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Mastour Saeed Alshahrani,1,&ast; Ravi Shankar Reddy,1,&ast; Adel Alshahrani,2,&ast; Saud F Alsubaie3,&ast; 1Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia; 2Department of Medical Rehabilitation Sciences-Physiotherapy Program, College of Applied Medical Sciences, Najran University, Najran, 55461, Saudi Arabia; 3Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Ravi Shankar Reddy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia, Tel +966 503587903, Email rshankar@kku.edu.saIntroduction: Shoulder proprioception is vital and this cross-sectional study investigated the association between glycemic control and shoulder joint proprioception in Type 2 Diabetes Mellitus (T2DM).Methods: A total of 120 participants, including 60 with T2DM and 60 healthy individuals, were assessed for shoulder joint position sense (JPS) using a digital inclinometer. The T2DM group exhibited significantly greater mean shoulder joint position errors in flexion (4.32° vs 2.15°), abduction, medial rotation, and lateral rotation compared to the healthy group (p < 0.001).Results: The study found significantly greater shoulder joint position errors in the T2DM group compared to the healthy group, highlighting notable proprioceptive deficits in individuals with T2DM. Additionally, a significant positive correlation was found between HbA1c levels and shoulder joint position errors in the T2DM group, suggesting a link between long-term glycemic control and proprioceptive accuracy.Discussion: The significant positive correlation between HbA1c levels and shoulder joint position errors suggests that poor glycemic control is associated with impaired proprioception in T2DM patients. This underscores the need for comprehensive management strategies to mitigate proprioceptive deficits and improve the quality of life in individuals with T2DM.Keywords: joint position sense, diabetes complications, sensory feedback, neuromuscular function, HbA1c Levels

Walid K Abdelbasset,1,2 Saud F Alsubaie,1 Sayed A Tantawy,3 Tamer I Abo Elyazed,4 Dalia M Kamel3,5 1Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; 2Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt; 3Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain; 4Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt; 5Department of Physiotherapy for Womens Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt Background: It has been documented that aerobic exercise may increase pulmonary functions and aerobic capacity, but limited data has evaluated a child’s satisfaction and pediatric quality of life (PQoL) with exercise training. Objectives: This study aimed to investigate the effects of moderate-intensity exercise training on asthmatic school-aged children. Subjects and methods: This study included 38 school-aged children with asthma (23 males and 15 females) aged between 8–12 years. They were randomly assigned to two groups, aerobic exercise (AE) and conventional treatment (Con ttt) groups. The AE group received a program of moderate-intensity aerobic exercise for 10 weeks with asthma medications and the Con ttt group received only asthma medications without exercise intervention. A home respiratory exercise was recommended for the two groups. Aerobic capacity was investigated using maximal oxygen uptake (VO2max), 6-minute walk test (6MWT), and fatigue index. PQoL was evaluated using Pediatric Quality of Life Questionnaire (PQoLQ). Also, pulmonary function tests were performed, and the results recorded. Results: The findings of this study showed significant improvements in pulmonary functions and VO2max in the two groups; however, this improvement was significantly higher in the AE group than in the Con ttt group (p0.05). All dimensions of PQoL significantly improved in the AE group (p0.05). Conclusion: Ten weeks of physical exercise had beneficial effects on pulmonary functions, aerobic capacity, and PQoL in school-aged children with asthma. Effort and awareness should be dedicated to encouraging the active lifestyle among different populations, especially asthmatic children. Keywords: asthma, pediatrics, maximum oxygen uptake, exercise-induced bronchoconstriction, moderate-intensity exercise

Background: The RHD gene is one of the most complex blood group genes. The molecular background of the RHD gene in RhD-negative and RhD-positive individuals varies within and among different populations. Knowing the molecular basis of the RHD gene in a specific population is required to establish effective genotyping methods. While the molecular basis has been revealed in many ethnicities, such as Caucasians and Black Africans, it still requires elucidation in Arabs., Objectives: The aim of this study was to gain insights into the molecular basis of RhD-positive and RhD-negative phenotypes in Saudi donors., Materials and Methods: Conventional serological tests were used to determine the Rh phenotypes in 136 Saudi donors by typing D, C, c, E, and e antigens. Multiplex-PCR and Single Specific Primer-PCR were used to detect the presence of exons 3, 4, and 7 and the hybrid Rhesus box gene, respectively, in RhD-negative and/or RhD-positive samples., Results: Of the 136 samples, 70 were RhD positive and 66 were RhD negative. None of the RhD-negative donors had any of the three tested exons, whereas the hybrid Rhesus box gene was detected in all, indicating the zygosity status of the RHD deletion allele. The hybrid Rhesus box gene was detected in 79% of the RhD-positive individuals, suggesting high frequencies of RHD -negative haplotypes., Conclusions: The study findings indicate that Saudis with the RhD-negative phenotype are likely to have an entire RHD deletion in the homozygous state. However, a more comprehensive analysis of variant RHD alleles in the Saudi population is required to implement effective and dedicated molecular RHD typing strategies., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Saudi Journal of Medicine & Medical Sciences.)

Background: Chronic Ankle Instability (CAI) is a common musculoskeletal condition characterized by recurring ankle sprains and impaired postural control (PC). Understanding the relationship between ankle muscle strength, PC, and the role of pain is essential for effective management., Objectives: This prospective cross sectional study aimed to 1. Compare ankle isometric muscle strength (IMS) and PC between CAI and asymptomatic sides. 2. Assess the correlations between ankle IMS and PC and explore the potential mediating effect of pain in individuals with CAI., Methods: A total of 44 individuals with CAI, were enrolled in the study. Ankle IMS (dorsiflexors, plantar flexors, invertors, and evertors) was measured using a dynamometer, while PC was evaluated using sway parameters (anterior-posterior and medial-lateral sway, ellipse area). Pain levels were reported using a Visual Analog Scale., Results: The CAI ankles exhibited significantly lower ankle IMS in all muscle groups compared to the asymptomatic ankles (p < 0.001). Additionally, the CAI side showed increased postural sway and a larger ellipse area (p < 0.001), indicating reduced PC. Negative correlations were observed between ankle IMS and PC parameters on the CAI side, with dorsiflexor strength showing correlations ranging from -0.423 to -0.387, plantar flexor strength ranging from -0.423 to -0.371, invertor strength ranging from -0.412 to -0.238, and evertor strength ranging from -0.451 to -0.365 (p < 0.001). Mediation analysis revealed that pain played a significant mediating role in connecting ankle IMS and PC parameters among individuals with CAI, with statistical significance (p < 0.05)., Conclusions: Individuals with CAI exhibit weaker ankle IMS and diminished PC in comparison to their healthy side. Moreover, pain was identified as a mediator in the relationship between ankle IMS and PC in CAI. These findings underscore the importance of addressing both ankle IMS and pain in the rehabilitation and management of CAI., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Ajay Prashad Gautam reports financial support was provided by 10.13039/501100023674King Khalid University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Low back pain (LBP) is a worldwide problem that affects numerous people and limits their mobility. Several factors, including chronic diseases, increase the risk of developing LBP. To date, the information available about the relationship between chronic diseases and the intensity and duration of LBP is quite limited., Aim: The aim of the present study was to address the relationship between chronic diseases and both the intensity and duration of LBP., Design: This is an observational cross-sectional study., Setting: The study was conducted in the community of Saudi Arabia., Population: 2181 adult participants (aged 18 years or more, mean age of 33 and standard deviation [SD] of ±11, 61% females) from Saudi Arabia with either recent or recurring LBP participated in the study., Methods: The participants of this study were surveyed, and their demographic information was obtained. They were asked whether they had LBP during the past year, and if they had, they were asked about their LBP in terms of the pain intensity on a scale that runs from 0 to 10, where 0 indicates no pain and 10 indicates extreme pain. Further, the participants were asked how long their pain lasted (in days). They were also inquired whether they had any of the following chronic diseases: diabetes mellitus, high blood pressure, hypotension, arthritis, cardiopulmonary diseases, kidney diseases, and hypothyroidism. Logistic regression was used to analyze the relationships between both of LBP's intensity and duration, and the presence of chronic diseases, while adjusting for the potential effect of age and gender., Results: A total of 2181 adults with either new onset of or recurrent LBP during the past 12 months participated in the present study. Of these, 356 (16%), who had LBP, suffered from one or more of the said chronic diseases. It was found that having one or more chronic diseases had statistically significant relationship with increased LBP's intensity (P=0.002), as well as prolonged duration (P=0.001). In particular, hypertension, arthritis, and hypothyroidism have statistically significant relationship with increased the intensity of the pain (P<0.05). Only, hypertension and arthritis have statistically significant relationship with increased the duration of pain (P≤0.001)., Conclusions: The presence of chronic diseases was associated with a more intense and longer duration of LBP., Clinical Rehabilitation Impact: In view of the results of this study, we expect that those who have chronic diseases will have a longer duration of LBP and more intense pain.

Objective: This study aimed to evaluate the physical therapists' knowledge and awareness of breast cancer, treatment modalities, contraindications, and clinical guidelines., Subjects and Methods: A cross-sectional survey was conducted from December 2020 to May 2021 in Saudi Arabia. The sample size was determined using the Raosoft sample size calculator, which indicated the need for 67 participants. All physical therapists of both sex in private and public hospitals in Ha'il and non-Ha'il regions were included in the study. Data was collected by a structured Google form questionnaire, consisting of 4 main domains with a maximum score of 43., Results: 57 physical therapists participated in the current study, out of which 31 were from the Ha'il region (42.1% male, 57.9% female) with a mean age of 29±7 years and a mean experience 6±7years. The referral of breast cancer patients was only 22.8%. Interestingly only 22.8% of the hospital has specific setups for oncology rehabilitation, and 12.3% have reported positive about continuing professional development (CPDs) workshops for breast cancer organized by their hospitals. 5.3% of patients with breast cancer are aware of the benefit of oncology rehabilitation, while 22.8% of patients come for follow-up sessions in the rehabilitation department. According to multiple regression, only gender was statistically significant for prediction, p<0.05. Females increased the mean score by 5.996 more than males. Female therapists are 38.2% more aware than males., Conclusions: Although physical therapists have a low level of knowledge and an average level of awareness, with a higher number of women than men, attitudes toward physical therapy are quite high, and the profession is practiced exceptionally well.

Vertebral disease is a main source of morbidity (MM) in individuals with multiple myeloma. The effects of associated osteolytic lesions and vertebral fractures on severe pain, functional limits, spinal deformity, and cord compression are well recognized. Systemic therapy, radiation, cementoplasty (vertebroplasty/kyphoplasty), and radiofrequency ablation are now available therapeutic options for severe MM spinal pain. We here reported a case of a 45-year-old male who had complained of progressive symptoms of pathological spine fractures. He had been examined and investigated for the cause of lytic lesions and found to have multiple fractures in the spine. A computed tomography (CT) revealed multiple osteolytic lesions noted in the thoracolumbar spine, ribs (bilaterally), and pelvic bones. Magnetic resonance imaging (MRI) showed a compression fracture of the T8 vertebral body with evidence of retro-bulging and a spinal canal narrowing. However, there was no evidence of spinal cord abnormal signal intensity. T2 weighted image (T2WI) keeping with edema is noted. A surgical intervention fixed the fracture and improved the quality of life. Vertebroplasty, a minimally invasive procedure, as a treatment option for vertebral lesions and pathologic fractures in the MM, showed good clinical improvement in the patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Almetrek et al.)

Skinfold measurement (SKF) can accurately measure abdominal obesity and is regarded as a surrogate marker to predict non-communicable diseases. The objective of the present study was to observe the degree of association between neck circumference (NC), SKF and handgrip strength (HGS). Secondly, also to know the effects of smoking on NC, HGS and SKF. The mean and standard deviations and frequencies in percentage were analyzed, respectively. The degree of association between NC, anthropometric characters and HGS was also analyzed using the Pearson correlation. Furthermore, multiple linear regression models were used to study the degree of influence of independent variables on dependent variables. Correlation assessment for neck circumference with waist circumference and HGS revealed a weak association. While with SKF for four sites, a strong association was found. A significant regression was found among the smokers in the model (F (2, 7) = 5.2, p -value of 0.04 with an R2 of 0.598). The predictor variables, like waist and NC, can produce a variation of 59.8% in the dependent variable. Whereas, among non-smokers, an insignificant regression was seen. In conclusion, neck circumference is associated with SKF. However, a small sample size of young smokers revealed that NC and waist circumference influenced HGS.

Adolescents with unilateral cerebral palsy (U-CP) experience an asymmetrical posture because the less-affected lower limb is preferred for bodyweight support as a strategy of compensating for the paretic side’s muscular weakness. This study was designed to compare the effect of 12 weeks of paretic-limb-only plyometric training (PLPT) and volume-matched double-limb training (DLPT) on balance capability and gait symmetry in adolescents with U-CP. Sixty-nine adolescents with U-CP were randomly assigned to PLPT, DLPT, or a control group (n = 23 each). Treatment was delivered twice/week (with at least 48 h recovery intervals) for 12 weeks in succession. The directional (LoSdirectional) and overall (LoSoverall) limits of stability in addition to the temporal (T-GSI) and spatial (S-GSI) gait symmetry indicis were assessed pre- and post-treatment. The LoSdirectional improved significantly in the PLPT group compared to either the DLPT or control group (for the forward (p = 0.027 and <0.001, respectively), backward (p = 0.037 and <0.001, respectively), affected-side (p = 0.038 and 0.004, respectively), and less-affected-side (p = 0.018 and 0.016, respectively)), and this was also the case for the LoSoverall (p < 0.001). Additionally, The T-GSI and S-GSI scores decreased significantly in the PLPT group compared to the DLPT (p = 0.003 and 0.047, respectively) or control (p = 0.003 and 0.036, respectively) group, indicating the development more symmetrical gait patterns. In conclusion, PLPT is likely more effective for enhancing balance capabilities and promoting symmetrical gait patterns than DLPT. Thereupon, it is worthwhile for physical rehabilitation practitioners to include the PLPT paradigm into the intervention plans for adolescents with U-CP.

Objective: Several researchers have evaluated the impact of exercise training on patients with chronic kidney disease (CKD). However, few studies have evaluated the impact of concurrent training (aerobic and resisted exercise) on non-dialysis days on the functional capacity and quality of life (QOL) of such patients. Our current study evaluated the effects of concurrent training on functional capacity and QOL of patients with CKD., Patients and Methods: Forty-three patients, aged ≥ 25 years, were recruited in this randomized study. They were divided into intervention and control groups (22 per group). The intervention group received concurrent aerobic and resistance exercises (three sessions per week for twelve weeks on alternative days). The control group continued their regular lifestyle practices and medical treatment without any exercise intervention. Before and after twelve weeks of training, the participant's functional capacity and quality of life (QOL) were measured., Results: Compared to the control group, the intervention group displayed a significant improvement in the distance walked in the 6-minute walk test and sit-to-stand test (STS1/s and STS-60) with p<0.001; furthermore, a significant improvement was observed in physical function, body pain, general health, role functioning/physical, vitality, and social functioning (p<0.05) of QOL assessed with the SF-36 questionnaire., Conclusions: The twelve-week concurrent aerobic and resistance exercise training had a positive impact on functional capacity and QOL in CKD patients. Concurrent exercise training should be recommended as an interventional modality in physical therapy and rehabilitation protocols in CKD patients.

Background: Mild traumatic brain injury (mTBI) or concussion is a complex injury that is difficult to diagnose and assess. There are negative impacts on cognition, balance, and mobility after a concussion. The Gait Disorientation Test (GDT) is an objective measure that assesses a person's balance ability by comparing the walking time with eyes open and the walking time with eyes closed in a standardized walking task. The purpose of this study was to assess the validity and the diagnostic properties of the GDT in children with concussions., Methods: Thirty-six children with concussions, and 91 controls aged between 9 and 18 years old participated in the study. Participants completed demographics, the GDT, the Functional Gait Assessment (FGA), the Pediatric Vestibular Symptom Questionnaire (PVSQ), and the Pediatric Visually Induced Dizziness Questionnaire (PVID)., Results: Children with concussions showed higher (worse) GDT scores ( M = 2.18 ± 1.93 s) than healthy controls ( M = 1.13 ± 0.95 s), which was statistically significant ( P = 0.014)., Conclusion: The GDT was able to distinguish between children with concussions and healthy controls. Given the simplicity of the GDT, it can be used to assist in discriminating between children with and without concussion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Alkathiry, Alsubaie, Alsalaheen and Whitney.)

Purpose: The cardio-respiratory function is compromised in children recovering from burns, particularly, those who sustain a burn injury across the chest, which leads to further prejudicial effects on physical and psychosocial health. This study endeavored to explore the efficacy of 12 weeks of graded aerobic exercise (GAEx) on the cardiorespiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest., Methods: Thirty-six burn-injured children aged 10-18 years (%TBSA: 24.2 ± 4.9, and 38.8 ± 12.9 months since injury) were randomly assigned to GAEx group (n = 18; undergone a 12-week intensity- and time-graded aerobic exercise program plus standard rehabilitation) or control group (n = 18; received the standard rehabilitation only). The cardio-respiratory fitness [marked by the peak oxygen uptake (VO 2peak ), minute ventilation (V E ), ventilatory equivalent of inhaled oxygen (VEq/VO 2 ), oxygen pulse (O 2 P), respiratory exchange ratio (RER), maximum heart rate (HR max ), and the heart rate recovery at one minute (HRR 1 )] and physical and psychosocial functioning were assessed pre- and post-intervention., Results: Children in the GAEx group showed significant increases in VO 2peak (P = 0.013), V E (P = 0.026), O 2 P (P = 0.034), HR max (P = 0.035), and HRR 1 (P = 0.04) and declines in VEq/VO 2 (P = 0.009) and RER (P = 0.011) as compared to the control group. Additionally, the GAEx group reported higher physical (P = 0.029) and psychosocial (P = 0.012) functioning., Conclusion: Twelve weeks of GAEx has salutary effects on cardio-respiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. These findings suggest that adding GAEx as a complementary therapy to the long-term rehabilitation protocol for this patient population is worthwhile., (Copyright © 2021 Elsevier Ltd and ISBI. All rights reserved.)

Background: A method for prescribing the difficulty or intensity of standing balance exercises has been validated in a healthy population, but requires additional validation in individuals with vestibular disorders., Objective: This study validated the use of ratings of perceived difficulty for estimation of balance exercise intensity in individuals with vestibular disorders., Methods: Eight participants with a confirmed diagnosis of a vestibular disorder and 16 healthy participants performed two sets of 16 randomized static standing exercises across varying levels of difficulty. Root Mean Square (RMS) of trunk angular velocity was recorded using an inertial measurement unit. In addition, participants rated the perceived difficulty of each exercise using a numerical scale ranging from 0 (very easy) to 10 (very difficult). To explore the concurrent validity of rating of perceived difficulty scale, the relationship between ratings of perceived difficulty and sway velocity was assessed using multiple linear regression for each group., Results: The rating of perceived difficulty scale demonstrated moderate positive correlations RMS of trunk velocity in the pitch (r = 0.51, p < 0.001) and roll (r = 0.73, p < 0.001) directions in participants with vestibular disorders demonstrating acceptable concurrent validity., Conclusions: Ratings of perceived difficulty can be used to estimate the intensity of standing balance exercises in individuals with vestibular disorders.

Aim: To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP)., Methods: A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n  = 19), balance exercises (BAL group, n  = 19), and combined plyometric and balance exercises (PLYO-BAL group; n  = 19). The maximum isometric muscle strength (IMS max ) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention., Results: By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMS max than the PLYO and BAL groups for the quadriceps ( p =.03 and p =.0002 respectively), hamstrings ( p =.018 and p <.0001 respectively), and dorsiflexors ( p =.006 and p <.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI ( p <.0001 and p =.0001 respectively), ML-SI ( p =.001 and p =.015 respectively), and O-SI ( p =.011 and p =.04 respectively)., Conclusions: Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.

Background: Both diabetes mellitus (DM) and burn injuries lead to physical and psychological impairments. Foot burns are still a challenging health condition because of its important sensory role. No previous studies have assessed the physical therapy intervention on diabetic patients with foot burns. Therefore, this study aimed to assess the potential efficacy of sensorimotor exercise on pain, proprioception, mobility, balance, and quality of life in diabetic patients with foot burns., Methods: Between July 2019 and February 2020, thirty-three diabetic patients with foot burns, aged 32 to 46yrs, were enrolled in this randomized control study, and randomized consecutively into two groups, study group (n=16) and control group (n=17). The study group underwent a sensorimotor exercise program thrice a week for 12 consecutive weeks, however the control group did not undergo the exercise intervention. Both groups were instructed to conduct home exercises. Visual analogue scale (VAS), proprioceptive responses, time-up and go (TUG) values, and short form-36 (SF-36) have been assessed prior and subsequent to the study intervention., Results: No significant differences were observed between groups regarding baseline data (p˃0.05). Subsequent to 12wk intervention, the study group showed significant improvements in outcome measures (proprioceptive responses, p˂0.05, VAS, p˂0.001, TUG, p=0.003, and SF-36, p˂0.001) and the control group exhibited significant changes in VAS and SF-36 (p=0.004, p=0.043 respectively) however, no significant changes were found in proprioceptive responses and TUG values (p˃0.05). Between groups, the post-intervention comparison demonstrated statistical differences with tending toward the study group (proprioceptive responses, p˂0.05, VAS, p˂0.001, TUG, p=0.013, and SF-36, p=0.046)., Conclusions: Sensorimotor exercise training may improve, pain, proprioceptive responses, mobility, balance, and quality of life in diabetic patients with foot burns. Physiotherapists and rehabilitation providers should include the sensorimotor exercise in their protocols in the treatment of diabetic patients with foot burns., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)

Background: Recently, poor cardiorespiratory fitness (CRF) has been postulated as an adverse health outcome related to poor sleep quality. However, studies investigating the relationship between CRF and a subjective sleep quality index are scarce. Thus, the current study aimed to investigate the association between CRF and the Pittsburgh Sleep Quality Index (PSQI) in apparently healthy people. The secondary aim was to investigate the association between reported physical activity (PA) and PSQI., Methods: Thirty-three healthy male participants volunteered to participate. CRF (VO 2PEAK ) was measured via cardiopulmonary exercise testing on a treadmill. A short form of the International Physical Activity Questionnaire (IPAQ) was used to measure PA, and PSQI was used for the sleep quality index., Results: There was no correlation between CRF and PSQI total score or any component of the PSQI. There was a significant inverse correlation between IPAQ and PSQI total score (r = -0.36, p = 0.04). Categorical data analysis of the two questionnaires revealed that 42.4% of the participants who reported low physical activity also had poor sleep quality., Conclusions: The current study showed no association between CRF and the subjective sleep quality index but demonstrated a moderate inverse association between reported PA and subjective sleep quality index. The findings suggest that the more reported PA, the better the overall sleep quality.

Background: Prevalence of frailty has been previously established in different Western countries; however, the prevalence and the burden of in the aging populations of Saudi Arabia has not been examined. Therefore, the aim of this study was to examine the prevalence of frailty, and associated factors among Saudi older population., Methods: The study included a total of 486 community-dwelling elderly adults aged 60 years and over living in the Riyadh area. This study took place from August 2019 to June 2020. The prevalence of frailty was determined using the Fried's frailty phenotype. Association between sociodemographic features and clinical factors and frailty was estimated by Odds Ratio and confidence intervals (OR, IC 95%) using a multinomial logistic regression model., Results: The overall prevalence of pre-frailty and frailty were 47.3 and 21.4%, respectively. The following factors were associated with being frail: age (OR: 6.92; 95%CI 3.11-15.41); living alone (OR: 2.50; 95%CI: 1.12-5.59); had more chronic conditions (OR: 1.96; 95%CI: 1.16-3.30); and cognitive impairment (OR: 7.07; 95%CI: 3.92-12.74)., Conclusions: The Compared with other populations, the prevalence of frailty and pre-frailty in the Riyadh region of Saudi Arabia was high. The implications of frailty in this population should be discussed in future study.

Objective: To find the short-term psychological and hormonal effects of virtual reality training on chronic low back pain in American soccer players., Design, Setting, Participants: The 3-block random sampling method was used on 54 university American soccer players with chronic low back pain, and they were allocated into 3 groups: virtual reality training (VRT; n = 18), combined physical rehabilitation (n = 18), and control (n = 18) groups at University Hospital. They underwent different balance training exercises for 4 weeks. The participants and the therapist who is assessing the outcomes were blinded. Psychological (pain intensity and kinesiophobia) and hormonal (glucose, insulin, Homeostatic Model Assessment of Insulin Resistance, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) values were measured at baseline, after 4 weeks, and after 6 months., Results: The baseline demographic, psychological, and hormonal data between the VRT, combined physical rehabilitation, and control groups show no statistical difference (P ≥ .05). Four weeks following training, the VRT group shows more significant changes in pain intensity and kinesiophobia than the combined physical rehabilitation and control groups (P < .001), and the improvement was noted in the 6-month follow-up. All the hormonal variables (glucose, insulin, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) show significant changes at 4-week training (P < .001), except for the Homeostatic Model Assessment of Insulin Resistance (P = .075) between the 3 groups. At 6-month follow-up glucose, prolactin, adrenocorticotropic hormone, and cortisol show more significant difference in the VRT group than the other 2 groups (P < .001). At the same time, insulin (P = .694), Homeostatic Model Assessment of Insulin Resistance (P = .272), and growth hormone (P = .145) failed to show significant changes between the groups., Conclusion: Training through virtual reality is an effective treatment program when compared with conventional exercise training programs from a psychological and hormonal analysis perspective in American soccer players with chronic low back pain.

Abstract: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that leads to many consequences such as early osteoarthritis and knee joint instability.To explore the association of the types of ACL tear (complete and partial) and side of injury (dominant vs nondominate) with types of playing surfaces, sports, shoes, and mechanism of injuries as well as to determine whether higher levels of fatigue and physical fitness are risk factors for complete ACL tear.This cross-sectional study used a questionnaire to collect information from young male adults with a confirmed ACL injury who were attending rehabilitation programs. The outcomes of interest were patterns of ACL injury, levels of fatigue before the injury on a 0 to 10 scale, and levels of physical fitness (hours per week). Mann-Whitney U and Kruskal Wallis tests were used to assess the differences between groups, while the odds ratios were calculated to evaluate risk factors for complete ACL tear.One hundred thirteen young male adults with a confirmed ACL injury were enrolled. Most of the reported ACL injuries in this study were complete tear (80.5%) and occurred more frequently in the dominant leg (74.6%) due to noncontact mechanism (63.6%). More ACL injuries happened while playing soccer (97.2%) on artificial turf (53.3%). The level of fatigue before ACL injury was significantly higher in partial ACL tear injuries compared to complete ACL tear injuries (P = .014). For every 1-point increase in the level of fatigue on a 0-10 scale, there was a 25% reduction in complete ACL injury risk (P = .023).The pattern of ACL types of tear and side of injury varies in different playing surfaces and mechanisms of injuries. Higher levels of fatigue seem to be associated with a partial tear of the ACL and reduction of a complete ACL tear risk factor., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Children with unilateral cerebral palsy (UCP) experience an asymmetrical gait pattern and poor balance capabilities. Effective interventions, therefore, are needed to facilitate remediation of these functional issues., Objective: This study was set out to investigate the emerging role of stretch-shortening cycle (SSC) exercises on gait-symmetry and balance in children with UCP., Methods: In this randomized controlled trial, 42 children with UCP (age; 8 -12 years) were enrolled and received either standard physical rehabilitation (control group; n = 21) or the SSC exercise program plus physical rehabilitation (SSC group; n = 21). Spatial- and temporal-gait symmetry index (GSI) and specific balance capabilities [reactive balance, directional control, movement synchronization, and sensory organization] were assessed before and after 16 sessions that were carried out twice/week over non-sequential days in an 8-week program., Results: Using the pre-treatment scores as covariates, the post-treatment spatial- (P = 0.006; ηp2= 0.17) and temporal- GSI (P < .001; ηp2= 0.46) scores reduced significantly in the SSC group as compared to the control group, suggesting favorable improvement of gait symmetry. Also, all measures of balance (P < 0.05; ηp2 ranged between 0.10 and 0.29) improved remarkably, post-treatment, in SSC group in comparison with the control group., Conclusion: The evidence from this study suggests that SSC exercises besides standard physical rehabilitation appear to be effective for improving gait symmetry and boosting balance capabilities in children with UCP.

Background & Objective: Exercise and dietary interventions are used to control dyslipidemia and depression in obese individuals, whilst rare investigations have examined the concurrent effects of a low-fat diet and moderate-intensity aerobic exercise training (MIAET) on dyslipidemia and depression in obese patients. Hence, we assessed the potential influences of a low-fat diet combined with MIAET on blood lipids and depression in those individuals., Methods: Forty-two obese patients aged 30-50 years have been enrolled in this randomized controlled trial. They have been randomized equally into MIAET group (n=14, 60-70% of the maximum heart rate (Max HR), three sessions a week), a low-fat diet group (n=14, fat, 30% Kcal/day), and a low-fat diet plus MIAET (n=14) for 10 consecutive weeks. Body mass index (BMI), lipid profile, and Hamilton depression rating scale (HDRS) have been assessed on two occasions, pre and post- 10 weeks., Results: It was demonstrated that a low-fat diet group showed an improvement in total cholesterol (T-Ch), p=0.046, with no changes in triglycerides (TGs), p=0.343, low-density lipoproteins (LDLs), p=0.187, and high-density lipoproteins (HDLs), p=0.224; however, MIAET group showed an improvement in TGs, p=0.042, HDLs, p=0.038 with no changes in T-Ch, p=0.126, and LDLs, p=0.368. Regarding the low-fat diet plus MIAET group, significant improvements were identified in TGs, p=0.003, T-Ch, p<0.001, LDLs, p=0.004, and HDLs, p<0.001. For the depression status, all groups showed a significant improvement in HDRS, p<0.001, with a low-fat diet plus MIAET group showing greater advantages, p<0.05., Conclusion: The results of the current trial suggest an important implication for promoting improvement in blood lipids and a reduction in depression status in obese patients with dyslipidemia following 10-week of a concurrent low-fat diet and moderate-intensity aerobic exercise more than low-fat diet or MIAET alone., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Evidence on the latest technologies in rehabilitation for reducing pain and altering serum stress hormones in low back pain (LBP) was lacking., Objective: To find the clinical and hormonal effects of virtual reality training (VRT) and isokinetic training (IKT) in chronic LBP patients., Methods: Through the simple random sampling method, 60 university football players with chronic LBP were allocated into three groups: NVRT= 20, NIKT= 20 and NCONTROL= 20. The three groups underwent different exercises for 4 weeks. Clinical (pain intensity and kinesiophobia) and hormonal (glucose, insulin, HOMA-IR, growth hormone, prolactin, ACTH and cortisol) values were measured at baseline, after 4 weeks and 6 months., Results: Four weeks following training, the VRT and IKT groups showed significant changes in pain intensity and kinesiophobia in comparison to the control group (p< 0.05). Hormonal measures also showed significant improvement in the VRT group in comparison to the other two groups (p< 0.05)., Conclusion: Training through virtual reality and isokinetic exercise is an effective approach in terms of pain and kinesiophobia. In terms of hormonal analysis, virtual reality shows slightly more improvements than isokinetic training in subjects with chronic LBP.

Background: Physical activity has been found to maintain and improve cognitive function and consequently improve health-related quality of life (HRQoL). The relationships between different types of physical activities, cognitive function, and HRQoL have not been studied sufficiently and compared in different age and gender groups. This study is aimed at examining the relationship between different types of physical activity (high-intensity, moderate-intensity, and walking exercise), cognitive function, and HRQoL. In addition, this study is aimed at examining these relationships in different age and gender groups., Methods: This cross-sectional study included 150 adults with a mean age of 50 ± 8.8 years. Participants completed the International Physical Activity Questionnaire (IPAQ) to assess the level of the physical activity types and the Short-Form Health Survey (SF-36) questionnaire to assess HRQoL. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) screening instrument. Spearman correlation analysis was used to explore the relationships between the different variables of the study., Results: There were significant positive relationships between all types of physical activities, cognitive ability, and HRQoL. The relationships between moderate-intensity physical activities and cognitive function ( r = 0.38) and HRQoL ( r = 0.33) were higher than the relationships with walking exercise and high-intensity physical activity. The middle-aged group had a significantly higher cognitive function compared to the senior adults ( p < 0.001), while there was no significant difference between the age groups in HRQoL ( p = 0.18)., Conclusion: The cognitive function and HRQoL were more related to moderate-intensity physical activities compared to walking exercise or high-intensity physical activities. These relationships were more pronounced in the senior adult population compared to the middle-aged group., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2020 Saud F. Alsubaie et al.)

Background: Isokinetic training (IKT) and core stabilization training (CST) are commonly used for balance training in musculoskeletal conditions. The knowledge about the effective implementation of these training protocols on radiological and biochemical effects in university football players with chronic low back pain (LBP) is lacking., Objective: To find and compare the effects of isokinetic training and CST on radiological and biochemical effects in university football players with chronic LBP., Design: Randomized, double-blinded controlled study., Setting: University hospital., Participants: 60 LBP participants were randomized into isokinetic group (IKT; n = 20), core stabilization group (CST; n = 20) and the control group (n = 20) and received respective exercises for 4 weeks., Outcome Measures: Radiological (muscle cross sectional area & muscle thickness) and biochemical (C-reactive protein, tumor necrosis factor -α, interleukin [IL]-2, IL-4, IL-6) values were measured at baseline and after 4 weeks (immediate effect)., Results: The reports of the IKT, CST and control group were compared between the groups. Four weeks following training IKT group shows more significant changes in muscle cross sectional area (Psoas Major, Quadratus Lumborum, Multifidus and Erector Spinae muscles) and muscle thickness (Multifidus) than CST and control groups (p < 0.001). Biochemical measures such as C-reactive protein, tumor necrosis factor -α, IL-2, IL-4 and IL-6 also show significant improvement in IKT group than the other 2 groups (P < .001)., Conclusion: Training through Isokinetic is an effective treatment program than conventional exercise programs in the aspect of radiological and biochemical analysis in university football players with chronic LBP, which may also help to prevent further injury. The present study can be used to improve the physical therapist's knowledge and clinical decision skills on LBP in football players., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Chronic nonspecific low back pain (chronic nsLBP) is one of the most common musculoskeletal disorders leading to disabilities and physical inactivity. Laser therapy was used in chronic nsLBP treatment; however, no previous studies have assessed the impacts of high-intensity laser therapy (HILT) versus low-level laser therapy (LLLT) on chronic nsLBP. This study compared the effects of HILT versus LLLT on individuals suffering from chronic nsLBP., Methods: The study was a randomized control trial. Sixty individuals with chronic nsLBP were enrolled in this study between May and November 2019. All participants were clinically diagnosed with chronic nsLBP. They were assigned randomly into three groups, 20 in each group. The first group received a program of LLLT, the second group received a program of HILT, and the third did not receive laser therapy (control group). Pain severity, disability, lumbar mobility, and quality of life were assessed before and after 12-week intervention., Results: Both LLLT and HILT groups showed a significant improvement of the Oswestry Disability Index (ODI), visual analogue scale (VAS), lumbar range of motion (ROM), and European Quality of Life (EuroQol) scores ( p > 0.05), while the control group did not show significant changes ( p > 0.05). Comparison among the three study groups postintervention showed significant differences in the outcome measures ( p > 0.05), while comparison between the LLLT and HILT groups showed nonsignificant differences ( p > 0.05)., Conclusion: There are no different influences of LLLT versus HILT on chronic nsLBP patients. Both LLLT and HILT reduce pain and disability and improve lumbar mobility and quality of life in chronic nsLBP patients., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Walid Kamal Abdelbasset et al.)

The objective of this study is to compare the effects of virtual reality training (VRT) and sensory-motor training (SMT) in bone morphogenetic proteins (BMP) and inflammatory biomarkers expression in post-traumatic osteoarthritis (PTOA) after the anterior cruciate ligament injury. Through a simple random sampling method, 60 eligible participants were allocated into VRT (n = 20), SMT (n = 20), and control groups (n = 20). They underwent training programs for 4 weeks. Clinical (pain intensity and functional disability) and biochemical (bone morphogenic proteins and inflammatory biomarkers) values were measured at baseline, after 4 weeks, 8 weeks and 3 months follow up. Four weeks following training, the VRT group shows more significant changes in pain intensity and functional disability than SMT and control groups (P < 0.001). Bone morphogenic protein (BMP) measures such as BMP 2, 4, 6, and 7 don't show any significant changes between the groups. But at the same time, the VRT group shows positive improvement in inflammatory biomarkers (CRP, TNF-α, IL-2, IL-4, IL-6) analysis than the other two groups (P < 0.001). Our study suggests that including virtual reality training in PTOA shows beneficial changes in pain, functional disability, and modification of inflammatory biomarkers than sensory-motor training, but at the same time it shows a negligible effect on bone morphogenic proteins.

Background: Different measures have been used to quantify body balance; some of which use technology to measure postural sway, others are physical performance or self-reported. However, there is little information on the best postural sway measures associated with aging, physical performance, and cognitive function measures., Objective: To evaluate the relationship between postural sway measures and aging, physical performance, and cognitive function measures., Methods: A total of 51 subjects (53% female, mean age 53.2 ± 21 years) participated in this cross-sectional study. The participants completed the Activities-specific Balance Confidence (ABC) Scale questionnaire, the Functional Gait Assessment (FGA), the Montreal Cognitive Assessment (MoCA) test, and gait speed. Afterward, the participants performed 8 balance exercises, and their postural sway was measured using a force plate. Spearman's rank correlation coefficient was used to examine the relationship between the study variables., Results: Age was negatively associated with cognitive function, gait speed, ABC scores, and FGA scores. In addition, cognitive ability was associated positively with ABC scores ( r = 0.38, p ≤ 0.01). Age, FGA scores, and gait speed were significantly associated with the postural sway of the AP direction in some exercises and in all exercises in the ML directions ( p < 0.05). The cognitive function and ABC scores were significantly associated with only postural sway measures in the ML direction ( p < 0.05)., Conclusion: The postural sway measures in the lateral direction had more and stronger associations with age, physical performance, and cognitive function measures compared to those in the AP direction., Competing Interests: The author declares that there are no conflicts of interest., (Copyright © 2020 Saud F. Alsubaie.)

Background: Standardized instruments for measuring the intensity of balance exercises in clinical environments are lacking., Objective: The objective of this study was to develop a method for quantifying the perceived intensity of standing balance exercises., Design: A test-retest study design was used, with repeated evaluations within the same visit and between visits 1 week later., Methods: Sixty-two participants who were healthy and 18 to 85 years old (with a mean age of 55 years [SD = 20 years]; 50% women) were enrolled. On each of 2 visits, they performed 2 sets of 24 randomized static standing exercises consisting of combinations of the following factors: surface, vision, stance, and head movement. Postural sway was measured with an inertial measurement unit, and ratings of perceived difficulty (RPD) were recorded using numerical and qualitative scales. The RPD scales were validated against the quantitative sway measures using a general linear model approach. The test-retest reliability of the RPD scales was examined using a weighted kappa coefficient., Results: Both RPD scales were associated with postural sway measures with correlation coefficients > 0.6 for the whole sample. The test-retest reliability of the ratings varied considerably across the different balance exercises, and the highest weighted kappa values occurred for RPD scores on the numerical scale within the second visit, as moderate agreement was achieved in 18 of the 24 exercises., Limitations: The limitations are that the RPD scales need to be validated for other types of balance exercises and in individuals with balance disorders., Conclusions: The RPD scores correlated with the magnitude of postural sway, suggesting that they can be used as a proxy measure of perceived intensity of balance exercises., (© 2019 American Physical Therapy Association.)

The purpose of this study was to compare the effects of laser photobiomodulation therapy (lPBMt) and ultrasound therapy (UST) in patients with chronic non-specific low back pain (CNLBP). Forty-five patients with CNLBP aged 30-40 years were divided randomly into three groups of 15 subjects each. The lPBMt group received 8 weeks of lPBMt with an exercise program, while the UST group received 8 weeks of UST with the same exercise program; the control group received only the exercise program for 8 weeks. Pain, disability, functional performance, and lumbar range of motion were assessed at the beginning of the study and after 8 weeks. There were no significant differences in demographic and clinical characteristics among the three groups at baseline (p > 0.05). At the end of the study, there were significant improvements in pain, disability, and functional performance in the two experimental groups (p < 0.05), but changes in the control group were non-significant. However, lumbar range of motion was significantly improved only in the lPBMt group (p < 0.05). When the three groups were compared in terms of a change in clinical variables, there was a significant difference among the three groups in all measures in favor of lPBMt group. Based on our results, both lPBMt or UST combined with an 8-week exercise program seemed to be effective methods for decreasing pain, reducing disability, and increasing functional performance in patients with CNLBP, although lPBMt is more effective than UST.

This study aimed to evaluate the association between physical activity level and health-related quality of life in community-dwelling middle aged and older adults in Egypt. Between May and August 2017, a cross-sectional study of 184 middle-aged and older adults between the ages of 55 and 64 years old (129 males and 55 females) with a mean age of 58 ± 4.3 years old participated in this study. Study participants were classified into 3 groups based on their level of physical activity (walking duration); low level of physical activity (<150 minutes/week), moderate level of physical activity (150-300 minutes/week), and high level of physical activity (>300 minutes/week). The health-related quality of life (HRQoL) was calculated using the Euro-Quality of life-5dimensions-3 levels scale questionnaire (EuroQol-5D-3L). Spearman's correlation coefficient was performed to determine the correlation between the physical activity level and HRQoL scores in community-dwelling middle-aged and older adults. The results showed a significant correlation between the physical activity levels and HRQoL dimensions. Significant differences were observed in the HRQoL scores between high, moderate and low-physical activity groups (P < .05). The moderate and high-physical activity groups had significantly higher HRQoL scores in all dimensions than low-physical activity group. The low-physical activity group showed a high predominance of the chronic disease compared to the high and moderate physical activity groups. It was concluded that high and moderate levels of physical activity have a great positive relationship with the HRQoL in community-dwelling middle-aged and older adults in Egypt. Recommendations should be dedicated to supporting the active lifestyle among the different population, particularly middle-aged and older adults.

The reliability of balance exercises performance in experimental and clinical studies has typically been confined to a small set of exercises. In order to advance the field of assessing balance exercise intensity, establishing the reliability of performance during a more diverse array of exercises should be undertaken. The purpose of this study was to investigate the test-retest reliability of postural sway produced during performance of 24 different balance tasks, and to evaluate the reliability of different measures of postural sway. Sixty-two healthy subjects between the ages of 18 and 85 years of age (50% female, mean age 55 ± 20 years) participated. Subjects were tested during two visits one week apart and performed two sets of the 24 randomized standing tasks per visit. The tasks consisted of combinations of the following factors: surface (firm and foam), vision (eyes open and eyes closed), stance (feet apart and semi-tandem), and head movement (no movement, yaw, and pitch). Angular position displacement, angular velocity, and linear acceleration postural sway in the pitch and roll planes was recorded via an inertial measurement unit. The postural sway measures demonstrated at fair to good test-retest reliability with few exceptions, and angular velocity measures demonstrated the greatest reliability. The between-visit reliability of two averaged trials was excellent for most tasks. The study indicates that performance of most balance tasks used as part of balance rehabilitation is reliable, and quantitative assessment could be used to document change.

There is little information in peer-reviewed literature to specifically guide the choice of exercise for persons with balance and vestibular disorders. The purpose of this study is to provide a rationale for the establishment of a progression framework and propose a logical sequence in progressing balance exercises for persons with vestibular disorders. Our preliminary conceptual framework was developed by a multidisciplinary team of physical therapists and engineers with extensive experience with people with vestibular disorders. Balance exercises are grouped into six different categories: static standing, compliant surface, weight shifting, modified center of gravity, gait, and vestibulo-ocular reflex (VOR). Through a systematized literature review, interviews and focus group discussions with physical therapists and postural control experts, and pilot studies involving repeated trials of each exercise, exercise progressions for each category were developed and ranked in order of degree of difficulty. Clinical expertise and experience guided decision making for the exercise progressions. Hundreds of exercise combinations were discussed and research is ongoing to validate the hypothesized rankings. The six exercise categories can be incorporated into a balance training program and the framework for exercise progression can be used to guide less experienced practitioners in the development of a balance program. It may also assist clinicians and researchers to design, develop, and progress interventions within a treatment plan of care, or within clinical trials. A structured exercise framework has the potential to maximize postural control, decrease symptoms of dizziness/visual vertigo, and provide "rules" for exercise progression for persons with vestibular disorders. The conceptual framework may also be applicable to persons with other balance-related issues.