Chronic obstructive pulmonary disease (COPD) features poor sleep quality due to nocturnal dyspnea and psychological distress, leading to increased hospital admissions and reduced quality of life. Considering patient preference and existing evidence, non-pharmacological intervention, i.e. cognitive behavioral therapy for insomnia (CBT-I), on sleep for COPD patients had its potential efficacy. However, current guidelines do not include sleep management as standard care, and there is a lack of comprehensive reviews on this topic. This systematic review hence evaluated the effectiveness of non-pharmacological treatments for poor sleep in COPD patients. Literature identification was conducted through MEDLINE, CINHAL PLUS, AMED and ScienceDirect under PRISMA guidance. Randomized controlled trials, cohort studies and cross-sectional studies regarding poor sleep quality among COPD population were retrieved. Abstract, title and full text screening were performed by the author and assessed by a second reviewer. Risk of bias and quality appraisal was done with JBI scale. 12 articles (783 patients) were identified, including 9 randomized controlled trials, 1 cohort study and 2 cross-sectional studies. The risk of bias (quality) was ranked: low (high) for 3, moderate (moderate) for 7 and high (low) for 2. Several interventions were identified (number of study): CBT-I (2) and cognitive behavioral therapy (1), pulmonary rehabilitation (PR) (2), progressive muscle relaxation technique (PMRT) (2), non-invasive ventilation (NIV) (3), relaxation exercise (RE) (1) and therapeutic touch (TT) (1). Significant improvement in sleep quality was reported in PMRT, TT and RE. PMRT, TT and RE showed improvement in sleep quality in COPD patients yet unable to rank their effectiveness as heterogeneous outcome measures across studies. No substantial evidence was capable to demonstrate effectiveness of CBT-I, CBT, PR and NIV to explicit COPD patients. Moreover, future research including combination of non-pharmacological treatments is needed. Cognitive Behavioural Therapy for Insomnia (CBT-I), Cognitive Behavioural Therapy (CBT), Pulmonary Rehabilitation (PR), and Non-invasive Ventilation (NIV) lack robust evidence for sleep improvement in COPD, despite their use in other populations. Multimodal (combination) therapies may offer greater promise for this population. Further high-quality research is needed to inform clinical guidelines.

Resistance training (RT) in post-operative cardiac rehabilitation (CR) complements aerobic exercise, enhancing physical capacity, independence, and quality of life. Traditionally, RT is delayed 6-8 weeks to reduce risks such as sternal instability and impaired healing after median sternotomy. However, emerging evidence suggests early RT (≤4 weeks) may be safe and beneficial for selected patients, improving recovery and functional outcomes. This paper explores the debate between traditional delay and early initiation, weighing potential benefits against risks to safety and healing. With growing support for early RT, should conventional timelines be reconsidered to optimize rehabilitation and long-term health?

Objective To investigate the effects of early resistance training combined with moderate-intensity continuous training (RT+MICT) versus moderate-intensity continuous training alone (MICT) on functional capacity, P-R interval, resting heart rate (RHR), and safety in patients following valve replacement surgery. Design A single-blinded, randomized controlled trial with two parallel groups. Settings Patients post-valve replacement surgery were randomly assigned to either MICT or RT+MICT. Participants Forty male patients (27.6±3.71 years) with rheumatic heart disease completed the study, with 20 in each group. Interventions The MICT group performed a warm-up, MICT (RPE 13–15), and cool-down. The RT+MICT group followed the same protocol with the addition of resistance training (RPE 13–15 to volitional fatigue), incorporating concentric, isometric, and eccentric contractions. Both interventions began 48 hours post-operatively and were conducted three times per week for four weeks. Outcome Measures Functional capacity (6-minute walk test), P-R interval, RHR, and safety (adverse events) were assessed pre- and post-intervention. Results RT+MICT led to significantly greater improvements in functional capacity (+118.50 ± 6.75 m vs. +41.75 ± 6.75 m; p=0.001) and P-R interval (-30.05 ± 3.21 ms vs. -11.65 ± 3.21 ms; p=0.02) compared to MICT. No significant difference was found in RHR (p=0.75). No major adverse events occurred; minor events were reported by 5% in RT+MICT and 7.5% in MICT (mild fatigue, transient muscle soreness, slight shortness of breath). Conclusions Adding resistance training to early MICT rehabilitation post-valve replacement is safe and significantly enhances functional capacity and P-R interval compared to MICT for younger patients. Future research should aim to replicate these results in larger, more diverse populations to strengthen the generalizability of the findings.

Cardiovascular disease (CVD) is caused by modifiable and non-modifiable risk factors and is consistently recognised as a leading cause of morbidity and mortality. Poor sleep caused by sleep disorders such as insomnia are linked to increased mortality in patients with CVD, yet it is routinely overlooked as a cause to treat. Furthermore, despite the impact of sleep disorders, management strategies are notably underrepresented in cardiac care guidelines and cardiac rehabilitation. This scoping review aimed to assemble recent published literature to explore how behaviour change interventions could be utilised as a method to integrate sleep management strategies into state-of-the-art cardiac rehabilitation for patients with cardiovascular disease. Four medical databases (Cochrane Library, MEDLINE, PsycINFO and CINAHL+) were searched using a PICO framework, publishing a total of 782 results. Of the 782 records identified, 23 were included to inform this review, including an additional article found from bibliography searching. A variety of study designs were identified, including randomised controlled trials, pilot trials, secondary data analysis and systematic reviews. Cognitive behavioural therapy emerged as the most consistently effective intervention, particularly in group and web-based formats. Brief behavioural treatment for insomnia was also identified as an emerging flexible and easily adaptable approach, also producing promising reductions in insomnia severity. Behaviour change interventions demonstrate significant potential for improving sleep outcome measures and insomnia severity when tested among patients living with CVD. Evidence gaps include heterogeneity in intervention protocols and sample populations. Future studies must involve key stakeholders to better shape the suggested interventions. Also, they should consider this whilst exploring the role of tele-health and the need for flexibility for strategies to be implemented into cardiac rehabilitation. Cognitive Behavioural Therapy For Insomnia (CBTI) and Brief Behavioural Treatment For Insomnia (BBTI) are scalable and effective tools for improving sleep in CR. Web-based delivery enhances accessibility and adherence to sleep interventions in CR. Future trials are needed to embed sleep into CR using behavioural change models.

OBJECTIVE:To investigate the effect of early balance training combined with traditional Phase I cardiac rehabilitation (based on circulatory, respiratory and progressive aerobic exercises) compared to Phase I cardiac rehabilitation alone, on balance, functional capacity, quality of life, length of hospital stay and adverse events in patients post coronary artery bypass graft surgery. DESIGN:Randomized controlled trial. SETTING:Cardiothoracic surgery departments from the Cairo University Hospitals. PARTICIPANTS:Adults (≥55 years) undergoing coronary artery bypass graft were randomly allocated to either an early balance training plus Phase I cardiac rehabilitation group or a Phase I cardiac rehabilitation alone group. Both groups commenced within 48 hours postoperatively and performed 30 minutes of moderate-intensity Phase I cardiac rehabilitation, thrice daily for 7 days. The cardiac rehabilitation Balance group performed an additional 5 minutes of balance training each session. MAIN MEASURES:Balance (Berg Balance Scale), functional capacity (5-Repetition-Sit-to-Stand test), quality of life (Short Form-36 Health Survey Questionnaire), length of hospital stay (number of days hospitalized) and adverse events were evaluated. RESULTS:Sixty coronary artery bypass graft patients completed the study. When compared to cardiac rehabilitation Alone group, the cardiac rehabilitation balance group significantly improved balance (39.77 ± 4.73 vs 34.03 ± 4.94, respectively, P < .001) functional capacity (11.93 ± 1.70 vs 15.97 ± 2.01, respectively, P < .001), quality of life (71.87 ± 3.21 vs 66.17 ± 2.94, respectively, P < .001) and hospital length stay (11.47 ± 1.22 vs 14.93 ± 1.36, respectively, P < .01). Additionally, both groups showed significant improvements in balance, functional capacity and quality of life. No adverse events were registered in any of the groups. CONCLUSIONS:Phase I cardiac rehabilitation plus early balance training improves balance, functional capacity, quality of life, and decreases length of hospital stay beyond that of Phase I cardiac rehabilitation alone, without an increase in adverse events.Institutional Research Committee:No: P.T.REC/012/004372Registration:clinicaltrails.gov NCT06490458).

Ankle sprains are common injuries that cause pain, swelling, and reduced range of motion (ROM), adversely affecting physical activity. In this study, we aim to review the effectiveness of mobilization with movement (MWM) in improving outcomes for patients with ankle sprains. We conducted a search of PubMed, Cochrane Library, PEDro, Web of Science, and Scopus up to October 2023 for English trials comparing Mulligan MWM with other treatments. The Cochrane Risk of Bias tool (ROB 2) was used for quality assessment, and mean differences (MD) with 95

Introduction: This study aimed to compare the effects of reduced-exertion high-intensity training (REHIT) versus short moderate-intensity continuous training (SMICT) on functional capacity, resting heart rate (RHR), and activity enjoyment in sedentary women. Methods: Thirty sedentary young women were randomly allocated to a: i) REHIT group (n = 15) or ii) SMICT group (n = 15) (2 sessions/week, 6 weeks) using a computer-generated random allocation sequence. Both groups performed an intervention on a cycle ergometer that included a warm-up (3 min at 50% of HRmax), the main part of the session, and a cool-down (3 min at 50% of HRmax). The main part in REHIT consists of 20-40 s divided on two maximum cycling sprints of all-out exercise at 100% of HRmax with an active rest of 3 min between them; whilst SMICT consisted of 6-12 min of moderate intensity exercise at 60-70% of HRmax. Functional capacity (6-min walking test) and RHR were measured before and after the intervention. Physical activity enjoyment (Physical Activity Enjoyment Scale) was assessed after the intervention. Results: The effects of the REHIT on functional capacity showed a significant interaction between time measurement and intervention group (p <0.001) that not occurred in RHR (p > 0.05). Intragroup post-hoc analysis revealed that both groups improve their values in functional capacity and RHR (p < 0.05). Between-groups comparison showed that REHIT group increased significantly functional capacity more than SMICT (p = 0.002). In addition, physical activity enjoyment scores were high in both groups without differences. Conclusion: REHIT and SMICT are appropriate for improving functional capacity and RHR, as well as being perceived as enjoyable in sedentary young women. REHIT offers higher improvements in functional capacity. Clinical trial registration number: NCT05875051.

This study aims to investigate the effect of sympathetic ganglion electrical modulation in peripheral arterial disease (PAD) patients and the resultant changes in claudication distance, haematological parameters, and Doppler ultrasound parameters. Forty male PAD patients were randomly divided into two groups: (i) transcutaneous electrical nerve stimulation (TENS) group (n = 20, mean age 55.55 ± 2.16 years), which received TENS at T12, L1, and L2 (4 Hz frequency, 200 µs pulse duration), and (ii) control group (n = 20, mean age 54.6 ± 2.56 years), which received sham therapy. Both interventions lasted 45 min per session, three times per week for 12 weeks. Outcomes included claudication distance [initial (ICD) and absolute (ACD)], Doppler parameters [ankle peak systolic velocity (APSV) and arterial diameter (AD)], and haematological markers [mean platelet volume (MPV) and red cell distribution width (RDW)]. The TENS group demonstrated significant improvements compared to the control group across all measured outcomes (p < 0.001). Notable enhancements were observed in absolute and initial claudication distances (mean differences: 150.5 m and 71.9 m, respectively), arterial diameter (+ 0.21 mm), and ankle peak systolic velocity (+ 10.39 cm/s). Additionally, mean platelet volume and red cell distribution width decreased significantly in the TENS group, indicating favourable haematological changes. Sympathetic ganglion modulation by TENS is an effective non-invasive intervention that significantly enhances walking capacity, vascular function, and haematological markers in patients with PAD. These results support its potential as a therapeutic adjunct to traditional PAD management strategies.

COVID-19 is a global pandemic that spread rapidly around the world. It led to changes in management plans for different diseases due to the occupation of the health services and staff with the COVID battel, in addition to lockdown consequences. Cardiac emergency management, such as ST-segment elevation myocardial infarction, was affected at multiple levels by the COVID-19 pandemic, including a delay in patients' threshold to call emergency medical services, decreased availability of ambulances, increased waiting time in the emergency departments, and time delay in percutaneous coronary intervention due to the time consumed for personal protective measures. ESC released a guide based on the experiences of healthcare workers to help in decision-making in different cases. The guide recommended various diagnostic modalities to detect vulnerable patients, but all these modalities have different limitations. Egypt, Saudi Arabia, United Arab Emirates, Yamen, Bahrain, Kuwait, and Tunisia are different Arab countries with different populations and political and economic conditions. They responded to the global pandemic according to their different conditions guided by the global cumulative experiences.

IntroductionThis study aimed to examine the effects of moderate-intensity interval training (MIIT) on the quality of sleep and functional capacity in atrial fibrillation (AF) patients with different presentations of sleep apnoea after coronary artery bypass graft (CABG) surgery.Methods18 participants with AF and sleep apnoea aged 45–65 years were assigned into two groups: AF with obstructive sleep apnoea group (group A, n1 = 9) and AF with mixed sleep apnoea group (group B, n2 = 9). Both groups received MIIT for ten weeks (3 sessions / week) and medical treatment (i.e., Continuous Positive Airway Pressure and drug therapy). Exclusion criteria were unstable cardiac comorbidities and neurological/musculoskeletal limitations to exercise intervention. Outcome measures included sleep parameters collected from the actigraphy, overall sleep quality rating domain of the Pittsburgh Sleep Quality Index (PSQI), and six-minute walk distance (6-MWD).ResultsSignificant changes were present in the means of all outcomes in group A (p < 0.05) and two outcomes (i.e., cut points & 6-MWD) in group B compared to baseline (p < 0.05). Also, there were significant differences in the absolute mean changes from baseline (∆) between the two groups, in favour of group A, in sleep latency (p < 0.001), total sleep duration (p = 0.026), sleep efficiency (p < 0.001), overall sleep quality rating item of the PSQI (p = 0.001), and 6-MWD (p = 0.008).ConclusionsMIIT can be a supplementary therapeutic intervention that could contribute to greater positive changes in sleep quality and functional capacity in AF patients with obstructive sleep apnoea rather than in AF patients with mixed sleep apnoea post-CABG. MIIT could enhance the functional capacity independent of improving sleep quality in patients with AF and mixed sleep apnoea post-CABG.

Abstract Background Cardiovascular disease (CVD) represents a significant health challenge in Egypt, yet there exists limited understanding regarding the knowledge, attitudes, and physical activity levels associated with CVD. These factors play a pivotal role in developing effective prevention and management strategies. Hence, this cross-sectional study aimed to evaluate Egyptian adults’ knowledge, attitudes, and physical activity (KAP) levels. Methods Data were collected using a previously validated questionnaire encompassing demographic characteristics, CVD knowledge (including risk factors and symptoms), attitudes toward CVD, and self-reported physical activity levels. The survey was distributed among social media channels, and trained researchers administered the questionnaire via face-to-face interviews with adult patients with and without CVD admitted to Cairo University Hospital clinics. Results The study involved 591 participants, of whom 21.7% had CVD. Overall, participants exhibited poor knowledge regarding CVD, with a mean score of 21 ± 7 out of 40, equivalent to 52.5%. Attitudes toward CVD were moderate, with a mean score of 66.38 ± 8.7 out of 85, approximately 78%. Physical activity levels per week were also moderate, averaging 1188 MET-min with a range of 1121–18,761. Subgroup analysis revealed that individuals with CVD had lower average knowledge, attitude, and physical activity levels than those without CVD. Working in the healthcare field was a predictor of higher knowledge score (standard error (SE) 5.89, 95% confidence interval (CI) 4.61 to 7.17, P < 0.001), while those with CVD and smokers were predictors of lower attitude score (SE -4.08, 95% CI -6.43 to -1.73, P < 0.001) and (SE -2.54, 95% CI -4.69 to -0.40, P = 0.02), respectively. Conclusion The study findings highlight a significant disparity in knowledge, attitudes, and physical activity levels related to CVD in Egypt. Targeted interventions aimed at improving awareness, fostering positive attitudes, and promoting physical activity among individuals at risk for CVD are crucial for effective prevention and management.

BACKGROUND: Stress and fatigue experienced by lactating employed mothers can affect mothers' and babies' mental and physical health detrimentally. Aerobic exercise is known to control stress and fatigue, but the dosages of the exercises needed to maintain long-term effects are still under investigation. OBJECTIVE: This study aimed to investigate the acute and long-term effects of aerobic exercise on controlling stress and fatigue in lactating, employed mothers. METHODS: This randomized control study involved sixty lactating, employed mothers suffering from stress and fatigue. They were divided into two groups: Group A received five sessions of 30-minute aerobic training on a treadmill per week, in addition to lifestyle modification advice for six weeks. Group B received the same lifestyle routine advice for the same duration without being trained. Assessments of stress and fatigue levels were done before, after 6 weeks, and after 6 months from the baseline assessments using the Perceived Stress Scale (PSS-10) and Fatigue Assessment Scale (FAS), respectively. RESULTS: Post-six-week comparisons within and between both groups showed a significant decline in PSS-10 and FAS in group A compared with group B (p < 0.001); however, after six months of follow-up, there were statistically significant effects within groups only (p < 0.05) and no statistically significant difference between groups at both variables (p > 0.05). CONCLUSION: Aerobic exercises for 6 weeks can induce an acute but not long-term effect on stress and fatigue control in lactating-employed mothers. Future research is needed to tailor the exercise prescription needed to maintain training's long-term benefits.

AIM:Recent studies supported the presence of a relationship between pain and frailty, but more research is needed to highlight the pain-frailty association. The study aimed to investigate the prevalence and the influence of different pain indicators on frailty while controlling for age, sex and country. METHODS:This observational study used data from the sixth wave of the SHARE survey. A sample of 22 356 community-dwelling individuals aged >60 years from six European countries (Spain, Estonia, France, Greece, Czech Republic and Sweden) was analyzed. The pain was measured through assessment of medication used for joint pain or other types of pain, pain location, polypharmacy and pain level. Frailty was assessed with the modified Fried Frailty phenotype. RESULTS:Pain indicators, especially widespread pain and pain severity, were significantly associated with prefrailty (odds ratio 3.30, 95% CI 2.40, 4.55; and odds ratio 0.61, 95% CI 0.51, 0.72) and frailty status (odds ratio 4.69, 95% CI 3.31, 6.67; and odds ratio 0.37, 95% CI 0.30, 0.44). Advancing age and female sex consistently correlated with increased prefrailty (odds ratio 1.06, 95% CI 1.05, 1.07; and odds ratio 1.36, 95% CI 1.22, 1.53) and frailty risk (odds ratio 1.11, 95% CI 1.10, 1.12; and odds ratio 1.71, 95% CI 1.48, 1.96). Country-specific differences emerged, with Spaniards showing higher odds ratios of prefrailty and frailty compared with Swedish, French and Czech individuals, whereas Greeks showed elevated odds ratios compared with Spaniards. The factors associated jointly explained 27.5% of the variance in frailty categories. CONCLUSION:Significant associations were identified, particularly with widespread pain and pain severity, highlighting their impact on frailty. Country-specific variations in frailty prevalence were observed, alongside consistent associations with advancing age and female sex. These findings provide valuable insights into the intricate interplay between pain and frailty, offering the potential for targeted interventions in older adults' care through tailored pain management strategies. Geriatr Gerontol Int 2024; 24: 1362-1369.

IntroductionObesity, sedentarism, and insulin resistance are strongly associated with increased deoxyribonucleic acid fragmentation index (DFI) of sperms, reduced total testosterone (TT), and low semen quality, which can be prevented by lifestyle modification. This study aimed to investigate the effect of 14-week moderate-intensity aerobic exercise on serum TT, semen parameters, and DFI in centrally obese men with hyperglycaemia.MethodsOverall, 40 men aged 26–39 years with waist circumference (WC) > 102 cm, body mass index (BMI) limited from 30 to 34.9 kg/m2, and fasting blood glucose (FBG) levels of 100–125 mg/dl were assigned to the study and control groups. The study group (n = 20) received supervised 14-week moderate-intensity aerobic exercise on a treadmill for 40 minutes, 3 times weekly, in addition to 1-hour home walking (on the alternative days of aerobic exercise), while the control group (n = 20) received general advice on increasing physical activity.ResultsIn the study group, exercise significantly improved BMI, WC, FBG, serum TT, sperm DFI, and semen parameters, including motility (progressive and static) and morphology (p < 0.05), while the volume and count of semen showed no significant difference. The control group presented no significant changes.ConclusionsThe deteriorating effect of central adiposity, hyperglycaemia, and sedentarism on semen quality and nuclear damage of sperms (assessed by DFI) is prevented or counteracted by increased exercise-induced TT production, resulting from decreased BMI, FBG, and WC.

Patients with multiple sclerosis (MS) typically experience varying degrees of impairments and disabilities. Taskoriented training (TOT) has been used for those patients to improve their motor skills. This review aimed to evaluate the primary research on the effectiveness of TOT in improving upper limb functions in patients with MS. The systematic search was performed using PubMed, Cochrane library and Physical therapy Evidence Database (PEDro) databases up to 2022. Only randomized controlled trials that used TOT alone for UL functions of adult patients with MS were included. Two independent reviewers screened records, extracted data and assessed studies' quality by using PEDro scale. The meta-analysis was based on the standardized mean differences and the random effect. The search screened 9148 records; only five randomized controlled trials were eligible; four of them were of good quality. The trials included 147 patients with MS; 66% of them were females, their mean average age was 47 years. TOT duration ranged from 40 to 210 min with total period of 10 days to 8 weeks; it was applied alone without conventional physical therapy. Meta-analyses compared TOT alone versus control interventions revealed non-significant difference in the improvement of UL functions on Nine-Hole Peg Test, Action Reach Arm Test, Motor Activity Log-Amount Of Use scale, and Manual Ability Measurement. This review concluded that TOT alone can be effective for improving UL functions in patients with MS but meta-analyses showed non-significant differences when it was compared with conventional physical therapy.

Background Resistance training (RT) for improving muscular strength is a fundamental part of the exercise component in Cardiac Rehabilitation (CR) protocols for post-open-heart surgeries. Although very early postoperative RT is safe and feasible, many delays start until after four weeks. It is evidenced that such delays can significantly affect the efficacy of CR outcomes. Aim For patients receiving valve replacement surgery, this study aimed to investigate the effect of very early resistance training (2 days postoperatively) on functional capacity, either when combined with aerobic training or compared to aerobic training alone. Additional clinical measures included the effects on the Electrocardiograph (ECG) P-R interval and resting heart rate (RHR). Methods 40 male valve replacement surgery patients (20-30 years) were randomly allocated into two equal groups: Group A received aerobic and very early resistance training (6 exercises targeting upper limbs, lower limbs, neck and back done till volitional fatigue with 9-12 repetitions/exercise) three sessions per week for one month and Group B received aerobic training only for the same frequency and time. The primary outcome was functional capacity, assessed using a six-minute walk test (6MWT). Secondary outcomes were P-R interval and RHR, both assessed using a resting ECG. Results Functional capacity (118.50±6.75m vs 41.75±6.75m for groups A and B respectively) and P-R intervals (30.05±3.21ms vs 11.65±3.21ms for groups A and B respectively) showed significant improvements in both groups (p=0.001 and 0.02, respectively) with greater changes in group A. However, there were no between-groups improvements in RHR (p= 0.75). Conclusion Very early resistance training combined with aerobic is generally safe and effective for patients after valve replacement surgery, however, potential gender variations and a larger sample-sized study should be conducted in future research. Also, different research designs with RT as a stand-alone intervention might still be needed.