Exercise Research Articles

From home to health: Telerehabilitation’s contribution to physical activity and quality of life in young adult teleworkers

BACKGROUND: The global implementation of full-time telework became widespread during the new normal conditions following the pandemic, resulting in reduced physical activity (PA) among teleworkers and young adults. It is vital to comprehend how telehealth interventions favorably impact PA levels and overall well-being of young adults who face increasingly blurred boundaries between work and home life. OBJECTIVES: The aim of this study is to examine the effect of telerehabilitation (TR) on PA levels and quality of life (QoL) in young adult teleworkers. METHODS: A quasi-experimental study was conducted on 82 teleworkers (54 females and 28 males). Levels of PA and QoL were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Health-Related Quality of Life (HRQOL-14) questionnaire. TR was provided to all participants for four weeks, three times a week, for 40 minutes per session. Levels of PA and QoL were evaluated at baseline and after four weeks of the intervention. Data were analyzed using descriptive and inferential statistics. RESULTS: After four weeks of TR, there has been a significant improvement in the scores of IPAQ and HRQOL-14 (p < 0.05). In regards to IPAQ-SF results, TR had a significant effect on the sitting or sedentary behavior of the teleworkers. CONCLUSION: The results showed that a short-term TR intervention improved both the level of PA and QoL in young adult teleworkers. Therefore, TR may be an effective treatment approach to improve PA and QoL and promote a healthy lifestyle in teleworkers.

Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: a pilot study

Physical activity can worsen migraine, leading to reduced activity levels in adults with chronic migraine. This study investigated the change in average steps per day, as a surrogate marker of physical activity, in adults with chronic migraine successfully treated with monoclonal antibodies against calcitonin gene-related peptide or its receptor. Data were obtained from adults with chronic migraine, who were classified as responders to preventive treatment with monoclonal antibodies. The primary endpoint was the difference in a mean number of steps per day between the 3 months prior to treatment initiation and the first 3 months after treatment initiation. The secondary endpoint was the correlation between the change in steps per day and the change in monthly migraine days. Twenty-two (20 females) participants with a median age of 48.5 years were enrolled. The median number of steps per day increased from 4421 at baseline to 5241 after treatment (P = 0.039). We found a positive correlation between the increase in steps per day and the treatment response (P = 0.013). In conclusion, an increase in physical activity, based on steps per day, positively correlated with treatment response to monoclonal antibodies. Automatically registered daily step count data might be used to monitor physical activity as a response to preventive treatment in adults with chronic migraine.

Effectiveness of a nurse-led mHealth approach in preventing obesity in adolescents: an intervention study

Background: Obesity prevention in adolescents is a public health priority given its increasing prevalence and health impact of obesity. Aim: To evaluate the effectiveness of an educational intervention in overweight and obesity using a mHealth app in improving nutritional and sports knowledge, adherence to the Mediterranean diet, physical activity and anthropometric measurements in adolescents. Methods: A randomised controlled trial with parallel groups that included 305 adolescents. The app includes the use of effective behavioural strategies to achieve habit change. Primary outcome variables were nutritional and sports knowledge score (GeSNK), adherence to a Mediterranean diet (KidMed) and level of physical activity (PAQ-A). Results: The study included 154 participants in the mHealth group and 151 in the control group. The level of nutritional and sports knowledge was significantly higher in the mHealth group, 47 points versus 42 points. Adherence to the Mediterranean diet improved in both groups, 9 points in the mHealth group versus 8 points in the control group. Physical activity was statistically higher in the intervention group, 160 minutes/week versus 120 minutes/week. Conclusions: The mHealth intervention showed a significant improvement in the level of nutritional and sports knowledge, adherence to the Mediterranean diet and time spent on physical activity.

The Impact of Physical Activity on Depression, Anxiety, and Stress during Pregnancy in Saudi Arabia: A Cross-Sectional Study

Background and Objective: This study aimed to explore the impact of physical activity on depression, anxiety, and stress among pregnant women in the Jazan region of Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among pregnant women attending randomly selected prenatal clinics in primary healthcare hospitals in Jazan, Saudi Arabia. The calculated sample size was 350. Data were collected conveniently through a semi-structured questionnaire covering demographic details, pregnancy-related characteristics, physical activity assessed using the Pregnancy Physical Activity Questionnaire (PPAQ), and mental health parameters evaluated by the Depression, Anxiety, and Stress Scale-21 (DASS-21). The statistical analyses included descriptive statistics and Wilcoxon and Kruskal–Wallis rank sum tests, with significance levels set at p < 0.05. Results: The study involved 406 pregnant females. Nearly a third (31%) had a family history of depression, anxiety, or distress. The prevalence of depression, anxiety, and stress was 62.6%, 68.7%, and 38.4%, respectively. The mean sedentary, light, moderate, vigorous, and total energy expenditures were 1.512, 24.35, 22.32, 4.84, and 53.02 metabolic equivalent tasks/day. Anxious females exhibited higher light activity (median 24, p = 0.033), while stressed ones showed higher light (median 25, p = 0.039), moderate (median 20, p < 0.001), and vigorous activity (median 3, p < 0.001). A significant association was observed between total energy expenditure and stress levels (p < 0.001). Conclusions: This study underscores the importance of physical activity in managing depression, anxiety, and stress among pregnant women in Jazan, Saudi Arabia. The findings suggest a need for tailored interventions to promote physical activity to improve mental well-being during pregnancy.

The relationship between accelerometer-based physical activity, sedentary behavior, and seven common geriatric syndromes: a two-sample Mendelian randomization study

IntroductionTo investigate the causal associations between accelerometer-based physical activity (PA), sedentary behavior (SB), and seven common geriatric syndromes (GSs) (frailty, falls, delirium, urinary incontinence, dysphagia, hearing loss, and visual impairment) by Mendelian randomization (MR) analysis.MethodsInstrumental variables from a genome-wide association study were used for MR analysis. The exposure factors were three PA phenotypes (average acceleration, overall activity, and moderate-intensity activity) and one SB phenotype (SB). The outcome variables were seven common GSs. The inverse variance weighted (IVW) method was utilized for the primary MR analysis. Additionally, sensitivity, pleiotropy, and heterogeneity analyses were subsequently conducted to assess the robustness of the present study’s findings.ResultsAccording to the primary MR results obtained using the IVW method, genetically predicted PA (average acceleration) decreased the risk of two GSs (frailty, p = 0.01; dysphagia, p = 0.03). Similarly, overall activity decreased the risk of two GSs (frailty, p = 0.01; delirium, p = 0.03), and moderate-intensity activity reduced the risk of three GSs (urinary incontinence, p = 0.04; hearing loss, p = 0.02; visual impairment, p = 0.01). Furthermore, SB was causally correlated with a greater risk for three GSs (frailty, p = 0.03; fall, p = 0.01; dysphagia, p = 0.04).ConclusionThis study provided evidence that accelerometer-based PA may be causally associated with a lower risk of GSs, while SB may increase the risk of GSs.

Gene-Environment Interactions Significantly Alter the Obesity Risk of SH2B1 rs7498665 Carriers.

Src homology 2 B adaptor protein 1 (SH2B1) gene and variants have been found to be associated with common obesity. We aimed to investigate the association between the common missense variant SH2B1 rs7498665 and common obesity risk as well as interactions with lifestyle variables in an Israeli population. An adult cohort (n=3,070; ≥18 years) with the SH2B1 rs7498665 variant and lifestyle, behavior (online questionnaire), and blood glucose data was analyzed. Associations between this variant, obesity risk (body mass index [BMI] ≥25 and ≥30 kg/m2), and interactions with behavioral and lifestyle factors (stress levels, eating habits score (EHS), physical activity (PA) and wine consumption) were investigated. Association and gene-environment interactions were analyzed using binary logistic regressions with interaction (SPSS version 29.0). SH2B1 rs7498665 carriers were significantly (P<0.05) more likely to be overweight (BMI ≥25 kg/m2) or obese (BMI ≥30 kg/m2) in recessive (odds ratio [OR], 1.9 and 1.36, respectively), additive (OR, 1.24 and 1.14, respectively), and codominant (OR, 2 and 1.41, respectively) genetic models. SH2B1 rs7498665 interacted with lifestyle and behavioral factors as well as glucose levels. PA and moderate wine consumption (1 to 3 drinks/week) reduced obesity risk (OR, 0.35 and 0.71, respectively). Conversely, carriers of two risk alleles who reported high stress levels, had ≥median EHS, and who had a fasting glucose level ≥90 mg/dL had a significantly increased obesity risk (OR, 3.63 and 5.82, respectively). Carrying SH2B1 rs7498665 significantly elevates the risk of obesity. Actionable lifestyle and behavioral factors significantly modulate the rs7498665 genetic predisposition to obesity; PA and moderate wine consumption attenuate the risk, while high stress, EHS, and fasting glucose level increase the obesity risk.

Eight-year follow-up of patient-reported outcomes in patients with breast cancer participating in exercise studies during chemotherapy.

Numerous randomized controlled trials (RCTs) have shown beneficial exercise effects on fatigue, anxiety and depression and health-related quality of life (HRQoL) in breast cancer (BC) patients during and shortly after treatment. Here, we investigated the long-term effects of exercise during chemotherapy for BC on these outcomes. We invited participants of two highly comparable RCTs that investigated the effects of exercise (EX) (versus usual care (UC)) during chemotherapy in patients with non-metastatic BC (N = 357) to participate in an 8-year follow-up. In both trials, fatigue, anxiety and depression and HRQoL were assessed using the same questionnaires, at multiple timepoints. Linear mixed-effect models were used to compare study arms over time. In total, 156 participants (EX = 82; UC = 74) completed the follow-up questionnaires. EX reported comparable general (between-group difference 0.73, 95% confidence interval (- 0.35; 1.80), ES = 0.18) and physical fatigue (0.55 (- 0.55; 1.65), ES = 0.13), small but statistically significantly higher levels of anxiety (1.24 (0.47 to 2.00), ES = 0.39) and depression (1.10 (0.34; 1.85), ES = 0.38), significantly lower global HRQoL (- 5.99 (- 10.65; - 1.32), ES = 0.34) and comparable summary HRQoL (- 1.90 (- 4.70; 0.89), ES = 0.16) compared to UC. No long-term beneficial effects of exercise during chemotherapy on BC patients' fatigue, anxiety, depression or HRQoL were observed. The less favourable outcomes for mood and HRQoL that were observed 8years after participation in an exercise intervention may be explained by selective loss-to-follow-up. The results highlight the need to incorporate strategies that promote physical activity maintenance after participation in an exercise programme to also counteract long-term detrimental side effects of cancer treatment.

The Relationship between Healthy Vascular Aging with the Mediterranean Diet and Other Lifestyles in the Spanish Population: The EVA Study

The aim of this study was to analyze the relationship between healthy vascular aging (HVA) and the Mediterranean diet alongside other lifestyles in a Spanish population aged 35 to 75 years without previous cardiovascular diseases. Methods: In this cross-sectional descriptive study, 501 individuals aged 35 to 75 years were recruited from five health centers by random sampling stratified by age and sex (55.90 ± 14.24 years, 49.70% men). HVA was determined in two steps. Step 1: Subjects with vascular damage to the carotid arteries or peripheral arterial disease were classified as non-HVA. Step 2: The study population was classified by age and sex using the percentiles of the vascular aging index (VAI), with VAI ≤p25 considered HVA and &gt;p25 considered non-HVA. The VAI was estimated using the following formula (VAI = (log (1.09) × 10 cIMT + log (1.14) cfPWV) × 39.1 + 4.76. Carotid–femoral pulse wave velocity (cfPWV) was measured with the SphygmoCor® device, and carotid intima–media thickness using Sonosite Micromax® ultrasound. Mediterranean diet (MD) adherence, alcohol and tobacco use were recorded through validated questionnaires. Physical activity was assessed with the ActiGraph-GT3X® accelerometer. Results: The mean VAI value was 61.23 ± 12.86 (men—63.47 ± 13.75 and women—59.04 ± 11.54; p &lt; 0.001). HVA was found in 18.9% (men—19.9% and women—17.8%). In the multiple regression analysis after adjusting for possible confounding factors, the mean VAI value showed a positive association with alcohol use (β = 0.020) and sedentary hours per week (β = 0.109) and a negative association with hours of activity per week (β = −0.102) and with the number of healthy lifestyles (β = −0.640). In the logistic regression analysis, after adjusting for possible confounding factors and compared to those classified as non-HVA, subjects classified as HVA were more likely to show MD adherence (OR = 0.571), do more than 26 h per week of physical activity (OR = 1.735), spend under 142 h per week being sedentary (OR = 1.696), and have more than two healthy lifestyles (OR = 1.877). Conclusion: The results of this study suggest that the more time spent doing physical activity and the less time spent in a sedentary state, the lower the vascular aging index and the greater the likelihood of being classified in the group of subjects with HVA.

Nutritional Status, Sugar Sweetened Beverage Consumption and Physical Activity Level in Male and Female College Students Living in Dormitory

Introduction: The global prevalence of obesity is on the rise, including in Indonesia. High energy intake from sugar is a growing concern worldwide due to its association with weight gain, tooth decay, and non-communicable diseases. A prior study revealed that 10.9% of Indonesian adults consumed energy from sweetened beverages in excess of the WHO recommendation. This study aimed to assess the consumption of sweetened beverages in male and female college students in Indonesia. Method: The study was conducted at Universitas Indonesia and involved 107 subjects aged 19-21 years who resided in student dormitories. Result: The result found the median BMI in female was higher than male. In female, 3 out of 10 students was overweight-obese, while 1 out of 10 in male. Interestingly, the median daily intake of sweetened beverages significantly higher in male than female; 387 (25–1580) vs 246 (0–762) ml/day (p=0.001). Added sugar content in beverages in males was higher than half of Indonesian recommendation (28.4 [1.9–134.4] vs 19.2 [0–61.1]) which contributed to energy as much as 170.9 (12.4–625.7) kcal/ day or about 8.9% of total energy intake than female (108.5 [0–394.4] kcal/day). Compared to Indonesian guideline, 12% of male subjects consumed added sugar higher than 50 g/day. Simultaneously, 7 out of 10 subjects consumed energy from sweetened beverages higher than 10% of their total energy intake (WHO recommendation). The BMI and prevalence of overweight-obese were higher in female, while the sweetened beverage was higher in male. It might be caused by the physical activity in male was higher than female. Although male had higher energy intake from SSB, their energy output through physical activity balanced with energy input. Conclusion: These finding alerted the university as educational institution should take an action to prevent this issue since the prevalence of overweight-obesity and sweetened beverage consumption has occurred in young age.

GOLD MICROFLOWER MODIFIED SCREEN‐PRINTED CARBON ELECTRODE FOR THE ELECTROCHEMICAL DETECTION OF LACTIC ACID IN BLOOD AND SWEAT

A nonenzymatic electrochemical lactic acid sensor was fabricated by electrodepositing gold microflowers on a screen‐printed carbon electrode and used to determine lactic acid in human serum and sweat quantitatively. Extensive voltammetric studies with lactic acid in phosphate‐buffer saline (PBS) and the analysis of the reduction product proved beyond doubt that lactic acid undergoes two‐electron reduction to form lactaldehyde. The reduction current increased quantitively with lactic acid concentration from 0.5 to 8.5 mM in 0.1 M PBS. The sensor showed excellent sensitivities of 1243 µA mM‐1 cm‐2 and 2752 µA mM‐1 cm‐2 in two linear ranges, 0.5 to 2.5 mM and 2.5 to 8.5 mM, respectively with a detection limit of 0.012 ± 0.0014 mM. The performance of the sensor was validated by estimating lactic acid in human serum and the sweat generated through physical exercise. The estimated lactic acid concentrations are in good agreement with clinical analysis data.This indicates the potential applicability of the sensor in the point‐of‐care detection of lactic acid.

Older adults exercising ON TIME: protocol for a randomized controlled cross-over study to assess the effect of physical activity timing on insomnia severity

BackgroundThere are increased indications that physical activity timing, irrespective of intensity, impacts insomnia and circadian clock function. Here, we describe the rationale and design of a randomized cross-over study, called ON TIME, to examine the effects of (changing) physical activity timing on insomnia severity and on multiple exploratory outcomes that are linked to circadian clock function.MethodsWe will conduct a randomized cross-over trial in 40 healthy older adults (aged 65 to 75 years) with subclinical or clinical insomnia (Insomnia Severity Index (ISI) scores of ≥ 10) from the Dutch municipality of Leiden and surroundings. Participants will undergo 3 intervention periods (14 days each) consecutively: one sedentary period and two periods of increased physical activity (one period with morning activity and one period with evening activity). The intervention periods are separated by a wash-out period of 1 week. In both active intervention arms, participants will follow coached or uncoached outdoor physical exercise sessions comprising endurance, strength, and flexibility exercises for 14 days. The primary outcome is change in insomnia severity as measured by the ISI. Additional exploratory outcomes include multiple components of objective sleep quality measured with tri-axial accelerometry and subjective sleep quality assessed by questionnaires as well as dim light melatonin onset and 24-h rhythms in heart rate, heart rate variability, breathing rate, oxygen saturation, mood, and objective emotional arousal and stress. Additionally, we will collect diary data on eating patterns (timing and composition). Finally, fasting blood samples will be collected at baseline and after each intervention period for measurements of biomarkers of metabolic and physiological functioning and expression of genes involved in regulation of the biological clock.DiscussionWe anticipate that this study will make a significant contribution to the limited knowledge on the effect of physical activity timing. Optimizing physical activity timing has the potential to augment the health benefits of increased physical exercise in the aging population.Trial registrationTrial was approved by the Medical Ethics Committee Leiden, The Hague, Delft, The Netherlands (June, 2023). The trial was registered in the CCMO-register https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm under study ID NL82335.058.22 and named (“Ouderen op tijd in beweging” or in English “Older adults exercising on time”). At time of manuscript submission, the trial was additionally registered at ClinicalTrials.gov under study ID: NL82335.058.22 and is awaiting approval.

The complicated relationship between asthma and swimming

Introduction: Apart from pharmacological treatment, non-pharmacological strategies including physical activity play a significant role in the management of asthma. The aim of this paper is to examine various topics related to swimming and asthma. They include the detailed effect of swimming on asthma control,the potential role of swimming in early childhood asthma development, exercise induced asthma in swimmers as well as the relationship between asthma and cold water swimming. Review methods: This article is based on the literature found in the PubMed Database from the period of 1971-2024 with the use of keywords such as “asthma”, “swimming”, “cold water swimming”, “exercise induced asthma”, “childhood asthma” Description of the state of knowledge: Swimming is a safe form of physical activity for asthma patients.Swimming training enhances aerobic capacity, reduces exercise-induced bronchoconstriction and improves lung function in both pediatric and adult patients. However, there is a concern regarding indoor swimming pools that chlorine can potentially induce airway inflammation. There is research suggesting that early life swimming pool exposure may contribute to the asthma development in atopic children. There is some premise to the thought that cold water swimming may help alleviate asthma symptoms, but it also carries many risks.Swimming is a major cause of exercise induced asthma in professional athletes. Conclusions: Alongside appropriate pharmacological treatment, swimming is a valuable strategy in asthma management in both pediatric and adult asthma patients. The risks of chlorinating pools are still not known to outweigh the benefits of swimming for asthmatics. Further research should be carried out on safety of early swimming in atopic children. Cold water swimming should also be evaluated in terms of safety and potential benefits for asthma patients.

The Thai Folk Game “Jik Sen” has Become a Recreational Sport for Older People in Senior Citizen Schools

Objectives. The purposes of this study were to: 1) develop an exercise program incorporating the Thai recreational sport “Jik Sen” for older people in senior citizen schools; 2) investigate the effects of the exercise program incorporating the Thai recreational sport “Jik Sen” on the physical fitness of older people in senior citizen schools; and 3) assess the satisfaction level of older people with the exercise program incorporating the Thai recreational sport “Jik Sen”. Materials and methods. This was a two-group experimental study including the experimental group of 17 people (65.53 ± 3.43 years) and the control group of 17 people (65.76 ± 3.60 years). The participants in this study were healthy individuals aged 60 years and above, who were actively engaged in the elderly school program. They were selected using a purposive sampling method and subsequently assigned them to the experimental and control groups using a matching method based on BMI. The research tools consisted of the exercise program, which incorporated the Thai recreational sport “Jik Sen” developed by the research team, and the Senior Fitness Test (SFT). For a period of 8 weeks, the experimental group involved in an exercise regimen comprising 60 minutes of daily training in the Thai recreational sport “Jik Sen”, with a frequency of 3 days per week. The control group was instructed to maintain their normal daily routine and did not participate in any physical activities or exercise programs during the experiment. The data were analyzed using mean, standard deviation, percentage, and t-test. Results. 1) The exercise program incorporating the Thai recreational sport “Jik Sen” for older people in senior citizen schools can be appropriately used to promote exercise and sports in elderly schools in Thailand. The IOC value was 0.97. 2) A significant difference was observed in the mean scores of the 8-foot up-and-go test between the pre-experimental ( = 7.94, S.D. = 1.34) and post-experimental (after 8 weeks) ( = 6.70, S.D.= 0.79) periods for the experimental group at the level of 0.05. The mean scores of the 8-foot up-and-go test between the control group (= 7.84, S.D. = 1.16) and the experimental group (=6.70, S.D. = 0.79) were also found to be significantly different at the level of 0.05. 3) The experimental group expressed high levels of satisfaction with the exercise program involving the Thai recreational sport “Jik Sen” for older people in senior citizen schools, with a mean score of 4.62 ± 0.51 points. Conclusion. The exercise program incorporating the Thai recreational sport "Jik Sen" can effectively enhance the dynamic balance of older individuals in senior citizen schools. Furthermore, it has been shown to facilitate social interaction, improve cognitive abilities including thinking and planning skills, and promote enjoyment.

Designing a mobile application to promote physical activity in spousal care partners of persons living with dementia and their care-recipient.

Background: Care partners of persons living with dementia and their care-recipient have low levels of physical activity. Mobile applications have demonstrated effectiveness in promoting physical activity among older adults. The purpose of this study was to explore the perceptions of spousal care partners of persons with dementia and their care-recipient on the design and content of a mobile application intended to promote physical activity.Methods: Semi-structured interviews were conducted with 14 care partners and their care-recipient. After the interviews were transcribed verbatim, thematic analysis was performed.Results: Four themes emerged from the participants' responses related to the design and content of a mobile application to promote physical activity: 1) exercise preferences and habits, 2) barriers to exercise, 3) motivations for exercise, and 4) mobile application preferences and supportive features.Conclusion: Findings lay the foundation for designing an effective user-friendly mobile application to promote physical activity that caters to the diverse needs, preferences, and challenges among spousal care partners of persons with dementia and their care-recipient.

Executive functions in mid-life adults with mild sensorineural hearing loss compared with age-matched controls with normal hearing

PurposeThis study explores the relationship between sensorineural hearing loss (SNHL) in mid-life adults and cognitive function, focusing on executive functions. Given the projected rise in dementia cases, identifying modifiable risk factors for cognitive decline is imperative. SNHL has emerged as a potential risk factor, with hearing loss accounting for a substantial portion of dementia cases. However, the cognitive implications of SNHL in mid-life adults are not well understood.MethodThe study examined 50 participants, 25 with bilateral unaided mild SNHL (AHL) and 25 with normal hearing (ANH). A battery of audiological assessments and cognitive tests, including the Trail Making Test (TMT), was administered. TMT measures included direct scores (completion time and errors) and derived scores (difference, ratio, proportion, sum, and multiplication scores).ResultsThe AHL group displayed significantly poorer peripheral hearing compared to the ANH group, as reflected in pure-tone audiometry, speech reception thresholds, and speech identification scores. Significant differences were observed in all direct and derived TMT measures except for the ratio and proportion scores. This suggests that while overall cognitive disturbances were evident in the AHL group, they were not exclusive to executive function deficits. Notably, we did not identify any statistically significant effects of hypertension, diabetes, smoking, alcohol consumption, or physical activity on TMT scores.ConclusionThis study highlights the potential impact of SNHL on cognitive function in mid-life adults. Mid-life SNHL is associated with cognitive differences, emphasizing its role as a modifiable risk factor for future cognitive decline. This research underlines the need for further investigation into the cognitive effects of aided hearing and a multidisciplinary approach to understanding these alterations in cognitive function.

Development of Teaching Elements Based on Total Physical Response Activities for Improving Quranic Recitation Proficiency among Converts: Application of The Fuzzy Delphi Method

The Quran is a vital guide for Muslims, requiring proper recitation with tajwid. However, many converts struggle with accurate Quranic recitation even after years of embracing Islam. This study aims to develop Total Physical Response (TPR)-based teaching activities to enhance Quranic recitation proficiency among converts by integrating physical movements with learning, aiding in recognizing Hijaiyah letters and tajwid rules. Utilizing the Fuzzy Delphi Method (FDM), this study achieved expert consensus on proposed TPR-based activities. Ten experts in technical and vocational education, educational technology, and curriculum development participated, selected through purposive sampling. Data collection involved a two-stage process: a workshop where experts rated each activity on a 5-point Likert scale, followed by FDM analysis, transforming responses into triangular fuzzy numbers. This rigorous evaluation required at least 75% consensus and a threshold value (d) not exceeding 0.2. Findings validated all 25 TPR-based activity elements, demonstrating their suitability for teaching Quranic recitation to converts. TPR’s integration of physical activities significantly enhances memory retention and understanding, making it effective for converts with diverse backgrounds and minimal prior Quranic knowledge. The study recommends developing structured modules, providing expert training, creating interactive learning environments, and implementing continuous assessments. Incorporating Higher Order Thinking Skills (HOTS) and varied teaching methods aims to improve engagement and motivation, ultimately making Quranic learning more effective and enjoyable for converts.

A walking aid selection, training, and education program (ADSTEP) to prevent falls in multiple sclerosis: A randomized controlled trial.

People with multiple sclerosis (MS) fall frequently. Poor walking aid selection, fit, and use contribute to falls in those who use walking aids. To determine if the Assistive Device Selection, Training, and Education Program (ADSTEP), with six weekly one-on-one virtual sessions with a physical therapist prevents falls and improves other outcomes in people with MS who use walking aids but still fall. A total of 78 people were randomized to ADSTEP or control. Participants recorded falls daily through 6 months post-intervention. Other outcomes were assessed at baseline, intervention completion, and 6 months later. Outcomes were compared between groups. The ADSTEP group's mean fall rate (falls/person/month) decreased from baseline to intervention completion (ADSTEP = -0.75, control = +0.90, p < 0.001) and to 6 months later (ADSTEP = -1.02, control = +0.03, p = 0.017) compared to controls. At 6 months, the ADSTEP group had improved physical activity (days/week walking ⩾ 10 minutes at a time: ADSTEP = +0.69, control = -0.58, p = 0.007; minutes/day sitting: ADSTEP = -57, control = +56, p = 0.009) and walking aid fit (proportion with good fit: ADSTEP = +25%, control = -13%, p = 0.018) compared to controls. ADSTEP likely reduces falls, increases physical activity, and improves walking aid fit in people with MS who use walking aids and fell in the past year.

Cognitive reserve as a modulator of cognitive decline and of behavioral symptoms in patients with amyotrophic lateral sclerosis

Introduction: Amyotrophic lateral sclerosis (ALS) has heterogeneous manifestations ranging from motor neuron degeneration to cognitive and behavioral impairment. This study aims to clarify the interactions between cognition and behavioral symptoms with relevant disease predictors and with cognitive reserve (CR), quantified through education, physical activity, and occupation proxies. Methods: A prospective sample of 162 ALS patients and 61 controls were evaluated with the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) (dependent variable), a Cognitive Reserve Index questionnaire (CRIq) and demographic data (age and sex), and, for patients, clinical variables: disease duration, site of onset, the ALS Functional Rating Scale (ALSFRS), forced vital capacity (FVC), and gene mutation chromosome 9 open reading frame 72 (C9orf72) (independent variables). Multiple regression and mediation analyses were performed to predict cognitive and behavioral symptoms. Results: For the ALS group, the statistical model explained 38.8% of variance in ECAS total (p < 0.001), 59.4% of executive functions (p < 0.001), and 55% of behavioral symptoms (p < 0.001). For controls, it accounted for 52.8% of variance in ECAS total (p < 0.001). Interaction effects and mediation analysis showed CR is an ECAS total modulator, with a differential effect within groups (p < 0.001). Verbal fluency was the single best cognitive score to differentiate patients from controls (p = 0.004), and the gene mutation C9orf72 was found to be a behavioral symptom’ predictor in patients (p = 0.009). Conclusion: This study supports the proposed concept that CR acts as a cognitive modulator in ALS patients and healthy individuals. Moreover, CR also modulates behavioral manifestations in ALS.

Bioenergetic analysis and anthropometric evaluation of bra-breast interface for improved design and breast health

Bioenergetics analysis of bra-breast Interface is an important technique for improving the design of bras and promoting breast health and comfort during physical activity. The objective of this study is to evaluate the compatibility between the anatomy of the breasts and bra. The study encompasses breast anthropometry via measurement. A measurement topology was proposed to determine breast mass, volume, shape, and asymmetry under loading (with-bra) and unloading (without-bra). Using the anthropometric data, the bioenergetics of the breasts were determined and compared to the rest of the body. From the bioenergetic analysis, a larger breast could require up to 69 J of energy during walking. The average mass of a breast ranges from 500 to 1000 g. Assuming breast shape to be standard, semi-conical, semi-spherical and semi-elliptical, breast volume was determined where semi conical and semi spherical breast shapes consistently predicted lower bound volume for each breast, whereas the standard and semi elliptical breast shapes predicted higher volume for the same breasts measurements. Mathematically, the medial-lateral boundaries of the breast were described by a secant of a curve, aligned on the coronal plane, causing eccentric loading when the two breast nipples were on different transverse planes. When this variation was more than 5% volume change, asymmetric breast shapes occurred and was responsible to displace bra heterogeneously compromising fit and support. A non-linear, leaf-function describing the relationship between the breast radius and volume invoked at a given body weight. In general, the current design for a bra assumes that the breasts are symmetrical, though the current investigation proves that this is not the case. The bra needs to be redesigned to better fit women, since left and right sides are not symmetrical. This is a significant problem today, as it is estimated that nearly 80% of women wear incorrectly- sized bras; 70% wore bras that are too small, and 10% wore bras that are too big. Current investigation highlights the crucial importance of incorporating the distance between the nipples into bra design to achieve optimal support, comfort, symmetry, and minimize breast movement. It ensures that the bra cups are positioned optimally to provide effective support and enhance the natural shape of the breasts. If the current bra models are redesigned, the amount of discomfort in women could potentially decrease.

Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment

Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. “Osmotic theory” and “thermal or vascular theory” have been proposed. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. Treatment options include both pharmacological and behavioral approaches. Considering medications, the use of short-acting beta-agonists (SABA) just before exercise is the commonest option strategy, but daily inhaled corticosteroids (ICS) can also be considered, especially when EIB is not controlled with SABA only or when the patients practice physical activity very often. Among the behavioral approaches, warm-up before exercise, breathing through the nose or face mask, and avoiding polluted environments are all recommended strategies to reduce EIB risk. This review summarizes the latest evidence published over the last 10 years on the pathogenesis, diagnosis using spirometry and indirect bronchoprovocation tests, and treatment strategies, including SABA and ICS, of EIB. A specific focus has been placed on EIB management in young athletes, since this condition can not only prevent them from practicing regular physical activity but also competitive sports.