Muscle Strength Research Articles

Exerkines and Sarcopenia: Unveiling the Mechanism Behind Exercise-Induced Mitochondrial Homeostasis

Background/Objectives: Sarcopenia, characterized by the progressive loss of muscle mass and strength, is linked to physical disability, metabolic dysfunction, and an increased risk of mortality. Exercise therapy is currently acknowledged as a viable approach for addressing sarcopenia. Nevertheless, the molecular mechanisms behind exercise training or physical activity remain poorly understood. The disruption of mitochondrial homeostasis is implicated in the pathogenesis of sarcopenia. Exercise training effectively delays the onset of sarcopenia by significantly maintaining mitochondrial homeostasis, including promoting mitophagy, improving mitochondrial biogenesis, balancing mitochondrial dynamics, and maintaining mitochondrial redox. Exerkines (e.g., adipokines, myokines, hepatokines, and osteokines), signaling molecules released in response to exercise training, may potentially contribute to skeletal muscle metabolism through ameliorating mitochondrial homeostasis, reducing inflammation, and regulating protein synthesis as a defense against sarcopenia. Methods: In this review, we provide a detailed summary of exercise-induced exerkines and confer their benefit, with particular focus on their impact on mitochondrial homeostasis in the context of sarcopenia. Results: Exercise induces substantial adaptations in skeletal muscle, including increased muscle mass, improved muscle regeneration and hypertrophy, elevated hormone release, and enhanced mitochondrial function. An expanding body of research highlights that exerkines have the potential to regulate processes such as mitophagy, mitochondrial biogenesis, dynamics, autophagy, and redox balance. These mechanisms contribute to the maintenance of mitochondrial homeostasis, thereby supporting skeletal muscle metabolism and mitochondrial health. Conclusions: Through a comprehensive investigation of the molecular mechanisms within mitochondria, the context reveals new insights into the potential of exerkines as key exercise-protective sensors for combating sarcopenia.

Associations Between Adherence to the Mediterranean Diet and Incident Sarcopenia in Prospective Cohort Studies

The loss of skeletal muscle mass and strength, known as sarcopenia, is prevalent in older adults and linked to an increased risk of disability, frailty, and early mortality. Muscle health is crucial for the functionality and independence of older adults. As the aging population continuously grows, finding cost-effective strategies for preventing and treating sarcopenia is an important public health priority. While nutrition is recognized as a key factor in the development of sarcopenia, its role in preventing and treating the condition is still under investigation. In recent decades, nutritional research has shifted from a focus on individual nutrients or healthy foods to examining the combination of nutrients and foods in dietary patterns, along with their potential synergistic and antagonistic effects. A balanced diet and regular participation in physical activity are essential for maintaining musculoskeletal health. One of the healthy eating patterns with the greatest evidence of multiple health benefits is the Mediterranean diet, which has also been linked to positive effects on muscle function in observational studies. However, there is a lack of intervention studies. This review explores the updated evidence from longitudinal prospective studies on associations between adherence to the Mediterranean diet and sarcopenia in order to promote preventive and intervention strategies for healthy muscle aging.

In a visual inverted pendulum balancing task avoiding impending falls gets harder as we age

Younger adults (YA) and older adults (OA) used a joystick to stabilize an unstable visual inverted pendulum (VIP) with a fundamental frequency (.27 Hz) of half that of bipedal human sway. Their task was to keep the VIP upright and to avoid ± 60° “fall” boundaries. Both age groups were tested with joystick gains and delays simulating age-related muscle strength and reflex slowing, respectively. In previous VIP and analogous self-balancing tasks, we observed a mixture of discrete corrective commands toward the balance point and destabilizing commands toward an impending fall. We hypothesized that (1) OA would fall more than YA, (2) traditional whole-trial stability and variability measures would differ across age groups and VIP conditions, and (3) different dynamics of corrective and destabilizing commands would discriminate falling from recovery. Results: (i) Traditional whole-trial performance metrics of fall incidence and the variance of position and velocity were worse in OA than YA and worse with longer delays and excessive joystick gains; (ii) OA made fewer corrective and more destabilizing commands than YA only when falling was imminent; (iii) when falls were imminent, a logistic model fit the percentage of inactive, corrective, and destabilizing commands as a function of time left to fall; and (iv) OA were like YA in switching between inaction and action, but exhibited less frequent and less prompt corrective commands than destabilizing commands relative to YA. We discuss whether such a decision-like process may also operate in a bipedal stance.

Effects of eHealth exercise on paediatric suppurative lung diseases: a systematic review and meta-analysis

BackgroundUtilizing information and communication technologies through eHealth in exercise programs could support their delivery and improve clinical outcomes in children and adolescents with chronic suppurative lung diseases (CSLDs). This study aimed to systematically investigate the effects of eHealth exercise programs on clinical outcomes for this population.MethodsFive databases were searched from inception to April 12, 2024. Two researchers independently screened the retrieved results and rated the methodological quality of the included studies using the revised Cochrane Risk of Bias tool for randomized trials and the Risk of Bias in Non-Randomized Studies – of Interventions tool. The quality of evidence was graded using the GRADE approach. A narrative synthesis of findings was performed, and a meta-analysis was conducted to evaluate the effects of eHealth exercise programs on clinical outcomes that had data from ≥2 studies.ResultsSeven studies used eHealth exercise programs through active video games (n=3), videoconferencing (n=3), and a digital spirometer (n=1) lasting from 3 to 12 weeks. Five studies had participants with cystic fibrosis (CF). Results showed a greater improvement in the 6-minute walk test following the intervention compared to the control group; pooled estimate mean difference [37.2 meters (95%CI: 7.91 to 66.48), p=0.013]. Pulmonary function, exercise capacity, balance, peripheral and respiratory muscle strength, and HRQoL were also improved. Still, most studies involved a considerable risk of bias.ConclusionseHealth exercise programs can improve clinical outcomes in children and adolescents with CF. Further research is needed for other pediatric populations with CSLDs and also for comparisons with conventional exercise programs.

Cerebral fat embolism following autologous fat injection in facial reconstruction: A case report

BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery. Although cerebral fat embolism (CFE) as a complication is rare, it carries serious health risks. CASE SUMMARY We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery. After the surgery, the patient experienced symptoms including headache, nausea, vomiting, and difficulty breathing, which was followed by neurological symptoms such as slurred speech and left-sided weakness. Comprehensive physical examination and auxiliary investigations, including blood tests, head and neck computed tomography angiography, and cranial magnetic resonance diffusion-weighted imaging, were performed upon admission. The clinical diagnosis was acute cerebral embolism following facial fat filling surgery. Treatment included measures to improve cerebral circulation, dehydration for intracranial pressure reduction, nutritional support, and rehabilitation therapy for left limb function. The patient showed a significant improvement in symptoms after 2 weeks of treatment. She recovered left limb muscle strength to grade 5, had clear speech, and experienced complete relief of headache. CONCLUSION Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction. To prevent these complications, plastic surgeons should enhance their professional knowledge and skills.

Association of aerobic capacity and muscular strength with health-related quality of life in adolescents: A school-based cross-sectional study

Background: The independent associations of aerobic capacity and muscular strength on health-related quality of life (HRQoL), when mutually adjusted, remain understudied, particularly in adolescents. Aim: To examine the association between aerobic capacity, muscle strength, and HRQoL in adolescents. Methods: A cross-sectional design was employed, including 202 Brazilian adolescents. Aerobic capacity was assessed using the PACER test and categorized into “healthy zone”, “needs improvement”, and “at risk”. Muscle strength was evaluated through field tests, including the 90º push-up, and categorized as “healthy zone” or “needs improvement”. HRQoL was measured using the validated KIDSCREEN-27 questionnaire. A generalized gamma regression model was used to estimate coefficients (β) and 95% confidence intervals for HRQoL domains, adjusting mutually for aerobic capacity and muscle strength as predictors. Results: In the physical domain, adolescents with aerobic capacity in the healthy zone (β=11.2; p<0.001) and needs improvement category (β=8.8; p=0.007) scored higher than those in the at-risk zone. Similarly, those with muscle strength in the healthy zone scored higher than in the needs improvement category (β=6.6; p=0.012). In the psychological domain, adolescents with aerobic capacity in the healthy zone (β=8.1; p=0.002) and needs improvement (β=5.9; p=0.027) also had higher scores than those at risk, as did those with healthy muscle strength compared to needs improvement (β=4.5; p=0.043). No significant associations were found in other domains (p>0.05). Conclusion: Adequate levels of aerobic capacity and muscle strength are positively associated with HRQoL, particularly in the physical and psychological well-being domains among adolescents.

Effect of Plant Versus Animal Protein on Muscle Mass, Strength, Physical Performance, and Sarcopenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Dietary protein is recommended for sarcopenia-a debilitating condition of age-related loss of muscle mass and strength that affects 27% of older adults. The effects of protein on muscle health may depend on protein quality. The aim was to synthesize randomized controlled trial (RCT) data comparing plant with animal protein for muscle health. Forty-three eligible RCTs were sourced from Medline, Embase, Scopus, Web of Science, and CENTRAL databases. Four reviewers (R.J.R.-M., S.F.B., N.A.W., D.L.) extracted data from RCTs (study setting, population, intervention characteristics, outcomes, summary statistics) and conducted quality assessment using the Cochrane Risk of Bias 2.0. Standardized mean differences (SMDs) (95% CIs) were combined using a random-effects meta-analysis and forest plots were generated. I2 statistics were calculated to test for statistical heterogeneity. Thirty RCTs (70%) were eligible for meta-analysis and all examined muscle mass outcomes. Compared with animal protein, plant protein resulted in lower muscle mass following the intervention (SMD = -0.20; 95% CI: -0.37, -0.03; P = .02), with stronger effects in younger (<60 years; SMD = -0.20; 95% CI: -0.37, -0.03; P = .02) than in older (≥60 years; SMD = -0.05; 95% CI: -0.32, 0.23; P = .74) adults. There was no pooled effect difference between soy and milk protein for muscle mass (SMD = -0.02; 95% CI: -0.20, 0.16; P = .80) (n = 17 RCTs), yet animal protein improved muscle mass compared with non-soy plant proteins (rice, chia, oat, and potato; SMD = -0.58; 95% CI: -1.06, -0.09; P = .02) (n = 5 RCTs) and plant-based diets (SMD = -0.51; 95% CI: -0.91, -0.11; P = .01) (n = 7 RCTs). No significant difference was found between plant or animal protein for muscle strength (n = 14 RCTs) or physical performance (n = 5 RCTs). No trials examined sarcopenia as an outcome. Animal protein may have a small beneficial effect over non-soy plant protein for muscle mass; however, research into a wider range of plant proteins and diets is needed. PROSPERO registration no. CRD42020188658.

Clinical and magnetic resonance imaging outcome after proximal hamstring tendon repair at mean 3 years follow-up

PurposeThe purpose of this study was to assess clinical and radiological outcome in patients after proximal hamstring tendon repair. We hypothesized that there is a significant correlation among subjective clinical outcome and interlimb asymmetries in muscle strength, fatty infiltration, and hamstring volume.MethodsThis retrospective monocentric case series included patients with surgical repair after proximal hamstring tendon rupture. Clinical outcome was assessed utilizing: Healthy Days Core Module (CDC HRQOL-4), numeric pain rating scale (NRS), modified Harris Hip Score (mHHS), Tegner Activity Scale (TAS), return to pre-injury activity level (RTPA), and patient satisfaction score. Postoperative hamstring strength was measured using a handheld dynamometer and radiological outcome was determined by postoperative magnetic resonance imaging (MRI).ResultsTwenty-seven patients with a mean age of 51.2 (± 12.6) years were available for follow-up at a mean of 41.11 (± 18.4) months. Patients state a mean of 10.6 (± 11.5) days in the unhealthy days (UHD) index and 88.9% show “good health” in the simple summary score (SSS). Mean subjective outcome scores were as follows: NRS 1.1 (± 2.4), mHHS 90.3 (± 14.8) and TAS 5.7 (± 2.2). A total of 59.3% RTPA and 88.9% state to be somewhat or very satisfied with their surgery. Mean interlimb strength ratio was 0.88 (± 0.21). MRI demonstrated a fully restored muscle–tendon unit, significantly greater fatty infiltration in the injured hamstrings (p = 0.009, d = 0.558), and a mean interlimb hamstring volume ratio of 0.94 (± 0.11). With respect to the 10% benchmark, patients had no significant asymmetries in muscle strength (p = 0.677, d = 0.084) or hamstring volume (p = 0.102, d = − 0.34). Correlation analysis revealed moderate correlation among asymmetries in strength and volume (p = 0.073, r = 0.373). In patients with the operated side inferior to the healthy side (n = 15), there was strong correlation among asymmetries in strength and volume (p = 0.002, r = 0.725). Statistically significant correlation was found between interlimb muscle volume atrophy and increase in fatty infiltration (p = 0.015, r = 0.481).ConclusionProximal hamstring repair results in good clinical outcome with satisfactory recovery of hamstring strength and volume. Interlimb asymmetries, in terms of muscle strength, fatty infiltration, and hamstring volume do not correlate with clinical outcome.Study TypeRetrospective cohort study; Level of evidence, 3.

Rehabilitation success in ACL reconstruction and medial meniscus repair: A case of delayed recovery and optimized outcomes

This case report highlights the rehabilitation process of a 23-year-old male who underwent anterior cruciate ligament (ACL) reconstruction with medial meniscus repair. Early rehabilitation is critical to prevent complications, but this patient experienced a significant delay, resulting in functional deficits such as a 10-degree fixed flexion deformity (FFD) and quadriceps lag at post-operative day 14. A structured rehabilitation protocol was initiated at day 14 post-operation. Progress was tracked using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Single Leg Balance Scale (SLBS). The rehabilitation focused on improving knee extension, muscle strength, balance, and proprioception. Significant improvements were observed by week 12. The patient’s KOOS scores improved across all domains, with pain improving from 45 to 80 and sports function from 10 to 60. The SLBS showed increased balance on the affected leg, improving from 5 to 25 seconds. The delayed rehabilitation approach still yielded positive outcomes, underscoring the importance of a structured physiotherapy program. This case demonstrates that even with delayed rehabilitation, significant functional recovery can be achieved through a structured physiotherapy protocol. The results reinforce the necessity of early rehabilitation to avoid delays in recovery and improve long-term functional outcomes.

Sugar-sweetened beverages, relative grip strength, and psychological symptoms among rural adolescents in western China: a cross-sectional study

BackgroundThe increasing prevalence of psychological symptoms in adolescents has become an important problem faced by all countries in the world. The increased sugar-sweetened beverages (SSB) consumption and the decreased muscle strength had a serious negative impact on adolescent health. However, previous studies have mainly focused on adolescents in developed countries and fewer studies have been conducted in developing countries, especially in rural areas of western China. This study aims to explore the association of sugar-sweetened beverages consumption, and relative grip strength with psychological symptoms among rural adolescents in western China.MethodsIn this study, 11,018 adolescents aged 13–18 years from rural areas of Xinjiang and Tibet in western China were recruited using stratified randomized whole-cluster sampling in 2023. The participants were assessed for sugar-sweetened beverages consumption, relative grip strength, and psychological symptoms. Non-parametric tests, t-tests, logistic regression analyses, and ordered logistic regression analyses of generalized linear models were used to analyze the associations of sugar-sweetened beverage consumption and relative grip strength with psychological symptoms in adolescents.ResultsThe proportions of adolescents with sugar-sweetened beverages consumption of &amp;lt;1 times/week, 2–4 times/week, and &amp;gt;4 times/week in rural areas of western China were 34.6, 52.7, and 12.7%, respectively. The prevalence of adolescents’ emotional problems, behavioral problems, social adjustment difficulties, and psychological symptoms were 28.7, 27.0, 20.2, and 22.1%, respectively. The mean and standard deviation of grip strength among adolescents was assessed as (32.52 ± 10.13) kg and the relative grip strength was (0.60 ± 0.16) in rural areas of western China. Taking participants with sugar-sweetened beverages consumption &amp;lt;1 times/week group and relative grip strength at the fourth quartile as the reference, participants with SSB consumption &amp;gt;4 times/week and relative grip strength at the first quartile had the highest risk (OR = 2.77, 95% CI: 2.09–3.67, p &amp;lt; 0.001) of psychological symptoms.ConclusionElevated sugar-sweetened beverages consumption and decreased relative grip strength were associated with an increased prevalence of psychological symptoms. Prospective cohort studies are needed in the future to explore the causal relationships among SSB consumption, muscle strength, and psychological symptoms.

Cardiometabolic Health Intervention Using Music and Exercise (CHIME) Delivered via Telehealth to Wheelchair Users: Protocol for a Randomized Controlled Trial

Background Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality. Objective The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos. Methods This study’s design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3×/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded. Results Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission. Conclusions The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users. Trial Registration ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432 International Registered Report Identifier (IRRID) DERR1-10.2196/57423

Effects of static stretching and walking during inter-set intervals of resistance training on muscle fatigue of the quadriceps

IntroductionInter-set rest intervals are essential to reduce muscle fatigue and increase the total amount of volume of resistance training. Static stretching and walking may increase muscle blood flow and promote recovery during inter-set rest intervals. Therefore, the purpose of this study was to investigate the effects of 20 seconds of static stretching and walking during inter-set rest intervals of leg extension exercises on the number of repetitions to exhaustion, total amount of volume, and flexibility of the quadriceps (joint range of motion and muscle hardness) in untrained healthy males.MethodsFourteen healthy, untrained men performed three different interventions (passive rest, static stretching, and walking) during inter-set rest intervals of a leg extension exercise with a 70% load of maximum muscle strength, in random order. The range of motion and muscle hardness of the quadriceps were measured before and immediately after all interventions using a goniometer and a portable muscle hardness meter. The number of repetitions to exhaustion and total amount of volume load (load × repetitions) of the leg extension exercise were assessed. Repeated two-way ANOVA and a Friedman test were used to analyze the variables.ResultsRange of motion and muscle hardness were increased after all interventions (both p &amp;lt; 0.05). There was no significant difference in the number of repetitions to exhaustion (p = 0.651) or total amount of volume load (p = 0.206) between interventions.DiscussionThese results indicated that static stretching and walking during inter-set rest intervals did not influence the change in flexibility and muscle fatigue of the leg extension exercise.

Distinct muscle growth and strength adaptations after preacher and incline biceps curl.

We compared performing preacher and incline biceps curls on changes in elbow flexors muscle size and strength. This was a between-group repeated measures randomized trial. Sixty-three young women performed preacher biceps curl (PC, n = 30) or incline biceps curl (IC, n = 33) for 8 weeks, twice a week. We measured the muscle thickness of elbow flexors at the proximal, middle, and distal sites. We assessed muscle strength using three repetition maximum (3RM) tests in the preacher curl (3RM-PC) and incline curl (3RM-IC). We observed a greater increase in proximal elbow flexors thickness in the IC compared to the PC (meandiff = 0.08 cm [95% confidence interval (95% CI): 0.02, 0.13 cm]). We observed a greater increase in distal elbow flexor thickness in the PC compared to the IC (meandiff = 0.10 cm [95% CI: 0.04, 0.15 cm]). The PC showed a greater increase in 3RM-PC (meandiff = 1.88 kg [95% CI: 1.14, 2.62 kg]). The IC showed a greater in-crease in 3RM-IC (meandiff = 0.86 kg [95% CI: 0.10, 1.62 kg]). Our findings suggest regional dif-ferences in muscle growth induced by the preacher and incline biceps curls. Strength gains appear to follow the principle of specificity.

Different effects of catheter ablation on exercise tolerance, leg strength, and quality of life in paroxysmal versus persistent atrial fibrillation

AbstractBackgroundCatheter ablation (CA) can improve exercise tolerance and quality of life (QOL) in patients with atrial fibrillation (AF). However, its differential effects on muscle strength between paroxysmal AF (PAF) and nonparoxysmal AF (Non‐PAF) remain unclear.MethodsWe evaluated 94 patients (67.8 ± 10.3 years old, 71% male) who underwent CA (PAF/Non‐PAF 46/48) without AF recurrence. Six‐minute walk distance (6MWD), leg strength, and an AF‐specific QOL questionnaire (AFQLQ) were evaluated at baseline, 3, and 6 months after CA.ResultsAt baseline, the 6MWD and AFQLQ subset 3 score were significantly lower in patients with PAF than in those with Non‐PAF, but the parameters of muscle strength were comparable between the two groups. Both 6MWD and AFQLQ significantly improved at 6 months after CA in both groups. However, leg strength at 6 months after CA significantly improved in the Non‐PAF group (54.9 ± 16.5 to 58.4 ± 15.2, p &lt; .05) but not in the PAF group.ConclusionSuccessful CA for both PAF and Non‐PAF improved QOL and exercise tolerance. Additionally, CA improved leg strength in Non‐PAF patients.

Ankle muscle strength and activation are associated with walking patterns in preschool and school-age children.

Walking patterns can differ between children and adults, both kinematically and kinetically. However, the detailed nature of the ankle pattern has not been clarified. We investigated musculature, biomechanics, and muscle activation strategies and their relevance to walking performance in preschool (PS) and school children (SC), with adults (AD) as reference. Twenty-six PS (3-5 yr), 20 SC (6-8 yr), and 17 AD (18-30 yr) participated. Tibialis anterior (TA) and medial gastrocnemius (MG) thicknesses, fascicle lengths, and maximal voluntary dorsi- and plantar flexion isometric torques were measured. Hip, knee, and ankle kinematics, ground reaction forces (GRFs), and TA and MG electromyographic activities were recorded during shod walking at each participant's preferred speed. Walking speed, step length, and cadence were correlated with age in PS. These walking performance measures were also correlated with muscle thickness and fascicle length, showing higher speed in individuals with thicker muscles and longer TA and MG fascicles (conversely, higher cadence with thinner muscles and shorter fascicles). AD demonstrated the largest values for muscle thickness (p<0.001), fascicle length (p<0.001), strength (p<0.001), and walking performance (speed p = 0.004; step length p<0.001; cadence p<0.001), followed by SC then PS. Both PS and SC exhibited higher TA activities than AD during the stance phase, resulting in a higher co-activation index. The GRFs relative to body weight were lower in both horizontal and vertical components in PS compared to SC and AD, while the relative lateral force during stance was greatest in PS followed by SC and then AD. Differences in preferred walking speed and step length were associated with age and muscle size. Children, particularly preschool-aged, employed a co-activation strategy of dorsi- and plantar flexors for stabilization, which resulted in sideways steps even at a preferred walking speed.

Sarcopenia and Cardiogeriatrics: The Links Between Skeletal Muscle Decline and Cardiovascular Aging

Sarcopenia, an age-related decline in skeletal muscle mass, strength, and function, is increasingly recognized as a significant condition in the aging population, particularly among those with cardiovascular diseases (CVD). This review provides a comprehensive synthesis of the interplay between sarcopenia and cardiogeriatrics, emphasizing shared mechanisms such as chronic low-grade inflammation (inflammaging), hormonal dysregulation, oxidative stress, and physical inactivity. Despite advancements in diagnostic frameworks, such as the EWGSOP2 and AWGS definitions, variability in criteria and assessment methods continues to challenge standardization. Key diagnostic tools include dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA) for muscle mass, alongside functional measures such as grip strength and gait speed. The review highlights the bidirectional relationship between sarcopenia and cardiovascular conditions such as heart failure, aortic stenosis, and atherosclerotic cardiovascular disease, which exacerbate each other through complex pathophysiological mechanisms. Emerging therapeutic strategies targeting the mTOR pathway, NAD+ metabolism, and senescence-related processes offer promise in mitigating sarcopenia’s progression. Additionally, integrated interventions combining resistance training, nutritional optimization, and novel anti-aging therapies hold significant potential for improving outcomes. This paper underscores critical gaps in the evidence, including the need for longitudinal studies to establish causality and the validation of advanced therapeutic approaches in clinical settings. Future research should leverage multi-omics technologies and machine learning to identify biomarkers and personalize interventions. Addressing these challenges is essential to reducing sarcopenia’s burden and enhancing the quality of life for elderly individuals with comorbid cardiovascular conditions. This synthesis aims to guide future research and promote effective, individualized management strategies.

A study to identify individuals at risk to be affected by late-onset Pompe disease who had previously been given a non-specific or tentative diagnosis for their muscle weakness (Pompe PURSUE)

BackgroundLate-onset Pompe disease (LOPD) is an autosomal recessive lysosomal storage disorder that results in severe progressive proximal muscle weakness. Over time, reductions in muscle strength result in respiratory failure and a loss of ambulation. Delayed diagnosis of LOPD deprives patients of treatments that can enhance quality of life and potentially slow disease progression. The objective of this study is to determine if patients with a nonspecific diagnosis, such as muscle weakness, may be at risk for LOPD using retrospective chart review of patients seen at two centers: an academic center and a community health system. ResultsInitial data pulls identified 80,070 patients with one of the ICD-10 codes of interest. Chart review found 551 of these patients also had at least one lab value commonly abnormal in individuals with LOPD and of these 110 scored as “at-risk”. After removing phenocopies/other confirmed unrelated diagnoses, 46 individuals were contacted either directly or through their healthcare provider for genetic counseling. Three patients had pretest genetic counseling and were tested for decreased levels of acid-α-glucosidase. One patient was found to have deficient acid-α-glucosidase. Additionally, a physician educated through the program ordered LOPD testing for their patient and diagnosed them with LOPD. ConclusionThis study confirms that a symptom-based scoring tool and chart review combined with provider education can identify patients who are at increased likelihood to have a missed LOPD diagnosis.

Efficacy of virtual reality balance training on rehabilitation outcomes following anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

The objective of this systematic review and meta-analysis is to clarify the rehabilitation efficacy of virtual reality (VR) balance training after anterior cruciate ligament reconstruction (ACLR). This meta-analysis was registered in PROSPERO with the registration number CRD42024520383. The electronic databases PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal Database, and Wanfang Digital Periodical database were systematically searched to identify eligible studies from their inception up to January 2024. The investigated outcomes included International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS), Holden grading, Extensor peak torque (EPT), Flexor peak torque (FPT), knee reaction time, knee reproduction angle difference. The pooled mean difference (MD) and 95% confidence intervals (CIs) were calculated using the random-effects model. Six RCTs with a total of 464 patients after unilateral ACLR were included for 8-12 weeks of VR balance training intervention. Analysis of the results showed that compared with the conventional rehabilitation control group, the VR balance training group significantly improved the International Knee Documentation Committee (IKDC) score (MD = 3.88, 95%CI: 0.95~6.81), Holden grading (MD = 0.42, 95%CI: 0.33~0.51), Extensor peak torque (EPT) (MD = 12.03, 95%CI: 3.28~20.78)and Flexor peak torque (FPT) (MD = 14.57, 95%CI: 9.52~19.63) in postoperative ACLR patients, and significantly reduced knee reaction time (MD = -0.30, 95%CI: -0.35~-0.25), knee angle reproduction difference at 30° (MD = -0.88, 95%CI: -1.16~-0.61), knee angle reproduction difference at 60° (MD = -0.80, 95%CI: -1.09~-0.50), and VAS score (MD = -0.52, 95%CI: -0.65~-0.39). Since many of the included results are based on low-or very-low-quality evidence, although the results show a certain trend, the conclusion has great uncertainty. In the rehabilitation training following ACLR and lower-limb balance training, the application of VR might be advantageous for the recovery of patients' knee joint function, lower-limb muscle strength, proprioception, and pain management. The level of immersion may influence the rehabilitation outcome. Because of the limitations in data quality and heterogeneity as well as the small sample size, the strength of the conclusions is weakened. These findings should be verified in further large-scale prospective studies.

Hämatrain-Hybrid movement therapy during inpatient and outpatient hematological treatment: correlations with physical and psychological parameters.

Prior research indicates that engaging in physical activity during chemotherapy can positively influence both physical and psychological parameters in individuals with hematological neoplasms. However, the most effective type, level, intensity, and frequency of exercise remains unclear. We enrolled 53 patients to a clinical trial assessing a partly supervised hybrid training program including both strength and endurance components, commencing at onset of induction therapy (T0) for hematological malignancies, including AML (n = 29), ALL (n = 5), and NHL (n = 19). Endpoints to evaluate efficacy included muscle strength in kg, cardiovascular fitness in steps, balance in scores, quality of life (QoL), and fatigue. Data were compared at three time points: the beginning of treatment (T0), during consolidation (T1), and 12 ± 2weeks later (T2). Average adherence to protocol specified activities was 63.2% (± 40.0% s.d.) for participants without a stem cell transplant (No-SCT) and 51.5% (± 29.3% s.d.) for participants with AML between T0 and T2. No serious adverse reactions related to the exercise program were reported. Positive correlations were found between adherence and hand strength (T0-T1: left: r = 0.48, p < 0.05; right: r = 0.56, p < 0.05) for patients without stem cell transplant as therapy, as well as a strong association between higher adherence and lower appetite loss between T1 and T2 (No-SCT: r = -0.67, p = 0.001; AML: r = -0,49, p = 0,03). In participants with AML, it was also shown that higher adherence at T2 was associated with reduced symptom burden due to financial problems (r = -0,65, p = 0,004). However, other aspects of quality of life and fatigue showed only weak to moderate correlations with adherence. This partly supervised hybrid exercise program during inpatient and outpatient care of patients with hematological cancer was safe and feasible. While useful in maintaining hand strength and reducing appetite loss in some patients, as well as reducing symptom burden due to financial problems in other patients, ambiguity was likely due to confounding factors, such as underlying disease biology and response to treatment. Corresponding author: Johanna Huesmann (johuesmann@gmx.de) (TRN: DRKS00034396, Date of registration: 07.06.2024; retrospectively registered).

Multicentric Castleman’s Disease presenting with bilateral panuveitis

Purpose: To report a rare case of Multicentric Castleman’s Disease presenting with bilateral panuveitis. Methods: Case report. Results: A 65-years-old caucasian man presented with progressive blurred vision in both eyes for two weeks, along with weight loss, polyarthralgias and reduced muscle strength persisting for about a year. Examination revealed bilateral panuveitis after intraocular lymphoma being initially considered. CT scans showed multiple lymph node enlargements suggestive of lymphoproliferative disorder. Excisional biopsy of an axillary lymph node confirmed the diagnosis of plasmacytic type Castleman’s disease. Treatment was started with topical dexamethasone and tropicamide for anterior chamber inflammation, followed by oral prednisolone. After definitive diagnosis, treatment with siltuximab was initiated, which led to significant improvement in panuveitis and systemic symptoms. The patient became off corticosteroids and continued on siltuximab with stable visual acuity and low-grade vitritis. Conclusion: To the best of our knowledge we described the first case in which the diagnosis of Multicentric Castleman’s Disease was established through the investigation of bilateral panuveitis, which was successfully managed with corticosteroids and siltuximab.