Exercise adherence plays a critical role in lowering physical disability and mortality rates among stroke survivors. Previous research indicates that exercise adherence among stroke survivors is generally low, influenced by various factors, the mechanisms of which remain not yet fully understood. This study aimed to explore the factors affecting exercise adherence in stroke survivors using the Capability, Opportunity, Motivation, and Behavior (COM-B) model in a cross-sectional study. Using convenience sampling, 359 participants were recruited from a tertiary hospital, and they filled out the demographic questionnaire, the Connor-Davidson Resilience Scale, and the Social Support Rating Scale, Stroke Rehabilitation Motivation Scale, and Stroke Functional Exercise Adherence Questionnaire Scale. Structural equation modeling (SEM) was used for data analysis. The average scores for psychological resilience, social support, rehabilitation motivation and exercise adherence were 67.86 ± 16.26, 36.60 ± 6.17, 107.70 ± 15.18, and 41.76 ± 6.13, respectively. The SEM showed a satisfactory fit (χ2/df = 2.097 < 3, RMSEA = 0.055, SRMR = 0.0376, CFI = 0.979, TLI = 0.974, IFI = 0.980, GFI = 0.933, AGFI = 0.902, and NFI = 0.951). Direct path analyses revealed that psychological resilience (β = 0.174, p < 0.01), social support (β = 0.184, p < 0.01), and rehabilitation motivation (β = 0.517, p < 0.001) significantly affected exercise adherence. Furthermore, both psychological resilience (β = 0.142, p < 0.001) and social support (β = 0.218, p < 0.001) exerted indirect effects on exercise adherence through their impact on rehabilitation motivation. Enhancing exercise adherence among stroke survivors requires attention to psychological resilience, social support, and particularly, rehabilitation motivation. The mediating influence of rehabilitation motivation in linking psychological resilience and social support to adherence is especially noteworthy. Interventions targeting these factors may effectively improve exercise adherence and optimize post-stroke recovery outcomes.

Objective: Frozen shoulder is a common condition causing shoulder pain and stiffness, with conventional therapies often hindered by low adherence due to their repetitive and painful nature. This randomized clinical trial aimed to evaluate the clinical effectiveness of immersive virtual reality (VR) exergaming in frozen shoulder rehabilitation.Materials and Methods: Fifty-four patients with primary frozen shoulder were randomly assigned to a VR therapy (VRT) group or a conventional therapy (CT) group. Both groups underwent 18 sessions over 6 weeks, consisting of 20 minutes of continuous passive motion exercises followed by 20 minutes of either VR exergaming or conventional functional exercises. We chose Beat Saber for the VR intervention, a rhythm game in which players slice blocks in sync with music. Its "level editor" allowed us to customize block patterns to simulate therapeutic shoulder movements.Results: Primary outcomes included passive range of motion (PROM) in external rotation, abduction, and flexion. Secondary outcomes assessed shoulder function (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) and resting pain (visual analog scale [VAS]). Assessments were conducted at baseline, postintervention, and 12 weeks after the trial. Both groups showed significant improvements in PROM, DASH, and VAS scores compared with baseline (P < 0.001). Between-group analysis revealed no significant differences in DASH (P = 0.483) or VAS (P = 0.220). However, the VRT group achieved superior abduction (P = 0.015) and flexion (P = 0.031), with no significant difference in external rotation (P = 0.637).Conclusion: These findings suggest VR exergaming is a promising adjunct to CT for frozen shoulder. Further studies are needed to investigate the influence of VR game design on rehabilitation outcomes.

We evaluated TAPSE/PAi, defined as the ratio of tricuspid annular plane systolic excursion to the indexed main pulmonary artery diameter, as a pragmatic functional-structural index and compared it with TAPSE/sPAP. In this retrospective study, 53 patients with PAH were analyzed. Associations of TAPSE/PAi and TAPSE/sPAP with clinical, biomarker, and invasive hemodynamic variables were assessed. Discrimination for WHO-FC ≥ 3, 6MWD < 165m, and PVR > 5 WU was evaluated by direction-aligned ROC analysis with Youden-optimal thresholds. Age- and sex-adjusted logistic regression models reported odds ratios (ORs) per 1-SD increase. TAPSE/PAi correlated more strongly than TAPSE/sPAP with WHO-FC (ρ=-0.592 vs. -0.384) and 6MWD (ρ = 0.493 vs. 0.378), whereas TAPSE/sPAP correlated more strongly with NT-proBNP/proBNP (ρ=-0.619 vs. -0.484) and with mPAP/PVR. TAPSE/PAi showed better discrimination for WHO-FC ≥ 3 and 6MWD < 165m while TAPSE/sPAP performed modestly better for PVR > 5 WU The Youden-optimal TAPSE/PAi threshold was ≤ 1.296 for both WHO-FC ≥ 3 and 6MWD < 165m. The higher TAPSE/PAi remained associated with lower odds of WHO-FC ≥ 3 and 6MWD < 165m after age- and sex-adjustment. TAPSE/PAi better reflects functional severity and exercise limitation, whereas TAPSE/sPAP is more closely related to biomarker/hemodynamic burden. The indices appear complementary, and TAPSE/PAi may be a practical TR-independent severity marker in PAH.

Decline in physical activity is believed to contribute to reduced exercise tolerance and diminished functional fitness. This underscores the importance of rehabilitation training in maintaining adequate levels of both. The aim of this study was to evaluate the relationship between exercise tolerance, functional fitness, age, and participation in rehabilitation training among women over the age of 60. The study included 106 women aged 60 to 89, of whom 60 participated in rehabilitation training and 46 did not. To assess exercise tolerance and functional fitness, researchers employed the 6-min Walk Test and the Short Physical Performance Battery. No significant relationship was found between age and either functional fitness or exercise tolerance among physically active women. Similarly, no association was observed between age and exercise tolerance in the group of inactive women. However, a significant correlation was identified between age and functional fitness in inactive women (p = 0.001). A notable difference in exercise tolerance between active and inactive participants was observed only in the subgroup of women aged 75 to 89, with those engaged in rehabilitation activities achieving significantly better results (p = 0.008). The level of physical activity among female nursing home residents from the western region of Poland is too low and poorly balanced. Rehabilitation training should be individually selected to bring benefits to the elderly.

Prolonged intensive care unit (ICU) hospitalization due to acute respiratory distress syndrome results in reduced muscle strength and increased fatigability. This study investigated the central and peripheral neuromuscular mechanisms underlying these impairments in sixty COVID-19 patients up to 12 months post-ICU discharge. Muscle strength (maximal voluntary contraction; MVC), functional exercise capacity (six-minute walk test; 6MWT), and perceived fatigue (Fatigue Severity Scale; FSS) were assessed at each follow-up. High-Density surface electromyography was collected from the Tibialis anterior muscle at 30%, 50%, and 70% MVC. 6MWT distance increased from 3 to 6 months, but not 6-12. FSS declined from 6 to 12 months, while MVC increased across both intervals. Motor unit (MU) discharge rate decreased from 6 to 12 months at all contraction intensities and from 3 to 6 months at 50% and 70% MVC. MU discharge variability decreased at all levels except 70% MVC from 3 to 6 months. MU action potential amplitude increased from 3 to 6 months but not 6-12. Central MU properties correlated with voluntary force at 3-6 months and with fatigue scores at 6-12 months. These interval-based analyses indicate that associations between neural adaptations and muscle strength were more prominent between 3 and 6 months following ICU discharge, whereas associations with perceived fatigue were more evident between 6 and 12 months.

Abstract Background and aims In acute stroke rehabilitation timely and frequent motor practice is essential for recovery (1,2). Staffing pressures and high patient volumes can limit opportunities for 1:1 therapy, potentially reducing daily activity time (3,4). We introduced an "open gym" model to increase patient-led activity, promote social interaction, and maximise staff efficiency. How can introducing an open gym model increase patient-led activity, promote social interaction and maximise staff efficiency? Methods An open gym space was established, allowing patients to access functional exercise equipment and participate in activities outside of scheduled therapy sessions. One physiotherapist and one rehabilitation assistant facilitated safe use but encouraged self-directed exercise and peer interaction. Data was collected over 4 weeks each at two stamp points (December 2024 and August 2025), comparing the average number of minutes of activity overall, number of patients seen by therapists and qualitative feedback from patients. Results Findings show an increase in average motor activity time in an open gym setting compared to a 1:1 session per patient. The number of patients engaged in rehabilitation activities per therapist increased. Patient feedback highlighted enhanced motivation, an increase in the number of repetitions achieved and understanding of why exercise is important. Conclusions The open gym model in acute stroke rehab can increase motor activity time, enhance social engagement, and promote accountability, offering a viable solution for maximising recovery opportunities when resources are limited. Conflict of interest Hayley West: nothing to disclose

Background: Hybrid cardiac rehabilitation (CR) combining supervised and home-based phases with wearable monitoring may improve access and outcomes after myocardial infarction (MI). Objective: To assess the impact of a 14-week hybrid CR program on functional class, exercise capacity, hemodynamics, body composition, and physical activity in post-MI patients with NYHA class II symptoms. Methods: Sixty-six adults post-MI underwent 2 weeks of in-hospital initiation followed by 12 weeks of home-based rehabilitation via a smartwatch–smartphone platform. Within-subject changes from baseline to week 14 were analyzed using appropriate paired statistical tests. Results: NYHA class improved significantly, with 39% of participants downgrading their class (p < 0.001). Body weight decreased by 1.27 ± 2.51 kg (p < 0.001). Systolic and diastolic blood pressures declined (both p ≤ 0.002). Maximal METS rose markedly (25.7% increase; p < 0.001), and watts/kg improved (p < 0.001). Resting heart rate decreased (p = 0.002); peak exercise heart rate change was non-significant. Fat mass declined and skeletal muscle mass increased (mean gain 0.98 kg; p < 0.001). Daily step count increased from 5550 ± 2026 to 7267 ± 2500 steps (p < 0.001). Total body water also increased (p < 0.001). Conclusions: The hybrid CR program produced significant improvements in functional class, exercise capacity, blood pressure, body composition, and physical activity in post-MI NYHA II patients, supporting its effectiveness as a remotely enabled secondary prevention strategy. However, the results are based on hypotheses and randomized controlled trials must confirm the benefits especially with a control group. Nonetheless, it is a feasible and potentially effective alternative to conventional programs in resource-limited settings.

ABSTRACT Background and Objective Respiratory dysfunction is a prevalent but underrecognized problem in individuals with spastic cerebral palsy (CP). Despite extensive research on postural control, functional capacity, and activities of daily living (ADL), the role of respiratory muscle strength in these functional domains remains largely unexplored. This study aimed to examine whether respiratory muscle strength is associated with postural control, functional exercise capacity, and activities of daily living (ADL) in individuals with spastic CP. Methods In this cross-sectional study, 29 individuals with spastic cerebral palsy and 29 typically developing peers were evaluated. Respiratory muscle strength was assessed using maximal inspiratory (MIP) and expiratory (MEP) pressures. Postural control (Trunk Control Measurement Scale (TCMS), Pediatric Berg Balance Scale (PBBS)), functional skills (Pediatric Disability Assessment Inventory (PEDI)- Functional Skills Section (FSS)), and exercise capacity (2MWT) were recorded. Results Individuals with CP demonstrated significantly lower MIP, MEP, TCMS, PBBS, PEDI-FSS, and 2MWT scores compared to typically developing peers (p < .001). Moderate to high correlations were found between respiratory muscle strength and postural control, ADL performance, and functional exercise capacity (r = 0.44–0.88). MIP explained 32% of trunk control, 30% of functional skills, and 39% of exercise capacity. Discussion: Respiratory muscle strength is a key determinant of trunk stability, balance, functional capacity, and ADL performance in spastic CP. Systematic assessment and incorporation of respiratory muscle training into rehabilitation may enhance functional outcomes. ClinicalTrials.gov Identifier NCT05682079.

Functional Activities to Optimize Patient Outcomes in Home Health: A Pilot Randomized Controlled Trial.

To determine the efficacy of functional training on cardiorespiratory fitness in individuals with cerebral palsy (CP). Randomized controlled trials involving individuals with CP who had functional training interventions, which also reported cardiorespiratory fitness outcomes, were included in this systematic review. Two independent reviewers searched PubMed, MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL up to February 2025, and selected studies and extracted data. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. Mean differences and standard mean differences with 95% confidence intervals (CIs) were calculated. From 594 papers, 11 randomized controlled trials (n=387, mean ages 5 years 10 months-20 years 6 months, Gross Motor Function Classification Systems levels I-IV) were included. Functional training had statistically and clinically significant effects on the 6-minute walk test (mean difference=30.91; 95% CI=28.34-33.48; p < 0.001) and Physiological Cost Index (mean difference=-0.16; 95% CI=-0.20 to -0.13; p < 0.001). No effect was found for gait speed or the timed stair test. Functional training has the potential to improve functional exercise capacity in individuals with CP. Given the significant impact of cardiorespiratory problems on the morbidity and mortality of individuals with CP, integrating cardiorespiratory parameters into functional training programmes may contribute to long-term health benefits.

Poor adherence to home-based functional exercises can substantially hinder recovery after ischemic stroke. This study aimed to develop and validate a web-based predictive nomogram to identify patients with ischemic stroke who are at risk of poor adherence to home-based functional exercises. We conducted a cross-sectional study of 536 patients with ischemic stroke and limb dysfunction at a tertiary hospital in China. Latent profile analysis (LPA) was used to classify adherence patterns based on the Exercise Adherence Questionnaire. The least absolute shrinkage and selection operator (LASSO) regression was applied to select predictors from 35 candidate variables, and multivariable logistic regression was then used to build the prediction model. Model performance was internally validated using 1000 bootstrap resamples and assessed in terms of discrimination, calibration, and clinical utility. A web-based nomogram was developed for clinical use. The sample included 254 males (47.4%) and 282 females (52.6%); 61.0% were aged ≥60 years. LPA identified three adherence profiles: low (18.1%), moderate (42.2%), and high (39.7%). The optimal cutoff score for distinguishing good from poor adherence was 36.5 points. Five independent predictors were retained: marital status (never married: odds ratio [OR] = 0.03, 95% confidence interval [CI]: 0.01-0.11), monthly income >5000 RMB (OR = 0.31, 95% CI: 0.14-0.67), spouse as primary caregiver (OR = 0.23, 95% CI: 0.10-0.53), knowledge level (OR = 0.92, 95% CI: 0.87-0.98), and exercise motivation (OR = 0.87, 95% CI: 0.81-0.93). Internal validation using 1000 bootstrap resamples showed good discrimination (apparent C-statistic = 0.858; optimism-corrected C-statistic = 0.848), good calibration (optimism-corrected calibration slope = 0.939; calibration intercept = 0.009), and a positive net benefit across threshold probabilities ranging from 0 to 0.80. After uniform shrinkage, model performance remained stable. We developed and internally validated a prediction model combining LPA with LASSO-logistic regression. The web-based nomogram may facilitate early identification of patients at risk of poor adherence to home-based functional exercises and support targeted interventions to improve rehabilitation outcomes.

Safety and efficacy of Nordic walking training in adult patients with asthma: A pilot randomised controlled trial with a mixed-methods approach.

Effects of adding balance training to pulmonary rehabilitation in individuals with COPD: A systematic review and meta-analysis of randomized controlled trials.

The present study aimed to examine the effects of a structured circuit training (CT) program on selected physical fitness variables, namely speed, strength, and agility, among private school students. In contemporary educational settings, students often experience reduced opportunities for moderate-to-vigorous physical activity due to academic demands, leading to declining fitness levels. Circuit training, characterized by a series of functional exercises performed consecutively with minimal rest, offers a time-efficient and effective training modality to address this issue. This paper adopts a theoretical and analytical approach by synthesizing evidence from exercise physiology, high-intensity functional training (HIFT), and occupational fitness research to propose a school-based CT model. The program emphasizes principles of specificity, progressive overload, variation, and recovery, and includes multi-joint, functional, and plyometric exercises designed to enhance neuromuscular and metabolic adaptations. The findings suggest that a well-designed CT program can significantly improve muscular strength through neural adaptations, enhance sprint performance by increasing rate of force development, and improve agility through better coordination, reactive strength, and movement efficiency. Additionally, improvements in aerobic and anaerobic capacity support sustained performance and faster recovery during physical activity. In conclusion, circuit training is an effective, adaptable, and practical approach for improving key fitness components in school settings. Its integration into physical education curricula can help bridge the gap between theoretical fitness importance and practical implementation, ultimately promoting holistic physical development and long-term health benefits among students.

Difficult-to-Control Asthma (DTCA) is characterized by persistent symptoms, frequent exacerbations, and reduced functional capacity despite optimized pharmacological therapy. Patients with DTCA commonly exhibit peripheral muscle dysfunction, making strategies that may potentiate the effects of resistance training clinically relevant. Photobiomodulation therapy (PBMT) has been investigated as a modality capable of improving muscle performance and exercise tolerance. The aim of this study was to determine whether combining resistance training with LED-based PBMT (RT+LEDT) results in greater improvements in peripheral muscle strength and functional exercise capacity compared with resistance training alone in adults with DTCA. This randomized, triple-blind controlled trial included 30 adults with DTCA who met predefined inclusion and exclusion criteria. Participants were allocated equally to an experimental group (RT+LEDT; n = 15) or a control group (RT; n = 15). Both groups completed supervised resistance training twice weekly for 12 weeks. The experimental group received active PBMT before each session, while the control group received placebo PBMT. The primary outcome was peripheral muscle strength assessed by one-repetition maximum (1RM). Secondary outcomes included cardiopulmonary exercise test variables, shuttle walk test performance, spirometry, physical activity level, and asthma control. Post-intervention group comparisons were performed using independent t-tests. Compared with RT alone, RT+LEDT produced greater post-treatment gains in 1RM strength across major muscle groups, along with significant improvements in oxygen consumption at the anaerobic threshold and shuttle walk test distance. No between-group differences were observed in pulmonary function or asthma control. PBMT combined with resistance training yielded clinically meaningful improvements in muscle strength and functional capacity, suggesting its potential as an adjunctive strategy in rehabilitation programs for DTCA.

Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular and autonomic complications. Although cardiopulmonary exercise testing (CPET) is a valuable tool for assessing cardiorespiratory function, data on physiological response to maximal exertion in adolescents with T1D remain limited and inconsistent. This study aimed to compare cardiovascular, respiratory, metabolic, and microvascular responses to CPET in adolescents with T1D and healthy peers. Sixteen participants aged 11-16 years (eight with T1D and eight healthy controls), matched for anthropometric characteristics, underwent CPET on a cycle ergometer. Respiratory gas exchange, heart rate, heart rate variability, blood pressure, blood glucose, lactate concentration, skin blood flow, skin temperature, and cutaneous vascular conductance were measured at predefined time points during rest, exercise, and recovery. Blood glucose, lactate concentration, and skin microvascular variables were assessed at rest and during recovery. Adolescents with T1D demonstrated a significantly lower V̇O2/power output slope and a higher ventilatory equivalent for oxygen at maximal effort, suggesting altered oxygen uptake efficiency. Maximal power output and maximal oxygen consumption did not differ between groups. Heart rate responses and heart rate variability were similar throughout testing. However, finger skin blood flow and cutaneous vascular conductance were significantly lower in the T1D group at rest and during recovery. Adolescents with T1D showed preserved cardiovascular function and comparable overall exercise capacity to healthy peers, despite subtle impairments in oxygen utilization and reduced skin microvascular function. These findings indicate that even at a young age, T1D is associated with altered metabolic, respiratory, and microvascular responses to maximal exercise. The results suggest that peripheral, rather than central mechanisms may underlie these differences, potentially involving glucose levels or synthetic insulin effects on vascular endothelium.

Objective: Functional training exercises involve complex multi-joint movements that challenge traditional rule-based or data-driven recognition systems. This paper introduces a Movement Description Language (MDL) designed to formally represent, analyze, and evaluate such exercises using camera-based pose estimation and interpretable, composable structures. Methods: The proposed MDL models each exercise as a finite-state machine defined by pose-derived angle proxy transitions, allowing movements to be described in a modular and reusable way. Demonstrated with MediaPipe landmark extraction from monocular video, while the MDL remains compatible with any pose estimation algorithm, the framework focuses on exercise phase detection and repetition counting. Experimental validation was conducted on a dataset of 1513 videos of 12 functional exercises (squats, deadlifts, lunges, shoulder presses, planks, push-ups, pull-ups, bent-over rows, box jumps, thrusters, overhead squats, and burpees) obtained from public pose datasets, competition footage, and recordings of 9 participants in real-world environments. Results: Automated repetition counts were compared against manually annotated ground truth, showing an overall repetition-counting accuracy of 97.2%, with a mean per-exercise accuracy of 98.8% (range 95-100%). The MDL successfully handled both simple and compound exercises, maintaining reliable phase detection despite variations in execution speed, camera perspective, and environmental conditions. Conclusion: The system was implemented using real-time pose estimation to demonstrate the practical execution of the MDL framework. The proposed MDL provides a transparent, extensible, and computationally efficient framework for functional exercise analysis. By bridging human-readable movement semantics with executable motion logic, it enables interpretable automatic repetition counting and phase detection, offering an alternative to black-box recognition approaches. The results support its potential for scalable deployment in training, monitoring and movement analysis applications. The proposed system is not intended for biomechanical measurement or clinical-grade kinematic analysis, but rather for interpretable modeling of exercise structure and repetition detection using approximate pose-derived signals.

With growing global life expectancy, age-related physical problems, including balance impairments, are becoming more prevalent, increasing the risk of falls, mobility limitations, and loss of independence. This review summarizes current evidence on how balance may be influenced and improved by training modalities including reactive, strength-based, and functional exercises, through neuromuscular adaptations relevant to postural control and functional stability in older adults. Emerging evidence suggests that gut microbiota may influence neuromuscular health via neuroimmune, metabolic, and mitochondrial pathways across the gut-muscle-brain axis. However, most studies focus on muscle metabolism, inflammation, and systemic physiological processes rather than direct assessments of balance or postural control. Gut dysbiosis has been associated with sarcopenia and impaired physical function, although evidence linking microbiota alterations to balance outcomes remains limited and mainly observational. Exercise has beneficial effects on neuromuscular function and gut microbial composition, including increased diversity and metabolite production. While exercise-induced neuromuscular adaptations are well supported experimentally, little direct evidence shows the contribution of gut-related mechanisms to balance regulation. Overall, neuromuscular and gut-related processes seem to be associated with balance capacity in older adults; however, further mechanistic and interventional studies are required to clarify the role of the gut-muscle-brain axis for balance.

Efficacy of Aficamten in Hypertrophic Cardiomyopathy Patients With Very-High Left Ventricular Outflow Tract Gradients.

The Impact of Neighborhood Material and Social Disadvantage on Respiratory Health Across Canada.