-analysis. There were no clinical phenotypes significantly associated with gene expression profiles. An acute bout of moderate-high intensity resistance exercise did not result in upregulation of myogenic genes in individuals with LSP. The response was characterized by mixed metabolic and fibrotic gene expression, upregulation of inflammation, and downregulation of myogenesis.

Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition

Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC. To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC. A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial. This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers. The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs. Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94). The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.

Stress syndromes of the elbow joint region (golfer's/tennis elbow) - a review of the recent literature

Introduction and Purpose: Tennis elbow and golfer's elbow are two stress syndromes of the elbow joint region which have received much attention due to their effects on everyday and sporting activities. This review intends to provide an up-to-date summary of the pathophysiology, clinical manifestation, diagnostic techniques, and treatment options for the two conditions.&#x0D; State of Knowledge: Recent research has emphasized the complexity of these diseases, connecting various causes to their emergence. The current study also shows how inflammation, tendon degradation, and neural involvement contribute to these disorders. Imaging advancements, such as ultrasound and MRI, have improved the diagnostic process by allowing visualization and recognition of underlying disorders. To ensure proper management, differential diagnoses, such as nerve compression syndromes and other musculoskeletal diseases, must be carefully evaluated. Rest, physiotherapy, NSAIDs, and corticosteroid injections are important first-line treatments. Novel therapeutic interventions, such as PRP therapy and ESWT have recently been studied as supplements or alternatives to traditional procedures. The exercise-based rehabilitation in controlling and preventing recurrence is also emphasized. Although surgery is reserved for the most difficult cases, advances in minimally invasive techniques have resulted in better outcomes.&#x0D; Conclusion: Recent literature has significantly contributed to our understanding of elbow stress syndromes. The synthesis of recent research provides clinicians with valuable insights into optimal management strategies. Although, further research is crucial to improve diagnosis, develop new treatments, and raise the standard of care for those affected by these conditions.

Effect Of Physical Exercise-based Rehabilitation On Post-acute Sequelae Of Covid-19: A Systematic Review And Meta-analysis

Effect Of Physical Exercise-based Rehabilitation On Post-acute Sequelae Of Covid-19: A Systematic Review And Meta-analysis