Correlación entre marcadores inflamatorios con función física y composición corporal en adultos mayores de la comunidad: estudio transversal / Correlation between inflammatory markers with physical function and bodycomposition in community older adults: a cross-sectional study

Introducción: El envejecimiento está relacionado con diversas enfermedades crónicas que causan inflamación sistémica, caracterizada por un aumento en los niveles sanguíneos de interleucina 6 (IL-6) y factor de necrosis tumoral alfa (TNF-α). La función física y la composición corporal podrían estar relacionadas con estos marcadores inflamatorios en adultos mayores.Objetivo: Analizar la correlación entre marcadores inflamatorios sanguíneos, función física y composición corporal en adultos mayores de la comunidad.Metodología: Estudio transversal con 245 adultos mayores (hombres 68±6 años; mujeres: 69%) de la ciudad de Londrina, Brasil. Se analizaron los niveles sanguíneos de IL-6 y TNF-α con citometría de flujo. Para la evaluación física fue considerado el equilibrio estático con la prueba de estación unipodal (PEU), la fuerza de prensión manual (FPM) utilizando un dinamómetro digital y la capacidad aeróbica con la prueba de caminata de seis minutos (PC6M). Para la evaluación de la composición corporal, fueron considerados los siguientes perímetros: cadera, pantorrilla, cuádriceps, bíceps braquial, tríceps braquial y cintura. Se analizó la correlación de las variables inflamatorias con las de función física y composición corporal, utilizando Pearson o Spearman con el software SPSS versión 22.Resultados: Los niveles de IL-6 se correlacionaron con la PEU (r: -0.22; p: 0.002), el perímetro de tríceps (r: 0.16; p: 0.023) y el de cintura (r: 0.34; p: 0.000). Los niveles de TNF-α se correlacionaron con FPM (r: -0.15; p: 0.035), el perímetro de tríceps (r: 1.79; p: 0.012) y el de cintura (r: 0.27; p< 0.001). Conclusión: Los marcadores inflamatorios están relacionados con menor fuerza, equilibrio estático y un aumento en el perímetro de tríceps y cintura en adultos mayores de la comunidad.(AU)

Introduction: Aging is associated with various chronic dis-eases that cause systemic inflammation, characterized by an in-crease in blood levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α). Physical function and body compositionmay be related to these inflammatory markers in older adults.Objective: To analyze the correlation between blood in-flammatory markers, physical function and body compositionin community-dwelling older adults.Methodology: A cross-sectional study was carried out with242 community-dwelling older adults (mean age was 68±6years for males and 70±6 years for females; the percentageof men was 36.6% and 69.4% of women) from the city ofLondrina, Brazil. Blood levels of IL-6 and TNF-α were analyzedwith flow cytometry. For the physical evaluation, static balancewas measured with the one-legged stance test (OLS), hand-grip strength (HGS) using a digital dynamometer and aerobiccapacity with the six-minute walk test (6MWT). For the evalu-ation of body composition, the following perimeters were con-sidered: hip, calf, quadriceps, biceps brachii, triceps brachiiand waist. The correlation of inflammatory variables withthose of physical function and body composition was analyzedusing Pearson or Spearman with SPSS version 22 software.Results: IL-6 levels were correlated with OLS (r: -0.22;p:0.002), triceps circumference (r: 0.16; p:0.023) and waist cir-cumference (r: 0.34; p:0.000). TNF-α levels were correlatedwith HGS (r: -0.15; p:0.035), triceps circumference (r: 1.79;p:0.012) and waist circumference (r: 0.27; p < 0.001).Conclusion: Inflammatory biomarkers are related to lowmuscle strength, static balance, and an increase in tricepsand waist circumference.(AU)

Effects of CICARE model combined with traditional Chinese medicine encapsulation on muscle strength and depression levels in hemiplegic patients with sequelae of cerebrovascular disease.

OBJECTIVE: To investigate the impact of the combination of CICARE (C - Connect, I - Introduce, C - Communicate, A - Ask, R - Respond, E - Exit) communication model and traditional Chinese medicine (TCM) poultice on muscle strength and depression levels in patients. METHODS: Patients were divided into three groups: basic treatment group, basic treatment + TCM poultice group, and combined treatment group. Conventional rehabilitation therapy, TCM poultice external application, and the combination of both with the CICARE communication model were applied in the respective groups. Muscle strength (AMA muscle strength grading scale), self-care abilities (Barthel Index), depression symptoms (Hamilton Depression Rating Scale), neurological deficit status (NIHSS score) and serum inflammatory factor levels were assessed at admission, 3 weeks, and 8 weeks of treatment. RESULTS: After 3 and 8 weeks of treatment, the combined treatment group had higher AMA muscle strength scores and improved Barthel Index scores compared to other groups (p < 0.05). Depressive symptoms also improved significantly in the combined treatment group, with lower HDRS scores at 3 and 8 weeks (p < 0.05). After 8 weeks, IL-1, IL-6, and hs-CRP levels decreased in all groups, with the combined treatment group showing the lowest levels (p < 0.05). NIHSS scores decreased significantly in all groups post-intervention, with the combined treatment group showing the greatest improvement (p < 0.05). CONCLUSION: The integration of CICARE communication model with TCM poultice shows notable benefits in enhancing muscle strength, daily living self-care abilities, reducing depression, neurological impairment, and inflammatory factors in post-stroke hemiplegia patients.

Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis.

PURPOSE: This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy. METHODS: A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed. RESULTS: In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I2 = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I2 = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I2 = 0%, p = 0.50). CONCLUSION: Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.

As stroke is known to cause long term disability, the implementation of strengthening interventions in rehabilitation becomes an indispensable part to optimize recovery.Peripheral electrical stimulation might be a useful intervention since it has the potential to repetitively activate the sensory-motor system via electrical pulses to nerves and muscles of the paretic limb.Results of the meta-analysis indicate a beneficial effect of electrotherapy on muscle strength when compared to conventional and sham therapy, and muscle thickness when compared to conventional therapy.

Benefits and limitations of isokinetic force assessments in swimmer's shoulders: A systematic review.

OBJECTIVE: To indicate the benefits and limitations of the isokinetic test results for the performance of the main shoulder joint movements in swimmers, considering the different competitive levels, swimming techniques, race distances, and sex. METHODS: Search on the PubMed, CENTRAL, Medline, LILACS, and SCOPUS databases for the oldest records up to October 2022. Risk of bias, methodological quality, and level of evidence were evaluated based on the NHLBI checklist. RESULTS: 29 articles met the criteria and were included in this study. The quality analysis classified three as "good" and 26 as "regular", with a KAPPA index of 0.87. The main benefits found involved assessments of the clinical condition of the shoulder joint complex, relationships with performance, and reliability studies. The limitations found point to the participant's positioning in the instrument, use of angular velocity above 180°/s, and sample size. CONCLUSION: The use of the isokinetic dynamometer allows verifying the levels of strength, endurance, balance, and asymmetries among swimmers of different techniques, distances, competitive levels, and sex. Thus, it helps in the analysis and monitoring of the clinical conditions of swimmers' shoulder joints, contributing to the decision-making process of physiotherapists and coaches.

Effect of foam rolling recovery on pain and physical capacity after resistance exercises: A randomized crossover trial.

OBJECTIVES: To compare the effects of passive recovery (PR), active recovery (AR), and recovery through self-massage with the aid of foam rolling (FRR) on pain and physical capacity in healthy volunteers after a resistance exercise (RE) session. METHODS: The sample of this randomized crossover trial comprised 37 physically healthy men who underwent three sessions of RE (squat, leg press, and leg extension), involving four sets of 10 repetitions with 80% of 10MR, with an interval of seven days between sessions. PR consisted of sitting for 20min, AR included a cycle ergometer for 20min at 50% maximum heart rate, and FRR involved 10 repetitions per target body area, followed by 1min rest. Variables of physical capacity (strength, power, agility, joint range of motion, flexibility, speed, and fatigue resistance) were assessed 1h after RE, whereas pain was assessed 24h, 48h, and 72h after RE. RESULTS: In the dominant lower limb, the percentage of strength decreased (p < 0.001) by 16.3% after RE but improved (p < 0.001) by 5.2% after AR and FRR in relation to PR. Similar results were observed in the non-dominant lower limb. Agility was enhanced (p < 0.001) by 3.6% in AR and 4.3% in FRR compared with the baseline assessment. The recoveries for the other physical variables were similar. Only FRR reduced (p < 0.001) pain at 24h (22.8%), 48h (39.2%), and 72h (59.7%) compared to PR. CONCLUSIONS: Self-massage using a foam roll reduced pain and improved agility and muscle strength during recovery after exercise. TRIAL REGISTRATION NUMBER: NCT04201977.

Prediction models for physical function in COVID-19 survivors.

BACKGROUND: The burden of caring for patients who have survived COVID-19 will be enormous in the coming years, especially with respect to physical function. Physical function has been routinely assessed using the Post-COVID-19 Functional Status (PCFS) scale. AIM: This study built prediction models for the PCFS scale using sociodemographic data, clinical findings, lung function, and muscle strength. METHOD: Two hundred and one patients with post-COVID-19 syndrome (PCS) completed the PCFS scale to assess physical function. Their levels of general fatigue were also assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, handgrip strength (HGS), and spirometry. RESULTS: The number of participants who scored 0 (none), 1 (negligible), 2 (slight), 3 (moderate), and 4 (severe) on the PCFS scale was 25 (12%), 40 (20%), 39 (19%), 49 (24%), and 48 (24%), respectively. The PCFS scale was significantly correlated with the following variables: FACIT-F score (r = -0.424, P < 0.001), HGS (r = -0.339, P < 0.001), previous hospitalization (r = 0.226, P = 0.001), body mass index (r = 0.163, P = 0.021), and sex (r = -0.153, P = 0.030). The regression model with the highest coefficient of regression (R = 0.559) included the following variables: age, sex, body mass index, FACIT-F, HGS, and previous hospitalization. CONCLUSIONS: Worse general fatigue and HGS are associated with more severe physical function impairments in PCS patients. Furthermore, a history of prior hospitalization results in worse physical function. Thus, prediction models for the PCFS scale that incorporate objective measures enable a better assessment of the physical function of these patients, thus helping in the selection of candidates for a program of physical reconditioning.

Can photobiomodulation improve quadriceps strength and endurance outcomes in asymptomatic adults? A double-blind randomized controlled trial.

AIM: To explore the effect of photobiomodulation on quadriceps strength and endurance torques in asymptomatic adults. METHODS: Twenty-eight asymptomatic adults were randomized to one of two interventions: photobiomodulation (n = 14) or sham (n = 14). Quadriceps strength was evaluated by maximum voluntary isometric contraction test (60°) and endurance by an elastic resistance in multiple-set knee extension/flexion repetitions using a traction dynamometer. The outcomes were measured at three time points: pre-baseline; baseline and; final assessment. The photobiomodulation was applied to the quadriceps and triceps surae muscles of each participant's dominant lower limb, using a cluster with 1 infrared laser diode and 3 led amber of 170 mW for 240 s over four consecutive days. The sham group went through the same procedures, but the equipment was off, and patients and assessors were blinded to the intervention. Reliability and minimal detectable change of the measures were obtained from the pre-baseline and baseline time points. Differences between interventions were tested by an analysis of covariance. RESULTS AND DISCUSSION: There was no difference between photobiomodulation compared to sham in maximum isometric torque (mean difference (95% CI) = 0.008 (-0.29 to 0.31) and endurance torques (mean difference (95% CI) = 0.04 (-0.03 to 0.12). The mean difference was lower than the minimal detectable change for the maximum isometric torque (1.02 Nm.kg-1) and endurance torque (0.49 Nm.kg-1). CONCLUSION: Photobiomodulation does not improve quadriceps strength and endurance outcomes in asymptomatic adults.

Effects of the elongated needling combined with routine acupuncture therapy in the patients with post-stroke hemiplegia and central pain： a randomized controlled trial. / èŠ’é’ˆé€åˆºè”åˆä½“é’ˆæ²»ç–—å¯¹ä¸­é£ŽåŽåç˜«ä¼´ä¸­æž¢æ€§ç–¼ç—›æ‚£è€ çš„ä¸´åºŠç–—æ•ˆè§‚å¯Ÿï¼šéšæœºå¯¹ç §è¯•éªŒ.

OBJECTIVES: To investigate the effects of the elongated needling at the points of hand and foot yang meridians and the Governor Vessel combined with the routine acupuncture therapy on pain, balance function and muscle strength of the patients with post-stroke hemiplegia and central post-stroke pain (CPSP), and to investigate whether its therapeutic mechanism is related to antioxidant damage. METHODS: Ninety-four patients with post-stroke hemiplegia and CPSP admitted from March 2020 to September 2021 were divided into a trial group (47 cases, 1 cases dropped out) and a control group (47 cases 3 cases dropped out). In the control group, the rehabilitation exercise combined with routine acupuncture therapy was used, and in the trial group, on the base of the treatment as the control group, the elongated needling at the points of hand and foot yang meridians and the Governor Vessel was supplemented. In the two groups, the treatment was given once daily, and 1 course of treatment was composed of 14 days, a total of 6 courses were required in the trial. Separately, before treatment, and 1, 2 and 3 months after treatment, between two groups, the score of visual analogue scale (VAS) and that of Berg balance scale (BBS), as well as muscle strength were compared；the neural function was evaluated using the national institutes of health stroke scale (NIHSS) and the serum contents of nitricoxide synthase (NOS), superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by ELISA in the patients. RESULTS: Compared with those before treatment, VAS score and NIHSS score were all decreased (P<0.05) in the trial and the control group after 1 month, 2 months and 3 months of treatment, and BBS score was increased (P<0.05)；and the case proportion of muscle strength grade 4 and 5 was higher (P<0.05) in the trial group. In the control group, the proportion of grade 4 increased after treatment for 2 months (P<0.05), and that of grade 4 and 5 increased after treatment for 3 months (P<0.05). The serum contents of NOS and SOD were increased (P<0.05), and MDA was decreased (P<0.05) after 3 months of treatment in the two groups. In comparison with the control group at the same time point, VAS score and NIHSS score were lower (P<0.05), BBS score higher (P<0.05) and the muscle strength grade was improved (P<0.05, P<0.01) after 1, 2 and 3 months of treatment, respectively；and the serum contents of NOS and SOD increased (P<0.05), and MDA decreased (P<0.05) after 3 months of treatment in the trial group. CONCLUSIONS: The elongated needling at the points of hand and foot yang meridians and the Governor Vessel, combined with the routine acupuncture therapy alleviates CPSP, improves balance and muscle strength and promotes the recovery of neural function in the patients with post-stroke hemiplegia, the mechanism may be related to antioxidant damage.

Exome-Based Amino Acid Optimization: A Dietary Strategy to Satisfy Human Nutritional Demands and Enhance Muscle Strength in Breast Tumor Mice Undergoing Chemotherapy.

Breast cancer patients undergoing chemotherapy often experience muscle wasting and weakness, which impact their quality of life. A potential solution lies in customizing amino acid compositions based on exome-derived formulations (ExAAs). The study hypothesized that tailoring dietary amino acids using ExAAs could enhance muscle health. Theoretical amino acid requirements were calculated from the genome's exome region, and a breast cancer mouse model undergoing paclitaxel treatment was established. The mice were supplemented with a cancer-specific nutritional formula (QJS), and the effects of QJS and amino acid-adjusted QJS (adjQJS) were compared. Both formulations improved the nutritional status without compromising tumor growth. Notably, adjQJS significantly enhanced muscle strength compared to QJS (1.51 ± 0.25 vs. 1.30 ± 0.08 fold change, p < 0.05). Transcriptome analysis revealed alterations in complement and coagulation cascades, with an observed upregulation of C3 gene expression in adjQJS. Immune regulation also changed, showing a decrease in B cells and an increase in monocytes in skeletal muscle with adjQJS. Importantly, adjQJS resulted in a notable increase in Alistipes abundance compared to QJS (10.19 ± 0.04% vs. 5.03 ± 1.75%). This study highlights the potential of ExAAs as valuable guide for optimizing amino acid composition in diets for breast cancer patients undergoing chemotherapy.

Does inspiratory muscle training improve lung function and quality of life in people with inclusion body myositis? A pilot study.

Inclusion body myositis is the most common acquired myositis in adults, predominantly weakening forearm flexor and knee extensor muscles. Subclinical respiratory muscle weakness has recently been recognised in people with inclusion body myositis, increasing their risk of respiratory complications. Inspiratory muscle training, a technique which demonstrates efficacy and safety in improving respiratory function in people with neuromuscular disorders, has never been explored in those with inclusion body myositis. In this pilot study, six adults with inclusion body myositis (age range 53 to 81 years) completed eight weeks of inspiratory muscle training. Measures of respiratory function, quality of life, sleep quality and a two-minute walk test were performed pre and post-intervention. All participants improved their respiratory function, with maximal inspiratory pressure, sniff nasal inspiratory pressure and forced vital capacity increasing by an average of 50 % (p = .002), 43 % (p = .018) and 13 % (p = .003) respectively. No significant change was observed in quality of life, sleep quality or two-minute walk test performance. No complications occurred due to inspiratory muscle training This pilot study provides the first evidence that inspiratory muscle training may be safe and effective in people with Inclusion Body Myositis, potentially mitigating the complications of poor respiratory function.

Effects of active vitamin D analogues on muscle strength and falls in elderly people: an updated meta-analysis.

Background: Elderly people are at high risk of falls due to decreased muscle strength. So far, there is currently no officially approved medication for treating muscle strength loss. The active vitamin D analogues are promising but inconsistent results have been reported in previous studies. The present study was to meta-analyze the effect of active vitamin D analogues on muscle strength and falls in elderly people. Methods: The protocol was registered with PROSPERO (record number: CRD42021266978). We searched two databases including PubMed and Cochrane Library up until August 2023. Risk ratio (RR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI) were used to assess the effects of active vitamin D analogues on muscle strength or falls. Results: Regarding the effects of calcitriol (n= 1), alfacalcidol (n= 1) and eldecalcitol (n= 1) on falls, all included randomized controlled trials (RCT) recruited 771 participants. Regarding the effects of the effects of calcitriol (n= 4), alfacalcidol (n= 3) and eldecalcitol (n= 3) on muscle strength, all included RCTs recruited 2431 participants. The results showed that in the pooled analysis of three active vitamin D analogues, active vitamin D analogues reduced the risk of fall by 19%. Due to a lack of sufficient data, no separate subgroup analysis was conducted on the effect of each active vitamin D analogue on falls. In the pooled and separate analysis of active vitamin D analogues, no significant effects were found on global muscle, hand grip, and back extensor strength. However, a significant enhancement of quadriceps strength was observed in the pooled analysis and separate analysis of alfacalcidol and eldecalcitol. The separate subgroup analysis on the impact of calcitriol on the quadriceps strength was not performed due to the lack to sufficient data. The results of pooled and separate subgroup analysis of active vitamin D analogues with or without calcium supplementation showed that calcium supplementation did not affect the effect of vitamin D on muscle strength. Conclusions: The use of active vitamin D analogues does not improve global muscle, hand grip, and back extensor strength but improves quadriceps strength and reduces risk of falls in elderly population.

Nutrient Intake and Its Association with Appendicular Total Lean Mass and Muscle Function and Strength in Older Adults: A Population-Based Study.

Treatment options for sarcopenia are currently limited, and primarily rely on two main therapeutic approaches: resistance-based physical activity and dietary interventions. However, details about specific nutrients in the diet or supplementation are unclear. We aim to investigate the relationship between nutrient intake and lean mass, function, and strength. Data were derived from the Gothenburg H70 birth cohort study in Sweden, including 719,70-year-olds born in 1944 (54.1% females). For independent variables, the diet history method (face-to-face interviews) was used to estimate habitual food intake during the preceding three months. Dependent variables were gait speed (muscle performance), hand grip strength (muscle strength), and the appendicular lean soft tissue index (ALSTI). Linear regression analyses were performed to analyze the relationship between the dependent variables and each of the covariates. Several nutrients were positively associated with ALSTI, such as polyunsaturated fatty acids (DHA, EPA), selenium, zinc, riboflavin, niacin equivalent, vitamin B12, vitamin D, iron, and protein. After correction for multiple comparisons, there were no remaining correlations with handgrip and gait speed. Findings of positive correlations for some nutrients with lean mass suggest a role for these nutrients in maintaining muscle volume. These results can be used to inform clinical trials to expand the preventive strategies and treatment options for individuals at risk of muscle loss and sarcopenia.

Outcome of arthroscopic triple release combined with rotator cuff repair in the treatment of rotator cuff injury combined with frozen shoulder.

Objective: To investigate the effect of arthroscopic triple release combined with rotator cuff repair in the treatment of rotator cuff injury combined with frozen shoulder and its influence on the range of motion and pain score of shoulder joint, and the levels of serum pain mediators. Methods: This was prospective study. A total of 132 patients with rotator cuff injury combined with frozen shoulder admitted to The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine from December 2020 to December 2022 were prospectively selected and divided into two groups according to the random number table method: control group (n=67) and observation group (n=65). Patients in the control group were treated with arthroscopic rotator cuff repair alone, while those in the observation group were treated with arthroscopic triple release combined with rotator cuff repair, and the surgical effects of the two groups were compared. Results: Three months after treatment, the external rotation, internal rotation, abduction, forward flexion, ß-endorphin(ß-EP), prostagranin E2 (PGE2) and substance P(SP)in the observation group were better than those in the control group (P<0.05), while the weight-bearing strength of the affected limb in internal rotation, external rotation and forward flexion was higher than that of the control group(P<0.05). Meanwhile, the Visual Analogue Scale (VAS) score of the observation group was lower than that of the control group at one month and three months after treatment, while the University of California at Los Angeles shoulder rating scale (UCLA) score and Constant-Murley Score (CMS) were higher than those of the control group (P< 0.05). Conclusion: Arthroscopic triple release combined with rotator cuff repair improves various effects for patients with rotator cuff injury combined with frozen shoulder, such as ameliorating the muscle strength of the affected limb and improving the level of pain mediators.

Management of a 25-Year-Old Female Patient With Limb-Girdle Muscular Dystrophy With Physiotherapy: A Case Report.

Limb-girdle muscular dystrophy (LGMD) is a collection of neuromuscular diseases that develop gradually and are rare, genetically, and clinically diverse. The weakness in muscles affecting the shoulder and pelvic girdles is a defining feature of LGMD. Calpainopathy is another name for limb-girdle muscular dystrophy type 2A (LGMD2A). Limb-girdle muscular dystrophy type 2A results from alterations in the calpain-3 (CAPN3) gene, which results in a CAPN3 protein shortage. Gower's sign is most commonly found in LGMD2A. The prevalence ranges from one person in every 14,500 to one in every 123,000. We present a case of a 25-year-old hypotensive female patient who complained of weakness in all four limbs and easy fatigue with a positive Gower's sign. For subsequent management, the neurologist referred the patient to the physical therapy department. The physical therapy goals included enhanced muscle strength, increased joint mobility, reduced fatigue, normalizing gait, and building dynamic balance and postural stability. Diagnosing LGMD clinical variability is important, emphasizing the importance of precise subtype identification and tailoring therapy. Tackling specific muscular deficits and functional restrictions emerges as a critical component in the holistic care of LGMD by physiotherapists. Continuous monitoring and evaluation using appropriate scales and measurements are essential for tracking performance and tailoring treatment strategies. Regular follow-up consultations with the physiotherapist are needed to identify changes in an individual's health and alter the treatment plan accordingly.

Association between vitamin D status, physical performance, sex, and lifestyle factors: a cross-sectional study of community-dwelling Kosovar adults aged 40 years and older.

PURPOSE: Vitamin D status and its association with age-related decline in physical performance and strength have already been highlighted in various ways, but data on the situation in developing countries are scarce. This study aimed to investigate vitamin D status, its association with muscle mass and function, and other potential determinants such as age, sex, lifestyle factors (physical activity, dietary behavior), self-perceived health status, medication intake, education and financial situation in adults from Kosovo. METHODS: This cross-sectional study included 297 participants (54.5% women), aged ≥ 40 years. Serum 25-hydroxyvitamin D (25(OH)D) concentration, hand grip strength and physical performance tests, body composition, vitamin D dietary intake and knowledge were assessed. The interaction between serum 25(OH)D status, lifestyle factors and muscle traits was investigated. RESULTS: Vitamin D deficiency (< 50 nmol/L) was observed in 47.5% of the total population, of whom 14.7% of them were severely deficient (< 30 nmol/L). No associations were found between 25(OH)D concentration and age. Daily dietary intake of vitamin D was low (1.89 ± 0.67 µg) and 87.6% of individuals did not take vitamin D supplements. However, vitamin D supplementation was the only variable that added statistical significance (p < 0.05) to the prediction of vitamin D status (3.8%). On the other hand, age, medication intake and vitamin D level contributed significantly to the overall regression model, explaining 24.9% of the 30-s chair stand performance as an indicator of lower-body strength endurance. CONCLUSION: Vitamin D deficiency is highly prevalent among community-dwelling adults in Kosovo and low serum 25(OH)D has been associated with low muscle strength. This implies an urgent need for the development of comprehensive prevention strategies, focusing on pharmacological (supplementation) but also on non-pharmacological strategies such as education, food fortification or lifestyle advices.

Supplementation with ß-hydroxy-ß-methylbutyrate after resistance training in post-acute care patients with sarcopenia: A randomized, double-blind placebo-controlled trial.

OBJECTIVES: This study aimed to evaluate the efficacy of adding ß-hydroxy-ß- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program. MAIN OUTCOME MEASURES: The primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up. RESULTS: After completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up. CONCLUSIONS: Our findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.

Improvement in muscular strength, body flexibility and balance by yoɡasana and with reduced detraining effects by yoɡa breathing maneuvers: A non-randomized controlled study.

BACKGROUND: YoÉ¡a was reported to have the potential to improve physical fitness. Its applications are being used by common persons for wellness, but literature on the training and detraining effects of components of yoga is scarce. OBJECTIVES: To explore the potential of different proportions of yoga postures (Yogasana) and yoga breathing maneuvers (YBM), consisting of Pranayama and kriya, on muscular strength, flexibility, and balance in training and detraining management. METHODS: ː 32 physically active male students, aged 20.5 ± 1.3 yrs, were divided into control (CG) and yoga group (YG). YG practiced yogasana, YBM, and dhyana for 45 min in each session for 6 days per week for 12 weeks. From 1st week to 6th week, they practiced yogasana in greater proportion. 7th week onwards YBM was inducted by increasing its duration and varieties. CG did not practice yoga. Back-leg strength (BLS), Hand Grip Strength (HGS), flexibility, and balance were recorded before, the 6th week and 12th weekend of training. RESULTS: ː.In YG, the pre-training value of BLS was 110.8 ± 12.6 kg. It increased (2.3 %) to 113.3 ± 11.4 kg (p < 0.001) on the 6th weekend. On the 12th weekend, it further increased in lesser magnitude (0.4 %) to 113.7 ± 11 kg (p < 0.05) and the pattern of improvement was the same in other parameters, but in flexibility and balance its magnitude was greater (p < 0.001). CG did not show such changes. CONCLUSIONS: ː Yogasana helps in the improvement of muscular strength, flexibility, and balance and YBM counteracts detraining effects in the absence of yogasana. Judiciously selected components of yoga/YBM may have applications in sports, occpational health and recuperative patients.

Comparison of Single and Combined Treatment with Exercise Therapy and Collagen Supplementation on Early Knee Arthritis among Athletes-A Quasi-Randomized Trial.

Athletic injuries are commonly implicated in the development of early osteoarthritic (EOA) changes in the knee. These changes have a significant impact on athletic performance, and therefore the early detection of EOA is paramount. The objective of the study is to assess the impact of different interventions on individuals with EOA, particularly focusing on recreational athletes. The study aims to evaluate the effectiveness of three treatment groups in improving various aspects related to knee EOA, including pain, range of motion, strength, and function. A study was undertaken with 48 recreational athletes with EOA who were assigned to one of three groups by the referring orthopedic surgeon: collagen (Col), exercise (Ex), or collagen and exercise (ColEx) groups. All the participants received their respective group-based intervention for 12 weeks. Visual analog scale (VAS), knee flexion range of motion (ROM) knee flexors and extensors strength, and KOOS were assessed at baseline, and after 4 weeks, 8 weeks, and 12 weeks of intervention. VAS for activity improved in all treatment groups, with no difference between groups. The between-group analysis for knee ROM revealed a significant difference (p = 0.022) in the Col vs. Ex group at 12 weeks. The knee flexor and extensor strength and the KOOS scores improved considerably in the Ex and the ColEx group (p < 0.05) at 12 weeks. Exercise therapy improved pain, strength and function in subjects with EOA, whereas the association of collagen seems to have accentuated the effects of exercise in bringing about clinical improvements.

The effects of neuromuscular electrical stimulation on hospitalised adults: systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: Neuromuscular electrical stimulation (NMES) is a treatment to prevent or reverse acquired disability in hospitalised adults. We conducted a systematic review and meta-analysis of its effectiveness. METHOD: We searched MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health (CINAHL) and the Cochrane library. Inclusion criteria: randomised controlled trials of hospitalised adult patients comparing NMES to control or usual care. The primary outcome was muscle strength. Secondary outcomes were muscle size, function, hospital length of stay, molecular and cellular biomarkers, and adverse effects. We assessed risk of bias using the Cochrane risk-of-bias tool. We used Review Manager (RevMan) software for data extraction, critical appraisal and synthesis. We assessed certainty using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: A total of 42 papers were included involving 1,452 participants. Most studies had unclear or high risk of bias. NMES had a small effect on muscle strength (moderate certainty) (standardised mean difference (SMD) = 0.33; P < 0.00001), a moderate effect on muscle size (moderate certainty) (SMD = 0.66; P < 0.005), a small effect on walking performance (moderate certainty) (SMD = 0.48; P < 0.0001) and a small effect on functional mobility (low certainty) (SMD = 0.31; P < 0.05). There was a small and non-significant effect on health-related quality of life (very low certainty) (SMD = 0.35; P > 0.05). In total, 9% of participants reported undesirable experiences. The effects of NMES on length of hospital stay, and molecular and cellular biomarkers were unclear. CONCLUSIONS: NMES is a promising intervention component that might help to reduce or prevent hospital-acquired disability.