ObjectivePre-frailty is prevalent and linked to diminished physical function and heightened healthcare needs. This study explored feasibility and preliminary effects of a structured 12-week exercise programme for pre-frail older adults and its impact on physical performance.MethodsA multi-centre, prospective quasi-experimental study with single-arm pre-post design was conducted from April 2022 to September 2023 across four regional primary care clinics in Singapore. Participants aged ≥65 years, with Clinical Frailty Scale (CFS) score of 3 or 4, were enrolled in a 12-week program consisting of nine supervised in-person and three asynchronous remote exercise sessions (via pre-recorded videos). Each session lasted one hour and targeted functional strength, balance, mobility, and endurance. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, satisfaction, and safety; clinical outcomes were considered secondary. Physical performance was assessed using Short Physical Performance Battery (SPPB), 30-Seconds Sit-to-Stand (30CST), and handgrip dynamometry at baseline and at 3 months (post-intervention). Changes in physical activity levels were evaluated using interviewer-administered International Physical Activity Questionnaire-Short Form (IPAQ-SF) at baseline, 6 months, and 12 months.ResultsOf 227 eligible participants, 162 started the programme (attended ≥1 session), and 139 completed the 3-month follow-up. The recruitment rate was 71.4%, and the retention rate was 85.8% (139/162) among those who started. The program achieved overall 81.9% average attendance rate across 12 sessions, with 64% of participants attending at least 10 sessions. Participants demonstrated an increase in SPPB scores (mean: +0.76 points; 95% CI: 0.48–1.04; p < 0.001) and in 30CST repetitions (mean: +2.82; 95% CI: 2.27–3.41; p < 0.001) from pre- to post- intervention. Female participants showed improved right-hand grip strength (mean: +0.65 kg; 95% CI: 0.16–1.14; p = 0.010), although male grip strength did not significantly change. No significant increase in total physical activity was observed at 6 or 12 months (IPAQ category shifts: p = 0.136 and 0.050 respectively), despite a positive trend towards higher activity levels. All respondents expressed satisfaction with the overall programme, and 93% were satisfied with the remote sessions. No exercise-related adverse events occurred. Qualitative feedback highlighted improved confidence and social engagement as added benefits.ConclusionThe structured hybrid exercise program was feasible in a primary care setting and associated with improvements in physical function among community-dwelling pre-frail older adults. Feasibility was demonstrated through strong attendance, completion rates and participant satisfaction. Despite no significant change in self-reported physical activity, the combination of in-person supervision and home-based exercise appears promising for scalable pre-frailty management. This pilot study's positive findings support further evaluation in a controlled trial and suggest that such hybrid models can be implemented to engage pre-frail seniors in regular exercise.

Anatomical and functional asymmetry predicts G-force tolerance in high-Intensity physical performers.

Background: In soccer, the repeated execution of unilateral actions may lead to uneven limb development, promoting the occurrence of asymmetries. However, there is no consensus on the impact of these asymmetries on sports performance or the influence of playing position on their magnitude. Methods: A cross-sectional study was conducted with 33 male federated soccer players (age: 18.42 ± 4.24 years; body mass: 70.23 ± 8.74 kg; height: 1.76 ± 0.07 m; body mass index: 22.6 ± 2.7 kg/m2). Hamstring strength asymmetry between the dominant and non-dominant limbs was assessed using functional electromechanical dynamometer (FEMD) at eccentric velocities of 0.4, 0.8, and 1.2 m/s. Physical performance was evaluated through a 30 m sprint and countermovement jump (CMJ). Differences according to playing position were also analyzed. Results: Significant between-limb differences were found in strength, power, and impulse, with effect sizes increasing as testing velocity rose. No significant differences in asymmetry levels were observed across playing positions, and no correlations were found between hamstring asymmetry and physical performance outcomes. Conclusions: Although functional lower-limb asymmetries were identified in soccer players, these asymmetries did not directly influence performance nor vary across playing positions. The findings suggest that certain asymmetries may represent normal functional adaptations in soccer rather than pathological structural imbalances.

Introduction: Youth football demands training strategies that optimize performance and reduce the risk of injury. Strength training based on movement patterns is presented as an effective alternative by integrating neuromuscular function, stability, and mobility, enhancing the player's speed and physical capabilities. Functional tests such as FMS and displacement speed allow for the individualized prescription of training. Objective: To determine the effect of a training program based on functional movement patterns on explosive strength and displacement speed in youth amateur football players. Methodology: This was a quantitative, quasi-experimental study with a two-group design (experimental and control). The experimental group received movement pattern-based training (MPB), while the control group continued their conventional training. Pre-test and post-test assessments were conducted using the countermovement jump (CMJ) and 30-meter sprint tests. Thirty-four 17-year-old athletes participated, meeting the inclusion and exclusion criteria. Differences between groups were assessed using homogeneity tests for independent samples (Student's t-test) and for paired samples (Wilcoxon signed-rank test). Results: The functional movement pattern-based training program significantly improved movement speed in young amateur soccer players. The null hypothesis was rejected, demonstrating how this type of training improves movement speed and physical performance in young soccer players. Conclusions: Functional movement pattern (FMS) training is becoming a novel training modality in soccer, improving movement speed and achieving adequate results for this physical capacity.

Transthyretin amyloidosis (ATTR) is a multisystemic disease impacting quality of life (QOL) through various symptoms. The Transthyretin Amyloidosis - Quality of Life Questionnaire (ATTR-QOL) was developed to assess disease-specific effects on QOL, but its associations with established patient-reported outcomes measures (PROs), clinical markers, and functional tests remain unexplored. This cross-sectional study included consecutive ATTR patients at Columbia University between 3/2024 and 1/2025 who completed the ATTR-QOL. The questionnaire includes 5 symptom and 4 impact scores (range: 0-100, higher scores indicate worse status). Clinical parameters, PROs, and functionality were recorded at the same visit. PROs of interest included the Kansas City Cardiomyopathy Questionnaire (KCCQ), SF36v2 and Composite Autonomic Symptom Score-31 (COMPASS-31), while 6-minute walk test and Short Physical Performance Battery Test were recorded as functionality measures. 194 patients (137 cardiomyopathy, 48 mixed, 9 neuropathy) were included. Most had early-stage disease (National Amyloidosis Center [NAC] Stage 1: 70%, Stage 2: 22%, Stage 3: 8%), and all were on disease-modifying treatment. ATTR-QOL exhibited good convergent validity with clinical parameters, functionality testing, and established QOL tools. Additionally, ATTR-QOL demonstrated strong known-groups discriminant validity, as evidenced by its ability to differentiate between various clinical and functional groups, as well as established patient-reported outcome (PRO) categories. ATTR-QOL, as a disease-specific PRO, effectively captures the multidimensional impact of ATTR and is associated with clinical parameters and functionality in patients with ATTR.

Strontium-doped wollastonite glass-ceramics with varying Sr concentrations (0.125, 0.25, and 0.50 wt%) were successfully synthesized via a melt-quenching technique and comprehensively evaluated for structural, physical, and biological performance, including in vitro biocompatibility, antimicrobial activity, and cytotoxicity. Characterization using DTA, XRD, and FE-SEM/EDX confirmed progressive hydroxyapatite (HA) formation following 28 days of immersion in simulated body fluid (SBF), with XRD revealing a reduction in wollastonite peaks and distinct HA signals, particularly in Sr-containing samples. FTIR spectra showed intensified phosphate absorption bands, while FE-SEM/EDX analyses highlighted a morphological shift from plate-like structures to needle-like HA crystals. Strontium doping was found to play a key role in guiding HA crystallization pathways while supporting wollastonite’s intrinsic isovalent cation exchange capacity. Among all compositions, the W3Sr sample (0.5 wt% Sr) exhibited the best balance of mechanical properties and biological efficacy. Biologically, the material demonstrated dose-dependent antifungal activity against Aspergillus niger (11–18 mm IZD) and Fusarium solani (10–16 mm IZD), no antibacterial activity, and excellent cytocompatibility with BJ1 human fibroblasts. Overall, this Sr-doped wollastonite system shows strong potential for next-generation orthopedic and dental applications, combining Sr-mediated bioactivity, mechanical strength, antifungal efficacy, and cell compatibility.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-026-36649-1.

ABSTRACT Research on two-phase fuels has advanced significantly in rotating detonation engines. However, the combustion process of liquid-phase fuels involving multiple complex stages like evaporation, mixing, and chemical reactions has not been studied in-depth. In order to investigate the macroscopic physical characteristics and performance of two-phase kerosene rotating detonation, this study employs a two-dimensional numerical simulation to compare the combustion processes and characteristics of gas-phase and two-phase fuels under inhomogeneous conditions. The results demonstrate that for gas-phase fuels, the detonation wave intensity exhibits a negative correlation with the injection total temperature and a positive correlation with the injection total pressure. In contrast, for two-phase fuels, the detonation wave intensity reaches a maximum at an optimal injection total temperature within a specific pressure range. Furthermore, an in-depth analysis is conducted on the diameter variation and spatial distribution of droplets within the flow field. Finally, a concept characterizing the intensity of detonation waves was proposed. This concept can represent thrust to a certain extent and provides the operational range of detonation waves under different fuels. This research provides a theoretical basis for the design and optimization of rotating detonation engines, especially for the application of two-phase fuels.

Iron dysregulation and mitochondrial dysfunction in aging: A longitudinal study on mobility decline in low- and high-functioning older adults.

Frailty in older adults is a common aging-related syndrome that can lead to adverse health outcomes. Although physical exercise and nutritional interventions have been widely recognized as beneficial for managing frailty, the comparative effectiveness of various intervention approaches remains uncertain. We systematically evaluated the effects of multicomponent exercise, nutritional supplementation, and combined interventions on frailty status and functional outcomes in older adults using network meta-analysis. Randomized controlled trials (RCTs) published between 2006 and 2025 were searched to include studies assessing the effects of multicomponent exercise, nutritional supplements (including amino acids and proteins, etc.), combined interventions, or standard care on frailty status in older adults aged ≥ 60 years. Changes in frailty scores constituted the primary outcome. Secondary outcomes comprised gait speed, the Short Physical Performance Battery (SPPB), and the Timed Up-and-Go test (TUG). Effect sizes were calculated using Standardized Mean Difference (SMD) and 95% Confidence Interval (CI), and ranked using network meta-analysis. Ultimately, 22 RCTs involving 2,055 participants were included, with comparable baseline characteristics among participants. Regarding the improvement in frailty scores, combined interventions demonstrated the greatest improvement (SMD = -0.92, 95% CI: -1.43 to -0.40), followed by multicomponent exercise (SMD = -0.78, 95% CI: -1.15 to -0.43), while nutritional supplementation showed a trend toward improvement that did not reach statistical significance (SMD = -0.69, 95% CI: -1.67 to 0.27). For gait speed, nutritional supplementation (SMD = + 0.37, 95% CI: +0.06 to + 0.68) yielded the greatest improvement, while multicomponent exercise (SMD = + 0.09, 95% CI: -0.04 to + 0.22) showed minimal benefit. Significant improvement in SPPB scores was observed only after multicomponent exercise (SMD = + 1.85, 95% CI: +0.33 to + 3.50). In the TUG test, combined interventions (SMD = -4.61, 95% CI: -9.36 to + 0.25) tended to reduce completion time (non-significant); conversely, multicomponent exercise alone significantly increased time (SMD = + 3.96s, 95% CI: +0.91 to + 7.07). Low heterogeneity was observed across outcomes with no evidence of publication bias. The impacts of different interventions on frailty in older adults exhibited outcome-specific variations. Combined interventions were most effective in improving frailty scores, demonstrating potential synergistic effects between physical exercise and nutrition, while nutritional supplementation showed the most significant benefit for gait speed. Multicomponent exercise alone also produced significant improvements in frailty scores and physical performance. These findings suggest that clinicians should consider combined approaches for overall frailty improvement while tailoring interventions based on specific functional objectives when developing management strategies for frailty in older adults. CRD420251038055.

Caffeine is one of the most widely consumed and extensively studied ergogenic aids in both amateur and professional sports. Its prevalence spans athletes across a range of disciplines. While some athletes regard caffeine as beneficial for athletic performance, others incorporate it into their daily routine. In competitive sports, where every detail of preparation can be essential, caffeine supplementation is frequently employed to enhance physical performance, cognitive function, and training capacity. This review summarizes current scientific evidence regarding the pharmacokinetics, mechanisms, effects, and safety of caffeine use in athletic populations. Biochemically, caffeine is a naturally occurring methylxanthine with rapid absorption, high bioavailability, and predictable hepatic cytochrome P450 1A2 mediated metabolism. Its ergogenic effects are attributed to non-selective antagonism of central adenosine receptors, which increases nervous system excitability, reduces perception of effort and pain, and enhances neuromuscular, cognitive, and psychomotor functions. Evidence-based recommendations indicate that low to moderate doses of caffeine, administered before or during exercise, are effective for most athletes, while smaller repeated doses are advantageous during prolonged events requiring sustained performance. Caffeine is generally considered safe within recommended limits; however, individual variability in dietary habits, genetic factors, and sensitivity necessitates personalized supplementation strategies. Overall, caffeine is a safe and effective ergogenic aid when used appropriately, with optimal outcomes achieved through individualized protocols tailored to specific sports and competition contexts.

Effects of urban forest-based intervention on sarcopenia prevention, depression, and quality of life in older adult women: A randomized controlled trial.

Introduction &amp; Purpose: Small-sided games (SSGs) are widely used in soccer training to recreate the physical, technical and tactical demands of official matches within controlled environments (Morgans et al., 2014). Manipulating pitch size, player numbers, and rules, allows SSGs to develop these demands, especially physical performance (Bujalance-Moreno et al., 2019). The interaction of pitch size and player numbers can be quantified through the relative pitch area (RPA; m2*player-1) (Hill-Haas et al., 2011; Olthof et al., 2019). A larger RPA elicits greater total distance, high-speed running, and sprinting demands (Riboli et al., 2020). However, limited evidence exists on age-related differences in physical demands among late-stage academy players. Therefore, this study investigated age-related differences in physical performance between U18 and U21 elite academy players across SSG formats defined by RPA. Methods: Thirty-seven male elite academy players (U18: n=17; U21: n=20) from one club performed SSGs over 9 weeks. Formats were classified by RPA as small (&gt;125 m2*player-1), medium (125-225 m2*player-1), and large (&gt;225 m2*player-1). Physical performance was measured via 10 Hz GPS with embedded inertial sensors. Outcome measures (per minute) were total distance (TD), high-speed running distance (HSRD; &gt;20 km*h-2), sprinting distance (SD; &gt;25km*h-1), accelerations (&gt;2 m*s-2), and decelerations (&gt;2m*s-2). Two-level mixed-effects models (measurements nested within players) tested effects of age category and SSG format (p&lt;0.05). Results: Multilevel analysis showed significant effects of both age category and SSG format on all physical variables (p&lt;0.05). U21 players covered greater high-speed running (HSRD: 2.2 m*min-1, p=0.003) and sprinting distances (SD: 1.0 m*min-1, p=0.005) compared to U18 players. Whereas U18 players performed more accelerations (0.44*min-1, p=0.014) and decelerations (0.44*min-1, p=0.017). No significant difference was observed in total distance (TD: p=0.326). Across formats, large-sided games elicited the highest TD (129 m*min-1), HSRD (10.0 m*min-1), and SD (2.3 m*min-1), followed by medium (122, 6,0, and 1.0 m*min-1) and small formats (105, 1.9 and 0.1 m*min-1). In contrast, small-sided games induced the most accelerations (3.6*min-1) and decelerations (3.4*min-1). All pairwise comparisons between formats were significant (p&lt;0.05). Discussion: The findings highlight age-related disparities in the physical demands of SSGs among late-stage academy players. Older players (U21) covered more distances at higher speeds, reflecting greater physical performance in larger available spaces. In contrast, younger players (U18) executed higher accelerations and decelerations, indicating a more intermittent movement profile. These findings align with previous work showing that older players show a greater physical performance, possibly influenced by differences in biological maturation and tactical behaviour (Buchheit et al., 2010; Radnor et al., 2021; Olthof et al., 2015). Furthermore, the progressive increase in external load across SSG formats confirms that RPA is a key determinant of physical demands, supporting the use of larger RPAs to replicate match demands (Riboli et al., 2022). Conclusion: This study gives a better understanding of physical performance differences in elite late-stage academy soccer, highlighting the influence of age category and game format. Manipulating RPA provides a practical strategy for coaches to optimise training design and support the physical transition from late-stage academy levels.

Aging-related muscle dysfunction has been conceptualized through the model of sarcopenia, but it embraces several other characteristics, e.g., dynapenia, myosteatosis, and powerpenia. Our perspective reframes muscle aging from a different point of view, the Skeletal Muscle Function Deficit (SMFD), a unifying approach that integrates muscle quality and mass into a single functional definition. An SMFD score has been adopted in the InCHIANTI study against many geriatric outcomes, such as risk of disability, physical performance, hospitalizations and falls, and incidence of major diseases, highlighting its potential value as a primary indicator of muscle failure and/or of healthy aging. At the core of SMFD lies inflammaging, the chronic, low-grade, age-related inflammation, linking functional outcomes to muscular and neural aging. Inflammatory mediators alter the anabolic/catabolic balance, accelerate myosteatosis, impair neuromuscular junction, and influence denervation. These findings support the idea of a common pathway that links neuro-muscular deficit and inflammation, which simultaneously targets cortical motor circuits, spinal motor neurons, peripheral nerves, and muscle fibers. The SMFD approach facilitates early detection, risk stratification, and possible intervention for muscle deterioration with aging.

Talent identification in sport plays a strategic role in optimizing athletic potential while supporting inclusive participation for individuals with intellectual disabilities. The availability of valid and reliable assessment instruments remains essential to ensure accurate evaluation of physical performance capacities within this population. The present study examined the construct validity and test–retest reliability of the Track and Field SportRec Talent Test Battery (SRTTB), which was developed to assess fundamental physical abilities relevant to track and field performance among individuals with intellectual disabilities. The study involved 74 male students with intellectual disabilities aged 14–20 years from a special education school in Klang. Data were collected using a series of physical performance tests, including the standing long jump, 30 m sprint, push-up, seated medicine ball throw, standing overhead medicine ball throw, standing backward overhead medicine ball throw, and the 20 m intermittent test for estimating VO₂max. Statistical analyses were conducted using IBM SPSS version 30. Construct validity was evaluated through convergent and discriminant validity analyses, while test–retest reliability was assessed using intraclass correlation coefficients (ICC). The results demonstrated excellent reliability for the standing long jump (ICC = 0.94), 30 m sprint (0.89), push-up (0.97), standing overhead medicine ball throw (0.84), standing backward overhead medicine ball throw (0.91), and VO₂max (0.99). Moderate reliability was observed for the seated medicine ball throw (ICC = 0.70). Convergent validity analysis indicated strong correlations among physical performance measures, with correlation coefficients ranging from 0.885 to 0.996. Discriminant validity analysis revealed low correlations between the SRTTB components and unrelated constructs, indicating that each test captured a distinct dimension of physical performance. Overall findings support the SRTTB as a psychometrically sound instrument for repeated application in talent identification and athlete development programs involving individuals with intellectual disabilities.

Patients with rheumatoid arthritis (RA) are at a higher risk for sarcopenia than the general population. Exercise therapy can improve muscle strength in older adults; however, its efficacy in older patients with RA has not been fully established. This study aimed to evaluate the efficacy of a personalized exercise program on physical function in older patients with RA at high risk for sarcopenia. A single-centre, parallel-group, two-arm, superiority randomized controlled trial was conducted in patients with RA aged 60-85 years who were at risk of sarcopenia. The intervention group (n = 69) underwent a 16-week personalized exercise program in addition to nutritional guidance and standard care, whereas the control group (n = 65) received only nutritional guidance and standard care. The primary outcome was the change in the total Short Physical Performance Battery (SPPB) scores from baseline to week 16. A total of 140 patients were randomized. Of these, 134 initiated the assigned intervention. There was a 0.2-point difference in SPPB total score from baseline to week 16 between the intervention group (+ 0.4 points) and the control group (+ 0.2 points); 95% confidence interval: -0.1 to 0.5; p = 0.206. Regarding the secondary outcomes at week 16, there was a tendency for improvement in the chair-stand test, grip strength, and the mental component score. The 16-week personalized exercise therapy did not improve the total SPPB scores. However, the intervention may improve standing ability, grip strength, and mental health-related quality of life in older patients with RA at high risk of sarcopenia. This study was registered with UMINCTR (trial number: UMIN000044930).

Abstract Introduction Acute sarcopenia in hospitalised older adults is associated with poor outcomes, such as functional decline, increased risk of falls and prolonged hospital stays. Despite this, its development among older inpatients remains poorly understood. We aimed to quantify the effects of acute hospitalisation on sarcopenia outcomes in older adults. Methods Medline, Embase, CINAHL, and Web of Science were searched from inception until January 2025. Studies that included acutely admitted patients aged 65 years or older and reported changes in at least one measure of sarcopenia during hospitalisation were included. Barthel Index was also included. A random-effects meta-analysis was undertaken. Results Fifty-five eligible studies were included (n = 14,919 participants, mean age = 82.2 years). Grip strength significantly increased during hospitalisation (SMD = 0.23, 95% CI: 0.13; 0.33). No physical performance measure showed a significant change, and muscle mass decreased when measured using MRI or DEXA. Barthel Index significantly decreased during hospitalisation when using a pre-admission score as baseline (SMD = -0.66, 95% CI: −0.92; −0.39). Both age and hospital length of stay had no effect on grip strength or Barthel Index. Conclusions This review has shown that grip strength improves during hospitalisation and decreases in muscle mass are observed when measured using MRI or DEXA. Muscle strength and physical performance on admission are less suitable baseline measures, as they are often adversely affected during acute illness and, therefore, not representative of true baseline capacity. The lack of improvement in physical performance outcomes is an important finding as it represents failure to return to pre-hospital baseline abilities.

Abstract Background Chronic inflammation and metabolic dysfunction are posited to contribute to sarcopenia and physical frailty; both are targets for metformin therapy. We investigated correlations between physical performance measures and inflammatory and metabolic biomarkers in a group of older people with sarcopenia and frailty/prefrailty and investigated the effect of metformin treatment on this biomarker panel. Methods We analysed samples collected at baseline and follow-up (4 months) from the randomised controlled MET-PREVENT trial. MET-PREVENT recruited participants aged 65 and over with probable sarcopenia (EWGSOP2 guidelines) and 4 m walk speed &amp;lt;0.8 m/s. Participants received 500 mg metformin 3x/day or matching placebo for 4 months. Blood sampling and physical performance measures (handgrip strength, 4 m walk speed, six-minute walk distance, 5x sit to stand) were conducted at baseline and 4 months. Biomarkers were measured using ELISA and Luminex platforms for insulin, CRP, adiponectin, leptin, MCP-1, IL-1b, IL-6, IL-8, and TNF-a. Baseline correlations and correlations of changes between baseline and follow-up, were analysed using Spearman’s test; median change between baseline and follow-up in the metformin and placebo groups was compared using Mann–Whitney tests. Results Seventy-two participants were studied, mean age 80 years. Higher baseline IL-6 concentrations correlated with lower six-minute walk distance, (r = −0.40, p = 0.008); other correlations were non-significant. Increased IL-1B and decreased adiponectin between baseline and 4 months were correlated with worsening grip strength (r = −0.25, p = 0.04; r = 0.29, p = 0.016); increased TNF-a and decreased MCP-1 were correlated with worsening 5x sit-to-stand time (r = 0.38, p = 0.02; r = −0.32, p = 0.04). Metformin treatment reduced circulating insulin concentrations more than placebo (median change between baseline and 4 months: -178 pg/ml [IQR -462, 180] vs 147 pg/ml [IQR -89, 353]; between-group p = 0.04) but did not significantly change other biomarkers compared with placebo. Conclusions In this trial population, only weak and inconsistent correlations were seen between physical performance and inflammatory/metabolic biomarkers, and metformin did not beneficially affect most biomarkers measured.

Brain metastases are common in non-small cell lung cancer (NSCLC) and affect prognosis and survival. While frailty and sarcopenia are associated with the overall survival in NSCLC the impact on outcome and survival after surgery for brain metastasis is unknown. We therefore analyzed 179 patients (81 women) with NSCLC undergoing resection for brain metastasis between 2011 and 2020 retrospectively. Frailty was measured using the Clinical Frailty Scale (CFS). Temporal Muscle Volume (TMV) was assessed in preoperative T1w MRI. The median age was 63 years. Clinical frailty was present in about 20.6%. Mean follow-up was 11 months. Frailty correlated significantly with age (r = 0.36, p < 0.001) and smaller TMV (r=-0.24, p = 0.002). However, only measurement of TMV predicted impaired survival (median OS 34.5 vs. 10.3 months, p < 0.001). Physical performance after surgery was negatively affected by frailty (r=-0.72, p < 0.001) and positively by TMV (r = 0.2, p = 0.038). Major postoperative complications were more strongly associated with sarcopenia rather than frailty. Treatment response towards immunotherapy improved in the absence of sarcopenia (B = 2.48, p = 0.031). TMV is a predictor for survival after resection of brain metastasis and an indicator of treatment response to immunotherapy in patients with NSCLC. Accounting for sarcopenia in surgical decision making could improve patient selection for different treatment modalities.

Background Mindfulness-based interventions (MBIs) are psychological skills training approaches that are well recognized for enhancing psychological factors that influence sports performance. However, some factors, such as time commitment, cost, and accessibility required for traditional MBIs, can be a barrier to regular practice. As a result, brief MBIs with a duration of ≤ 30 min have gained popularity. This systematic review aims to explore the effect of brief MBIs on short sport-related performance. Method A comprehensive search was conducted in five databases, including Web of Science, Scopus, PubMed, China National Knowledge Infrastructure, and EBSCOhost, for articles published up to 14 November 2025. The search utilized a combination of keywords related to brief MBIs and sport-related performance. The methodological quality of included studies was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Results Ten randomized controlled trials met the inclusion criteria. Overall, brief MBIs demonstrated beneficial effects on several short sport-related performance outcomes, particularly precision-based motor skills. Significant improvements were observed in golf putting, hand grip strength, basketball tactical performance, and in some cases basketball free-throw shooting and soccer penalty kicks. However, results for basketball free-throw accuracy were mixed, and no significant effects were found for muscular endurance. The interventions varied in type, duration, and delivery mode, with most employing 4–30 min of audio-guided mindfulness practices. Risk of bias across studies was generally low, though inadequate reporting of randomization procedures was the most common concern. Conclusion Brief MBIs lasting 30 min or less may induce short-term enhancements in certain domains of sport-related performance, particularly in tasks requiring attentional stability, fine motor control, and decision-making. However, these effects appear to be acute in nature, evidence remains inconsistent across sport types, and conclusions are limited by the small number of available studies. Future research should adopt standardized mindfulness assessments, include a broader range of physical performance indicators and relevant physiological measures to better elucidate the mechanisms underlying short-term brief MBIs effects in real competitive environments. Systematic review registration https://inplasy.com/ , INPLASY2022120086.

Abstract Introduction Regular exercise to improve muscle strength and balance is recommended for older people. Providing extra protein to older people may enhance the benefits of exercise especially in people who have insufficient dietary protein. Our study evaluated the feasibility of conducting a definitive trial to evaluate the effectiveness of mobility and strength training +/− protein supplements for pre-frail/frail older people with low protein intake. Method A multi-centre feasibility randomised controlled trial in 4 NHS community trusts. Recruitment via physiotherapy caseloads, an existing cohort study and community advertising. Participants: ≥60 years, pre-frail/frail, reported walking difficulties and low protein intake (&amp;lt;1 g protein/kilogram body weight (kgBW)/day). The recruitment target was 50. Interventions everyone undertook exercise 2x/week supported by a physiotherapist for 24 weeks. Half were randomised (1:1) to receive 24 weeks of daily protein supplements increasing protein intake up to 1.6 g/kgBW/day. Feasibility outcomes recruitment, intervention fidelity, adherence, tolerance and study retention. Clinical outcomes Short Physical Performance Battery, 6-Minute Walk Test and participant reported outcomes (baseline and 5–8-month follow-up). Results Initially recruitment focused on existing caseloads, but patients were more unwell and disabled than anticipated and ineligible. No participants were recruited from the cohort. A community recruitment strategy was implemented, and we randomised 20 participants, but we ran out of time to fully implement this strategy. We achieved good intervention fidelity. The median number of exercise sessions completed was 10.5/16 (IQR 7, 13). Six participants received supplements which they tolerated well and took regularly. Fourteen participants (70%) completed follow-up with no difference in retention between arms. All clinical outcomes showed a trend towards larger improvements in the exercise+protein arm but were not statistically significant. Conclusion A definitive trial would not be feasible as originally proposed. Recruitment was the biggest challenge with community advertising proving most successful and the recommended method for a future trial.