Improvement In Physical Performance Research Articles

The effectiveness of medical and psychological rehabilitation of patients with nervous tension

Abstract. The prevalence of anxiety disorders during life among residents of developed countries reaches 34 %. The low effectiveness of pharmacotherapy and psychotherapy determines the search for comprehensive technologies for the treatment of patients with nervous tension. The purpose of the study: to determine the prognosis of the effectiveness of medical and psychological rehabilitation (MPR) in patients with nervous tension and to identify its determinants. Methods: 254 patients aged 32 (19–50) years with nervous tension (ICD–X code R45.0) were studied. The complex of medical and psychological rehabilitation included physical exercises, courses of audiovisual polysensory relaxation, transcranial magnetic therapy, alpha massage, sodium chloride baths, climatotherapy, cognitive behavioral psychotherapy and therapeutic nutrition. The total duration of the MPR course is 10–20 days. To determine the relationship between integral health parameters and individual clinical and functional signs of nervous tension, correlation analysis was performed, canonical correlation analysis was used to select the most informative signs, and discriminant analysis was used to determine the prognosis of MPR and the dominants of its effectiveness. Results: A significant improvement in clinical and psychological status, physical health, increased physical performance, increased adaptive potential and autonomic regulation in patients was revealed. Significant high correlations of improvement of adaptive potential and physical performance with SAD (0.77), double product (0.81), Martin — Kushelevsky breakdown (0.74), average — with heart rate (0.58), DBP (0.69), level of physical health (0.54), weak — with BMI (0.47) were established. The effectiveness of MPR in patients with FA is 90 %. The determinants of effectiveness are indicators characterizing the heart rate, SAD, double product, BMI, age, Kerdo vegetative index, DAD, indicators of the Martinet — Kushelevsky test and physical performance PWC170–1. Conclusion: Various components of the pathogenesis of nervous tension determine the choice of rehabilitation technologies, the combination of mechanisms of therapeutic action of which determine the high effectiveness of MPR in patients with nervous tension.

Seasonal Variation in Vitamin D Status Does Not Interfere with Improvements in Aerobic and Muscular Endurance in Conscripts during Basic Military Training.

Considering a lack of respective data, the primary objective of this study was to assess whether seasonal variation in vitamin D status (D-status) affects the extent of improvement in physical performance (PP) in conscripts during basic military training (BMT). D-status, PP and several blood parameters were measured repeatedly in conscripts whose 10-week BMT started in July (cohort S-C; n = 96) or in October (cohort A-C; n = 107). D-status during BMT was higher in S-C compared to A-C (overall serum 25(OH)D 61.4 ± 16.1 and 48.5 ± 20.7 nmol/L, respectively; p < 0.0001). Significant (p < 0.05) improvements in both aerobic and muscular endurance occurred in both cohorts during BMT. Pooled data of the two cohorts revealed a highly reliable (p = 0.000) but weak (R2 = 0.038-0.162) positive association between D-status and PP measures both at the beginning and end of BMT. However, further analysis showed that such a relationship occurred only in conscripts with insufficient or deficient D-status, but not in their vitamin D-sufficient companions. Significant (p < 0.05) increases in serum testosterone-to-cortisol ratio and decreases in ferritin levels occurred during BMT. In conclusion, a positive association exists between D-status and PP measures, but seasonal variation in D-status does not influence the extent of improvement in PP in conscripts during BMT.

Assessing the individual relationships between physical test improvements and external load match parameters in male professional football players-a brief report.

This study aimed to explore whether a meaningful improvement in physical performance following an in-season strength training intervention can be related to external load match parameters at an individual level in professional male football players. Eight male professional football players (25.4 ± 3.1 years, 184.1 ± 3.4 cm, 79.3 ± 2.2 kg) completed a 10-week strength intervention period in addition to football-specific training and matches. Commonly used physical and external load measures were assessed before and after intervention. Physical performance improvements had to exceed the measurement's typical error and the smallest worthwhile difference (SWD) to be considered meaningful. External load match parameters were assessed before and after the intervention period using SWD and non-overlap of all pairs (NAP) analysis. A Bayesian pairwise correlation analysis was performed to evaluate relationships between changes in physical performance and external load match parameters. Three players displayed meaningful improvements in two to five physical performance measures. However, positive changes exceeding the SWD and positive effects in NAP results were observed for all players in external load match parameters. Kendall's tau correlation analysis showed evidence (base factor >3) for only one correlation (maximum speed - decelerations, τ = -0.62) between the changes in physical performance and external load measures, while the remaining comparisons exhibited no relation. The findings suggest that improvements in physical performance may not necessarily translate to improvements in external load match parameters. Further research, with larger sample sizes, is needed to understand potential mechanisms between acute and chronic physical performance changes and football external load parameters during training and matches.

The Use of Diets to Improve the Quality of Life of Women With Breast Cancer.

There has been an increase in the incidence of breast cancer cases in the last decade, and despite the treatment increasing the chances of survival, it reduces the quality of life. In this context, diets could decrease the adverse effects of treatment and improve quality of life. A form with the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, which contains specific scores for physical, cognitive, emotional, symptomatic, and functional performance, was made available in a Facebook support group. Afterward, the data were analyzed using linear regression and a t-test of independent samples using Jamovi version 2.3.24 (retrieved from https://www.jamovi.org). There was a low number of participants who followed the ketogenic diet or intermittent fasting. In general, adherence to the diets was good. In the t-test, diets showed improvement in physical performance. Linear regression correlated treatment with chemotherapy, metastases, and bad diet adherence with worse symptomatic scores. There is evidence that diets can improve the symptoms of these patients; however, there is no consensus about which diet produces the best effect, requiring further studies on this subject.

Partially supervised exercise programmes for fall prevention improve physical performance of older people at risk of falling: a three-armed multi-centre randomised controlled trial

BackgroundFalls have a major impact on individual patients, their relatives, the healthcare system and related costs. Physical exercise programmes that include multiple categories of exercise effectively reduce the rate of falls and risk of falling among older adults.MethodsThis 12-month, assessor-blinded, three-armed multicentre randomised clinical trial was conducted in adults aged ≥ 65 years identified as at risk of falling. Four hundred and five participants were randomly allocated into 3 groups: experimental group (n = 166) with the Test&Exercise partially supervised programme based on empowerment delivered with a tablet, illustrated manual and cards, reference group (n = 158) with the Otago partially supervised programme prescribed by a physiotherapist delivered with an illustrated manual and control group (n = 81) with the Helsana self-administrated programme delivered with cards. Experimental and reference groups received partially supervised programmes with 8 home sessions over 6 months. Control group received a self-administered program with a unique home session. The 3 groups were requested to train independently 3 times a week for 12 months. Primary outcome was the incidence rate ratio of self-reported falls over 12 months. Secondary outcomes were fear of falling, basic functional mobility and balance, quality of life, and exercise adherence.ResultsA total of 141 falls occurred in the experimental group, 199 in the reference group, and 42 in the control group. Incidence rate ratios were 0.74 (95% CI 0.49 to 1.12) for the experimental group and 0.43 (95% CI 0.25 to 0.75) for the control group compared with the reference group. The Short Physical Performance Battery scores improved significantly in the experimental group (95% CI 0.05 to 0.86; P = 0.027) and in the reference group (95% CI 0.06 to 0.86; P = 0.024) compared with the control group.ConclusionThe self-administered home-based exercise programme showed the lowest fall incidence rate, but also the highest dropout rate of participants at high risk of falling. Both partially supervised programmes resulted in statistically significant improvements in physical performance compared with the self-administered programme.Trial registrationNCT02926105. ClinicalTrials.gov. Date of registration: 06/10/2016.

Health consultations at a performing arts health centre among classical music students based on electronic health record data: a cross-sectional study.

Physical and mental health problems in music students are usually identified using self-reported data. The use of an Electronic Health Record database can avoid biases to give an overview of the extent of health problems in this population. Therefore, the aim of this study is to gain insight into both physical and mental health related issues in classical music students using this type of data collection. An Electronic Health Record database including five years of data from a Performing Arts Health Centre (PAHC) of a university or the arts, was used to analyze the number and characteristics of health consultations in music students. The total number of students, health consultations and the average number of visits per health consultation were calculated over five years. Furthermore, numbers and percentages of both physical and mental health consultations were registered. Also, the number and percentage of health consultations per instrument group were compared to the proportion of each instrument group within the specific sample. Over a period of five years, 230 students visited the PAHC and 417 health consultations were reported. 43.5% of the students who visited a health professional indicated at least one physical health consultation, 29.1% at least one mental health consultation and 27.4% at least one in both categories. An injury was the most frequently registered physical health consultation (40.2%), followed by performance improvement (9.8%) and stress (9.6%). Voice students registered relatively most health consultations. As far as we know, this is the first cross-sectional study using Electronic Health Record data from a PAHC to gain insight into both physical and mental health related issues in a population of classical music students. Looking at the variety of health consultations registered in the database, a multidisciplinary team and multidisciplinary approach are necessary to meet the needs of the students in terms of physical and mental health support and performance improvement.

Pulmonary diffusing capacity for carbon monoxide and nitric oxide after COVID-19: A prospective cohort study (the SECURe study).

Many patients exhibit persistently reduced pulmonary diffusing capacity after coronavirus disease 2019 (COVID-19). In this study, dual test gas diffusing capacity for carbon monoxide and nitric oxide (DL,CO,NO) metrics and their relationship to disease severity and physical performance were examined in patients who previously had COVID-19. An initial cohort of 148 patients diagnosed with COVID-19 of all severities between March 2020 and March 2021 had a DL,CO,NO measurement performed using the single-breath method at 5.7months follow-up. All patients with at least one abnormal DL,CO,NO metric (n=87) were revaluated at 12.5months follow-up. The DL,CO,NO was used to provide the pulmonary diffusing capacity for nitric oxide (DL,NO), the pulmonary diffusing capacity for carbon monoxide (DL,CO,5s), the alveolar-capillary membrane diffusing capacity and the pulmonary capillary blood volume. At both 5.7 and 12.5months, physical performance was assessed using a 30 s sit-to-stand test and the 6min walk test. Approximately 60% of patients exhibited a severity-dependent decline in at least one DL,CO,NO metric at 5.7months follow-up. At 12.5months, both DL,NO and DL,CO,5s had returned towards normal but still remained abnormal in two-thirds of the patients. Concurrently, improvements in physical performance were observed, but with no apparent relationship to any DL,CO,NO metric. The severity-dependent decline in DL,NO and DL,CO observed at 5.7months after COVID-19 appears to be reduced consistently at 12.5months follow-up in the majority of patients, despite marked improvements in physical performance.

Promoting pain coping skills in haemophilia: A remote intervention integrating exercise and pain education.

Chronic joint pain is a significant and widespread symptom in people with haemophilia (PWH). Despite medical advancements, effective pain management remains challenging. This study presents an innovative approach that integrates remote physical exercises, pain neuroscience education, and coping strategies to address chronic pain in PWH. The remote intervention consisted of sixteen 5-min videos encompassing physical exercises for chronic pain management and pain education strategies. These videos formed an 8-week remote intervention program. Clinical and physical assessments were conducted before and after the intervention. A total of thirty-one PWHs, with a median age of 34 years (ranging from 16 to 59years), completed the remote intervention. The study revealed significant improvements in pain intensity, disability, and physical performance among PWH with chronic pain. Enhanced functional capacity was evident in the Timed Up and Go and Single Leg Stance tests, accompanied by improved scores on the Functional Independence Score in Haemophilia (FISH). Although lacking a control group, our findings are consistent with other successful exercise and pain education programs. This innovative intervention holds promise for managing chronic pain in PWH, underscoring patient empowerment, education, and collaboration. Notably, our study stands out by uniquely combining pain education and coping strategies, bolstering evidence for effective pain management.

Hip abductor strengthening vs iliotibial band stretching exercises in conventional knee osteoarthritis rehabilitation: a comparative trial

Abstract The aim of this study is to compare the effect of hip abductor and iliotibial band (ITB) exercises for patients of knee osteoarthritis (OA). 60 patients with knee OA were randomly divided into three groups. Group A received hip abductor strengthening along with quadriceps strengthening exercises, Group B received iliotibial band stretching along with quadriceps strengthening exercises and Group C received conventional knee exercises. The treatment duration was three sessions per week in alternate days for 3 weeks. The outcome measures were pain, physical performance and quality of life, which were evaluated at the baseline and after 3 week of intervention with the visual analogue scale, chair sit to stand test and knee injuries and osteoarthritis outcome score questionnaire. All the three groups showed statistically significant improvement in pain, physical performance and quality of life in patients with knee OA. Hip abductor strengthening exercises group showed more significant improvement in pain, physical performance and quality of life than the Iliotibial band stretching exercises group. The results of the study suggest that the hip abductor strengthening exercises can be more effective than iliotibial band stretching exercises in reducing pain, improving quality of life and physical performance in patients with knee osteoarthritis. But we can also use iliotibial band stretching exercises with other interventions in case of knee OA because iliotibial band stretching exercises also gives result in reduction of pain, symptoms and improvement in physical performance and quality of life. Clinical trial registry of India No. CTRI/2023/06/054225

Nonpharmacological Interventions for Chronic Pain in Older Adults: A Systematic Review and Meta-Analysis.

Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Nonpharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different nonpharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions. Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences -0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity. Nonpharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults.

Association of Hibiscus sabdariffa and high-intensity interval training induces reduction in adiposity and beneficial metabolic adaptations in obesity without changes in lipid metabolism.

High-intensity interval training (HIIT) has stood out as a treatment for obesity, leading to adaptations of the cardiovascular system and reducing body adiposity. In addition, the search for alternative therapies for weight loss has intensified. The administration of Hibiscus sabdariffa (Hs) has been described as an efficient supplement in weight loss and in the treatment of metabolic changes associated with obesity. In this context, the objective was to investigate the effects of the association of Hs and HIIT on metabolic adaptations and lipid metabolism in obese rats. Wistars rats were subjected to obesity and subsequently randomized into 4 groups: obese (Ob), obese + HS (ObHs), obese + HIIT (ObHIIT), and obese + HS + HIIT (ObHsHIIT). For 8 weeks, ObHs and ObHsHIIT rats received Hs extract daily (150 mg/kg of body weight) and trained groups (ObHIIT and ObHsHIIT) were subjected to a HIIT program on a treadmill. Nutritional profile, glycemic curve, biochemical profile, and liver glycogen were determined. HIIT decreased caloric intake, feed efficiency, body adiposity, total body fat, and body weight gain, associated with improvements in physical performance parameters and a smaller glycemic curve and area. Hs had a hepatoprotective effect, reducing alkaline phosphatase values, but its effects were more pronounced when associated with HIIT. Therefore, the combination of treatments promoted a reduction in food consumption and body adiposity, as well as an improvement in physical performance and glycemic profile, but without changes in lipid metabolism.

Microbiome and physical activity.

Regular physical activity promotes health benefits and contributes to develop the individual biological potential. Chronical physical activity performed at moderate and high-intensity is the intensity more favorable to produce health development in athletes and improve the gut microbiota balance. The athletic microbiome is characterized by increased microbial diversity and abundance as well as greater phenotypic versatility. In addition, physical activity and microbiota composition have bidirectional effects, with regular physical activity improving microbial composition and microbial composition enhancing physical performance. The improvement of physical performance by a healthy microbiota is related to different phenotypes: i) efficient metabolic development, ii) improved regulation of intestinal permeability, iii) favourable modulation of local and systemic inflammatory and efficient immune responses, iv) efective regulation of systemic pH and, v) protection against acute stressful events such as environmental exposure to altitude or heat. The type of sport, both intensity or volume characteristics promote microbiota specialisation. Individual assessment of the state of the gut microbiota can be an effective biomarker for monitoring health in the medium to long term. The relationship between the microbiota and the rest of the body is bidirectional and symbiotic, with a full connection between the systemic functions of the nervous, musculoskeletal, endocrine, metabolic, acid-base and immune systems. In addition, circadian rhythms, including regular physical activity, directly influence the adaptive response of the microbiota. In conclusion, regular stimuli of moderate- and high-intensity physical activity promote greater diversity, abundance, resilience and versatility of the gut microbiota. This effect is highly beneficial for human health when healthy lifestyle habits including nutrition, hydration, rest, chronoregulation and physical activity.

Molecular profiling of high-level athlete skeletal muscle after acute endurance or resistance exercise – A systems biology approach

ObjectiveLong-term high-level exercise training leads to improvements in physical performance and multi-tissue adaptation following changes in molecular pathways. While skeletal muscle baseline differences between exercise-trained and untrained individuals have been previously investigated, it remains unclear how training history influences human multi-omics responses to acute exercise. MethodsWe recruited and extensively characterized 24 individuals categorized as endurance athletes with >15 years of training history, strength athletes or control subjects. Timeseries skeletal muscle biopsies were taken from M. vastus lateralis at three time-points after endurance or resistance exercise was performed and multi-omics molecular analysis performed. ResultsOur analyses revealed distinct activation differences of molecular processes such as fatty- and amino acid metabolism and transcription factors such as HIF1A and the MYF-family. We show that endurance athletes have an increased abundance of carnitine-derivates while strength athletes increase specific phospholipid metabolites compared to control subjects. Additionally, for the first time, we show the metabolite sorbitol to be substantially increased with acute exercise. On transcriptional level, we show that acute resistance exercise stimulates more gene expression than acute endurance exercise. This follows a specific pattern, with endurance athletes uniquely down-regulating pathways related to mitochondria, translation and ribosomes. Finally, both forms of exercise training specialize in diverging transcriptional directions, differentiating themselves from the transcriptome of the untrained control group. ConclusionsWe identify a “transcriptional specialization effect” by transcriptional narrowing and intensification, and molecular specialization effects on metabolomic level Additionally, we performed multi-omics network and cluster analysis, providing a novel resource of skeletal muscle transcriptomic and metabolomic profiling in highly trained and untrained individuals.

Physical rehabilitation in heart failure with reduced ejection fraction: are the cardiac implantable devices a barrier?

The development of implantable cardiac devices brought a spectacular improvement in the prognosis of patients with heart failure with reduced ejection fraction, reducing the risk of sudden cardiac death by implanting a cardiac defibrillator, improving ventricular remodeling through cardiac resynchronization and, at the same time, increasing the pa-tient's functional capacity, reducing decompensation episodes and hospitalization. Phys-ical training at moderate exercise intensity is safe and effective in patients with heart fail-ure and cardiac implantable devices; even if they have a severely impaired effort capacity and device-related issues, the assessment of the disease status and of the device parame-ters before the enrollment in the training program warrants the improvement of physical performance and disease outcomes without notable adverse events.

Simultaneous Data Dissemination Among WiFi and ZigBee Devices

Recent advances in Cross-Technology Communication (CTC) have opened a new door for cooperation among heterogeneous IoT devices to support ubiquitous applications, such as smart homes and smart offices. However, existing work mainly focuses on physical layer performance improvements. In this paper, we explore how to leverage the latest CTC techniques for network layer performance improvements. Specifically, we introduce Waves, which leverages WiFi to ZigBee CTC and WiFi access point’s adaptive transmit power control techniques for reliable and fast data dissemination in low-duty-cycle ZigBee networks. We extensively evaluate our design under various settings. Evaluation results show that Waves can provide reliable data dissemination and is 33.5 times faster than the state-of-the-art protocol in terms of dissemination time.

The impact of elective total hip and knee arthroplasty on physical performance in orthogeriatric patients: a prospective intervention study

BackgroundOsteoarthritis is a prevalent condition in older adults that leads to reduced physical function in many patients and ultimately requires hip or knee replacement. The aim of the study was to determine the impact of hip and knee arthroplasty on the physical performance of orthogeriatric patients with osteoarthritis.MethodsIn this prospective study, we used data from 135 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Physical function, measured by the Short Physical Performance Battery (SPPB), was assessed preoperatively, 3 and 7 days postoperatively, 4–6 weeks and 3 months after hip and knee arthroplasty. For the statistical analysis, the Friedman test and post-hoc tests were used.ResultsOf the 135 participants with a mean age of 78.5 ± 4.6 years, 81 underwent total hip arthroplasty and 54 total knee arthroplasty. In the total population, SPPB improved by a median of 2 points 3 months after joint replacement (p < 0.001). In the hip replacement group, SPPB increased by a median of 2 points 3 months after surgery (p < 0.001). At 3 months postoperatively, the SPPB increased by a median of 1 point in the knee replacement group (p = 0.003).ConclusionElective total hip and knee arthroplasty leads to a clinically meaningful improvement in physical performance in orthogeriatric patients with osteoarthritis after only a few weeks.Trial registrationThis study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.

Whole-Body Cryostimulation in Post-COVID Rehabilitation for Patients with Obesity: A Multidisciplinary Feasibility Study.

A post-COVID condition can reduce activity and quality of life, resulting in a significant socioeconomic and health burden. Understanding its impact on patients' health is important for the development of personalized rehabilitation interventions. An independent association between obesity and post-COVID condition was found because of complications and comorbidities. Sixteen patients with obesity and post-COVID symptoms (i.e., dyspnea, pain, poor sleep quality, muscle fatigue), admitted to the Istituto Auxologico Italiano, Piancavallo (VB), Italy, were recruited for a four-week rehabilitation program including conventional exercise therapy, nutritional intervention, psychological support and whole-body cryostimulation (WBC). All participants attended all sessions of the program. Anthropometric data showed statistically significant changes in weight, waist circumference and body mass index. Biochemical analyses showed significant reductions in lipid and inflammatory profiles. There was a significant improvement in physical performance, reduction in pain and improvement in psychological well-being. A multidisciplinary rehabilitation protocol including WBC, designed for patients with obesity and a post-COVID condition, is safe and feasible. The overall improvements demonstrate that multidisciplinary rehabilitation was effective on post COVID patients and suggest that the use of WBC is safe and could play a role as a booster in rehabilitation programs.

Possible perspectives for using phytoadaptogens in post-COVID period

Currently the new coronavirus infection caused by SARS-CoV-2 continues to be a serious public health problem. The fight against this virus includes a continuous search not only for the optimal treatment of the disease itself, but also for the full rehabilitation of patients in the postcovid period. Given the clinical variability and the need for one-stage correcting functions of many systems and organs after this disease, it seems appropriate to use in the recovery of these patients plant adaptogens, which have multiple effects on the body. Our review demonstrates the phytoadaptogen uniqueness in their mild multidirectional impact on neuroendocrine-immune regulation, which leads to the correcton of physiological functions disturbed during the disease. Plantl adaptogens were shown to help reduce pathological changes in the lungs, have antihypoxic and antioxidant effects, exhibit psychotropic and neuroprotective properties, influence on carbohydrate metabolism and cardiovascular system activity, support immune homeostasis and have a general adaptogenic effect. In addition, these biologics enhance the effectiveness of the entire complex therapy and allow neutralizing the side effects of the jointly taken synthetic drugs. To achieve the optimal effect of phytoadaptogens in post-COVID-19 patients it is preferable to use adaptogenic plant combinations, taking into account the mutually reinforcing pharmacological plant properties and leading pathognomonic syndromes. The phytoadaptogen use in the post-COVID-19 patient treatment will contribute to their psychoemotional stabilization, immunoresistance increase, pathological change regression in organs and tissues, mental and physical performance improvement, which will eventually improve the life quality of recovered from COVID-19 patients and preserve public health.

Telerehabilitation after acute coronary syndrome warrants a similar improvement in physical performance as stationary rehabilitation regardless of the age profile of the compared groups

Abstract During the COVID-19 pandemic, the availability of cardiac rehabilitation (CR) was limited. On the other hand, during the epidemic hazard period, patients after acute coronary syndromes (ACS) required careful control and ensuring their improvement after the coronary event. The aim of this study was to assess whether CR conducted during the epidemic threat in remote mode ensures similar improvement in physical performance as rehabilitation conducted in stationary mode before the pandemic COVID-19. Material and methods In this one-center study, the demographic and clinical profiles in the groups of patients after ACS who completed a stationary CR before COVID-19 era or telerehabilitation during the COVID-19 pandemic were compared. The workload on the initial and final exercise tests (ExT) obtained by patients was assessed, as well as the values of differences between the final and initial ExT were compared. 359 patients (pts) participating in stationary CR before October 2020 and 60 pts - in telerehabilitation after July 2021 were included. Both, stationary and tele- CR were performed according to the guidelines of Working Group for Cardiac Rehabilitation of the national cardiac society. Telemedic platform was used to control ECG, blood pressure and body mass of pts participating in telerehabilitation. Statistical analysis included U Mann-Whitney test, T Student test and chi square test. Results The improvment of physical performance did not differ significantly between both groups. The pts who completed telerehabilitation were significantly older than those who completed stationary CR. The values of other parameter, like percent of females, BMI, percent of pts with arterial hypertension and diabetes mellitus type 2 or ejection fraction of left ventricle did not differ significanty between compared groups. The results of statistical analysis are presented in the table below. Conclusions In our center, telerehabilitation after acute coronary syndrome guaranteed an equally good improvement in physical capacity, which was observed in stationary rehabilitation patients, regardless of the difference in the age profile of the compared groups. These results encourage popularization of the cardiac rehabilitation mode with the remote control of the ECG, blood pressure and body weight.Comparison of the study groups

Improved Quality of Life upon Shifting from Darbepoetin to Luspatercept in Patients with Low-Risk Myelodysplastic Syndrome (MDS)

Introduction: Low-risk MDS is characterized by refractory anemia due to Dyserythropoiesis 1. Standard of care treatment is mainly Erythropoiesis stimulating agents (ESA) or blood transfusion or both 1. Response to ESA is achieved in some patients whose erythropoietin (EPO) level is less than 500 mu/ml 2. Luspatercept is a red cell maturing agent that may lead to an increase in Hb of up to 3 g/dL 3 in responders. Response to ESA can be enhanced with the addition of Luspatercept 4. Hereby we are reporting successful shifting of two patients from Darbepoietin to Luspatercept with significant increase in Hb level and improvement in quality of life. Case 1: A 62-year-old man without previous illness presented in April 2018 with progressive symptomatic anemia. His body weight was 107 kg, and his physical examination was unremarkable other than pallor and tachycardia. The laboratory investigation revealed WBC, 5.62 x 10 3/uL, RBC 2.2 x 10 3/uL, Hb 7.8 g/dL, MCV 110.4 fl, platelets 706 x 10 3/uL, and reticulocytes 1%. Blood film showed reduced RBC count with numerous macrocytes and no other abnormalities. Bone marrow revealed 80% cellularity with Dyserythropoiesis, 16% ring sideroblasts, and 2% blasts. The Ferritin level, B12 levels were elevated (table). EPO level was elevated but less than 500 mlU/ml and the cytogenetic analysis showed normal karyotype. However his molecular profiling demonstrated SF3B1 and TET2 mutations. At the time of diagnosis, the Revised International Prognostic Scoring System (IPSS-R) was 2.0, indicating low risk MDS. He was given darbepoetin 300 mcg SC weekly for four weeks without any improvement, then darbepoetin dose was escalated to 500 mcg weekly with a good response. Hb level remained at 8.5 - 9.5 g/dl for three years. The patient's physical performance improved moderately, with an increase in walking distance on flat surfaces from 20 to 35 minutes. In August 2022, he was switched to Luspatercept 100 mcg SC on a three-weekly schedule. Within three months, his hemoglobin level increased to 10.8 g/dl and he experienced significant improvement in physical performance and mental well-being, along with a significant reduction in fatigue, enabling him to increase his walking distance to 76 minutes. Case 2: A 77-year-old man with type 2 diabetes mellitus and mild renal impairment who developed an unexplained progressive anemia. His body weight was 79 kg, and his physical examination was unremarkable other than pallor. His laboratory investigations showed WBC 4.5 x 10 3/uL, RBC 1.5 x 10 6/uL, Hb 5.2 g/dL, MCV 96 fl, platelets 706 x 10 3/uL, and reticulocytes 0.8 %. Blood film showed reduced RBC count, normocytic anemia, and no other abnormalities. Bone marrow revealed 60% cellularity with Dyserythropoiesis, 17% ring sideroblasts, and 1% blasts. His baseline serum creatinine was 1.8 mg/dl, and HbA1C 10.0. Two units of packed red blood cells were transfused every 2- 4 week to keep his Hb level around 8 g/dL. Darbepoetin 80 mcg SC weekly for four weeks,150 mcg weekly for 4 weeks and 300 mcg weekly for further 4 weeks without any response. Eventually, he responded to 500 mcg of Darbepoetin per week. As a result, his Hb increased to the range of 8.6-9.4 g/dl for one year, with moderate improvements in performance status. Darbepoetin was switched to Luspatercept 75 mcg three-weekly in January 2023, resulting in an increase in his hemoglobin level to 10.3 g/dl, with significant improvement in his energy level and overall well-being. Discussion: Blood transfusion and ESA have traditionally been used as standard treatments for low-risk MDS. Recently, Luspatercept in combination with ESA has shown enhanced effectiveness in elevating Hb levels. Both of our patients had significant increases in Hb levels along with a noticeable improvement in quality of life because of Luspatercept alone. Conclusion: Following the switch from Darbepoetin to Luspatercept, there was a significant improvement in Hb level and in quality of life in our 2 patients. This finding needs to be confirmed with larger studies.