Delayed grip relaxation is a common symptom of myotonic dystrophy type 1 (DM1), differing from other muscle diseases. Preclinical studies suggest myotonia may reverse quickly with targeted treatment and video hand opening time (vHOT) could be a straightforward method for assessing myotonia in multicenter trials, but few studies have evaluated vHOT in large DM1 cohorts. This study aimed to evaluate how vHOT performs and relates to other disease aspects in a large, well-characterized DM1 population. The vHOT was conducted in the END-DM1 natural history study across 22 international sites, including adult DM1 patients with a genetic or research criteria diagnosis. The primary outcome involved video-recorded hand opening after a maximum 3-second grip, performed twice at each study visit with 5-minute rest between trials, and blinded scoring at a central site. Muscle strength and function were assessed by myometry, timed functional tests, and patient-reported outcomes. Procedures were repeated after 1 year for a subset of participants. Wilcoxon signed-rank was used to evaluate differences and Spearman correlation for associations. A total of 591 patients with DM1 (mean age 43.7 ± 12.9 years, 57% female) were included, showing a broad spectrum of vHOT severity (median 3.9 seconds, interquartile range 1.8-7.9 seconds). At a single study visit, there were no systematic difference and good agreement between trials (mean difference 0.1 ± 3.7 seconds [p = 0.05], intraclass correlation coefficient 0.84 [95% CI 0.81-0.86]). vHOT correlated relatively weak with self-reported myotonia (ρ = 0.39), and even lower for other measures of muscle impairments such as grip strength (ρ = -0.21) or 9-hole pegboard (ρ = 0.12). 270 patients completed the 1-year follow-up, with vHOT showing no progression (mean difference 0.4 ± 4.7 seconds, p = 0.34). The vHOT procedure was performed successfully in a large international study, with grip relaxation delay varying from minimal to highly prolonged in an unselected cohort. The weak correlation with grip weakness supports the notion that myotonia and weakness are mechanistically distinct. Study limitations include underrepresentation of congenital DM1 and lack of other myotonia measures (e.g., handgrip relaxation myometry). It seems that vHOT is not suitable to assess disease progression, but stability over 1 year may support its use to assess improvement. The END-DM1 observational study is registered with number NCT03981575.

Effects of resistance training on postmenopausal women's muscle strength, muscle volume and muscle fat infiltration: A secondary analysis of a randomised controlled trial.

Sarcopenia is an age-related condition characterized by progressive muscle mass, strength and physical performance declines, contributing to frailty and adverse health outcomes. Despite increasing interest in molecular biomarkers, longitudinal data with external validation are limited. This study applied high-throughput proteomic analysis to identify and validate biomarkers associated with sarcopenia progression in two independent prospective cohorts. The discovery cohort (n = 171) was classified into three groups: (1) nonsarcopenic at both baseline and the 2-year follow-up; (2) newly developed sarcopenia; and (3) persistently sarcopenic. The validation cohort (n = 93) was followed up for 2 years. Plasma proteomic profiling was conducted using data-independent acquisition (DIA) mass spectrometry. For the validation cohort, targeted quantification (Hyper Reaction Monitoring-DIA) and immunoassays were employed to verify key findings. Statistical analyses included multivariable regression and pathway enrichment analysis. In the discovery cohort, 102 proteins were differentially expressed between groups (p < 0.05). Compared to the stable nonsarcopenic group, individuals who developed sarcopenia demonstrated significant APOA1 (fold change -1.42, p < 0.001) and KLKB1 downregulation and LECT2 upregulation. Those who remained sarcopenic exhibited persistent B2M (+1.58, p < 0.001), S100A9 and LYZ elevation. We identified seven robust protein signatures (LRG1, CST3, TIMP1, C2, ITIH1, AMBP and LYZ) that showed consistent significant associations with sarcopenia components in both cohorts. LRG1 and TIMP1, CST3 and C2 were reproducibly associated with muscle strength, physical performance and muscle mass, respectively. Pathway enrichment analyses consistently highlighted LXR/RXR signalling, acute phase response signalling and complement cascade activation as central mechanisms across these domains. This study identified and validated plasma protein signatures and pathways associated with sarcopenia progression. Complement activation, acute inflammatory response and lipid dysregulation emerged as central mechanisms. These robustly validated biomarkers may represent targets for early detection and intervention strategies in sarcopenia.

Introduction: Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by persistent hyperglycaemia, which leads to systemic complications affecting the musculoskeletal and nervous systems. This contributes to lower limb weakness, sensory deficits, and impaired postural control, thereby increasing the risk of falls. While most balance assessments focus on anticipatory control. Reactive balance is critical for responding to sudden disturbances, which is often overlooked. The Balance Evaluation System Test (BESTest) includes a reactive balance component, making it a suitable tool for this purpose. Aim: To evaluate the impact of lower limb muscle strength on forward reactive stepping in diabetic and non diabetic patients. Materials and Methods: A cross-sectional study was conducted among 46 diabetic (aged 45-60 years, diabetes duration 3-5 years) and 46 non diabetic individuals in the Department of Endocrinology and Physiotherapy Outpatient Department (OPD) Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India, from February 2025 to April 2025. Diabetic neuropathy patients were excluded using the Diabetic Neuropathy Symptom Score. Handheld Dynamometer (HHD) was used to measure the strength of hips abductors, knee extensors and ankle plantar flexors. Forward reactive stepping was assessed through the compensation stepping correction component of the BESTest, and parameters like First Step Length (FSL) and First Step Time (FST) were analysed using Tracker 6.1.3 software. Pearson’s correlation and Independent t-tests were applied. Effect sizes were reported. Statistical significance was set at p-value&lt;0.05. Results: In diabetic participants, muscle strength showed no significant correlation with FSL but demonstrated moderate negative correlations with FST (r-value=-0.448 to -0.548, p-value &lt;0.001). In non diabetic participants, weak positive correlations were found between muscle strength and FSL (r-value=0.285– 0.350), and moderate negative correlations were found with FST (r-value=-0.331 to -0.560). Between-group comparisons showed significant differences in correlations, suggesting diabetes influences the strength- balance relationship. Conclusion: In diabetic individuals, lower limb muscle strength alone may not significantly influence reactive balance, likely due to sensory or neuromotor impairments. Thus, effective balance interventions should include components beyond strength training.

Anabolic androgenic steroids are synthetic derivatives of testosterone that mimic its actions in various tissues. Due to its strong anabolic activity, weak androgenic effects, and resistance to hepatic metabolism, oxandrolone is one of the most commonly used anabolic steroids among female athletes. This study aimed to evaluate the anabolic effects of oxandrolone and its toxicological profile in female rats subjected to a strength training protocol. A total of 24 female Wistar rats (60 days old) were randomly assigned to receive oxandrolone (1.77 mg/kg/day) or its vehicle (corn oil) (n = 12 per group) via daily gavage for 28 days. The exercise protocol consisted of six climbs on an inclined ladder, with two climbs per workload (50 %, 75 %, and 100 % of each animal's maximum load) performed three times per week. Investigators remained blinded throughout experimentation and data analysis. Oxandrolone did not significantly affect body weight gain, relative organ and muscle mass, or muscle strength. However, it altered mean corpuscular volume, eosinophil count, and urea levels. Additionally, liver TBARS levels increased, while no changes were observed in plasma lipid peroxidation, antioxidant enzyme activity, total non-protein thiol levels, or mitochondrial respiratory chain complex activity. Histopathological analysis revealed oxandrolone-induced damage to cardiac and skeletal muscle, along with structural alterations in the spleen and adrenal gland. Given its limited effect on muscle strength, along with histopathological changes and increased liver lipoperoxidation, these findings raise concerns about oxandrolone use in healthy individuals seeking aesthetic or athletic benefits.

Real-world effectiveness of oral semaglutide on body weight, composition, and metabolic parameters in patients with obesity without diabetes.

Amyotrophic lateral sclerosis (ALS) patients can exhibit split phenomena, with preferential weakness of specific muscle groups. The aim of this review is to investigate the split elbow (SE) phenomenon (different weakness/wasting pattern between biceps and triceps) as a potential clinical and neurophysiological feature in ALS. Our study was reported according to the PRISMA statement and registered in PROSPERO (CRD42024528359). MEDLINE, SCOPUS, Web of Science, and grey literature sources were searched using the terms "split elbow" and "amyotrophic lateral sclerosis" up to April 2025. English-written peer-reviewed, randomized, non-randomized, observational, diagnostic accuracy, and case-control studies were included. Study quality was assessed using Joanna Briggs Institute critical appraisal tool. Regarding muscle strength, we pooled the standardized mean difference of normalized Medical Research Council (MRC) scores using random effects. We used a bivariate random-effects model to evaluate SE index (SEICMAP, compound muscle action potential of biceps/triceps) in distinguishing ALS from controls. Seven studies with 1941 ALS patients (61.8 % male) met inclusion criteria. Pooled standardized mean difference (triceps - biceps MRC scores) was -0.17 [95 % CI, -1.03 to 0.69], p = 0.63, indicating no significant difference in muscle strength between elbow flexion and extension. Between-study heterogeneity was high (I2 = 97.1 % [95.5 %; 98.2 %], p < 0.0001). The SEICMAP demonstrated only moderate accuracy in distinguishing ALS from controls (pooled sensitivity, specificity, and AUC of 0.789 [0.655-0.880], 0.580 [0.487-0.668], and 0.661, respectively). Current evidence does not support a consistent SE pattern in ALS. Methodological variability and small sample sizes limit the generalizability of available findings, indicating that the SE is unlikely to provide meaningful diagnostic utility in routine clinical practice.

Association between pain catastrophizing and sarcopenia in patients with knee osteoarthritis: A cross-sectional study.

Mitigating loss of lean muscle in GLP-1 and dual GLP-1/GIP agonists: Pipeline opportunities and limitations.

Effects of VR exercise interventions on cognitive function and physical function in older adults: A systematic review and meta-analysis.

Multiple sclerosis (MS) causes immune-mediated inflammation and neurodegeneration in the central nervous system, often leading to weakness and impaired mobility. In older adults with MS, it can be challenging to distinguish MS vs. age-related contributions to weakness. Studies are needed to examine the neuromuscular mechanisms of age-related declines in muscle strength to better understand their relative contribution to weakness in older adults with MS. To investigate the neuromuscular mechanisms underlying age-related declines in muscle strength and their contribution to weakness in older adults with MS. We conducted a study to determine whether older adults with MS exhibit differences in knee extensor voluntary (neural) activation, MRI-derived muscle volume, and skeletal muscle contractile quality compared to age-, sex-, and BMI-matched individuals without MS. Group comparisons were performed using nonparametric statistical analyses. In 10 older adults with MS and 10 age-, sex-, and BMI-matched controls, participants with MS had reduced isokinetic strength relative to body weight (MS 0.95 N·m/kg [0.77, 1.06], controls 1.48 N·m/kg [1.23, 1.66]) and summed torque relative to muscle volume (MS 10.31 × 103 N·m/cm3 [8.24 × 103, 11.84 × 103], controls 13.32 × 103 N·m/cm3 [12.50 × 103, 13.59 × 103]). In MS compared to controls, we also observed reduced peak isometric strength relative to muscle volume (MS 0.47 N·m/cm3 [0.37, 0.51], controls 0.58 N·m/cm3 [0.56, 0.63]) and reduced isokinetic strength relative to muscle volume (MS 0.37 N·m/cm3 [0.33, 0.42], controls 0.56 N·m/cm3 [0.52, 0.56]). Quadriceps muscle volume was similar in participants with MS (168.42 cm3 [158.55, 196.74]) and controls (183.26 cm3 [175.62, 202.25]). There was decreased neural activation parameters in MS including central activation ballistic torque (CAB) ratio (MS 0.31 [0.18, 0.35], controls 0.46 [0.40, 0.57]) and voluntary activation (MS 87.87% [84.09, 90.09], controls 94.82% [92.89, 95.78]). No statistically significant correlations between neuromuscular function and MS clinical outcomes were found. Neuromuscular function deficits in older adults with MS are largely attributed to impaired neural activation without significant differences in muscle quality compared with controls.

The effects of beta-hydroxy-beta-methylbutyrate on sarcopenia in stable decompensated cirrhosis: A pilot randomized controlled trial.

With an aging population, muscle health, encompassing locomotion and metabolic function, has become a public health priority. Handgrip strength is a validated surrogate measure of general muscle strength, but measurement may not be feasible in low-resource settings. The SARC-F questionnaire (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) provides a simple, low-cost, and practical tool for sarcopenia screening, though its optimal cut-off remains debated. To evaluate the predictive validity of SARC-F cut-off scores in identifying low muscle strength among community-dwelling older adults in a low-income population. We included 733 participants (221 men, 512 women; aged 60-95years) from the Amazonas region of Brazil. All completed the SARC-F and underwent handgrip strength testing. Low handgrip strength was based on EWGSOP2 criteria (<27kg men, <16kg women). Agreement, sensitivity, specificity, predictive values, and ROC curves were calculated for cut-offs ≥4 and≥2, stratified by sex. Low handgrip strength was highly prevalent (47.1% in men, 94.1% in women). Agreement between SARC-F and muscle weakness was generally poor (κ <0.4), except for men at the ≥4 threshold (κ=0.41). Sensitivity was higher in men than in women (≥4: 48% vs 37%; ≥2: 70% vs 69%). Lowering the cut-off to ≥2 improved sensitivity but reduced specificity (65.8% men, 56.7% women). ROC analysis identified ≥2 as the optimal threshold, with AUC 0.68 in men and 0.63 in women. A SARC-F cut-off of ≥2 improves sensitivity for detecting probable sarcopenia and may be more suitable for screening in low-income settings. Longitudinal validation is warranted across diverse populations.

Rehabilitation before (prehabilitation) and after solid organ transplantation is gaining increasing interest as an important aspect of holistic treatment. Despite guidelines recommending clinical implementation, there are very few established prehabilitation or rehabilitation programmes routinely delivered within transplant centres. This review provides insight into the current landscape within this area. Prehabilitation and rehabilitation has demonstrated potential to improve clinical outcomes for individuals preparing and living with solid organ transplantation, particularly with regards to aerobic capacity, muscle strength and quality of life. These programmes can address important components of pre/posttransplant clinical outcomes, particularly frailty, length of hospital stay, cardiovascular risk and metabolic health. Research has to date been limited by small sample sizes and heterogeneous interventions. Further high-quality research is needed alongside clinical implementation. Research to date has demonstrated the potential of prehabilitation and rehabilitation across the solid organ transplantation pathway to improve clinical outcomes, as well as to support individuals to live well. Further research with large randomised controlled trials is warranted, with the aim to support the implementation of pre/rehabilitation as part of routine care in multiprofessional clinics.

Nailfold video capillaroscopy as a non-invasive biomarker in juvenile dermatomyositis: A longitudinal analysis of microvascular changes and clinical relevance over one year.

Effects of exercise on the efficacy and adverse effects of immunosuppressants: a systematic review and meta-analysis.

This study aimed to propose reference values for all tests in the two domains: the muscle strength and endurance domain (MSED) and the balance, stability, and coordination domain (BSCD) of this new knee functional performance-based tool. The secondary aim was to study the correlation between tests. One hundred and eleven participants (51 male, 60 female) aged 18 to 75 years were recruited and underwent all functional knee tests. Descriptive data were calculated for all dependent variables: Superman (SUP), hinge with calves raised (HCR), squat with trunk rotation (STR), standing hip flexion with arm raised (SHFAR), and standing hip and shoulder abduction (SHSAB). Test-retest reliability was calculated for each variable using Spearman's rank correlation and the corresponding 95% confidence interval (CI). Pearson's chi-square test was conducted to assess whether there was a significant difference between genders. Spearman’s rank correlations demonstrated high reliability across all measures (ρ&gt;0.8; P&lt;0.0001). Composite time scores showed that males were faster than females in all BSCD tests on both sides: SHFAR (left 6.42 vs 6.65 seconds; right 6.50 vs 6.66 seconds) and SHSAB (left 5.86 vs 6.03 seconds; right 5.73 vs 6.08 seconds). In MSED, females recorded slightly shorter times for SUP (7.23 vs 7.41 seconds) and HCR (6.39 vs 6.60 seconds), whereas males were faster for STR (18.24 vs 19.23 seconds) (all P&gt;0.05). Age-stratified results suggested higher STR times in older groups, while BSCD measures remained relatively stable (~5–7 seconds) across ages. Proposed reference thresholds were SUP&lt;7.8 seconds, HCR&lt;7.0 seconds, STR&lt;19.6 seconds, SHFAR&lt;6.8 seconds, and SHSAB&lt;6.3 seconds. High reliability demonstrated that this new tool was reproducible and easily adapted to the clinical setting. Future studies should include larger sample sizes for each age group and conduct group comparisons between healthy and clinical populations to provide specific cutoff values for each group.

Impacts of non-pharmacological interventions on post-intensive care syndrome: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials.

Medicinal plants in the management of muscle loss and sarcopenia: A narrative review of preclinical and clinical evidence from eight species.

Promoting healthy aging: A systematic review of the transformative effects of nutritional interventions in elderly population.