Physical Function Research Articles

Evaluation of the Effectiveness of Compression Therapy Combined with Exercises Versus Exercises Only Among Lipedema Patients Using Various Outcome Measures

The treatment of lipedema remains challenging, largely due to widespread misconceptions. Selecting the appropriate treatment method necessitates the use of accurate outcome measures. This study aims to evaluate the effectiveness of compression therapy combined with exercises versus exercises alone in lipedema patients using various outcome measures. Twenty-four women with lipedema were divided into two equal groups: one group received compression therapy plus exercises while the other group performed exercises only. The effectiveness of the treatment was assessed before and after the intervention using several measures: an SF-36 questionnaire, a symptom severity survey, circumference (via 3D scanning), and body composition analysis. Significant improvements were observed in the SF-36 Physical Functioning and SF-36 Energy/Fatigue scores among participants in the compression group. Additionally, there was a reduction in the heaviness of extremities, the disproportion between the trunk and limbs, and the level of swelling in the compression therapy. Circumferences decreased in both groups. Although more circumferences were significantly reduced in the compression group, the reduction at the point above the knee was greater in the non-compression group. Compression therapy is an effective treatment for lipedema. Various measures, such as quality-of-life questionnaires and symptom severity surveys, can be used as valuable tools for assessing the effectiveness of lipedema treatment.

Long-Term Disabilities in ICU Survivors of COVID-19.

COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post-hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability. In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post-hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied. The subjects (N = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated (n = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups (P < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group (P = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use. Disability persisted at 6 month post-hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation.

The effectiveness of vitamin D supplementation in patients with end-stage knee osteoarthritis: Study protocol for a double-blinded, randomized controlled trial.

Osteoarthritis (OA) knee is one of the most common chronic degenerative conditions that imposes clinical and economic burdens on individuals and societies worldwide. Previous studies showed vitamin D levels correlated positively with lean muscle mass and grip strength, implying that vitamin D supplementation may improve muscle health in knee OA subjects. This randomized controlled trial (RCT) aims to compare the effects of vitamin D supplementation on knee muscle strength, physical function, pain, and sarcopenia status in patients with end-stage knee OA. Patients and outcome assessors will be blinded to group allocation. Fifty-six end-stage knee OA patients with vitamin D insufficiency fulfilling our inclusion criteria will be invited to participate in this study. Patients will be randomly assigned to take vitamin D supplementation (4,000 IU capsule daily) or placebo for six months. Measurements will be taken at baseline, three and six-month after the commencement of the vitamin D supplement, and 6-month after the interventional period. The primary outcome includes the isometric quadriceps and hamstring muscle strength measured by a hand-held dynamometer. Secondary outcomes include pain, performance-based and self-reported physical function and sarcopenia status. The success of this study will provide scientific evidence of whether the relatively cheap and well-tolerated vitamin D supplement can improve quadriceps muscle strength, physical function, pain symptoms, and sarcopenia status of this increasingly large population for end-stage knee OA patients. The study has great clinical significance given Hong Kong's lengthy and growing waiting list for complete knee replacement procedures. Trial registration: The trial was registered on clinicaltrials.gov (NCT05981534) on 31st July 2023.

The association between ultrasonographic findings and pain, physical function, and symptoms in patients with shoulder pain.

Shoulder ultrasonography (US) is commonly employed to differentiate the causes of shoulder pain. However, the correlation between ultrasonographic findings and the individual's functional disability and daily activities remains unexplored. To investigate the relationship between shoulder US findings and physical function, disability, and pain. The study investigated patients with shoulder pain. Tendons of supraspinatus, infraspinatus, subscapularis, and long head of biceps brachii, acromiohumeral distance, and acromioclavicular joint (ACJ) degeneration were evaluated using US. The QuickDASH questionnaire was employed to evaluate physical function, symptoms, and disability, while the visual analog scale (VAS) was utilized to assess pain levels. The study included 84 patients (69 [82.1%] women, mean age = 55.7 ± 11.9 years). Ultrasonographic examination revealed ACJ degeneration in 61 (21.4%) patients and biceps tendinitis in 21 (25%) patients. In addition, supraspinatus tendinosis was identified in 51 (61%) patients, while 28 (33%) exhibited a supraspinatus tear. The patients demonstrated a mean VAS score of 7.03 ± 1.49 and mean QuickDASH score of 45.6 ± 15.3. Individuals with a supraspinatus tear exhibited higher VAS (P = 0.008) and QuickDASH (P = 0.016) scores. Patients presenting with ACJ degeneration demonstrated increased VAS scores (P = 0.014), whereas those with biceps tendinopathy showed higher QuickDASH scores (P = 0.035). The results obtained from our research demonstrate significant correlations between ultrasonographic data and pain, disability, and physical manifestations. The findings of this study indicate that shoulder US provides valuable information regarding the difficulties individuals face in their daily tasks and the degree of pain they endure.

Constructing a picture of fatigue in the context of cancer: assessment of construct overlap in common fatigue scales.

Individuals diagnosed with cancer experience multiple inter-related short- and long-term side effects. Chief among such symptomology is cancer-related fatigue (CRF), which, if left unmanaged, can become chronic and result in increased disability and healthcare utilization. A growing number of self-report scales have been developed to measure CRF symptoms based on various theoretical conceptualizations with the aim of promoting targeted assessment and intervention efforts. It may be, however, unwise to assume that the various measures are conceptually similar (i.e., that they assess for the same constructs). Accordingly, we aimed to characterize item content among nine self-report scales, using a Jaccard index to quantify content overlap among scales. We characterized construct assessment among nine self-report scales recommended to assess CRF by a recent clinical practice guideline, and used a Jaccard index to quantify content overlap among scales. Analysis of 208 items across nine rating scales resulted in 20 distinct symptoms of CRF assessed. The most common symptoms were energy level (captured in all nine scales), cognitive function, impaired task performance (in eight scales), sleepiness, and physical function (in seven scales). Mean overlap among all scales was low (Jaccard index = 0.455). Only one construct (duration of fatigue; 5.0%) was captured by a single scale, and one symptom (energy level; 5.0%) was common across all scales. The PFS, MFSI, and BFI each captured at least one symptom from each of the NCCN domains of CRF. CRF scales are heterogeneousin the content they measure, critically impairing integration of knowledge across studies using disparate scales. Future work is urgently needed to build more integrated theoretical and/or computational models of CRF based on relevant mechanisms.

A Systematic Review Toward a Comprehensive Framework for Measuring Non-chronological Age

As populations age globally, there is a need to refine the understanding of aging beyond simply chronological age. Therefore, this study used the PRISMA framework to synthesize literature on alternative aging metrics beyond chronological age. We analyzed articles from 6 databases (SCOPUS, PsychINFO, Web of Science, CINAHL, Engineering Village, and PubMed) and selected 18 articles that explored factors that lead to older adults’ individual differences. Findings indicated the necessity of a consistent terminology that better describes one’s cognitive and physical functioning, such as “non-chronological age.” Also, the review found that daily cognitive, physical, and social activities may result in different non-chronological ages. A comprehensive tool to measure non-chronological age and thereby provide a more accurate representation of aging that incorporates these critical factors is needed. The findings may contribute to the development of theories in non-chronological age.

Evaluating a digital tool for supporting people affected by breast cancer: a prospective randomized controlled trial—the ADAPT study

PurposeThis study reports the findings from the ADAPT randomized controlled trial (RCT), concerning the impact of a digital tool for supported self-management in people affected by breast cancer on patient activation as the primary outcome, with health-related quality of life (HRQoL), and health status as secondary outcomes.MethodsWomen with early-stage breast cancer were randomly assigned to standard care (control) or standard care in addition to the breast cancer digital tool (intervention). Data were collected using a demographic questionnaire, the Patient Activation Measure (PAM-13), the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), and the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) at baseline, 6 weeks, 3 months, 6 months, and 1 year from diagnosis. Linear mixed effect model regression was used to assess the effect of the digital tool over the first year from diagnosis while correcting for intra-participant correlation.ResultsA total of 166 participants were included, with 85 being randomized into the intervention. No significant differences (p > 0.05) in the PAM-13 scores, EORTC QLQ-C30 scales (global QoL, physical functioning, emotional functioning, pain, fatigue), and EQ-5D-5L Index between the control and intervention groups were observed. It is important to note that there was significant non-adherence within the intervention group.ConclusionThe breast cancer digital tool had no statistically significant impact on patient activation, HRQoL, and health status over time compared to standard care alone in women with early-stage breast cancer. Future research should focus on identifying and addressing barriers to digital tool engagement to improve efficacy.Clinical trial informationThe study was registered at https://clinicaltrials.gov (NCT03866655) on 7 March 2019 (https://clinicaltrials.gov/study/NCT03866655).

Assessing acute effects of two motor-cognitive training modalities on cognitive functions, postural control, and gait stability in older adults: a randomized crossover study.

The process of aging often accompanies a decline in cognitive function, postural control, and gait stability, consequently increasing the susceptibility to falls among older individuals. In response to these challenges, motor-cognitive training has emerged as a potential intervention to mitigate age-related declines. This study aims to assess the acute effects of two distinct motor-cognitive training modalities, treadmill dual-task training (TMDT) and interactive motor-cognitive training (IMCT), on cognitive function, postural control, walking ability, and dual-task performance in the elderly population. In this randomized crossover study, 35 healthy elderly individuals (aged 60-75) participated in three acute training sessions involving TMDT, IMCT, and a control reading condition. Assessments of executive function, postural control, gait performance, and cognitive accuracy were conducted both before and after each session. Both TMDT and IMCT improved executive functions. Notably, IMCT resulted in a significant enhancement in correct response rates and a reduction in reaction times in the Stroop task (p < 0.05) compared to TMDT and the control condition. IMCT also led to an increase in dual-task gait speed (p < 0.001) and showed a trend towards improved cognitive accuracy (p = 0.07). Conversely, TMDT increased postural sway with eyes open (p = 0.013), indicating a potential detriment to postural control. The findings suggest that IMCT holds greater immediate efficacy in enhancing cognitive function and gait stability among older adults compared to TMDT, with a lesser adverse impact on postural control. This underscores the potential of IMCT as a preferred approach for mitigating fall risk and enhancing both cognitive and physical functions in the elderly population.

Assessing the measurement properties of PROMIS Computer Adaptive Tests, short forms and legacy patient reported outcome measures in patients undergoing total hip arthroplasty.

The commonly used ('legacy') PROMs evaluating outcomes of total hip arthroplasty (THA), have several limitations regarding their measurement properties and interpretation of scores. One innovation in PROMs is the use of Computerized Adaptive Testing (CAT). The Patient-Reported Outcomes Measurement Information System (PROMIS®) is a validated system of CATs. The aim of this study was to assess the measurement properties of PROMIS and legacy instruments in patients undergoing THA. Patients in this multicenter study filled out a questionnaire twice, including Dutch-Flemish PROMIS v1.2 Physical Function (PROMIS-PF) and v1.1 Pain Interference (PROMIS-PI) CATs and short forms, PROMIS v1.0 Pain Intensity, and legacy PROMs (Hip disability and Osteoarthritis Outcome Score (HOOS), HOOS-Physical function Shortform (HOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), and two numeric rating scales measuring pain). The reliability, measurement precision (Standard Error of Measurement (SEM)), smallest detectable change (SDC), and burden of PROMIS instruments were presented head-to-head to legacy PROMs. Furthermore, construct validity was assessed. 208 patients were included. All instruments had a sufficient test-retest reliability (range ICC: 0.83-0.96). The SEM of PROMIS CATs and short forms ranged from 1.8 to 2.2 T-score points, the SEM of legacy instruments 2.6-11.1. The SDC of PROMIS instruments ranged from 2.1 to 7.3 T-score points, the SDC of legacy instruments 7.2-30.9. The construct validity of PROMIS CAT and short forms were found sufficient, except for the PROMIS-PI short form. The burden of PROMIS CATs was smaller than PROMIS short forms (range 4.8-5.2 versus 8-20 items, respectively). The burden of legacy instruments measuring physical functioning ranged from 5 to 40 items. The PROMIS-PF is less burdensome, with high measurement precision, and almost no minimal or maximal scores, and an equal reliability compared to legacy instruments measuring physical functioning in patients undergoing THA. The PROMIS Pain Intensity 1a is comparable to the legacy pain instruments in terms of burden, reliability and SDC. Measuring the construct Pain Interference may not have additional value in this population because of its high correlation with instruments measuring physical functioning. The SDC values presented in this study can be used for individual patient monitoring.

Profiles of brain topology for dual-functional stability in old age.

Dual-functional stability (DFS) in cognitive and physical abilities is important for successful aging. This study examines the brain topology profiles that underpin high DFS in older adults by testing two hypotheses: (1) older adults with high DFS would exhibit a unique brain organization that preserves their physical and cognitive functions across various tasks, and (2) any individuals with this distinct brain topology would consistently show high DFS. We analyzed two cohorts of cognitively and physically healthy older adults from the UK (Cam-CAN, n = 79) and the US (CF, n = 48) using neuroimaging data and a combination of cognitive and physical tasks. Variability in DFS was characterized using k-mean clustering for intra-individual variability (IIV) in cognitive and physical tasks. Graph theory analyses of diffusion tensor imaging connectomes were used to assess brain network segregation and integration through clustering coefficients (CCs) and shortest path lengths (PLs). Using support vector machine and regression, brain topology features, derived from PLs + CCs, differentiated the high DFS subgroup from low and mix DFS subgroups with accuracies of 65.82% and 84.78% in Cam-CAN and CF samples, respectively, which predicted cross-task DFS score in CF samples at 58.06% and 70.53% for cognitive and physical stability, respectively. Results showed distinctive neural correlates associated with high DFS, notably varying regional brain segregation and integration within critical areas such as the insula, frontal pole, and temporal pole. The identified brain topology profiles suggest a distinctive neural basis for DFS, a trait indicative of successful aging. These insights offer a foundation for future research to explore targeted interventions that could enhance cognitive and physical resilience in older adults, promoting a healthier and more functional lifespan.

Cross-sectional associations between fruit and vegetable intake and successful ageing across 6 countries: findings from the WHO Study on global AGEing and adult health (SAGE).

This study develops successful ageing profiles across six low and middle-income countries (LMICs) and examines associations with fruit and vegetable (F&V) intake. A cross-sectional analysis was conducted in mid-aged and older adults from the WHO Study of Global Ageing. Participants without chronic disease, cognitive impairment, depression or disability and with good physical, cardiovascular and respiratory function were considered to have successfully aged. Associations between F&V intake (serves/day) and successful ageing were examined using log-binomial regression adjusting for key confounders. China, Ghana, India, Mexico, Russia and South Africa. A total of 28785 men and women aged aged 50 years and over. Successful ageing ranged from 4% in Mexico to 15% in China. After adjustment, only Ghana showed an association between fruit intake and successful ageing, with an inverse association identified (Prevalence Ratio [PR]=0.87, 95% Confidence Interval [CI]: 0.78-0.98). An inverse association between vegetable intake and successful ageing was found in China (0.97, 0.95-0.98) but no other country. An inverse association was shown for both China (0.98, 0.96-0.99) and Ghana (0.92, 0.84-1.00) when considering fruit and vegetables combined. Associations between F&V intake and successful ageing are inconsistent. Further studies on LMIC countries are needed to meet the challenges of the ageing population.

The Influence of Mental Fatigue on Physical Performance and Its Relationship with Rating Perceived Effort and Enjoyment in Older Adults

ABSTRACT The study investigated the influence of mental fatigue on older people’s enjoyment during a series of physical exercises. Using a randomized cross-over design, participants (n = 35) completed a 6-minute walking test − 6MWT, a Timed Up and Go—TUG test and three sets of knee extension exercise (first set: KE1, second set: KE2, third set: KE3) under two experimental conditions (control or mental fatigue). The Nonparametric Analysis of Longitudinal Data in Factorial Experiments was used to compare the number of repetitions performed during three sets of resistance exercise between conditions. The same analysis method was applied to compare the perception of effort and enjoyment across five moments (Post-6MWT, Post-TUG, Post-KE1, Post-KE2, Post-KE3) and two conditions and the Visual Analogue Scales (VAS) across four moments (baseline, Pre-6MWT, Pre-TUG, Pre-KE) and two conditions. Mental fatigue did not affect the physical function, perception of effort and enjoyment of exercise in older people. Participants, however, reported higher enjoyment for walking and dynamic balance compared to strength exercise. Mental fatigue had no effect on the physical function, perception of effort and enjoyment of exercise of older people. Participants presented a higher enjoyment for walking and dynamic balance compared to strength exercise. Given the importance of resistance exercises for health, clinicians should prioritize resources to education programs emphasizing the benefits of resistance exercise in both short- and long-term health. Including social interaction opportunities in physical exercise programs and prescribing activities appropriate to participants’ ability levels could enhance engagement and adherence.

Correlation between Fear of fall, Physical Function And Psychological Health Among Obese And Non-Obese Older Adults Diagnosed With Knee Osteoarthritis

Correlation between Fear of fall, Physical Function And Psychological Health Among Obese And Non-Obese Older Adults Diagnosed With Knee Osteoarthritis

Enhancing Athletic Recovery: Scar Treatment Using Microneedling, Dermal Fillers, and Lasers

Introduction and purpose: Scars represent a prevalent skin irregularity encountered by a significant portion of the population. Beyond merely impacting physical appearance, they can also contribute to the onset of depression and anxiety disorders, which may hinder athletic recovery. The treatment landscape for scars is diverse, spanning non-invasive to invasive procedures. This literature review endeavors to explore scar management, particularly focusing on methodologies involving microneedling, dermal fillers, and laser interventions. By examining these innovative approaches, we aim to provide insights into their efficacy and implications for clinical practice, with a particular emphasis on facilitating a faster return to sport and optimal athletic performance. Material and methods: The literature was conducted using "Pub Med" and "Google Scholar" databases with the keywords „scars”, „microneedling”, „dermal fillers”, „lasers” Brief description of the state of knowledge: Scar therapy using microneedling, dermal fillers, and lasers has shown high effectiveness and significantly improves the lives of patients undergoing treatment. Results and conclusions: Treating scars using microneedling, dermal fillers, and laser therapy has led to significant enhancements in both physical functioning and psychological well-being among patients with visible scars. These procedures exert their efficacy by promoting collagen synthesis and facilitating skin regeneration, thereby ameliorating skin redness, erythema, and scar tissue formation. However, it's important to note that the effectiveness of these interventions varies depending on factors such as the type and depth of the scar, as well as the age of the patient.

Identifying Clusters of Curatively-Treated Esophageal Cancer Patients Using Patient-Reported Outcome Measures at Three Months from Discharge: A Secondary Analysis from a Longitudinal Single Center Study.

This study aims to identify meaningful clusters based on Patient-Reported Outcome Measures (PROMs) in curatively-treated esophageal cancer patients at three months post-discharge. This secondary analysis of a longitudinal single-center study included 46 esophageal cancer patients who underwent curative surgery. Patients were selected based on their completion of PROMs surveys at three months post-discharge, were aged 18 years or older, and had undergone surgical resection (esophagectomy) with or without neoadjuvant chemotherapy and/or radiotherapy. The analysis utilized t-distributed Stochastic Neighbor Embedding (t-SNE) for dimensionality reduction and hierarchical clustering to analyze PROMs data collected three months post-discharge. Clustering was performed on physical, emotional, cognitive, and social functioning variables, symptom burden, and health literacy. Three distinct clusters were identified: Cluster 1 (n = 24) with higher functioning and moderate symptoms, Cluster 2 (n = 14) with moderate functioning, higher symptoms, and lower health literacy, and Cluster 3 (n = 8) with the highest functioning, lowest symptoms, and highest health literacy. Significant differences between squamous cell carcinoma and adenocarcinoma subtypes were observed across several PROMs domains, including critical health literacy, general health status/quality of life, nausea and vomiting, and insomnia. These clusters provide an exploratory framework for tailoring post-operative interventions to enhance patient recovery, which necessitates further confirmatory investigations, including outcomes such as complications and mortality, in the analysis. This study fills a research gap by demonstrating the utility of PROMs in identifying distinct recovery patterns in esophageal cancer patients post-surgery. The findings support the use of PROMs to guide personalized post-operative care, potentially improving patient outcomes and quality of life. Further research is needed to validate these findings in larger, diverse populations.

Special Issue on Robotics and Mechatronics Technology for Sports, Exercise, and Health Care (Part 2)

Robotics, mechatronics, and digital technologies are advancing significantly in sports, exercise, and healthcare, and offer innovative solutions that shape the future of these fields. In Part 2 of this special issue, we examine independent research and cutting-edge developments that address new challenges and provide unique contributions to these domains. Technological advancements in assistive devices and rehabilitation offer new solutions for improving the quality of life of individuals with physical challenges. Researchers of wearable assistive devices and prosthetics continue to devise methods to enhance mobility and support physical functions, thereby benefiting both users and healthcare providers. Sports and motion analysis remains a key focus area, where innovative technologies are employed to analyze and improve athletic performance. By capturing and evaluating detailed movement data, these technologies can help athletes refine their techniques and achieve greater precision in their sports, thus ultimately resulting in enhanced performance and injury prevention. As in Part 1, the studies presented in this issue demonstrate the practical applications of cutting-edge technologies and offer insights into their future potential. We hope that these contributions will inspire researchers and practitioners alike and provide a foundation for continued advancements in these exciting and impactful fields.

Combined Exercise and Nutritional Therapy Improves Physical Functions and Activities of Daily Living in Patients With Multimorbidity Undergoing Convalescent Rehabilitation: A Case Report

Combined Exercise and Nutritional Therapy Improves Physical Functions and Activities of Daily Living in Patients With Multimorbidity Undergoing Convalescent Rehabilitation: A Case Report

Solving wave equations in the space of Schwartz distributions: the beauty of generalised functions in physics

Solving wave equations in the space of Schwartz distributions: the beauty of generalised functions in physics

Lightweight Mutually Authenticated Key Exchange with Physical Unclonable Functions

Authenticated key exchange is desired in scenarios where two participants must exchange sensitive information over an untrusted channel but do not trust each other at the outset of the exchange. As a unique hardware-based random oracle, physical unclonable functions (PUFs) can embed cryptographic hardness and binding properties needed for a secure, interactive authentication system. In this paper, we propose a lightweight protocol, termed PUF-MAKE, to achieve bilateral mutual authentication between two untrusted parties with the help of a trusted server and secure physical devices. At the end of the protocol, both parties are authenticated and possess a shared session key that they can use to encrypt sensitive information over an untrusted channel. The PUF’s underlying entropy hardness characteristics and the key-encryption-key (KEK) primitive act as the root of trust in the protocol’s construction. Other salient properties include a lightweight construction with minimal information stored on each device, a key refresh mechanism to ensure a fresh key is used for every authentication, and robustness against a wide range of attacks. We evaluate the protocol on a set of three FPGAs and a desktop server, with the computational complexity calculated as a function of primitive operations. A composable security model is proposed and analyzed considering a powerful adversary in control of all communications channels. In particular, session key confidentiality is proven through formal verification of the protocol under strong attacker (Dolev-Yao) assumptions, rendering it viable for high-security applications such as digital currency.

Combinations of physical and cognitive training for subcortical neurodegenerative diseases with physical, cognitive and behavioral symptoms: a systematic review.

The onset of the symptoms of subcortical NDs is due to a unique part of the brain which strengthens the idea of reciprocal influence of physical activity and cognitive training in improving clinical symptoms. Consequently, protocols combining the two stimulations are becoming increasingly popular in NDs. Our threefold aim was to (A) describe the different combinations of physical and cognitive training used to alleviate the motor and cognitive symptoms of patients with subcortical neurodegenerative disorders, (B) compare the effects of these different combinations (sequential, dual tasking, synergical) on symptoms, and (C) recommend approaches for further studies. We conducted literature searches of PubMed, BASE and ACM, to carry out a systematic review of randomized controlled trials and controlled trials of combined physical and cognitive training among patients with Huntington's disease, Parkinson's disease, amyotrophic lateral sclerosis, Lewy body dementia, spinocerebellar ataxia, Friedreich's ataxia, and progressive supranuclear palsy. Physical, neuropsychological, behavioral outcomes were considered. The Cochrane risk-of-bias tool was used to verify the critical appraisal. Twenty-one studies focused on Parkinson's disease with 940 participants were included. Despites promising benefits on cognitive and physical function, our results revealed discrepant findings for research on combined training. Inconsistencies were linked to the choice of tests, the functions that were targeted, disease progression, and trainings. There was a dearth of follow-up data. Differences between combined training are unclear, particularly regarding the role of cognitive load. Future studies should focus on comparing the feasibility, tolerability, and effectiveness of different combinations of motor-cognitive training.