Public Health and Healthcare

Abstract: Background/Objective: Rehabilitation for gait asymmetry in cerebral palsy (CP) commonly treats improvements in gait symmetry indices as a subtype-general marker of therapeutic success. Building on a trajectory-divergence model developed in a companion review, we propose that hemiplegic and diplegic CP represent opposing developmental deviations from the normative gait-symmetry trajectory — persistent, actively regulated compensatory asymmetry in hemiplegia versus pathological rigid symmetry in diplegia — such that a single, shared correction target is conceptually misaligned for at least one subtype. This review critically evaluates, through a narrative synthesis of literature published between 2010 and 2026, whether rehabilitation strategies for hemiplegic and diplegic CP should be differentiated according to this model rather than converging on gait-symmetry restoration. Methods: A structured narrative review following a Population–Concept–Context (PCC) framework and JBI-aligned appraisal, drawing on 70 unique sources across 21 thematic searches. Results: In hemiplegic CP, compensatory asymmetry is mechanistically and energetically dissociable from correction, but its magnitude, not its presence, predicts balance and locomotor outcomes, bounding rather than eliminating the case for conservation. In diplegic CP, restoring adaptive motor variability is supported by convergent evidence but is conditional on confirming genuine bilateral rigidity, since a meaningful subset of diagnosed diplegic children presents with clinically significant inter-limb asymmetry. A provisional Divergent Rehabilitation Response Index (DRRI) organizes four domains of subtype-specific therapeutic congruence: counter-evidence, such as correction-beneficial cases, inconsistent functional transfer, evidentiary concentration, and long-term musculoskeletal risk signals, are directly addressed. Conclusions: Differentiated magnitude- and subtype-conditional rehabilitation targets, rather than universal symmetrization, are proposed for hemiplegic and diplegic CP, alongside an explicit research agenda.

Abstract: Background: Because falls can lead to loss of autonomy in individuals with post-tuberculosis lung disease (iwPTLD), assessing fall risk is an important health issue. This study aimed to evaluate balance control (BC) in iwPTLD and correlate it with functional capacity during exertion (FCE), pulmonary function, muscle strength, and fatigue. Methods: This cross-sectional study assessed BC in iwPTLD using the Berg Balance Scale (BBS), the Tinetti Balance Scale (TBS), and the Timed "Up and Go" Test (TUGT). Participants also underwent assessments of pulmonary function, respiratory muscle strength, handgrip strength (HGS), quadriceps strength (QMS), general fatigue, and functional capacity during exertion (FCE) using the six-minute step test (6MST). Results: Of the 50 individuals with iwPTLD, 66%, 38%, and 46% had a BBS, TBS, and TUGT, respectively, indicating a moderate/high risk of falls. The degree of agreement between BC classifications was weak to poor (Kappa between 0.15 and 0.35). The BBS correlated significantly with the QMS (rs=0.373, p=0.007) and the 6MST (r_s=0.290, p=0.041). The TBS correlated significantly with fatigue (r_s= 0.376, p=0.016), HGS (rs= 0.325, p=0.021), BBS (r_s= 0.291, p=0.040), and 6MST (r_s= 0.310, p=0.028). The TUGT correlated significantly with fatigue (r_s= -0.340, p=0.015), residual volume/total lung capacity (r_s=-0.500, p=0.0004), QMS (r_s=-0.641, p<0.0001), and 6MST (r_s=0.696, p<0.0001). Conclusions: In iwPTLD, BC damage appears to be common, with alterations observed in up to two-thirds of cases. In these individuals, the worse the BC, the greater the static pulmonary hyperinflation, the worse the peripheral muscle strength, and the more deteriorated the FCE.

Abstract: Background. Body fat percentage is considered in sports science as a stable, comparable, and interpretable measure. Athletes are compared to sport-specific reference ranges, values from different instruments are directly compared, and differences between sports are attributed to contact demands. None of these assumptions have been systematically tested, and the reference tables most widely used have not been verified against the primary literature they are thought to be based on. Objectives. To assess whether body fat percentage supports the comparisons typically made with it. Specifically: whether values obtained by different measurement methods are comparable; whether the conventional sport-specific reference ranges originate from primary sources; whether a single percentage has a consistent physiological meaning across the competitive spectrum; and whether contact classification accounts for differences in body composition between sports. Methods. A narrative review was conducted. Sources were identified through PubMed, publisher databases, and references from recent reviews. Each data point was categorized as Tier 1 (traceable to a primary peer-reviewed source with details on sample size, measurement method, and dispersion) or Tier 2 (common practitioner ranges without primary source attribution). Sports were organized using the American Academy of Pediatrics contact taxonomy, which served as the main stratification criterion and was evaluated against alternative classifications. Competitive level was determined using the Participant Classification Framework. Results. Tier 1 data included 5,144 athletes and 228 controls with reported sample sizes, along with 232 data points from a review of 90 studies [1]. Elite male athletes had a mean body fat of 14.1 ± 5.4% (range: 8.7–19.5%), and elite females averaged 21.8 ± 4.1% (17.7–25.9%). Contact level did not align with body type clustering; instead, body mass demand—which is a new classification introduced here—accounted for 68.6% of differences between sports, compared to 17.4% for contact level (permutation p = 0.0017). Measurement method influenced variance more than sex: in basketball, values ranged from 12.4% (skinfold) to 21.4% (DXA), a 9-point difference that exceeds the 7.6-point difference between males and females within the same sport. Combat sports (boxing, taekwondo) clustered at 9.8 ± 2.2%, the leanest group, similar to endurance sports. Collision team sports without weight classes (American football, rugby) averaged 15.9 ± 2.6%. Within collision team sports, positional differences exceeded differences between sports: NFL rosters averaged 17.9 ± 6.9%, with defensive backs around 12% and linemen over 25%. Of 32 ranges examined, none were identified within the search described in Section 2.2 as tracing to primary sources. Decomposition of the gradient at each end of the competitive range revealed two opposing mechanisms: below Tier 2, fat mass index decreased by 29.1% while fat-free mass index was unchanged (−1.2%); between Tier 0–1 and Tier 4–5, lean mass was 52.9% greater while fat mass was 10.8% greater in absolute terms. Coefficient of variation was approximately half as large in sports with low mass demand (20.1%) compared to capped (38.8%) or high (38.7%) mass demand sports. Conclusions. Body fat percentage combines two physiologically opposite processes and thus provides no clear information about which process is dominant: below Tier 2, a decreasing percentage indicates fat loss with stable lean mass, while at Tier 4–5, a lower percentage reflects lean mass gain against increasing fat mass. This offers a mechanistic explanation for why lean mass more reliably indicates training status than adiposity. It also suggests that fat mass index and fat-free mass index should be reported alongside, or instead of, body fat percentage. Contact level is not related to body composition. One possible explanation, proposed here as a hypothesis, is body mass demand—what the sport's mechanics and rules require in total mass—leading to low, high, or capped categories. Methodologically, body composition should not be used as a proxy or covariate for head-impact exposure in neurotrauma risk models, as these are independent factors. Standard sport-specific ranges generally align with Tier 1 data but should be viewed as heuristic rather than definitive values. Two additional analyses (by competitive tier and age) and an applied reference are included. All data are cross-sectional and only show associations. Data for female non-athletes and female sub-elite athletes could not be sourced.

Abstract: Gait symmetry in children is increasingly understood as a development-dependent continuum rather than a fixed endpoint of perfect bilateral equivalence, a framework that this review extends into a developmental systems model of divergence in cerebral palsy. Typically developing children retain small but measurable inter-limb asymmetries that progressively decrease from early childhood to adolescence. This narrative review asks whether gait asymmetry in hemiplegic and diplegic CP simply fails to reach this normative curve or diverges from it in phenotype- and construct-specific ways that a single asymmetry index cannot capture. Synthesizing longitudinal, cross-sectional, and intervention-based evidence across four interacting domains — direct interlimb symmetry, global and joint-level kinematic deviation, neuromuscular and coordination control, and functional balance — we show that hemiplegic CP is characterized by lateralized divergence involving compensatory changes in the nominally unaffected limb, with partial improvement in directly measured asymmetry over time. Diplegic CP, by contrast, frequently presents with preserved or near-normal left–right symmetry that coexists with progressive, growth-linked deterioration in specific sagittal-plane impairments concealed beneath a stable global gait score, and with a more coupled, less variable coordination strategy that does not correspond to comparable neuromuscular maturation. The recurring finding across both phenotypes is that these domains do not move in parallel, such that reliance on any single metric risks masking clinically important divergences. Building on this evidence, we propose a provisional, non-summative, phenotype-conditioned Trajectory Divergence Index as a hypothesis-generating framework for multi-domain monitoring and identify the absence of longitudinal, multi-domain, multi-phenotype cohorts as the principal evidence gap in the field.

Abstract: Neuromuscular dysfunction during the sit-to-walk (STW) task in Parkinson’s disease (PD) remains poorly understood. We aimed to analyze surface electromyography (sEMG) signals across STW phases using explainable machine learning (ML) and deep learning approaches in PD. Individuals with PD (n = 102) and healthy controls (n = 50) performed a standardized STW task while sEMG signals were recorded bilaterally from eight lower-limb muscles. These signals were preprocessed and segmented into three phases in the STW task. Feature-based ML models were compared with convolutional neural networks (CNN) trained on wavelet-transformed sEMG spectrograms. Explainable artificial intelligence methods identified physiologically interpretable neuromuscular patterns. STW phase 1 was the most sensitive interval for detecting PD-related neuromuscular abnormalities. Feature-based models achieved high classification performance, identifying frequency-domain features and rectus femoris–biceps femoris short head co-contraction indices as key discriminants. CNN-based analyses revealed earlier and temporally concentrated activation patterns in individuals with PD, particularly in proximal muscles critical for momentum generation and postural stabilization. Our findings revealed impaired predictive neuromuscular control and maladaptive proximal muscle coordination during STW phase 1 as core features of PD. This approach provides a physiologically grounded foundation for developing interpretable digital neuromuscular biomarkers and timing-focused rehabilitation strategies in PD.

Abstract: Background: Ageing is associated with changes in the immune system that may contribute to a chronic low-grade inflammatory state (inflammaging). Regular physical exercise has been recognized as an important non-pharmacological strategy for modulating this process. However, studies comparing different exercise modalities in exclusively male samples remain scarce. To compare pro- and anti-inflammatory cytokines in older men participating in an aquatic exercise programme and a land-based multicomponent exercise programme. Methods: A cross-sectional exploratory study was conducted with 15 older men allocated to two groups: aquatic exercise (AE) (n = 7; 70.8 ± 4.5 years) and multicomponent exercise (ME) (n = 8; 75.4 ± 4.1 years). The cytokines IL-1β, TNF-α, IL-10, and IL-1ra were analysed using enzyme-linked immunosorbent assay (ELISA). Body composition was assessed as a secondary variable to characterise the sample. Group comparisons were performed using Student’s t-test, Welch’s t-test, or the Mann–Whitney U test, according to data distribution and homogeneity. Results: No statistically significant differences were observed between the groups in IL-1β, TNF-α, IL-10, or IL-1ra concentrations. Likewise, no significant differences were found in the body composition variables analysed. Effect sizes were generally trivial to small, except for muscle mass, which showed a moderate effect. Conclusions: In this sample, older men participating in aquatic exercise and land-based multicomponent exercise exhibited similar inflammatory profiles. Future studies with larger samples and longitudinal and intervention designs are needed to clarify the effects of these exercise modalities on the inflammatory profile of older men.

Abstract:

Introduction: Non-alcoholic fatty liver disease (NAFLD) is closely associated with insulin resistance and chronic low-grade inflammation. Exercise training and taurine supplementation have emerged as promising strategies to improve metabolic function by modulating insulin signaling and inflammatory pathways. This study investigated the effects of taurine supplementation and high-intensity interval training (HIIT), alone and in combination, on insulin signaling and inflammasome-related pathways in a high-fat diet (HFD)-induced mouse model of NAFLD. Methods: Fifty-six male C57BL/6J mice were assigned to either a control diet (CON, n = 8) or an HFD (n = 48). After 12 weeks, HFD-fed mice were randomized into six groups: HFD, HFD+HIIT (HE), HFD+2.5% taurine (HT-2.5), HFD+HIIT+2.5% taurine (HET-2.5), HFD+5% taurine (HT-5), and HFD+HIIT+5% taurine (HET-5) (n = 8/group). Interventions were performed concurrently for 10 weeks. Results: Compared with controls, HFD-fed mice exhibited increased HOMA-IR, impaired PI3K/AKT signaling, elevated PTEN expression, and increased hepatic TXNIP, NLRP3, and caspase-1 levels (all p < 0.05). All intervention groups improved HOMA-IR and reduced PTEN, TXNIP, and caspase-1 expression compared with the HFD group (p < 0.05). PI3K phosphorylation increased only in the HET-2.5 group, whereas AKT phosphorylation increased in the HE, HT-5, and HET-2.5 groups (p < 0.05). Notably, concurrent enhancement of both PI3K and AKT phosphorylation was observed exclusively in the HET-2.5 group. Conclusion: HIIT and taurine supplementation improved metabolic and inflammatory alterations associated with HFD-induced NAFLD. These findings support the potential of combined exercise and nutritional interventions as complementary strategies for mitigating metabolic dysfunction associated with NAFLD and warrant further clinical investigation.

Abstract: Previous research has demonstrated that self-talk can enhance athletic performance and that longer quiet-eye duration is positively associated with successful performance. However, the effects of strategic self-talk on quiet-eye duration and free-throw performance have not been fully examined. This study investigated the effects of strategic self-talk on quiet-eye duration, gaze location, and free-throw performance in novice female basketball players. Forty participants were randomly assigned to a strategic self-talk group or a practice-only control group; data from 35 participants (18 in the self-talk group and 17 in the control group) were included in the final analyses. Both groups completed identical pre-tests and post-tests consisting of three blocks of 30 free throws. Between tests, they completed a three-week supervised practice program comprising two sessions per week and three blocks of 10 attempts per session. The strategic self-talk group used assigned and individualized self-talk cues, whereas the control group completed the same practice without self-talk instructions. Free-throw performance was evaluated using the six-point Hardy and Parfitt scoring system, and gaze behavior was recorded using eye-tracking technology. Compared with the control group, the strategic self-talk group showed greater improvements in free-throw performance and quiet-eye duration, a higher percentage of fixations directed toward the basket, and a lower percentage directed toward irrelevant locations (all p < .05). These findings suggest that strategic self-talk may enhance performance by promoting longer quiet-eye durations and more task-relevant gaze behavior.

Abstract: Background: Psychological factors influence rehabilitation and return to sport following anterior cruciate ligament (ACL) injury, yet evidence in futsal players remains limited. Methods: A qualitative multiple-case study was conducted with eight federated futsal players (five women and three men) with confirmed ACL injuries and five physiotherapists experienced in ACL rehabilitation. Semi-structured interviews explored athletes’ experiences across injury, rehabilitation, and return to sport, while physiotherapist interviews provided a clinical and temporal framework. Data were analyzed using thematic analysis and cross-case comparison. Results: Seven themes were identified: (1) emotional impact at the time of injury, (2) psychological challenges during early rehabilitation, (3) psychological adaptation throughout rehabilitation, (4) factors influencing rehabilitation adaptation, (5) return to sport and psychological readiness, (6) role of physiotherapists and social support, and (7) perceived psychological needs during rehabilitation. Fear of reinjury, uncertainty, frustration, loss of independence, motivational fluctuations, and reduced confidence were prominent challenges. Progressive goal achievement, individualized rehabilitation, previous injury experience, and support from physiotherapists, family, and teammates facilitated recovery. Seven athletes considered structured psychological support potentially beneficial. Conclusions: ACL rehabilitation in futsal should be understood as an individualized, dynamic biopsychosocial process. Repeated psychological monitoring, progressive sport-specific exposure, and access to specialist support may promote a safer and more sustainable return to sport.

Abstract: The gold standard for assessing anaerobic performance is the laboratory Wingate cycle-ergometer test; however, cycling is not a sport-specific movement pattern for soccer players. The aim of this study was to determine whether mechanical variables from a 220-m field sprint test, combined with anthropometrics, could predict maximal anaerobic capacity in elite youth male soccer players. Forty-three elite Brazilian players were evaluated according to their competitive division: under-16 (n = 22) and under-18 (n = 21). Anaerobic capacity was assessed using the laboratory Wingate test and a 220-m sprint analyzed via kinematic modeling. Raw maximum sprint velocities did not differ significantly between categories (p = 0.322). Multiple linear regression modeling optimized through the Akaike Information Criterion (AIC) and influence diagnostics revealed that Average Power (AVG_Watts) was robustly predicted by a parsimonious model integrating Body Mass (B = 5.13, p = 0.004) and Mean Velocity (V_m, B = 94.74, p = 0.021). The final model was highly significant (p < 0.001), achieving an adjusted R2 of 0.414. The proposed mathematical model provides a feasible, robust, and cost-effective method for estimating laboratory-derived anaerobic performance using accessible field metrics on the soccer pitch.

Abstract: Static stretching is widely used in sports medicine, rehabilitation, and exercise science to improve joint range of motion (ROM) and flexibility. However, its effects on human movement remain incompletely understood because previous research has primarily examined individual outcomes—including ROM, passive stiffness, force production, power output, stretch–shortening cycle function, jumping performance, landing biomechanics, and balance—in isolation. Consequently, the relationship between tissue-level mechanical adaptations and functional performance has remained fragmented. This integrative review synthesizes current evidence on the biomechanical adaptations induced by static stretching and proposes a conceptual framework linking tissue mechanics, neuromechanical regulation, and human movement. Current evidence demonstrates that repeated static stretching consistently increases ROM while reducing passive stiffness, particularly within skeletal muscle. Acute stretching may transiently reduce maximal force after prolonged stretching durations, whereas chronic interventions generally produce neutral or modestly beneficial effects on maximal strength. In contrast, adaptations in power output, stretch–shortening cycle performance, jumping ability, landing biomechanics, and postural stability remain inconsistent and appear to depend on the interaction between mechanical, neural, and task-specific factors rather than on passive tissue mechanics alone. The proposed framework suggests that the functional consequences of static stretching emerge through a hierarchical continuum extending from tissue mechanical adaptations to neuromechanical regulation and ultimately to human movement. As movement complexity increases, the contribution of isolated mechanical variables progressively decreases, whereas coordinated sensorimotor regulation and task-specific movement organization become increasingly important determinants of performance. Overall, static stretching should be regarded not merely as an intervention for improving flexibility but as a biomechanical stimulus whose functional effects arise from the interaction between tissue mechanics and neuromuscular regulation. This integrative perspective provides a unified framework for interpreting the heterogeneous effects of static stretching in sport and rehabilitation.

Abstract: Background: Sports injuries in children and adolescents may affect physical health, emotional well-being, sleep, quality of life, confidence, participation, and readiness to return to sport. Objective: This systematic review aimed to synthesize evidence on the relationship between sports-related injuries and mental health in athletes aged 19 years or younger, considering both psychological factors associated with injury vulnerability and psychosocial outcomes following injury. Methods: The review followed PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, and Google Scholar were searched from inception to July 2026. Methodological quality was assessed using Joanna Briggs Institute tools, and findings were synthesized narratively. Results: Twenty-one studies were included. Lower psychological well-being, anxiety, stress, fatigue, sleep disturbance, kinesiophobia, and reduced psychological readiness were associated with injury occurrence, symptom burden, recovery, or reinjury. Conversely, sports injuries were associated with anxiety, depressive symptoms, sleep problems, reduced health-related quality of life, lower confidence, altered participation, identity disruption, and difficulties returning to sport. Conclusions: The findings support a potentially bidirectional and biopsychosocial relationship between sports injury and mental health, although heterogeneity and predominantly observational designs limit causal inference.

Abstract: Body image (BI) is an important psychosocial aspect of well-being; however, its relationship with quality of life (QoL) among adults with cerebral palsy (CP) remains insufficiently explored. This study aimed to examine the association between BI and QoL across specific QoL domains, and to investigate whether BI and QoL differ according to selected socio-demographic characteristics among adults with CP. A cross-sectional study included 30 adults with CP aged 21-50 years. Participants completed a socio-demographic questionnaire, the Body Image Quality of Life Inventory (BIQLI) and the Short Form Health Survey (SF-36). Given partial departures from normality, the small sample size, and the ordinal nature of the response scales, non-parametric statistical analyses were applied. The results showed that BI was significantly associated with the following specific QoL domains: Mental Health, Vitality and Social Functioning, whereas it was not significantly associated with Physical Functioning, General Health, Bodily Pain, or role limitations due to physical and emotional problems. BI was also weakly associated with overall QoL. Regarding socio-demographic characteristics, no significant differences in BI or QoL were identified according to gender. Significant age-related differences were observed in Physical Functioning and Bodily Pain, with the oldest group (41-50 years) reporting poorer physical functioning and more bodily pain than the younger groups. Being in a romantic relationship was associated with better Mental Health and Social Functioning, while employed participants reported more positive BI, better Mental Health, and greater Vitality. These findings highlight the importance of integrating BI into comprehensive rehabilitation and psychosocial interventions aimed at improving QoL in adults with CP. Future longitudinal mixed-methods studies with larger, more diverse samples are needed to further elucidate the complex relationships between BI and QoL and to inform the development of evidence-based interventions aimed at improving the well-being of adults with CP.

Abstract: Background: Functional fitness has evolved from a niche training methodology into an influential movement in contemporary exercise science, sports performance, and the fitness industry. Among the competitive formats that have recently emerged, Hyrox® has become a prominent standardized model of hybrid fitness competition. This review aimed to critically synthesize the available evidence on the development of Hyrox® and its physiological demands, psychological characteristics, and performance determinants. Methods: Given the limited evidence available, a narrative review was conducted. PubMed, Scopus, and Web of Science were searched for original and review articles investigating Hyrox® athletes or participants. The evidence was synthesized across three major domains: physiology, psychology, and performance determinants. Results: Eleven studies were included, comprising eight original articles and three review articles. The available evidence indicates that Hyrox® imposes sustained high metabolic and per-ceptual demands, with functional stations eliciting particularly elevated blood lactate concentrations. Running capacity consistently emerged as the strongest determinant of overall performance. Psychological, recovery, sleep, and injury-related aspects remain insufficiently investigated. Conclusions: Hyrox® represents a promising research model for hybrid fitness because of its standardized competition format and rapidly growing international participation. However, the evidence base remains limited and is pre-dominantly derived from observational studies and analyses of publicly available competition data. Controlled interventions, longitudinal monitoring, and physiological, biomechanical, and psychosocial investigations are required to support evidence-based recommendations for athlete preparation and competition.

Abstract: Assessment of sagittal spinal alignment depends on the classification system applied, as different approaches use distinct category structures and normative thresholds. This study evaluated the differentiation of sagittal postural profiles in children using classical and nine-type posture classification systems based on three-dimensional surface topography and Shannon entropy analysis. A total of 952 children aged 10-12 years (478 girls and 474 boys) underwent body posture assessment using the DIERS Formetric III 4D rasterstereographic system. Thoracic kyphosis and lumbar lordosis angles were used for posture classification according to the classical five-type model and the nine-type Wilczyński typology. Category distributions were compared using the chi-square test, Cramér’s V coefficient, and Shannon entropy analysis. The classical classification concentrated the majority of participants in two categories (round back, 53.6%; normal posture, 40.5%), whereas the nine-type typology distributed participants more evenly across posture profiles. A strong association was observed between the classification systems (Cramér’s V = 0.69; p < 0.001). Entropy was higher for the nine-type typology (H = 1.86) than for the classical classification (H = 1.17), indicating greater differentiation of sagittal posture profiles. These findings demonstrate that the choice of classification system substantially influences posture profile distribution. Shannon entropy provides an objective quantitative measure of classification differentiation and may support the evaluation of posture classification systems based on three-dimensional surface topography.

Abstract:

The aim of the present review was to summarize the effects of physical exercise of varying intensity, duration, and frequency on the key biological and biomechanical factors that determine erythrocyte deformability. Erythrocyte deformability is a multifactorial property influenced by mechanical, biochemical, metabolic, and hemodynamic mechanisms activated during exercise, including membrane rheology, osmotic balance, hemoglobin concentration, intracellular Ca²⁺ homeostasis, ATP availability and release, nitric oxide (NO) signaling, oxidative stress, erythrocyte age, and temperature. Current evidence indicates that the effect of physical exercise on erythrocyte deformability is bidirectional. Moderate and well-adapted exercise generally improves membrane properties, microcirculatory blood flow, and oxygen delivery, whereas exhaustive or prolonged exercise may induce oxidative and structural damage and transiently reduce deformability. NO-dependent vasodilation and ATP release from erythrocytes appear to play central regulatory roles in optimizing microvascular perfusion during exercise. Osmotic changes, lactate accumulation, intracellular Ca²⁺ concentration, dehydration, and temperature are critical physiological modulators of erythrocyte mechanics. Because each athlete may exhibit an individual erythrocyte deformation profile shaped by biological, hemorheological, physiological, and training-related factors, individualized training loads and regular monitoring of hemorheological indicators are recommended. Such an approach may contribute to the development of hemorheological fitness and improved exercise performance.

Abstract: Background/Objectives: Electroconvulsive therapy is an effective treatment for major depressive disorder but may cause transient neurological and motor side effects. Limited evidence exists regarding acute balance disturbances following treatment. Therefore, The aim of the study was to assess the balance changes observed after initial electroconvulsive therapy in patients diagnosed with major depression. Methods: Twenty-two participants diagnosed with major depression disorder were enrolled according to the inclusion criteria such as being between the ages of 18-65, being diagnosed with major depression, and receiving electroconvulsive therapy (ECT) for the first time. Exclusion criteria were a diagnosis of any vestibular or neurological disease. The balance of the participants was evaluated with the Berg Balance Scale (BBS). The same physiotherapist performed the assessments before, at the 1st hour after ECT, and at the 24th hour after ECT. Results: Mean Berg Balance Scale scores were 55.04 ± 1.78 before electroconvulsive therapy, 40.22 ± 2.54 at 1 hour, and 54.86 ± 1.64 at 24 hours after treatment. Balance decreased significantly at 1 hour compared with baseline (mean difference: −14.82 points, p < 0.001) and improved significantly by 24 hours (mean difference: 14.64 points, p < 0.001). No significant difference was observed between baseline and 24-hour measurements (p = 0.640). Conclusions: Marked balance impairment was observed during the first hour following electroconvulsive therapy, suggesting a potential increase in fall risk. Further studies are needed to determine whether targeted fall-prevention strategies may improve patient safety following electroconvulsive therapy.

Abstract: Background and Objectives: Adults with moderate-to-severe traumatic brain injury (TBI) frequently experience medical complications during post-acute rehabilitation that may adversely affect recovery. Although falls and infections are common among medically complex rehabilitation populations, their relationship with functional outcomes in long-term acute care hospitals (LTACHs) has not been well characterized. This study evaluated whether hospitalization-related falls and infections were associated with functional rehabilitation outcomes among adults with moderate-to-severe TBI receiving LTACH rehabilitation. Materials and Methods: A retrospective cohort study was conducted using electronic medical record data from adults admitted to an LTACH between January 2017 and December 2024. Among 272 screened patients, 239 met the eligibility criteria. Functional rehabilitation outcomes were determined using Centers for Medicare & Medicaid Services (CMS) Section GG mobility and activities of daily living (ADL) assessments completed at admission and discharge. Hospitalization-related falls and infections were examined as predictor variables using logistic regression models adjusted for age, gender, and race/ethnicity. Results: Falls occurred in 11.3% of participants and infections in 15.9%, while 33.1% achieved functional improvement. After adjustment for demographic characteristics, hospitalization-related falls were associated with 69% lower odds of functional improvement (OR = 0.31; 95% CI, 0.10–0.98; p = .046), whereas infections were associated with a 62% lower odds of improvement (OR = 0.38; 95% CI, 0.15–0.97; p = .042). No significant demographic interaction effects were identified. Conclusions: Hospitalization-related falls and infections were independently associated with poorer functional rehabilitation outcomes among adults with moderate-to-severe TBI receiving LTACH care. These findings support the importance of multidisciplinary strategies aimed at preventing and promptly managing clinical complications throughout post-acute rehabilitation.

Abstract: Spatial hearing is a key auditory function that enables the perception and interpretation of sound location and spatial cues in the environment. It plays a crucial role in everyday listening situations, particularly in complex acoustic settings. Despite its importance, spatial hearing remains under investigated in Brazil due to the limited availability of validated assessment instruments. Background/Objectives: Currently, few tools are available, including the Listening in Spatialized Noise Sentences (LiSN), the Speech, Spatial and Qualities of Hearing Scale (SSQ) and its short version (SSQ-12), and the Spatial Hearing Questionnaire (SHQ). While the SSQ has been adapted into Brazilian Portuguese, it is not exclusively focused on spatial hearing, and the LiSN adaptation is still in progress. Thus, there is a need for validated instruments specifically designed to assess spatial hearing in this population. Methods: This methodological study aimed to translate, cross-culturally adapt, and validate the Spatial Hearing Questionnaire (SHQ) into Brazilian Portuguese. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (UFMG) (approval number 3,605,895). Data were collected at the Audiology Service of Hospital São Geraldo (UFMG). A total of 126 individuals with normal hearing thresholds (≤25 dB HL from 250 to 8000 Hz) and type A tympanometric curves participated. After signing informed consent, participants completed the Mini-Mental State Examination (MMSE), Visual Analog Scale (VAS) of the tinnitus magnitude, SSQ-12, and the Brazilian Portuguese version of the SHQ. Semantic validation, conducted with 30 individuals, showed comprehension rates above 80% for all items, with no need for modifications. Statistical analyses included the Shapiro–Wilk test, Wilcoxon signed-rank test, Cronbach’s alpha, and Spearman’s correlation. Conclusions: Internal consistency was high (Cronbach’s alpha: 0.97 for SHQ; 0.96 for retest; 0.88 for SSQ-12). Significant differences were observed in SHQ, VAS, MMSE, and SSQ-12 spatial scores between individuals with and without auditory complaints. No significant differences were found between SSQ-12 items 6–8 and total SHQ scores. The Brazilian Portuguese version of the SHQ demonstrated excellent reliability and validity, supporting its use as a robust instrument for assessing self-perceived spatial hearing abilities in Brazilian Portuguese-speaking populations.

Abstract: Background/Objectives: Recovery between exercise exposures is often framed as the rapid suppression of soreness, inflammation, oxidative stress, and fatigue, although the same perturbations may also initiate tissue repair and training adaptation. This review proposes recovery-adaptation coupling (RAC) as a decision framework for matching nu-tritional strategies to recovery bottlenecks while preserving adaptive signals. Methods: A mechanistic narrative synthesis integrated evidence on exercise-induced muscle dam-age, inflammation resolution, immune-redox regulation, muscle protein turnover, glyco-gen restoration, connective-tissue remodeling, micronutrient sufficiency, nutrient timing, individual variability, and recovery monitoring. Results: RAC links four tar-gets—damage attenuation, inflammation resolution, anabolic remodeling, and adaptive signal preservation—to the next athletic demand, the dominant recovery bottleneck, and the markers used to verify response. Nutritional strategies are interpreted according to context, dose, timing, and response phenotype. Conclusions: RAC is a heuristic decision architecture rather than a validated universal algorithm; it aims to restore readiness without indiscriminately suppressing the signals required for longer-term adaptation.