Adolescents with obesity face numerous health risks and encounter barriers that lead to physical inactivity. We developed a virtual reality sports system, named REVERIE (Real-World Exercise and VR-Based Exercise Research in Education), which used deep reinforcement learning to train transformer-based virtual coaching agents, offering immersive and effective sports guidance, with biomechanical performance comparable to real-world physical sports. We integrated REVERIE into a randomized controlled trial involving an 8-week intervention in adolescents with excess body weight (n = 227). Participants were randomized (1:1:1:1:1) to physical table tennis, physical soccer, REVERIE table tennis, REVERIE soccer or control. REVERIE sports intervention was effective in reducing primary outcome fat mass (mean -4.28 kg (95% confidence interval (CI) -6.35 to -2.22), relative to control), with no significant difference compared with physical sports (mean -5.06 kg (95% CI -7.13 to -2.98), relative to control). For secondary outcomes, decreases in liver enzymes and low-density lipoprotein cholesterol levels were found in physical and REVERIE sports groups compared to control. Physical and REVERIE sports showed improvements in physical fitness, psychological well-being and sports willingness after an 8-week intervention, which remained at the 6-month follow-up in the REVERIE sports group. REVERIE sports demonstrated superior cognitive enhancements compared to physical sports in exploratory analyses, as evidenced by olfactory tests (total score: mean 2.84 (95% CI 1.15 to 4.53)) and working memory paradigm (2-back accuracy: mean 10.88% (95% CI 1.19% to 20.56%)). Functional magnetic resonance imaging exhibited that REVERIE sports enhanced neural efficiency and neuroplasticity. Multi-omics analyses revealed distinct changes induced by REVERIE sports that were closely associated with cognitive improvement. Minimal injury rates were 7.69% for REVERIE and 13.48% for physical sports, with no serious adverse events. Collectively, this study demonstrates that the virtual reality sports therapy could provide an empathetic approach to addressing adolescent obesity, offering comprehensive improvements in physical, psychological and cognitive health beyond mere weight loss. Clinical Trial registration: ChiCTR2300068786 .
Objective: Transcutaneous auricular vagus nerve stimulation (tVNS) may be an innovative treatment for symptoms of knee osteoarthritis (OA) due to possible shared pathological mechanisms between diminished parasympathetic function, central pain mechanisms, and knee pain. Thus, we sought to test the safety and preliminary efficacy of tVNS in people with knee OA. Design: A pilot trial in which participants received a 60-min tVNS was conducted. At baseline, immediately after, and 15 min after tVNS, we assessed knee pain, pressure pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and high-frequency power of heart rate variability (HF). We examined the extent to which these outcome measures changed after tVNS using linear mixed models. Results: 30 participants with knee OA were included, and all completed the intervention without any major side effects. Compared to baseline, knee pain was reduced by 1.27 (95 % CI, -1.74, -0.80) immediately after and by 1.87 (-2.33, -1.40) 15 min after tVNS; CPM improved by 0.11 (0.04, 0.19) and 0.07 (-0.01, 0.15); and HF improved by 213.29 (-0.38, 426.96) and 234.17 (20.49, 447.84). PPT and TS were not changed after tVNS. Conclusions: Our preliminary data demonstrated that tVNS may be a safe pain-relieving treatment for people with knee OA. Our findings suggest that improvement of knee pain might be derived from improvement of parasympathetic function and central pain mechanisms as no local therapy was applied. A large study is needed to confirm that tVNS is a novel intervention to ameliorate knee pain in people with knee OA. Clinical Trial: ClinicalTrials.gov (NCT05625178).
Background: Previous research has reported higher rates of both injury and illness among Paralympic athletes compared with Olympic athletes during the Winter Olympic and Paralympic Games, but no studies have directly compared injury and illness incidence between Olympic and Paralympic athletes competing in a Summer Games. Purpose: To compare injury and illness rates between Olympic and Paralympic Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games. Study Design: Descriptive epidemiology study. Methods: All injuries and illnesses that occurred among the Team USA athletes competing in the Tokyo 2020 Summer Olympic or Paralympic Games were documented. A total of 701 Team USA athletes (53.6% female) competed in the Tokyo 2020 Summer Olympic Games, across 34 different sports. For the Tokyo 2020 Summer Paralympic Games, a total of 245 athletes (51.6% female) competed across 20 sports. Incidence rates (IRs) per 1000 athlete-days were calculated according to sex, sport, anatomic location, and illness type. IR ratios (IRRs) were calculated to compare IRs between male and female athletes and between Olympic and Paralympic athletes. Results: Overall, there were no differences in injury incidence (IRR, 1.18; 95% CI, 0.84-1.68) or illness incidence (IRR, 0.68; 95% CI, 0.41-1.15) between Olympic and Paralympic athletes. Male Paralympic athletes were less likely to sustain an illness compared with female Paralympic athletes (IRR, 0.35; 95% CI, 0.11-0.90). Conclusion: There were no differences in injury or illness rates between Olympic and Paralympic Team USA athletes competing at the Tokyo 2020 Summer Games, contrary to previous comparisons among winter sport athletes. These results challenge the prevailing notion that Summer Paralympic athletes are at greater injury and illness risk, suggesting that factors beyond Olympic or Paralympic Games participation influence health concerns.
Return to work (RTW) after burn injury is dependent on many variables, including type and location of burn injury, access to care, and preinjury mental and physical health. Noting that prior studies were limited by small sample sizes, we aimed to use a large database to explore the associations between hand burn severity, functional hand outcomes, and RTW postinjury. Data from a multicenter longitudinal study were analyzed. Adults with burn injuries were classified into 6 groups ranking in the severity of hand injury: (0) no hand burns, (1) single hand burn no grafting, (2) bilateral hand burn no grafting, (3) single hand burn requiring grafting, (4) bilateral hand burn requiring unilateral graft, and (5) bilateral hand burn requiring bilateral grafts. Grafting was used as a proxy for burn severity. Self-reported employment status, Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) scores, and reported requests for work accommodations were collected at discharge, 6-, 12-, and 24-month postinjury. Descriptive statistics and analysis of variance (ANOVA) with post-hoc Tukey test were completed to examine differences in outcomes by hand injury severity. A total of 4621 participants met the inclusion criteria. Group 5, those with the most severe burns, had significantly longer RTW times than groups 0-3 (P < 0.005). Group 5's (bilateral burn/unilateral graft) average RTW was greater, however, not significantly, compared to group 4. At 6 months, the mean PROMIS UE scores for grafted groups (group 3, 40.6; group 5, 35.4) were significantly worse than non-grafted groups (group 1, 46.8; group 2, 45.0; P < 0.0001). At 12 and 24 months, mean PROMIS UE scores were worse for grafted groups, though differences were no longer significant compared to non-grafted groups. At every time point, the majority of respondents did not request accommodations for their injuries from their employers, regardless of severity. Burn severity plays a significant role in both RTW and hand function for participants with hand burns. In addition, the lack of correlation between burn severity and request for work accommodations hints at the baseline vulnerability of these populations. These findings suggest a need for systematic improvements in the way these patients are cared for and re-integrated into the workforce.
Objective:To compare clinical outcomes following steroid injections using the anterior and posterior approaches.Design:Systematic review with meta-analysis.Setting:Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies.Patients:Patients with adhesive capsulitis.Interventions:Glenohumeral steroid injections using either anterior or posterior approach.Main Outcome Measures:Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs.Results:We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications.Conclusions:While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.
