The essential role of the physiotherapy profession in incretin-based weight loss.

Cardiac Rehabilitation for Coronary Artery Disease: Gaps, Digital Models, and the Future of Personalized Prevention.

An AI-Assisted Adaptive Boolean Rubric for exercise prescription evaluation: A pilot validation study.

Parkinson's disease (PD) is a classic neurodegenerative disorder characterized by both motor and nonmotor symptoms, with circadian rhythm disruption being particularly prominent. This disruption leads to issues such as sleep disturbances, cognitive decline, and mood fluctuations in patients. Research has shown a close relationship between circadian rhythm dysregulation and these symptoms, making circadian rhythm regulation an emerging therapeutic strategy. Exercise, as a nonpharmacological treatment, has been demonstrated to modulate circadian rhythms through various mechanisms, thereby improving sleep quality, cognitive function, and emotional state in PD patients. Furthermore, exercise regulates the biological clocks of peripheral tissues such as muscle, liver, and adipose tissue, and affects the central nervous system's rhythms through neuroendocrine pathways, leading to improvements in PD symptoms. This paper introduces the concept of "exercise as chronotherapy," highlighting its role in regulating circadian rhythms and alleviating nonmotor symptoms of PD. It also discusses the future design of personalized exercise prescriptions and technological applications, aiming to provide new perspectives and strategies for the comprehensive treatment of PD.

Comparative effectiveness of exercise modalities on psychological outcomes and quality of life in digestive system cancer survivors: a systematic review and network meta-analysis.

Multimodal exercise prescription for frail older adults with cardiovascular disease: A safe and effective approach to enhance physical function and quality of life.

Optimizing exercise interventions for depression in stroke patients: A network and dose-response meta-analysis.

P0131 Prescription exercise for older men with urinary disease (PROUD) trial

Exercise intolerance, combined with low levels of physical activity, are commonly observed in individuals with Primary Mitochondrial Disease (PMD). However, access to health professionals with expertise in prescribing exercise to this population is limited. The use of digital health technology (DHT) may be a feasible and acceptable approach for therapists to support people with PMD to increase levels of physical activity, including exercise. Ten participants with mild to moderate PMD were recruited. All were provided with an eight-week home exercise program via an online exercise prescription app and remotely monitored using a smart watch. Participants received telehealth supporting their home exercise regimen along with reminders to move from the smart watch. The primary outcomes were feasibility and acceptability. Secondary outcomes were physical performance measures and fatigue, measured pre- and post-intervention. Only 26% of eligible participants enrolled. There were no dropouts, and four minor adverse events reported. Most participants (80%) participated in 80% or more of the telehealth sessions and wore the smart watch on 80% or more days during the study. Daily step target achievement was poor and only one participant met their individualised target on ≥80% of days. Half the participants achieved their weekly target of 150 intensity minutes (heart rate >50% of their theoretical maximal heart rate) on 7 or more weeks. Home exercise program adherence was low with only 30% of participants completing 80% or more of the scheduled strength training sessions over 8 weeks. Post-hoc exploration found pre-intervention exercisers achieved 4 out of 5 intervention targets compared to 0 for non-exercisers. Acceptability outcomes extracted from post-program questionnaires were overall positive towards the smart watch and home exercise program. There were no meaningful changes in any physical outcome measures or fatigue post-test. The use of DHT may be feasible and acceptable for prescribing home exercise and monitoring activity levels in individuals with mild to moderate forms of PMD, particularly those with a history of exercise.

Exercise medicine has gained significant recognition owing to its demonstrated benefits throughout the breast cancer treatment continuum. While resistance exercise (RE) promotes improvements in lean mass and muscle strength, aerobic exercise (AE) enhances cardiorespiratory fitness, with several studies investigating both exercise modes in patients with breast cancer. However, because of an effect often referred to as interference effect, it is hypothesised that combining resistance and aerobic exercise (COMB) may compromise gains in lean mass and muscle strength and other outcomes in cancer populations. This study aims to investigate the presence of an interference effect from prescribing COMB compared with RE on fatigue, lean mass, physical function and muscle strength in women with breast cancer. In addition, it examines a range of demographic, clinical and exercise prescription moderators within this population. We searched seven databases from inception to January 2024 (PROSPERO CRD42023491118), with an updated search in April 2025. Eligible trials examined the effects of RE, AE and/or COMB in women diagnosed with breast cancer. The primary outcomes for this review were cancer-related fatigue, lean mass, physical function and/or lower-limb muscle strength. A random-effects network meta-analysis was undertaken to examine the effect of different exercise programs and controls, with specific focus on the comparisons between RE and COMB. Differences between RE and COMB above 0.20 standardised mean difference (SMD) were an indicative of a potential interference effect. We included a total of 131 articles describing 116 randomised trials (n = 9206). Both RE (SMD - 0.52, 95% CI - 0.83 to - 0.21, p = 0.001) and COMB (SMD - 0.47, 95% CI - 0.65 to - 0.29, p < 0.001) similarly reduced fatigue compared with controls. However, a potential interference effect was observed on fatigue during surgery (SMD - 0.23, 95% CI - 0.58 to 0.12, p = 0.191) and chemotherapy (SMD - 0.22, 95% CI - 0.59 to 0.16, p = 0.257), with RE showing greater benefits than COMB. For physical function, both RE (SMD 0.86, 95% CI 0.41-1.30, p < 0.001) and COMB (SMD 0.90, 95% CI 0.58-1.22, p < 0.001) improved outcomes compared with controls, though RE was superior to COMB in patients receiving hormone therapy (SMD 0.62, 95% CI - 0.56 to 1.81, p = 0.303). Differences between RE and COMB in lean mass (MD 0.18kg, 95% CI - 0.17-0.53kg, p = 0.303) and muscle strength (SMD 0.43, 95% CI - 0.01-0.86, p = 0.056) were not significant in the main analyses; however, sensitivity analyses omitting the outliers indicated significant differences favouring RE for lean mass (MD 0.36kg, 95% CI 0.15-0.57kg, p < 0.001) and muscle strength (SMD 0.40, 95% CI 0.08-0.71, p = 0.014). Our findings emphasise the importance of personalised exercise medicine targeted to treatment characteristics in women with breast cancer. While COMB may offer benefits across the outcomes investigated, prescribing RE alone may be preferable to minimize potential interference effects on lean mass and muscle strength, regardless of demographic, clinical and exercise prescription characteristics, as well as fatigue and physical function tests, particularly during adjuvant and hormonal therapies.

The anxiolytic effects of exercise: a systematic review and meta-analysis of randomized controlled trials.

Physical activity recommendations for pregnant women with gestational diabetes mellitus: A best evidence synthesis.

Background: Asthma is a chronic inflammatory airway disease that can limit exercise tolerance and promote physical deconditioning. While aerobic exercise is widely studied and recommended, resistance training remains under-investigated despite potential clinical benefits. Objective: This narrative review summarizes the rationale, physiological mechanisms, and clinical effects of resistance training in adults with asthma, with a focus on practical exercise prescription. Methods: Evidence from randomized controlled trials, systematic reviews, and observational studies addressing resistance, aerobic, and combined exercise interventions in adults with asthma was reviewed. Outcomes included asthma control, muscle strength, exercise capacity, and quality of life. Results: Resistance training improves muscle strength, functional capacity, and exercise tolerance, with a low risk of exercise-induced bronchoconstriction. Combined resistance and aerobic programs further enhance cardiorespiratory fitness, muscle function, and quality of life. Physiological mechanisms involve counteracting deconditioning, enhancing muscle mass, and modulating dyspnoea perception. Structured exercise programs with warm-up, progressive intensity, and symptom monitoring optimize safety and effectiveness. Conclusion: Resistance training is a safe and clinically relevant adjunct to aerobic exercise in asthma management, offering complementary benefits for physical function and quality of life. Further well-designed studies are needed to define optimal protocols, particularly for older adults and severe asthma populations.

This study examined effects of two moderate-intensity aerobic exercise prescriptions on inflammatory cytokines and oxidative stress biomarkers in middle-aged obese Hispanic females. Fifty-four subjects were randomly assigned to a lower-moderate intensity group (55% VO2max, LT, n = 18), an upper-moderate intensity group (70% VO2max, HT, n = 19), or a non-exercise control group (CON, n = 17). Blood samples collected before and after a 12-week intervention were analyzed for tumor necrosis factor-alpha (TNF-α), adiponectin, C-reactive protein (CRP), total antioxidant status (TAS), and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Body fat percentage (%BF) and visceral adipose tissue (VAT) were assessed using dual-energy X-ray absorptiometry. TNF-α significantly decreased in both LT (p = 0.004) and HT (p < 0.001). Significant increases in adiponectin (p = 0.001) and reductions in CRP (p < 0.001) were observed within the HT, whereas these changes were not significant within the LT. TAS significantly increased in both exercise groups (p < 0.001), and 8-OHdG significantly decreased in the HT (p < 0.001) and LT (p = 0.002). Both LT and HT demonstrated significant reductions in %BF (p < 0.001) and VAT (p < 0.05), with no significant changes in CON. Results indicate that moderate-intensity aerobic exercise improves inflammatory and oxidative stress profiles when total exercise volume is matched, regardless of differences in exercise intensity within the moderate range. Although post-intervention differences between groups were not statistically significant, the observation that CRP, adiponectin, and 8-OHdG changed significantly only within HT suggests that exercise intensity may influence biomarker responsiveness and warrants further investigation.

Aging is a multifactorial biological process driven by progressive declines in cellular energy production, hormonal signaling, and immune regulation. While advances in geroscience have identified key molecular hallmarks of aging, translation into practical, clinician-friendly frameworks remains limited. Current medical approaches often address metabolic, endocrine, and inflammatory dysfunction in isolation, which may fail to capture the interconnected biology underlying accelerated aging and chronic disease. The Longevity Triad is presented as a systemsbased clinical framework integrating three interdependent pillars-mitochondrial resilience, hormonal orchestration, and inflammation modulation-to guide precision longevity care. Mitochondria regulate cellular energy availability, redox balance, and stress adaptation; hormonal networks coordinate metabolism, reproduction, and tissue repair; and chronic low-grade inflammation acts as a central accelerator of biological aging. Dysregulation in any one pillar can destabilize the others, creating self-reinforcing feedback loops that promote metabolic decline, immune dysfunction, and reduced physiologic reserve. This manuscript synthesizes emerging mechanistic and clinical evidence linking the Longevity Triad to established hallmarks of aging and demonstrates its application through case-based clinical examples. Diagnostic strategies including functional metabolic testing, comprehensive endocrine assessment, inflammatory and immune biomarkers, and lifestyle-related exposure evaluation are discussed. Targeted interventions encompassing lifestyle modification, nutritional and micronutrient support, exercise prescription, and individualized hormonal optimization are illustrated to show how coordinated, multi-pillar treatment can restore physiologic balance and improve patient-centered outcomes. The Longevity Triad offers a practical, integrative roadmap for clinicians seeking to move beyond symptom-based management toward systems-level, personalized strategies that support healthy aging, metabolic flexibility, and long-term resilience

Exercise reshapes cellular function and intercellular communication through dynamic post-translational modifications (PTMs) that fine-tune protein activity and inter-organ signaling. However, the traditional aerobic-anaerobic dichotomy does not fully capture PTM-driven regulatory logic across exercise modes. This review centers on the muscle-brain and muscle-liver axes and proposes an operational concept of exercise-specific PTM signatures, emphasizing acetylation, ubiquitination, and lactylation as core PTMs implicated in metabolic memory and adaptive remodeling. To connect exercise intensity with metabolic improvement, we introduce the PTM threshold theory and outline how integrated exercise-PTM-disease target databases, coupled with machine-learning approaches, can support personalized exercise prescription and translation toward exercise pharmacology and rare-disease rehabilitation. Overall, PTM-centered regulatory networks provide a unifying and actionable framework for decoding exercise adaptation and prioritizing therapeutic strategies.

Background and aims Exercise is key to ameliorating sleep disorders in obese populations; however, the relative benefits of different exercise modes and the optimal dosage remain unclear. This study aims to systematically evaluate the relative efficacy and dose–response characteristics of seven exercise interventions on sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and body mass index (BMI) in overweight and obese populations via network meta-analysis (NMA). Methods This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and systematically searched nine databases, including PubMed, Embase, and China National Knowledge Infrastructure (CNKI), from inception to 15 October 2025. Randomized controlled trials (RCTs) evaluating the effects of the aforementioned exercise interventions on sleep quality (primarily PSQI) or body mass index (BMI) in overweight or obese individuals were included. Network meta-analysis was conducted using Stata 18.0 software. The standardized mean difference (SMD) was used as the effect size, and interventions were ranked using the Surface Under the Cumulative RAnking curve (SUCRA). Results The network meta-analysis revealed that combined aerobic and resistance training (ART, SUCRA ≈ 77.1%) and resistance training (RT, SUCRA ≈ 75.2%) were significantly superior to other interventions in improving sleep quality. Conversely, erobic Exercise (AE, SUCRA ≈ 74.0%) was most effective in reducing BMI. Dose-effect analysis indicated that improvements in sleep quality did not exhibit significant linear dose-dependency ( p &amp;gt; 0.05). However, BMI improvement showed a significant non-linear “U-shaped” dose–response relationship (p_quadratic = 0.009). The fitted curve suggests that a cumulative intervention duration of 60–70 h represents the optimal dosage window for weight loss, with diminishing marginal returns observed beyond this range. Conclusion Exercise interventions demonstrate significant specificity in their benefits for health outcomes in obese populations. Resistance and combined training are recommended as the preferred strategies for improving sleep, with benefits depending more on the mode than on high cumulative dosage. Conversely, aerobic exercise is the optimal protocol for weight loss, provided the exercise volume is controlled within the optimal dosage window to maximize returns. These findings offer evidence-based grounds for clinical practice to formulate differentiated and precise exercise prescriptions for obesity and sleep management. Systematic review registration www.crd.york.ac.uk/prospero , identifier CRD420251251401.

Studies have established the safety and benefits of exercise training in patients admitted with acute heart failure, yet heterogeneity in exercise delivery patterns exists. Hence, a scoping review was undertaken to map the evidence on early exercise-based interventions (early mobilization with/without exercise training) in patients recovering from acute heart failure (admission to up to 2 weeks post-hospitalization), for geographic distribution, exercise prescription, and exercise initiation time. A systematic search was conducted across 5 databases until September 2024. Studies, including protocols, providing early exercise-based intervention anytime between admission and up to 2 weeks from discharge, in any setting, were included. Data were extracted from 30 included studies, and the obtained evidence was mapped. This study uses the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-Extension for Scoping Reviews. The review included 1,54 980 participants with acute heart failure, and 26.6% (8 of 30) of the studies focused on the older adult population. Early exercise-based interventions, ie, early mobilization (n=12), exercise training (n=5), or combined (n=13), were limited to higher- (n=23) and upper-middle-income (n=6) countries and were primarily observational (n=19) in design. The median (Q1-Q3) initiation time to exercise was 3.8 days (2.8-5.5), with a dose of eight sessions (4.7-21). The intensity ranged from very low to moderate intensity, with the duration per session ranging from 10 to 60 minutes. The use of pre-specified, well-developed initiation, monitoring, and termination criteria was not common. Early exercise-based interventions were comprehensive, multi-modal, and of low-moderate intensity, initiated within 4 days of admission.

Exercise is considered a cornerstone of Metabolic dysfunction-associated steatotic liver disease (MASLD) management, but the independent role of exercise intensity in hepatic fat reduction has not been fully elucidated in clinical practice. The primary objective in this study is to evaluate the difference in exercise-induced reduction of hepatic fat content (HFC) between energy-matched high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT). Furthermore, this study aims to investigate whether high-intensity exercise with lower exercise volume can yield comparable HFC reductions to moderate-intensity continuous training. This single-center, three-arm, open-label randomized controlled trial will recruit 105 adults aged 18-45 years with MASLD. Participants will be randomized in a 1:1:1 ratio to HIIT, MICT, or a low-volume HIIT (LHIIT). The sample size of 35 participants per group was calculated to provide 90% power to detect a significant difference in HFC reduction between the HIIT and MICT groups (two-sided α = 0.05, accounting for 20% dropout). The supervised exercise training will be conducted at a community fitness center for 12 weeks. The primary outcome is the absolute change in HFC, measured by magnetic resonance imaging-proton density fat fraction. Secondary outcomes include anthropometric parameters, abdominal adipose tissue, body composition, cardiometabolic biomarkers, and cardiorespiratory fitness. The analysis of the primary and secondary outcomes will be conducted according to the intention-to-treat principle. This trial rigorously evaluates the independent effect of exercise intensity on HFC under energy-matched conditions, while simultaneously exploring the therapeutic efficiency of low-volume interventions. The findings of this study are expected to provide a theoretical and practical basis for precise exercise prescriptions for the MASLD population. The results will be disseminated through a peer-reviewed journal. https://www.chictr.org.cn/showprojEN.html?proj=279678, identifier ChiCTR2500107821.

Balance is a fundamental component of daily activities and plays a critical role in preventing falls. Balance can be influenced by a variety of factors, including age-related physiological changes, making it important to consider age when assessing balance performance. However, an empirical basis for estimating the difficulty of balance exercises has yet to be developed. The primary aim of this study was to determine the effect of age and different balance exercise conditions on difficulty of exercises as determined by self-reported perceived difficulty, and to show that Rating of Perceived Difficulty (RPD) can serve as a practical measure of difficulty for guiding balance exercise prescription and progression. Sixty-two healthy adults between the ages of 20 and 85 years with a mean age of 55 ± 20 years (50% female) participated in this cross-sectional study. Subjects performed four 30 s trials of 24 static standing balance exercises, and the average of these four trials was used for analysis. For each exercise, subjects' ratings of perceived difficulty (RPD) were recorded using a 0-10 scale. A significant increase in RPD across all balance exercises occurred as age increased (p < 0.02). From the youngest age group to the oldest, RPD increased by more than 100%. Ratings of perceived difficulty increased on a foam surface (110%), eyes closed (43%), semi-tandem stance (150%), and head movement (50%) compared with a firm surface, eyes open, feet apart, and head held still, respectively (p < 0.01). RPD measurements across a range of standing balance exercises can be used as a measure of difficulty and a practical tool for prescribing and progressing balance exercises in rehabilitation programs.